HC 6 Medical treatment & team approach Flashcards Preview

Dysphagia > HC 6 Medical treatment & team approach > Flashcards

Flashcards in HC 6 Medical treatment & team approach Deck (21)
Loading flashcards...
1
Q

What do medical therapies rely on?

A

On the etiology of the dysphagia (treat the underlying medical condition)

  • neuromuscular disease
  • GER (gastroesophageal reflux)
  • xerostomia
2
Q

What’s the medical therapy for a person with neuromuscular disease?

A
  • Determine any medication that may contribute to dysphagia, as many drugs affect the cholinergic nervous system (e.g. production of saliva)
  • ask list of prescribed medications

=> find a blance between therapeutic benefit and side effects of the medication

3
Q

Which patient populations are more at risk to GER contributing to swallowing difficulties?

A
  • asthma,
  • cricopharyngeal bar on DSS
  • glottic incompetence (risk for aspiration)
4
Q

Which treatment do we provide to patients with GER?

A
  1. behavior modifications
  2. if behavior modification is not adequate to control reflux symptoms: add specific medication
5
Q

Which anti-reflux recommendations do we give?

A
  • At least 3 to 4 hours before supine position (bed time): no eating
  • No bedtime snacks
  • Sit upright and use gravity to minimize risk
  • Elevate head of the bed by 10-15 cm (blocks are more effective than pillows)
  • Antacid medication before going to bed
  • Avoid certain foods -> increase gastric acid, lower resting tone, dehydratation (Coffee, tea, pepermint, chocolate, citrus fruits, alcohol)
  • Avoid tobacco
6
Q

What medication may help with GER?

A
  1. H2-blockers = standard therapy: specific dose and schedule
  2. proton-pump inhibitors (2-3 months) = more powerful to decreasing gastric acid production but increased risk of side effects
  3. symptoms controlled -> replace proton-pump inhibitors by H2-blockers -> can be used long term
7
Q

What’s the consequence of xerostomia?

A

Problems with

−Bolus lubrication

−Bolus flow. Poor flow => bolus residue (tongue, palate, pharyngeal wall), risk for aspiration

−Oral mucosal health

−Dental health

−Esophageal GER defense

−Increased viscosity => bolus residue => at risk for aspiration of obstructive bolus

8
Q

Which factors predispose patients to xerostomia?

A
  • autoimmune conditions
  • radiation effects
  • medication (dry mucosa, decrease saliva)
  • iron or vit. B12 deficiency
9
Q

How will we treat xerostomia?

A

−Maximizing general hydration

−Limiting mouth-breathing

−Minimizing products that would contribute to xerostomia (certain medications, mouthwashes or toothpaste with alcohol)

−Minimizing products that favor increased oral bacterial growth

−Maximizing oral hygiene: artificial saliva, pilocarpine

−Avoid potentially irritating foods because of oral sensitivity

−Wet the bolus during oral preparation

10
Q

When would we consider surgical therapy?

A
  • when structural or anatomic abnormalities results in incompetence
  • occasionally when muscular weakness is the etiology
11
Q

How would surgery benefit lips and oral muscles?

A
  • release contractures that prevent oral closure
  • recreate an intact orbicularis oris muscle
12
Q

How would surgery benefit the soft palate?

A
  • soft palate tissue defects and soft palate muscular weakness may be surgically repaired with local flaps (pharyngeal flap)
  • palatal obturators
13
Q

How would surgery benefit the tongue?

A
  • reconstruction after a floor of the mouth cancer resection to minimize tethering and improve tongue mobility
  • when loss of tongue bulk: tissue flaps or fill with body fat
14
Q

How would surgery beneft the vocal folds?

A
  • vocal fold medialization to correct de vocal fold paralyses -> not always successful in eliminating aspiration
15
Q

How would surgery benefit the UES opening?

A

1) relaxation of cricopharyngeus:
- CP myotomy: incisision or cut CP muscle (only if driving forces are still good enough!)
- CP dilatation = enlarged pharynx at rest (catheter with inflatable balloon and stretch muscle -> greater opening)
- botox injection in UES sphincter
2) elevation hyoid & larynx:
- further research needed

16
Q

What is a Zenker’s diverticulum. How can it be treated surgically?

A
  • result of long-term failure of PES to relax
  • out-pouching of the pharyngeal mucosa (above CP muscle and between the inferior pharyngeal constrictor fibers) => food and liquids collect => regurgitation, aspiration
  • complete myotomy of the CP muscle
17
Q

If nothing works, there are some last options to protect the airway. Which ones?

A
  • laryngeal stent: plug into the larynx (tracheostomy needed)
  • laryngotracheal separation (tracheostomy needed)
  • total laryngectomy
  • feeding tubes:
  • nasogastric tube
  • gastrostomy: PEG or PEJ
18
Q

What do we do after the treatment plan has been finalized?

A

Communicate the plan to the patient and all relevant caregivers and family members:

−Summarise medical and feeding history

−Summarise clinical and radiographic evaluations

−Additional observations?

−Current capabilities and impairments

−Impact on nutrition and respiratory health

−Prognosis

−recommendations for follow-up (few generalisations possible)

19
Q

Explain: it is imperative that we have good, reliable and valid assessment tools to diagnose dyshpagia, but also to track change.

A

Possible tools:

−Biomechanical measures, standardized manner: DSS

−Imaging studies: e.g. endoscopy

−Laboratory studies: e.g. blood to check for inflammation

−Special studies: e.g. pH testing to monitor medication GER

−Clinical evidence: e.g. weight gain, less feeding restrictions needed

−Self-assessment tool: e.g. SWAL-QUOL, EAT-10

20
Q

What does the nurse play an important role in?

A
  • Nurse is often the first person to recognize the signs and symptoms of dysphagia
  • Major role in

−Alternative feeding methods (nurse knows how it works)

−Monitoring dietary recommendations and restrictions

−Monitoring psychosocial factors

•Communication with other team members

21
Q

What do we have to educate the nurse in to do so?

A

−Risk factors for aspiration

−How to observe during meals

−Aspiration and feeding precautions e.g. upright position

−Observation of patients from tube to oral feeding

−Observation & care of patients with artificial airways