Quiz 3- Week 10 Article Cards

Question 1

Definition of Dysphagia

Answer 1

Dysphagia is defined as problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.

Question 2

Consequences of Dysphagia

Answer 2

Malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death.

Question 3

Adults with Dysphagia may experience..

Answer 3

(a) disinterest and/or less enjoyment of eating or drinking and/or
(b) embarrassment or isolation in social situations involving eating.
(c) Dysphagia may increase caregiver burden and may require significant lifestyle alterations for the patient and the patient’s family.

Question 4

Who treats and dx oral and pharyngeal Dysphagia pts?

Answer 4

SLP’s

Question 5

Signs and Symptoms of Dysphagia

Answer 5

• drooling and poor oral management;
• food/liquid remaining in oral cavity after the swallow;
• inability to maintain lip closure, food/liquids leak from
the oral cavity/
• food /liquids leaking from nasal cavity
• complaints of food “sticking”;
• globus sensation / “fullness” in the neck;
• pain when swallowing;
• wet or gurgly sounding voice during or after eating or
drinking;
•

Question 6

S/S of Dysphagia Contd.

Answer 6

coughing during or right after eating or drinking;
• difficulty coordinating breathing and swallowing;
• recurring aspiration pneumonia/respiratory infection
and/or fever;
• extra effort or time needed to chew or swallow;
• changes in eating habits—specifically, avoidance of
certain foods/drinks; and
• weight loss or dehydration from not being able to eat
enough.

Question 7

Dysphagia may result from numerous etiologies secondary to damage to the (CNS) and/or cranial nerves, and unilateral cortical and subcortical lesions, due to

Answer 7

• stroke;
• TBI
• spinal cord injury;
• dementia;
• Parkinson’s disease; MS, ALS
• muscular dystrophy;
• developmental disabilities in an adult population (i.e.,
cerebral palsy);
• post-polio syndrome; and/or myasthenia gravis.
• cancer in the oral cavity, pharynx, nasopharynx, or
esophagus;

Question 8

Dysphagia may result from numerous etiologies secondary to damage to the (CNS) and/or cranial nerves, and unilateral cortical and subcortical lesions, due to
CONT’D.

Answer 8

Chemo
• trauma/surgery involving the head and neck;
• decayed or missing teeth;
• oral intubation and/or tracheostomy;
• certain medications;
• pts. with certain metabolic disturbances;
• pts. with infectious diseases (e.g., sepsis, [AIDS]);
• pts. with a variety of pulmonary diseases (e.g.[COPD]);
• pts. with GERD;
• pts. following cardiothoracic surgery; and/or
• in decompensated elderly patients.

Question 9

SLP role with Dysphagia pts. PART 1

Answer 9

• Identifying
signs and symptoms of dysphagia
• normal and abnormal swallowing A/P
• indications and contraindications specific to each pt.
for various non-instrumental and instrumental
assessment procedures
• signs of potential disorders in the upper
aerodigestive tract /making referrals to appropriate
medical personnel
• Performing, analyzing, and integrating info from non-
instrumental and instrumental assessments of
swallow fxn. collaboratively with medical
professionals, as appropriate

Question 10

SLP role with Dysphagia pts. PART 2

Answer 10

Providing safe and effective treatment for swallowing disorders, documenting progress, and determining appropriate dismissal criteria
• Identifying and using appropriate functional outcome
measures
• Understanding a variety of medical diagnoses and their
potential impact(s) on swallowing
• Awareness of typical age-related changes in swallow
function
Providing education and counseling to individuals
and caregivers
• Incorporating the client’s/patient’s dietary preferences and cultural practices as they relate to food choices during evaluation and treatment services
• Respecting issues related to QOL for individuals and/or caregivers
• Practicing interprofessional collaboration as an integral part of the patient’s medical care team

Question 11

SLP role with Dysphagia PART 3

Answer 11

Educating other professionals on the needs of individuals with swallowing and feeding disorders and the SLP’s role in the diagnosis and management of swallowing and feeding disorders
• Advocating for services for individuals with swallowing and feeding disorders
• Advancing the knowledge base through research activities
• Maintaining competency of skills through reading current research and engaging in continuing education activities
• Determining the safety and effectiveness of current nutritional intake (e.g., positioning, feeding dependency, environment, diet modification, compensations)

Question 12

Are swallowing screenings a Pass or Fail procedure?

Answer 12

Yes

Question 13

What does a swallow screening provide?

Answer 13

Screening does not provide a detailed description of the patient’s swallow function but, rather, identifies individuals who are likely to have swallowing impairments related to function, activity, and/or participation as defined by the World Health Organization (WHO, 2001).

Question 14

What is the purpose of a swallowing screening?

Answer 14

• the likelihood that dysphagia exists and

* the need for further swallowing assessment

Question 15

What do screening protocols include?

Answer 15

• interview or a questionnaire that addresses the pts perception of and/or concern with swallowing fxn;
• observation of:
- the presence of the signs and symptoms of oropharyngeal and/or esophageal swallowing dysfunction;
-routine or planned mealtime situations, if indicated;
-administration of the 3-oz Water Swallow Test
• recommendation for additional assessment; and
• communication of results/recommendations to team

Question 16

Modified Evans Blue Test

Answer 16

The Modified Evans Blue Dye Test (more informally referred to as “blue dye test”) is completed in patients with a tracheotomy by tinting oral feedings blue/green with the intent to identify aspiration in these patients

Question 17

Screenings may result in..

Answer 17

• recommendations for rescreening;
• recommendations for additional assessment—including clinical and/or instrumental examinations—to determine whether, and the degree to which, swallowing physiology may be impaired; and/or
• referral for other examinations or services

Question 18

Purpose of Assessment is to identify and describe:

Answer 18

• typical /atypical parameters of str. and fxn. affecting swallowing;
• effects of swallowing impairments on indiv. activities (capacity and performance in everyday contexts) and participation;
• contextual factors that serve as barriers to or facilitators of successful swallowing and participation for individuals with swallowing impairments.

Question 19

Swallowing assessment allows the SLP to integrate information from

Answer 19

(a) the interview/case history
(b) medical/clinical records including the potential impact of medications
(c) the physical examination
(d) previous screening and assessments
(e) collaboration with physicians and other caregivers.

Question 20

During assessment, SLPs determine whether:

Answer 20

• pt is an appropriate candidate for treatment and/or management;
• determination is based on findings that include:
• medical stability
• cognitive status
• nutritritional status
• psychosocial
• environmental
• behavioral factors.

Question 21

Assessment may result in one or more of the following outcomes

Answer 21

• Description of the charac of swallowing fxn,
• Dx of a swallowing disorder
• Determination of the safest and most efficient route (oral vs. non-oral) of nutrition and hydration intake
• Identification of the effectiveness of intervention and support
• Recommendations for intervention and support for oral, pharyngeal, and/or laryngeal disorders
• Prognosis for improvement and identification of relevant factors
• Referral for other services or professionals
• Counseling, education, and training to the pt, health care providers, and caregivers

Question 22

SLPs conduct assessments in a manner that is sensitive to:

Answer 22

• individual’s cultural background
• religious beliefs
• preferences for medical treatment

Question 23

True or False

Answer 23

True
For patients with signs and symptoms of pharyngeal dysphagia, instrumental procedures can provide more sensitive and objective findings than the clinical examination.

Question 24

Purpose of Non-Instrumental Swallowing Assessment

Answer 24

observe the presence (or absence) of signs and symptoms of dysphagia, with consideration for factors such as fatigue during a meal, posture, positioning, and environmental conditions.

Question 25

A non-instrumental assessment may provide

Answer 25

sufficient information for a clinician to diagnose oral dysphagia; however, aspiration and other physiologic problems in the pharyngeal phase can be directly observed only via instrumental assessments.

Question 26

A non-instrumental swallowing assessment may include the following procedures: (PART 1)

Answer 26

• A case history
• An oral mechanism exam
o Cranial nerve assessment
o Structural assessment of face, jaw, lips, tongue, hard and soft palate, oral pharynx, and oral mucosa
o Fxn assessment of muscles and structures used in swallowing, including symmetry, sensation, strength, tone, range and rate of motion, and coordination of movement
o Observation of head–neck control, posture, oral reflexes, and involuntary movements
• Assessment of :
overall physical, social, behavioral, and cognitive/communicative status, patient’s perception of fxn, severity, change in functional status, and QOL, speech and vocal quality at baseline and any changes following bolus presentations
• Monitoring of physiological status, including heart rate and oxygen saturation

Question 27

A non-instrumental swallowing assessment may include the following procedures: (PART 2)

Answer 27

Assessment of alterations in bolus delivery and/or use of rehabilitative or compensatory techniques, as indicated
• Eval of the method (spoon, cup, self-fed, examiner-fed) and rate of bolus presentation to assess the effects on swallow function
• Assessment of secretion management skills
• Observation of the patient eating or being fed food
• Assessment of labial seal and anterior spillage, and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence
• signs and symptoms of penetration/ aspiration, such
• consistency of skills across the feeding opportunity to rule out any negative impact of fatigue on feeding/swallowing safety
• the ability to clear the airway, and assessment of cough strength

Question 28

Assessment may also include monitoring vital signs.

Answer 28

The clinical examination alone may form the basis for recommendations for the management of dysphagia—or it may serve as a tool for (a) identifying clinical presentations of dysphagia, (b) determining the potential need for additional instrumental evaluation, and (c) specifying diagnostic questions to be answered by any instrumental evaluations.