Tubes & Dysphagia

Question 1

WHY would a person have a tracheostomy tube?

Answer 1

• UPPER AIRWAY OBSTRUCTION or POTENTIAL OBSTRUCTION at or above the level of the VF’s!
• PROVISION of respiratory care

Question 2

WHERE & HOW is a trach tube placed?

Answer 2

TUBE INSERTED IN TRACHEA

via SURGICAL INCISION b/w 3rd & 4th tracheal ring

Question 3

WHAT are the 3 parts of the trach tube?

Answer 3

OUTER CANNULA (holds trach site OPEN)
INNER CANNULA ( BREATHING tube) 
OBTURATOR ( SMOOTH TIP for insertion)

Question 4

Which are the 3 TYPES of trach tubes?

Answer 4

CUFFED

CUFFLESS

FENESTRATED

Question 5

A ______________ tube has a SHORT TERM use.

Answer 5

FENESTRATED

Question 6

A _____________ tube has a LONG TERM use.

Answer 6

CUFFLESS

Question 7

What are some facts of the CUFFED ?

Answer 7

prevents ASPIRATION!
used with VENTILATORS
INFLATED for MORE PRESSURE (expands the tracheal walls inside)

Question 8

Which trach tube does NOT expand the tracheal walls?

Answer 8

CUFFLESS

Question 9

What are some facts of the CUFFLESS ?

Answer 9

• ASPIRATION MAY OCCUR
• MAY INTERFERE with LARYNGEAL ELEVATION
• Assists in breathing and SECRETION REMOVAL
• LONG TERM USE

Question 10

What are some facts of the FENESTRATED ?

Answer 10

• It is SMALLER
• used for DECANNULATION
• SHORT TERM USE

Question 11

A pt. can use a FENESTRATED trach tube for 3 weeks.

Answer 11

FALSE!!! (3-5 days)

Question 12

What INFORMATION do you need to know before you work on swallowing with a trach patient.

Answer 12

1) Pt. hx (symptoms of dysphagia)
2) Know type of trach and if inflated
3) Determine length of time with trach
4) Deflate cuffed tube w/ medical consent
5) Suction oral and trach deflating
6) Occlude pt’s trach with gloved finger during several seconds after each swallow

Question 13

T or F: It is recommended to write down the directions for swallowing to the trach tube pt.

Answer 13

TRUE!

Question 14

T or F: You can start swallowing tx without having to do any dry swallows first.

Answer 14

FALSE! start with dry swallows!!!!

Question 15

When you are doing the swallowing trials you provide the patient with NO MORE THAN _______ of liquid/paste/puree

Answer 15

3cc!

Question 16

How can you feel hyolaryngeal excursion?

Answer 16

5-finger test!!! - should be done during the trial swallows!!!

Question 17

During the swallowing tx. (trials) you want the pt. to _____________!

Answer 17

COUGH COUGH COUGH

Question 18

When you are finished giving the pt. the intake for the trial you have them do what?

Answer 18

PHONATE a sustained vowel to check if they have a wet gurgly voice

Question 19

T or F: Swallow usually worsens on vent.

Answer 19

TRUE!

Question 20

When a person is on a ventilator their ________ period is affected.

Answer 20

APNEIC - becomes uncoordinated…respiration is controlled by vent

Question 21

T or F: When a person is on a vent they CAN LENGTHEN EXHALATION for their swallow.

Answer 21

FALSE!!! their swallow is disrupted

Question 22

Which kind of trach tube is on a vent?

Answer 22

CUFFED

Question 23

What is the main thing you work at during swallowing tx?

Answer 23

TIMMING!!! of swallow during exhalation

Question 24

What can the blue dye test reveal?

Answer 24

If pt. is aspirating! If blue dye comes out of the trach that means that they aspirated

Question 25

What are some of the COMPLICATIONS that may happen w/ a person that has been INTUBATED?

Answer 25

- LARYNGEAL TRAUMA from tube placement. (TE fistula from tube rubbing) - LARYNGEAL PATHOLOGIES: granulomas, vf paresis/paralysis, edema , erythema

Question 26

Can you perform swallowing treatments on a person who is INTUBATED?

Answer 26

NO!!!!!!! | Not until is person EXTUBATED for at least 1 week.

Question 27

When a person has been EXTUBATED for a week or more...how can you start swallowing tx?

Answer 27

w/ ROM exercises!!!!

Question 28

NG method =

Answer 28

tube placed NASALLY

Question 29

PEG method=

Answer 29

tube placed by percutaneous endoscopic/laparoscopic gastrostomy

Question 30

RIG method=

Answer 30

RADIOLOGICALLY inserted gastrostomy

Question 31

SURGICAL method=

Answer 31

OPEN or laparoscopically inserted gastrostomy

Question 32

What are the 7 types of FEEDING TUBES?

Answer 32

NNNOGGJ 1) Nasograstric (NG) 2) Nasoduodenal (ND) 3) Nasojejunal (NJ) 4) Orogastric (OG) 5) Gastrostomy (G or GT) 6) Gastrostomy w/ dual port to jejunum (GD) 7) Jejunostomy (GJ or PEJ)

Question 33

T or F : 10% or 20% of weight loss is common and considered moderate.

Answer 33

TRUE

Question 34

MORE than _______ of weight loss is considered SEVERE

Answer 34

20%

Question 35

What are some signs "red flags" that might tell you that a person is DEHYDRATED?

Answer 35

- rapid weight loss (4+ lbs in 48hrs) - thin liquid dysphagia - skin turgor - complaint of thirst - decreased urination - hypernatremia (increased serum sodium) - elevated BUN (blood urea nitrogen)

Question 36

Which is the most common feeding tube used?

Answer 36

NASOGASTRIC

Question 37

T or F: Feeding tubes are only used for people who cannot eat orally.

Answer 37

FALSE! They might be used for supplemental nutrition or oral pleasure.