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Fall '15-227 (Exam 1) > SLPs & the Dysphagia Team > Flashcards

SLPs & the Dysphagia Team Flashcards

1
Q

Which professionals may work with the SLP in a medical setting, specifically with dysphagia pts. ?

A

Speech Pathologist (SLP)

Nursing (RN, LVN, CNA) (need to be our best friends)

Doctor (MD, DO)

Dietitian (RD) (they need to be our best friends)

Occupational Therapist (OTR)

Physical Therapist (PT) →go to them for seating and positioning advice

Radiology Technicians (RT)—assist with MBS

Respiratory Therapist (RT)—will go in if someone has a trach

Social Worker (MSW)—in terms of discharge, and family being aware of our recommendations.

Mental Health, Recreational Therapists (RT, MT)—you’ll see this part of a SNF

Kitchen Staff Workers—they’re the ones who thicken the liquids for each meal.

Family Members

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2
Q

What are the parts of the chart?

A
  • Physician Orders
  • Patient Care Plan**(know this)
  • Nursing Progress notes (good to see how the patient is doing today)
  • Physician Progress Notes
  • Labs
  • Radiology
  • Treatment Record
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3
Q

What are some examples of what you would find in the physician orders?

not sure if this is on exam

A

Therapy orders

Diet orders

Tests/procedures ordered

Precautions

Medications

Code status

Allergies

Adverse Drug Reactions

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4
Q

ON EXAM

Describe the patient care plan

A

Purpose is for all disciplines to identify problem areas to allow the staff to address the problems (interdiscipline) using the following:Problems, Goals, Interventions, Dates of onset, target, and completions

You’re involved in this b/c you create a plan of care when doing dysphagia, and when you need to create a communication system

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5
Q

What do you find in the nursing progress notes?

not sure if this is on exam

A

Find vital statistics, pt. changes from baseline, & daily care provided by nursing.

ADL records

Medicine Administration Record (MAR)

Weight Record

Intake/Output (I&O)

Treatment Administration Record (TAR)

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6
Q

What do you find in a patients labs?

not sure if this is on exam

A

Blood work

Renal Parameters (BUN, Creatinine, Electrolytes)

Nutritional Parameters (Albumin, Anemia panel)

Blood Glucose Monitors (fasting blood glucose, HgbA1c, Oral glucose tolerance test

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7
Q

What do you find in the radiology portion?

not sure if this is on exam

A

Chest X-rays (Check for infiltrates for possible pneumonia)

MRI/CT scan results

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8
Q

What do you find in the treatment record?

not sure if this is on exam

A

Speech Therapy Reports & Notes

OT Reports & Notes

PT Reports & Notes

RD Assessments (registered dietitian)

RT Notes

Audiology Reports & Notes

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9
Q

What is the role of the occupational therapist in terms of evaluation?

not sure if this is on exam

A

to figure out what is the deficit

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10
Q

What does the OT work on in terms of treatment?

A

Strengthening; use of adaptive techniques/equipment/assistive devices; increase/improve independence

ADL/self-care (dressing, bathing, toileting, hygiene/grooming)

Seating/positioning

Wheelchair mobility

Cognitive skills

Self-Feeding ON EXAM*

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11
Q

What must we make sure are working, clean, and in place before evaluating/treating a patient?

A

dentures, eye glasses, hearing aides

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12
Q

What is the issue for self-feeding if a patient is in pain?

A

if they’re in pain they may not be able to feed themselves very well…. Work with the OT/Nurse to discuss pain medications

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13
Q

What should we keep in mind about hygiene and grooming?

A

maintain people’s dignity by just helping them clean them a little bit. An OT is very in tune to all of that.

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14
Q

In terms of feeding, what should we consider for the environment?

ON EXAM

A

Eating meals seated in a chair is optimum and should be encouraged for all meals.on exam*

Chair: Upright, symmetrical, postural supports in place, comfortable.

Table: Chair should be brought close to the table so items are within reach.

Bed: If eating a meal in bed is necessary, the head of the bed should be fully upright with the individual positioned symmetrically. Nice and straight @ a 90 degree angle.

In the bed—scoot the pt up in bed so that when you raise the head of the bed they can bend/sit up where they should be.

  • Positioning the hips is key and the first step for good positioning.ON EXAM**
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15
Q

In terms of feeding, what should we keep in mind in terms of the set up of the tray and table?

A

Unnecessary Items – remove from tray

Use contrasting color to enhance visual identification –

(i.e. white plate on dark placement or table cloth)

Arrange items on tray – within reach, organized

Place tray on table – close enough to edge of table to bring items within reach

A lap tray or bedside table can be used to bring tray closer

Height of table – adjusted

Distance between individual and table – bring chair close

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16
Q

What are assistive feeding devices used for?

A

used to compensate for limited range of motion, weakness, impaired coordination, tremor, loss of sensation

17
Q

What are the types of assistive feeding devices?

A

built up handle

weighted and/or curved handles

textured grip

plate guard

partitioned plates

nosey cup

weighted cups

18
Q

Describe a nosey cup

ON EXAM

A

has a section cut out of the cup. For patients who have to do a chin tuck

19
Q

What do weighted utensils help with?

A

help with tremors

20
Q

What are some feeding recommendations we can make?

A

Encourage choice of next bite/sip – give as much control as possible

Be attentive

Interact/communicate at eye level

Small sips and bites

Slow pace, wait for swallow

Observe for Red Flags indicating difficulty swallowing

Encourage good intake

21
Q

What is the role of the dietitian?

A

Thorough nutrition assessment and intervention helps improve or maintain health

This always involves a collaborative effort with other members of the medical team, including physicians, nurses, speech therapists, and occupational therapists.

22
Q

What are the types of diets?

A

therapeutic diets

mechanical diets

23
Q

Describe therapeutic diets

A

Alteration of nutrients to help treat a medical condition

*Each facility has a different mix of therapeutic diets

Examples:
•Calorie restricted or enhanced (i.e., overweight or underweight)

•Protein restricted or enhanced (i.e., renal insufficiency, celiac disease, wound healing)

CHO modified (i.e., diabetes, reactive hypoglycemia, lactose intolerance, diverticulosis)

Fat modified (i.e., hyperlipidemia, ASHD)

Modified electrolytes (i.e., ESRD, CHF)

Metabolic processes (i.e. gout, PKU)

24
Q

What are mechanical diets? And what types of medical disorders use this diet?

A

Alteration of food and/or fluid textures to help treat a medical condition

*Each facility has different mechanical diets

These diets may be used for a variety of medical conditions, including dysphagia, poor dentition, jaw dysfunction, stomatitis (infection in your mouth), and esophageal disorders

25
Q

What are some examples of mechanical diets?

A

• Examples of Mechanical Diets: (make sure to say solids & liquids in your recommendations)

Solid Texture
•Pureed (most extreme)
•Mechanical soft-ground (everything is ground into tiny pieces)
•Mechanical soft-chopped (everything is chopped up into small pieces)
•Regular

Liquids
•Thin (water)
•Nectar (tomato juice/v8) 
•Honey 
•Pudding*
26
Q

What is enteral nutrition?

A

tube feeding

Refers to nutrition support provided when use of an oral diet is either contraindicated (due to safety) or insufficient to meet a person’s nutritional needs

Enteral infers that the digestive tract is functional and can be used for nutrient ingestion and absorption

27
Q

What is parenteral nutrition?

A

Parenteral nutrition is used when any part of the digestive tract is not functional (i.e., short bowel syndrome (SBS), obstruction, ileus, malabsorption) or when it is necessary to minimize GI function (i.e., fistulas, IBD, acute pancreatitis)

28
Q

What are the routes of administration of enteral nutrition?

ON EXAM

A
  • orogastric (OG tube) or Orojejunal tube (OJ tube)
  • Nasogastric (NG tube) or nasojejunal tube (NJ tube)
  • Gastrostomy (G-tube) or Percutaneous endoscopic Gastrostomy (PEG)

Jejunostomy (j-tube) or percutaneous endoscopy jejunostomy (PEJ)

29
Q

ON EXAM

Describe OG/OJ tubes

A

Tube goes in through the mouth down to the stomach

Orejujunal bypasses the stomach and goes down to the jujunem.

**not common b/c it causes poor oral care, can’t communicate. Scott doesn’t like this either*

30
Q

ON EXAM

Describe NG tubes/NJ tubes

A

Through the nose and down into the stomach

10 days… an NG tube decreases the integrity of the sphincter muscle, which doesn’t allow the CP to stay contracted.

They act as a siphon for reflux

It’s a breeding ground for bacteria because it’s hard to keep clean.

Scott is not a huge fan of this

31
Q

ON EXAM

Describe G-tubes/PEG

A

Difference between the two is how it’s placed**

G-tube—puts you out, do x ray, then put hole and tube in.

PEG—camera goes down through scope, the light is super bright and acts as a landmark for the incision.

32
Q

ON EXAM

Describe Jejunostomy (J-Tube) or PEJ

A

Tube bypasses the stomach and goes straight to jujunem

33
Q

ON EXAM

What are the types of enteral feedings?

A

Continuous (pump)

Intermittent (pump or gravity bag)

Bolus (syringe)

34
Q

Describe intermittent feeding

A

Maybe somebody has a PEG and can be active during the day and then hook a gravity bag at night and just hook it up while you’re sleeping.

35
Q

what are some pros/cons for bolus/syringe feeding

A

Pro: It mirrors what you’re doing with eating. Keeps the regular function of your GI system.

Con: Reflux—a large amount all at once can be a problem.

36
Q

ON EXAM

What are some tube feeding complications?

A

Related to mechanics of the TF process, GI function, metabolic processes, psychosocial factors, or infection

Nausea (improper tube placement, excessive rate or volume, anxiety)

Vomiting (excessive volume, improper formula, contamination, anxiety)

Diarrhea (cold formula, excessive rate, high osmolarity, anxiety)

Constipation (low fiber formula, inadequate fluid)

Tube occlusion (formula viscosity, failure to flush tube)

Aspiration (HOB [head of bed], tube placement, excessive gastric residual)

       Even if your on a pump you still need to be elevated 30 degrees.
37
Q

What are some Ethics of tube feeding?

A

Tube feeding may be considered “life support”

Short term versus long term tube feeding

End of life care

We need to make sure we educate educate educate.. give the families options!!!** Then document the heck out of it!**

38
Q

Describe the transition protocol for enteral to oral nutrition

CHECK GRID ON PG 23 as well….***

A

Objective: To eliminate a resident’s dependence upon enteral nutrition support w/out jeopardizing his/her general health or safety.

Oral food/fluids are introduced in sequential phases, one meal at a time, w/ concurrent reduction in enteral nutrition support.

*People involved in this are SLPs, dieticians, and Nurses….

Fall '15-227 (Exam 1) (7 decks)

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