Dysphagia, oral care & hydration Anita Lopes, RD David - - PDF document
26/05/2017 Dysphagia, oral care & hydration Anita Lopes, RD David Beattie, SLP Palate Velum Tongue Lips Teeth Pharynx Valleculae Epiglottis Mandible Hyoid Larynx Sulcus Esophagus Cheek Trachea Salivary Glands Nursing Best
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Anita Lopes, RD David Beattie, SLP
Nursing Best Practices 2
Mandible Lips Teeth Tongue Palate Pharynx Larynx Hyoid Epiglottis Valleculae Esophagus Trachea
Sulcus Cheek Salivary Glands
Velum
Oral preparation:
chewing, moistening, formation and control of bolus
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Oral propulsive: transit of bolus to posterior oral cavity
Pharyngeal: airway protection, propulsion
Esophageal: transit to the stomach by peristalsis
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Normal Swallow
https://www.youtube.com/wa tch?v=PwVreNrTKBw
Oral Pharyngeal Esophageal
Not managing secretions Loss of food/fluid from the mouth Unable to form bolus Food residue in cheeks, on tongue
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Frequent throat clearing Coughing, choking Gurgling or wet voice Nasal or oral regurgitation Food “stuck in throat” Absent swallow
Nursing Best Practices 12
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50% of stroke patients have dysphagia in the first few days after the stroke. Of these, 1/3 have swallowing difficulties that persist beyond 3 months post-onset.
Bilateral, subcortical or brainstem stroke
Unilateral hemisphere stroke
15
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33% of patients with dysphagia develop pneumonia requiring treatment.
35% of post-stroke deaths are caused by pneumonia.
Aspiration on videofluoroscopy
http://www.youtube.com/watch?v=1sFNMk87558
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Dysphagia ↓ Poor secretion Aspiration Management
Aspiration & Poor oral hygiene ↓ Pneumonia
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Pathogens that cause aspiration pneumonia (as well as VAP) can colonize the
patients within 48 hours of admission.
Where does
bacteria end up?
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Nosocomial pneumonia accounts for 10-15% of all hospital acquired infections.
Treatment with oral hygiene alone can reduce occurrence of pneumonia in older adults in nursing homes by 30%.
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Patients who have swallowing difficulties are at risk for poor oral hygiene and aspiration.
Screen stroke patients on admission for obvious signs of dental disease, level of oral care, and appliances.
Independent? Needs help? Dependent?
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Cognition & LOC Activity tolerance UE function Handedness Oral motor function Severity of dysphagia
—
Patients who cannot eat
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…are for moisture and relief—not for cleaning teeth.
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