Feeding and Swallowing

Question 1

What is dysphagia?

Answer 1

difficulties with chewing and swallowing

Question 2

What are the 3 main stages of the swallowing process?

Answer 2

1. oral stage
2. pharyngeal stage
3. esophageal stage

Question 3

Describe the oral stage of the swallowing process

Answer 3

It is a voluntary phase and the purpose is to prepare the food/liquid for the swallow
–> involves moving the bolus to the back of the mouth using the tongue

Question 4

What are some problems associated with the oral phase?

Answer 4

-lips need to be coordinated and strong enough to keep food/fluids inside the mouth (otherwise dribbling)
-tongue needs good control to move the food to the back of the mouth

Question 5

What aspects are required for effective swallowing?

Answer 5

-good muscle tone in jaw, tongue, esophagus, sphincters
-good trunk control

Question 6

Describe the pharyngeal phase of swallowing

Answer 6

-involuntary phase which takes 1-2 seconds
-protects the airway
-soft palate rises to block the nasal passage
-hyoid bone moves epiglottis which closes trachea and makes you not choke

Question 7

What are the problems in the pharyngeal phase?

Answer 7

choking when airways don’t fully close– older adults tend to prolonged pharyngeal phase and a reduced cough reflux

Question 8

Describe the esophageal phase

Answer 8

-involuntary phase
-from pharynx to stomach
-peristaltic waves

Question 9

What are the problems in the esophageal phase?

Answer 9

-retention of food in esophagus can result from a mechanical obstruction, motility disorder, or impaired opening of the lower esophageal sphincter
-GERD (gastroesophageal reflux disease)– heart burn

Question 10

What are the effects of aging on our ability to chew and swallow?

Answer 10

-decreased saliva production
-weakened esophageal sphincter
-decreased tongue mass and strength
-facial muscles atrophy
-weakened cough reflex

Question 11

What are some causes of dysphagia?

Answer 11

-aging
-medications– called drug induced dysphagia
-complication of therapeutic action
-drug induced esophageal injury
-many acquired, congenital, and degenerative neurological conditions

Question 12

What are the 8 steps to the standard feeding procedures?

Answer 12

1. Check the care plan
2. Assume mealtime position
3. Check diet order
4. Assume feeding position (beside and eye level)
5. Feed safely using resident-specific strategies
6. Clean mouth / oral hygiene (twice a day)
7. Stay upright for 30 minutes minimum (Minimum 30°)
8. Report any problems

Question 13

What are the ideal head positions for swallowing?

Answer 13

-head tilted towards the strong side
-head turn to the weak side (closes off the weak side of the esophagus)
-chin tucked to chest

Question 14

What is the free water protocol

Answer 14

a protocol developed to provide patients with dysphagia an option to consume thin water between mealtimes– no increased evidence of aspiration pneumonia but also not a statistically relevant amount of fluid intake

Note: know the policy of your site

Question 15

What is the med pass nutritional supplement program?

Answer 15

program to provide nutritionally high-risk clients with a concentrated nutrition supplement– a common one is Resource 2.0
–> is on the MAR and ordered in the same way as a medication