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List some signs and symptoms of dysphagia
- Protracted mastication
- Impaired oral sensation
- Oral incontinence/drooling
- nasal regurgitation
- uncontrolled bolus flow into pharynx
- abnormal swallow onset
- laryngeal penetration and laryngeal secretions
- pharyngeal residue and stasis
- retrograde bolus flow
- esophageal considerations
Instrumental measurements of pathophysiology
- Bolus formation/propulsion
- Swallow initiation and coordination
- airway protection
- swallow duration
- respiratory swallow coordination
- pharyngeal clearance
- esophageal components
How many right lobes? Left?
What is pleural effusion?
What is atelectasis?
What is infiltrate?
- 3 right, 2 left
- Fluid between lung/pleural wall--SOB, pain, rapid breathing, coughing
- Absence of gas from part or whole of lungs due to failure of expansion or reabsorption of gas from alveoli--Pain, coughing, breathing difficulty
- Fluid or congestion on x-ray in airways
Consequences of swallowing impairment:
Which are most serious, bacterial or viral?
- Bacteria, fungus, viruses
- Cough with greenish or yellow mucus, bloody sputum, happens on occasion, fever with shaking chills, sharp or stabbing chest pain worsened by deep breathing or coughing, rapid shallow breathing, SOB
- Bacterial are most serious
What is the most common cause of death in dysphagia patients due to neurological disorders?
What is aspiration pneumonia?
What are risk factors?
How is it treated?
- Inhalation of colonized oropharyngeal material, development of a radiographically evident infiltrate in at risk patients
- Increased bacterial burden of secretions in those with compromised immune systems, poor dentition/oral care
What is aspiration pneumonitis?
- Acute lung injury after regurgitation of gastric contents
- Decrease consciousness due to drug overdose, seizures, CVA or anesthesia. Depends on acidity and volume of contents aspirated. Can occur in patients with enteral feedings gastroparesis or small bowel obstruction
- Airway suctioning, endrotrachial intubation for those without airway protection.
- Prophylactic antibiotics NOT recommended
Tube feeding & Aspiration
- Does not eliminate risk for aspiration no difference between PEG and NG in prevention. No protection from colonized oral secretions (saliva)
- Increased risk of aspiration pneumonia due to supine position, gastropareiss, and NG intubation. 30% in supine position have GER
What is a PEG tube?
- Percutaneous endscopic gastronomy tube: through nose/mouth through esophagus/LES, go down to stomach and blow balloon to keep it in
- Nasogastric tube: through nose to esophagus to stomach; Continuous feedings (pump feeding, better for gastric emptying, more for acute care), bolus feeding (syringe hooked up, pour drink/bolus, more for rehab/going home)