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Dysphagia Screening 2011

Dysphagia Screening 2011. Anatomy of the Swallowing Mechanism. Structures involved in deglutition ( chewing ) are: oral cavity pharynx larynx esophagus. Dysphagia Screening.

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Dysphagia Screening 2011

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  1. DysphagiaScreening2011

  2. Anatomy of the Swallowing Mechanism • Structures involved in deglutition (chewing) are: • oral cavity • pharynx • larynx • esophagus

  3. Dysphagia Screening • Dysphagia (difficulty swallowing) is common with neurologic disorders such as stroke, Parkinson’s disease, dementia, history of prolonged or multiple endotracheal intubations or tracheostomy. • Aid in identifying at risk patients and decrease risk of chest infection, malnutrition, persistent disability, prolonged hospitalization, morbidity and mortality

  4. Dysphagia Screening • Performed by the nurse upon patient’s arrival to the unit before any food, drink or oral medications are administered • Should be initiated in the Emergency Department on all neuro patients • If not initiated in the ER the admitting nurse should administer the screen within 4 hours of admission • The screen is an online assessment under Dysphagia assessment

  5. Dysphagia Screening Procedure • Elevate patient to at least a 45 to 50 degree angle prior to dysphagia screen to achieve the best possible screen • If any impairment or severe impairment is found during screening, an automatic trigger will be sent to Speech Therapy • If any impairment is found, the nurse should notify the doctor to determine if an NPO status and consult to Speech Therapy is warranted

  6. Dysphagia Screening • Assessment of the patient’s swallowing ability should be ongoing with any intake • Nurse must monitor patient for clinically observable signs of dysphagia: • coughing or choking on food or saliva • pocketing of food • garbled speech • facial muscle weakness • delayed or absent swallow reflex • drooling • watery eyes following any intake or a gurgling voice

  7. Dysphagia Screening Assessment • History of Aspiration: information may be obtained from patient, family, facility patient transferred from, or from past medical history if modified barium swallow/swallow evaluation performed at JRMC (information available under SPEECH in Invision) • Controls Secretions: no secretions; does patient drool; does patient require suctioning of own secretions? Red flag for pharyngeal dysphagia

  8. Dysphagia Screening Assessment • Consciousness: is patient alert; lethargic; or obtunded? • Respirations: normal, on room air; dyspneic or face mask O2; tracheostomy • Voice Quality: normal; impaired, decreased volume/pitch range/ dysphonia; wet/gurgly, sounds like they need to clear their throat • Follows Commands: consistently; less than 50% of the time; does not follow directions

  9. Dysphagia Screening Assessment • Volitional Cough: strong/adequate; weak; absent, unable to adduct vocal folds/clear secretions • Facial Weakness: normal; asymmetrical; inadequate labial seal • Soft Palate Elevation: symmetrical; asymmetrical; no elevation or unable to test • Gag Reflex: present; diminished; absent

  10. Dysphagia Screening Assessment • Tongue Strength: move tongue circumorally; tongue deviates to one side (weaker side); no lingual movement • Lip Closure: normal; weak; not achieved, unable to impound intra-oral air pressure • Swallow: within 2 seconds; delayed; aphagic (absent swallow, must watch & feel for the swallow) • Dysarthria: normal speech; slurred speech; unintelligible speech

  11. Eyes watering Gagging Change in respiratory rate Change in lung sounds Facial grimacing Chest pain Reddening of the face Difficulty breathing Coughing Gurgly voice quality Spiked fever Chronic copious clear secretions Audible breathing High or low back pain Delay in swallowing Signs & Symptoms of Aspiration

  12. Care of the Patient with Dysphagia • Patient should be placed in high Fowler’s position for a meal • Patient should be left sitting upright for 30 minutes after a meal • Mouth care should be done prior to a meal to facilitate sensation • Food should be placed in the unaffected side of the mouth

  13. Care of the Patient with Dysphagia (continued) • Patient should be fed small portions • Respiratory assessment should be done after feeding with suctioning apparatus near the patient at all times • Educate the patient and family on aspiration and precautions. • No straws to be used, unless recommended by Speech Therapy. • Use of sip cups as recommended by Speech Therapy/doctor.

  14. Dysphagia You have completed the reading portion of the Dysphagia Screening Module Please return to the Clinical Staff Reference page • Print the Dysphagia Screening Module post test & certificate • Complete both & return to your PCM

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