Radiation Saftey, Tx Planning, Ethics, OWL, End of Life Decision Making Flashcards
The Principle of ________ is in practice for all institutions using medical radiation.
ALARA
As low as reasonably achieveable (w/out affecting accuracy of VFSS)
Acceptable radiation doses are lower in children b/c
Children’s developing organs are more susceptible to the effects of radiation
The three most sensitive tissues to radiation:
The least sensitive:
Eyes, thyroid, upper esophagus
Skin
For SLPs the primary source of radiation during the VFSS is from:
The patient because of radiation scatter
Three basic tenets of radiation protection:
Time
Distance
Shielding
Key to tx planning
Link physiology to short term goals
Signs at Oral Prep Phase
Loses food from mouth, can’t form cohesive bolus
Signs at Oral Phase
Can’t move bolus to back of mouth
Lose bolus over back of tongue
Signs at Pharyngeal Phase
Food enters airway before during or after swallow
Food left in vallecula or pyriform sinus
Signs at Esophageal Phase
Retrograde flow causes food to enter pyriforms or airway
What is the functional ST objective and measurable approaches if the patient has food left in the valleculae?
ST: PT will reduce residue left in the valleculae that might fall into the airway
Measurable Approaches:
Compensatory: PT will use an effortful swallow/chin tuck w/without cues on ___% of trials.
Rehab exercises: PT will demonstrate TBR w/ resistance on ___ of ___ trials.
Diet: PT will avoid sticky foods with/without cues on ___ of ___ trials. Pt will only take pills crushed & mixed in pudding.
**See lecture for more ST objectives
Common long-term goal linked to ability to maintain:
Adequate hydration & nutrition on a given diet level w/ no overt difficulty or s/s of aspiration
Evidence Based Practice includes:
Current best evidence
Clinical expertise
Client values
Basic principles of medical ethics:
- PTs must be able to fully participate in decisions regarding their health care
- QOL paramount
Most common ethical dilemma in SLP
PT who aspirates refuses to use a feeding tube under any circumstance
- document recommendations/pt refusal for legal purposes
- Conversations w/ family & education received
- right to ask another professional w/ different perspective to assume care
Guidelines to ethical practice:
- Autonomy - PT has right to make decision regarding fate
- Beneficence - Steps taken to prevent harm
- Justice - fairness regarding ax and tx
- Veracity, confidentiality, fidelity
Solutions to ethical dilemmas in medical setting involve:
Pt’s health preferences
Medical risks/benefits
Pt’s QoL
Legal constraints
Quality of Life is…
It depends on…
Person’s consciously perceived positive and negative, cognitive and affective experience
(whatever the patient says it is!)
On person perceives and reacts to their health status
Heisenberg Principle in QoL measurement:
The questionnaire renders them depressive so it is not ethical
Generic vs. HRQoL vs. disease-specific measures
Generic measures: comprehensive in scope, broad applicability, yet may not be responsive/relevant to SLP tx outcomes (holistic, cast a wide net)
HRQOL - can overestimate impact of impairments; do not always line up with PT perceptions of QoL
Disease-specific: BEST - sensitive to small changes, discriminating severity, relevant questions (but only apply to narrow group)
Define competence
Legal concept related to PTs financial & civic right
PEG Guidelines
Indicated for nutritional impairments associated w/: HNC; acute stroke / persistent dyaphagia expected 1 mth after hospital discharge; neuromuscular dystrophy syndromes
Contra-indicated: Aspiration, cancer w/ short life expectancy, dementia, persistent vegetative states, anorexia/cachexia syndromes
Feeding Tubes should be used if…
- prevents aspiration pneumonia
- improves survival
- improves QoL and PT comfort
- improves functional status
- prevents malnutrition
Alternatives to Tube Feeding
- discontinue nonessential medicines that may reduce eating difficulties
- staff education**(oral hygiene etc)
- use finger foods, preferred foods, strong flavors, hot or cold foods, gravy or juices, calorie-dense enrichers (cream)
- reminders to swallow, bolus
