Tubes and Dysphagia Flashcards
1
Q
Tracheostomy Tubes- Why?
A
- Upper airway obstruction at or above the level of the bf’s
- Potential upper airway obstruction (edema post surgery)
- Provision of respiratory care
2
Q
Tracheostomy Tubes- How?
A
Tube is inserted into the trachea via a surgical incision b/n 3rd and 4th tracheal ring
3
Q
Tracheostomy Tubes- What?
A
- Outer cannula- holds trach sit open
- Inner cannula- actual breathing tube in trachea
- Obturator- smooth tip for initial insertion
4
Q
Signs of aspiration or reflux
A
- Food in trach
2. Endotracheal secretions- you need suctioning for both
5
Q
Cuffed trach
A
Cuffed
- Prevents aspiration
- Used w/ventilators
- Inflated for increased pressure
6
Q
Cuffless trach
A
Cuffless
- Aspiration may occur
- May interfere w/laryngeal elevation during swallow
- Assist breathing & secretion removal
- Long-term use
7
Q
Fenestrated trach
A
Fenestrated
- Smaller
- Used for weaning & decannulation
- Short-term (3-5 days)
8
Q
Swallowing tx with tracheostomy
A
- pt history (pt symptoms of dysphagia)
- Know type of trach tube if inflated (cuffed)
- Determine the length of time of trach- of 6+ months trached, scar tissue can restrict laryngeal elevation
- Deflate cuffed tube (w/medical clearance)- inflated cuffs irritate tracheal wall during swallow, restricts laryngeal elevation, compresses on the esophagus, reduces laryngeal sensitivity
- suction oral and trach as deflating
9
Q
Swallowing treatment with tracheostomy
A
- pt occludes trach w/gloved finger or gauze or one-way valve during & several seconds after each swallow for near normal pressure and clearance of possible airway residues (exhalation)
- Dry swallows first
- Write down directions for swallowing
- no more than 3cc liquid puree for swallow trials (start with easiest consistency for pt)5 finger test- ready to suction
- cough, cough, cough
- phonate sustained vowel after swallow, head turn
10
Q
Ventilator depedent
A
- Swallow usually worsens on vent
- respiration is controlled by vent
- pt can’t lengthen exhalation for swallow (disrupted swallow)
- cuffed trach tube
11
Q
swallowing treatment/ ventilator dependent
A
Swallowing treatment
- timing of swallow at exhalation
- Blue dye test- shows up on vent or trachea
- present a variety of consistencies
12
Q
Intubated
A
- May be laryngeal trauma from tube placement, TE fistula from tube rubbing
- Laryngeal pathologies- granuloma, vf paresis/paralysis, edema, erythema
- swallowing tx- none until extubated for ~ 1 week
- then ROM ex’s
13
Q
Feeding tubes
A
- Nasogastric- SLP- tube placed nasally
- Nasoduodenal- physician
- Nasojejunal-physician
- orogastric-SLP
- gastronomy- g or gt /PEG- tube placed by percutaneous endoscopic/laparoscopic gastronomy
- gastronomy with jejunum
- jejunostomy
- RIG method- radiologically inserted gastronomy
- Surgical method- open or laparoscopically inserted gastronomy
14
Q
Weight loss/ RED FLAGS
A
Weight loss
- 10% to 20% loss is common (moderate)
> 20% of usual weight (severe)
-significant weight loss (% of change) 1 week- 1-2 1 month- 5 3 months-7.5 6 months- 10 - greater percentage of loss is considered severe weight loss
15
Q
RED FLAGS/ Hydration
A
- Rapid weight loss of 4+ lbs within 48 hours
- pts with thin liquid dysphagia
- complaint of thirst
- reduced skin turgor
- decreased urination
- hyperatremia- increased serum sodium
- elevated BUN (blood urea nitrogen)
% of ideal body weight/ % of usual body weight
mild malnutrition 80-90/85-95
moderate malnutrition 70-79/75-84
severe malnutrition 0-69/ 0/74
