Eating and Swallowing (exam 3)

What is deglutition?

The normal consumption of solids or liquids.

What structures are involved in the swallowing process?

Brainstem, cerebral cortex, six cranial nerves, first three cervical nerve segments (C1-C3), and 48 pairs of muscles.

What is dysphagia?

Impaired swallowing due to dysfunction in any component of the swallowing process.

What are the phases of swallowing?

Anticipatory phase, oral preparatory phase, oral phase, pharyngeal phase, and esophageal phase.

What influences the anticipatory phase of swallowing?

Psychological factors, emotional state, social interactions, cultural influences, and environmental factors.

What occurs during the oral preparatory phase?

Food is masticated, mixed with saliva, and formed into a bolus of appropriate texture for swallowing.

What is the role of the lips in the oral preparatory phase?

To maintain closure and prevent food loss.

What triggers the oral phase of swallowing?

The tongue initiates posterior movement of the bolus toward the pharynx.

What happens during the pharyngeal phase?

The soft palate elevates, larynx elevates and moves anteriorly, epiglottis closes over the airway, and pharyngeal muscles contract to move the bolus downward.

Is the pharyngeal phase of swallowing voluntary or involuntary?

Involuntary.

What begins the esophageal phase?

When the bolus enters the esophagus through the cricopharyngeal junction.

What is peristalsis?

The coordinated muscle contractions that transport the bolus to the stomach.

What is the purpose of a thorough eating and swallowing assessment?

To evaluate for dysphagia or feeding problems.

What does the occupational therapist evaluate during an eating and swallowing assessment?

Medical history, cognitive and perceptual skills, physical control, oral structures, oral motor control, sensation, swallowing ability, and risk for aspiration.

What is aspiration?

The entry of food/material into the airway below the level of the true vocal folds.

What is aspiration pneumonia?

Occurs when material enters the lungs and is identified via x-ray.

What are some predictors of aspiration pneumonia?

Frequent suctioning, COPD, congestive heart failure, feeding tube use, swallowing problems, multiple medications, and eating dependence.

What additional risk factors can contribute to aspiration?

Smoking history, underweight status, abnormal pharyngeal delay, laryngeal penetration, and elevated temperature.

What indicators of dysfunction might be observed in a medical chart review?

Altered diet textures, IV fluids indicating possible dehydration, and weight loss due to chronic feeding/swallowing issues.

What is the significance of hydration and nutritional status evaluation?

To assess intake and output, dietary notes, and nursing documentation for potential issues.

What indicates the presence of a feeding tube?

Significant dysphagia

What are some medication considerations for patients with feeding tubes?

They may affect alertness, orientation, saliva production, appetite, and muscle control.

What nursing notes may indicate issues with medication administration?

Coughing or choking with medications.

What is critical for safe swallowing?

Head and neck control.

What does the assessment of active movement include?

Turning head side to side and moving head up and down.

What does poor head control indicate?

Decreased strength, abnormal muscle tone, or decreased postural awareness.

Why is adequate head control required?

To provide a stable base for jaw and tongue movement and support an effective swallow response.

What is essential for safe eating and swallowing?

Trunk control.

What does trunk control assessment include?

Ability to sit upright in midline, equal weight bearing on both hips, and maintaining position during eating.

What are the goals of proper trunk alignment?

Ensure optimal positioning of swallowing structures and reduce the risk of aspiration.

What does oral assessment evaluate?

Outer oral status, sensation, musculature, oral reflexes, intraoral status, dentition, and tongue movement.

What may poor oral sensation present as?

Drooling, food remaining on lips, or food falling from mouth without awareness.

What are the two primary categories of intervention for dysphagia?

Rehabilitative techniques and compensatory strategies.

What do rehabilitative techniques aim to improve?

Underlying physiology.

What is an example of a rehabilitative technique?

Effortful swallow, Mendelsohn maneuver, Masako maneuver, or Shaker head lift.

What do compensatory strategies aim to do?

Increase safety during swallowing without changing swallow physiology.

What is the goal of postural techniques in dysphagia intervention?

Redirect bolus flow and reduce aspiration risk.

What is the ideal positioning for safe swallowing?

Seated on a firm surface with feet flat on the floor, knees at 90°, and slight forward trunk flexion.

What are common contributing factors to positioning challenges?

Decreased strength, poor balance, reduced motor control, and abnormal muscle tone.

What is the role of oral hygiene in dysphagia management?

Prevents gum disease, plaque buildup, and aspiration of residual food particles.

What are the indications for non-oral feedings?

Aspiration >10% of intake, oral + pharyngeal transit time >10 seconds, or unsafe swallow despite intervention.

What is a nasogastric (NG) tube?

A tube inserted through the nose to the stomach for temporary feeding.

What are the advantages of a PEG tube?

Supports full nutrition and hydration with less aspiration risk than an NG tube.

What is the goal of diet selection for dysphagia patients?

Based on a comprehensive swallowing assessment to ensure safety and nutrition.

What food characteristics are contraindicated for dysphagia patients?

Mixed textures, fibrous/stringy foods, crumbly foods, and foods that liquefy.

What is the purpose of using different bolus textures?

To improve swallow efficiency and reduce aspiration risk.

What is the most appropriate diet for clients with oral motor impairment?

A puréed diet.

What does the assessment of oral musculature include?

Symmetry, need for assistance, and palpation to detect abnormal resistance.

What are the signs of poor dental status?

Dysphagia, pain during chewing/swallowing, dehydration, malnutrition, and weight loss.

What is the role of a multidisciplinary team in dysphagia management?

To provide comprehensive care including physicians, therapists, dietitians, and family.

What is the impact of fatigue on swallowing?

It limits the ability to maintain position and impacts safety during meals.

What should be done if a client is hypersensitive during oral hygiene?

Gradual desensitization and external stimulation may be required.

What is the goal of dysphagia intervention?

To facilitate safe and efficient eating while maintaining adequate hydration and nutrition.