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Semester 5 FSNM Exam 8 > Swallowing > Flashcards

Swallowing Flashcards

1
Q

What is the body’s number one priority

A

BREATHING!

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2
Q

Goals for feeding

A

Needs to be safe
Needs to be positive/pleasant experience
Needs to provide adequate nutrition

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3
Q

Sucking definitions - Non nutritive sucking

A

Finger, pacifier, or at the breast - no nutrition given
Rate of 2 sucks per second
Series of sucks and pauses should start to be rhythmical at 34 weeks

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4
Q

Sucking definitions - Non nutritive sucking - Suck to swallow ratio is

A

6 to 8 sucks per 1 swallow

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5
Q

Sucking definitions - Nutritive sucking

A

Half the rate of NNS or 1 per second
Jaw drops down, tongue drops and moves in an ant/post pattern
Seal btw tongue and palate
Tongue is cupped

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6
Q

Sucking definitions - Nutritive sucking - Suck to swallow ratio

A

1:1 - typically but can be 2:1 or 3:1 too

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7
Q

Sucking definitions - Mature sucking pattern

A

1:1:1 ratio
10-30 sucks per burst and then brief pause
Rhythmical
Baby’s “fingerprint”

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8
Q

Sucking definitions - Immature sucking pattern

A

3 to 5 sucks per burst and then pause of equal duration due to breath coming after all sucks and not in synchrony

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9
Q

Sucking definitions - Transitional suck pattern

A

6 to 9 sucks per burst and variable pauses

Considered abnormal after 40 wks gestation because the mature pattern has not developed

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10
Q

Suck/Swallow/Breathe

A

SSB Synchrony - infant stops breathing briefly for every swallow
The avg. length of time infant stops breathing while swallowing is 1 sec

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11
Q

SSB - impact of sucking on swallowing

A

Compression of nipple and expression of milk
Triggers the swallow
Rate, size, and speed of bolus affect frequency and timing of swallow

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12
Q

SSB - Impact of swallowing on breathing

A

Respiration is suppressed during swallowing as a protective mechanism
Frequent supressions of nutritive sucking leads to dec RR and depth of breaths

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13
Q

SSB - Impact of breathing on sucking

A

Abnormal resp. function results in abnormal sucking patterns to minimize compromise
Sucking rhythm may influence the RR and pattern

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14
Q

Oral experiences

A 
Intubation
OG/NG tubes
Taping 
Suctioning
Washing faces
Placing pacifier in mouth
Feeding
Tracheostomy
Breathing tx
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15
Q

Infant feeding stress cues

A 
State and attention will tell you a lot 
Irritability, crying
Frequent gaze aversion
Silent crying
Inconsolible 
Staring
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16
Q

Infant feeding stress cues - motoric

A 
Flaccid
Hyperext of legs, arms
Arching trunk
Fisting hands
Splaying fingers
Grimace
17
Q

Infant feeding stress cues - autonomic

A 
Hiccuping
Sighing
Yawning
Cyanosis 
Spitting up 
Coughing
18
Q

!!! Questions to ask caregivers about bottling

A
  1. Typical duration of feeding at home (should be no more than 20 to 30 m)
  2. Type of bottle and nipple used
  3. Preferred position
  4. Temp of milk
  5. Frequency of emesis and amount
  6. Typical feeding - what does it look like
19
Q

Questions to ask caregivers about bottling - first question

A

Duration of feeding - do not give them a number to go off - just ask
There is no nutritional gain after 30 min

20
Q

State regulation with feeding

A 
Positioning
Alertness 
Swaddling 
Hands to midline and mouth
Environment
"Shut down" versus sleeping
21
Q

Reasons why children won’t eat

A

Physical - pain, discomfort, immature motor, oral motor, and/or swallow skills (sensory processing)
Bx/Emotional - child factors, parent factors, environmental factors

22
Q

Phases of swallowing

A

Oral preparatory
Oral phase
Pharyngeal Phase
Esophageal Phase

23
Q

Phases of swallowing - Oral preparatory

A

Preparation of the bolus to make it cohesive
Not necessary in infant but key once suck is no longer reflexive (3-4 m)
Suckle for purees
Munching/chewing bolus, collective bolus from cheeks and tongue, forming cohesive bolus

24
Q

Phases of swallowing - Oral phase

A

Movement of the cohesive bolus posteriorly to trigger proper timing and coordination of swallow reflex

25
Q

Phases of swallowing - Pharyngeal phase

A

Closure of nasal, laryngeal, and oral openings
Opening at cricopharyngeal sphincter
Creation of pressure gradient to transport bolus from oral cavitiy to esophagus opening

26
Q

Phases of swallowing - esophageal phase

A

Relaxation of upper and lower esophageal sphincters
Peristaltic contraction to propel bolus
Assessed completely by UGI/Esophagram

27
Q

Pooling

A

Food/Liquid entering the pharynx before the swallow

28
Q

Residue

A

Food/liquid that is left behind in the mouth or pharynx after the swallow

29
Q

Penetration

A

Entry of food/liquid into the larynx at some level down to but not below the true vocal cords

30
Q

Aspiration

A

Entry of food/liquid into the airway below the true vocal cords

31
Q

!!! Signs of swallowing problem

A 
Coughing, choking, gagging, vomiting
Hx of chronic respiratory illness or pneumonia
Wet vocal or respiratory quality 
Color changes, apnea, bradycardia with eating
Chronic food refusal
Failure to thrive
Weight gain difficulty
Prolonged mealtimes 
Excessive drooling
Nasopharyngeal regurg
Multiple swallows needed to clear mouth
Fever of unknown origin
Feeding refusal for specific foods or liquids
32
Q

Purpose of Videoswallow

A

Evaluate the status and the safety of the pharyngeal stage of the swallow

33
Q

Videoswallow procedure

A

Completed in radiology with radiologist

Barium given in normal feeding position

34
Q

Videoswallow - strengths

A 
Real time record
Simulates eating experience
Ability to try various textures
Ability to evaluate tx techniques
Good detail of function with magnification
35
Q

Videoswallow - limitations

A

Does NOT identify GERD (reflux) or esophageal problems well

Small sample of feeding - is one moment in time

Semester 5 FSNM Exam 8 (5 decks)

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