Evaluation Begins Here

The Evaluation Begins Here!

Medical Chart  

Current Graphics/Vitals

B/P – Optimal: Systolic 120, Diastolic 80

Normal 130 85

High Norm 130-139 85-89

HTN Stage 1 140-159 90-99

Stage 2 160-179 100-109

Stage 3 +180 +110

Respirations

Normal rate is 14 inspirations per min.

Breath Sounds:

Rhonchi – course, dry rales

Rales – abnormal resp sound

Wheeze – whistling sound

Congestion – gurgly sound

Pulse

Normal adult rate varies 60-80 beats per min.

 

Temperature

Normal 98.6 F

A temp spike resulting from aspiration will occur 30 minutes to 1.5 hours after a meal

Pulse Oximetry–

Pulse and degree of O2 saturation should be maintained at 95%-100%. Below 90% is abnormal. This is notable after aspiration.

 

CXR

Infiltrate – Fluid or cells infiltrated into lung tissue

Telecasts – Collapsed lung tissue from fluid or air.

Aspiration is typically noted in RLL

Nutrition and Hydration

Energy needs range from 1200 calories a day to over 200 for those who are depleted.

BUN – WNL: 9-12

Lower than 6 could result in:

Overhydration

Renal Failure

Diabetes

Infection

BUN of 25+ coupled with Creative of 1.5+ may be the result of:

Kidney and or renal Failure

Muscle Breakdown

Albumin – WNL 3.5-5.5

Lower than 2.1 could be a result of:

Malnutrition

Blood Loss

Edema

Stress

Diarrhea

Over hydration

Cancer

Fact: Labs are typically decreased in a dysphagia patient and 30% of all hospital patients are malnutritioned and 35-85% of long-term care residents.

 

HYDRATION

Some items should be avoided to keep from drying mucous membranes

• No dairy products: milk, ice cream, cheese etc (thicken mucous)
• No chocolate in any form: drinks, candy, cookies, etc.
• No brown colored sodas: Coke, Pepsi, Dr. Pepper, etc.
• No coffee or tea
• No alcoholic drinks
• No smoking
• Fruit juices and non-brown colored drinks, and water are allowed

Dysphagia Deficits

Oral Phase Deficits

Oral Hold – decreased lingual coordination, apraxia, and cognition.

Lingual rolling – secondary to lingual coordin.

Tongue pumping – secondary to lingual coordination

Piecemeal deglutition – possibly due to fear of swallowing or decreased coordination

Oral Residues – decreased lingual mvmt, strength and coordination

Hard palate residue – decreased tongue tip elevation

Soft palate residue – decreased velopharyngeal elevation

 

Pharyngeal Deficits

Delays – If there is a delay there is posterior bolus leakage before the swallow

1-3 sec – mild

4-6 sec – moderate

7-10 sec – severe

10+ = profound or absent/nonfunctional

Residues – These move, that is why they are important. Either base of tongue, aryepiglottic folds, posterior pharyngeal wall, or subepiglottic residue, or vestibular wall

Retention – This is something you find in the valleculae or the pyriforms. It may be unilateral or bilateral.

Valleculae – decreased tongue base retraction, epiglottic dysfunction

Pyriforms- decreased laryngeal elevation or cricopharyngeal dysfunction.

Retention can be due to decreased pharyngeal motility, pressure or peristalsis.

Penetration

Before the swallow – decreased lingual control, swallow delay

During the swallow – decreased or delayed laryngeal closure. Delayed swallow initiation, decreased lingual control. Epiglottic dysfunction is also a contributing factor.

After the swallow – pharyngeal residue

 

Aspiration

Before the swallow – decreased lingual control, swallow delay

During the swallow – decreased laryngeal closure.

After the swallow – pharyngeal residue or retention or vestibular residues.

 

Muscles of the Larynx

Laryngeal Elevators – Diagastric, Mylohyoid, Geniohyoid, Stylohyoid, Hyoglossus

Laryngeal Depressors – Omohyoid. Sternohyoid, Sternothyroid, Thyrohyoid

(KNOW WHERE THESE ARE!!!!!!!)

 

 

Diagnosis that can include Dysphagia Acquired Central Disorders – Stroke, Head Injury, Alzheimer’s

 

Movement Disorders –Parkinson ’s disease, Huntington Chorea, Myasthenia Gravis, Multiple Sclerosis, Wallenburg Syndrome, Friedreich’s ataxia, Wilson’s Disease, Shy Drager Syndrome, Gulliane Barre Syndrome

 

Neuromuscular Disorder – Bulbar Palsy, ALS

 

Acquired Peripheral Disorder – Carcinoma, Diabetes (uncontrolled)

 

Neurodevelopmental Disorder – Cerebral Palsy

 

Systematic Diseases – AIDS, Lupus, Sjogrens Syndrome, Scleroderma

 

Other – Laryngectomy, Tracheostomy, Tiri, Cervical Fusion, Radiation, Osteophytes, Zenker’s Diverticulum, Esophageal Obstruction, COPD, CHF, Renal Failure, Wallenburg, Meningitis, Lyme disease, Creutzfeldt-Jakob Disease, Tardive Dyskinesia, Torticollis, Goiters, Chagas Disease, Spinal injury, Mental Retardation, Vitamin B-12 deficiency, GERD