Class 2

Question 1

What does NBM stand for?

Answer 1

Nill by mouth.

Question 2

What does assessment data allow the SLT to determine?

Answer 2

• NBM or oral feeding
• normal diet or modified diet
• normal fluids or thickened fluids
• unlimited oral vs. limited oral
• postural changes
• airway protection strategies
• rehab potential
• additional precautions
• liaison w other professionals/ family members/ carers

Question 3

When is enteral feeding provided?

Answer 3

When patients are unable to swallow any consistency safely or meet their nutritional needs with oral intake.

Question 4

What are the most common methods of enteral feeding?

Answer 4

NG (nasogastric) tube
PEG (percutaneous endoscopic gastrostomy) tube
RIG (radiologically inserted gastrostomy) tube

Question 5

What tube is used for a more temporary purpose?

Answer 5

A nasogastric (NG) tube.

Question 6

_____ and _____ tubes will be inserted if tube is required for a longer time.

Answer 6

PEG, RIG

Question 7

Who prescribes a feeding regime?

Answer 7

a dietitian.

Question 8

Enteral feeding has an _______ issue. Explain this.

Answer 8

Ethical.
Some patients may not want to be tube fed or the prolonging of life may not be considered in the patient’s best interests.

Question 9

What does diet and fluid modification slow?

Answer 9

It slows the passage of the bolus to reduce requirement for chewing etc.

Question 10

Slowing the passage of the bolus reduces the requirement for chewing, ____ _______ and reduces the risk of __________.

Answer 10

Food preparation

Residue

Question 11

_________ is considered when the risks of aspiration are so great that the patient’s health is likely to be compromised by the introduction / continuation of oral intake.

Answer 11

NBM.

Question 12

NBM is a _____ decision (we only suggest).

Answer 12

medical

Question 13

Name this:

A feeding tube is passed through the nose, down the oesophagus and into the stomach.

Answer 13

NG tube.

Question 14

An endoscope with a powerful light source identifies the point of incision. A thread is pulled through the needle at the incision, pulled up by the endoscope, attached to the ______ tube and pulled back down.

Answer 14

PEG.

Question 15

Thickened liquids slow down the passage of the bolus to allow time for _________ ___________.

Answer 15

Airway Closure

Question 16

What do very thick liquids and solids need?

If muscle strength is compromised, what is there a risk of?

Answer 16

• Very thick liquids and solids need good tongue and pharyngeal muscle strength
• risk of residue if muscle strength is compromised

Question 17

Foods that require chewing can be difficult for patients with _________ or _____________ __ __ ___________ _____________.

Answer 17

No/few teeth

Weakness in the masticatory muscles.

Question 18

Why is diet and fluid modified?

Answer 18

Diet and fluids are modified to make the preparation of foods for swallowing, and the process of swallowing easier.

Question 19

Apart from reducing swallowing, what would be another diet modification?

Answer 19

Considering the size of mouthfuls, the amount taken at any one time.

Question 20

What is it important to consider when modifying diet?

Answer 20

Patients may be less keen for oral intake so you will often have to liaise with a dietitian so they still have all their nutritional needs.

Question 21

Name the national descriptors for diet.

Answer 21

Normal Diet
Texture E
Texture D
Texture C
Texture B
Texture A

Question 22

Describe Texture E.

Answer 22

Fork Mashable

Question 23

Describe Texture D.

Answer 23

Pre-mashed diet, requires little chewing.

Question 24

Describe Texture C.

Answer 24

Thick puree, can hold it’s own shape.

Question 25

Describe Texture B.

Answer 25

Thick puree, needs spoon.

Question 26

Describe Texture A.

Answer 26

Thin Puree, needs spoon.

Question 27

Name the national descriptors for drink.

Answer 27

``` Stage 3 fluids (v. thick) Stage 2 fluids (honey) Stage 1 fluids (syrup) Naturally thick fluids Normally thick fluids. ```

Question 28

Name the stages of the international descriptor.

Answer 28

7. Regular 6. Soft and Bite Sized 5. Minced and moist 4. Pureed food/ extremely thick drink 3. Liquidised food/ moderately thick drink 2. Mildly thick drink 1. Slightly thick drink 0. Thin Drink.

Question 29

In the international desciptor what stages for food and drinks overlap?

Answer 29

4. pureed food/ extremely thick drink | 3. Liquidised food / moderately thick drink.

Question 30

As well as dietary modifications, name some additional precautions.

Answer 30

- Optimum position for eating and drinking is fully upright - Meal time strategies include visual, physical or verbal cues - supervision/assistance - monitor chest status - discontinue if problems arise - encourage coughing - good oral hygeine - dentures to be worn (if they fit) - medications to be given in alternative form if possible (not our decision though).

Question 31

Intake needs to be monitored for _______and in relation to ________ ___________.

Answer 31

Safety | Nutritional Requirements.

Question 32

Intake needs to be monitored for _______and in relation to ________ ___________.

Answer 32

Safety | Nutritional Requirements.

Question 33

If medications need to be given in an alternative form, who's decision is this and what needs to be done?

Answer 33

NOT DECIDED BY SLT- medical decision Must liaise with medical staff and pharmacist.

Question 34

``` What are these regarding? Broad spectrum of dysphagia Formulation of medication Nutrition Medicine acquisition cost Therapeutic dilemmas. ```

Answer 34

The difficulties in administering medication.

Question 35

What do SLTS often have a stock of to help with swallowing?

Answer 35

Adapted utensils eg. adapted cups.

Question 36

What do adapted cups do?

Answer 36

They control the amount of liquid provided, reduce the effort needed to take a bolus and ensure that head posture is optimised.

Question 37

In dysphagia management what will the SLT be working in?

Answer 37

A multi-disciplinary team.

Question 38

Give a few examples of professions within the multidisciplinary team for dysphagia.

Answer 38

- Radiologist - medical staff on ward - GP - Nurses - Dietitian - OT - Physio - Paid carers - Family members

Question 39

All clinical decisions aren't isolated problems to be solved, they are supported by sound _______ principles.

Answer 39

Ethical.

Question 40

What are they key principles of ethical practice?

Answer 40

Self Determination Beneficence Non-maleficence Justice

Question 41

What is self-determination?

Answer 41

Respecting the right of the individual

Question 42

What is Beneficence?

Answer 42

Acting in the good of the patient.

Question 43

What is non-maleficence?

Answer 43

Avoidance of unnecessary harm.

Question 44

What is justice?

Answer 44

Acting fairly, distributing resources fairly.

Question 45

In addition to liaising with health professionals, who else must be involved in decisions?

Answer 45

- family/carers | - The Patient

Question 46

What questions must we ask when it comes to patient and family liaison?

Answer 46

- What does the patient want to do? - Are they capable of making this decision? - Are they aware of the risks if they go against professional advice? - What awareness, knowledge and skills do family members have of the swallowing difficulty? - Are family members able to accommodate the recommendations?

Question 47

Patients need to _____ to any assessment or intervention you provide.

Answer 47

consent

Question 48

Why is consent really important for dysphagia?

Answer 48

For dysphagia, there may be the added: - personal invasion of being fed or being given modified diet or fluids - physical invasion of the insertion of feeding tubes.

Question 49

To be able to give consent, what must a patient have?

Answer 49

They need to have decision making capacity.

Question 50

Before a videofluoroscopy, what is needed from the patient?

Answer 50

Consent.

Question 51

What does the concept of decision making capacity refer to?

Answer 51

The patient's ability to understand, retain and balance information and communicate a choice.

Question 52

Name factors that can affect decision making capacity.

Answer 52

Intoxication from alcohol Acquired injury to the brain presence of a Developmental disability associated with cognitive impairment presence of a Brain disorder such as dementia.

Question 53

Loss of capacity cane be _____, _______ or permanent.

Answer 53

Temporary Fluctuating Permanent

Question 54

What are these the principles of: Take your past and present wishes into account Make sure you get the information and support you need to take part in decisions Take the views of your carer, named person, guardian or welfare attorney into account Look at the full range of options for your care Give you treatment that provides maximum benefit Take account of your background, beliefs and abilities Make sure that any restrictions on your freedom should be the 'minimum necessary in the circumstances' Make sure that you are not being treated less favourably than other patients Your carers' needs are taken into account and they get the information and support  they need to help them care for you Take special care of your welfare if you are under 18 years of age

Answer 54

The metal health act 2015

Question 55

GIRFEC AWI Act ASP act The mental health act all relate to what?

Answer 55

Decision Making ability and protection of vulnerable groups.

Question 56

What is a power of attorney?

Answer 56

A legally appointed person to make decisions on the patient's behalf. This person is appointed while the person has capacity.

Question 57

Name- This person is appointed when a patient has lost capacity and someone needs to be nominated to make decisions on their behalf over the long term.

Answer 57

Welfare Guardian.

Question 58

What are advance directives?

Answer 58

These are statements from patients about treatments they don't wish to be given in the future should they lose the capacity to make the decision or communicate this. aka. living wills :)

Question 59

What is an advance statement?

Answer 59

A statement of wishes of how the patient would like to be treated if they lose capacity and covers any aspect of care.

Question 60

What can an advance statement include?

Answer 60

food preferences religious or spiritual views if they like bath/shower if they want light left on etc.

Question 61

For children where may issues arise?

Answer 61

If parental wishes conflict with those of the SLT.

Question 62

What is important when clients are transitioning from pediatric to adult caseloads?

Answer 62

Good communication and well considered transfers between teams so that the SLT care can continue as required. A proactive approach (not reactive)

Question 63

For learning disability caseloads carers showed a high level of _____ but were limited by what factors?

Answer 63

Compliance | External factors eg. limited utensils

Question 64

End of life decisions for can be _________ and young adults living at home may be more likely _________ comply with professional advice .

Answer 64

Complex | Not to