Dysphagia 10/11/2012

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Dysphagia 10/11/2012
2012-10-11 19:12:13

"Notes on Dyspahgia 10/3/2012
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  1. Dysphagia
    • -Difficulty in swallowing or an inability to swallow
    • -May result in malnutrition and dehydration
    • -As a result of Dysphagia, the individual may avoid or can't tolerate eating/drinking
  2. Advanced Directive
    The patient has clearly stated his/her preference about feeding or other life saving issues.
  3. Aspiration
    • -refers to food, liquid, saliva penetrating the larynx and entering the airway (going straight to the lungs).
    • -goes below the vocal folds
    • -food or liquid enters the lungs rather than the stomach after swallow
  4. Aspiration Pneumonia
    An acute inflammation of the lungs caused by foreign material entering the lung tissue and resulting  in inflection.
  5. BCA
    Bedside Clinical Ax
  6. Bolus
    A rounded mass such as a large pill or a soft mass of chewed food mixed with saliva
  7. CVA
    Cerebrovascular accident - a stroke which is an interruption of blood supply to some area of the brain.
  8. Strokes results from:
    Embolus - a moving clot (piece of a blood clot or a piece of atherosclerotic plaque) from another part of the body that lodges in the artery.

    Thrombosis - occurs when an artery has gradually filled with plaque. Atheroschlerotic plaque can lead to atherosclerosis which is hardening of the arteries.

    Both an ambolus and a thrombosis result in the blockage of an artery to the brain. The blockage leads to anoxia which is the deprivation of oxygen  to the area of the brain served by that vessel.

    Infarct is tissue death

    Hemorrhagic strokes - involve bleeding in the brain.

    Aneurysm - A weakening in the artery that bulges and breaks leading to an interruption of blood flow to areas of the brain served by that vessel.
  9. Degluttion
  10. DNR
  11. FEES
    Fiberoptic Endoscopy Evaluation of Swallowing
  12. Gastric tube (G-tube)
    A feeding tube that is placed directly into the stomach through an incision.
  13. Gastroenterologist
    Physician who deals with the "gut" - digestive tract
  14. Intravenous
    A needle placed in a vein used to deliver liquid nutrition or medication
  15. Mastication
    chewing food in preparation for swallowing and digestion
  16. MBS
    Modified Barium Swallow
  17. NG tube
    Nasogastric tube. A feeding tube that goes through the nose, through the pharynx and into the stomach.
  18. NICE
    Noninstrumental clinical exam (BCA)
  19. NICU
    Neonatal Intensive Care Unit
  20. NPO
    nil per os - nothing by mouth
  21. Penetration
    Bolus material enters the larynx BUT remains above the vocal folds
  22. Peristalsis
    contraction of smooth muscles leading to movement of food through the digestive tract
  23. Pocketing
    residue in between the cheeck and the gum or under the tongue
  24. Productive cough
    a cough strong enough to expel material from the airway
  25. Silent Aspiration
    Penetration of food or liquid into the larynx and passing below the vocal folds without a protective cough or choking occuring.
  26. TBI
    Traumatic Brain Injury
  27. Treatment Efficacy
    The extent to which an intervention can be shown to be beneficial under optimal or ideal conditions.
  28. Treatment effectiveness
    The extent to which services are shown to be beneficial under typical conditions.
  29. What are the 4 stages/phases of a normal swallow?
    • Anticipatory Stage/Oral preparatory phase
    • Oral Stage/Phase - under voluntary control
    • Pharyngeal Stage/Phase
    • Esophageal Stage/Phase
  30. Anticipatory Stage/Oral preparatory phase
    • -Involves all of the senses
    • -Begins with cognitive level of awareness that food or drink is available to be consumed
    • -The next cognitive process is to decide how to bring the food or liquid to the mouth
    • -Once in the mouth it must be chewed
    • How we chew
    • How long we chew
    • Temperature of the food
    • Size of the bite
    • Texture and consistency of the bite
    • -While chewing, we tighten our cheeks to prevent food from lodging between our gums and cheeks. We pull the soft palate down against the base of the tongue to prevent food from falling past the tongue into the open airway. We use our tongue to move food around inside our mouth and between our teeth to chew. The lip or labial seal prevents food/liquid from falling out.
  31. Oral Stage/Phase - under voluntary control
    Begins when we stop chewing and the tongue tip elevates to touch the alveolar ridge. The food is on top of the tongue, the tongue quickly sweeps back, pulling the food to the back of the mouth and toward the pharynx. The soft palate moves up to make contact with the posterior pharyngeal wall to prevent food from accidently entering the nasal passage. TAKES 1 SECOND.
  32. Pharyngeal Stage/Phase
    • -Begins when the bolus makes contact with the anterior faucial pillars which stimulate the tactile sensation that initiates the swallow response
    • -4 physiological responses occur during the pharyngeal phase
    • FIRST - the soft palate raises and makes contact with the posterior pharyngeal wall to prevent material from entering the nasal passages.
    • SECOND - As the bolus flows over the base of the tongue, there is a "stripping action" caused by contraction of the pharyngeal constrictor muscles - called peristalsis. Peristalsis moves the bolus downward. Simultaneously, muscles elevate the larynx
    • THIRD - The true and false vocal folds adduct tightly providing two more levels of protection.
    • FOURTH - The Upper Esophageal Sphincter (UES) valve relaxes and is pulled open allowing the bolus to enter the esophagus. TAKES 1 SECOND
  33. Esophageal Stage/Phase
    As the bolus passes the UES (sphincter at the top of the esophagus) the sphincter closes and the peristaltic action of the esophagus muscles carries the bolus to the Lower Esophageal Spinchter (LES). (at the bottom of the esophagus which briefly opens to allow the bolus to enter the stomach)

    When the bolus has passed, the sphincter closes to prevent gastric contents from re-entering the esophagus (a problem here leads to REFLUX) TAKES 8-20 SECONDS
  34. What causes dysphagia in infants?
    • -See in infants who are premature, have cerebral palsy, clefting, genetic disorders, illness, or sensory deficits.
    • -GERD (Gatroesophageal Reflux Disease)
    • -Stenosis - narrowing of the pyloric sphincter (at the bottom of the stomach)
    • -Esophageal atresia - the esophagus ends in a blind pouch
    • -Tracheoesphageal fistula-connection between the esophagus and the tracheal wall
    • -Respiratory disorders
    • -Laryngeal web - failure of the vocal folds to completely separate in utero leaving an anterior "web"
    • -Asthma
    • -Vocal fold paralysis
    • -CNS/PNS damage
    • -Cardiac problems
  35. What causes dysphagia in adults?
    • -can occur at any age
    • -stroke
    • -TBI
    • -Dementia
    • -Neuromuscular diseases - MS, ALS, MG, Parkinson's disease, MD
    • -Cancer and treatments for cancer
    • -Surgery
    • -Trauma
    • -Side effects of medications - more than 300 medications affect the production of saliva which leads to a dry mouth
    • -Alcohol may cause or contribute
    • -HIV and AIDS
  36. What are the types of AXs for Dysphagia?
    • Bedside Exam - may be an interview regarding any difficulty involved with eating, drinking, taking a pill. Assess respiratory, phonatory, resonatory and articulatory systems - safe to swallow. Dysphagia tray (items of varying consistency, liquids, pudding, cookie)
    • Noninstrumental exam
    • Instrumental Ax (MBS-Modified Barium Swallow) and FEES (Fiberoptic, Endoscopic, Evaluation of Swallowing)
  37. What are the treatment plans for Dysphagia?
    • -Oral motor excercises
    • -Positioning (chin tuck, head rotation, head tilt)
    • -Cueing-step by step directions
    • -Bolus modifications - smaller sips and smaller bites
    • -Swallowing strategies - (Double or dry swallow - clearing any residual material; Effortful/hard swallow - tell patient to squeeze hard in the back of the throat during swallow; Superglottic swallow - forced closure of the vocal folds)
    • Mendelsohn maneuver
    • Thermal tactile stimulation
  38. Why do we eat?
    • Nutrition
    • Hydration
    • Pleasure
    • Social
  39. ADD
    Attention Deficit Disorder
  40. LD
    Learning Disability