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Dysphagia > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Can a bedside evaluation tell you the cause of the dysphagia?

A

no, only instrumental evaluations can do that

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2
Q

What can decreased breath signs during chest auscultation suggest?

A

aspiration

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3
Q

What are some things to check during bedside evaluation?

A
  • laryngeal elevation
  • wet voice
  • nasal regurgitation
  • coughing/choking
  • respiratory issues
  • Oxygen saturations
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4
Q

What does it mean if a patients o2 sats are going below 90%?

A

there is likely a lot of work that is going into breathing/eating

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5
Q

What should you do if a patient’s o2 sats start to drop as a meal progresses?

A

suggest that the client eat 5-6 smaller meals

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6
Q

What is the point of a bedside evaluation?

A
  • hypothesize about what is causing the swallowing issue
  • help decide what materials to bring to instrumental eval
  • help decide if you are going to try techniques during instrumental eval
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7
Q

What are some things to remember to do during bedside evaluation?

A
  • have client sit at 90 degrees if at all possible
  • oral motor exam
  • pitch slide
  • check for volitional cough (assesses pressure, ability to clear bolus)
  • sensory check
  • volitional swallow
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8
Q

What are some rules of thumb for when you start giving client food?

A
  • start conservative
  • try varying amounts
  • pay attention to signs and symptoms
  • look for residue (pocketed food)
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9
Q

What are some other names for modified barium swallow study (MBSS)?

A
  • videofluoroscopic swallow study (VFSS)

- dynamic barium swallow study (DBSS)

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10
Q

What are the differences between MBSS and BSS?

A
  • MBSS assess looks at the first three stages of swallowing and the BSS only looks at the esophagus
  • MBSS assesses the patient when they are sitting up, BSS assesses the patient when they are lying down
  • MBSS does small boluses, BSS does large boluses
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11
Q

What are things you need for an MBSS?

A
  • fluoroscopy table and tube
  • possibly c-arm
  • monitor for where you are viewing the study
  • lead apron
  • thyroid collar
  • radiation badge
  • gloves
  • supplies
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12
Q

What are the supplies needed for MBSS?

A
  • barium
  • pen light to view structures
  • specific food that patient has problems with (if possible)
  • various consistencies of food and liquid
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13
Q

What view is used most often during a MBSS?

A

lateral view

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14
Q

Why is the lateral view used most often during MBSS?

A

it is the only way to see aspiration and penetration

-it is also the best way to measure transit times

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15
Q

When is the anterior/posterior view used during MBSS?

A

so you can view the symmetry of the bolus and the residue

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16
Q

Should food be placed on the stronger or weaker side during MBSS?

A

stronger side

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17
Q

What is MBSIMP?

A

a class that you can get certified in where everything becomes standardized in amounts of bolus you give and things you look for

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18
Q

should patient swallow a bolus via cup or straw during MBSS?

A

whatever they prefer

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19
Q

What should you offer people when doing self feeding?

A

at least three consistencies…two boluses per consistency

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20
Q

What kind of view should you have during a fluoroscopy?

A

anterior=lips
superior=hard palate
posterior=pharyngeal wall
inferior=vocal folds

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21
Q

Explain the oral transit time

A
  • you measure initiation of A/P movement until the bolus head reaches the trigger point.
  • the pharyngeal swallow should trigger when the bolus reaches where the tongue bass crosses the mandible
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22
Q

How long should a typical oral transit time take?

A

.3-1.5 seconds

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23
Q

Explain pharyngeal time delay

A

start counting when the bolus head reaches the trigger point until laryngeal elevation begins

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24
Q

What is considered a normal pharyngeal delay time?

A

about 1 second

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25
Q

What is a 10 second delay considered?

A

not functional

26
Q

What is more than a 20 second delay considered?

A

an absent pharyngeal swallow

27
Q

What is pharyngeal transit time?

A

measured from the onset of LE until the bolus tail goes through the UES

28
Q

What is esophageal transit time?

A

measured from bolus entry into the UES until it passes into the stomach

29
Q

Why it is important to be conservative with the A/P view of the MBSS?

A

because the patient’s thyroid is cartilage is exposed to a lot of radiation

30
Q

What is something to look for on the A/P view of the MBSS?

A
  • symmetry of the pharyngeal walls
  • symmetry of the bolus
  • symmetry of residue
31
Q

how can you see the VFs during A/P view on an MBSS?

A

have the patient lift the chin slightly and phonate

32
Q

Explain the instructions you give the patient during fluoroscopy?

A
  • explain the risks and benefits of the study
  • tell them what we will be looking at different amounts of things
  • tell the patient to eat and drink as normally as possible
33
Q

What are the postural techniques that you can instruct a patient to do during MBSS?

A
  • Chin down/chin tuck
  • Chin up
  • Head rotation
  • Head tilt
  • Lying down
  • Dry swallows
34
Q

Explain chin tuck

A

causes the vallecula to get bigger and the epiglottis to hang over the airway

35
Q

Who is chin tuck good for?

A

patients who have premature spillage of the bolus or pharyngeal delay

36
Q

Explain the chip up technique

A

uses gravity to your favor if the oral phase is deficient

37
Q

Who is the chin up technique good for?

A
  • someone who has problems pushing the bolus back.

* only recommended for someone who has sufficient pharyngeal phase

38
Q

Explain the head rotation technique

A
  • when a patient turns the chin toward the shoulder

- this should open up the stronger side and allow the bolus to be moved to the stronger side

39
Q

Do you turn you head to the strong or weak side during the head rotations technique?

A

the weak side

40
Q

What other technique might you want to combine with the head rotation?

A

chin tuck

41
Q

explain the head tilt technique

A

-tilt the head towards the shoulder

42
Q

During the head tilt, do you tilt your head towards the strong or weak side?

A

the strong side

43
Q

Who is the head tilt good for?

A

someone who needs help with the oral phase

44
Q

When is lying down used?

A

-for patients who have a serious oral phase problem

45
Q

What are dry swallows used for?

A

-if people don’t spontaneously clear their throat

46
Q

What are the sensory stimulation techniques?

A
  • increase pressure with a spoon
  • presenting a sour or cold bolus
  • presenting a bolus that requires more chewing
  • presenting a large volume
47
Q

When is it appropriate to do maneuvers during an MBSS?

A
  • if the patient has really good cognition

- if the patient is in for a repeat MBSS

48
Q

What are the maneuvers?

A
  • supraglottic swallow
  • super supraglottic swallow
  • dump and swallow
  • effortful swallow
  • Mendelsohn maneuver
  • diet change
49
Q

When interacting with a patient during a bedside eval, what are some things you should screen for?

A
  • can they follow directions?
  • can they tell you what is wrong?
  • brief cognitive screening
  • check teeth
50
Q

Explain the supraglottic swallow

A
  • designed to increase airway closure

- have patient take a breath, hold it, keep holding it while you swallow, then immediately cough after the swallow

51
Q

what is the purpose of the supraglottic swallow?

A

make the VFs close and then clear anything that was leftover

52
Q

Explain the super supraglottic swallow

A

tell the patient to do a very tight breath hold, then bear down on something while you swallow, and then immediately cough after the swallow

53
Q

what is the purpose of the super supraglottic swallow?

A
  • the very tight breath hold will hopefully get the false VFs to close
  • bearing down will help add more pressure to generate a harder swallow
54
Q

explain the dump and swallow

A
  1. have the patient hold the bolus in the mouth
  2. hold breath
  3. tilt head back
  4. swallow as many times as needed to clear bolus
  5. cough
55
Q

What is effortful swallowing?

A

increasing the effort of the swallow

56
Q

What does effortful swallowing help with?

A

BOT-R

57
Q

explain the Mendelsohn maneuver

A
  1. get patient aware of the swallow
  2. train them that during the middle of the swallow, they should hold their adams apple up position. Do this by holding breath for several seconds
  3. count 3-5 while the larynx is up and then let it come back down
58
Q

What does the flexible endoscopic evaluation of swallowing (FEES) do?

A
  • allows you to see the pharyngeal view of the vestibule

- might be able to make inferences about the oral phase, but you can’t see any of it

59
Q

What can you see during FEES?

A

only what is happening before and after the pharyngeal swallow

60
Q

What are some instrumental non-imaging techniques?

A
  • electromyophgraphy (EMG)
  • pharyngeal manometry
  • cervical auscultation
61
Q

What is electromyography (EMG)?

A

uses surface electrodes to measure muscle activity, muscle strength, duration of muscle contraction

62
Q

What is pharyngeal manometry?

A

when you pass a flexible tube through the nose that has pressure sensors in it.
- the goal is to see how much pressure the pharyngeal walls create during the swallow

Dysphagia (4 decks)

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