Feeding Unit Flashcards
(156 cards)
1
Q
the process of “setting up, arranging, and bringing food or fluid from the plate or cup to the mouth, sometimes referred to as ‘self-feeding’
A
feeding
2
Q
the “ability to keep and manipulate food/fluid in the mouth and swallow it; eating and swallowing are often used interchangeably
A
eating
3
Q
a complicated process in which food, liquid, medication, and saliva pass through the mouth, pharynx and the esophagus into the stomach.”
A
swallowing
4
Q
considered the normal consumption of solids and liquids
A
deglutition
5
Q
In the first year of life a baby should ___ his or her weight
A
triple
6
Q
considered a measurable outcome of feeding or eating
A
growth
7
Q
Feeding, eating and drinking are important for
A
social interaction and human function
8
Q
old man’s best friend
A
aspiration pneumonia
9
Q
method of receiving food via the gastric system or naso-gastric system
A
enteral feeding
10
Q
dysfunction in any stage or process of eating. It includes any difficulty in the passage of food, liquid, or medicine, during any stage of swallowing that impairs the clients ability to swallow independently or safely.
A
dysphagia
11
Q
eating and feeding are natomically and physiologically complex activities that require effective, coordinated function of ____, _____, and ____
A
motor, sensory, and cognition
12
Q
contexts important to evaluate in feeding/eating
A
culture attitudes & values social opportunities effect of medical condition environmental factors
13
Q
extension-retraction of the tongue, up and down jaw excursions, and loose approximation of the lips
A
suckling
14
Q
negative pressure in the oral cavity, rhythmic up and down jaw movements, tongue tip elevation, firm approximation of the lips and minimal jaw excursion
A
sucking
15
Q
head turning in response to tactical stimulation
A
rooting
16
Q
rhythmic bite and release pattern
A
phasic bite reflex
17
Q
1 suck/second
A
nutritive suck
18
Q
2 sucks/second
A
non-nutritive suck
19
Q
other issues from birth-6 months
A
weak or uncoordinated sucking
20
Q
flattening & spreading of the tongue combines with up and down jaw movements
A
munching
21
Q
spreading & rolling movements of the tongue, tongue lateralization and rotary movements
A
chewing
22
Q
movement of the tongue to the sides of the mouth to propel food between the teeth for chewing
A
tongue lateralization
23
Q
smooth interaction & integration of vertical, lateral, diagonal & eventually circular movements of jaw used in chewing
A
rotary jaw movements
24
Q
easy, gradual closure of the teeth on the food, with an easy release of the food for chewing
A
controlled, sustained bite
25
If child has
Head control
More mature suck, ready for ___
Spoon feeding
| Strained or pureed foods
26
If child handles food through
sucking action but can
not move food to sides of
mouth, ready for ___
Thickened pureed or soft
| mashed foods
27
If child begins up and down
| chewing movement, ready for ___
Ground table foods
28
If child has Increased tongue and lip
Control; sits alone without
support, ready for ___
cup drinking
29
Foods to suggest when a child is ready for spoon feeding and strained or pureed foods
Infant cereal, 1st and 2nd stage baby foods, pureed table foods
30
Foods to suggest when a child is ready for thickened pureed or soft mashed foods
Mashed potatoes, well cooked mashed vegetables, soft diced fruits, applesauce
31
foods to suggest when child is ready for Ground table foods
Ground fruits and vegetables, non-stringy meat mixed with gravy
32
when do feeding skills develop
In utero
33
when does sucking begin
Utero: last month of pregnancy
34
what is the earliest feeding pattern
suckling
35
what happens during sucking
lips form tight seal on nipple, less jaw excursion. Up and down movement pattern.
36
when will babies typically achieve a 1:1 ratio for sucks to breaths
2 days of age
37
How much can infants suck per feeding at 3 months
7-8 oz
38
When can children eat strained foods
6 months
39
When can cup drinking begin
4-6 months
40
When can soft solids be introduced
7 months
41
Explain what happens during munching
up and down jaw movements with uncontrolled force
42
What are interfering factors to feeding
```
prematurity
abnormal tone
sensory feedback
delayed cognitive development
behavior
respiratory illness
GI problems
chronic illness
anatomic abnormalities
```
43
elevates mandible. Most efficient muscle to chew
masseter
44
Most efficient muscle to crush objects
temporalis
45
flap of skin that covers the larynx to prevent food from entering larynx
epiglottis
46
stage of swallowing where food is chewed and prepared for swallowing
oral preparatory phase
47
stage of swallowing where the tongue pushes the food or liquid to the back of the mouth
oral transit phase
48
stage of swallowing where the swallow is triggered and the food or liquid is moved into the pharynx (the canal that connects the mouth to the esophagus
pharyngeal phase
49
stage of swallowing where food or liquid enters the esophagus and is carried into the stomach
esophageal phase
50
4 stages of swallowing
oral preparatory, oral transit, pharyngeal, and esophaeal
51
airway is open during what stages of swallowing
oral prep, oral, and esophageal
52
what texture should you give a client who has delayed swallowed
viscous or thickened
53
prerequisite/developmental issues
1. Behavioral observations
2. Oral motor behaviors
3. Feeding guidelines
4. Progression of food textures
5. Typical growth expectations
6. Monitoring growth
54
In 1st year, weight doubles by __ months
6
55
In 1st year, weight triples by __ months
12
56
In 2nd year, weight gain by _-_ pounds
4-6
57
In 2nd year, length gain by _-_ inches
4-5
58
In 3rd year, weight gain is _-_ pounds
3.5-5.5
59
In 3rd year, length gain is _-_ inches
2-2.5
60
what is the schedule of loss due to factors like malnourishment
weight, length, and head circumference
61
role of OT in dysphagia screening and evaluation
Ot is trained to
select
administer
interpret dysphagia screening & assessment tools
62
provides early ID of clients who are at risk for a particular problem. Checks to see if there is further need for evaluation. Easy to use, quick, safe, inexpensive.
screening
63
provides a wide variety of information on how the client performs through an entire meal in the most natural setting
assessment
64
protocol for assessment
```
O Chart review & interview (feeding history)
O Cognitive component
O Visual perceptual component
O Physical component
O Test tray of different foods/textures
```
65
if a meal takes > __ minutes or < __ minutes, it is concerning
30, 10
66
example screening
```
O Under/over weight
O no weight gain in one month
O meal > 30 minutes or meal< 10 minutes
O signs of discomfort
O gagging, coughing, or choking
O difficult to position
O fed semi-reclined
O exclusive breast or formula fed
O not on table food at 16 months
O not using utensil by 2 1/2 years
O food refusal
O anatomic abnormalities
O garage feedings-tube
```
67
Fluoroscopic recording and videotaping of the anatomy and physiology of the oral cavity, pharynx, and upper esophagus using boluses to assess swallowing function
modified barium swallow
68
use of stethoscope or microphone to assess swallowing function by listening to the swallow sounds and concurrent breathing sounds
cervical ascultation
69
Process of passing a flexible fiberoptic endoscope through the nose and positioning it to observe structures and function of the swallowing mechanism to include nasopharynx, oropharynx, and hypopharynx.
fiberoptic endoscopic evaluation of swallowing (FEES)
70
Active swallowing by the patient allows for a measure of ____ _____ along the esophagus in manometry
muscle contraction
71
A procedure which measures the strength, timing, and sequencing of pressure events in the esophagus by a catheter with pressure transducers.
manometry
72
procedure for measuring the reflux
(regurgitation or backwash) of acid from the
stomach into the esophagus that occurs in
gastroesphageal reflux disease.
esophageal pH monitoring
73
probe monitors the ________in the esophagus and transmits the information to a recorder that is worn by the patient
acidity
74
if you thought a child had silent aspiration or might be at risk for aspiration, which test would you choose
modified barium swallow
75
if a client was complaining of a lot of pain while eating, which test would you choose
esophageal pH monitoring
76
if you were suspecting food wasn't going down because of a blockage, which test would you choose
fiberoptic endoscopic evaluation of swallowing (FEES)
77
in the pre-oral phase, what are somethings you want to screen for
```
Trunk control and positioning
Oral hygiene
Arousal
Attention
Orientation
Organization/problem solving
Behavior
Visual acuity & perception
Olfaction & gustatory sense
Habits
Affect
Stress & anxiety
Motor planning
UE control
```
78
what are difficulties associated with dysphagia during the oral preparatory phase
Poor lip closure
Difficulty holding a bolus together due to tongue movement or coordination
Difficulty creating a bolus
Food falling into sulci due to lip tone or strength
Difficulty holding food against palate
79
what are difficulties associated with dysphagia during the oral (transit) phase
Delayed initiation of oral phase due to apraxia
Deficient anterior tongue movement
Poor bolus mobilization
Difficulty contacting the hard palate with tongue
Deficient posterior tongue movement
“Piecemeal deglutition”
80
what are difficulties associated with dysphagia during the pharyngeal phase
Delayed “triggering” of the pharyngeal swallow
Reduced tongue base movements
Insufficient closure of the soft palate
Unilateral or bilateral pharyngeal weakness
Reduced laryngeal elevation
Laryngeal penetration or aspiration
81
what are difficulties associated with dysphagia during the esophageal phase
```
Incompetence of UES
Incompetence of LES
Abnormalities in flow of food
Anatomy
Stricturing (narrowing of esophagus)
```
82
can lead to swallowing difficulty with possible nocturnal aspiration of residue in the diverticulum.
Zenker diverticulum
83
Type of dysphagia where there is disruption of UMN causes alteration in sensation, tone, and coordination
Swallowing may be weak or poorly coordinated
Pseudobulbar
84
Type of dysphagia that results from lower motor cranial nerve involvement
Weakness
Sensory deficits
paralytic
85
Type of dysphagia where there is loss of motor or sensory innervation
Due to anatomical structure abnormality
mechanical
86
what you would see with dysphagia from CVA
```
Unilateral cortical
Poor coordination & reduced tone
Food loss
Boluses difficult to control
Food pocketing
Reduced oral sensation
Delay in swallow response
Pharyngeal weakness
```
87
what you would see with dysphagia from TBI
Deficits depend on location and size of lesion
Similar to strokes
Behavioral and cognitive challenges
Postural challenges due to tone
88
difficulties of feeding with MS
progressive oral and pharyngeal weakness,
89
difficulties of feeding with PD
oral and pharyngeal muscle weakness
Develop delayed swallow response and reduction in airway protection, which makes them at risk for aspiration.
Weak cough
Weakness or spasticity in limbs
90
difficulties of feeding with AD
Forgetting when to eat
Develop dyspraxia (forget what the purpose of things are)
Sensory aversion
91
difficulties of feeding with ALS
```
Spasticity
Decreased endurance (reduce amount of food you give them)
```
92
difficulties of feeding with MG
Oral and pharyngeal muscle weakness
| Fatigue
93
feeding problems may occur due to what 3 things
Motoric problems
Sensory processing problems
Behavioral problems
94
what might contribute to motoric feeding problems
decreased ROM
irregular tone
praxis problems (motor planning)
95
what might contribute to sensory feeding problems
oral tactile aversion
gustatory aversion
low registration to sensory information of food
96
motoric feeding interventions are targeted to assist the client with:
Successfully bring food or drink to the mouth without spilling
To independently feed him or herself age appropriate or developmentally appropriate meals
Maintain correct and safe posture for feeding and drinking
97
posture feeding interventions (motoric)
Appropriate posture for feeding based on client’s needs
Seating system
Positions to reduce tone or provide enough support for low tone
Upright position may be best if there are pharyngeal problems requiring chin-tuck modified swallowing
Therapist posture/position
98
advantages/disadvantages of front positioning of therapist
advantages: can look at symmetry, they can see you, better body mechanics
disadvantages: if they have a lot of tone, it's hard to control them
99
advantages/disadvantages of side positioning of therapist
advantages: can use more parts of your body to support them
disadvantages: can't see the other side of body
100
advantages/disadvantages of behind positioning of therapist
advantages: Hand over hand scooping
Providing jaw support
Helping facilitate the lips and other muscles
disadvantages: can't see face
101
gathering food on utensils interventions (motoric)
Adaptive Equipment
| Practice scooping and transporting of non-food items or food items to self or other container
102
bringing food or drink to mouth interventions (motoric)
Resting elbows on tray or table for greater stability
Provide tactile cueing at mouth
Provide physical assistance if spillage is an issue, even after AE is used
103
apraxia interventions (motoric)
Consistent environment
Minimal conversation
Milieu in which client’s responses are expected
Hand-over-hand guiding techniques
Alternating food textures and tastes may stimulate sequencing
104
Facilitating arousal to oral areas interventions (oral preparatory)
Towel swipes
Facial massage
Vibration
Beckman oral motor exercises
105
Facilitating increased ROM interventions (oral preparatory)
ROM to oral structures
Tongue lateralization
Beckman Exercises
106
strengthening interventions (oral preparatory)
```
Bite blocks
Gauze chewing (putting food in gauze wrap and have them practice chewing)
```
107
how to facilitate a bite reflex
avoid tugging or pulling on the spoon, use a coated spoon, turn spoon slightly, provide downward pressure on chin to release the bite, you can also provide pressure on the condyle region of the TMJ while applying downward pressure on the mandible to try and release the bite.
108
how to facilitate tongue thrust
The client may need to eat thicker foods to reduce tongue thrust. Provide downward pressure on tongue when presenting the bite to prevent tongue thrusting, encourage backward and forward motion of the spoon to help the tongue retract. Facilitate mouth closure after the bite to reduce tongue thrust. For clients who can follow HEPs, you can practice the tongue-thrust, slurp, swallow method which is demonstrated during the first minute of the you-tube clip. This technique facilitates tongue retraction.
109
how to facilitate chewing
Pre-requisites of chewing include- 1) can swallow without coughing, 2) cognitive development above 6-8 mos, and 3) demonstrates adequate jaw support. Client must also have tongue lateralization and up and down munching movements of the jaw prior to chewing. You can facilitate chewing by placing long narrow food in between the molars (licorice) and facilitate jaw control- soft foods that can easily be broken down or food can be easily broken down by saliva. If the food is not easily broken down then place the food in cheese cloth or gauze.
110
how to facilitate tongue lateralization
can be performed by taking a nuk brush or a tongue depressor and touching it to the sides of the mouth, teeth, roof of mouth or lips by the therapist and having the client follow with his or her tongue.
111
working on oral management is best accomplished when the client is :
Alert
Can maintain adequate trunk and head positioning with assistance
Need to be gaining tongue control
Can manage secretions with minimal drooling
Has a reflexive cough
112
exercise and facilitation technique interventions (pharyngeal phase)
biofeedback
| thermal stimulations
113
how to stimulate a swallow
```
Temperature (cold bolus)
Sour bolus
Carbonated bolus
Textured bolus
Dry swallows
```
114
types of modified swallows
Chin tuck
Head turn/rotated
Effortful swallow
Supraglottic swallow
115
This technique involves simultaneous swallowing and breath-holding, closing the vocal cords and protecting the airway. The patient thereafter can cough to expel any residue in the laryngeal vestibule. The Valsalva maneuver may be used to maximize vocal cord closing
Supraglottic swallow
116
Dysphagia Management for Patients with Progressive Neurological Disorders
```
Rest before eating
Position chair so that it is accessible
Lightweight utensils
Hotplate
Cups with spouts
Straw drinking
Built-up handles
Ample time to eat
High caloric mini meals
Remain upright after the meal
Oral hygiene following all meals and snacks
```
117
Interventions for Unilateral CVA: R or L
Avoid thin liquids and sticky boluses
Have client hold lips closed on paretic side
Provide cheek and lip support to maintain straw or spoon.
Increase flavor of bolus
Provide bolus of 10-20 mL to improve swallow
Practice chewing with gauze on the hemiparetic side to build musculature
Have client sweep tongue across cheek and perform cheek massage to clear pocketing on hemiparetic side
Thermal tactile stimulation
Head rotation to affected side
Chin tuck
118
Interventions for L CVA only
Use tips for feeding a client with apraxia
Hand of hand guiding
Cheek stimulation
Use gestures and non-verbal cues more than verbal cues
119
Interventions for R CVA only
Provide assistance to grade bolus size
Gentle external stimulation to cheek to facilitate lip seal
Rubbing cheek on paretic side to clear food
Pinch straw or provide HoH A for control cup drinking to limit bolus consumption
Chin tuck or rotation techniques
Coughing after swallows
120
Interventions for brainstem CVA
```
Sensory stimulation techniques
Thermal tactile stimulation
Strengthening exercises for the larynx
Chin tuck
Mendelsohn Maneuver
```
121
Interventions for multiple CVAs
More compensatory vs. rehabilitative interventions
Diet manipulation- avoiding thin liquids or loose foods (thickened purees)
Potentially alternative nutrition methods than oral nutrition
122
Interventions for brain injury
Stabilization of the body using proper positioning
Inhibition techniques to manage hyper or hypo-tonicity prior to feeding
Interventions focused on triggering a swallowing reflex and tong control (biggest areas of deficit in this population)
Oral preparatory interventions to help client control the bolus
Desensitization programs to decrease pathological reflexes
Have client sweep tongue on both sides and massage both cheeks or on affected side if unilateral weakness to clear pocketing
Thermal tactile stimulation
Extra time at meals given
Diet texture manipulation to reduce aspiration risk (avoid thin liquids)
Swallowing retraining
123
Interventions for brain tumors
ROM and resistive exercises to oral muscles innervated by cranial nerves to maintain strength required for oral manipulation of food
Retraining sensation to oral motor structures
Similar strategies to CVA for swallowing
Thermal tactile stimulation
Effortful swallow, supraglottic swallow or super-superglottic swallow
124
Interventions for MS
Modified swallowing techniques taught early on in disease process
ROM and strengthening to improve weakness of facial and oral muscles- DO NOT over exert client
Seating and positioning especially for head positioning
Adaptive equipment for eating
Provide modified easy-to-use meal programs to assist with frontal lobe memory loss for client and caregiver
Thickened liquids
Chin tuck
125
Interventions for PD
Coincide mealtime when medications are most effective
Stretching of upper body, shoulders and neck to reduce rigidity before meals
Positioning to reduce tremors
Adaptive equipment (especially weighted equipment- can reduce spilling caused by tremors)
Supervision during feeding to facilitate appropriate grading of the bolus
AROM for oral structures prior to feeding
Voice treatment to strengthen phonation helps with oral and pharyngeal phases of swallowing
126
common dysphagia problem where foreign substances enter lungs on inhalation
aspiration
127
common dysphagia problem where there is inflammation of the lungs caused by foreign substances
pneumonia
128
food or secretions when inhaled “aspirated” may cause
aspiration pneumonia
129
greater than average fluid loss from the body or fluid intake below the recommended amount can lead to ____
dehydration
130
causes of greater than average fluid loss
increased urination, diarrhea, vomiting, excessive drooling, perspiration
131
causes of fluid intake below the recommended amount
problems in sucking, drinking, or swallowing
inability to communicate thirst
incorrect mixture of tube feedings or formulas
loss of appetite from medications
132
how can we help with excessive drooling
verbal cues, positioning
133
symptoms of dehydration
loss of body weight
reduced output of urine or no urination
excessive thirst, loss of appetite, dryness of mouth, and mucous membranes
sunken eyes
increased respiration, and heart rate
lethargy, drowsiness, irritability, flushed skin, etc.
134
conditions associated with dehydration
Oral motor feeding difficulties, especially with drooling
Short-bowel syndrome or ileostomy
Conditions with prescribed diuretics such as cardiac conditions or BPD
Seizures: seizure medication can cause constipation
Inability to signal thirst
135
Infrequent passage of feces or the passage of extremely hard, dry fecal matter
constipation
136
An ____ _____ and a ____ ______ are the most important signs to monitor for the presence of constipation.
irregular pattern and hard stool
137
Constipation can cause
discomfort, pain, swelling of abdomen, and irritability
138
causes of constipation
decreased physical activity
dehydration
abnormal muscle tone leading to impaired function of the intestinal tract
lack of routine toileting habits or the inability to attain an upright, supported position for toileting
Child who is extended has difficulty producing a bm due to not being able to obtain enough flexion
abnormal anatomy or neurological function of the intestinal tract
139
type of non-oral feeding given to a client on life support
parenteral nutrition
140
all nutrients provided intravenously by not using the gastrointestinal tract. The IV solution contains pre-digested nutrients that are absorbed directly at the cellular level
parenteral nutrition
141
non-oral feeding that is preferred. Uses the GI tract.
enteral nutrition
142
why is enteral nutrition the more preferred route
```
less risks involved
maintain use of intestines
cost effective
formula is easy to prepare, and
the procedure may be more accepted by the consumer
```
143
Tube placement where it is passed through the mouth into the stomach. Usually inserted at mealtime and removed following feeding.
oral gastric
144
Tube placement where it is passed through the nose into the stomach. Generally used on a short-term basis.
nasogastric (NG tube)
145
Tube placement where it is passed directly into the stomach through the abdominal wall. Used for moderate-term or long-term basis.
gastrostomy (G tube)
146
Pros and cons of NG tube
+ nonsurgical
+ bolus or continuous
+ allows for prefeeding and feeding while in place
- desensitizes swallowing response
- increase aspiration risk, pharyngeal -secretions, & nasal reflux
147
Pros and cons of G tube
- surgical
+ bolus or continuous
+ allows for prefeeding & feeding program
+ less risk of reflux & aspiration
+ does not irritate the swallowing mechanism
- stoma can be inflamed
- families perceptions
148
dysphagia diet 1
Thin liquids (e.g., fruit juice, coffee, tea)
149
dysphagia diet 2
Nectar-thick liquids (eg, cream soup, tomato juice)
150
dysphagia diet 3
Honey-thick liquids (ie, liquids are thickened to a honey consistency
151
dysphagia diet 4
Pudding-thick liquids/foods (eg, mashed bananas, cooked cereals, purees)
152
dysphagia diet 5
Mechanical soft foods (eg, meat loaf, baked beans, casseroles)
153
dysphagia diet 6
Chewy foods (eg, pizza, cheese, bagels)
154
dysphagia diet 7
Foods that fall apart (eg, bread, rice, muffins)
155
dysphagia diet 8
Mixed textures (eg, chicken noodle soup)
156
S&S of dysphagia
Difficulty initiating swallowing
A feeling of obstruction as if food has become stuck in the throat
Voice change
Difficulty with chewing or weakness of muscles of mastication
Pocketing of food in the mouth
Coughing after eating
Drooling
Impaired gag reflex and ability to clear bolus, cough, and /or breath
Nasal regurgitation
Weight loss
Recurrent pneumonia
