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23 Cards in this Set
- Front
- Back
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At what stage of the swallow is the bolus transported via action of the tongue and its interaction with the palate, teeth, and cheeks
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oral phase
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At what stage is the tongue the primary manipulator of food?
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oral phase
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duration of oral stage
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1-1.5 sec
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At what stage does the velum elevate
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pharyngeal phase
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What structures are involved in the pharyngeal phase
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tongue, velopharynx, and larynx
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what triggers the forward motion of the hyolaryngeal mechanism to increase the opening of the UES? what stage is this in?
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tongue elevates and velopharyngeal closure begins triggering the forward motion of the hyolarngeal mechanism... during the pharyngeal phase
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duration of the pharyngeal phase
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1 second
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primary function of the esophageal body is
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passage of injected material from teh pharynx to the stomach
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descending inhibition
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bolus is propelled through the esophagus by relaxation below the bolus
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primary peristalsis vs. secondary
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primary: when a swallow induces peristaltic activity
secondary: initiation of a propagated contraction wave in the absence of a swallow |
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duration of the esophageal phase
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8--12 sec
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protective mechanisms regarding the airway to prevent aspiration
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retraction of the epiglottis
elevation and forward movement of the hyoid and larynx (tucks the larynx under the base of the tongue somewhat) adduction of the true vocal folds sphincter squeezing/ closure of the laryngeal vestibule |
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pulse ox should always be above
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96%
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consistencies
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thin liquid
thickened liquid (nectar, honey, spoon) puree mechanically altered (mechanical-chopped, mechanical-ground) soft |
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how much liquid to start with
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50ml of H2o (5 spoonfuls)
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purpose of bedside eval
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screening for possible dysphagia
determine as much as possible, the physiologic factors contributing to the dysphagia make a determination for the need for other tests make recommendations for the safest means of intake recommend diet |
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cranial nerve signs during oral-facial exam
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V- muscles of mastication
VII- dry mouth, loss of taste, obicularis oris IX- touch walls of phayrnx- should contract X - deviated uvula, dropped soft palate XI- muscle wasting in neck XII - tongue position and strength |
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fluoroscopy visualizes
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bolus during height of the swallow
analyzes oral phase completeness of tongue retraction UES opening laryngeal elevation extent of aspiration submucosal changes |
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endoscopy visualizes
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secretions
direction assesses sensation directly views surface anatomy mucosal abnormalities effect of altered anatomy on bolus flow and airway protection glottis closure path of the bolus clearly location of bolus within the phyopharynx |
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advantages of FEES
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transnasal passage of a flexible laryngoscope into the phyopharynx whereupon food and liquid were presented
portable biofeedback no limitation to the amount of time avail for observing b/c no radiation exposure unequaled view of airway protective patterns good for pt with sudden onset of pharyngeal dysphagia or acute phase after stroke, etc good for pts who have had fluoroscopy and confirmed dysphagia for retesting |
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advantages of fuloroscopy
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best for questions regarding oral stage impairments
best for pts being seen for the 1st time with longstanding dysphagia or vague complaints and confounding signs during bedside pts with complaints of food stuck at the level of the thyroid notch or below and pts with obvious signs of upper esophageal or esophageal dysphagia |
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FEES
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flexible endoscopic evaluation of swallowing
transnasal allows view of the swallow immediately before and after triggering of the swallow reflex can observe VP closrue, structural integrity of the larynx/pharynx, excess secretions, sensation and TVC ad/abduction observe dry swallows and clearing of secretions can view: preamature spillage/pooling; penetration/ aspiration' pharyngeal residue; effectiveness of cough; effectiveness of dry swallow to clear residue can view effectiveness of various postures and compensatory maneuvers |
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MBSS/VDSW
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oral cavity, pharynx, and somteimes upper portion of the cervical esophagus is viewed radiographically
lateral view primarily with some anterior views |
