Download DYSPHAGIA When the sensation, strength, and/or coordination of

EVALUATION BY THE SPEECHLANGUAGE PATHOLOGIST (SLP)
DYSPHAGIA
When the sensation, strength, and/or
coordination of muscles involved in
swallowing are affected it is referred to as
dysphagia. Strokes, traumatic brain injury,
degenerative diseases and other medical
conditions can result in dysphagia.
POSSIBLE CONSEQUENCES
1. Death: When a person aspirates, they may
go into respiratory distress resulting in
ventilation dependency or death.
2. Aspiration Pneumonia: Aspiration may
occur if food or liquid passes into the lungs as
a result of entering the airway instead of the
esophagus. The person who aspirates may be
at risk for pneumonia.
3. Weight loss/ malnutrition
4. Dehydration
Many people with dysphagia may not have a
protective response and do not cough when
food or liquid goes into the airway, which is
referred to as silent aspiration.
INDICATIONS OF SWALLOWING
PROBLEMS
A patient with swallowing problems typically
shows one or more of the following signs:
 Coughing and/or choking during or
shortly after taking a drink or eating
food
 Throat clearing after swallowing
 Voice change with wet gurgly
characteristics
 Increased drooling or saliva
 Effort while attempting to swallow
 Extra swallows needed to swallow
one mouthful of food or liquid
 Increased effort and mouth
movement when chewing or
swallowing
 Sudden increase in body temperature
within 30 to 60 minutes after eating
Bedside Swallow Evaluation(BSSE):
The SLP will receive a physician referral, review
the patient’s history, discuss with RN or
appropriate staff member regarding the patient’s
swallowing, and proceed as appropriate.
The purpose of the BSSE is to:
1. Assess the patient’s oral motor function
2. Administer trials with a variety of liquid and
food consistencies to determine if the patient has
dysphagia and if there are clinical indicators of
aspiration or airway penetration.
3. Recommendations can include:
 NPO if the patient does not appear
safe for oral intake
 Diet modification recommendations
if the patient appears safe with
certain consistencies
 Swallowing instructions to be
followed for the patient’s safety
 Cookie swallow study in x-ray to
further evaluate the pharyngeal phase
of swallowing
 Inform staff of recommendations on
diet and safe swallowing strategies.
What is a cookie swallow study?
Known by other names such as modified barium
swallow study(MBSS), it is a running video under
x-ray with a radiologist and SLP which allows the
SLP to view food and liquid moving through the
oral cavity, pharynx, and into the esophagus.
Aspiration and airway penetration can been seen.
During the study, the SLP tests different
consistencies of liquid and food to determine what
consistency the patient is most safe with and what
postural and swallowing techniques increase the
patient’s ability to protect his/her airway.
PASS or FAIL?
Rarely are the results of a swallow study
considered as pass or fail. The purpose of the
swallow studies (BSSE or MBSS) are to:
1. Make diet recommendations
2. Determine safe swallow
strategies
3. Determine therapeutic goals
TREATMENT BY THE SLP
When the patient is in the acute care hospital,
the SLP will instruct patients on diet
modifications and compensatory/ safe
swallow strategies. The SLP will follow up
with the patient to assess tolerance of the
recommended diet, training on compensatory
strategies and to communicate with staff
regarding eating/swallowing concerns. If
appropriate, the SLP will initiate exercises to
improve swallow functioning.
One way for the SLP to communicate to staff
members who may be assisting in feeding the
patient or general care for the patient is to post
recommendations at the bedside.
SIGNAGE POSTED AT THE BEDSIDE
MAY INCLUDE:
1.
2.
3.
4.
5.
Level of supervision:
Setup; intermittent; dependent; 1:1
feeding; or specific instructions to assist
the patient with eating.
Diet:
FOOD CONSISTENCIES—regular; soft;
pureed; dysphagia mechanically altered.
LIQUID CONSISTENCIES— all liquids;
nectar thickened liquids; honey thickened
liquids; spoon thickened liquids; no
liquids by mouth.
Specific Instructions:
May include— body positioning; chin
tuck; alternate solids and liquids; bite
size; rate
Presentation of Medications:
As tolerated; applesauce; crushed in
applesauce
Identification:
Patient’s name; speech pathologist; pager
number; date instructions placed.
**A laminated sign will be posted at the head of
the bed to specifically indicate the liquid level the
patient may have. Diet recommendations can
also be written on the dry erase boards**
What Can Nursing Do to Prevent
Aspiration?
DIET MODIFICATIONS AND COMMON
COMPENSATORY STRATEGIES
RECOMMENDED BY THE SLP
1.
2.
3.
4.
5.
Thickened liquids: The thicker the liquid
the slower it moves through the pharynx
allowing more time for the patient to
swallow. Thickened liquids can come prethickened or liquids can be thickened by
powders or gels. Thickeners are available
on every nursing unit and can also be
ordered from dietary.
Moistened foods, ground meat, pureed:
Many patients may have poor oral control
and weakness making chewing difficult.
Modified solids may reduce pocketing,
residue, and allow the patient to use less
effort to prepare solids.
Positioning and posture: Upright, 90
degrees, and body midline is typically the
optimal position for patients to eat and
drink. A chin tuck is often recommended
which may allow the patient to protect
his/her airway more effectively.
Alternating solids and liquids and double
swallow: These strategies can help reduce
the amount of residue in the pharynx after
the patient swallows.
1:1 feeding: A patient may need handover-hand feeding, assistance with using
utensils, or need supervision to follow
strategies.
A Speech Language Pathologist
may be contacted
through the
Rehabilitation Therapies Department Phone #:
734-458-3381
Post Test
Name: ___________________ Date: ______
1. What are 2 of the 4 possible consequences of
dysphagia? _________________, _____________.
2. What are 4 of the 8 signs of swallowing
problems? _________________, ______________
____________________, __________________.
3. When someone does not have a protective
response when something goes into the airway, it
is called ____________________.
4. T or F. The purpose of the Bedside Swallow
Evaluation is to assess the patient’s oral motor
function, administer trials with a variety of liquid
and food consistencies to determine if the patient
has dysphagia and if there are clinical indicators of
aspiration or airway penetration and make
recommendations.
Swallowing
Problems?
How to Prevent
Aspiration
5. What are 3 of the 5 possible recommendations
made from a bedside swallow evaluation?
_______________, ________________________,
______________________________.
6. A running video under x-ray used to visualize
swallowing is called __________________.
7. T or F. The purpose of the cookie swallow
study is to make diet recommendations, determine
safe swallow strategies and therapeutic goals.
8. What is included on the sign posted at bedside?
__________________, _______, _____________,
______________________, _________________.
9. What strategies can help reduce the amount of
residue in the pharynx after the patient swallows?
_________________________________________
_________________________________________
10. If a patient has a thickened liquid diet, should
the patient have thin water at bedside? Yes or No
Five Minute Forum
For RNs, LPNs, PCAs, TPs
Developed January 2010
Revised 02/2013