Speech Pathology/Therapy Flashcards
Speech Pathologists do
Swallowing** assessment and treatment
Speech and language** evaluation and treatment
Cognitive** assessment and treatment
Swallowing is normally
strong, coordinated, and timely
Phases of swallowing
oral
pharyngeal
esophageal
Dysphagia
Difficulty swallowing
Structural reasons for dysphagia
Oral cancer–glossectomy, etc.
Poor dentition or ill-fitting dentures
Throat cancer–laryngectomy
Tracheostomy
Diverticulum
Other esophageal pathologies (strictures, webs, rings, cancer, etc)
Glossectomy
removal of tongue
Esophageal diverticulum
Muscle wall develops a pouch due to expansion
food or liquid is caught
Functional Patho dysphagia
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)
Cognitive dysphasia
Dementia
Head injury
Lethargic or obtunded patients
**May affect feeding efficiency, adequacy of p.o. intake
Nursing Role in Dysphagia Management
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
S/S of Dysphagia
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
Complications of Dysphagia
Aspiration pneumonia suspected
Recurrent pneumonia - aspiration
Weight loss
Chronic dehydration or malnutrition
IF PT HAS DYSPHAGIA THEN THEY HAVE TROUBLE WITH MEDS BUT
NOT ALL DIFFICULTY OF TAKING MEDS IS DYSPHAGIA
If a pt has difficulty taking meds but not other signs, then have the pt
single pill with water
puree
crushed in puree
Top Three Risk Factors for Aspiration Pneumonia
Dependence on others for feeding
Dependence on others for oral care
Missing or decaying teeth
Speech Pathologist is Dysphagia Management Dx
Bedside Swallow Evaluation,
Modified Barium Swallow,
Fiberoptic Endoscopic Evaluation of Swallowing
- nature and severity
SP manages
diet and feeding recommendations
education
direct therapies
referrals
Silent aspiration
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
Feeding/Swallowing Precautions
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
Clear liquid diets
broth jello
sometime with thickener
Full liquid
cloudy and creams
Diet Restrictions are prescribed by
RD or MD
International Dysphagia Diet
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
Soft diet
diced meat and partially processed
Minced and moist
ground up with minimal chewing
Pureed
mashed potatoes consistency = extremely thick (applesauce)
Liquidized
honey thickness (moderate)
How to use Simply Thick
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.
Frazier Water Protocol
high risk of aspiration to have ice and water throughout the day.
oral bacteria is the source of aspiration pneumonia, not water
Benefits of Frazier Water protocol
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.
What causes infection in the lungs?
bacteria not water or food
Requirements of Water Protocol
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.
Oral Hygiene
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.
Dysarthria
difficulty articulating words “drunk” – muscle decreased
Apraxia (motor planning)
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
Motor-speech disorders often seen in
CVA (usually Rt.), Parkinson’s, ALS, MS, MG, Other
Expressive aphasia
can’t express how they are doing
Receptive dysphasia
difficulty understanding what you are saying
Language Disorders are caused by
left brain injury
Cognitive-Communicative Disorders
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
Communicating with aphasia pts
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
Communicate with dysarthric pts
pt speaks loudly**
slow-down speech
finish sentences
re-word
Word/alphabet boards may be helpful
Communicating with hearing-impaired pts
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
Passy-Muir Speaking Valves
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
