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Dysphagia > Quiz 2 > Flashcards

Quiz 2 Flashcards

RED FLAGS Case histories - ID what the red flags are, ID where you will begin assessment, contraindications (living will... is there any reason you shouldn't be there based on the info given), info you want to know before eval (other than what's given... ENT, VF, has he been assessed, what's he eating now), what are some possible swallowing probs based on the history (form those hypothesis) (TBI: impulsivity, rate control...) Look through notes to answer questions that are posed in syllabus!

1
Q

How do SLPs document reflux?

A

retrograde flow of bolus/material from esophagus to the pharynx (or lower esophagus to mid esophagus)
- CANNOT DX REFLUX

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2
Q

Red flags for Angie’s patient

A

Thrush, Paralyzed Right VF, hasn’t eaten since November

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3
Q

Maternal Conditions - Contributing factors

A

Contributing factors: poor diet, maternal weight, maternal age, smoking habits, substance abuse

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4
Q

Maternal conditions - pre-existing factors

A

Diabetes, cardiac diseases, peeclampsia, eclampsia, use of corticosterioids, anermia, toxoplasmosis, rubella, CMV, herpes, STDs, Group B strep

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5
Q

Inraparturm risk factors

A

Preterm labor
Medication used during preg and delivery
Abruptio Placentai (the placenta separates from uterus)
Placenta previa (placenta grows in the lowest part of the womb and covers all or part of the openings of ther cervix)
Umbilical cord prolapse (when the umbilical cord precedes the fetus’ exit from the uterus)

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6
Q

Antepartum disorders

A

Prematurity: before 37 weeks (12% of all US births are premature, approx 2% at less than 32 weeks)
Necrotizing Enterocolitis: intestine - cannot eat/digest anything
Gastoesophageal Reflux Disease: flow of the stomach’s contents to the esophagus
Tracheoesophageal Fistula and Atresia - hole b/w trachea and esophagus

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7
Q

Premies and Feeding Related Problems

A

Sleepy Baby
Difficulty sucking
Coordination of suck swallow breathe sequence
Poor endurance
Greater likelihood of resp illness and poor ability to feed due to immature mechanism…

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8
Q

When intervention is needed for reflux in a baby…

A

Isn’t gaining weight
• Spits up forcefully, causing stomach contents to shoot out of his or her mouth • Spits up green or yellow fluid
• Spits up blood or a material that looks like coffee grounds
• Resists feedings
• Has blood in his or her stool
• Has other signs of illness, such as fever, diarrhea or difficulty breathing • Begins vomiting at age 6 months or older
• Is fussy/crying consistently and difficult to calm/soothe
• Develops chronic respiratory infections otherwise unexplained

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9
Q

MAJOR RED FLAG for intervention for reflux - peds

A

Develops chronic respiratory infections otherwise unexplained

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10
Q

Respiratory Disorders

A

Can be a red flag, especially in newborns (Apnea)
Shared use of the pharynx by respiratory and feeding system increases the risk of aspiration in children whose resp system are compromised
Syndromes lead to a decrease in ability to ward off any issues related to feeding/swallowing, which can lead to refusal (know what’s good/bad for them)
Decreased endurance and coordination…

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11
Q

TEF

A

small hole between trachea and esophagus

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12
Q

Atresia

A

esophagus ends in a pouch

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13
Q

Peds and cardiovascular disorders

A

Not great breastfeeders
Fatigue
Decreased endurance
Early satiety (poor growth… failure to thrive… can’t get through the bottle)

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14
Q

Allergies

A

DAIRY!

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15
Q

Neurologic disorders - peds

A

can cause problems with feeding

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16
Q

CVA - peds

A

Loss of food or liquid due to labial or lingual weakness
Decreased bolus formation and manipulation
Decreased rotary chew
Delay in pharyngeal swallow

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17
Q

Brain tumor - peds

A 
Changes in taste sensation
Oral hypersensitivity
Reduced salivary gland reduction
May see:
- Poor suck response with CN involvement
- Delay in pharyngeal swallow
- Reflux
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18
Q

Anoxia, Meningitis, Encephalitis

A

Weak suck
Poor coordination of breathing and swallowing
Absent or delayed pharyngeal swallow

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19
Q

TBI and feeding/swallowing - Peds

A
  • slow initiation of voluntary movements (opening of mouth, bolus propulsion)
  • Immature feeding/swallowing patterns
  • Oral hypersensitivity
  • Bite reflex
  • Absent or delayed initiation of pharyngeal swallow
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20
Q

CP - 3 kinds

A

Spastic - lots of feeding/swallowing problems, including aspiration
Athetoid - poor coordination and manipulation
Ataxia (Hypotonic) - any combination of feeding or swallowing probs from spastic or athetoid

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21
Q

Down Syndrome

A

Low tone! Poor oral hygiene (freq resp infections)

- Small mandible, obstruction of nasal passages, poor sucking and swallowing…

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22
Q

ASD

A

-Resistance to change
- Sensory integration dysfunction
- GERD and constipation
- Food selectivity
USUALLY FEEDING (rather than swallowing)

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23
Q

Oral-Facial Anomalies

A

Clefts
Micrognathia (small jaw)
Pierre-Robin Sequence (triad of micrognathia, upper airway obstruction, and cleft palate)

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24
Q

CVA

A

Brainstem lesions - medulla is the center of swallowing! Even unilateral damage can cause complete inability to swallow
Spontaneous recovery does take place
Important to eval during first week post CVA
Most rapid recovery takes place during first 3-6 weeks
Constantly (daily) re-evaluate changes in swallow function)

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25
Q

Subcortical CVA

A

THALAMIC STROKE is a RED FLAG

  • Mild to moderate problem in coordination of swallow
  • Sensory recognition causing residue or aspiration
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26
Q

TBI - adults

A

More often feeding/behavioral problem
IF INTUBATED: major RED FLAG for dysphagia and silent aspiration
- Most common problem is delay in triggering pharyngeal swallow

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27
Q

Cervical Spinal Cord Injuries

A

Post Cervical Spine Injury - automatic orders for dysphagia/dysphonia consult

  • Injury to pharyngeal plexus (CN IX and X)
  • Peripheral nerve injury and VF paralysis
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28
Q

Post-surgical Dysphagia

A

INTUBATION - trauma (especially high risk of VF paralysis if self-extubate)
– tube lies on tongue –> atrophy
Tumor resection: CN damage?

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29
Q

Degenerative Diseases

A 
Dementia
Parkinson
ALS
MS
Muscular dystrophy
30
Q

Management with degenerative diseases

A

Assessment as disease progresses

Changes in strategies and diet as swallowing function changes

31
Q

AD Early Stages

A

May forget to eat
Depression may lessen desire to eat
May become distracted and not finish eating

32
Q

AD Middle Stages

A

Tend to pace, wander; not sit long enough for meal
Agnosia for food (don’t recognize food as food/ non-food as food)
Swallowing apraxia

33
Q

AD Late Stage

A

Does not have sufficient oral and pharyngeal motor skills to take food or liquid by mouth
Malnutrition often occurs
Tubes don’t prolong life, but affect quality of life

34
Q

Dementia

A 
Misinterpret bodily needs of hunger and food
- offer water and snacks!
Plays with food
- Signal beginning of meal
Does not use utensils correctly
- Limit number of utensils
Eats with fingers instead of utensils
- Increase number of finger foods available
Limited Attention
Poor judgment and safety
Sensory and Perceptual Dysfunction
Poor communication... unable to verbally communicate preference
Anxiety - need for sameness
35
Q

Parkinson’s Disease

A

May have problems in any or all of three stages of swallowing

36
Q

ALS

A

Affects all phases of the swallow
Involves both upper and lower motor neurons
Breathing and swallowing muscles may be the first muscles affected
As progresses, will need extensive diet modifications

37
Q

MS

A 
Swallowing disorders depend on site of lesion
Decreased chewing (fatigue), delayed pharyngeal trigger, and reduced pharyngeal wall contraction
38
Q

Psychiatric or Behavioral

A

Globus Pharyngeus: sensation of a lump or discomfort in the throat…
Delirium
Alcohol (ETOH) Related

39
Q

Laryngeal Cancer: risk factors

A 
Tobacco Use
Excessive Alcohol Consumption
Poor Nutrition
HPV
Weakened Immune System
Occupation exposure (asbestos)
Males 4x > than women
>55
African Americans > Whites
40
Q

Causes of Head and Neck Cancer

A 
Tobacco use
Alcohol use
Chronic Denture irritation
Prolonged exposure to UV light
HPV
Industrial exposures
41
Q

Symptoms of Head and Neck Cancer

A

Mouth sore that doesn’t heal or gets bigger
Persistent pain in mouth/tongue/jaw
Lumps or white, red, or dark patches
Thickening of inside cheek tissue
Difficulty chewing or swallowing or moving the tongue
Difficulty moving the jaw or jaw swallowing pain
Sore throat or feeling that something is caught in throat
Pain around teeth, or loose teeth
Numbness of tongue or elsewhere in mouth
Changes in voice
Lump in neck
Persistent earache

42
Q

Radiation therapy

A

Can cause fibrotic tissue (hardening of tissue)

43
Q

Supraglottic laryngectomy

A

Some of the worst swallows, because there’s a removal of airway protection
SLP role before procedure is to determine patient’s ability to learn techniques to protect airway
Removes structures necessary for airway protection –> tracheotomy tube

44
Q

Total Laryngectomy

A

Do not have risk of aspiration, but may present with other swallowing problems
Patients need more lingual pressure to compensate for lack of larynx when swallowing

45
Q

Endotracheal intubation

A

RED FLAG!!
Want to know how long and how traumatic
Insertion of a tube into mouth or nose, passing through the pharynx and VF into the trachea
Temporary - if can’t be extubated w/in 14-21 days, a tracheotomy is usually performed

46
Q

Complications of oral intubation

A
  • Trauma to teeth and gums
  • Abrasions to lips/tongue/pharynx/larynx
  • Tearing of the mucous membrane in the posterior oropharynx
  • Damage to VF
  • Hypoxemia (oxygen available to the tissue is below normal)
  • Left lung collapse - RIGHT LOWER LOBE PNEUMONIA is a RED FLAG angle of the right bronchus predisposes the entry of the tube to the right lung
  • Esophageal intubation
  • Rupture of esophagus
  • Cardiac complications
47
Q

Impact of tracheostomy tube on swallowing

A

Mechanical impact
- Reduced laryngeal excursion, secretion of management
Physiological impact
- Disruption of airway pressures, reduction of airflow through the glottis

48
Q

Oral feeding in the presence of an inflated cuff

A
  • Aspiration risk - sits on top of cuff
  • Limited to absent airflow for protective cough, throat clean - can’t feed them, need to restore upper airflow, which is vital before swallowing
  • Inability to taste or smell
  • Overinflated trach tube cuffs may impinge on esophagus increasing risk of backflow or spillover into airway and the disruption of esophageal pressures
49
Q

Osteophytes

A

Bony changes in the vertebrae of cervical spine (epiglottis can’t invert… protrusion that is literally an obstruction

  • may push on the posterior pharyngeal wall or esophagus
  • Osteophytes located at C3 usually produce symptoms - epiglottis may not invert, aspiration usually occurs during the swallowing
  • At C6 - results in disorders of flow through the PES/UES and esophagus, aspiration usually occurs after the swallow
  • Results in postural changes to eliminate aspiration and avoidance of solid foods
50
Q

What spine sites are RED FLAGS?

A

C3
C4
C5

51
Q

Signs and Symptoms of Esophageal Swallowing Disorders

A
  • Fullness, tightening in throat or chest
  • Localized or radiating neck, jaw, or chest pain
  • Sore throat
  • Acidic taste
  • Orophayngeal dysphagia
  • Chronic cough or throat clearing
  • Excessive secretions
  • Laryngeal dyskinesia
  • Breathlessness
  • Hoarse vocal quality
52
Q

SLPS and esophageal disorders

A

Not in scope of practice to dx or tx
Must be aware of interdependency of oral, phayngeal, and esophageal phases
- WE SCREEN - review esophageal phase of swallowing

53
Q

Esophageal Diverticulum

A
  • At level of UES
  • A pouch that protrudes outward in a weak part of the esophageal lining that collects food
  • When large, dysphagia for liquids and solids, regurgitation of previously swallowed food back into mouth
54
Q

Lower Esophageal Sphincter (LES) Abnormalities

A

Achlasia: condition in which a non-relaxing or incompletely relaxing LES prevents the passage of swallowed material into the stomach (BIG DEAL… nothing moves, just stays there)

  • Liquids and solids
  • Regurgitation
55
Q

GERD

A

Most common esophageal problem

  • GER is normal
  • When symptoms are overt - GERD
  • Heartburn is generally of esophageal origin –> often confused with cardiac event
56
Q

Esophageal Cancer

A

Most common manifestation of esophageal cancer is progressive dysphagia - often how it’s caught
- Aspiration caused by reflux, strictures, or decreased sensation

57
Q

Esophagitis

A
  • Inflammation of esophagus
  • Most common cause of esophageal phase dysphagia
  • GERD is primary cause
58
Q

Eosinophilic Esophagitis (EE)

A

Emerging cause of esophageal dys in children and adults.
- Allergic, inflammatory response of esophagus
Now EE clinic at Children’s…treated with diet

59
Q

Arching of baby’s back

A

Babies arch because of reflux!!

If they’re rigid - trouble feeding or swallowing

60
Q

Criteria for peds referral

A
  • Sucking swallow incoordination
  • Weak suck/inefficiency
  • Respiratory issues (desats) related to feeding (see this in preemies all the time)
  • Excessive gagging or recurrent coughing during feeds
  • New onset feeding difficulty
  • DX of disorders associated w/ dys
  • Falling off growth chart, weight loss, or failure to thrive
  • Severe irritability or behavioral problems during feeds
  • History of recurrent pneumonia
  • Concern for possible aspiration during feeds
  • Lethargy or decreased arousal during feeds
  • Feeding periods longer than 30-40 minutes (RED FLAD… infant burns more calories than getting)
  • Unexplained food refusal and failure to thrive
61
Q

Apgar scores

A

Color, respiration, heart rate, reflex, irritability, muscle tone at 1/5/10 minutes.
Score b/w 1-10
Anywhere between 1-5 is a RED FLAG

62
Q

Physical examination of infants

A
  • Face: small jaw, big tongue, wide-set eyes, asymmetries
  • Nose: nasal flaring is sign of stress or mouth breathing, blockage
  • Mouth: smack on bottle, heart shaped or notched tongue, can baby protrude tongue to lips?
63
Q

Observation of pediatric feeding process

A

If “never hungry”, RED FLAG
Eating on the go, RED FLAG (why grazing)
- can they not eat that much food at one time?
- is it behavioral (your job is not to tell parent how to parent)

64
Q

Awareness of ped vital signs

A

Does color change during certain foods/swallow (resp rate, oxygen, heart rate)

65
Q

Red Flags for adults

A

GERD
Changes in mental status or levels of alertness
Presence of feeding tubes
Thrush, presence of lesions, drool, poor dentition, poor oral care, dentures
Voice - problems with VF, nasality

66
Q

Signs of dysphagia

A 
Unexplained fever spikes
Increasing white blood count in the absence of other infections
Presence of pnuemonia
Pulmonary congestion
Desaturation with oral intake
67
Q

Symptoms of dysphagia

A 
Coughing
Choking
Wet vocal quality
Throat clearing
Oral Motor weakness
68
Q

Red Flags for adults

A

GERD
Changes in mental status or levels of alertness
Presence of feeding tubes
Thrush, presence of lesions, drool, poor dentition, poor oral care, dentures
Voice - problems with VF, nasality

69
Q

Signs of dysphagia

A 
Unexplained fever spikes
Increasing white blood count in the absence of other infections
Presence of pnuemonia
Pulmonary congestion
Desaturation with oral intake
70
Q

Symptoms of dysphagia

A 
Coughing
Choking
Wet vocal quality
Throat clearing
Oral Motor weakness

Dysphagia (1 decks)

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