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Flashcards in Test 2 Deck (34):
1

Symptoms of GERD

Heartburn, Acidic taste, Regurgitation, Odynophagia, Dysphagia, Can reach level of larynx: voice difficulties (hoarseness)

2

Treatment for GERD

-Diet (no spicy food; less lactose; etc.)
-Sleep (30-45 degrees head up on wedge to reduce chance of stomach acid going into larynx; posture)
-Meds (long-term negative effects)
-Surgery (If really severe)

3

Zenker’s diverticulum

-Pharyngeal pouch due to weakening of pharyngeal wall near UES/PES
-Coughing up food after eating, complaints of GERD,
-Viewed best anteriorly/posteriorly on MBS study
-Tx: surgery

4

Endotracheal tube

-Inserted in mouth via intubation, past VFs, into trachea
-Attached to ventilator and very medically fragile (usually ICU)
-Unfenestrated and cuffed (Closed airway so no vocalization)
-NPO (Latin: nil per os = nothing by mouth)
-Progression from endotracheal tube: If patient still needs ventilation, will insert tracheostomy tube

5

Tracheostomy tube placement and size

-Placed in trachea, via trach stoma below VFs
-Different sizes (impinging on pharyngeal wall)- try to decrease size for comfort and better swallowing abilities because it will press against back of trachea and hit esophagus, which impinges swallow flow

6

Outer cannula

holds stoma open

7

Inner cannula

Inner cannula: fits inside outer cannula and removable for cleaning on daily basis

8

Flange

neck plate anchored by neck ties that surrounds outer cannula to prevent tube movement

9

Obturator

-used to open stoma if outer cannula is removed
-Like a “plunger” with a pointed edge in case stoma closes while things are being cleaned

10

Cuffed vs noncuffed

-Cuffed (closed system): does not allow movement of trach tube or air to escape up the VFs, prevents aspiration, no vocalization
-Noncuffed (open system): suctioned to get secretions out, air escapes up the VFs and pt can vocalize




11

Fenestrated vs unfenestrated

-Fenestrated (open system): hole on curvature of trach tube to allow increased airflow to upper airway and hit VFs for vocalization
-Unfenestrated (closed system): no opportunity for air to go through VFs so no vocalization

12

decannulation

removal of trach tube

13

progression of trach tube

-Decrease size of trach tube
-Cuffed to noncuffed
-Unfenestrated to fenestrated

14

One-way valve

-Takes in air, air must exit through vocal folds
-Inner cannula is removed if one-way valve is used

15

How do we conduct a bedside swallow evaluation with someone with a tracheostomy tube?

-Dye materials different colors
-if colour is seen around stoma = aspiration
-Deflate cuff, suction client to get secretions out of trachea & lungs
-DON’T stand directly in front of trach

16

Describe the steps involved in a Bedside Swallow Evaluation

-1/2 tsp puree
-“Hold it in your mouth”
-Place index finger on chin (jaw movement), middle finger on base of tongue (tongue pumping or other unwanted movement), ring finger on hyoid (feel for movement), and little finger on thyroid notch (feel for elevation)
-“Now swallow” (feel for wave motion, chin/tongue/hyoid/larynx movement)
-“Say ah” (listen for gunky or wet sounding “ah”)
-Can have them cough and then swallow and say “ah” again
-if still bad, do MBS
-otherwise do 1 tsp puree
-1/2 tsp water, 1 tsp water
-small pieces of solid then bigger piece

17

Limitations of bedside swallow

cannot see the structures and patient could silently aspirate w/out clinician knowing

18

What are you looking for in bedside swallow?

-any delay or multiple swallows
-After each swallow, have the patient open their mouth and say “ah” listen for vocal quality and look for any signs of pocketing, which could indicate weakness or hemineglect. If the voice sounds wet or gurgly or coughing or choking is evident, recommend an instrumental dysphagia assessment to determine if there is any penetration or aspiration

19

Parkinson's disease

-Progressive
-Involuntary movement (tongue pumping- back and forth trying to push bolus posteriorly)
-Slowness (initiation) causes delay of swallow
-Drooling
-Esophageal abnormalities (e.g. GERD)

20

Tx of PD

-Lee Silverman Voice Tx (LSVT): “Think loud, think big”, Recalibrate, Use muscles for swallowing, voice, & speech (strengthens pharyngeal musculature)
-Meds may temporarily help with symptoms (good time to eat)
-Monitor weight & nutrition (dietician/nutritionist, physician)
-Using spoon to place food more posteriorly on tongue to push it closer to oropharynx (but if weak pharyngeal phase… increase risk of penetration/aspiration)
-Chin-tuck: increase volume of valleculae to catch more food (but need to have strength to swallow)
-Alternative feeding (get patient perspective before too late)

21

TBI

-Severity
-Recovery (agitation)
-May need alternative feeding
-Short bits of attention: can do swallow assessment (takes time; start with puree)
-Trach tube or ventilator
-Cognitive deficits, especially early on
-WM: Won’t remember what you tell them to do
-Sustained attention
-Lack of awareness
-Apraxia (Left hemisphere): Oral apraxia (cannot do oral mech movements) or apraxia of speech (cannot repeat speech)
-Reminder to chew & swallow

22

CVA

-Acute stages (lethargy, fatigue, trach tube)
-Left CVA: Motor planning, right neglect, comprehension problems, More aware of penetration/aspiration
-Right CVA: Left neglect (pocket food on left side), cognitive deficits, silent aspiration, confabulation, Less aware of penetration/aspiration
-Could lead to: Aspiration pneumonia
-Tx: Control diet and hydration, Safety of oral intake, alternative feeding

23

TNM system of cancer

-T (X to 4) = size of tumor
-N (X to 3) = affected the lymph nodes
-M (X to 1) = metastasis
-X = unable to assess
0 = no evidence (progressively worse as number increases)

24

Chronic Obstructive Pulmonary Disease (COPD)

-Abnormal CO2 & O2 exchange, requires O2 with nasal cannula
-O2 desaturation during meals (add rest time between bites for breathing)
-Could lead to: Wet-sounding cough -> wet-sounding voice quality, Congestive heart failure, Aspiration pneumonia, Subcategories: emphysema, asthma, cystic fibrosis
-Tx: Meds relax LES but increase GERD potential

25

During patient interviews, SLPs ask questions about dysphagia. What are typical questions we would ask?

-Medical history
-What symptoms are you experiencing? Site of problem? -(may not be accurate)
-Pt. interview/ caregiver interview
-Provide questionnaire for dysphagia (which will vary by facility)
-What is your current diet? Are there any textures you avoid or find hard to swallow?
-Do you have symptoms of GERD?
-Look for signs (clinical characteristics of dysphagia)

26

When the SLP reviews the medical report for patients with possible dysphagia, what information should we focus on for swallowing issues?

-Congenital
-Neurologic/neurogenic disorder
-Psychiatric (e.g., Schizophrenia)
-Surgical (anesthesia, endotracheal tube)
-Cancer related
-Systemic & Metabolic (e.g., diabetes, toxins)
-Respiratory issues
-Esophageal disorders
-Prior swallowing studies
-Advance directives (living will, feeding tube)

27

Fibrosis:

-Thickening and scarring of connective tissue, usually as a result of injury or radiation for cancer
-Affects mvmt of pharynx

28

Trismus

reduced jaw opening

29

Cervical auscultation

-Use of stethoscope placed laterally at level of VFs to assess swallowing sounds
-Useful?

30

Odynophagia

painful swallow

31

Achalasia

-Nonrelaxing or incomplete relaxing LES
-Food cannot pass into the stomach so pt may regurgitate undigested food

32

NPO

- “nil per os” (Nothing by mouth)
-Something nurses will put a pt as until evaluated by SLP

33

Piecemeal deglutition

Little pieces being swallowed rather than cohesive bolus; saliva breaks away bits

34

Describe the water test and why it is given.

-Other professionals give 3 oz of water to determine NPO until SLP can do study
-Watch oxygen saturation level (usually below 90% = NPO)
-Look for aspiration signs (water is the safest thing to aspirate as long as oral cavity is clean)
-Coughing/choking
-Changes in vocal quality
-Not good at detecting ‘silent aspiration’