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(DIFFICULTY SWALLOWING)

DYSPHAGIA

DYSPHAGIA
SIGNS AND SYMPTOMS

Coughing is a reflex, its the bodys response to clear the airway

Vomitingis due to esophageal dysfunction
Droolingsigns of dysphagia
Wet Vocal Cordshappens after choking
Railsa metal sound a medical person hears with a stethoscope in
a persons lungs that may be congested
Refusal behaviorpreferences to certain foodsdue to the feeling
of choking with certain foods
Fever (high) can or may lead to aspiration
Pocketing food in mouth
Weight loss
Gaging
Throat clearing
Multiple swallows
Excessive time to swallow

DYSPHAGIA
MECHANISMS
When swallowing you can feel the larynx move forward
Place 2 or 3 of your fingers to your throat and swallowfeel the
movement pushing against your finger? This is the larynx doing its
part in the swallowing process to move food down the esophagus
Its takes approximately 20 seconds to swallow

Dysphagia
Causes of Dysphagia

Developmental Delay
Seizure Disorder
Motor deficitsCP, CVA, TBI, neuromuscular disorders
Cognitive ImpairmentMR, CVA, TBI, dementia
Cancer of the head or neck
Meds that: (sedate, decrease saliva production)

Dysphagia
Abnormal Pathology
Piecemeal deglutinationmany tiny swallow
Premature spillagefood spills into the esophagus before
swallowing
Pooling in sinusesfood pools in these cavities eventually will clear
with swallowing
Penetrationto the level of the vocal cords
Silent aspirationfood may pass the larynx, pass the pharynx no
coughing noted (usually unaware)
Barretts Esophagusout pocketing of esophagus bacteria can
collect & predispose area to cancer (precancerous)
Stricture scarring- due to trauma, Eg. Induced vomiting (bulemina)
eventually esophagus will reduce in size

Dysphagia
FYI
Average person swallows 2000 times a day
Our population is at high risk from death from aspiration pneumonia
History of Reflux will create weaker sphincters which may again
lead to aspiration pneumonia
Aspiration pneumonia is when someone swallows and instead of the
substance going down the esophagus it goes down the windpipe
into the lungs and causes an infection which leads to pneumonia
Consumers with severe scoliosis are at a higher risk

Dysphagia
Health Impact
When a person is diagnosed with Dysphagia they become a higher
risk for the following:
Poor absorption of mediations
Dehydration
Aspiration Pneumonia
Poor eating habits
Fear of aspiration (choking)
Refluxage and or anatomy as contributing factors, if untreated can
cause significant problems

Dysphagia
Documention
Direct Care Staff
It is important to record when consumers refuse to eat what is on
their diet plan, and record what they eat. Make sure you offer what
is on their meal plan at every meal.
Diet adjustments will take time. Eg. Prader Willi (a condition when
the brain can not register with the stomach that the person is full)
You may help at meal time by deferring them with a activity
If you notice a consumers is starting to exhibit some signs and
symptoms of difficulty swallowing. You will need to make good
documentation and notify the nurse and their home what you are
observing.

Dysphagia
High Risk Foods

Certain foods can often be potential hazards to someone with Dysphagia or even
very young children if not properly prepared

Eg. Hotdogs, grapes, popcorn, peanut butter on white bread,

candy, nuts, raisins, raw fruit/veggies
Note:
At meal-time talking or distractions away from eating can create a potential choking
situation for someone with Dysphagia, it is important to create a calm atmosphere for
meal-time
Make sure if the consumer has a habit of eating to fast to remind them to slow-down
Positioning:
Pelvis as a core base of support (have buttdocks to the back of the sit)
Lock in legs next
90 90 90 degree angle of body
Trunk in medline
External supports as needed

Dysphagia
Tube Feeders
Make sure the person you are feeding of giving liquids via G-tube is
sitting up during and after feeding to prevent choking and aspiration
If you are having difficulty with the food going down the tube you
may reposition the consumers or place a pillow on their side to help
the procedure go more smoothly
Consumers who have a G-tube have been diagnosed with some
degree of difficulty swallowing
FYI: G-tube feeders if given not given oral care within 5 years will
loose their ability to eliminate secretions after instilling the tube
To help stimulate salvia production 2 foods that can help assist
are cotton candy and lolly-pops. These are pleasure foods.

Dysphagia
Adaptive Equipment

There are many utensils that can help a person stay as independent
with self-feeding as possible. A few are listed below:
Nosey cup
3 section plate
Kennedy cup (designed to prevent spillage)
Infant spoons (help fast eaters to slow-down)
Weighted utensils help clients with tremors
Cuff handle adheres to hand for self-feeders
Pizza knife (as a cutting tool)
Note: You can use foam hair rollers on utensils to create a larger
circumference for better control for self-feeders

Dysphagia
Team Members
The following people can make-up a team for a consumer who has
Dysphagia:
Oral Motor / Dysphagia SpecialistOccupational therapy or speech
MD
Dietician
Physicial Therapist
Caregiver (Direct care)
The individual

Dysphagia
Food Consistences
ADA National Dysphagia Diet

Level 1
Level 2
Level 3
Level 4
Level 5

Liquid Textures:
Thinalmost everything we drink
Nectortomato juice / sauce consistency
MilkshakeMcDs consistency
Puddingfed by a spoon

Thicket:
Thicket is a thickening agent to help make liquid foods easier to swallow per doctors
orders
Start with the recipe on the can per doctors orders
Whisk versus stir into food
It will thicken over time do not allow to sit, use immediately

Pureed
minced 1/8
ground
chopped
modified regular

Dysphagia
Head Control Techniques
Use only APPROVED head control techniques such as:
Chin liftthumb on chin; index finger under chin pull down
Chin or cheek cupform aC between thumb & index finger
place on each side of the cheeks and press slightly
Crowning techniquesopen hand place the palm at the top of
the forehead push up slightly
(these techniques will help with feeding or giving medications)
Note: The above techniques have been approved to use in feeding

Dysphagia
Dependent / Independent Feeding

Dependent Feeding:
Fed by caregiver due to physical inability, safety issues,
Note: tsp of solid to 1 sip of liquid or 1 bite / sip 1 swallow
Alternate solids with liquids5 bites to 12 sips ratio
Independent Feeding:
Is assisted and supervised, monitoring consumers skills as they eat
Visually Impaired Diner:
Consistent place a the table
Place setting by the Clock Eg. Meat at 12:00, Potato at 3:00
Hands as help

The Quiz is next..when your done taking the quiz, you may put it
in the nurses box.

Dysphagia
Quiz

1.

List 3 signs that may indicate a person is having a swallowing problem.

__________________________________________________________
__________________________________________________________
__________________________________________________________

2.

What is dysphagia?__________________________________________
__________________________________________________________

3.

Name 2 things that can contribute to dysphagia

________________________
__________________________

4.

List 4 foods that may contribute to choking

________________________
__________________________
________________________
__________________________

Dysphagia
Quiz

5.

List 2 pleasure foods to help stimulate salvia production

6.

List 2 team members who would assist in the care of someone with
dysphagia. _______________________
___________________________

7.

Describe what (Thicket) is?______________________________________________

____________________________________________________________________

8.

Name 2 types of consistency food can be prepared at.

___________________________
__________________________________

9.

When you aspirate food, where does it go?__________________________________

10.

What will adaptive equipment help the individual be able to do?

____________________________________________________________________
____________________________________________________________________

11.

When caring for a person with a G-tube, you should leave the tubing out so you
can see it? True or False
(circle the right answer) Explain why____________
____________________________________________________________________