Dysphagia Flashcards

1
Q

Impact of Dysphagia on Nutrition Status

A
  • Impaired feeding efficiency (length of time to finish a meal)
  • Decreased food & fluid intake
  • Altered taste sensation
  • Decreased appetite
  • Weight loss
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2
Q

Important Anatomical Structures in Swallow

A
  • Oral cavity
  • Pharynx: Nasopharynx, Oropharynx, Hypopharynx
  • Larynx
  • Esophagus
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3
Q

Important Anatomical Structures in the Oral Cavity

A
  • Tongue
  • Teeth
  • Lips
  • Palate
  • Anterior & Lateral Sulci
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4
Q

Infant swallow

A
  • Oral & Pharyngeal Cavities Smaller
  • Tongue size rel. larger
  • Fat pads in cheeks (creates buffer and gives muscle strength for BF)
  • Larynx / hyoid elevated under tongue (anterior)
  • Pyriform sinuses-smaller & elevated
  • Soft palate, pharyngeal wall & tongue base closer together
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5
Q

Stages of Swallowing

A
  • Oral Preparatory /Oral Stage
  • Pharyngeal Stage
  • Esophageal (May have problem with reflux since motility is still developing but usually doesnt bug them)
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6
Q

What can be observed to see if swallowing?

A

Wath for hyoid bone going up and forward

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7
Q

Oral preparatory stage

A
  • Lip Closure (important for BF technique)
  • Rotary, lateral jaw & tongue movement (developed 12-18 months)
  • Facial Tone (extra fat pads)
  • Anterior pulling of soft palate
  • Salivation
  • Can last for as long as you wish…
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8
Q

What is the oral preparatory phase negatively affected by?

A
  • poor salivary gland function (lubrication)
  • surgical or anatomical defects
  • neurological disorders (biggest challenge)
  • poor dentition
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9
Q

Oral stage

A

voluntary - 1 sec
* Tongue elevation in anterior to posterior direction to trigger swallow
* bolus movement through oral cavity

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10
Q

What can the oral stage be effected by?

A
  • surgical defects (tongue weakness)
  • neurological disability
  • cognitive status/LOA
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11
Q

Pharyngeal phase

A

1 second
* shortest but most complex
* soft palate elevates (velar elevation): Closes off nasopharynx and prevents nasopharyngeal regurgitation
* The superior constrictor muscle contracts (pharyngeal peristalsis)
* tongue base drives the bolus posteriorly

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12
Q

Esophageal phase

A

3-6 seconds for infant (8-20 for adult)
* bolus is propelled about 25 cm from the cricopharyngeus through the thoracic esophagus via peristaltic contractions.
* The lower esophageal sphincter relaxes and the bolus moves into the gastric cardia.

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13
Q

What phase is the biggest risk for aspiration?

A

esophageal phase

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14
Q

treatment strategies for abnormal swallow

A

You have to understand the underlying cause and the anatomy/physiology to understand what treatment modality to consider
* positional (best strategy)
* dietary texture (6-12 months thickening BM; consistent texture)
* Assistive feeding devices
* Tube feeding

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15
Q

Common causes of dysphagia

A
  • Neurological impairment caused by stroke, neurological disorders (eg Cerebral Palsy, Muscular Dystrophy)
  • Structural abnormalities of the oral cavity (eg cleft palate), head and neck cancers
  • Psychogenic (rare)
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16
Q

Major Warning Signs of Oral Dysphagia

A
  • Drooling
  • Slow rate of intake/chewing
  • Altered posturing of head/neck (arch back/ throw back neck)
  • Food residue in mouth after eating
  • Coughing before swallowing (++liquids)
17
Q

Major Warning Sigs of Pharyngeal Dysphagia

A
  • Coughing during or after swallow
  • abnormal breathing while feeding (should be consistent
  • Choking with SOB
  • Voice quality changes (wet - especially when crying)
  • Nasal escape of liquids (not uncommon in first 3 months)
  • Expectoration of food/saliva
18
Q

clinical indications of aspiration

A
  • Dysphonia / aphonia
  • Wet phonation (++breath sounds)
  • Wet spontaneous cough
  • Some or no swalllowing secretions
  • Abnormal palatal reflex:unilateral/bilateral
  • Reclining posture
  • Abnormal/absent laryngeal elevation
19
Q

Major Nutrients Affected by Dysphagia

A
  • Energy, Protein and Fluid top 3!
  • Fiber
  • Iron
  • Calcium
20
Q

feeding strategies for dysphagia

A

Developmental disability can result in delay of development of normal swallow therfore swallowing abilities may not match chronological age!!
* Alter food textures ( to match developmental swallow)
* Alter nutrient density (energy etc)

21
Q

Use of EN for dysphagia

A

Typically implemented sooner rather than later to avoid malnutrition
* Hydration is the determining factor in decision re: enteral support
* Supplemental (most common) vs Total Enteral Support
* Short-term (nasogastric, nasojejunal) vs long-term (gastrostomy, gastrojejunal) support affect choice of access device

22
Q

Impact of Dysphagia on Nutritional Status

A
  • Impaired feeding efficiency (length of time to finish a meal)
  • Decreased food & fluid intake
  • Altered taste sensation
  • Decreased appetite
  • Weight loss