Decisions Regarding Management

Question 0

What are the aims of dysphagia management?

Answer 0

Primary:
Maintenance of nutrition and hydration
Safety - prevention of aspiration

Secondary:
Re-establish oral feeding

We aim to maximise safety whilst respecting clients wishes

Question 1

What choices do we have regarding management?

Answer 1

1) oral/non oral feeding
2) direct/indirect therapy
3) surgical/non-surgical intervention

Question 2

Ideally, how will decisions regarding management be made?

Answer 2

With client, carer and family in conjunction with the MDT

Question 3

What are the advantage of non-oral feeding?

Answer 3

Improves:
Nutrition
Quality of life
Alertness
Recovery 
Resistant to infection

Question 4

What are the disadvantage of non-oral feeding?

Answer 4

Decrease:
Fear
Stress and anxiety
Skin breakdown and other complications

Question 5

What are the issues surrounding non-oral feeding?

Answer 5

Whether it is short or long term
The timing of introduction - refeeding syndrome cannot go from nothing to everything
Whether it takes place in the hospital or community
Acceptability
Patient choice

Question 6

What are the reasons for selecting NG or PEG tube feeding?

Answer 6

NG = short term, less well tolerated

PEG = long term, higher mortality rates but more cosmetically appealing

Question 7

What are the benefits of dysphagia cups?

Answer 7

Channels liquid centrally, does not promote anything being lost laterally

Weighted - helps to reduce flow for people who have tremor

Better lip seal

Nose clearance - do not have to tilt head back - better posture?