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Spring '14-127 (Final Exam) > Swallowing > Flashcards

Swallowing Flashcards

1
Q

T/F

Artificial Larynges can be pneumatic, electronic, intramural, or neck types

A

True

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2
Q

Pneumatic devices use air from the …

A

Stoma

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3
Q

The main goal for a patient using the electronic neck-type artificial larynx is probably…

A

intelligibility

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4
Q

Leakage through a TEP is probably due to….

A

Prosthesis failure

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5
Q

Leakage around a TEP probably means…

A

Puncture dilation

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6
Q

What are the swallowing phases?

A

1st phase: oral phase

2nd phase: pharyngeal phase

3rd phase: Esophageal Phase

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7
Q

Describe the 1st phase–oral phase

A

-It’s something that we don’t often think of, but the process of swallow begins in your mouth, not your throat. You form a bolus, even with liquid, it is put in a “group” so that it doesn’t go into your cheeks, under your tongue, and it doesn’t dribble out the corners of your mouth

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8
Q

What is the 1st phase characterized by?

A
  • It is characterized by a bunch of closures, no leaking. Your lip forms the seal, and the velopharyngeal port closes.
  • Everything is contained in the mouth→NO LEAKAGE!
  • The oral phase contains both food and liquid completely in the mouth. Leakage through the lips, the nose, or the larynx is bad! Esp. the larynx leak!
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9
Q

What is the second phase?

A

the pharyngeal phase

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10
Q

What is one of the factors in the pharyngeal phase? describe this.

A
  • One of the factors in the pharyngeal phase is negative air pressure
  • Because you have closed the velopharyngeal port and have a lip seal, you have closed off air participating in the swallow
  • Negative pressure helps to drive the bolus backward
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11
Q

What is the biggest part of the swallow during the pharyngeal phase?

A
  • all of the muscles that work together to drive the bolus into the esophagus
  • The first set of muscles is the tongue, the tongue presses up to the roof of the mouth, squeezes from front to back, and propels the bolus back. The tongue is the first set of muscles of peristalsis.
  • Peristalsis starts with the tongue!
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12
Q

In the pharynx, another process is taking place, it is the single most important one. What is happening?

A

Larynx LIFTS & CLOSES tightly! It’s a phincteric action! This is the single most important action to the swallow is the larynx lifting and closing otherwise your food or drink will go down into the trachea→NOT GOOD!

In the pharyngeal phase the tongue propels the bolus into the pharynx, once the bolus is to the mid back of the tongue, the larynx is already up and pretty much closed.

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13
Q

What is the pharyngeal phase characterized by and when is it triggered?

A
  • The pharyngeal phase is characterized by even more closure than the oral phase.
  • The pharyngeal phase is triggered as food gets to the back of the tongue*
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14
Q

What type of protection does the larynx have?

A

Quadruple protection

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15
Q

Describe the quadruple protection of the larynx

A
  • The epiglottis closes backwards and over the opening of the larynx (aka the additus laryngeus/vestibule)
  • The aryepiglottic folds close inward
  • The false vocal folds close up tight
  • The true vocal folds close up tight
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16
Q

What else is working in a peristaltic motion to push the bolus into the esophagus?

A

the superior, inferior, and middle pharyngeal constrictors

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17
Q

What is the third phase?

A

esophageal phase

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18
Q

Describe the third phase

A
  • The upper esophageal sphincter (cricopharyngeus) opens up, the peristaltic motion moves everything down into the esophagus and then into the stomach.
  • Once the bolus gets into the esophageal phase, our job is done. The problem is when the food comes back up again.
  • We are peripherally involved if food comes back up out of the esophagus and it leaks into the larynx—that’s only if the larynx doesn’t stay up!!! That’s when we’re involved. If it get’s into the stomach, it’s WAY out of our field—we do not get involved!
  • We need to understand the esophageal phase, we can potentially deal with it, but most likely not.
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19
Q

What is normal swallowing?

A

moving the food from the mouth to the stomach

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20
Q

In what population do swallowing disorders occur?

A

in all age groups

neonatal to end of life

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21
Q

What is the issue in terms of swallowing for our patients?

A

is it safe to swallow?

Can they protect the airway? –safe swallow means it goes into the esophagus and into the stomach

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22
Q

What is the primary importance in terms of swallowing?

A

Airway protection

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23
Q

In a normal patient, what will happen if food/water goes into the trachea?

A

it’ll come right back out again!

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24
Q

What is aspiration pneumonia?

A
  • Food going beyond the trachea, into the mainstem bronchi, secondary bronchi, tertiary bronchi, etc…
  • Pneumonia can be a killer!
  • Figure this: people who are aspirating are already sick and have an unhealthy system, adding pneumonia on top of that is what causes the issue and leads to death.
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25
Q

What is another issue other than aspiration in terms of swallowing?

A

pocketing. is food getting lost somewhere?!?

26
Q

What are the important muscles for swallowing?

A

the extrinsic and intrinsic muscles of the larynx.

27
Q

What are the extrinsic muscle subgroups?

A

suprahyoids & infrahyoids

28
Q

What are supra hyoids?

A

1) digastricus (anterior & posterior belly)
2) mylohyoid
3) stylohyoid
4) geniohyoid

29
Q

What does aspiration mean?

A

below the level of the true vocal folds!!!!

30
Q

Where does food often pocket?

A

the valleculae, the pyriform sinuses aka VESTIBULE, and in the adittus laryngeus.

31
Q

Bottom to top, what are the four things that protect the airway?

A
  1. true vocal folds
  2. false vocal folds
  3. aryeppiglottic folds
  4. epiglottis
32
Q

If there is anything left in the valleculae (or any of the spaces), what may happen?

A

it can easily slide into the larynx! If they’re not sensing that they should be clearing their throat, especially if it’s left in the anterior commissure it’s because they aren’t feeling it! If they can’t sense that food/beverage sitting in the anterior commissure then there is neurological damage and they may aspirate!

33
Q

What does the cricopharyngeus do?

A

aka upper esophageal sphincter

peristaltic motion into the esophagus

LES

34
Q

What do infra hyoids do?

A

laryngeal depressors (pull the hyoid from below, caudally)

35
Q

What are the four infra hyoids?

A

sternohyoid

omohyoid

thyrohyoid**This one acts like a supra hyoid! it elevates!

Sternothyroid

36
Q

What are the risks for dysphagia?

A
  1. Lack of muscle function
  2. Lack of Sensation
  3. Lack of swallow reflex/ cough reflex
  • Anyone who is showing lack of muscle function is at risk for dysphagia.
  • If they are dribbling their food, you need to be concerned about dysphagia.
  • Especially if along with muscle function is lack of sensation.
37
Q

What is aspiration?

A

Below the level of the true vocal folds

38
Q

What is Penetration?

A

means that the food/liquid may be sitting right at the level of the true vocal folds →because the food is in the vestibule!

39
Q

What is residue?

A
  • Is what’s left over in the false vocal folds or in the laryngeal area
  • It can also be what’s left behind in the mouth if it’s sitting on the tongue
  • If it’s in the cheeks or under the tongue, then it’s pocketed.
40
Q

What is back flow?

A
  • It is referring to the esophageal phase. Food or liquid has gone into the esophagus and is coming back up into the pharynx or nasal cavity.
  • The reason we care about this is that it’s probably being aspirated b/c when it comes up from the esophagus it leaks back up again
41
Q

Describe the screening or bedside clinical assessment

A
  • Typically identifies that the patient is aspirating, but not WHY
  • A bedside screening is assessing that the patient is aspirating! It’s a yes/no evaluation. Yes=aspiration, no=no aspiration
  • But then you have to do a swallow study!
42
Q

What are the signs and symptoms of aspiration?

A
  • Coughing after swallowing
  • History of pneumonia
  • Diagnoses that put the patient at greater risk (such as: if there’s been laryngeal damage, stroke, head injury, or neurological damage/disease… progressive that leads to paralysis/paresis—lessened sensation)
  • Food squirting out the tracheostomy
  • severe respiratory problems
  • gurgly voice,cry
  • coughing before, during, or after swallowing
  • infrequent swallowing
43
Q

What is the most typical videoflouroscopic procedure?

A

MODIFIED BARIUM SWALLOW

44
Q

What does a MBS look for?

A

laryngeal function

45
Q

What are the two purposes of a physiological evaluation such as FEES or MBS?

A

to determine the abnormalities in anatomy & physiology causing the patient’s symptoms

to identify and evaluate treatment strategies

46
Q

What does FEES stand for?

A

fiberoptic endoscopic evaluation of swallow

47
Q

Describe FEES

A
  • This is different than a modified Barium Swallow Study
  • FEES can be done by a SLP w/out a radiologist (the MBS requires a radiologist)
  • For either the MBS or FEES they are designed to show you where the abnormality is in the anatomy and/or physiology and to identify what your treatment strategies might be.
  • You need to know where the breakdown is so you know how you might treat this!
  • During the MBS or FEES you will have your patient try a few treatment strategies and then get out esp. with the MBS b/c of the radiation
48
Q

What consistencies do you use for a swallow study?

A

thin liquid

thickened liquid

thick liquid

barium on a cracker

49
Q

Describe thin liquids:

A

Water—this is generally the hardest for the patient to manage. It’s the hardest to keep it in a bolus and keep it from leaking.

  • You may spoon the thin liquid in or have them drink from a straw or a cup.
  • You are looking for a SAFE swallow!
50
Q

Describe thickened liquids

A

Nectar—Smoothies, like an odwalla

51
Q

Describe thick liquids

A

sort of a pudding, applesauce (milkshake)

52
Q

What are some treatment strategies/swallowing maneuvers you can do?

A
  • Head positioning
  • Laryngeal manipulation
  • Food alterations
  • Multiple Swallows
  • Swallow-Cough
53
Q

Describe head positioning

A
  • If you are having difficulty getting food cleared out of the pharynx, it actually might help to lift your head and let gravity take things down. Chin position may help.
  • Conversely, if food is getting stuck in there, you may need to lower your chin to make the valleculae smaller.
  • Left side paralysis may help to turn your head… closes up your left side a little bit!
54
Q

Describe laryngeal manipulation

A

It may help to actually manipulate the larynx. Maybe close the left side paralysis so that you can close off the opened area.

55
Q

Describe food alterations

A

If you have trouble with eating something thicker, take a bite of the thicker food, then sip a thin liquid.

Alternating consistencies may help clear the bolus!

56
Q

Describe multiple swallows

A

You may teach them to just swallow multiple times so that it clears. Multiple squeezes of the spaces and places will clear it out before it gets aspirated.

57
Q

Describe the swallow-cough

A

Sometimes you teach them to swallow and cough

They don’t feel the penetration/aspiration but the cough will clear the aspiration

58
Q

What are some practicalities to consider when going through swallowing maneuvers?

A
  • Is your patient cognitively impaired, if he/she cognitively impaired will they remember the maneuvers, and remember to do them!?
  • If they are not, is there someone who takes care of them and can be with them at feeding time to remind them?!
  • For someone who has a stroke or TBI –cold & something bitter –little lemon swabs and you swab their oral cavity and the back of the tongue and have them swallow. The cold and bitter can wake up sensation. They’re also doing a lot of work with muscle electrodes. They shock the swallowing muscles and this restores function.
  • Swallowing is a huge part of our field! If you work in a hospital it’s 90% of what you do!
59
Q

What is absolutely essential to do when working in any place, with any kind of client?

A

REPORT & CHART WHAT YOU DO, WHAT YOU FIND, WHO YOU TOLD, WHEN YOU TOLD THEM, ETC…

60
Q

what is the ultimate goal when working with swallow patients?

A

to keep our patients eating and drinking

61
Q

When working with swallowing, we work with a multidisciplinary team, who may be on that team?

A

-SLP working as the swallowing therapist

(This is the one aspect of our field where you can kill someone.)

  • Physician
  • Nursing staff, dietitian, occupational therapist, physical therapist, pharmacist, and radiologist
62
Q

What are some issues with a modified barium swallow?

A

-Be careful when using a MBS—you are getting radiated as well as the patient is getting barium which constipates them.

Spring '14-127 (Final Exam) (2 decks)

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