What are the 4 stages of normal swallowing?
1. Oral preparatory or anticipatory
2. Oral phase
3. Pharyngeal phase
4. Esophageal phase
The Oral
... [Show More] preparatory or anticipatory is __________ (voluntary or involuntary)? The food enters the mouth and forms a _________, while the tongue _________ .....
voluntary;
bolus;
holds food against hard palate
Some problems with the Oral preparatory stage is when the pt can't move bolus from the _________ of the oral cavity to __________. This causes drooling, poor lip control, and the __________ of food b/w cheek and gums/under tongue/against hard palate.
front; pharyngeal
"pocketing"
The oral phase of swallowing is ___________ (voluntary/involuntary)? This is when the food is passed to the ____________. The bolus passes the soft palate to trigger a ___________ reflex.
voluntary;
throat;
swallowing
Some problems that happen in the oral phase is _________ in the cheeks, delayed _________, and food _________ in the throat.
pocketing; swallowing; sticks
The pharyngeal phase is __________ (voluntary/involuntary)? The things that happen during this phase are the closing of the _____________, while the larynx raises while the __________ drops. This is to prevent __________..........
involuntary;
nasopharynx/vocal cords;
epiglottis;
food from entering the lungs
Problems that arise during the pharyngeal phase is
copious secretions
gurgly voice
coughing, choking
aspiration
delayed swallowing
The Esophageal phase is __________ (voluntary/involuntary). This is when a reflex called _____________ moves bolus down the esophagus to the stomach.
involuntary;
"peristalsis"
Some problems that arise in the Esophageal phase is food "stuck in throat", and has _________ when lying down. __________ foods may cause problems, while _________ food is okay.
reflux;
solid; pureed
Two ways of diagnosing swallowing problems is Videofluoroscopy which has the pt swallow __________ during radiography, and the Fiberoptic endoscopic evaluation of swallowing - which is done __________......
barium;
bedside w/ no radiation or barium
The ________ _________ method is to help with swallowing and decreased risk of aspiration.
"chin tuck"
Achalasia is the failure of ____________ to relax.
lower esophageal muscles
2 main goal of the RD in dysphagia is identify __________ and their relevance to the nutritional status of the pt; and documenting ___________....
documented problems;
observed problems not already documented (swallow eval by sppech pathologist)
What are the roles of these key team members in dysphagia?
1. Speech & language pathologist
2. Occupational therapist
3. Dietitian
4. Nurses
1. dx & extent of dysfunctions
2. works w/ pt to strengthen swallowing abilities & self-feeding skills
3. provide appropriate food choices
4. ensure adherence to recommendations (i.e. chin tuck)
The hardest liquid consistency to sense and control is _________.
thin
-passes thru quickly
A liquid that is thickened that coats and drips off a spoon like unset gelatin is called _______ _________.
Nectar-like
(ex's: tomato juice, eggnog, Ensure)
The consistency that flows off a spoon in a ribbon is called _________ ___________.
Honey-like
(ex: syrup, molasses)
The consistency that is similar to pudding is called
Spoon-thick - remains on spoon
(ex: yogurt, ice cream, Popsicle)
Things cornstarch and dry milk powder that thicken regular liquids are called
thickening modulars
The order in which you progress the 5 National Dysphagia Diets is:
1. Pureed (NDD 1)
2. Mixed (NDD 1 + 1)
3. Mechanically Altered (NDD 2)
4. Mechanically Soft (NDD 2 +)
5. Advanced (NDD 3)
The NDD that is pudding like with no lumps is called the Dysphagia __________. The subcategory is called the Dysphagia _________, which is when you have characteristics from NDD1 and 2.
Pureed
(ex's: pureed chicken/carrots, mashed potatoes and gravy, applesauce, chocolate pudding)
Mixed
(ex's: oj, plain yogurt, cream of wheat, scrambled egg)
The NDD that allow foods that are moist and soft textured is the Dysphagia _________ _________. The subcategory is called the __________ __________.
Mechanically Altered
(ex's: tender ground or diced meats, soft cooked veggies, soft fruit)
Mechanical Soft
Mechanical Soft diet (NDD 2 +) adds in what 3 foods?
1. bread
2. cake
3. rice
The last Dysphagia diet is the __________, which includes most regular foods except hard, sticky, or crunchy items.
Advanced
(ex's: bread, rice, shredded lettuce tender, moist meats)
The diet that is based on a general, adequate diet and modified for individuals (i.e. religion) is called the
Therapeutic diet
Postgastrectomy, you should hold food at least _________ hours after surgery to avoid ___________. This is due to __________.
8 hrs; regurgitation/aspiration
illeus (no GI peristalsis) - listen for bowel sounds [Show Less]