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Dysphagia Quiz/Exam > stuff he told us to study ONLY > Flashcards

stuff he told us to study ONLY Flashcards

1
Q

SOAP: Subjective

A 
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
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2
Q

SOAP: Objective

A 
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
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3
Q

SOAP: Assessment

A 
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.
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4
Q

SOAP: Plan

A

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

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5
Q

NPO Diet (6)

A

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)

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6
Q

Mechanisms responsible for aspiration in patients bearing an NG tube are:

A
  • 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
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7
Q

Etiologies of GERD (5)

A
  • esophageal influences
  • trauma/surgery influences
  • infections influences
  • food/liquid influences
  • other influences
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8
Q

etiology of GERD: esophageal influences

A
  • 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)
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9
Q

etiology of GERD: trauma/surgery

A
  • Gastric or duodenal surgeries
  • Excessive vomiting (Bulimia)
  • Swallowed acid or foreign objects
  • Smoking
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10
Q

etiology of GERD: infectious influence

A

Fungal (Candida)

Viral (Herpes Simplex)

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11
Q

etiology of GERD: food/liquid influence

A 
Alcohol
Caffeine (chocolate)
Spicy foods
Acidy foods (processed tomato products, OJ)
Fatty foods
Medications
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12
Q

etiology of GERD: other influences

A 
Diminished salivation
Prolonged NG intubation
Overeating
Obesity
Tight clothing
Pregnancy
Body posture
Hormones
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13
Q

assessing GER

A 
Reflux Symptom Index (RSI)
VFSE/MBS
Esophagram
UGI 
EGD (esophagogastroduodenoscopy)
pH monitoring
Manometry
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14
Q

Assessing GER: reflux symptom index

A

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

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15
Q

Assessing GER: VFSS/MBS

A

Done in radiology with ST

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16
Q

Assessing GER: esophagram

A

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

17
Q

Assessing GER: upper GI

A

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

18
Q

Assessing GER: Esophagogastroduodenoscopy (EGD)

A

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

19
Q

Assessing GER: pH monitoring (2 types)

A
  1. 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
  2. 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
20
Q

Assessing GER: manometry

A

Measures internal pressures

Usually done by GI doctor

21
Q

Treatment for GER: DIEZ technique

A
  1. Place the material in your mouth.
  2. Inhale through your nose using a diaphragmatic breath and hold.
  3. Swallow.
  4. Exhale S-L-O-W-L-Y.
22
Q

Orotracheal intubation pros

A
  • More common
  • Less traumatic
  • Larger diameter tube
  • –Facilitates secretion removal
  • –Decreases airway resistance
  • Placement is temporary (10-15 days)
23
Q

Orotracheal intubation cons

A
  • Discomfort and gagging
  • Accidental extubation
  • Oral hygiene is difficult
  • P.O. nutrition impossible
  • Damage to lips, teeth, gums, oropharynx, and Vocal folds
24
Q

Nasotracheal intubation pros

A
  • 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

25
Q

Nasotracheal intubation cons

A
  • Less common
  • More complications
  • Increased airway resistance- because the tube has to be smaller so you can’t get that much air in
  • Sinusitis
  • Otitis Media
  • Suctioning is difficult
  • Frequent tube changes are required
26
Q

Trach tube pros

A
  • Decreased resistance (larger tube than oral or nasal tube)
  • Efficient secretion removal/cleaning
  • Minimizes damage to larynx, vocal cords
  • Oral nutrition is possible
  • More comfortable
  • Verbal communication possible
  • Bypasses upper airway
27
Q

Trach tube cons (complications)

A
  • Hemorrhage
  • Thyroid gland injury
  • Injury to laryngeal nerves, especially recurrent
  • Air leaks (e.g. pnemothorax)
  • Tracheoesophageal fistula
  • Cardiac arrest
  • Tracheostomy too high or low
28
Q

Trach tube physiological changes

A
  • Phonation
  • Humidification/filtration/warming
  • Secretions
  • No Valsalva maneuver- bearing down
  • Decreased ciliary activity
  • Increased airflow resistance
  • Decreased back pressure within lungs
  • Bathing/showering
  • Swallowing (anchors larynx & reduces laryngeal elevation; decreases supraglottic pressure)
  • Psychological changes

Dysphagia Quiz/Exam (7 decks)

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