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Swallowing Difficulty

Swallowing Difficulty. In-service Training Guide. Four Phases of Normal Swallow. Oral Preparatory Oral / Voluntary Pharyngeal / Involuntary Esophageal / Involuntary. Oral Preparatory Phase. “Anticipatory stage” Occurs prior to the food entering the mouth

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Swallowing Difficulty

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  1. SwallowingDifficulty In-service Training Guide

  2. Four Phases ofNormal Swallow • Oral Preparatory • Oral / Voluntary • Pharyngeal / Involuntary • Esophageal / Involuntary

  3. Oral Preparatory Phase • “Anticipatory stage” • Occurs prior to the food entering the mouth • Your mouth begins watering and your stomach may start to growl • Your body’s reaction to the anticipation of eating

  4. Oral Phase / Voluntary • The tongue moves the food around in the mouth for chewing. Chewing makes the food the right size to swallow and helps mix the food with saliva. Saliva softens and moistens the food to make swallowing easier. The tongue collects the prepared food or liquid, making it ready for swallowing.

  5. Pharyngeal Phase / Involuntary • This stage begins when the tongue pushes the food or liquid to the back of the mouth, which triggers a swallowing reflex that passes the food through the pharynx (the canal that connects the mouth with the esophagus). • During this stage, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the lungs. • Aspiration is most likely to occur during this phase.

  6. Esophageal Phase / Involuntary • The food is propelled downward from the upper esophagus to the stomach by a peristaltic movement. • Impaired esophageal functioning can result in retention of food & liquid in esophagus after swallowing • An interval of 8-20 seconds may be required to drive food into the stomach.

  7. Abnormal Swallow • 53 – 74% of Nursing Home Residents Affected • Aspiration Pneumonia • 5th Leading Cause of Death = over 60 year of age • 3rd Leading Cause of Death = over 80 years of age

  8. Swallowing Difficulties Actually symptoms of other underlying conditions.

  9. Two Broad Types of Swallowing Difficulties -Oropharyngeal Dysphagia Affects the mouth & upper throat -Esophageal Dysphagia Affects the esophagus

  10. Oropharyngeal Dysphagia • Characterized by difficulty moving food or liquid to the back of the throat, and initiating a swallow. • Food accumulates in the mouth - spills out the corners or from the back of the mouth into the nasal passages • Will actually pass the vocal cords and enter the trachea causing respiratory distress.

  11. Esophageal Dysphagia • Characterized by a sensation that swallowed food or liquid is sticking in the esophagus somewhere near the neck or chest.

  12. Stroke Parkinson's Disease Muscular dystrophy Tumors of the mouth Radiation-induced dry mouth Drug-induced dry mouth Chemotherapy-induced inflammation of the mouth Causes of Oropharyngeal Dysphagia

  13. Causes of Esophageal Dysphagia • Inability to produce involuntary, wave-like contractions of the esophagus • Esophageal spasms that block food and liquid instead of propelling them downward toward the stomach.

  14. Causes of Esophageal Dysphagia(continued) • Age related changes of motor function of esophagus • Tumors of the esophagus • Functional dysphagia with no physical reason - stress • Esophagitis induced by reflux disease (GERD)

  15. Difficulty chewing Difficulty initiating swallowing Persistent sensation of a "lump" in the throat Frequent need to clear throat Drooling Pain during swallow Bad breath Change in voice (Nasal voice or hoarseness) Hiccups Weight Loss Heartburn Chest Pain Symptoms of Dysphagia

  16. Taking a long time to begin a swallow Needing to swallow 3-4 times for each bite Coughing Frequent throat clearing Difficulty swallowing liquids in mouth Wet / gurgly voice Extremely slow eater - > 45 minutes Rocking tongue back & forth Spitting food out Warning Signs of Swallowing Difficulty

  17. Malnutrition Weight Loss Dehydration Choking Aspiration Pneumonia Depression Swallowing Difficulty Complications

  18. Swallowing Assessment • Watch the resident while he or she drinks a few ounces of water – delayed swallowing initiation, coughing, a wet or hoarse voice quality may indicate a problem. After the swallow, observe resident for 1 minute or more to see if delayed cough response is present. • Document observations in medical record.

  19. Signs to Report • Oral leaking • Choking • Pocketing food • Taking longer than 2-10 seconds to swallow • Choking on pieces of food

  20. Positioning for Swallowing Difficulty • 90 degree angle / swallowing is easier & safer • If paralyzed on one side, turn head slightly to the weak side & slightly down • (may increase ability to swallow – positioning this way may help reduce the passageway on the paralyzed side of the esophagus)

  21. Tilt the head down slightly Place food in the back of the mouth If paralyzed on one side, place food on strong side of mouth For tongue thrusting – try placing food on the back of the tongue Small management sips or bites Keep upright for 30 minutes after eating to prevent risk of aspiration Reducing Swallowing ProblemsSolutions/Interventions/Techniques

  22. Meal Time Interventions • Remove distractions • Use special swallowing maneuvers recommended by SLP • Eat more slowly • Smaller mouthfuls of food • Special utensils & prosthetics • Adjust temperature, taste & texture of food

  23. Avoid dry foods – moisten with gravy, sauce or broth Wait for resident to swallow prior to placing any more food in mouth Check mouth very carefully after meals Clear all food from back of mouth, between cheek & gums & under dentures NEVER RUSH BE VERY ATTENTIVE Solutions/Interventions/Techniques

  24. Soft, chopped, ground or pureed foods Thickened liquids Cohesive foods Serve food cold or hot, (not warm). Cold, sour foods or liquids can improve the oral stage of the swallow by the triggering of a swallow. Making Swallowing Easier

  25. Stop feeding immediately Call for assistance Utilize Heimlich maneuver if needed Sit the individual forward (If unable to sit, turn head to side) Do not give water or fluids until symptoms subside Trained personnel may need to use suctioning techniques Do not give water or fluids until symptoms subside What if Choking Occurs?

  26. Always follow the recommendations of the Speech Language Pathologist (SLP),in addition to your facility’s policy and procedures.

  27. Questions? Thank you for all that you do for our residents!

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