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Dysphagia > Week 8 > Flashcards

Week 8 Flashcards

1
Q

What is the difference between treatment, compensation, and management?

A

Treatment requires actively changing the swallow. Target is changing the strength, timing, and/or coordination of the swallow to make it safer/more efficient.

Compensation is a “Band-aid” approach. No change in the physiology, but manipulation of a feature to make swallowing safer and more efficient

Management reduced the impact of dysphagia and the manifestation of its sequelae (aspiration and pneumonia)

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2
Q

What are the specific risk factors for developing aspiration pneumonia?

A 
Dependent for feeding
Dependent for oral care
Number of decayed teeth
Tube feeding
More than one medical Dx
Number of medications
Smoking
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3
Q

Aspiration of what liquids most likely does less damage than what other liquids?

A

Thin liquids probably do less damage than thick

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4
Q

What is better to aspirate? neutral or acidic and fat based items?

A

Neutral

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5
Q

In what condition are oral bacteria worse?

A

Dry mouth/xerostomia

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6
Q

When might stomach contents be aspirated?

A

Reflux

Vomiting in the medically compromised

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7
Q

What are the different types of oral care tools and their effectiveness?

A

Lemon glycerine swabs - not effective! has a drying agent that promotes xerostomia

Toothette - not very effective

Toothbrush - yes! even better with suction, most expensive

Chlorhexidine mouthwash - effective! MD prescribed manages bacteria. More powerful than Listerine. NOT GOOD FOR PTS WITH ASPIRATION. ALSO, DO NOT USE WITH IMPULSIVE PTS

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8
Q

What is the free water protocol?

A

Allowing pts who are on thickened-liquids to have water between meals AFTER oral care

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9
Q

Why have a free water protocol?

A
  • Not all who aspirate thin liquids will develop pneumonia and prescribed modified diets can be unnecessarily restrictive.
  • Pts do no like drinking thickened liquids and are noncompliant
  • Potential for increased aspiration risk of thickened liquids post swallow due to pharyngeal residue
  • Increased risk for AP or death when aspirating thickened liquids
  • Limited empirical evidence of medical effectiveness of fluid viscosity modification

The greatest concern is those on thickened do not consume enough fluids

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10
Q

What are factors to consider for free water protocols?

A 
Supplies/staff/support for oral care
Cognition
Compliance
Impulsiveness
Health status
Ambulatory status
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11
Q

When should 1-to-1 feeding assistance/observation be performed?

A

Reduced alertness or attention
Difficulty following directions
Impulsive

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12
Q

What are the types of assistive devices for dysphagia?

A

Cups (provale, nosey)
Spoons
Non-slip pads
Straws (regular vs. diameter adjusted)

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13
Q

What are different bolus delivery compensation?

A 
Multiple swallows per bolus
Alternate liquids and solids (clear pharyngeal residue)
Feed only when alert
Reduce distractions
Needs verbal cues to use recommended strategies
Small sips and bites when eating
Slow rate; pacing
Clearing swallow b/t sips/bites
No straw (controversial)
Sips by straw only (controversial)
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14
Q

What is the positioning for all pts with dysphagia?

A

Upright during all PO

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15
Q

What is the positioning for all patients with confirmed (or even suspected) residue?

A

Remain upright for 30 minutes post-PO

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16
Q

Other than PO, when is it also important to take heed to position?

A

Oral care

Bacteria being dislodged has the potential to be aspiration

17
Q

How does positioning increase bolus flow?

A

Used to redirect the bolus to improve safety or efficiency

18
Q

What are the types of bolus flow positioning techniques?

A

Lateral tilting
Anterior tilting (chin tuck)
Posterior tilting
Head/neck rotation

19
Q

Lateral tilting of the head

A

Bolus flow will be directed through the oral chamber biased to the downhill side; enter the pharynx on the downhill side, BUT will travel through the pharynx unaltered

Physiological targets - Unilateral impairment of lingual movement, sensation or anatomy

20
Q

Anterior tilting of the head (chin tuck)

A

Keeps the bolus in the mouth until actively compressed by the tongue; compresses the airway closed

Physiological targets - Premature spill, poor airway closure, penetration/aspiration before and/or after the swallow

21
Q

What are precautions for chin tuck?

A

If there is a lot of post-swallow residue, chin tuck may push more residue into pharynx.

Must test with instrumentation

22
Q

Posterior tilting of the head

A

Facilitated oral transit of thicker consistencies using gravity; pt must have adequate airway protection (puts into a vulnerable position

Physiological targets - impaired anterior-posterior bolus transport but with good airway protection

23
Q

Head rotation

A

Maximal rotation to the weak side will compress the weak side and divert the bolus to the more functional side; it will also decrease or eliminate weaker piriform sinus

Physiological targets - unilateral impairment in pharyngeal constriction and/or UES opening; unilateral post-swallow residue.

EX. Impairment on left, look maximally to the left

24
Q

What are types of bolus manipulation?

A 
Temperature
Taste
Size
Carbonation
Viscosity
25
Q

What is the most common compensatory strategy used in clinical practice?

A

Bolus viscosity

Rationale: Thin moves quickly, thicker allows more time to swallow safely. Less agility and control needed than thin liquids

26
Q

What are the caveats of bolus viscosity?

A

Thicker liquids are more likely to cause residue
Thicker liquids have more potential for airway obstruction
Thicker liquids have SERIOUS consequences for QoL and patient compliance

27
Q

What is enteral feeding?

A

Delivery of food directly to the GI tract

AKA ‘tube feeding’

28
Q

Does enteral feeding prevent aspiration?

A

No.

  1. Saliva
  2. Reflux
29
Q

What are the types of feeding tubes?

A 
Nasogastric
Nasoduodenal
Nasojejunal
Gastrostomy (G-tube)
Jejunostomy
Total parenteral nutrition
30
Q

All nasal-enteral feeding must…

A

be confirmed w/ x-ray for placement

can cause sinusitis

Dysphagia (13 decks)

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