Swallowing Disorders Chapter 5

* Identify presence of signs and symptoms of dysphagia * Chart Review * Observation at bedside or at a meal * Determine whether an evaluation should be completed

* Infants/Children/Developmentally delayed adults * Rejection of Food * Food selectivity * Gagging * Open Mouth posture

* Information on * current medical diagnosis and medical history * Nutritional and respiratory status * oral anatomy * respiratory function and its relationship * labial control * palatal function * Pharyngeal wall contraction * Laryngeal control

* Information on * General ability to follow directions * Reaction to oral sensory stimulation including taste, temperature, and texture * Reactions and symptoms during attempts to swallow

* Respiratory status * Radiology reports * Presence of a tracheostomy tube * History of mechanical ventilation * History of patient’s swallowing problem * Nutritional information- oral diet

* Current and past medical problems that may cause dysphagia * Current and immediate past medications that cause dry mouth, reduced alertness, or delayed reaction time * History of the swallowing disorder * Presence of placement of an airway device * Presence and complications of oral and nonoral nutrition

* Observe the following * Respiratory rate * Timing of the patient’s saliva swallows in relation to the phases of the respiratory cycle * Timing of any coughing in relation to respiration * Duration of comfortable breath hold * Rest breathing pattern, oral or nasal

* Gather exact nature of symptoms from patient, nursing staff, and/or family * Did it worsen gradually or rapidly? * Does the problem differ with different consistencies of food or liquids? * Does the patient cough or choke? * Pattern of swallowing difficulty with particular consistencies

* Universal precautions- gloves, wash hands before and after * Evaluate range, rate, and accuracy of movements of the * Lips * Tongue * Soft palate * Pharyngeal walls

* What if they don’t open their mouth? * What do you do?

* Strength of a voluntary cough * Ability to change pitch * Ability to sustain phonation * Voice quality * Gurgly * Hoarseness * breathy

* Ordered and interpreted by a Physician * Can a patient tolerate any amount of aspiration? * No guidelines as to the level of pulmonary function that a patient must have in order to tolerate aspiration

* Posture * Head at 90 degree angle, sitting up as much as possible * Food position * Oral weakness on one side- place on stronger side * Food consistencies * Current diet? * Utensils * Cup, spoon, straw

* Clinician should place fingers in the following positions (very light touch) * Index finger just behind the mandible * Middle finger at the hyoid bone * Third finger at top of thyroid cartilage * Fourth finger at bottom of thyroid cartilage * What are you going to observe?

* Any s/s of aspiration- coughing, throat clearing, watery eyes, runny nose * Have patient sustain /ah/ for several seconds after the swallow * Gurgly, wet vocal quality * Have patient force out a deep exhale * Any residue in valleculae may be moved out * Turn head to each side and vocalize * Any residue in pyriform sinus may be squeezed out

* What consistencies should you give? * Ice chips * Water by teaspoon, cup, straw * Pudding/applesauce by teaspoon * Graham cracker

* See PDF file