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Dysphagia > Swallow Screening & Evaluation > Flashcards

Swallow Screening & Evaluation Flashcards

1
Q

what happens when a patient comes in who needs a swallowing screening?

A

new patient → swallowing screening → pass or fail → (if failed) SLP → clinical bedside evaluation; instrumental evaluation → recommendations

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2
Q

who can a swallowing screening be administered by?

A

anyone in the hospital; often the nurse or MD

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3
Q

What is the Yale Swallow Protocol?

A

a swallowing screening that involves…

  • uninterrupted drinking of 3 oz (90 ml) of water by cup or straw
  • cough (immediate or delayed) = fail
  • throat clear = fail
  • stop drinking = fail
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4
Q

what is the Toronto Bedside Swallow Screening Tool?

A

swallow screening that involves …

  • water swallows (10 x 1 tsps)
  • cough (immediately or delayed) = fail
  • wet voice after swallow = fail
  • tongue protrusion and lateralization: deviation or decrease of ROM = fail
  • if voice before the swallow is breathy, gurgle, hoarse, whisper, etc. = fail
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5
Q

what is the EAT 10?

A

a swallowing screening tool that is a self assessment tool given to the patient.

  • answer on 0-4 scale for 10 questions pertaining to swallowing difficulty
  • max score of 40
  • scores >3 are thought to reflect swallowing impairment and warrant a referral for in depth SLP assessment
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6
Q

what is the goal of a clinical swallow evaluation?

A

to gather information from various sources to make a perceptual judgment about a patient’s safety and efficiency for eating and drinking by mouth (without instrumental assessment)

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7
Q

what is the CSE not good at identifying?

A
  • presence or absence of physiological abnormalities of the pharynx
  • competence and quality of airway protection
  • how the swallowed food and liquid are flowing (beyond the mouth)
  • silent aspiration
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8
Q

list all the components of a CSE

A
  1. Medical/case history [Chart review and/or interview(s)]
  2. Swallowing history [interview(s)]
  3. Physical exam (i.e., OMSE) and physical observations
  4. Food/liquid trials (if appropriate)
  5. Documentation/plan
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9
Q

what is the difference between a sign and a symptom?

A

a sign is something you tangibly observe as the clinician

a symptom is something the patient reports or complains of

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10
Q

what does the medical case history portion of an CSE entail?

A

general information

  • age, gender, reason for admission, etc.
  • current diet

medical history

  • Cardiac–general condition/fatigue, RLN issues?
  • Pulmonary–past pneumonia? Airway status? Require O2? Method?
  • Gastrointestinal–GERD? Ulcers/bleeds?
  • Neurological–sensory and motor issues for swallow? Progressive conditions?
  • Otolaryngological–any issues pertaining to anatomy of oral/pharyngeal/laryngeal regions?
  • Oncological–past or current CA? Treatment method for past CA?
  • Recent hospitalizations /surgeries
  • Prior speech/language/voice/swallow problems
  • PsychiatricHx
  • Social/cultural Hx
  • Current meds (GERD, xerostomia, LOA)
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11
Q

what re the steps of the swallowing history/interviewing process?

A
  1. get consent
  2. collect information about…
    • current method and schedule of eating
    • diet (baseline & current)
    • onset of the problem
    • description of the problem
  3. determine…
    • variable characteristics of the problem
    • if the patient is using compensation for their dysphagia
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12
Q

what are the three parts of the physical exam and observations?

A
  1. general observations (body tone and positioning, vocal quality, baseline cough, comprehension, etc.)
  2. medical observations (oxygen, trach, alternate feeding methods, dentures)
  3. direct physical exam (sensory & motor testing)
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13
Q

what are some reasons you would wait to conduct swallowing trials?

A
  • NPO (nothing by mouth)
  • level of alertness
  • respiratory/lung/trach status
  • medical status
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14
Q

what should you do before you start swallowing trials?

A
  1. get consent
  2. position your patient properly (upright)
  3. oral care
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15
Q

why is oral care so important before swallowing trials?

A

if they have bacteria in their mouths and they aspirate, the bacteria can get into their lungs and cause infection (e.g., pneumonia)

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16
Q

the swallowing trials are a _____________ and _____________ process

A

systematic and dynamic

17
Q

what is the overall goal of the swallowing trials?

A

to synthesize swallowing performances with other components of the clinical assessment and make recommendations for the patient’s feeding status

18
Q

what are the steps of the general swallowing trial process?

A
  1. administer a bolus while palpating the hyolaryngeal complex
  2. watch and listen for aspiration
  3. observe signs of post-swallow residue
  4. redord data
19
Q

what are some signs of aspiration?

A
  • cough
  • throat clear
  • wet voice
20
Q

what are some signs of post-swallow residue?

A
  • multiple swallows
  • oral residue
  • reduced hyolaryngeal excursion
21
Q

what is to be recorded in swallowing trials data?

A
  • number of trials
  • number of observations of coughing
  • number of swallows per bolus, etc.
22
Q

what is palpation?

A

placing your hand on the patient’s larynx in order to…

  • detect presence or absence of swallow
  • capture how many swallows per bolus are complete
  • detect the time that lapses between bolus administration and pharyngeal swallow onset
23
Q

palpation is not accurate for…

A
  • detecting delated swallow initiation

- quantifying adequacy or anterior/superior hyolaryngeal movement

24
Q

how do you evaluate oral manipulation & what does it tell you about the patient’s swallowing?

A

watch ; decreased oral efficiency/ difficulty with coordination

25
Q

how do you observe oral residue & what does it tell you about the patient’s swallowing?

A

look inside patient’s mouth; decreased oral efficiency/ unilateral impairment

26
Q

what does coughing tell you about a patient’s swallowing?

A

decreased swallow safety

27
Q

what does throat clearing tell you about the patient’s swallowing?

A

decreased swallow safety

28
Q

how do you observe +/- swallow and what does it tell you about the patient’s swallowing?

A

hyolaryngeal palpation; sensory integrity

29
Q

how do you observe repeated swallow and what does it tell you about the patient’s swallowing?

A

hyolaryngeal palpation; decreased pharyngeal efficiency

30
Q

what does wet voice tell you about the patient’s swallowing?

A

decreased swallow safety

31
Q

what type of liquid should you test first & why?

A

thin liquids, preferably water

  • this is normal for the patient
  • aspiration of a thinner liquid can be less detrimental than thicker substances to the patient
  • less likely to cause residue
  • if not problems are noted with thin liquid, there is no reason to test thick liquids
32
Q

if the patient has problems with swallowing a thin liquid (e.g. water) what should you do?

A

test a thick liquid (nectar consistency) and observe is the dysphagia improves or worsens
- then either stop or test honey consistency

33
Q

in a liquid swallowing trial, what should the patient start with and what should you do to continue if s/s of difficulty do not occur?

A 
ice chip
tsp of water
cup sip
sequential drinking from cup
straw drinking
34
Q

in a solid swallowing trial, what should the patient start with and continue with if no difficulties are shown?

A

start with puree

  • mechanically altered (fruit of a fruit cup (no liquid)
  • advanced (e.g., cookie)
  • mixed (e.g. fruit cup with liquid)

Dysphagia (4 decks)

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