Dysphagia Exam 2

Why do people go on ventilators?

- their diaphragm is not working, there is an obstruction in the upper airway or, or something has happened, so they are not ventilating on their own.

intubation

process that inserts a flexible plastic tube through a patient's mouth or nose into the windpipe to keep the airway open

Endotracheal goes through what

Endotracheal goes through mouth

Who is endotracheal good for?

Good for unconcious , and surgeries

Which type of airway has more options for feeding and voice avaliable?

tracheotomy

What part of tracheostomy tube is SLP responsible for?

They are responsible for changing inner and outer cannula.

What do the cuffs do?

Prevent air escape

Side effects long term cuff inflattion

desensitization, stenosis, granulomas

When do you never place a valve?

If it is inflated you come back later

What can happen when valve is first put on?

There can be a build up of secretions and mucus

What can ask patient to do when you first put valve in?

Dry swallow, cough, hum, phonate (AH)

Finger occlusion

Do to see if patient can handle cap

What would you never put on patient with laryngectomy:

never put speaking valve

What can SLPs do to take care of tracheostomy?

SLPs can suction, oral hygiene to reduce bacteria

how do you evaluate trach and vents patients?

case history, ome to see how the structures are working and responding, see cough, phonate,

FEES for traches and vents

• Better for mechanically ventilated patients who can't transport

MBS or VFS

good for patients who can actually transport to radiology, and you can see it more clearly.

when can you wean off?

Once they can tolerate that cap on for twenty-four hours, at that point, you can actually advocate for that trach either to be reduced in size or removed altogether.

Speaking valve is also for what?

redirect airflow and restore sensation

what is the goal of artificial ventilation?

help patient maintain a patent airway

what kind of patients are endotracheal tubes good for?

good for surgery and unconscious patients

what might happen when you deflate cuff for first time?

there might be a lot of mucus and secretions

why can kids have one way speaking valve?

kids with muscular dystrophy have difficulty ventilating

What can you do to wake up the sensory nerves?

do finger occlusion and have patient put ice chip in mouth

why is oral hygiene so important?

we dont want patients to aspirate bacteria

what evaluative testing is good for tracheotomy?

MBS is better because they can be transported to radiology

when is it appropriate to use FEES?

It is better to use for patients still on mechanical ventilator and cannot transport

neurodegenerative disease

relating to the progressive loss of structure, function, and eventual death of neurons (nerve cells) in the central nervous system (the brain and spinal cord)

what is guaranteed with individuals with neurodegenerative diseases?

developing dysphasia

what interventions can be done for PD patients?

PD patients can have pharmacological interventions aka dopamine replacements

what can co occur with PD?

esphogoeal dysfunction, drastic weight loss

what is dyskinesia?

when you take too much dopamine

what does a weak cough signal?

good predictor that patient has swallowing dysfunction

what is different about parkinson’s plus?

decline is a lot faster

what is life expectancy with parkinson’s plus?

6 to 10 years from the time they’re diagnosed

what dont PD+ patients benfit from?

does not benefit from dopamine medication

Chorea

neurological movement disorder characterized by brief, abrupt, irregular, and involuntary dance-like movements of the face, trunk, and limbs

apoptosis

writhing of their hands and limbs

lingual chorea is what?

an involuntary, rapid, non-rhythmic, and dance-like movement disorder restricted to or predominantly affecting the tongue

lingual chorea shows up with what?

huntington’s

why is lateral x-ray be better than fees for PD+?

they are choreic so they move around a lot which isnt good for FEED

bulbar als sees changes in what first?

notices changes in speech and swallowing first

spinal als sees changes in what first?

they are going to be wheelchair bound first, lose function in their arms, legs

where is a peg tube placed?

placed through esophagus

what is the survey to ask MS patients?

Dymus is a 10 item questionnaire for MS

diverticulum

mall, abnormal pouch or sac that bulges outward from the wall of a hollow or fluid-filled organ in the body

non-degenerative diseases

a condition, disease, or tissue change that does not worsen, break down, or progressively decline over time

writers cramp is example of what?

dystonia

what is dystonia?

muscles become fatigued, may hyper contract and its painful

Suckling

Stimulating the infant's lip swill resultin suckling -followed by a swallow

Rooting

Stimulating the area around the infants mouth will elicit a head turn in the direction of the stimulus

Grasping

Infants fingers will close tightly around the stimulus placed in the palm

Gagging

Protective reflex that triggers a strong physical reaction to substances entering the airway

Transient

Short lived or readily correctable

Episodic

Occurs periodically

Chronic

Ongoing and cannot be resolved

Oral phase deficits in child

Absent oral reflexes

Weak suck

Uncoordinated suck

Organic Causes of dysphasia in peds

Neuronmotor, mechanical obstruction, medical/genetic abnormality

babies with carcadic treatment

Apnea

Absent breathing

Bradycardia

low heart rate

Gavage feeding

Most common, tube through nose/mouth for duration of feed

What is rare in peds?

PEG tube

TPN stands for what

total parental nutrition

TPN does what

Delivers nutrients directly into bloodstream through a vein

Developmental care in NICU

-consider fetal developmental of sensory systems

-think about what can overwhelm their sensory systems

-timing of care delivery(when is baby hungry)

-lighting, noise level

Artificial nipple

Binkies, bottles

Nutritive suck how to measure

Count the number , 2 minutes is critical

Signs of feeding distress

Color change, fussiness,nasal flaring , chin tugging, gulping, cough, choking

What strategies can you do for babies.

Modifications : environmental, positional, nutritional, material selection , scheduling

Strategies : compensatory, handling, medial management

CP issue

More spastic more espogeal issue

GERD treatment options

Dietary thickeners

positioning after meals

-small more frequent meals

Nissan fundoplication

Tissue Wrapped around stomach , to create esophageal sphincter

Micrognathia

Small jaw

Treacher Collins syndrome

Lowered eyes

Tracheesopjageal fistula

Abnormal connection between esophagus and trachea

Esophageal Atresia

Esophagus doesn’t form properly in utero

Cleft lip/palate

Craniofacial creates feeding challenge

Cleft palate surgery -palate

9 to 12 months of age

Why is undo tracheal better for unconscious patient?

Good for short term immediate airway support. Also don't need to have surgery

what is this ?

nasal cannula

what is this?

simple face mask

what does ECMO stand for?

extracorporeal membrane oxygenation

What is EMCO?

It adds oxygen, removes carbon dioxide, warms the blood, and returns it to the body, giving a patient's failing heart and lungs time to rest and heal

decannulation

the planned and safe medical removal of a tracheostomy tube once a patient no longer needs it to breathe or clear secretions

what does it mean the cuff is inflated?

there’s no air moving through the upper airway

kangaroo care

the baby is placed upright, directly against a parent's bare chest in skin-to-skin contact.

closed box

buccinator, palate, tongue

cleft lip palate doesn’t have what

closed box

cleft palate cannot do what

close pressure

why arent babies born with neck?

protects larynx

what food type can 0-4 months old have?

liquid only

what food type can 4-6 months have?

breast milk or formula, thin purees

what kind of binkys do we want?

want something that mimics palate

where does zenker diverticulum occur?

UES

what can occur with zenker diverticulum?

halitosis

halitosis

unpleasant odor originating mostly from bacteria trapped on the tongue, food breakdown, and poor oral hygiene

process of airway support

1. Mechanical ventilation

Ventilator provides breathing support.

2. Ventilator weaning

Support is gradually reduced as the patient does more breathing independently.

3. Spontaneous breathing

Patient breathes without the ventilator, if medically appropriate.

4. Speaking-valve trials and capping

Upper-airway airflow and breathing tolerance are assessed.

5. Decannulation

Tube is removed when the medical team determines it is appropriate.