Lect 6 Dysphagia.pdf

Dysphagia, other disorders of the Upper GI, and Medications Chapter 14 Lecture #6 Dysphagia • Definition – Difficulty swallowing • Not a medical diagnosis – Actually a symptom – Often neurological in nature Dysphagia Dysphagia – Symptom of Dysphagia • Signs – Drooling, pocketing of food, co...

Dysphagia, other disorders of the Upper GI, and Medications Chapter 14 Lecture #6 Dysphagia • Definition – Difficulty swallowing • Not a medical diagnosis – Actually a symptom – Often neurological in nature Dysphagia Dysphagia – Symptom of Dysphagia • Signs – Drooling, pocketing of food, coughing, choking, gurgling • Complications – Weight loss – Malnutrition – Dehydration – Aspiration ، ‫ السعال‬، ‫ جيب الطعام‬، ‫سيالن اللعاب‬ ‫االختناق والغرغرة‬ Dysphagia • Diagnosis ‫النهج املهني‬ – Interprofessional approach • RNs, RDs, SLP, PTs, OTs, PharmDs, • Testing – Bedside evaluation – SLP ‫تقييم االستلقاء على جنب في السرير‬ – Modified Barium Swallow - MBS Dysphagia - NCP • Assessment – Weight loss, inadequate intake, physical difficulties eating • Diagnosis – Inadequate oral intake – Inadequate fluid intake – Swallowing difficulty Dysphagia - NCP • Intervention (Nutrition Rx) – Regular Diet • Thin, or thickened liquids – National Dysphagia Diet – NPO • Requires enteral nutrition ‫النظام الغذائي الوطني لعسر البلع‬ Dysphagia National Dysphagia Diet NDD1 Dysphagia Pureed NDD2 Dysphagia Mechanically Altered NDD3 Dysphagia Advanced Liquids Spoon Thick Honey Thick Nectar Thick Thin National Dysphagia Diet 1, 2, and 3 Thickening Agents and Specialty Food Products Dysphagia • Monitor and Evaluate – Oral intake/enteral intake – Weight status – Hydration status – Advance diet when medically able Other Upper GI Disorders • Cancer of the mouth, esophagus, or stomach – Chewing, swallowing, salivations, and taste issues – Weight loss is common • Indigestion or dyspepsia – Epigastric discomfort after meals – Abdominal pain, bloating, early satiety, nausea – Smaller meals, fat intake Other Upper GI Disorders • Gastroparesis – Delayed gastric emptying – Complex condition associated with chemical and neurological factors – Causes include: • Viral infections, diabetes, and surgery most common causes • smooth muscle disorders, neurological conditions, psychological disorders, and obstruction Other Upper GI Disorders • Bezoar – Related to undigested food such as cellulose, hemicellulose, lignin and fruit tannins – Risk factors • Gastric surgeries • Diabetes or end-stage kidney disease • On a mechanical ventilator ‫على جهاز تهوية ميكانيكي‬ – Treatment • Some combination of dietary and medication intervention Medications used for Upper GI Disorders • Antiemetics – For nausea and vomiting • Antibiotics – Eradicate H.Pylori – Prevent infections • Antacids – Neutralize gastric acid in GERD and PUD Medications for Upper GI Disorders • Proton Pump Inhibitors PPIs (prazole) – Decrease gastric acid secretion • Histamine 2 receptor Antagonist (tidine) – Block histamine receptors which prevents acid secretion Medications used for Upper GI Disorders • Sucralfate ‫يحمي بطانة املعدة وقد يزيد من مقاومة الغشاء املخاطي‬ ‫ويحمي من الضرر الحمضي أو اإلنزيمي‬ – Protects stomach lining and may mucosal resistance to acid or enzyme damage • Metoclopramide – Stimulate gastric emptying for gastroparesis Summary • Dysphagia is difficulty swallowing and can be a result acute or chronic neurological problems • Requires a interprofessional approach • National Dysphagia Diet as of 2002 • Other upper GI disorders include dyspepsia, gastroparesis and bezoars • Nutrition is an important interventions but sometimes the best treatment may be medications