Dysphagia Associated Conditions, and Feeding Tubes
87 Questions
6 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What 4 groups are at higher risk of malnutrition and dehydration?

Stroke Head and neck cancer Dementia Progressive neurodegenerative diseases (MS, PD, ALS)

Provide 3 examples of structural deficits that can impact the esophageal stage of swallowing

Cervical osteophytes Strictures Stenosis Webs Rings

When making diet recommendations and developing a treatment plan, the safety of the swallow is a priority. What is the other priority?

Receive adequate nourishment

This protocol allows patients who are NPO or on thickened liquids to have ice chips/water between meals when following specific guidelines.

<p>Fraizer free water protocol</p> Signup and view all the answers

Dehydration may cause temporary cognitive impairments

<p>True</p> Signup and view all the answers

What is iatrogenic dysphagia?

<p>Dysphagia due to medications, surgery, radiation or other medical reason</p> Signup and view all the answers

Esophagitis is most commonly caused by reflex and may result in forming of esophageal strictures.

<p>True</p> Signup and view all the answers

Infections and toxins can result in systemic disorders and dysphagia. Provide one example

<p>Infections, toxins sepsis (infection in blood) toxic encephalopathy: (disease of brain) digoxin or lithium toxicity (produces reduced arousal/alertness)</p> Signup and view all the answers

This condition results in impaired LES relaxation and impaired/absent esophageal peristalsis

<p>Achalasia</p> Signup and view all the answers

Malnutrition affects overall medical status, strength, resistance to infection, and the healing process

<p>True</p> Signup and view all the answers

Describe GERD and provide an example of what can happen in patients with chronic GERD/Reflux

<p>GERD occurs through one of three mechanisms: Inappropriate or transient lower esophageal sphincter relaxation Increased abdominal pressure or stress-induced reflux Incompetent or reduced lower esophageal sphincter pressures or spontaneous free reflux Chronic reflux is associated with Barrett’s esophagus (pre-cancerous): associated with chronic reflux causing changes in epithelium of esophagus due to damage of mucosa; considered premalignant lesion that can lead to adenocarcinoma Is a compensatory change in the esophageal mucosa from squamous to specialized intestinal epithelium, and it occurs in up to 15% of patients with atypical presentations of GERD.</p> Signup and view all the answers

Who is the trained professional who selects the proper calories and nutrition content of. the diet and monitors the nutritional status and continuing needs of the patient?

<p>Dietician</p> Signup and view all the answers

What is rheology?

<p>Study of the deformation and flow of matters</p> Signup and view all the answers

A dysphagia diet may need to be adjusted based on several factors, including the viscosity of liquids. What are some other factors to be considered?

<p>Amount Viscosity Consistency Timing Of meals</p> Signup and view all the answers

Those who are on thickened liquids are at risk of dehydration. Provide 3 reasons to support this statement.

<p>Limited access to thickened liquids Change in taste and texture Inability to quench thirst.</p> Signup and view all the answers

Briefly describe the Fraizer Free Water Protocol Guidelines

<p>Patient is allowed to drink water between meals (beginning a minimum of 30 minutes after meals). Oral care must be done prior to consuming water. Patient should sit upright and use appropriate swallowing strategies.</p> Signup and view all the answers

Evidence supports the use of thickened liquids in patients with dysphagia to reduce the incidence of pneumonia.

<p>False</p> Signup and view all the answers

This is an international movement to promote the use of standardized terminologies across countries that consists of 8 levels of foods and drinks numbered 0-7. What is it?

<p>International Dysphagia Diet Standardization Initiative (IDDSI)</p> Signup and view all the answers

Why do thickened liquids result in decreased overall PO intake?

<p>Thickened liquids are less palatable so patients drink less. They also increase intrabolus pressure leading to increased effort and strength to swallow which can lead to overall fatigue during the meal with a decrease in overall intake.</p> Signup and view all the answers

What are the 2 categories of non-oral nutrition? What is the difference?

<p>Parenteral (intravenous) and Enteral (Feeding Tubes)</p> Signup and view all the answers

This is a temporary feeding tube that is minimally invasive, but not meant to stay longer than 2 weeks. The stomach must be functioning properly and uninvolved with primary disease.

<p>Nasogastric (NG) Tube</p> Signup and view all the answers

These feeding tubes are temporary and placed lower in the GI tract. They are useful in conditions of gastroparesis or impaired stomach emptying and if the esophageal reflux present.

<p>Nasoduodenal;/Nasojejunal</p> Signup and view all the answers

These tubes are placed through a small opening called a stoma that is made in the wall of the abdomen. The procedure to create the opening ins called an ostomy.

<p>G tubes, J tubes, and GJ Tubes</p> Signup and view all the answers

What are the three main ways a feeding tube ostomy may be done?

<p>Image-guided, surgical, endoscopic</p> Signup and view all the answers

This surgical feeding tube is a good alternative feeding route if the stomach is impaired

<p>Jejunostomy (J-Tube)</p> Signup and view all the answers

What is the primary goal of a treatment plan for dysphagia?

<p>To restore function</p> Signup and view all the answers

What is the term for the condition in which food, liquids, or pills pass into the airway below the true vocal folds?

<p>Aspiration</p> Signup and view all the answers

Which of the following groups is at a higher risk of malnutrition and dehydration due to dysphagia?

<p>All of the above</p> Signup and view all the answers

What is the term for the systemic infection that can occur due to feeding lines into the venous system or due to aspiration?

<p>Sepsis</p> Signup and view all the answers

What is the term for the continuous and degenerative changes in swallowing functions that occur in healthy aging?

<p>Presbyphagia</p> Signup and view all the answers

What is the term for the pulmonary infection that results from acute or chronic aspiration of fluids, foods, or oral secretions from the mouth or from fluids arising in the stomach?

<p>Aspiration pneumonia</p> Signup and view all the answers

What is the primary cause of esophagitis?

<p>Reflux</p> Signup and view all the answers

What is the primary characteristic of achalasia?

<p>Impaired LES relaxation and esophageal peristalsis</p> Signup and view all the answers

What is the role of a dietitian in dysphagia management?

<p>To select the proper calorie and nutrition content of the diet</p> Signup and view all the answers

What is the result of the failure of the LES to relax during swallowing?

<p>The bolus is unable to move through into the stomach</p> Signup and view all the answers

What is the term for the protrusion of part of the stomach through the diaphragm into the thorax?

<p>Hiatal hernia</p> Signup and view all the answers

What is the priority of diet treatment in dysphagia management?

<p>To ensure swallow safety and receive adequate nourishment</p> Signup and view all the answers

Which type of aspiration syndrome is caused by chemical injury due to inhalation of sterile gastric contents?

<p>Chemical pneumonitis</p> Signup and view all the answers

What is the most common type of PNA (Pneumonia)?

<p>RLL PNA</p> Signup and view all the answers

What is the term for the narrowing of the passageway in the pharynx and esophagus?

<p>Stenosis</p> Signup and view all the answers

Which of the following is a neurogenic degenerative etiology of dysphagia?

<p>Muscular dystrophy</p> Signup and view all the answers

What is the term for the outpouches of one or more layers of the esophageal wall that can cause food to be retained in the pouch?

<p>Diverticulum</p> Signup and view all the answers

Which of the following is a structural etiology of dysphagia?

<p>Cervical osteophyte</p> Signup and view all the answers

What is the term for the inflammation or swelling of the lining of the esophagus?

<p>Esophagitis</p> Signup and view all the answers

Which of the following is a type of PNA that is acquired in the hospital?

<p>Nosocomial PNA</p> Signup and view all the answers

What is the term for the thin layers of cells that grow inside the esophagus and can cause food to be retained in the pouch?

<p>Webs</p> Signup and view all the answers

Which of the following is a risk factor for aspiration?

<p>Oral weakness</p> Signup and view all the answers

What is the main cause of dysphagia due to esophageal dysmotility?

<p>Abnormal motility of the esophagus</p> Signup and view all the answers

Which type of feeding is used in patients who are unable to take adequate nutrition by mouth but have a functioning gastrointestinal tract?

<p>Enteral feeding</p> Signup and view all the answers

What is a common side effect of antipsychotic drugs that can contribute to dysphagia?

<p>All of the above</p> Signup and view all the answers

What is the term used to describe the retrograde movement of gastric contents from the stomach through the lower esophageal sphincter and into the esophagus?

<p>GERD</p> Signup and view all the answers

What is the name of the premalignant lesion that can occur in patients with chronic GERD/Reflux?

<p>Barrett's esophagus</p> Signup and view all the answers

What is the term used to describe the compensatory change in the esophageal mucosa from squamous to specialized intestinal epithelium?

<p>Barrett's esophagus</p> Signup and view all the answers

Which type of medication can cause xerostomia, leading to dysphagia?

<p>All of the above</p> Signup and view all the answers

What is the term used to describe the group of medical conditions in which the esophagus does not work properly?

<p>Esophageal dysmotility</p> Signup and view all the answers

What is the term used to describe the umbrella term used to describe a group of medical conditions in which the esophagus does not work properly?

<p>Esophageal dysmotility</p> Signup and view all the answers

Which type of feeding is used in patients who require long-term nutritional support?

<p>Enteral feeding</p> Signup and view all the answers

What is the main objective of the International Dysphagia Diet Standardization (IDDSI)?

<p>To standardize the terminology of food and liquid textures across countries</p> Signup and view all the answers

What is the purpose of the IDDSI flow test?

<p>To determine the viscosity level of a liquid</p> Signup and view all the answers

Why are patients on thickened liquids at risk of dehydration?

<p>Because of limited access to thickened liquids, change in taste and texture, and inability to quench thirst</p> Signup and view all the answers

What is the main concern when modifying liquids for patients with dysphagia?

<p>Finding a consistency that allows maximal protection from penetration and aspiration, but minimal post-swallow residue</p> Signup and view all the answers

What type of thickening agent is xanthan-based?

<p>Gel-based</p> Signup and view all the answers

What is the purpose of providing clear and simple written guidelines on food and drink preparation to family members or healthcare providers?

<p>To ensure family members or healthcare providers can prepare food and drinks correctly</p> Signup and view all the answers

What is the main benefit of the Fraizer Free Water Protocol?

<p>It allows patients who are NPO or on thickened liquids to have ice chips/water between meals</p> Signup and view all the answers

What is the term for the study of the deformation and flow of matters?

<p>Rheology</p> Signup and view all the answers

What is the term for the resistance to flow or alteration of shape?

<p>Viscosity</p> Signup and view all the answers

What is the term for the compactness of a substance?

<p>Density</p> Signup and view all the answers

What is the primary reason for using water in the Free Water Protocol?

<p>Because it is the least toxic to lungs and most absorbable</p> Signup and view all the answers

What is the purpose of oral care in the Free Water Protocol?

<p>To prevent aspiration by removing residue</p> Signup and view all the answers

What is the minimum amount of time a patient should wait after a meal before consuming water in the Free Water Protocol?

<p>30 minutes</p> Signup and view all the answers

What is the term for the decision to use alternative routes for medication administration?

<p>Critical decision</p> Signup and view all the answers

What is the term for the condition where a patient is unable to take adequate nutrition orally?

<p>Non-oral diet</p> Signup and view all the answers

What is the purpose of a feeding tube ostomy procedure?

<p>To create an opening in the abdomen for a feeding tube</p> Signup and view all the answers

What is the term for the feeding tube that is placed lower in the GI tract and is useful in conditions of gastroparesis or impaired stomach emptying?

<p>Nasoduodenal tube</p> Signup and view all the answers

What is the term for the risk of developing pneumonia in patients who are on honey-thick liquids?

<p>PNA risk</p> Signup and view all the answers

What is the term for the condition where a patient's wishes for medical care are documented in writing?

<p>Advance directive</p> Signup and view all the answers

What is the primary goal of instrumental testing in dysphagia diagnosis?

<p>To assess the efficiency of swallowing</p> Signup and view all the answers

What is the primary advantage of a percutaneous radiologic gastrostomy (PRG) procedure?

<p>It is a non-surgical procedure</p> Signup and view all the answers

What is the main difference between a gastrostomy (G-Tube) and a jejunostomy (J-Tube) feeding tube?

<p>The location of the tube in the small intestine</p> Signup and view all the answers

Why was a temporary NG tube used in the case study of T.L.?

<p>To give the patient time to recover neurologically and regain function</p> Signup and view all the answers

What is the primary benefit of using an endoscope in a percutaneous endoscopic gastrostomy (PEG) procedure?

<p>It provides a video image of the inside of the stomach for accurate placement</p> Signup and view all the answers

What is the main complication of a jejunostomy (J-Tube) feeding tube?

<p>Loss of controlled emptying of the stomach</p> Signup and view all the answers

What is the primary advantage of a surgical feeding tube placement?

<p>It can be performed under general anesthesia</p> Signup and view all the answers

What is the primary characteristic of a gastrostomy (G-Tube) feeding tube?

<p>It is suitable for long-term feeding</p> Signup and view all the answers

Why is insertion site care needed for a gastrostomy (G-Tube) feeding tube?

<p>To prevent infection and skin irritation</p> Signup and view all the answers

What is the primary benefit of a percutaneous endoscopic gastrostomy (PEG) procedure?

<p>It is a minimally invasive procedure</p> Signup and view all the answers

What is the main complication of a gastrostomy (G-Tube) feeding tube?

<p>Risk of infection and skin irritation</p> Signup and view all the answers

Study Notes

Esophagitis and Esophagospasm

  • Esophagitis: most commonly caused by reflux, may result in forming of esophageal strictures
  • Esophagospasm: phasic, nonpropulsive contractions or abnormal LES function, painful

Achalasia

  • Unknown etiology
  • Impaired LES relaxation and esophageal peristalsis
  • Esophagus is dilated
  • Characterized by degeneration of neural elements in the wall of the esophagus, particularly at the LES
  • Many medications and bulimic patients can cause achalasia

Diet and Nutrition

  • Diet treatment priorities:
    • Ensure swallow safety
    • Receive adequate nourishment
    • Amount of calories
    • Content of calories
    • Degree of satisfaction
  • Dietitian: a trained professional who selects the proper calorie and nutrition content of the diet and monitors the nutritional status and continuing needs of the patient

Feeding Tubes

  • Types of feeding tubes:
    • G tube (gastric tube)
    • GJ tube (gastric-jejunal tube)
    • J tube (jejunal tube)
  • Placement methods:
    • Surgical feeding tube placement (in the operating room)
    • Percutaneous radiologic gastrostomy (PRG)
    • Endoscopic percutaneous gastrostomy (PEG)
  • Characteristics:
    • Suitable for long-term feeding
    • Concurrent oral intake is possible in certain cases
    • Cosmesis: feeding tube can be hidden under clothing
    • Easy tube replacement
    • Insertion site care needed
    • Lowers risk of tube migration and aspiration
    • Possible complications: insertion may require surgery, risk of infection, excoriation, and skin irritation at gastrostomy site, potential fistula at insertion site after tube removal, potential risk of pulmonary aspiration and reflux

Case Study: T.L

  • History: 28-year-old female with Guillain-Barré Syndrome (GBS)
  • Diagnosis: dysphagia and dysphonia
  • Initial MBS: silent aspiration
  • Recommendations: puree diet and nectar thick fluids
  • Results of MBS: upgraded to full diet and thin fluids

Dysphagia and Associated Conditions

  • Consequences of dysphagia:
    • Aspiration: respiratory distress, pneumonia, death
    • Choking: airway compromise
    • Tracheostomy
    • Malnutrition/dehydration
    • Weight loss
    • Chronic respiratory illness
  • Principles of rehabilitation:
    • Plan of biological plausibility
    • Restoring function
    • Managing/reducing symptoms
    • Protecting the airway
    • Optimizing nutrition

Aspiration and PEG/NG/J Tube Placement

  • Aspiration: condition in which food, liquids, or pills, or oropharyngeal secretions pass into the airway below the true VFs
  • PEG, NG, OG, or G Tube/J Tube placement: consideration for patients at risk of aspiration

Malnutrition and Dehydration

  • Groups at risk of malnutrition and dehydration:
    • Stroke
    • Head and neck cancer
    • Dementia
    • Progressive neurodegenerative diseases (MS, PD, ALS)
  • Dehydration:
    • ↓ fluid intake due to discomfort of aspiration
    • Lab values: BUN (blood-urine-nitrate) – if elevated from baseline; Na (sodium) – if > 145
    • May cause temporary cognitive impairments (toxic metabolic encephalopathy TME)

Aging Population

  • Presbyphagia: continuous and degenerative changes in swallowing functions in healthy aging
  • Up to 84% of elderly may develop changes in swallowing functions
  • Up to 68% of nursing home residents have signs of swallowing disorders

Sepsis

  • Definition: systemic infection from feeding lines into venous system or due to aspiration
  • Pulmonary complication/aspiration PNA: when pulmonary infection results from acute or chronic aspiration of fluids, foods, or oral secretions

Medication Induced Dysphagia

  • Definition: dysphagia due to medications, surgery, radiation, or other medical reasons
  • Examples:
    • Medications that reduce spasticity (Baclofen)
    • Medications that cause xerostomia
    • Antipsychotic drugs
    • Denture powders containing anesthetic
    • Parenteral feeding

Esophageal Dysmotility

  • Umbrella term to describe a group of medical conditions in which the esophagus does not work properly
  • Leading to changes in the strength and condition of the muscles
  • Remember: the esophagus is made of sphincters (proximal and distal)

GERDS and Esophageal Dysmotility

  • GERDS: caused by incompetent LES; defined as the retrograde movement of gastric contents from the stomach through the lower esophageal sphincter and into the esophagus
  • Esophageal dysmotility: group of medical conditions in which the esophagus does not work properly
  • GERD: associated with chronic reflux, causing changes in epithelium of esophagus due to damage of mucosa; considered premalignant lesion that can lead to adenocarcinoma

RHEOLOGY

  • Study of the deformation and flow of matters

  • Key terms:

    • Density: compactness of a substance
    • Viscosity: resistance to flow or alteration of shape### Aspiration Syndromes

  • Aspiration syndromes occur in 3 ways based on pathophysiology: Chemical pneumonitis, Bacterial infection, and Acute airway obstruction.

  • Chemical pneumonitis occurs due to chemical injury caused by inhalation of sterile gastric contents from the stomach or esophagus.

  • Bacterial infection occurs due to increased volume of oropharyngeal secretions coupled with impaired defense mechanisms.

  • Acute airway obstruction depends on multiple factors, including amount, nature, acidity of the aspirate, consistency, cough reflex, and host immune defense.

Conditions and Factors Associated with Aspiration

  • Oral, pharyngeal, or vocal fold weakness increase the risk of aspiration.
  • Conditions that increase the risk of aspiration include recent stroke, paralysis to one or both vocal folds, and neurological disorders.

Pulmonary Complications

  • Aspiration pneumonia (PNA) is a common complication, often occurring in the right lower lobe (RLL PNA).
  • Other pulmonary complications include bronchitis, COPD exacerbation, pulmonary infiltrates, and atelectasis.
  • Atelectasis is a shrunken, infected, airless state of lungs due to various factors, including foreign bodies.
  • Infiltrates refer to infections passing into the lungs, denser than air, which lingers in the lungs.

Types of PNA

  • Bacterial PNA is treated with antibiotics.
  • Viral PNA occurs 48h or more after admission and not incubating at the time of admission.
  • Nosocomial PNA is PNA acquired in the hospital.

Etiology and Conditions of Dysphagia

  • Neurogenic dysphagia etiologies include Alzheimer's, Parkinson's disease, Amyotrophic lateral sclerosis (ALS/Lou Gehrig's Disease), Post-polio syndrome, Muscular dystrophy (MD), Dermatomyositis, Multiple sclerosis (MS), Myasthenia gravis (MG), Huntington's disease, and Dystonia.
  • Structural etiologies of dysphagia include stenosis, rings, webs, and strictures throughout the pharynx and esophagus.

Structural Abnormalities

  • Cervical osteophyte is a bony outgrowth or protrusion from cervical vertebrae, which can impinge on pharynx and/or esophagus, causing stenosis.
  • Strictures typically occur in adulthood after esophagitis, causing edema, inflammation, and fibrosis, resulting in narrowing.
  • Esophageal rings occur anywhere in the esophagus or hypopharynx, partially or completely blocking the esophagus.
  • Webs are thin layers of cells that grow inside the esophagus, characterized by one or more thin horizontal membranes of squamous epithelial cells.
  • Diverticulum is an outpouching of one or more layers of the esophageal wall, causing food retention in the pouch and subsequent aspiration after swallowing.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Description

Jeopardy questions (1-24)

More Like This

Public Health and Community Nutrition
20 questions

Public Health and Community Nutrition

FastestBowenite1875 avatar
FastestBowenite1875
Public Health and Community Nutrition
60 questions

Public Health and Community Nutrition

FastestBowenite1875 avatar
FastestBowenite1875
Nutrition and Health Assessment
5 questions

Nutrition and Health Assessment

AmazedElectricOrgan avatar
AmazedElectricOrgan
Maternal and Child Health Overview
43 questions

Maternal and Child Health Overview

Ceegee avatar
Ceegee
Use Quizgecko on...
Browser
Open
Browser
Browser