1. DEFINITION –DIFFICULTY SWALLOWING HEATHER RAWLS RN MS Dysphagia

2. Diseases/ Occurences Causing Dysphagia Parkinson’s disease Multiple Sclerosis Dementia Stroke Trauma

3. Negative Consequences of Dysphagia Dehydration Weight loss Malnutrition Aspiration  the entry of material (such as pharyngeal secretions, food or drink, or stomach contents) from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract.

4. Symptoms of Dysphagia or Possible Aspiration Drooling, increased oral secretions Difficulty swallowing Heartburn, chest pain Coughing or choking at meals Difficulty chewing or swallowing Hoarseness or increased throat clearing Gurgling voice Increased throat clearing

5. Assessment of Dysphagia https://www.youtube.com/watch?v=tqjET- nG21ovideo presentation of assessing for dysphagia

6. Interventions to Prevent Aspiration during Feedings Provide rest before feedings Sit the person at 90-degrees for oral intake (including PO meds) Most important Avoid rushed feeding, adjust rate of feeding and size of bites to the individual Alternate solids and liquids Place food on non-impaired side of the mouth Have suction equipment ready at all times Avoid sedatives and hypnotics that may impair the cough reflex and swallowing.

7. Case Study Mrs. Gonzalez is a 65-year-old Hispanic woman who comes to the emergency department with slurred speech, right facial droop, and weakness in her upper and lower right-side extremities. She is admitted to the hospital with a diagnosis of acute stroke. She has a daughter and two teenage grandchildren who live in another town nearby.

8. Case Study (cont’d)  Mrs. Gonzales is awake and alert in her hospital room, yet is drooling from the right side of her mouth. When she tries to drink water, she starts to cough. The physician has ordered nothing by mouth (NPO). Evaluation by the speech language pathologist (SLP) indicates inadequate clearance of food and liquid from the vocal folds and aspiration of thickened liquids.  Mrs. Gonzalez has trouble swallowing with oropharyngeal dysphagia. The SLP recommends enteral feedings, and speech and swallowing therapy to help her return to oral feedings.

9. Case Study (cont’d) Matt is a nursing student assigned to Mrs. Gonzalez. As he prepares to assess her, he recalls information about the effects of dysphagia on nutrition and rehabilitation. He will assess Mrs. Gonzales’ weight, weight history, diet history, and cultural customs. Matt knows to consult with a registered dietitian (RD) to assess Mrs. Gonzales’s nutritional status and interventions. Matt is responsible for inserting Mrs. Gonzalez’s small-bore nasogastric feeding tube and starting her tube feedings. The RD has recommended continuous tube feeding for 12 hours during the day.

10. Case Study (cont’d) What is the difference between a small bore NG tube & large bore NG tube? Which tube has a higher risk for aspiration? Which tube does not require you to aspirate the contents to check the amount of residual? Which tube uses radiology to check placement? What will Matt do if he fines an inappropriate amount of residual when he aspirates? What complications do you need to look for when starting tube feeding?