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Swallowing disorders/difficulties - Coggle Diagram
Swallowing disorders/difficulties
Red flags
Patient
Reports problem BUT most pts also have comm issues
More time with meals
Refusing to eat, drink, self-selecting softer foods but check baseline
Fluctuating lvls of alertness, consciousness, drowsy, confused mental state
Weight loss
On certain meds: dry mouth
Systems
Digestive: drooling, poor oral hygiene
Respiratory: dysarthria, dysphonia, gurgly voice, coughing on food/fluid, weak or absent cough, chest infections, unexplained temp spikes
General info
Aim: Avoid aspiration
Identify penetration vs. aspiration. Lvl of risk pt is at for dev extreme health impacts from dysphagia
Before swallow triggered
Poor oral control- bolus spillover BOT, down into pharynx and airway before triggering swallow
Problems and effects
Problem 1
P: Reduced labial closure
E: X clear food from spoon, food spill from mouth, lack saliva control, drooling
Problem 2
P: Impaired tongue fn--> Less able to form and hold bolus at tip and base, lack of bolus control in oral stage
E: particles fall over BOT during oral stage, may be aspirated
Problem 3
P: Weak jaw, poor fn. Food X properly chewed into size appropriate for safe swallow
E: increased risk of choking
Problem 4
P: Reduced oral sensitivity, X prep bolus appropriately for swallowing (size, texture),
E: bolus spills over BOT prematurely
Problem 5
P: Ix velopharyngeal (VP) fn. VP X drape against BOT during oral stage. Plus poor tongue function will make it worse
E: Aspiration before swallow initiated
Problem 6
P: Absent swallow.
E: Bolus trf into pharynx, airway not protected, aspiration of bolus
Problem 7
P: Delayed swallow
E: Bolus will reach pyriform sinus, overspill into laryngeal inlet before airway protection happens
Problem 8
P: Reduced laryngeal elevation
E: X tucked under BOT, airway X fully protected
Aspiration during swallow
Bolus passes thru, pharynx part of bolus enters airway (bcos TVF fail to close)
Problem 1
P: Poor tongue fn--> Poor BOT retraction--> Ix hyoid mvt, laryngeal elevation, epiglottic deflection
E: Ix airway protection
Problem 2
P: reduced laryngeal closure
E: Airway protection affected- lead to aspiration during
Aspiration after swallow
Residue left post swallow in oral cavity, pharynx will enter airway at later time point
Problem 1
P: Impaired tongue fn--> Less able to control, manipulate food in mouth during mastication. If not properly chewed, food spreads throughout oral cavity- piecemeal deglutition, swallowed in bits
E: Residue may remain in mouth can later fall over BOT, into unprotected airway, aspirated later on
Problem 2
P: Lack pressure behind bolus tail to help bolus flow thru pharynx
E: Residue may remain in pharynx, valleculae, pyriform sinus, may be aspirated later on
Problem 3
P: Reduced buccal tension
E: Food may fall into lateral sulcus during chewing, remain as residue. Need help to be removed by active tongue mvt, use finger. Otherwise might fall over BOT, aspirated later on
Problem 4
P: material falls, trapped in areas of reduced sensitivity, left as residue in mouth
E: particles fall over BOT, aspirated later on
Problem 5
P: Poor VP function. X contract, seal off nasal cavity.
E: Discomfort, residue fall into pharynx later
Problem 6
P: reduced laryngeal elevation
E: Poor epiglottic deflection, residue trap in valleculae
Problem 7
P: reduced laryngeal elevation
E: CP sphincter X properly pulled open--> bolus flow problem--> residue in pyriform sinus
Problem 8
P: reduced pharyngeal contraction
E: Larynx X elevate (long muscles of pharynx help in elevating). Poor bolus transition into pharynx, residue may remain in valleculae, pyriform sinuses
Problem 9
P: Ix CP opening bcos of 1) absence of hyoid mvt--> lack up and forward mvt that helps open CP sphincter 2) CP sphincter X relax bcos of spasm
E: material will fail to pass thru UES, residue pool in pyriform sinuses, pharynx, might enter airway later
Problem 10
P: Weak CP muscle. Fail to close behind tail of bolus
E: Peristaltic activity may cause some bolus to return to pharynx through semi-open sphincter, spill into airway
Problem 11
P: poor oesophageal peristalsis, physical obstruction
E: 1) Bolus may not transit efficiently-build up behind, X pass. 2) Subsq boluses backflow/remain in pharynx, enter open airway post swallow
Stages
Oral prep
Reduced oral sensitivity
Reduced buccal tension
Reduced jaw strength and fn
Ix tongue fn
Reduced labial closure
Oral
Ix VP function
Reduced oral sensitivity
Pharyngeal
Delayed, absent swallow
Reduced laryngeal closure
Reduced pharyngeal contraction
Ix CP opening
Weak CP muscle
Oesophageal
Poor oesophageal peristalsis, physical obstruction