General Flashcards
(20 cards)
Definition
disorder of, or difficulty swallowing (pain, coughing, choking, food sticking, drooling, regurgitation, weight loss)
*is a secondary diagnosis
Risks for aspiration pneumonia
(Langmore et. al. 1998)
- feeding tube (more colonization)
- dependent for feeding
- dependent for oral care
- number of decayed teeth
- presence of tooth decay/periodontal disease
- immunocompromised
- smoking
- multiple medical diagnosis/multiple medical medications
Swallow center
in the brainstem, associated with medulla
- involves precisely timed movements of 25+ muscles cordinated by generators in the reticular formation
- sensory info arrives at NTS and motor responses are generated in nucleus ambiguous and hypoglossal nucleus
Oral Preperatory Phase
food/liquid enters mouth and is manipulated into a cohesive bolus
- food containment within oral cavity
- problems: anterior or posterior spillage
Oral Phase
tongue begins to propel bolus towards pharynx
-problems: difficulty initiating swallow (delayed swallow)
Pharyngeal Phase
bolus reaches ramus of mandible and BOT
- swallow reflex should be triggered
- arytenoids medialize towards petiole of epiglottis, laryngeal vestibule lifts to retroflex epiglottis, VFs adduct to close off airway, pharyngeal constrictors squeeze bolus through pharynx towards esophagus
- problems: inadequate bolus clearance (residue in BOT, vallecula, pyriforms, diffuse)
- CN X relaxes cricopharyngeus muscle to open UES
Esophageal Phase
bolus passes through UES into esophagus
-Peristalsis continue (CN X)
pharyngeal delay
- seconds until swallow begins
- start timing when bolus reaches ramus of mandible and BOT
- note how far bolus spills before swallow triggered
- liquids on commands: <.5 seconds
- no command: liquids .8 seconds; food 1.3-1.6 seconds
- general… should be less than 3 second delay
residue indications
- laryngeal vestibule: epoglottis did not retroflex/comletely retroflex
- lateral channels: arytenoids did not cover cover glottis well enough
- beneath VFs: VFs did not close or timing was off
Trach patients
-blue dye screening: check immediately after swallow and 30 minutes after.. suction device inserted into trch to see if dye is present
swallow frequency
normal= every 2/3 minutes with scope in place
indicators of aspirations
throat clear before or after swallow
coughing before/after swallow
change in vocal quality
silent aspiration
protocol 201
(logemann)
- immediate effects of thin and thick liquids.. honey thick was aspirated the LEAST
- BUT: long-term effects found that honey-thick group was more dehydrated, had longer hospitalizations in long-term effect study over 3 months.. also more likely to get pneumonia if honey was aspirated
3 oz Water Swallow Test
- Suiter and Leder (2007)
- goal is to predict ASPIRATION in IPs
- very sensitive, but not very specific (too many people referred when they did not actually aspirat)
TOR-BSST
- Marinto
- administered by nurses
- goal to predict DYSPHAGIA
- 4 predictors of dysphagia: voice before, tongue movement, water swallow test (50 ml), voice after
- pt referred for instrumental if they follow and of the 4 predictor items
pons damage
delayed pharyngeal swallow
reduced hyolaryngeal excursion with CP dysfunction
Medullary damage/ stroke
- absent pharyngeal swallow (THE WORST)
- reduced hyloaryneal excusrion
- unilateral vocal fold paresis/paralysis
food and liquid consistency order
- ice chips
- thin liquid
- thick liquid (nectar/honey..milkshakes)
- puree (applesauce, etc)
- semi-solid food (mashed patato, banana, pasta)
- soft solid food (requires some chewing): bread and cheese, soft cookie, casserole, veggies
- hard,chewy,crunchy: meat, salad, raw fruit
- mixed consistencies: soup with food, cereal and milk
-bolus size progression
- <5 cc if pt is medically fragile
- 5 cc (1 tsp)
- 10 cc
- 15 cc ( 1 tbsp)
- 20 cc (heaping tablespoon)
- single swallow from cup/sraw (monitoreD)
- single swallow from cup/straw self-controlled
- free consecutive swallows
- feed self at own rate
Oral Care!!
(Adachi et al)
-fatal aspiration incidence is lower in nursing how where professional oral care given
(Sjogren, et al)
-systematic review- found that RCTs show positive preventative effects of oral care on pneumonia
