quiz 4 Flashcards
2 Diagnoses that can result in trach:
- Tumors
- Vocal cord paralysis (VCP)
- Large tongue or small jaw that blocks airway
- Severe neck or mouth injuries
- Airway burns from inhalation
- Foreign body obstruction
- Coma
Why is the Passy-Muir valuable/important?
redirects airflow through the vocal folds, mouth and nose enabling voice and improved communication
improved swallowing, secretion management, and oxygenation.
• Restores Positive Airway Pressure:
• Superior Voice/Speech Production:
• Improves Swallow & May Reduce Aspiration:
• Restores Subglottic Pressure:
Function of Vagus CN?
- Provides motor and sensory innervation to the palate, pharynx, esophagus, stomach and respiratory tract
- Involved in regulation of blood pressure
- Include motor innervation from nucleus ambiguous and sensory innervation from nucleus solitaries
Dysphagia complications (oral or pharyngeal of the Left CVA
- Apraxia of swallow →Generally swallow better left alone
- Mild oral transit delays
- Mild delay of trigger
- Treatment: Sensory enhancement (Increase taste, pressure on spoon, therm stim)
Dysphagia complications (oral or pharyngeal) of Spinal cord
- Delay in trigger
- Decreased laryngeal excursion resulting in decreased cp opening
- Decreased tongue base mvmt
- Unil / bi-lat pharyngeal wall dysfunction
- Decreased airway closure due to decreased laryngeal motion
- Decreased vocal fold closure due to intubation trauma
- C1-3
- Decreased sensory awareness
- Often require mech vent
Dysphagia complications (oral or pharyngeal) of Closed head injury
- Decreased lip closure
- Decreased tongue ROM
- Decreased bolus control
- Abnormal oral reflexes – bite
- Decreased trigger pharyngeal swallow – or absent
- Decreased laryngeal elevation
- Decreased CP opening
Dysphagia complications (oral or pharyngeal) of Parkinson’s Disease
• Oral – repetitive anterior-posterior rolling
• Delay in trigger of swallow
o Usually only 2-3 seconds
• After trigger: Decrease pharyngeal wall contraction & Decreased tongue base retraction
1. Results in residue in vallecula and pyriform sinuses
2. Often builds with consecutive swallows
Advantages of MBS
- All stages of swallow in real time
- Measures bolus transit time, motility disorders, amount and cause of aspiration
- Swallow techniques can be tested during the study and effects are immediately known
- Video helps with patient/family education
Advantages of FEES
- Portable
- Can have sensory testing
- No radiation
- Can use compensatory strategies
- No time limits
4 components of radiation safety
- Time: Minimize # of procedures and time
- Distance: Knowledge and respect of the field
- Shielding: Patient shielding; appropriately fitting apron; thyroid shield, badges (over/under the apron); rings and gloves.
- Intensity: Pulse & Pediatrics- calibrated equipment
Hierarchy for liquids (4)
- Thin- tap water; drinks in their normal state, not altered
- Nectar- thickened liquids to nectar state, juice nectars
- Honey- thickened to be honey consistency
- Pudding- thickened to pudding consistency; less common recommendation (not often used, similar to puree in foods)
Hierarchy for foods (4)
- Regular- not altered
- Soft- Meat may be cut into small pieces, nuts and raw fruits/vegetables avoided, no popcorn or mixed consistencies
- Mechanical Soft/Mechanically Altered- chopped or ground meat, soft foods only, avoid breads, mixed consistencies, etc.
- Pureed- blenderized food, pudding-like consistency, consistency is like baby food but do NOT use that example with patients!
Function of Glossopharyngeal CN?
- Provides sensory innervation to oropharynx and the base of tongue
- Supports taste fibers at base of tongue
- Motor innervation to the stylopharyngeus muscle
Function of Trigeminal CN?
- 3rd division of this nerve supplies sensory innervation to the tongue (lingual nerve) and the inferior alveolus, buccal mucosa and lower lip.
- Innervation of oral tongue is conferred via lingual nerve
- Supplies motor innervation to mastication muscles
Disadvantages of MBS
- Exposure to radiation is small but can be a concern if repetition is needed
- Equipment is not portable – must be done in radiology
- Requires training to determine anatomic structures and abnormalities
- Expensive
- Requires radiologist
