Final Exam Flashcards
(101 cards)
1
Q
What is the difference between FEES and MBS?
A
FEES:
- Videoendoscopy in which a flexible scope with a camera is inserted into the nose to the level of the velum.
- It examines oral and pharyngeal structures.
- Green food coloring is added to the different consistencies to highlight the bolus.
- Aspiration during swallow can only be inferred due to white out period.
- Performed in the superior view.
- Performed by SLP who has been trained in FEES.
MBS:
- X ray technique that examines the oral, pharyngeal, and esophageal structures by adding barium to a variety of consistencies for the pt. to swallow.
- Performed in the lateral view w/supplementing anterior-poster view if needed.
- Performed in radiology dept. by SLP
2
Q
What are the pros of an MBS vs. FEES?
A
- MBS can look at the esophagus; FEES does not.
- MBS views the entire swallow - no white out period.
- MBS is the most frequently used technique.
- MBS does not use specialized equipment (FEES needs endoscope and standard FEES cart)
- MBS is not invasive
3
Q
List the pros of FEES vs. MBS.
A
- FEES allows for flexible positioning
- Better for bed-bound pts or large pts
- Better for voice pts.
- Portable
- Can be performed by the SLP alone
- Imaging is in color so you can look at the tissue health.
4
Q
What consistency do you start with in an MBS?
A
Thin liquids so that you don’t confound the study by residue from thicker liquids.
5
Q
What are 3 medical red flags to look for during a clinical bedside swallow eval?
A
- Diagnoses
- Does the pt. need to be fed by caregiver?
- Age/frailty
6
Q
What are 3 oral red flags to look for during a clinical bedside swallow eval?
A
- Difficulty taking material from utensil?
- Pocketing?
- Leakage of material out of oral cavity?
(4. Drooling)
7
Q
What are 3 pharyngeal red flags to look for during a clinical bedside swallow eval?
A
- Coughing
- Throat clearing
- Wet voice quality
(4. Drop in O2 sats below 90)
8
Q
What are 3 esophageal red flags to look for during a clinical bedside swallow eval?
A
- Belching
- Heartburn
- Globus sensation
9
Q
What is the difference between an MBS and an Esophagram?
A
MBS is an x-ray technique performed by an SLP in the radiology department that uses a variety of consistencies w/barium in them. MBS looks at oral, pharyngeal, and esophageal structures.
An Esophagrum (AKA: Barium Swallow Study) is an x-ray technique that also uses barium, but is performed by a radiologist (not an SLP) and looks at pharyngeal and esophageal structures as well as the stomach and duodenum.
10
Q
What are some behavioral treatments for GERD?
A
- Elevate head of bed 6-8 inches.
- Eat more smaller meals throughout the day.
- Watch weight.
- Use PPIs or H2 receptor blockers
11
Q
What are 2 surgical treatments for GERD?
A
- esophageal dilation
2. Stretta system
12
Q
What is an exercise for GERD?
A
Diez Technique
13
Q
Explain the Diez Technique
A
-Exercise for GERD:
- Place material in mouth
- Inhale through nose, expanding the rib cage w/diaphragmatic breathing and hold.
- Swallow
- Exhale S-L-O-W-L-Y
14
Q
Explain the Blue Dye Test. What is it used for, and how do you do it?
A
This test is used for detecting aspiration during a swallow in trach patients.
- Check if pt. can voice by occluding stoma w/finger. If pt. cannot achieve voicing, they’re not ready for swallowing.
- Use finger occlusion or valve during swallowing bc a closed pressure system may help the pt. swallow.
- *Do bedside swallow eval as usual, but add blue food coloring or grape juice to all consistencies. (DO NOT FORGET TO DEFLATE THE CUFF!!!)
- Suction immediately after each swallow, 10 minutes later, & 20 minutes later. Nurse will continue to monitor throughout the day.
15
Q
____ pts are often silent aspirators.
A
Trach pts.
16
Q
List 3 milestones that occur between 0-3 months.
A
- Jaw, tongue, and cheeks work as a unit.
- Sucking pads
- Reflexes: rooting, gag reflex.
17
Q
List 3 milestones that occur between 3-6 months.
A
- Spoon feeding introduced between 4-6 months
- Sucking pads disappear by 6 months
- *Begins to have a choice about eating, vs. an automatic response when given the bottle.
18
Q
List 3 milestones that occur between 6-9 months.
A
- Learns about pressure (raspberries)
- *Strong active suck (vs. reflexive)
- Cup drinking: gulping w/tongue under cup surrounded by lower lip.
19
Q
List 3 milestones that occur between 12-18 months.
A
- Active lips clean spoon.
- **Rotary chewing begins (18 months)
- Spits food
20
Q
List 3 milestones that occur around 24 months.
A
- Tongue becomes major cleaner inside & outside of mouth.
- Good lip closure.
- Controlled, sustained bite.
21
Q
Around what age are oral motor feeding skills and coordination fully established?
A
4-5 years
22
Q
At how many weeks gestation are the Suck-Swallow-Breathe structures present?
A
3.5 weeks of gestation!
23
Q
During gestation, around how many weeks does the swallow first occur?
A
14-17 weeks gestation (15 oz of amniotic fluid/day)
24
Q
At how many weeks gestation does the S-S-B begin to have coordination?
A
31-33 weeks gestation
25
At how many weeks gestation is the S-S-B functionally mature?
37-38 weeks or longer.
26
What is the anatomical link between the S-S-B structures?
Hyoid bone
27
T/F: S-S-B is a reflex and thus cannot be learned.
TRUE
28
What is the nutritive suck rate?
1 suck/second
29
What is the fully mature S-S-B pattern?
20-30 sucks/burst
30
What are sucking pads?
Fatty tissue pads that are surrounded by inactive cheek muscle that provide stability and support to help the baby's tongue compress the nipple and to control/direct the liquid flow.
31
When are sucking pads developed?
The last 2 weeks in utero
32
At what age do sucking pads disappear?
6 months old
33
What are 2 of the first stress signs/symptoms of an infant?
1. Facial changes --> eyes, eyebrows
| 2. Pulling away/ "stop sign" -->hand displayed, fingers splayed
34
What are 2 moderate stress cues of an infant?
1. Yawning
| 2. Startling
35
What are 2 major stress cues of an infant?
1. Color change
| 2. Gagging/choking
36
What are 2 behavioral stress cues of an infant that relate to feeding?
1. "Shutting down"/going to sleep (often briefly)
| 2. Pushing bottle away
37
What are 3 signs of GER in infants?
1. Eats small amounts/self limits
2. Turns head to left during or after feeding (Sandifer sign)
3. Arches back into hyper extension during or after meals.
38
What are 4 GERD management techniques/treatment strategies for infants?
1. Parental counseling
2. Formula changes
3. Position changes
4. NEVER give babies antacids due to aluminum toxicity!
39
***What are 5 diagnoses at risk for children to have oral motor feeding problems?
1. Neurological impairment (CP, TBI)
2. Drug/alcohol exposure
3. GI issues
4. Negative oral stimulation
5. Poor caregiver bond
40
What are 3 common red flags for infants that warrant a referral?
1. Needing to be fed every 30-40 minutes
2. Unexplained food refusal
3. Weight loss or lack of weight gain
*Infants on nipple feeds: weak suck, S-S-B incoordination
41
What is tone?
- Tension
- Resistance to movement
- Balance: lengthening and shortening of muscles that allows us to move
42
What are the 3 types of tone?
1. Hypertonia (increased)
2. Hypotonia (decreased)
3. Flucuating (most challenging)
43
What are 2 factors that can alter tone?
1. Constipation
| 2. Position
44
What are 3 abnormal tone risk factors?
1. Low birth weight/prematurity
2. Multiple births
3. Infections during pregnancy
45
What is aversion?
When a baby who is physically capable of feeding/eating exhibits partial or full food refusal.
46
T/F: Aversion can be to touch, taste, temperature, textures, smells, or sight
TRUE
47
What are some responses that indicate a feeding aversion?
Crying, grimacing, wiggling, arching away, shutting down/"sleeping", gagging, vomiting, & keeping tongue glued to roof of mouth.
48
What are 4 feeding problems that can occur with babies/toddlers?
Food refusal, aversion & selectivity, oral motor problems, & dysphagia.
49
What are 2 reasons for tracheostomy tubes?
1. Upper airway obstruction at or above the level of the true VFs
2. Potential airway obstruction (e.g., edema following surgery)
50
List at least 5 physiological changes that occur because of trach tubes?
1. Phonation
2. Humidification/filtration/warming
3. Secretions
4. No Valsalva maneuver (ability to bear down)
5. Bathing and showering -- & can't go swimming anymore!
6. Swallowing problems because trach tube anchors the larynx thus reducing laryngeal elevation- also decreases S-G pressure.
51
List the parts of a trach tube.
Outer cannula
Inner cannula
Obturator
52
What is a common type of speaking valve used for trach pts?
Passy-Muir Valve (allows air to come in through the trach tube but not out, forcing air up through the vocal folds, allowing a voice to be produced)
53
When should valves be used for trach pts?
- As part of the weaning process
| - To create a closed pressure system
54
What is the Frazier Water Protocol?
Allowing oral water safely to patients w/dysphagia or chronic dehydration.
55
Explain the Frazier Water Protocol.
RULES:
* Oral water is allowed UNTIL THE FIRST BITE OF A MEAL.
* No water is allowed during meals unless it is thickened as prescribed.
* After the meal, the pt's mouth is sanitized and water is permitted again.
- The use of all other swallowing strategies determined by the SLP are encouraged.
- All hospital staff who interact w/the pt are trained in teh protocol.
56
Who is not appropriate for the Frazier Water Protocol?
Super Coughers
57
Who CAN benefit from the Frazier Water Protocol?
Pts who:
- are NPO
- have thickened liquids as part of their diet
- have chronic dehydration problems
58
What is a hiatal hernia?
When part of the stomach gets pulled up through the hiatius of the diaphragm
59
What is peristalsis?
The wave-like contractions that the esophageal muscles make in order to move the food from the esophagus into the stomach.
60
Which cranial nerves are involved in swallowing?
```
V - Trigeminal
VII - Facial
IX - Glossopharyngeal
X - Vagus
XI - Spinal Accessory
XII - Hypoglossal
```
61
What are the 5 POSITIONS you can recommend for pts w/dysphagia?
1. Head turns
2. Head tilt
3. List to left or right
4. Recline
5. Upright 90 degrees (always optimal)
62
Which POSITION would you recommend for a pt. with a glossectomy (no tongue)?
Recline
63
Which POSITION would you recommend for a pt. with unilateral oral weakness?
Head tilt during chewing
| chew on strong side so as not to pool on the weak side
64
Which POSITION would you recommend for a pt. with unilateral pharyngeal weakness?
Head turn to the WEAK side DURING a swallow to close off the weak side.
Head turn to the STRONG side AFTER a swallow to open the weak side and clear the material away.
65
What are the 8 swallowing STRATEGIES for pts w/dysphagia?
1. Small bites
2. Chin tuck
3. Hard effortful swallow
4. Repeat/extra swallows
5. Periodic throat clears
6. Alternate solids w/liquids
7. Super supra-glottic swallow
8. Mendelsohn Maneuver
66
Which STRATEGY would you recommend for a pt. with premature spillage into the pharyngeal area while chewing?
Chin tuck
67
Which STRATEGY would you recommend for a pt. with a swallow delay
Chin tuck
68
Which 3 STRATEGIES would you recommend for a pt. with decreased posterior tongue retraction
1. Hard effortful swallow
2. Repeat/extra swallow
3. Alternate solids w/liquids
69
Which 3 STRATEGIES would you recommend for a pt. with decreased posterior pharyngeal wall contraction?
1. Hard effortful swallow
2. Repeat/extra swallow
3. Alternate solids w/liquids
70
Which 3 STRATEGIES would you recommend for a pt. with decreased laryngeal elevation?
1. Mendelsohn Maneuver
2. Repeat extra swallow w/head turns
3. Alternate liquids w/solids
71
Which 2 STRATEGIES would you recommend for a pt. with residue in the valleculae?
1. Repeat/extra swallow
| 2. Alternate solids w/liquids
72
Which 2 STRATEGIES would you recommend for a pt. with residue in the pyriform sinuses?
1. Repeat/extra swallow
| 2. Alternate solids w/liquids
73
Which 2 STRATEGIES would you recommend for a pt. with a paralyzed vocal fold?
1. Supra super-glottic swallow
| 2. Head turn
74
What are the 6 EXERCISES for dysphagia?
1. Oral motor exercises
2. Laryngeal elevation exercises (Mendelsohn)
3. Vocal fold closure exercises (Lee Silverman)
4. Shaker exercises (C-P sphincter opening)
5. Masako Maneuver (post. tongue retraction & post. pharyngeal wall contraction)
6. Therabite Jaw Motion Rehab System (jaw excursion)
75
Which EXERCISE would you recommend for a pt. with a tight C-P sphincter?
Shaker
76
Which EXERCISE would you recommend for a pt. with residue in the valleculae? (dec. laryngeal elevation)
Mendelsohn
77
Which EXERCISE would you recommend for a pt. with residue in the pyriform sinuses? (dec. laryngeal elevation)
Mendelsohn
78
Which EXERCISE would you recommend for a pt. with a paralyzed VF?
Vocal Fold Closure exercises (shouting, bearing down on chair while voicing, etc...)
79
Which EXERCISE would you recommend for a pt. with leakage out of the oral cavity and pocketing?
Oral Motor exercises (tongue, lips, etc...)
80
Which EXERCISE would you recommend for a pt. with decreased posterior pharyngeal wall contraction?
Masako Maneuver
81
Which EXERCISE would you recommend for a pt. with decreased posterior tongue retraction?
Masako Maneuver (pt anchors tongue tip w/teeth and performs a dry swallow)
82
Which EXERCISE would you recommend for a pt. with TMJD or trismus?
Therabite
83
What does DPNS stand for?
Deep Pharyngeal Neuromuscular Stimulation
84
What does NMES stand for?
Neuromuscular Electrical Stimulation
| Brand Name: Vital Stim
85
What is a manual treatment stimulation technique used to correct restrictions in muscle and connective tissue and improve pt's ability to develop muscular tension for successful swallowing?
Myofacial Release
86
List some types of enteral routes of administration
- NG tube (Nasogastric tube)
- Gastrostomy (G tube)
- PEG tube (Percutaneous endoscopic tube)
- J tube (Jejunostomy tube)
- TPN (total paraenteral nutrition)
87
List the stimulation techniques (there are 4)
1. DPNS
2. NMES
3. Myofacial Release
4. Thermal-tactile Stimulation
88
What does LPR stand for and what is it?
Laryngopharyngeal Reflux: backflow from stomach all the way into the THROAT (known as daytime reflux) - only 50% of people report heartburn.
89
What does GER stand for and what is it?
Gastroesophageal Reflux: backflow from the stomach into the esophagus (known as nighttime reflux) - people usually report heartburn.
90
What are some signs and symptoms of LPR?
```
Hoarseness
Sinus congestion
Post Nasal Drip (PND)
Chronic cough
Halitosis
Heartburn
Tooth decay
```
91
What are the 5 etiologies (e.g., influences) of GERD?
1. Esophageal influences (decreased LES resting tone)
2. Trauma/surgical influences (excessive vomiting)
3. Infection influences (fungal-candida, or viral- herpes)
4. Food/liquid influences (alcohol, caffeine, spicy foods)
5. Other influences (obesity, overeating, pregnancy)
92
What does EGD stand for?
Esophagogastroduodenoscopy :)
93
What is esophagogastroduodenoscopy (EGD)?
An outpatient procedure performed by a GI doctor w/an endoscopy scope and camera that goes through the mouth and into the esophagus and can look into the stomach. (Pt. is in twilight during procedure)
-Good for looking at anatomy
94
What are the 3 radiation safety guidelines?
1. Barrier (lead apron & thyroid wrap)
2. Distance
3. Time (measured by Dosimeter)
95
What is a therapeutic diet vs. mechanical diet?
Therapeutic: alters NUTRIENTS to help treat a medical condition.
Mechanical: alters TEXTURES to help treat a medical condition.
96
List some enteral feeding complications.
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Tube occlusion
- Aspiration
97
What are 3 diagnoses at risk for dysphagia (adults)?
- Neurological events (CVA, TBI)
- Neurological diseases (Parkinson's, Alzheimers)
- Head and Neck Cancer
98
MBS SOAP Notes: What is listed under the "Subjective" section
```
Age
Level of care
Medical history
Bedside swallow findings
Pt. complaints
MD concerns
Referred for...?
```
99
MBS SOAP Notes: What is listed under the "Objective" section
VIEWS (lateral, A-P)
POSITION (seated upright 90 degrees)
TEXTURES PRESENTED (thin & thick liquids, pureed, wet soft, dry soft, dry crumbly, meat, tablet/pill
100
MBS SOAP Notes: What is listed under the "Assessment" section
PHASES OF SWALLOWING (Oral preparatory phase, oral transit phase, pharyngeal phase, esophageal phase, + structural anomalies & penetration/aspiration)
STRATEGIES & POSITIONS TRIED --> what worked and what did not work.
101
MBS SOAP Notes: What is listed under the "Plan" section (8 things)
```
Treatment (how many sessions & for what)
Diet Recommendations
Strategies
Exercises
Positioning
Stimulation Techniques
Additional Recommendations
Goals
```
