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30 Cards in this Set

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Your patient needs nutritional intake but can't feed orally. What non-oral options are available? Name 5.
1. Nasogastric tube
2. pharyngostomy
3. esophagostomy
4. gastrostomy
5. jejunostomy
Think you know your non-oral feeding procedures? Well, what's a PEG
Percutaneous Endoscopic Gastrostomy (or Jejunostomy). G-Tube is inserted into the stomach through the abdominal wall using local.
Compare/contrast oral and non-oral feeding for me.
Non-oral feeding is more expensive and there is more reflux, but risk of aspiration is fairly equal for oral/non-oral feeders.
The __________ isn't mature in ________. What's needed, and what's the procedure called to do it?
Lower sphincter
surgery to reinforce LES
Fundoplication/Nissan
What does Fundoplication/Nissan procedure do?
wrap/twists stomach around LES to reduce reflux
______ of patients experience swallowing problems after intubation
30%
What do you need to know about a patient regarding intubation?
Were they and for how long, was it traumatic or easy?
You should wait at least _____ after removal of intubation before testing swallowing. ____ is preferable.
24 hours
3 days
True or false

A fenestrated cannula is not recommended for a patient who is aspirating.
True
Name 3 types of suctioning
Oral care
Trach suctioning
Deep suctioning
The goal of therapy is to improve oropharyngeal swallow by ________. What are five ways to do this?
changing the physiology.
1. ROM
2. Strength
3. Timing
4. Coordination
6. Sensory Input
Therapy is designed to be both ______ and ______
functional and measurable
True or False

You should not introduce a bolus in a patient who is aphonic.
True
True or False

It's okay to introduce a bolus with a patient whose voice is merely very breathy
False
A bedside swallow exam is usually ________, _______
high risk, low benefit
You will have trouble getting reimbursed for pharyngeal therapy, if ______
you don't do an instrumental exam first.
There should only be about ____ between contraction of tongue muscles and the hyoid life (as felt by the 1st and 2nd fingers) during the oral phase of the swallow. Any longer is considered what? What techniques can you try, if any?
1 sec
a pharyngeal delay
thermal-tactile stimulation
What are some techniques for which no evidence exists?
DPNS (Deep pharyngeal neuromuscular stimulation)
Vitalstim (electrical stimulation protocol)
Myuofascial release
laryngeal analyzer
Why even perform an endoscopy?
Good for anatomy
Whats the difference between transnasal endoscopy and rigid (oral) endoscopy?
Transnasal has a weaker light source but is good when watching a supraglottic swallow, oral has a great light and gives a great view of the larynx!
Why use ultrasound with patients?
Good for biofeedback.
True or false

Ultrasound can be used to evaluate movements of the tongue surface, hyoid, and pharynx.
False

Not great for pharynx
True or false

Surface EMG can be useful as an additional diagnostic procedure.
False
What two types of manometry are there? Which is best for swallow?
Water manometry and solid state manometry
solid state
_______ measures pressure during swallow. It is often used with ________.
Manometry
videofluoroscopy
where are the sensors placed in solid state manometry
below the UES
above the UES
at the base of tongue
_____ of dementia patients derive benefit from the chin down procedure.
1/3
Why not provide therapy for patients in the end stages of a fatal, degenerative disease?
The prognosis is the same and the costs outweigh the benefit.
______ procedures are used at mealtimes, ______ exercises are used at therapy.
Compensatory, therapeutic
What does the Shaker do?
It strengthens the muscles that raise the larynx!