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Advanced Medical Nutrition Therapy > Dysphagia > Flashcards

Dysphagia Flashcards

(78 cards)

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1
Q

_____ is the difficulty or inability to swallow properly

A

Dysphagia

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2
Q

Symptoms of dysphagia include…

A

-Choking

-Coughing

-Drooling

-Multiple swallows for one bite of food

-Pocketing food

-Gurgly voice

-Absent gag reflex

-Frequent upper respiratory infections

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3
Q

What neurological disorders can cause dysphagia?

A

-Stroke

-Dementia

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4
Q

What neuromuscular disorders can cause dysphagia?

A

-ALS

-MS

-Parkinson’s disease

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5
Q

A _____ _____ injury may also cause dysphagia

A

Traumatic brain

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6
Q

What types of cancer may cause dysphagia?

A

-Oral cavity

-Pharynx

-Esophagus

-Treatment modalities (surgery, radiation)

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7
Q

Medications may also cause dysphagia by causing side effects like…

A

-Sedation

-Dry mouth

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8
Q

Advanced _____ and frailty may also cause dysphagia

A

Age

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9
Q

What are the three phases of swallowing?

A

-Oral phase (voluntary)
-Pharyngeal phase (involuntary)
-Esophageal phase (involuntary)

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10
Q

In the oral phase, food is introduced into the ____ ____, chewed, and mixed with saliva

A

Oral cavity

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11
Q

During the oral phase, the tongue pressed food against the ___ ____, forming a bolus and forcing it toward the pharynx

A

Hard palate

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12
Q

In the pharyngeal phase of swallowing, the soft palate raises to seal off the _____

A

Nasopharynx

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13
Q

During the pharyngeal phase, the ____ elevates causing the epiglottis to move over the glottis and the vocal cords close to prevent food from entering the trachea

A

Larynx

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14
Q

The last step of the pharyngeal phase is that the ____ contracts while the ____ ____ ____ relaxes, allowing food to pass into the esophagus

A

Pharynx; upper esophageal sphincter

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15
Q

In the esophageal phase of swallowing, the bolus moves through the esophagus into the ____

A

Stomach

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16
Q

Steps to identify dysphagia:

A

-Diet interview
-Observation at mealtime
-If dysphagia is suspected, recommend a SLP consult for swallowing evaluation (done with clinical exam and/or videofluoroscopy, Modified Barium Swallow)

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17
Q

Oral phase swallowing problems include…

A

-Weakened or poorly coordinated movements of the tongue
-Difficulty forming a bolus
-Food pocketing
-Weakened lip muscles cause an inability to seal the lips-> drooling, food spillage

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18
Q

Swallowing problems in the pharyngeal phase can cause…

A

-Nasal regurgitation
-Choking
-Aspiration

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19
Q

Swallowing problems in the esophageal phase are often due to mechanical obstruction, but may also be due to a neurologic disorder called _____, which causes decreased peristalsis so it feels like there is food stuck in the chest

A

Achalasia

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20
Q

Consequences of dysphagia:

A

-Inadequate intake
-Weight loss
-Development of nutritional deficiencies and malnutrition
-Dehydration
-Increased risk of aspiration pneumonia
-Increased frailty

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21
Q

MNT for dysphagia:

A

-Proper positioning (elevate HOB to >29 degrees)
-Consistency modification as per SLP
-Small, frequent meals
-Minimize environmental distractions and conversations during mealtime
-Foods that are flavorful or cold help stimulate the swallow reflex
-Avoid alcohol
-Patient education
-MVI with minerals if needed
-Enteral nutrition may be necessary if aspiration risk is too great or oral intake is inadequate

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22
Q

The ____ ____ ____ ____ ____ is a multidisciplinary taskforce

A

International Dysphagia Diet Standardisation Initiative (IDDSI)

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23
Q

What are the goals of IDDSI?

A

-Develop standardized, international terminology and definitions to describe texture-modified food and thickened liquids
-Improve patient safety by increasing consistent communication and standards

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24
Q

IDDSI Level 0 includes ____ ____ that flow like water

A

Thin liquids

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25
To classify as level 0, use the flow test: < ____ mL of residue remains in syringe after 10 seconds of flow
1
26
What types of beverages classify as level 0, thin liquids?
-Water, fruit juice, milk, soda, tea, coffee -Liquid oral nutrition supplements -Broth -Ice cream, frozen yogurt, sherbet, milkshakes, and gelatin
27
Thin liquids are easily ____
Aspirated
28
The IDDSI Flow Test measures how thick a liquids by how much flows through a 10 mL syringe in ___ seconds
10
29
IDDSI level 1 is ___ ____ ____
Slightly thick liquids
30
IDDSI level 1 (slightly thick liquids) are thicker than water, but thin enough to flow through a ____
Straw
31
IDDSI level 1 is used when thin drinks flow too ____ to be controlled safely
Fast
32
The IDDSI flow test for level 1 that that there should be __-__ mL left in syringe after 10 seconds
1-4
33
IDDSI level two is ___ ____ ____
Mildly thick liquids
34
IDDSI level 2 (mildly thick) liquids pour ____ from a spoon but slower than "slightly thick" drinks
Quickly
35
____ effort is needed to drink mildly thick liquids through a straw
Mild
36
When are IDDSI level 2 (mildly thick) liquids indicated?
When tongue control is slightly reduced
37
IDDSI flow test for level 2 is that ___-___ mL are left after 10 seconds
4-8
38
IDDSI level 3 is ___ ___ ___/___ ___
Moderately thick liquids/liquidized food
39
Moderately thick liquids drip ____ through the slots of a fork
Slowly
40
Moderately thick liquids/foods have a smooth texture with no ____
Lumps
41
IDDSI level 3 requires ____ effort to drink through a straw
Moderate
42
Indications of IDDSI level 3:
-Difficulty with tongue control -Pain on swallowing
43
IDDSI flow test for level 3:
Leaves >8 mL after 10 seconds
44
Examples of level 3/moderately thick liquids and blenderized foods:
-Runny pureed fruit -Some sauces and gravies
45
IDDSI level 4 is ____ ___ ____
Extremely thick liquids
46
Extremely thick liquids fall off a spoon in a single spoonful and ___ ___ ___
Hold its shape
47
Can you drink extremely thick liquids from a straw?
No (usually eaten with a spoon)
48
Extremely thick liquids have a smooth texture with no lumps and are not sticky; this allows more time for ___ ____
Oral control
49
Indications of extremely thick liquids:
-Significantly reduced tongue control -Pain on chewing and swallowing
50
What is an example of a food that is extremely thick?
Pudding
51
If thin liquids are not permitted, fluid needs can be met with ___ ____
Thickened liquids
52
Thickening liquids allow for better control over the ____
Swallow
53
Examples of thickening agents:
-Infant rice cereal -Pureed fruits or vegetables -Pudding -Commercial products -Corn starch, flour
54
Commercial instant thickeners include...
-Resource ThickenUp Clear -SimplyThick -Thick-It
55
___-____ products are used for convenience and include things like juice, water, milk, and coffee
Pre-thickened
56
Adequate ____ ____ can be difficult to be achieved for people receiving thickened liquids (high risk of dehydration)
Fluid intake
57
Two methods of helping to increase fluid intake:
-Provide education -Frazier Free Water Protocol
58
Frazier Free Water Protocol:
-No use of thickened liquid -No beverages during meals -Water in between meals -Crucial to maintain very good oral care so that if/when they aspirate, it won't have any bacteria in it
59
IDDSI level 4 also include ____ _____
Pureed foods
60
Indications of pureed food:
-Unable to bite of chew food -Tongue control is significantly reduced
61
Pureed foods have a "____-____" texture
Pudding-like
62
Pureed foods are easy to swallow because they are...
-Smooth -Lump-free -Homogenous -Cohesive -Not sticky
63
When pureeing foods, what can you add to prevent lumps and provide moisture?
-Gravy -Sauce -Vegetable juice -Cooking water -Fruit juice -Milke -Half and half
64
IDDSI fork drip test for level 4:
-Pureed foods/extremely thick liquids sit in a mouth or pile above the fork -Liquid does not dollop or drip continuously through the fork prongs -A small amount may flow through and form a tail below the fork
65
IDDSI spoon tilt test:
-Sample holds its shape on the spoon and falls off fairly easily if the spoon is tilted or flicked -Sample should not be firm or sticky
66
Pureed foods must pass ____ the fork drip test and the spoon tilt test
Both
67
IDDSI level 5 is ____ and ____ ____
Minced and moist
68
IDDSI level 5 is used for...
-Patients who are unable to bite foods -Patients who have pain or difficulty chewing foods -Patients who easily tire when chewing foods
69
Level 5 foods should be minced into pieces no larger than ___ mm width lump size
4
70
Minced and moist foods should be soft and moist with no separate ___ ___
Thin liquid
71
IDDSI level 6 is ___ and ___-___
Soft and bite-sized
72
IDDSI level 6 is used for patients who...
Are unable to safely bite off pieces but are able to chew the food into pieces that can be swallowed
73
Level 6 foods should be cut into pieces no larger than ___cm x ___cm
1.5 x 1.5
74
Add ___ and ____ to level 6 foods to keep food moist
Gravies and sauces
75
IDDSI level 7 is ___ ___ ____
Easy to chew
76
Easy to chew food is normal food of ___ texture
Soft
77
IDDSI level 7 is used for people who...
-Find hard and/or chewy foods difficult or painful to chew and swallow
78
With easy-to-chew foods, avoid things that are...
-Hard -Tough -Chewy -Fibrous -Stringy -Crunchy -Crumbly

Advanced Medical Nutrition Therapy (14 decks)

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