1. Maria Hodapp Kelsey Fanelli Sarah Bomrad
Safe Feeding in the SNF
Maria Hodapp Kelsey Fanelli Sarah Bomrad

2. Overview of Presentation
Terminology
Signs of Dysphagia
Importance of Safe Feeding
Methods of Safe Feeding
Risks of Unsafe Feeding
Referral to SLP

3. What is Dysphagia?
Dysphagia is a term used to describe a patient having difficulty chewing and/or swallowing.
Can result from various things including:
Normal aging
Neurogenic diseases (i.e., Parkinson’s, ALS, cerebrovascular accident, acquired brain injury)
Cancer/Radiation
Tracheostomy, Prolonged Intubation
Etc.

4. Basic Terminology and Concepts
Aspiration- entry of material into the airway, below the level of the true vocal folds
- not always followed by a cough (Silent aspiration)
Pocketing- when food becomes stuck in the cheek area (i.e., buccal cavity). Some patients with nerve damage are unable to clear this pocketed food
Residual- elements (i.e., liquid and/or solid food) is leftover after completion of the swallow

5. Concepts cont. Stages of the Swallow
Each stage of the swallow is not an isolated event; they are interconnected and if one stage is damaged, damage may occur in other stages
Typically, we talk about 3 stages : Oral (preparing the food in the oral cavity, makes use of tongue and teeth), Pharyngeal (food is sent posteriorly through the pharynx), and Esophageal (food is sent inferiorly through the esophagus into the stomach)

7. Signs and Symptoms of Dysphagia
Food loss from mouth or drooling
Inability to chew
Pocketing of food in sides of mouth
Nasal regurgitation- food/drink coming out of the nose
Effortful swallow
Important to know that the resident may be unaware of this, and may need to be cued to take another swallow to clear food left in oral cavity

8. Signs cont. Coughing before, during, or after swallow
Change in vocal quality (i.e., wet and/or gurgly sound)
Changes in breathing pattern
Throat clearing

9. Importance of Safe Feeding
Improve patient’s quality of life and comfort
Reduce risk of aspiration which can lead to pneumonia
Dysphagia can lead to malnutrition, dehydration, poor wound healing, decreased ability to fight disease, pulmonary issues

10. Oral Hygiene
If a patient is aspirating food then they are at risk for aspirating saliva. If the mouth is full of bacteria and it enters the lungs patient is at great risk for infection.
Be cognizant of patient’s oral hygiene. If the patient’s swallow is compromised and is at risk for aspiration, we would like to decrease the risk of them aspirating harmful oral bacteria.
Should be provided several times a day
Ensure dentures are being regularly cleaned

11. Methods of Safe Feeding
Check food tray to ensure correct diet and diet consistencies
Ensure proper upright position-trunk of body at a 90° angle with head support
Feed/assist patient from a seated position (i.e., patient’s eye level)
Maintain up-right position for 30 minutes after oral intake (to decrease risk of aspiration of residual)
Check mouth after feeding for pocketing

12. Here we see an SLP assisting the patient at eye level
Here we see an SLP assisting the patient at eye level. This can aid the patient in feeling more comfortable and relaxed during feeding.

13. When to refer to SLP If patient is exhibiting signs of aspiration
If patient is exhibiting difficulty eating their regular diet/not eating at all
Be aware if patient develops fevers, this may indicate infection and source could be aspiration