Swallowing Disorders Chapter 5

*Evaluation of Swallowing Disorders

*Screening

*Identify presence of signs and symptoms of dysphagia

*Chart Review

*Observation at bedside or at a meal

*Determine whether an evaluation should be completed

*Screening

*Infants/Children/Developmentally delayed adults

*Rejection of Food

*Food selectivity

*Gagging

*Open Mouth posture

*Bedside Examination

*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

*Bedside Evaluation

*Information on

*General ability to follow directions

*Reaction to oral sensory stimulation including taste, temperature, and texture

*Reactions and symptoms during attempts to swallow

*Patient Chart Review

*Respiratory status

*Radiology reports

*Presence of a tracheostomy tube

*History of mechanical ventilation

*History of patient’s swallowing problem

*Nutritional information- oral diet

*Patient Chart Review

*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

*Respiratory Status

*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

*History

*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

*Oral Mechanism Examination

*Universal precautions- gloves, wash hands before and after

*Evaluate range, rate, and accuracy of movements of the

*Lips

*Tongue

*Soft palate

*Pharyngeal walls

*Oral Mechanism Examination

*What if they don’t open their mouth?

*What do you do?

*Laryngeal Function

Examination

*Strength of a voluntary cough

*Ability to change pitch

*Ability to sustain phonation

*Voice quality

*Gurgly

*Hoarseness

*breathy

*Pulmonary Function Testing

*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

*Trial Swallows at Bedside

*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

*Trial Swallows at Bedside

*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?

*Trial Swallows at Bedside

*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

*Trial Swallows at Bedside

*What consistencies should you give?

*Ice chips

*Water by teaspoon, cup, straw

*Pudding/applesauce by teaspoon

*Graham cracker

*Clinical Bedside Swallow

*See PDF file