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NBCOT LAST Attempt > swallowing/feeding > Flashcards

swallowing/feeding Flashcards

1
Q

dysphagia causes

A

stroke, head trauma, MS, CP, dementia, brain/SC tumor, cervical spine injury, motor neuron disease, myopathy

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2
Q

dysphagia symptoms

A
  • choking
  • coughing during/after swallow
  • coughing/vomiting up food
  • weak, soft, gurgly voice
  • aspiration
  • excessive saliva/drooling
  • difficulty chewing
  • trouble moving food to back of mouth
  • food stuck in throat
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3
Q

pharynx

A

throat; funnels food into esophagus
- shared by food & air

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4
Q

larynx

A

voice box
- closes during swallowing (valve to trachea) to protect from aspiration
- vocal folds, pitch, volume of voice

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5
Q

trachea

A

allows air into lungs
- closed by larynx during swallowing

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6
Q

cranial nerve V: trigeminal nerve damage

A

no sensation, unable to move mandible

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7
Q

cranial nerve VII: facial nerve damage

A

no taste to front of tongue, no jaw opening/closing, poor lip strength, dry mouth, paralyzed face muscles

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8
Q

cranial nerve IX: glossopharyngeal nerve damage

A

decreased taste/salivation, inhibited gag reflex, weak cough reflex

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9
Q

cranial nerve X: vagus nerve damage

A

no gag, no pitch, difficulty swallowing, nasal regurgitation, hoarse/breathy/wet voice

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10
Q

cranial nerve XII: hypoglossal nerve damage

A

unable to position food for chewing = food pocketing

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11
Q

phases of swallowing

A
  1. oral preparatory phase
  2. oral phase
  3. pharyngeal phase
  4. esophageal phase
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12
Q

oral preparatory phase

A

VOLUNTARY, TIME DEPENDS ON FOOD CONSISTENCY
oral manipulation: chewing to form bolus

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13
Q

oral phase

A

VOLUNTARY: 1-3 SECONDS
tongue moves bolus to back of mouth, ends with beginning of pharyngeal swallow

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14
Q

pharyngeal phase

A

INVOLUNTARY: 1-3 SECONDS
swallowing, epiglottis retroflexes to protect airway

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15
Q

esophageal phase

A

INVOLUNTARY: 8-10 SECONDS
bolus pushed towards & into stomach

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16
Q

esophageal dysphagia

A

FEELING OF FOOD STUCK IN THROAT WHILE SWALLOWING
- symptoms: pain when swallowing, sensation of food stuck in throat, regurgitation, heartburn, back-up of food or stomach acid into the mouth or throat, hoarseness, sudden weight loss
- Cause: GERD, radiation for cancer, scleroderma, esophageal tumors or spasms

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17
Q

oropharyngeal dysphagia

A

WEAK MOUTH/THROAT MUSCLES, FOOD & LIQUID CAN’T BE MOVED TO STOMACH OR ESOPHAGUS
- symptoms: coughing/gagging when swallowing, drooling, sudden weight loss, can’t swallow, need food cut into small pieces or avoid some foods
- Cause: neurological disease/damage, pharyngoesophageal diverticulum, cancer or cancer tx

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18
Q

pharyngoesophageal diverticulum/Zenker’s

A

a small pouch just above the esophagus that collects food particles

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19
Q

Achalasia

A

esophagus muscle spasms or strictures/restriction

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20
Q

esophagitis

A

esophagus inflammation

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21
Q

Videofluoroscopy

A

moving x-ray (fluoroscopy) to observe food and liquid as it travels down the GI tract

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22
Q

how do OTs support SLPs?

A
  • carryover of feeding/swallowing techniques during ADLs
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23
Q

what replaced the national dysphagia diet?

A

International Dysphagia Diet Standardization Initiative (IDDSI) Framework

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24
Q

levels 0-1 liquids

A

THIN-SLIGHTLY THICK
0 = nothing remaining after 10 second flow
1 = 1-4 mL remaining after 10 second flow
- normal consistency
EX: water, milk, juice, broth, foods that melt such as popsicles, coffee, tea

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25
level 2 liquids
MILDLY THICK, NECTAR THICK 2 = 4-8 mL remaining after 10 second flow LEVEL 150 FLUID - liquid slightly thickened, slowing flow EX: Tomato juice, fruit nectar, smoothies, cream soup
26
level 3 liquids
MOD THICK, LIQUIDIZED, HONEY THICK 3 =. 8-10 mL remaining after 10 second flow LEVEL 400 FLUID - thickened until it drips/flows slowly off spoon EX: honey, syrup
27
level 4 liquids
PUDDING, EXTREMELY THICK/PUREED 4 = IDDSI fork drip test & spoon tilt test LEVEL 900 FLUID - does not flow/drip off spoon EX: pudding, ice cream
28
IDDSI levels of food consistency
3: liquidized/mod thick 4: pureed/extremely thick 5: minced & moist 6: soft & bite sized 7: regular (levels 5-7 = transitional levels)
29
level 4 foods
PUREED - pudding consistency, add liquid to dry foods EX: mashed potatoes/bananas/squash, cooked cereals applesauce
30
level 5 foods
MECHANICAL SOFT, MIN CHEWING - 4 MM PARTICLE SIZES (2MM FOR KIDS) - Soft, cohesive foods are allowed unaltered - Chunkier foods or harder foods are cooked and fork-mashed, ground or softened - NO BREADS EX: ground meat, mashed vegetables, meat loaf, baked beans, casseroles
31
level 6 foods
SOFT: no choking/asphyxiation risk - 1.5 CM OR 15 MM (NO LARGER THAN 8 MM FOR KIDS) - Soft solid foods, chewy foods - Meat cooked well and cut into small pieces - Fruits and vegetables peeled and/or cooked - Soft breads EX: Diced beef or chicken, canned meat such as tuna, canned vegetables, soft fruits like bananas, strawberries, pizza, cheese, bagels
32
level 7 foods
REGULAR - foods that fall apart (bread, rice, muffins) then mixed textures
33
piriform sinus
pear shaped fossa at entrance to laryngeal space - channels swallowed material before it enters esophagus
34
vocal folds
vocal cords (vagus nerve controls) - open when breathing/vibrating (speaking, singing) - produce sounds for speech - protect airway from choking, regulate airflow into lungs
35
bronchioles/bronchi
major air passage of lungs coming from windpipe
36
if someone aspirates food, they are at risk for
pneumonia
37
esophagus
food/liquid normally enters while swallowing
38
upper esophageal sphincter
bundle of muscles at top of esophagus - consciously controlled, used when breathing, eating, belching, vomiting
39
oral sensory problem
- food pocketing - lack of awareness of food on side of mouth with decreased sensation - spilling food into airway when vocal cords are open - swallow sequence timing is off
40
cricopharyngeal junction
junction of pharynx & esophagus
41
when there is weakness of the elevation of the pharynx during swallowing, what happens?
incomplete trigger of pharyngeal phase of swallowing
42
vocal cord paralysis leads to
aspiration (vocal cords dont close during swallow)
43
clinical aspiration
food enters airway, person clears by coughing (reflex intact) - aspirates when food comes up & patient can't swallow it
44
silent aspiration
food enters lung, person does not react, respiratory distress without cough, too weak of cough to get bolus out of lungs
45
no esophageal motility
bolus sits in esophagus, can slowly either move down towards stomach or up towards pharynx
46
when does swallowing dysfunction come into question?
- coughing during/after drinking water/thin liquid - changes in face color during/after eating (flushed, ashed, blanches = pale) - gasps for breath
47
immediate action for aspiration
- heimlich maneuver - basic life support if they lose consciousness (abdominal thrusts, back blows, periodically looking in oral canal to try to see object)
48
heimlich maneuver
clear obstruction & raise bolus that has been aspirated - HAVE TO BE AWAKE/RESPONSIVE
49
bedside swallowing eval
1. assess alertness, direction following, anosognosia, orientation 2. assess sensory & motor components of swallowing 3. assess ability to manage secretions via auscultation & clin obs 4. assess swallowing via trial bolus (suggest diet modification, recommend further testing)
50
ascultation
listening to heart, lungs with stethoscope
51
modified barium swallow (MBS)
- swallowing team + radiologist - person upright at edge of table (must have good sitting balance, must be supervised at all times) - trial bolus of mixed food consistencies laced with barium which coats GI tract & can see problem areas on x ray - test ceases if they aspire (xray shots still taken) - dx swallowing disorders, GI dysfunction
52
FEES
- bedside or office - foods laced with green food coloring - variety of consistencies to swallow - see whether swallow is intact/impaired using flexible endoscopic catheter with mini camera - tests for LIGHT TOUCH sensation in pharyngeal cavity by forcing air through endoscopic tube - can dx swallowing disorder, GI dysfunction
53
psychosocial effects of tube feeding
- change in roles - uncomfortable with dining in public - infantilizing - sex appeal & self image - how others see them
54
pre oral phase
- salivating - smell & visual appreciation of food
55
chin tuck
- for delayed swallow initiation - Moving CHIN TOWARDS CHEST while swallowing - Protects airway - Reduces aspiration risk
56
Mendelsohn maneuver
- Prolong opening of upper esophageal sphincter during swallow - pushing tongue into upper palate while manually elevating Adam’s apple
57
supraglottic swallow
Close vocal cords before/during swallow - Cough at the end of the swallow to clear food - Take deep breath - Hold breath while swallowing - COUGH to clear saliva or food that may have passed beyond vocal cords
58
super supraglottic swallow
Close airway entrance ABOVE vocal cords - Take deep breath - Hold breath and BEAR DOWN (as in bowel movement) while swallowing - COUGH to clear saliva, food that may have passed beyond vocal cords
59
For mealtime FATIGUE: (ALS)
eat frequent small meals rather than 1 big meal
60
For correct JAW control while feeding child from the SIDE
Jaw opening/closing controlled by index & middle fingers - thumb on child’s neck (fulcrum of jaw movement)
61
For correct JAW control while feeding child from the FRONT
- thumb on child - middle finger under chin to control opening/closing of jaw - index finger on side of child’s face
62
sequence of swallowing
food into mouth --> forms bolus --> bolus pushed to back of mouth with tongue --> larynx elevates/protracts --> bolus into pharynx --> into esophagus

NBCOT LAST Attempt (50 decks)

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