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Dysphagia > Midterm > Flashcards

Midterm Flashcards

1
Q

What are five components involved in central alignment?

A
  1. Head flexion neutral
  2. Neck and trunk elongated
  3. Shoulder girdle stable & depressed
  4. Hips at 90 degrees
  5. Pelvis stable and symmetrical in neutral position
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2
Q

Stability is the foundation for ________ and _________.

A

function - movement

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3
Q

What cranial nerves are involved in the pharyngeal phase ?

A

IX, X, XI

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4
Q

Describe some aspects of the Upper Aerodigestive Tract

A

2 tubes: oral cavity and pharynx with valves with a variety of functions
 Lips: keep food in mouth
 Oral tongue: push food against palate
 Velopharyngeal region: closes to keep food from nose
 Larynx: prevent food from going into airway
 Tongue base/pharyngeal wall: squeeze bolus through the pharynx
 CP region (UES): allows bolus into esophagus
 LES: muscular sphincter, keeps food in stomach

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5
Q

What are some differences between infant and adult anatomy?

A
  • Oral space in newborn is small
  • Lower jaw in newborn is small & retracted
  • Sucking pads present
  • Tongue takes up more space
  • Infant tongue has restricted movement
  • Newborns are obligate nose breathers (means they are preferred nose breathers, 6-8 mos. Is when they start to use their mouth)
  • Epiglottis and soft palate are in approximation in the newborn as a protective mechanism
  • Larynx is higher in the newborn pharynx eliminating the need for coordinated laryngeal closure to protect the airway
  • Eustachian tubes of the infant lie horizontal, with a more vertical angel in the adult
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6
Q

What are some signs of dysphagia in an adult?

A
    1. Recurrent pneumonia
    1. Wet/Gurgley vocal quality
    1. Drooling
    1. Refusal to eat
    1. Multiple swallow pattern
    1. Coughing/choking before/during/after swallow
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7
Q

Describe the Phasic Bite reflex. When is it present/decrease?

A
  • Pressure to gums = rhythmic open/close of jaws

- Present 28 weeks gestation, decreases by 9-12 months after birth

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8
Q

When does pharyngeal swallow develop in utero?

A

One of the first motor responses seen in pharynx at 10-11 weeks
Swallow has been observed at 12.5 weeks

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9
Q

When should a baby start eating by mouth? What week?

A
  • Around 32 weeks

- This is when the suck pads come in and you can start to feed them orally

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10
Q

What are the suck pads? What muscles are involved?

A
  • An encapsulated mass of fat in the cheek on the outer side of the buccinators muscle especially marked in the infant; supposed to strengthen and support the cheek during the act of sucking
  • Just help to close the oral cavity and help to keep things organized
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11
Q

Explain APGAR scores.

A
  • Scores range from 0-2 on each section, the higher the score the better
  • 0-10 scale to evaluate infant’s physical condition; heart rate, respiration, muscle tone, response to stimuli, color are evaluated at 1 and 5 minutes after birth; may be continued every 5 minutes up to 20 minutes until two scores of 8 or more are achieved
  • Rated on skin color/complexion, pulse rate, reflex irritability, and muscle tone
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12
Q

What are some calming/arousal techniques?

A

CALMING: swaddle, non-nutritive sucking (pacifier), create nesting, change position, or change environment
AROUSAL: unwarp, massage, and elicit rooting, face-to-face interactions, smooth gradual transitions

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13
Q

How do you facilitate infant feeding?

A
  • Rooting
  • Non Nutritive suck
  • Cheek support- increases flow
  • Chin/jaw support- increases flow
  • Pacing- brief breaks (external pacing=caregiver imposed, self-pacing= infant imposed)
  • Change nipple flow
  • Positioning
  • Alertness
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14
Q

What are some generic problems that cause GERD?

A

-Too much volume
-Too fast of rate
S/S: gagging, projectile vomiting, arching, head turning, irritability, inconsolable crying and feeding aversion

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15
Q

What is considered full term for a baby?

A

-37 weeks, the average is 38, and 40 weeks is preferable but should NOT go over 40 weeks

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16
Q

What should the goals be for a hypertonic child?

A

 Inhibition of excessively increased tone
 Inhibition of proximal fixation
 Facilitation of end range of movement
 Prevention of further physical deformity

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17
Q

What should the goals be for a hypotonic child?

A

 Promotion of alignment and stability
 Maintenance of upright posture for feeding
 Promotion of symmetry and midrange control

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18
Q

Anticonvulsant – what can that cause/side effects as far as dysphagia?

A
  • Indication: Anti-seizure, mood stabilizer, pain
  • Common Drugs: (1) Phenobarbital, (2) Dilantin, (3) Tegretol
  • Effect: (1) Dry mouth, sweating, hypotension, tremor (2) ataxia, slurred speech and dystonia, (3) glossitis, stomatitis, dry mouth
19
Q

Nutritional Risk Factors - name a few.

A 
	Failure to grow over 2-3 months 
	Weight/height below the 5th percentile
	Chronic diarrhea/constipation
	Long term use of drugs (especially seizure medication)
	Excessive drooling
	Frequent reflux / emesis
	Mechanical feeding difficulties
	Metabolic disorders
	Abnormal CBC / urine screen
	Suspected caregiver neglect
20
Q

What are some important factors when choosing a nipple?

A
  • Flow rate (how fast)
  • How firm is the nipple (firm/no firm)
  • How much contact the baby’s tongue is making with it
21
Q

What are some signs and symptoms during an evaluation that would make you want to do a swallow study?

A
  • Weak suck
  • Sucking/swallowing incoordination
  • Breathing disruptions or apnea during feeding
  • Excessive gagging or recurrent coughing during feeds
  • New onset of feeding difficulty
  • History of recurrent pneumonia and feeding difficulty
  • Feeding periods longer than 30-40 minutes
  • Delay in feeding developmental milestones
22
Q

Signs of Dysphagia

A
  • Inability to recognize food
  • Inability to control food or saliva
  • Coughing/choking before/during/after swallow
  • Frequent throat clearing
  • Multiple swallow pattern
  • Recurrent pneumonia
  • Unexplained weight loss
  • Wet/Gurgley vocal quality
  • Drooling
  • Cyanosis (around the lips)
  • SOB (short of breath)
  • Increased time to finish meal
23
Q

In what order do the laryngeal sphincters close?

A

-From the bottom up – to protect the airway!

24
Q

Explain the difference between tippers and dippers?

A

Tippers (80%- held between midline then put it back to the alveolar ridge then you swallow)
Dippers (20% hold on the floor of their mouth)

25
Q

What are the 3 functions of the larynx?

A
  1. Protection
  2. Respiration
  3. Phonation
26
Q

What are the phases of the swallow?

A
  1. Oral Prepitory
  2. Oral
  3. Pharyngeal
  4. Esophageal
27
Q

Define: Failure to thrive -

A

Term used to describe a child’s abnormal growth in which weight drops below 5th percentile; also used with adult population

28
Q

Define: Oral aversion -

A

negative association with or response to anything placed in or near the mouth

29
Q

Define: Pacing –

A

systematic stopping of nipple flow to impose breathing pauses-=-do NOT remove from mouth!

30
Q

Define: Stridor –

A

upper airway noise that indicates turbulent airflow through a narrow airway, not a diagnosis but an indication of abnormal airway

31
Q

Define: TPN –

A

Total Parenteral Nutrition- nutrition provided exclusively by intravenous access, not the GI tract (means this person is not at all eating)

32
Q

Define: Aspiration –

A

anything that goes below the level of your true vocal folds has been aspirated, entry of food or liquid into the airway below the level of the true vocal folds

33
Q

Define: Penetration –

A

entry of food or liquid into the larynx at same level down to but NOT below the true vocal folds

34
Q

Define: Gestational Age -

A

the number of weeks the baby has been in the uterus

35
Q

Define: Swallowing -

A

it is the entire act of deglutition from placement of food in the mouth through the oral, pharyngeal and esophageal stages of the swallow, until the materials enter the stomach through the gastro esophageal junction.

36
Q

Define: Silent Aspiration –

A

when someone aspirates but doesn’t know it

37
Q

Define: Dysphagia –

A

difficulty swallowing or inability to swallow

38
Q

Define: Aphagia –

A

when a person cannot swallow at all

39
Q

Define: Vallecula –

A

wedged shape space formed between the base of the tongue and the epiglottis

40
Q

Define: Neonate -

A

term for infants in first 28 days of life

41
Q

How do neonates coordinate breathing and swallowing?

A

Because they are Predominately nose breathers

42
Q

When should you begin spoon feeding a baby? When feed self?

A

4 months spoon feed, feed self by 12-18 months

43
Q

What are some signs of aspiration?

A

Wet gurgle sound, coughing, gagging, gulping

44
Q

Name 6 milestones of a 4 month old

A

Blowing bubbles w/ saliva, eating rice cereal, suckle off a spoon, increased sound imitation, voluntary control of mouth, and tactile awareness of hands

Dysphagia (4 decks)

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