Tracheostomized Related Swallowing Disorders

Question 1

Surgical procedure performed when oral/nasal breathing is not adequate and produces respiratory distress

Answer 1

Tracheostomy

Question 2

What are the indications for tracheostomy?

Answer 2

• upper airway obstruction
• disruption of normal air exchange into/out of the lungs
• prolonged intubation
• need for long-term mechanical ventilation
• need for permanent teach tube

Question 3

What is the purpose of articial airway?

Answer 3

• elimination of airway obstruction
• ventilation and oxygenation
• connect to mechanical ventilation
• provide access to lungs for pulmonary toilet

Question 4

Nasotracheal vs orotracheal

Answer 4

• might damage to VFs

- Bad vocal quality or no voice

Question 5

Where does a tracheostomy occur?

Answer 5

usually in 2nd to 4th tracheal ring

Question 6

Cuff inflated vs cuff deflated

Answer 6

inflated: no air going through, no voice, no cough
deflated: get expiratory air for throat clearing/clearing airway

Question 7

Fenestrated vs. non fenestrated

Answer 7

• providing extra expiratory air for throat clearing, coughing and voicing
• not used in individuals at high risk of aspiration
• fenestrated tube used as part of weaning process

Question 8

What is the overall impact of tracheostomy?

Answer 8

• swallowing may or may not be affected by presence of trach.
• impaired smell and taste
• increased secretion
• disrupt of airway pressures
• trauma related to cuff
• may increase potential dysphagia

Question 9

What is the impact on swallowing function of tracheostomy?

Answer 9

• potential for dysphagia is increased due to tracheostomy tube presence and surgical procedures
• changes of phsyiology of swallowing such as airflow pressure differences, reduced laryngeal sensitivity, reduced laryngeal excursion and all this may lead to aspiration

Question 10

Normal laryngeal sensitivity =

Answer 10

cough

Question 11

Decreased tongue base movement and propulsion, delayed trigger, reduced pharyngeal constriction, and UES not opening completely are all due to?

Answer 11

Reduced laryngeal excursion

Question 12

The loss of expiratory airflow through the upper airway for normal respiration has been linked to…

Answer 12

increased pooling of secretions within the larynx and pharynx.

Question 13

Trach is not associated with increased risk of aspiration and pneumonia. T or F?

Answer 13

False; it is.

delayed laryngeal vestibule closure which is associated w/aspiration

Question 14

Priot to swallow assessment and feeding cuff must be at least partially _______ to identify potential aspiration.

Answer 14

deflated

full cull deflation is the goal

Question 15

Can pts cough through larynx to clear laryngeal vestibule with cuff inflation?

Answer 15

No they cannot

Question 16

What can repetitive swallow movements with an inflated cuff cause?

Answer 16

tracheosophageal fistula due to rubbing on tracheal wall

Question 17

Assessing w/ deflated cuff allows….

Answer 17

pt to cough/clear throat and general airway protection abilities

Question 18

IF assessing w/ inflated cuff only assess…

Answer 18

oral stage and ability to trigger swallow

Question 19

Oral intake should be deferred until at least ________ is achieved.

Answer 19

partial cuff deflation

Question 20

What should you do if physician desires pt do eat w/ fully inflated cuff?`

Answer 20

Explain and document limiations and damages of swallowing in presence of inflated cuff!

Question 21

Before blue due test protocol…

Answer 21

• place pulse oximeter, deflate cuff partially or fully
• have pt suctioned as needed
• perform oral hygiene
• dry swallow
• oral mech exam

Question 22

Blue Dye Test Protocol

Answer 22

• administer food/liquids as in reg. bedside eval.
• start w/ water colored blue
• check vocal quality and encourage throat clearing/cough
• look for blue secretions in suction catheter (positive finding)
• suction
• rest
• resuction

Question 23

What do you do if blue dye test is positive/negative?

Answer 23

if positive: terminate test

if negative: allow further trials of test swallows

Question 24

When full cuff deflation is not possible…

Answer 24

only a few exercises can be used to strengthen and prepare for swallow

Question 25

Breath holding techniques will work with open trach. T or F?

Answer 25

False, they will not work.

Question 26

Compensatory Techniques (6)

Answer 26

chin tuck
head turn
chin tuck and head turn
effortful swallow 
double/multiple swallow
clearing throat after swallow