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NBCOT LAST Attempt > swallowing/feeding > Flashcards

swallowing/feeding Flashcards

1
Q

dysphagia causes

A

stroke, head trauma, MS, CP, dementia, brain/SC tumor, cervical spine injury, motor neuron disease, myopathy

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2
Q

dysphagia symptoms

A
  • choking
  • coughing during/after swallow
  • coughing/vomiting up food
  • weak, soft, gurgly voice
  • aspiration
  • excessive saliva/drooling
  • difficulty chewing
  • trouble moving food to back of mouth
  • food stuck in throat
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3
Q

pharynx

A

throat; funnels food into esophagus
- shared by food & air

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4
Q

larynx

A

voice box
- closes during swallowing (valve to trachea) to protect from aspiration
- vocal folds, pitch, volume of voice

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5
Q

trachea

A

allows air into lungs
- closed by larynx during swallowing

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6
Q

cranial nerve V: trigeminal nerve damage

A

no sensation, unable to move mandible

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7
Q

cranial nerve VII: facial nerve damage

A

no taste to front of tongue, no jaw opening/closing, poor lip strength, dry mouth, paralyzed face muscles

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8
Q

cranial nerve IX: glossopharyngeal nerve damage

A

decreased taste/salivation, inhibited gag reflex, weak cough reflex

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9
Q

cranial nerve X: vagus nerve damage

A

no gag, no pitch, difficulty swallowing, nasal regurgitation, hoarse/breathy/wet voice

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10
Q

cranial nerve XII: hypoglossal nerve damage

A

unable to position food for chewing = food pocketing

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11
Q

phases of swallowing

A
  1. oral preparatory phase
  2. oral phase
  3. pharyngeal phase
  4. esophageal phase
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12
Q

oral preparatory phase

A

VOLUNTARY, TIME DEPENDS ON FOOD CONSISTENCY
oral manipulation: chewing to form bolus

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13
Q

oral phase

A

VOLUNTARY: 1-3 SECONDS
tongue moves bolus to back of mouth, ends with beginning of pharyngeal swallow

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14
Q

pharyngeal phase

A

INVOLUNTARY: 1-3 SECONDS
swallowing, epiglottis retroflexes to protect airway

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15
Q

esophageal phase

A

INVOLUNTARY: 8-10 SECONDS
bolus pushed towards & into stomach

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16
Q

esophageal dysphagia

A

FEELING OF FOOD STUCK IN THROAT WHILE SWALLOWING
- symptoms: pain when swallowing, sensation of food stuck in throat, regurgitation, heartburn, back-up of food or stomach acid into the mouth or throat, hoarseness, sudden weight loss
- Cause: GERD, radiation for cancer, scleroderma, esophageal tumors or spasms

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17
Q

oropharyngeal dysphagia

A

WEAK MOUTH/THROAT MUSCLES, FOOD & LIQUID CAN’T BE MOVED TO STOMACH OR ESOPHAGUS
- symptoms: coughing/gagging when swallowing, drooling, sudden weight loss, can’t swallow, need food cut into small pieces or avoid some foods
- Cause: neurological disease/damage, pharyngoesophageal diverticulum, cancer or cancer tx

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18
Q

pharyngoesophageal diverticulum/Zenker’s

A

a small pouch just above the esophagus that collects food particles

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19
Q

Achalasia

A

esophagus muscle spasms or strictures/restriction

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20
Q

esophagitis

A

esophagus inflammation

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21
Q

Videofluoroscopy

A

moving x-ray (fluoroscopy) to observe food and liquid as it travels down the GI tract

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22
Q

how do OTs support SLPs?

A
  • carryover of feeding/swallowing techniques during ADLs
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23
Q

what replaced the national dysphagia diet?

A

International Dysphagia Diet Standardization Initiative (IDDSI) Framework

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24
Q

levels 0-1 liquids

A

THIN-SLIGHTLY THICK
0 = nothing remaining after 10 second flow
1 = 1-4 mL remaining after 10 second flow
- normal consistency
EX: water, milk, juice, broth, foods that melt such as popsicles, coffee, tea

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25
Q

level 2 liquids

A

MILDLY THICK, NECTAR THICK
2 = 4-8 mL remaining after 10 second flow
LEVEL 150 FLUID
- liquid slightly thickened, slowing flow
EX: Tomato juice, fruit nectar, smoothies, cream soup

26
Q

level 3 liquids

A

MOD THICK, LIQUIDIZED, HONEY THICK
3 =. 8-10 mL remaining after 10 second flow
LEVEL 400 FLUID
- thickened until it drips/flows slowly off spoon
EX: honey, syrup

27
Q

level 4 liquids

A

PUDDING, EXTREMELY THICK/PUREED
4 = IDDSI fork drip test & spoon tilt test
LEVEL 900 FLUID
- does not flow/drip off spoon
EX: pudding, ice cream

28
Q

IDDSI levels of food consistency

A

3: liquidized/mod thick
4: pureed/extremely thick
5: minced & moist
6: soft & bite sized
7: regular
(levels 5-7 = transitional levels)

29
Q

level 4 foods

A

PUREED
- pudding consistency, add liquid to dry foods
EX: mashed potatoes/bananas/squash, cooked cereals applesauce

30
Q

level 5 foods

A

MECHANICAL SOFT, MIN CHEWING
- 4 MM PARTICLE SIZES (2MM FOR KIDS)
- Soft, cohesive foods are allowed unaltered
- Chunkier foods or harder foods are cooked and fork-mashed, ground or softened
- NO BREADS
EX: ground meat, mashed vegetables, meat loaf, baked beans, casseroles

31
Q

level 6 foods

A

SOFT: no choking/asphyxiation risk
- 1.5 CM OR 15 MM (NO LARGER THAN 8 MM FOR KIDS)
- Soft solid foods, chewy foods
- Meat cooked well and cut into small pieces
- Fruits and vegetables peeled and/or cooked
- Soft breads
EX: Diced beef or chicken, canned meat such as tuna, canned vegetables, soft fruits like bananas, strawberries, pizza, cheese, bagels

32
Q

level 7 foods

A

REGULAR
- foods that fall apart (bread, rice, muffins) then mixed textures

33
Q

piriform sinus

A

pear shaped fossa at entrance to laryngeal space
- channels swallowed material before it enters esophagus

34
Q

vocal folds

A

vocal cords (vagus nerve controls)
- open when breathing/vibrating (speaking, singing)
- produce sounds for speech
- protect airway from choking, regulate airflow into lungs

35
Q

bronchioles/bronchi

A

major air passage of lungs coming from windpipe

36
Q

if someone aspirates food, they are at risk for

A

pneumonia

37
Q

esophagus

A

food/liquid normally enters while swallowing

38
Q

upper esophageal sphincter

A

bundle of muscles at top of esophagus
- consciously controlled, used when breathing, eating, belching, vomiting

39
Q

oral sensory problem

A
  • food pocketing
  • lack of awareness of food on side of mouth with decreased sensation
  • spilling food into airway when vocal cords are open
  • swallow sequence timing is off
40
Q

cricopharyngeal junction

A

junction of pharynx & esophagus

41
Q

when there is weakness of the elevation of the pharynx during swallowing, what happens?

A

incomplete trigger of pharyngeal phase of swallowing

42
Q

vocal cord paralysis leads to

A

aspiration (vocal cords dont close during swallow)

43
Q

clinical aspiration

A

food enters airway, person clears by coughing (reflex intact)
- aspirates when food comes up & patient can’t swallow it

44
Q

silent aspiration

A

food enters lung, person does not react, respiratory distress without cough, too weak of cough to get bolus out of lungs

45
Q

no esophageal motility

A

bolus sits in esophagus, can slowly either move down towards stomach or up towards pharynx

46
Q

when does swallowing dysfunction come into question?

A
  • coughing during/after drinking water/thin liquid
  • changes in face color during/after eating (flushed, ashed, blanches = pale)
  • gasps for breath
47
Q

immediate action for aspiration

A
  • heimlich maneuver
  • basic life support if they lose consciousness (abdominal thrusts, back blows, periodically looking in oral canal to try to see object)
48
Q

heimlich maneuver

A

clear obstruction & raise bolus that has been aspirated
- HAVE TO BE AWAKE/RESPONSIVE

49
Q

bedside swallowing eval

A
  1. assess alertness, direction following, anosognosia, orientation
  2. assess sensory & motor components of swallowing
  3. assess ability to manage secretions via auscultation & clin obs
  4. assess swallowing via trial bolus (suggest diet modification, recommend further testing)
50
Q

ascultation

A

listening to heart, lungs with stethoscope

51
Q

modified barium swallow (MBS)

A
  • swallowing team + radiologist
  • person upright at edge of table (must have good sitting balance, must be supervised at all times)
  • trial bolus of mixed food consistencies laced with barium which coats GI tract & can see problem areas on x ray
  • test ceases if they aspire (xray shots still taken)
  • dx swallowing disorders, GI dysfunction
52
Q

FEES

A
  • bedside or office
  • foods laced with green food coloring
  • variety of consistencies to swallow
  • see whether swallow is intact/impaired using flexible endoscopic catheter with mini camera
  • tests for LIGHT TOUCH sensation in pharyngeal cavity by forcing air through endoscopic tube
  • can dx swallowing disorder, GI dysfunction
53
Q

psychosocial effects of tube feeding

A
  • change in roles
  • uncomfortable with dining in public
  • infantilizing
  • sex appeal & self image
  • how others see them
54
Q

pre oral phase

A
  • salivating
  • smell & visual appreciation of food
55
Q

chin tuck

A
  • for delayed swallow initiation
  • Moving CHIN TOWARDS CHEST while swallowing
  • Protects airway
  • Reduces aspiration risk
56
Q

Mendelsohn maneuver

A
  • Prolong opening of upper esophageal sphincter during swallow
  • pushing tongue into upper palate while manually elevating Adam’s apple
57
Q

supraglottic swallow

A

Close vocal cords before/during swallow
- Cough at the end of the swallow to clear food
- Take deep breath
- Hold breath while swallowing
- COUGH to clear saliva or food that may have passed beyond vocal cords

58
Q

super supraglottic swallow

A

Close airway entrance ABOVE vocal cords
- Take deep breath
- Hold breath and BEAR DOWN (as in bowel movement) while swallowing
- COUGH to clear saliva, food that may have passed beyond vocal cords

59
Q

For mealtime FATIGUE: (ALS)

A

eat frequent small meals rather than 1 big meal

60
Q

For correct JAW control while feeding child from the SIDE

A

Jaw opening/closing controlled by index & middle fingers
- thumb on child’s neck (fulcrum of jaw movement)

61
Q

For correct JAW control while feeding child from the FRONT

A
  • thumb on child
  • middle finger under chin to control opening/closing of jaw
  • index finger on side of child’s face
62
Q

sequence of swallowing

A

food into mouth –> forms bolus –> bolus pushed to back of mouth with tongue –> larynx elevates/protracts –> bolus into pharynx –> into esophagus

NBCOT LAST Attempt (50 decks)

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