stuff he told us to study ONLY Flashcards
SOAP: Subjective
S: Subjective= Includes age level of care (ICU, CCU, outpatient independent living, etc.) medical history pt. complaint (including quotes) clinical/bedside swallow eval findings MD concerns what they’re being referred for
SOAP: Objective
O: Objective= Includes what was done Some clinicians include the phases here I include them in the ‘A’ section Include views (lateral? A-P?) Textures tried
SOAP: Assessment
A: Assessment= Include phases of swallowing here. Include the deficits. Make sure you discuss ‘causes & effects’ and strategies/positioning that worked. This is the “meat” of it all.
SOAP: Plan
P: Plan=
Include what your plan is. What are your recommendations? Make sure you include:
-Diet recommendations (both solids & liquids)
-Swallow therapy recommendations (frequency & duration)
-Positions
-Strategies
-Exercises
-Stimulation techniques
-Other specialty recommendations (GI, UGI, Voice evaluation, etc…)
-Goals
NPO Diet (6)
Orogastric (OG)- very rare
Nasogastric (NG)- very common
Percutaneous Endoscopic Gastrostomy (PEG)- different than a G-tube b/c of where it’s placed
Gastrostomy (G-tube)
Jejunostomy (J-tube)
Total Parenteral Nutrition (TPN) (directly into veins)
Mechanisms responsible for aspiration in patients bearing an NG tube are:
- Loss of anatomical integrity of the upper & lower esophageal sphincters
- Increase in the frequency of transient lower esophageal sphincter relaxations (results in GERD)
- Desensitization of the pharyngoglottal adduction reflex
- Reduced reflex to react if going down the wrong way
Etiologies of GERD (5)
- esophageal influences
- trauma/surgery influences
- infections influences
- food/liquid influences
- other influences
etiology of GERD: esophageal influences
- Transient lower esophageal tone
- Decreased LES resting tone
- Ineffective esophageal clearing
- Inability of esophageal tissue to resist injury or repair itself
- Mechanical obstructions (hiatal hernia, strictures, rings, cancer)
- Motility disorders (Scleroderma, spasms, age)
etiology of GERD: trauma/surgery
- Gastric or duodenal surgeries
- Excessive vomiting (Bulimia)
- Swallowed acid or foreign objects
- Smoking
etiology of GERD: infectious influence
Fungal (Candida)
Viral (Herpes Simplex)
etiology of GERD: food/liquid influence
Alcohol Caffeine (chocolate) Spicy foods Acidy foods (processed tomato products, OJ) Fatty foods Medications
etiology of GERD: other influences
Diminished salivation Prolonged NG intubation Overeating Obesity Tight clothing Pregnancy Body posture Hormones
assessing GER
Reflux Symptom Index (RSI) VFSE/MBS Esophagram UGI EGD (esophagogastroduodenoscopy) pH monitoring Manometry
Assessing GER: reflux symptom index
Uses a patient self-rating form
Based on a 5 point scale to be completed for nine symptoms
If score is >13, then significant reflux is suspected
Assessing GER: VFSS/MBS
Done in radiology with ST
Assessing GER: esophagram
Done in Radiology by Radiologist
Looks at swallow function from the pharyngeal phase through the esophageal phase and into the stomach
Good for looking at esophageal function
Also known as a Barium Study
Assessing GER: upper GI
Done in Radiology by Radiologist
Looks at swallow function from the pharyngeal phase through the esophageal phase and into the stomach & then further into duodenum and possibly jejunum
-Good for assessing esophageal and upper GI function
Assessing GER: Esophagogastroduodenoscopy (EGD)
Done by a GI doctor with endoscopy camera through the mouth and into the esophagus and further into the stomach
Can be done in the MD office or as an outpatient procedure under “twilight” anesthesia
Good for looking at anatomy
Assessing GER: pH monitoring (2 types)
- pH probe monitoring:
- Done with nasal endoscopy by a GI doctor or ENT
- Tube left in place for 24 hrs
- Monitors how much acid reaches the esophagus and to what level
- Patients wear a monitor to also allow them to document when they feel a symptom
- Instructed to not alter eating habits during assessment - Bravo pH study:
- Done during an EGD by a GI doctor
- A capsule is placed and pinned into the esophagus
- Measures acid reflux over 48 hours
- Patient wears monitor to allow documentation of symptoms
- Capsule falls off on its own & disposed of during a BM
- Instructed to not alter eating habits during assessment
Assessing GER: manometry
Measures internal pressures
Usually done by GI doctor
Treatment for GER: DIEZ technique
- Place the material in your mouth.
- Inhale through your nose using a diaphragmatic breath and hold.
- Swallow.
- Exhale S-L-O-W-L-Y.
Orotracheal intubation pros
- More common
- Less traumatic
- Larger diameter tube
- –Facilitates secretion removal
- –Decreases airway resistance
- Placement is temporary (10-15 days)
Orotracheal intubation cons
- Discomfort and gagging
- Accidental extubation
- Oral hygiene is difficult
- P.O. nutrition impossible
- Damage to lips, teeth, gums, oropharynx, and Vocal folds
Nasotracheal intubation pros
- More comfortable
- Oral hygiene can be facilitated
- Smaller diameter tube necessary
- Better tube stability
- Better toleration of tube
*Used in cases of oral trauma/surgery
