Assessment
Help!
|
|
||||
|---|---|---|---|---|---|
| 3 Major Components of CSE | 1. medical history
2. physical examination of the swallowing mechanism (OME)
3. test swallows
🗑
|
||||
| Purposes of CSE | - determines presence of dysphagia but does not disprove or prove aspiration
- gives insight to anatomical and physiological factors
- relative complication risks
- alternate means of management
- additional tests needed
🗑
|
||||
| Relative Complication Risks of Dysphagia | - aspiration
- dehydration
- malnutrition
- loss of enjoyment
🗑
|
||||
| 6 Reasons for CSE | 1. determine potential cause
2. develop a working hypothesis
3. tentative treatment plan
4. develop further questions
5. is the pt ready for treatment?
6. instrumental eval?
🗑
|
||||
| Outcomes of CSE | - determine underlying neuromuscular function
- onset, progression pattern, symptoms/signs
- influencing factors
- monitor progression
- estimate prognosis
- estimate long-term outcomes
🗑
|
||||
| Limitations of CSE | - lack of methods for scoring
- inconsistencies in observations
- complete information not provided
- aspiration/penetration cannot be viewed
- only one moment in time
🗑
|
||||
| Additional Factors to Monitor/Consider | - heart rate
- pulse oximetry (oxygen is bound to hemoglobin)
- respiration
🗑
|
||||
| Signs and Symptoms of Hypoventilation | - fatigue
- hallucinations
- lethargy
- disturbed sleep
- depression
- reduced appetite
🗑
|
||||
| Signs | - objective
- clinical measures/observations of behaviours during an exam
🗑
|
||||
| Symptoms | - subjective
- patient-reported change in bodily functions or sensations
🗑
|
||||
| Pulmonary Defence Risk Factors for Pneumonia | - oral hygiene
- loss of anatomical defences
- blunted airway reflexes
- impaired mucocillary clearance
- weakened immune system
🗑
|
||||
| Chart Review | 1. current hospital status
2. Hx and nature of the problem
3. medical conditions
4. medications
5. airway device hx?
6. hx and current nutrition status
🗑
|
||||
| Interview Questions | - when did it start
- how did it progress
- what foods/liquids cause issues
- do things get stuck
- pain?
- food allergies?
- baseline diet
- health history
🗑
|
||||
| Observations during Ax | - LOA/mental status/behaviour
- affect
- nutritional state
- motor speech
- lang
- independence
- hydration
- medical/health aids
🗑
|
||||
| General Physical Findings | - respiration
- speech/voice
- mobility
- upper extremity function
- visual and auditory systems
- muscle and bodily stability
- coordination
🗑
|
||||
| More Observations | - positioning
- alertness
- speech & lang
- attention to the task
- desire to eat
- agitation
🗑
|
||||
| Oral Phase Observations | - adequacy of chewing
- oral clearance/residue
- duration of the oral phase
- endurance/fatigue
- manner of feeding
- behaviours during feeding
- pocketing
- premature spillage
🗑
|
||||
| Pharyngeal Phase Observations** | - signs of airway compromise
- vocal quality (before and after the swallow)
- weakness (unilateral often)
- decreased strength of pharyngeal constriction
- residue
- decreased hyolaryngeal elevation
- delayed initiation d/t decreased sensation
🗑
|
||||
| Signs of Airway Compromise | - post swallow expiration
- airway congestion
- coughing/throat clearing
- change in breathing pattern
- shortness of breath post swallow
- increased resp rate
- wheezing
🗑
|
||||
| Vocal Quality (Before and After Swallow) | - wetness?
- difficulty clearing secretions?
- dry?
- endurance or fatigue over time
🗑
|
||||
| Esophageal Phase Observations ** | - effortful, repeated swallows
- regurgitation
- pt report globus sensation
- reflux
- increased transition time
🗑
|
||||
| PO for CSE | - ice chips
- water
- nectar thick liquids or thickening agent
- purees
- mixed consistency (fruit cup)
- dry solids (graham cracker/cookies)
🗑
|
||||
| Objectives for MBSS | - evaluate anatomy and physiology
- ID pattern of impaired physiology
- ID consequences
- evaluate the effect of compensatory strategies
- confirm pt symptoms
- make predictions
🗑
|
||||
| MBSS MUST | - CSE fails to address the clinical questions presented by pt or symptoms
- dysphagia characteristics are vague
- respiration compromise
- underlying medical problems
- results required to set clinical course **
🗑
|
||||
| MBSS MAYBE | - direction of swallow rehab
- high risk of aspiration due to pre-existing med dx
- swallowing demonstrates an overt change
- status fluctuates
🗑
|
||||
| MBSS NO | - pt is in a fragile condition
- pt won't fit into the machine
- pt is not likely to cooperate
- clinical judgement is such that the results will not alter clinical course*
🗑
|
||||
| FEES MUST | - CSE fails to address the clinical questions presented by pt or symptoms
- dysphagia characteristics are vague but esophageal issues are not detected
- results are required to set clinical course
- MBSS is not an option
🗑
|
||||
| FEES NO | - blood range doesn't permit
- nasal fractures/complex facial features
- pt is agitated
- pt has a CSF leak
🗑
|
||||
| OME V Trigeminal | - touch different parts of face
- open jaw and resist
- move jaw side to side
🗑
|
||||
| OME VII Facial | - raise eyebrows
- close eyes tightly
- puff out cheeks
- purse out your lips
- smile
- put lips around a straw
🗑
|
||||
| OME X Vagus | - voliltional cough
- stick out your tongue and say "ahhhhh" and then ah-ah-ah
- palpitate the swallow
🗑
|
||||
| OME XII Hypoglossal | - stick tongue out
- move tongue up and down
- move tongue side-to-side
- press tongue against the side of your cheek
- sweep teeth with tongue
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
KarleeAJones
Popular Speech Therapy sets