NR 228 Edapt: Dysphagia

Mrs. Robinson was diagnosed with dysphagia and will be going home. The family asks for further direction in what they can do to help prevent complications, such as aspiration. The health care provider would educate the client and family to do which of the following? (SATA)

-Allow adequate time (for example, 20-30 minutes) for them to eat. -Avoid asking them to talk while eating. -Position them upright, bent slightly forward, with the chin tucked and head tilted forward. -Eliminate distractions so they can focus all attention on the meal.

Swallowing occurs in three phases. Identify the location of each phase below.

1. Voluntary or oral phase​ 2. Pharyngeal phase​ 3. Esophageal phase

Once a diagnosis of dysphagia has been established, the goal of nutrition therapy is to_____(1)_______ to enable the individual to ___(2)_____ while ____(3)______. Solid foods may be minced, mashed, ground, or pureed and thin liquids may be thickened to facilitate swallowing and decrease the risk of aspiration.

1. modify the texture of foods and/or the viscosity of liquids 2. achieve adequate nutrition and hydration 3. decreasing the risk of aspiration

Case Study: Mr. Harper​ Drag the correct phrase from the choices below to fill in each blank found in the following sentences: The healthcare provider realizes that Mr. Harper is struggling to eat. Because of the tremors, he is struggling to pick up and maneuver the spoon. To support Mr. Harper in his ability to feed himself, the healthcare provider can _____(1)_________. The healthcare provider also witnessed Mr. Harper coughing after taking a bite of food. The nurse can also take steps to decrease the risk of aspiration. To reduce the risk of aspiration, the provider can place the client in an upright or high Fowler's position and ___(2)______.

1. use adaptive eating devices such as built-up utensils and mugs with spouts, if indicated 2. encourage small bites and thorough chewing

Various feeding techniques may facilitate safe swallowing. Drag the appropriate steps listed below into the right column.

Appropriate Steps Column: -Encourage patients with dysphagia to rest before mealtime -Serve small, frequent meals to help maximize intake -Give mouth care immediately before meals to enhance the sense of taste -Postpone meals if the patient is fatigued

The healthcare provider is speaking to a group of elderly individuals about dysphagia. Which of the following are mechanical conditions that could cause dysphagia? (SATA)

Edema Obstruction Surgery of the throat Inflammation

Match the food textures below to their proper definitions.

Ground--Food that is moist, soft-textured, and easily formed into a rounded ball in the mouth (bolus). Meats are ground or minced into pieces no larger than a quarter inch; all pieces are moist, and stick together slightly. Minced--Foods that are soft and moist naturally or after cooking. Pureed--Cooked food, usually vegetables, fruits or legumes, that has been ground, pressed, blended or sieved to the consistency of a creamy paste or liquid. Mashed--Foods cooked into a smooth, evenly textured mixture.

What are the four levels of liquid consistencies?

Honeylike Spoon-thick Nectarlike Thin

The health care provider is concerned about Mr. Harpers nutritional status. A review of the electronic health record (EHR) identifies a prescription for a pureed diet. The provider recalls the items on Mr. Harpers dinner tray and realizes that the foods provided were not in alignment with the pureed diet. ​ Drag the foods that should be on a pureed diet. Choose only the foods that do not require further processing.

In Pureed Diet Column: Pudding Yogurt Applesauce Soup (tomato, cream of chicken)

What are the three levels of solid food consistencies?

Mechanically Altered Advanced Pureed

A client has been diagnosed with dysphagia. When planning a meal for the client, the family should consider which of the following solid food consistencies? (SATA)

Minced Ground Mashed

The healthcare provider is speaking to a group of elderly individuals about dysphagia. Which of the following are neurological conditions that could cause dysphagia? (SATA)

Multiple sclerosis Myasthenia gravis Cerebral palsy Cerebrovascular accident Traumatic brain injury Amyotrophic lateral sclerosis (ALS)

Match the four levels of liquid consistency to their definitions below.

Nectarlike--Liquids thicker than water but thin enough to sip through a straw. Spoon-thick--Liquids thickened to pudding consistency that need to be eaten with a spoon. ​ Thin--Unthickened beverages and supplements. Honeylike--Liquids that can be eaten with a spoon but do not hold their shape.

What are the three phases of swallowing?

Pharyngeal phase Esophageal phase Oral phase

Case Study: Mr. Harper​ The healthcare professional is reviewing the nurse's note. Click to highlight the findings that would require follow-up. Dinner arrived. The health care professional planned time to assess Mr. Harper's mealtime ritual. Upon entering the room, the health care professional found the tray out of patient reach. The healthcare professional moved the tray to the bedside, uncovered and opened all the items on the dinner tray. Mr. Harper showed no interest in eating. Upon encouragement from the healthcare professional, the client picked up the spoon. The professional noted that he had tremors while trying to pick up the spoon and had difficulty coordinating movement of the spoon to the tray to gather food and then to the mouth. ​Once Mr. Harper could place the food in his mouth, upon swallowing, he immediately started to cough. When speaking with Mr. Harper, he indicated that he has a sensation that food was stuck in his throat. His voice was "gurgly" or wet sounding. Mr. Harper put down the spoon, pushed his food away, and verbalized that he is not hungry.

Tray out of patient reach had tremors difficulty coordinating movement of the spoon started to cough voice was "gurgly" or wet sounding

Individuals with dysphagia often exhibit which of the following symptoms? (SATA)

Unexpected weight loss. Sensation of food getting stuck in the throat or chest Coughing or choking when eating or drinking Bringing food back up (regurgitation) Persistent drooling of saliva