Bedside Swallow Eval 1 Flashcards
(27 cards)
Symptoms of Dysphagia
*Cannot get swallow started
*Coughing
*Choking
* Sticking
*Bolus comes back up
Types of Evaluation Procedures
- Swallowing Screening
*Bedside/Clinical Swallow Exam
*Instrumental Swallow Exam
Swallowing Screening: Purpose
-Identify highest risk patients who
- require further assessment with full bedside exam
- instrumentation to assess swallow physiology
Swallowing Screening: pass/fail procedure
-Brief chart review
≫Look for factors indicative of dysphagia
≫If in-pt setting, look for nursing daily report
−Brief pt observation
»Brief cognition/following simple command/swallowing function
Screening: Observation (during mealtime)
(Observation)
* Reaction to food/self-feeding skills
* Oral movements in chewing
* Coughing, clearing throat or struggle behaviors
* Changes in breathing
* Co-ordination of breathing and swallowing
* Secretion levels through meal
* Duration of meal and total intake
[Screening] Signs suggesting a need for a referral
for a further evaluation
- Decreased alertness/cognitive dysfunction
- Inappropriate approach to food
- Manifestations of impaired oropharyngeal function
[Screening] Signs suggesting a need for a referral: Pt Complaints
- Pt complaints or observations of…
-Difficulty initiation swallow
-Long oral transport time (holding/pocketing food in mouth)
-Sensation of obstruction of bolus in chest/throat
Swallowing Screening Tools
By trained nursing staff or medical professionals
* Selected Swallow Screening Tests
* Yale Swallow Protocol
* Toronto Bedside Swallowing Screening Test (TOR-BSST)
* EAT-10 (Patient questionnaire)
[Screening] Water-Swallow Test/ 3 oz water Test
(Controversial) NOT a standardized procedure
* (Suiter &
Leder, 2008)
-pt is given 3 oz. of water in a cup, and told to drink it all without stopping
-An abnormal response would be coughing during or after the exam, or a
change in vocal quality, to wet or hoarse
[Screening] Water-Swallow Test/ 3 oz water Test
- High false positive rate
-Pts who fail the test may not dysphagic
-May result in over-referral
Bedside Swallow Exam
FIRST, obtain physician’s approval/referral before
proceeding to the exam
Bedside Swallow Exam: Purposes (1-2)
1) Determine physiologic factors contributing to the dysphagia
≫Focus of the pt’s dysphagia (oral, pharyngeal..)
2) Make recommendations for safest means of intake
≫Recommend diet
≫Selection of optimal swallow strategies
Bedside Swallow Exam: Purpose (3-5)
3) Make determination for need for other tests
* Pharyngeal dysphagia: instrumental exam is required
4) Management/Treatment decision
* Exercises & practice the compensatory strategies
5) Educate (Providing in-service) healthcare staff & family
* Assisting to ensure swallowing safety for pt
Swallowing Exam: Clinical Questions
- Is there a h/o aspiration pna?
- What is the anatomical/functional status of the oral
mechanism? - Is there a risk for aspiration given the current diet?
- Is the pt improving or maintaining nutritional status on
current diet? Significant weight loss?
Swallowing Exam: Clinical Questions
- Should the pt be referred for an instrumental swallow
eval? - Is the pt cognitively able to participate in an
instrumental eval or follow swallow
recommendations/participate in tx? - What are the diet and/or therapy recommendations?
- PO or NPO?
Components of Bedside Exam:
- /History/Chart review/: Medical report and Pt’s complaints
- Physical exam:
- Oral mechanism exam
-Test swallows (Trials of Swallow)
Components of Case Hx: Medical Chart
Medical Chart: Recent hospitalization –
reasons
* Past medical history
* History of PNA? causes?
* History of swallowing problem
−Onset/progression
* Medication
* Respiratory status
* Current nutritional status
* Associated symptoms - e.g.
voice changes, weakness
Components of Case Hx: From Pt
- Identify complaints
- Define cognitive status
−Alert/oriented, follow direction,
etc. - Pt/caregiver’s descriptions of
the problem
−Onset of the problem
−Course of the problem
−Presence of coughing
−Difficulty with any types of food
» Management of various food
consistencies
When to NOT perform the eval?
- Pt is not alert
- Pt refuses
Oral Mech Exam
5 areas:
− Oral
structures/functions/
sensation
− VP mechanism
− Laryngeal function
− Respiration
− Observation of reflexes
Exam the sensory/motor
functions of cranial nerves V, VII,
IX, X, XI and XII.
- Variables of interest
−Size, position, strength, speech,
ROM, steadiness, tone, accuracy
−Examine structures at rest
during sustained postures, and
during repetitive movements
Bedside exam> Physical Exam
Oral Hygiene
Oral Mech Exam:
- Cheeks, lips, jaw, tongue, dentition
- sensation
CN V, VII (tongue ,lips, cheeks, gums, floor of mouth)
CN IX : posterior tongue
Sensory provides info if delayed triggered.
Oral mech: Sensory:
Check quality/ quantity of secretions:
Reduces intra oral sesnation or alertness may result in pooling
or drooling
* Dry mouth may be due to meds, x-ray tx, tube fed, pts on
supplemental O2 or ventilation
Velopharyngeal (VP) Mechanism
- Palate at rest
- Palatal elevation with phonation (motor)
*Resonance during nasal/non-nasal sentences (motor)
Palatal reflex and Gag reflex
VP mechanism: *Palatal reflex:
*Palatal reflex: (elevation of the soft palate without pharyngeal wall
contraction) is elicit by stroking the soft palate (sensory) à motor response
