midterm Flashcards

Question

What about ACUTE strokes?

Answer 1

-PNA noted in 10% of acute stroke pt ~contributed by dysphagis ~aspiratation of foods / liquids/ oropharyngeal secretions ~dependence on nonoral feeding (PEG) = HIGHER respiratory infection - nutrition / hydration deficits ~prevalence of nutritional deficits from hosptial to rehab =50% ~dehydration = 53% (increase w/ dysphagia) -NIHSS national institute of health stroke scal ~determines stroke severity

Answer 2

1. poor bolus control: involuntary movements ~oral ~oropharyngeal 2. residue from inefficient swallow ~oral ~oropharyngeal ~pharyngeal 3. difference among swallow types ~automatic vs. intentional movement

Answer 3

-slow progressive disease of the basal ganglia -key problem in execution of voluntary movements -resisting tremor, bradykinesia (slow progressive hesitations or halts in movement/speed), rigidity (stiffness)

Answer 4

-lingual tremor -repetitive tongue -prolonged ramplike posture -piecemeal deglutition -velartremor -buccal retention

Answer 5

-vallecular retention -piriform sinus retention -impaired laryngeal elevation -airway (supraglottic) penetration -aspiration

Answer 6

-drooling -excess and reduced secretion management -sensory impairment -reduced frequency of spontaneous swallowing

Answer 7

-delayed emptying of the stomach -vagus nerve damage -sx: heartburn, nausea, vomiting, & feeling full quickly

Answer 8

- HOME of SWALLOWING center - major ascending sensory tracts receive input from the head & neck region by way of cranial nerves -coordinates swallowing mechanism & breath swallow coordination damage to BS: -sensory deficits to head/neck -motor deficits w/ upper & lower motor neurons medulla oblongata: swallowing

Answer 9

-LMN connect w/ muscles at the myoneural junction -Damage can cause: ~flaccid weakness (reduced muscle tone) ~WORESNING MOTOR FUNCTION W/ USE ~RECOVERY OF MOTOR FUNCTION W/ EXTENDED REST ~ sensory loss

Answer 10

-disease that affects LMN and peripheral muscle groups are progressive -diet modification -behavior modification -establish oral vs. nonoral nutrition -exercise can fatigue muscle groups -med Tx: Intravenous Immunoglobulin Therapy

Answer 11

-structural disorders cause obstruction of bolus passage -ES: narrowing of the lumen or channel of the esophagus -difficulty w/ tough, dry, fibrous solids & soft absorbent solids that swell when mixed w/ saliva (bread pasta) -difficulty w/ liquids after esophageal impact of solids -1/3 pt w/ obstruction near distal esophagus point to their neck as the site obstruction (innacurate sensation) -esophagus size in pt w/ luminal --> less than 12mm -can be caused by rings, web, benign structure, or malignant structures

Answer 12

-band of tissue made of mucosa and submucosa --> located in esophagogastic junction -Schatzki's ring: MOST COMMON; bandlike, symmetric , ring tissue that forms inside esophagus/ causes: esophageal narrowing -tx: dilation

Answer 13

-ban of tissue made of mucosa and submucosa located in esophagus or hypopharynx -not associate w/ anemia -frequently asymetric -dysphagia w/ solids -tx: dilation

Answer 14

-zenker's diverticulum occurs when pouch of tissue forms above where the pharynx meets esophagus -Cause: increased pressure inside esophagus, resulting in tightening and bulging above point of pressure -SX: bad breath, weight loss, globus sensation, chronic cough, dysphagia, delayed regurgitation -esophageal diverticulum is rare and usually asymptomatic -SX: dysphagia of solids/ liquids w/ delay regurg.

Answer 15

-peristaltic, wave like movement of food through esophagus -normal esophageal transit: 8-20 seconds

Answer 16

-common cause of esophageal dysmotility -can coexist w/ esophagitis -further aggravated by hiatal hernia in place due to compromised LES (lower esophageal sphincter) protective barrier by pushing LES into chest cavity -Eval: 24hr monitoring (nasogastric catheter placement) -fluorosocopy

Answer 17

-GERD is a common physiological event due to constantly changing pressure relation between stomach and esophagus -LES briefly relaxes, stomach content enter the distal esophagus, and immediately clear back into the stoma

Answer 18

when sx such as heartburn, chest pain, regurgitation, and dysphagia, become overt

Answer 19

-when gastric content reaches the laryngeal/ pharyngeal level -Globus sensation, odynophagia, chronic cough, hoarseness, chronic throat clearing, sore throat -Endoscopy findings: mucosal abnormalities on the PPW, edema on arytenoids cartilages, and generalized erythema in the laryngeal vestibule

Answer 20

-alternation of lifestyle -pharmaceutical involement -surgery

Answer 21

-Avoid acid-triggering food/liquids -Upright during meals and at least -45 minutes after -No smoking -Don't bend over after eating. Wait two hours after eating, before going to bed -Sleep with HOB (head of bead) elevated at 30+ degrees (bed wedge) -6 small meals, instead of three large meals

Answer 22

-antacids (symptomatic relief of intermittent, infrequent heartburn) -Proton-pump inhibitors (PPIs)E.g., lansoprazole, pantoprazole, omeprazole) – severe GERD or esophagitis

Answer 23

-Hiatal hernia repair -Lasparascopic approaches -Suturing of the LES -Electrical stimulation -Radiofrequency ablation (reduced frequency of tSLERs

Answer 24

-Appearance of a bar within the pharngoesophageal segment (at the level of the cripharyngeal muscle, near C6-C7) -Failure of cricopharyngeus muscle to full distend versus the development due to increased tone (higher PES pressures) in the cervical esophagus as a result of the failure for LES to relax -Can cause obstruction of bolus flow within the pharyngoesophageal segment, noting retention and retrograde flow -Can coexist with Zenker’s diverticulum -Tx: Dilation and/ or cricopharyngeal myotomy

Answer 25

1 hyoid bone 11 cartilages (single thyroid, cricoid, & eplogottic cartilgaes & paired arytenoid, corniculate, cuneiform and triticeal cartilages

Answer 26

-adducting vocal folds / closing rima glottidis rima glottidis: narrowest part of the cavity of larynx glottis: interval between the vocal folds

Answer 27

internal laryngeal nerve branch of superior laryngeal nerve supplies the level above the vocal cords and the level below the vocal cords is supplied by recurrent laryngeal nerve. The lining of vocal cords and the who larynx is supplied by sensory fibers (there is a picture in slide)

Answer 28

-long, plastic, flexible tubes, connected to a ventilator -oral or nasal -cuff attached to the end of tube ~located --> below vocal cords ~seals tracheal lumen prevents orals secretions from aspirating & prevents air from escaping past the tube -7-12 days -prolong intubation: risk for laryngeal & lung injury

Answer 29

Develop: ~granuloma ~hematoma ~edema ~risk for ventilator -trauma can cause: ~arytenoid displacement ~vocal fold paralysis

Answer 30

-Emergent or elective -Difficulty weaning from ETTs -Airway obstruction above the level of the trachea (present or anticipated) -Allows possibility for voicing (PMV) & swallowing -Less trauma to the vocal cords (because of cut below the vocal cords

Answer 31

-Tracheal edema/ erythema of the tracheal lumen -Increased secretions from bodys response to foreign object -Tracheomalacia: cartilage of trachea becomes weak --> cause tracheal wall to collapse --> block the airway (tx:medical → dilate the trachea) -Tracheoesophageal fistula: abnormal connection between trachea and esophagus due to tissue breakdown from constant irritation

Answer 32

-Inflammation of the lungs caused by infection w/ bacteria, viruses and other organism -SX:Chest pain, fever, shaking, chills, SOB, increased RR and HR, cough, mental status change

Answer 33

-CA-PNA ~contracted by individuals outside the hospital environment --> cause viral resp infeciton -HA-PNA ~contracted at hospital

Answer 34

-VA-PNA ~develops 48hrs or longer after mechanical ventilation is given by means of an endotracheal tube or traschectomy -A-PNA ~development in PTs at risk aspiration of oropharyngeal content

Answer 35

-Aspiration of food and liquids during the swallow -Aspiration of oropharyngeal secretions -Aspiration of emesis

Answer 36

-dysphagia -Poor oral care (bacteria colonization) -Reduced respiratory drive for adequate cough -Reduced spontaneous swallowing frequency -Reflex -Anatomical deviations in the upper aerodigestive tract -Various health conditions, increase risk for generalized weakness and deconditioning -Age (65+)

Answer 37

-frequency, type & amount of aspiration -excessive bacteria increases risk for resp. infection -leading cause of death in pt's w/ dysphagia 2ndary to neuro diseases/ conditions

Answer 38

-Antibiotics -Dysphagia evaluation / tx for prevention of recurrence -Collaboration with RD (registered dietitian) to facilitate improved nutritional status and subsequent stronger immune function -Physical therapy for pulmonary toileting

Answer 39

-Chronic Obstructive Pulmonary Disease -group of resp diseases that causes airflow blockage & breathing related problems ~Emphysema (airsacks are damaged) ~Chronic bronchitis ~Asthma ~Cystic fibrosis -3rd leading cause of death and 5th leading cause of disability worldwide -Complicated by Chronic Heart Failure (CHF) in 20-30% of patients

Answer 40

-Reduced hyoid excursion -Earlier and longer airway closure durations (reduced breath swallow coordination) -Earlier airway closure time relative to PES relaxtion onset (increasing risk for mistiming of swallow) -Oropharyngeal and pharyngeal swallow delay due to muscular weakness -Ineffective cough reflux

Answer 41

-GERD can increase risk for acute exacerbation of COPD -COPD meds cause relaxation of LES pressures, thus patients with COPD are at greater risk for GERD -Pathological Reflux scores is 62% of patients w/ COPD Half reported NO GERD symptomology

Answer 42

-Edema -Interference to the peripheral nerve supply to the muscles of swallowing (e.g, endarterectomy, throidectomy, and cervical spinal fusion) -Loss of central nervous system (brainstem) innervation (posterior fossa and skull base sx), affecting peripheral CNs (V, VII, IX, & XII) -Replacement of swallowing structures that also interfere w/ peripheral cranial nerves

Answer 43

-reconstruction of cardiac valves -damage/ trauma to CN X (vagus) -causing vocal fold paralysis w/ dysphagia -Additional complications ~Prolonged intubation ~Tracheotomy

Answer 44

-sustained brain injury -intubation -tracheotomy

Answer 45

-anterior cervical diseconomy & fusion -Surgery is approached through the anterior neck to get to the cervical spine.The target spinal disc is removed from between two vertebral bones. Afusion involves placing bone graft and/or implants where the disc originally was in order to provide stability and strength to the area. -Leaves patients with cervical spinal hardware -hyperextended cervical posture, increase risk for tracheal aspiration

Answer 46

-Bone spurs of the cervical spine, ranging from C1 vertebra to C7 vertebra Primary cause: degeneration, trauma -Obstruction of bolus flow, oropharyngeal and esophageal depending on location of osteophytes ~Can impact airway protection and bolus flow At C3 level – aspiration usually occurs during the swallow At C6 level – aspiration usually occurs after the swallow -Tx options: diet modifications, aspiration precautions, compensatory strategies, postural changes, surgery (ACDF)

Answer 47

-Narrows pharyngeal space -Reduces laryngeal elevation -Subsequent risk for penetration / aspiration

Answer 48

-spinal -Cortical -Bones laryngeal skeleton (comprises airway, vocal fold injury) mandibular fracture (affecting oral acceptance/oral phase) -Proximal esophageal injury from blunt trauma to the neck -Dental Trauma (affecting oral preparation and delivery) -Thermal Burn Trauma -Respiratory supports ~Intubation ~Tracheostomy

Answer 49

-Side effects: ~Cognition ~State of arousal ~Motor performance ~Xerostomia (dry mouth) ~Gastrointestinal function (GERD) -Antipsychotics, anticonvulsants, opioids (e.g., morphine), and antianxiety (e.g., diazepam and clonazepam) meds: ~May affect state of arousal and motor performance -Long-term use of antipsychotic drugs may result in tardive dyskinesia (uncontrollable, repetitive, regular movements of the tongue and lips) ~Interferes with oral preparatory and oral initiation stages of swallowing

Answer 50

-any change in bodily function that the patient notices -Patient interview -Reliable/ standardized questionaires ~EAT-10 (QoL & swallowing Sx) ~Burke Dysphagia Screening Test (stroke) ~ SWAL-CARE questionnaire

Answer 51

-quetioning disorder beyond localization to imporve accuracy -obstruction -liquid vs. solid food -avoidance of certain foods -GERD -eating habits

Answer 52

-# of breaths per minute -normal RR: 12 - 20 breaths per min -RR under 12 or over 25 while resting = abnormal -impacted by: asthma, anxiety, PNA, CHF, lung disease, use of drugs

Answer 53

-% of O2 bound to hemoglobin -96-100% = NORMAL - less than 90% = hypoxemia

Answer 54

-white blood cells -help fight infection -4300-10800/ mm3 normal range

Answer 55

-Oral candidiasis (milk white appearance) -Xerostomia: dry mouth -Oral mucositis ~Edema/erythema ~Mouth sores -Secretions -Dentition ~Edentulous? ~Missing dentition? ~Decaying dentition? ~Dentures? (full or partial) -Clean, moist mucosa? Is oral care indicated?

Answer 56

-Groups of bacteria that rapidly reproduce on wet surfaces and fight together against host defense mechanisms -Large amounts of bacteria found are in dental Biofilm-due to ideal surfaces and environment -BRUSHING is very important as it breaks down biofilm barrier -Swabs or mouth wash/rinse alone may not be effective in breaking biofilm barrier down.

Answer 57

-LIPS & MOUTH ~Cracking, lesions, ulcers, swelling, discoloration, redness -BUCCAL MUCOSA ~abrasions, moisture, discoloration, hygiene -TONGUE/FLOOR OF MOUTH ~Color, size, symmetry, coating, lesions, deviation, tremor -PALATE ~Symmetry, lesions, coloration -GINGIVA (gums) ~Color, bleeding, swelling, food impaction -TEETH ~Visible decay, loose teeth

Answer 58

-Anterior spillage of the bolus -Bolus acceptance (ataxic oral motor movements?) -Bolus manipulation (oral holding?) -Bolus formation/a-p propulsion (any oral residue post initial swallow?) -Timing of swallow initiation -Hyolaryngeal excursion on palpation -Overt s/s of laryngeal penetration/aspiration -Respiratory drive (adequate cough strength, if present?) -Audible belching (wet/dry?) -Any patient c/o oropharyngeal or esophageal dysphagia symptoms during PO trials? -Feeding behaviors

Answer 59

Coughing Choking Throat clearing Sneezing Watery eyes Runny nose Wet vocal quality SOB or respiratory distress (e.g., wheezing) Increased respiratory rate Drop in oxygen saturation

Answer 60

-Easily distracted? ~Is the patient talking while eating? ~Is the patient patient attention to the television, affecting cervical posture and increasing risk for mistiming due to inattention? -Self-feeding? ~Are they impulsive? ~Can the patient use utensils to transport food to mouth? ~Do they need 1:1 assistance? -Able to maintain upright positioning during meals and after meals? (aspiration and reflux precautions) ~Do they need external support -Eating/drinking? ~Are they on the safest diet? ~Do they demonstrate fatigue while eating/drinking? ~Are they maintaining adequate nutrition/hydration?

Answer 61

-Imaging of the upper aerodigestive tract, oral cavity, velopharynx, pharynx, larynx, pharyngoesophageal segment, and esophagus -Assess movement patterns of swallowing-related structures -Identify and describing any airway compromise (aspiration, penetration) and the circumstances under which these events occur -Evaluate of the effectiveness of compensatory strategies -Identify and describe secretion management -Complete a cursory eval of esophageal A&P. -Assist in forming clinical recommendations -Referrals to medical specialist, other medical tests/procedures or further -speech pathology services as appropriate

Answer 62

-Obtain a video image of the upper aerodigestive tract and esophagus during swallowing -Evaluate anatomy and physiology of the dynamic swallow function -Identify structural abnormalities and impaired physiological components of the dynamic swallow function -Evaluate the effectiveness of compensatory strategies -Confirm pt symptoms -Assist with development of POC -Referrals to medical specialist, other medical tests/procedures

Answer 63

a. Labial closure b. Mandibular motion and mastication efficiency c. Lingual ROM and coordination for lingual hold, onset of bolus propulsion, elevation and seal, lateral control and anterior to posterior bolus propulsion. d. Tongue base retraction (apposition of the tongue base to the pharyngeal wall) e. Velopharyngeal closure f. Timing of pharyngeal complex response relative to bolus location g. Pharyngeal muscle contraction h. Timing, excursion and duration of laryngeal elevation i. Airway protection at supraglottic and glottic levels j. Epiglottic movement for vestibular closure k. Pharyngeal stripping wave l. Pharyngoesophageal segment opening m. Presence of upper esophageal clearance or retention; only the proximal 1/3 of the esophagus should be viewed.

Answer 64

-Transport to radiology is risky; a medically fragile patient -Fluoroscopy is not available -Patient is obese -Positioning patient in fluoroscopy chair is too difficult -There is a concern for radiation exposure. -Patient has severe dysphagia and needs a conservative exam, i.e.; brainstem CVA or NPO for prolonged period -There is compromised pulmonary clearance and need for a conservative exam -There is a question of aspiration of secretions -The larynx needs to be visualized (i.e. the voice suggests laryngeal involvement or if there are anatomical changes/laryngeal trauma/ post intubation etc.) -Need to visualize velopharyngeal competence -Sensation in the laryngopharynx needs direct assessment -Biofeedback is needed in therapy -The Modified Barium Swallow does not answer all the clinical questions (need increased sensitivity to microaspiration) -There is an allergy to barium

Answer 65

-anxious pt -Pt's post surgery to the nose -Nasopharyngeal trauma/obstruction, significant edema, significant erythema/irritation

Answer 66

Discomfort Gagging Nosebleed Allergic reaction to topical anesthetic, if used Laryngospasm Vasovagal response

Answer 67

-Improved glottal closure, enhancing airway protection Medialization thyroplasty Injection of biomaterials Stents Laryngotracheal separation Total laryngectomy (extreme approach) (would need to add a stoma) Pharyngeal Esophageal Segment Opening Dilatation Myotomy Botulinum toxic injection to relax and open the PES

Answer 68

-Supraglottic swallow (compensatory strategy or rehab exercise) -Super-supraglottic swallow (compensatory strategy or rehab exercise) -Mendelsohn maneuver (compensatory strategy or rehab exercise) -Effortful swallow (compensatory strategy or rehab exercise) ral motor exercises -Tongue-hold maneuver -Head-lift exercise (Shaker exercise) -Chin tuck against resistance (CTAR)

Answer 69

-short term -adjustments to posture, food, & feeding behaviors for safe oral intake -no rehab impact & no lasting effect on functional swallowing

Answer 70

-No single posture improves swallowing function in all patients -Lying down : increases hypophayrngeal pressure on bolus -side-lying: on stronger side

Answer 71

-head posture adjustment -raises chin -Widens oropharynx -Assists with passage of bolus from oral cavity to pharynx -Must have adequate pharyngeal function and airway protection -Increases intraluminal pressure (less relaxation), decreasing duration of PES relaxation

Answer 72

-head posture adjustment -chin tuck -Oropharyngeal narrowing -Helps patients with a delayed swallow, increases airway protection, and reduced base of tongue movement.

Answer 73

-head posture adjustment -head turn -Unilateral pharyngeal deficit -Narrows and closes the swallowing tract on the side toward which the head is turned. -Facilitates an increase in amount swallowed with less residue, reducing risk of airway compromise

Answer 74

-head posture adjustment -Tilted towards the healthy side (~45 degree angle) Widely used with patients with unilateral oral or pharyngeal weakness When the head is tilted, food flows toward the direction of head tilt or towards the stronger side

Answer 75

-Smaller bolus size ~Teaspoon size bolus (5 ml) -Slower rate of swallowing ~Encourage frequent breaks if experiencing increased WOB (work of breathing) and fatigue during meals.

Answer 76

0- Thin Liquids -->fast 1- Slightly Thick --> thicker than waater/ more effort 2- Mildly Thick (nectar thick liquids) -->flow off spoon/ effortful 3- Moderately Thick (honey thick)--> consumed via cup/spoon IDDSI 4- Pureed Solids-->not chewing/ no lumps IDDSI 5- Minced & Moist Solids--> small lumps/ fork smash IDDSI 6- Soft, bite sized -->bite sized pieces/ no liquid leak from food IDDSI 7- Regular Diet -->normal food age approrpriate

Answer 77

Change in drug effects Lethargy Constipation Infections Poor wound healing Pressure sores UTI’s Altered cardiac function Acute renal failure Weakness Declining nutritional intake Confusion

Answer 78

-Pt allowed ice chips or regular water w/ supervision, and with strict aspiration precautions -Pt & caregivers express concern that long-term orders for thickened liquids or tube feedings without an option for water or ice chips denies basic drive to refresh the senses. -Water is a clear neutral ph and is compatible with other body fluids. -If water is aspirated, it will be absorbed by the lung mucosal tissues without harm. -Per SLP clinical judgement

Answer 79

-exercise -Can improve bolus acceptance/containment as well as bolus formation, control, and propulsion -Can improve tongue base retraction, pharyngeal constriction, hyolaryngeal elevation and excursion, vocal fold adduction, PES opening -Can improve overall airway protection and oropharyngeal and pharyngoesophageal bolus passage / clearance

Answer 80

Labial Mandibular Lingual/tongue base Larynx Vocal cords

Answer 81

-Short-term effect on swallow timing (does not equate to therapy outcomes) -May stimulate swallow initiation. Reported benefit in patients with dysphagia from neurologic deficit

Answer 82

-Non-invasive method to objectively measure muscular patterns and activity during swallowing. Multiple muscle groups can be assessed at the same time. -provides immediate information about the timing and intensity of muscle activity

Answer 83

imulates motor and sensory nerve fibers via small electrical currents, enhancing the strength of the muscles associated with swallowing and facilitating reflexive swallowing

Answer 84

-aspiration due to: Loss of subglottic air pressure Loss of upper airway sensitivity because of airway bypass Loss of normal laryngeal closure reflex Muscle weakness Extent of respiratory illness (breath-swallow incoordination) Mental status fluctuations

Answer 85

-Improvement in voicing/speech production -Restoration of smell, taste -Improves subglottic pressure, sensation, and pt ability to cough/clear secretions, improving swallow function and secretion management -Improved normal pattern oxygenation -Step towards tracheostomy weaning and decannulation -Improved quality of life

Answer 86

-fatigue -nausea/vomit -mouth sores/mucositis -odynophagia -xerostomia -loss of appetite -weak immune system -redness /irritation of skin -tissue necrosis -hair loss -altered taste & smell -dental problems -edema errythema -dysphagia -fibrosis -neuropathy

Answer 87

partial glossectomy total glossectomy palatal resection total laryngectomy

Answer 88

-Pre-treatment evaluation strongly recommended -Ongoing evaluation during/after treatment to assess for side effects and adjustment tx methods accordingly -Identify underlying cause of swallowing difficulty -Monitor weight/oral intake to ensure adequate nutrition/hydration – work with RD (registered dietitian) -Engage in swallow-related exercises before, during, and after radiation treatment to reduce risk of fibrosis and disuse dysfunction. -Provide education on oral care

Answer 89

Biotene, Salivart, Xero-Lube, Oralbalance, Magic Mouthwash/ humidifier NOT use: -vaseline -glycerin swab

Answer 90

-4% -room air =21% -Nasal Cannula: 1 L/min flow rate can increase FiO2 to 24%, 2 L/min to 28% 3 L/min to 32% 4 L/min to 36% 5 L/min to 40% 6 L/min to 44%.

Answer 91

Nasal Cannula -1-6 L/min Moderate Flow Nasal Cannula -7-15 L/min High Flow Nasal Cannula -Up to 60L/min, 100% FiO2 -Facilitates improved communication, compared to BiPAP -Increased risk for breath-swallow coordination and aspiration/microaspiration

Answer 92

Reduces the patient’s work of breathing and increases the functional residual capacity (FRC) of the lungs (FRC is the volume of air left in the lungs at the end of exhalation) A mask or nasal plugs are connected to the ventilator. The machine supplies pressurized air into your airways 2 PRESSURE SETTINGS: - inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP)

Answer 93

-infectious disease /virus -Mild to moderate illness - recover without requiring special treatment. -Severe illness - respiratory failure, lasting lung and heart muscle damage, nervous system problems, kidney failure or death. -Older individuals and those with underlying medical conditions, such as cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to develop serious illness. -Medication is prescribed to reduce inflammation, with antiviral activity for hospitalized patients on mechanical ventilators or who require supplemental oxygen

Answer 94

Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle or body aches Headache New loss of taste or smell Sore throat Congestion or runny nose Nausea or vomiting Diarrhea Hypoxia Hypoxemia