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Module 4 (MedSurg 2) > Speech Pathology/Therapy > Flashcards

Speech Pathology/Therapy Flashcards

1
Q

Speech Pathologists do

A

Swallowing** assessment and treatment

Speech and language** evaluation and treatment

Cognitive** assessment and treatment

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2
Q

Swallowing is normally

A

strong, coordinated, and timely

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3
Q

Phases of swallowing

A

oral
pharyngeal
esophageal

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4
Q

Dysphagia

A

Difficulty swallowing

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5
Q

Structural reasons for dysphagia

A

Oral cancer–glossectomy, etc.
Poor dentition or ill-fitting dentures
Throat cancer–laryngectomy
Tracheostomy
Diverticulum
Other esophageal pathologies (strictures, webs, rings, cancer, etc)

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6
Q

Glossectomy

A

removal of tongue

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7
Q

Esophageal diverticulum

A

Muscle wall develops a pouch due to expansion
food or liquid is caught

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8
Q

Functional Patho dysphagia

A

Acute neurological event (CVA, head injury)
Progressive neurological disorders (PD, tumors, MS)
General weakness (aging, decompensation from medical problems, cardiac patients)
Esophageal pathologies (reflux, motility disorders)

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9
Q

Cognitive dysphasia

A

Dementia

Head injury

Lethargic or obtunded patients

**May affect feeding efficiency, adequacy of p.o. intake

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10
Q

Nursing Role in Dysphagia Management

A

Good history (RN assessment forms)
Good oral mechanism exam by talking
Observation with meals and medications
Assistance with oral care **
Assistance with feeding **
Hasten referrals to other professionals

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11
Q

S/S of Dysphagia

A

Cannot manage oral secretions = drooling, coughing
Difficulty chewing, prolonged chewing
Pocketing** of food in buccal cavities
Holding food in mouth for long periods
Excessive drooling during meals
Absent swallow (know how to palpate) = jumps and closes the airway
Coughing/choking or throat clearing after swallows**

Wet, gurgly voice after swallows

Pain with swallowing

Swallowing many times for small bolus
Tube feeding

Multiple medical diagnoses

Chronic reflux

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12
Q

Complications of Dysphagia

A

Aspiration pneumonia suspected
Recurrent pneumonia - aspiration
Weight loss
Chronic dehydration or malnutrition

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13
Q

IF PT HAS DYSPHAGIA THEN THEY HAVE TROUBLE WITH MEDS BUT

A

NOT ALL DIFFICULTY OF TAKING MEDS IS DYSPHAGIA

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14
Q

If a pt has difficulty taking meds but not other signs, then have the pt

A

single pill with water
puree
crushed in puree

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15
Q

Top Three Risk Factors for Aspiration Pneumonia

A

Dependence on others for feeding

Dependence on others for oral care

Missing or decaying teeth

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16
Q

Speech Pathologist is Dysphagia Management Dx

A

Bedside Swallow Evaluation,
Modified Barium Swallow,
Fiberoptic Endoscopic Evaluation of Swallowing
- nature and severity

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17
Q

SP manages

A

diet and feeding recommendations
education
direct therapies
referrals

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18
Q

Silent aspiration

A

Aspirated material is undetected by a desensitized trachea
Consequently, no reflexive cough is triggered to protect the airway
Results in false neg. Bedside swallow eval
If suspected, an MBS or FEES study would be better able to identify the aspiration

19
Q

Feeding/Swallowing Precautions

A

Chin-tuck (sip of water, hold, and chin-tuck)
Thickened liquids – quick fix
Follow-up swallows - residue
Straws v. No straws – depends pt
Throat clearing
**“General Precautions” - Sit up, alert, with small bites and sips

20
Q

Clear liquid diets

A

broth jello
sometime with thickener

21
Q

Full liquid

A

cloudy and creams

22
Q

Diet Restrictions are prescribed by

A

RD or MD

23
Q

International Dysphagia Diet

A

0 - Thin
1 - Slightly thick
2 - Mildly thick
3 - Moderately thick or liquidized
4 - Extremely thick - pureed
5 - minched and moist
6 - soft and bite sized
7 - regular and easy to chew

24
Q

Soft diet

A

diced meat and partially processed

25
Q

Minced and moist

A

ground up with minimal chewing

26
Q

Pureed

A

mashed potatoes consistency = extremely thick (applesauce)

27
Q

Liquidized

A

honey thickness (moderate)

28
Q

How to use Simply Thick

A

One entire packet to 4 oz. of liquid
Shake for 5 seconds in mixing cup with lid or Stir with a fork for 20 seconds.
Do not compromise please!
Simply Thick mixes smooth and clear and tastes much better than traditional, corn starch-based thickeners.

29
Q

Frazier Water Protocol

A

high risk of aspiration to have ice and water throughout the day.
oral bacteria is the source of aspiration pneumonia, not water

30
Q

Benefits of Frazier Water protocol

A

Gives dysphagic, NPO patients increased therapeutic opportunities to swallow and hastens a return to safe PO intake.

Increases hydration, especially orally, to reduce bacterial growth.

Has the potential to improve a patient’s psychological state of mind.

31
Q

What causes infection in the lungs?

A

bacteria not water or food

32
Q

Requirements of Water Protocol

A

Must be ordered by a physician.

Daily oral hygiene per protocol specifications
Hydrogen peroxide entire mouth

Patients are able to swallow water w/o demonstrating excessive coughing and discomfort.

Patients are able to maintain alertness and arousal.

Patients are able to elicit a timely/efficient swallow (determined by SLP) and are able to maintain upright posture.

33
Q

Oral Hygiene

A

One of the most important points of care is oral hygiene.
If the patient is unable to independently perform oral care, be sure it gets done everyday
As a reminder, put yourself in their position and imagine not brushing your teeth for days.

34
Q

Dysarthria

A

difficulty articulating words “drunk” – muscle decreased

35
Q

Apraxia (motor planning)

A

strokes common
Difficulty using motor functions when trying to
Ice cream allows the tongue to move out due to different hemispheres
pressure to perform = harder to do it

36
Q

Motor-speech disorders often seen in

A

CVA (usually Rt.), Parkinson’s, ALS, MS, MG, Other

37
Q

Expressive aphasia

A

can’t express how they are doing

38
Q

Receptive dysphasia

A

difficulty understanding what you are saying

39
Q

Language Disorders are caused by

A

left brain injury

40
Q

Cognitive-Communicative Disorders

A

Head Injury
Right-brain CVA
Dementia
Anoxic brain injury
Toxic-metabolic encephalopathy – can’t function
May affect pragmatic (social) skills = social inappropriate, problem-solving, and memory

41
Q

Communicating with aphasia pts

A

Use hearing aids and/or glasses
Speak slowly, directly, and keep sentences short
Allow plenty of time for responses
Give two choices rather than asking open-ended questions if possible
Use word boards only if directed
Do not “talk down” to patient please

42
Q

Communicate with dysarthric pts

A

pt speaks loudly**
slow-down speech
finish sentences
re-word
Word/alphabet boards may be helpful

43
Q

Communicating with hearing-impaired pts

A

Use hearing aids (make sure batteries work) and glasses
Stand/sit close to the patient
Look at the patient
Speak slowly and in a low pitch
Keep sentences short
Re-phrase, rather than just yelling louder

44
Q

Passy-Muir Speaking Valves

A

Trach. cuff must be fully deflated
Supervision and length of use as directed by speech pathologist
Do not use during breathing treatments or when patient is asleep
- giving pt ability to talk and breath with trach

Module 4 (MedSurg 2) (36 decks)

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