Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dysphagia > Swallowing Assessment > Flashcards

Swallowing Assessment Flashcards

1
Q

Clinical Exam should include:

A
  1. Medical and psychosocial history
  2. Physical evaluation (inc mental status screening & exam head/neck muscles
  3. Test swallows of liquid, semi-solid and solids (if appropriate)
    * If clinical exam does not reveal cause of symptoms, INSTRUMENTAL EXAM is required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Instrumental Exam:

Most common technique for visualizing all stages of swallowing:

A

MBS or VFSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Instrumental Exam:

A standard barium swallow only assesses:

A

Esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Instrumental Exam:

Endoscopy allows for direct visualization of:

A

Pharynx, larynx and esophagus through use of a scope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Instrumental Exam:

Manometry measures ____ and is done to evaluate the ________

A

Pressure during the swallow

Esophagus (rather than mouth or pharynx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Goals of Care:

A
  1. Ensure patient can safely consume enough food/liquid to stay nourished
  2. Determine which tx options are most viable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 Main areas of Tx

A

Behavioural (compensations, strategies, muscle strengthening)
Dietary (modify textures, tastes, volume)
Medical (change meds affecting mental status/swallow, placement of NG tube)
Surgical (placement of G tube or PEG tube, mobilization of a weak VF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Three main components of the Bedside clinical exam:

A

Medical history
The physical exam (vs. oral mech)
Observations of swallowing competence (test swallows, meal and environmental ax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Purposes of the Bedside exam:

A
  • Screen for presence of swallowing impairment
  • Determine nature (locus) of the problem
  • Determine relative risks of selected foods and liquids
  • Determine candidacy for instrumental eval
  • Monitor progress, determine possibility of upgrading/downgrading
  • Assess structure/function (motor/sensory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Caveat of Bedside Exam:

A

Non invasive and easy to perform but poorly predicts presence of silent aspiration (aspiration and laryngeal penetration indistinguishable)
May over dx aspiration, unwarranted diet restrictions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why some pts w/ dysphagia develop pneumonia and others do not?

A

Aspiration pneumonia is an “opportunistic” disease, developing in PTs who are already seriously ill.
(neurological/structural factors and immune system factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical Exam Flowchart

A
  • medical history
  • rapport w/ pt
  • interview pt/family/staff
  • observe pt bevr
  • screen cognitive communication
  • perform OME
  • perform swallowing ax
  • make recommendations
  • generate written report
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When reviewing medical chart, look at:

A
  • Dysphagia symptoms
  • Respiratory conditions, disease and current status
  • Weight loss, current diet textures, restrictions
  • Other diseases
  • Dr notes
  • Medications
  • Medical staff interview
  • Surgical procedures (anesthesia can compromise airway protection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bedside Exam:

Clinical observation/patient interview to determine:

A 
LOC
Orientation/mental status
Insight, motivation, family support
Neurological status (motor speech, language, cognition, spatial perceptual fx)
General health
Hydration
Assistive aids
PT report of impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Environmental Ax:

When cognitive impairment, may need to ID envtal variables that influence problem behaviours at mealtime:

A

Physical - noise, lighting, tray set up, food presentation, traffic flow, # people

Psychosocial - seating arrangement, eating companions, attitudes of CGs, waiting periods, length of mealtimes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bedside/Clinical

Other observations:

A 
Speech sample - artic, intelligibility
Voice - normal pitch, loudness, quality
Resonance - normal/hyper nasal?
Muscles of facial expression 
Lips - seal, strength
Ability to manage secretions
Oral mucosa - hydration, oral health
Dentition
Tongue 
Palate (gag reflex provides minimal info about swallowing)
Neck exam
Sensation
Pathological reflexes
Volitional cough (not predictive of protectional cough)
Sustained phonation
Volitional dry swallows (laryngeal elevation)
Body position
17
Q

Contra-indicators for trial swallows

A
  • poor respiratory status
  • unstable medical status
  • poor cough reflex
  • low level of arousal/responsiveness
  • difficulty, inability to swallow secretions
  • absent/delayed swallow
  • bedridden
  • very poor oral hygiene
18
Q

Bedside exam if NPO:

A

Use innoculous stimuli to assess readiness for PO intake (ice water, maybe ice chip)
Progress to more challenging textures very slowly and cautiously

19
Q

Bedside exam if PO:

A

3 ounce water test

  • provide variety of textures to determine safest texture/volume
  • trial adaptive aids to facilitate self-feeding
  • trial compensatory strategies, postures and maneuvers
  • manipulate environment as necessary
20
Q

During test swallows/meal observation look for:

A

Recognition of food items/ability to focus on task
Fatigue over course of meal
Ability to judge appropriate bolus size and feeding rate
Use utensils
Lip seal
Throughout mastication
Timely transit of bolus from oral cavity
No coughing before swallow
Awareness and appropriate management oral residue
No coughing or through clearing or resp distress
No change in voice quality
Laryngeal elevation to palpation
Subjective complaints

21
Q

Recommendations following assessment:

A
  • need for VFSS
  • NPO (pretty severe)
  • appropriate food/fluid texture
  • volume/frequency meals
  • method of med administation
  • positioning
  • feeding techniques
  • comp strategies
  • environmental needs
  • oral hygiene needs
  • need for re-ax
  • referrals
22
Q

VFSS allows for _______ of anatomical structures and ________, _______, ________.

Evaluation of the efficacy of:

A

Direct visualization

How they move, timing of swallow events, observation of how efficiently the bolus moves

  • Adjustments of bolus volume, consistency & rate of delivery (start w/ 5-10 ml bolus)
  • Adjustments in positioning
  • Implementation of maneuvers
23
Q

Contra-indications for VFSS

A
  • pt no longer has dysphagia complaints
  • pt too medically compromised/uncooperative
  • clinician’s judgement is the exam would not alter clinical course/management plan
24
Q

During VFSS look for:

A
  • Effectiveness of bolus preparation and transit
  • Triggering of pharyngeal swallow in relation to bolus position
  • movement of pharyngeal structures
  • transit times
  • efficiency of bolus movement
  • evidence and timing of penetration/aspiration and patient reaction
25
Q

Penetration Aspiration Scale is an 8 point scale to discretely quantify

A
  • occurrence of airway penetration and aspiration
  • depth of airway invasion and residue
  • responsiveness - cough/clear airway

*sensitive to differences in airway protection across the age span in healthy adults (score of 2 “high penetration” w/ no clearance of residue is normal in older adults)

26
Q

Dysphagia Severity Rating Scale

A 
0-normal swallowing mechanism
1-minimal dysphagia
2-mild
3 -mild/mod
4-moderate
5-moderately severe (pt aspirates 5-10% w/ potential for aspiration on all consistencies, cough reflex absent, alternate mode of feeding needed)
27
Q

Pulse Oximetry
Refers to:
Link to aspiration:

A

-monitoring of peripheral blood oxygenation through fingertip device (detects hemoglobin in blood - worrisome if

28
Q

Types of instrumental exams:

A

MBS/VFSS
Standard barium swallow (esophagus only)
Endoscopy
Manometry (pressure during swallow in esophagus)

Dysphagia (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions