Speech Pathology/Therapy

Question 1

Speech Pathologists do

Answer 1

Swallowing** assessment and treatment

Speech and language** evaluation and treatment

Cognitive** assessment and treatment

Question 2

Swallowing is normally

Answer 2

strong, coordinated, and timely

Question 3

Phases of swallowing

Answer 3

oral
pharyngeal
esophageal

Question 4

Dysphagia

Answer 4

Difficulty swallowing

Question 5

Structural reasons for dysphagia

Answer 5

Oral cancer–glossectomy, etc.
Poor dentition or ill-fitting dentures
Throat cancer–laryngectomy
Tracheostomy
Diverticulum
Other esophageal pathologies (strictures, webs, rings, cancer, etc)

Question 6

Glossectomy

Answer 6

removal of tongue

Question 7

Esophageal diverticulum

Answer 7

Muscle wall develops a pouch due to expansion
food or liquid is caught

Question 8

Functional Patho dysphagia

Answer 8

Acute neurological event (CVA, head injury)
Progressive neurological disorders (PD, tumors, MS)
General weakness (aging, decompensation from medical problems, cardiac patients)
Esophageal pathologies (reflux, motility disorders)

Question 9

Cognitive dysphasia

Answer 9

Dementia

Head injury

Lethargic or obtunded patients

**May affect feeding efficiency, adequacy of p.o. intake

Question 10

Nursing Role in Dysphagia Management

Answer 10

Good history (RN assessment forms)
Good oral mechanism exam by talking
Observation with meals and medications
Assistance with oral care **
Assistance with feeding **
Hasten referrals to other professionals

Question 11

S/S of Dysphagia

Answer 11

Cannot manage oral secretions = drooling, coughing
Difficulty chewing, prolonged chewing
Pocketing** of food in buccal cavities
Holding food in mouth for long periods
Excessive drooling during meals
Absent swallow (know how to palpate) = jumps and closes the airway
Coughing/choking or throat clearing after swallows**

Wet, gurgly voice after swallows

Pain with swallowing

Swallowing many times for small bolus
Tube feeding

Multiple medical diagnoses

Chronic reflux

Question 12

Complications of Dysphagia

Answer 12

Aspiration pneumonia suspected
Recurrent pneumonia - aspiration
Weight loss
Chronic dehydration or malnutrition

Question 13

IF PT HAS DYSPHAGIA THEN THEY HAVE TROUBLE WITH MEDS BUT

Answer 13

NOT ALL DIFFICULTY OF TAKING MEDS IS DYSPHAGIA

Question 14

If a pt has difficulty taking meds but not other signs, then have the pt

Answer 14

single pill with water
puree
crushed in puree

Question 15

Top Three Risk Factors for Aspiration Pneumonia

Answer 15

Dependence on others for feeding

Dependence on others for oral care

Missing or decaying teeth

Question 16

Speech Pathologist is Dysphagia Management Dx

Answer 16

Bedside Swallow Evaluation,
Modified Barium Swallow,
Fiberoptic Endoscopic Evaluation of Swallowing
- nature and severity

Question 17

SP manages

Answer 17

diet and feeding recommendations
education
direct therapies
referrals

Question 18

Silent aspiration

Answer 18

Aspirated material is undetected by a desensitized trachea
Consequently, no reflexive cough is triggered to protect the airway
Results in false neg. Bedside swallow eval
If suspected, an MBS or FEES study would be better able to identify the aspiration

Question 19

Feeding/Swallowing Precautions

Answer 19

Chin-tuck (sip of water, hold, and chin-tuck)
Thickened liquids – quick fix
Follow-up swallows - residue
Straws v. No straws – depends pt
Throat clearing
**“General Precautions” - Sit up, alert, with small bites and sips

Question 20

Clear liquid diets

Answer 20

broth jello
sometime with thickener

Question 21

Full liquid

Answer 21

cloudy and creams

Question 22

Diet Restrictions are prescribed by

Answer 22

RD or MD

Question 23

International Dysphagia Diet

Answer 23

0 - Thin
1 - Slightly thick
2 - Mildly thick
3 - Moderately thick or liquidized
4 - Extremely thick - pureed
5 - minched and moist
6 - soft and bite sized
7 - regular and easy to chew

Question 24

Soft diet

Answer 24

diced meat and partially processed

Question 25

Minced and moist

Answer 25

ground up with minimal chewing

Question 26

Pureed

Answer 26

mashed potatoes consistency = extremely thick (applesauce)

Question 27

Liquidized

Answer 27

honey thickness (moderate)

Question 28

How to use Simply Thick

Answer 28

One entire packet to 4 oz. of liquid Shake for 5 seconds in mixing cup with lid or Stir with a fork for 20 seconds. Do not compromise please! Simply Thick mixes smooth and clear and tastes much better than traditional, corn starch-based thickeners.

Question 29

Frazier Water Protocol

Answer 29

**high risk of aspiration to have ice and water throughout the day.** **oral bacteria is the source of aspiration pneumonia, not water**

Question 30

Benefits of Frazier Water protocol

Answer 30

Gives dysphagic, NPO patients increased therapeutic opportunities to swallow and hastens a return to safe PO intake. Increases hydration, especially orally, to reduce bacterial growth. Has the potential to improve a patient’s psychological state of mind.

Question 31

What causes infection in the lungs?

Answer 31

bacteria not water or food

Question 32

Requirements of Water Protocol

Answer 32

Must be ordered by a physician. **Daily oral hygiene per protocol** specifications Hydrogen peroxide entire mouth Patients are able to swallow water w/o demonstrating excessive coughing and discomfort. Patients are able to maintain alertness and arousal. Patients are able to elicit a timely/efficient swallow (determined by SLP) and are able to maintain upright posture.

Question 33

Oral Hygiene

Answer 33

One of the most important points of care is oral hygiene. **If the patient is unable to independently perform oral care, be sure it gets done everyday** As a reminder, put yourself in their position and imagine not brushing your teeth for days.

Question 34

Dysarthria

Answer 34

difficulty articulating words “drunk” – muscle decreased

Question 35

Apraxia (motor planning)

Answer 35

strokes common Difficulty using motor functions when trying to Ice cream allows the tongue to move out due to different hemispheres *pressure to perform = harder to do it*

Question 36

Motor-speech disorders often seen in

Answer 36

CVA (usually Rt.), Parkinson’s, ALS, MS, MG, Other

Question 37

Expressive aphasia

Answer 37

can't express how they are doing

Question 38

Receptive dysphasia

Answer 38

difficulty understanding what you are saying

Question 39

Language Disorders are caused by

Answer 39

left brain injury

Question 40

Cognitive-Communicative Disorders

Answer 40

Head Injury Right-brain CVA Dementia Anoxic brain injury Toxic-metabolic encephalopathy – can’t function May affect pragmatic (social) skills = social inappropriate, problem-solving, and memory

Question 41

Communicating with aphasia pts

Answer 41

Use hearing aids and/or glasses Speak slowly, directly, and keep sentences short Allow plenty of time for responses **Give two choices rather than asking open-ended questions if possible** Use word boards only if directed **Do not “talk down” to patient please**

Question 42

Communicate with dysarthric pts

Answer 42

pt speaks loudly** slow-down speech finish sentences re-word Word/alphabet boards may be helpful

Question 43

Communicating with hearing-impaired pts

Answer 43

Use hearing aids (make sure batteries work) and glasses Stand/sit close to the patient Look at the patient Speak slowly and in a low pitch Keep sentences short Re-phrase, rather than just yelling louder

Question 44

Passy-Muir Speaking Valves

Answer 44

Trach. cuff must be fully deflated Supervision and length of use as directed by speech pathologist Do not use during breathing treatments or when patient is asleep - giving pt ability to talk and breath with trach