2DysphagiaIs a problem or difficulty with swallowing
3SwallowingDuring the oral phase, the lips, teeth, tongue, and jaw muscles mix the food with saliva to create the proper consistency for ingestion.Once the bolus is formed in the oral cavity it is propelled into the oropharynx by the tongue; this completes the oral phase of swallowing.
4SwallowingDuring the oral phase, the lips, teeth, tongue, and jaw muscles mix the food with saliva to create the proper consistency for ingestion.Once the bolus is formed in the oral cavity it is propelled into the oropharynx by the tongue; this completes the oral phase of swallowing.
5SwallowingOnce the bolus reaches the tonsils, it triggers the pharyngeal phase of the swallowing reflex.This phase of the swallow mechanism is completely automatic.The palate closes against the back wall of the throat separating the oral cavity from the nasal cavity.The epiglottis tilts posteriorly, covering and protecting the vocal cords.The upper esophageal sphincter relaxes.
6Swallowing The final phase of the swallow is the oesophageal phase. Once the food bolus enters the esophagus, it is actively transported down to the stomach.Swallowing is complete when the bolus passes the lower esophageal sphincter and into the stomach
7Causes of dysphagiaThese may develop suddenly or develop slowly over an extended period of timeSevere painTrauma/accidentSurgeryRadiationObstructionStructural defects
8Causes of dysphagia (cont) Abnormal peristalsisNeuromuscularDegenerative diseasesMetabolic/toxicImpaired gag reflexNeurologicalUnconscious statesExcessive, scant, or thick oral secretions
9Some conditions that cause dysphagia StrokeClosed head injuryParkinson’s diseaseMotor neuron diseaseHuntington’s disease
10Clinical manifestations of impaired swallowing Patient reports difficultyCoughing with food or liquid intakeLonger time taken with meals than other peopleDrooling, constantly open mouth, constantly mopping mouth"Gurgly" voiceFood remaining in mouth after mealsChoking or asphyxiation with oral intake
11Clinical manifestations of impaired swallowing Diminished or absent coughDiminished or absent gag reflexWeight lossPneumoniaX-Ray evidence of aspirationFluctuating levels of consciousnessTracheostomyNaso-gastric feeding tube
12To prevent aspiration/choking Sit person upright to assist gravity. Sometimes the person needs to sit out of bed for all meals.Maintain slight neck flexionEnsure that patient is awake and alertModifications to the consistency of the food and fluid may be required:Soft/pureed diet, thickened fluids (nectar or honey consistency)Initiation of the swallowing reflex may be required – press on the tongue
13To prevent aspiration /choking Offer food and fluid at a rate that the person can cope with – prevents aspirationOne mouthful at a timeEffective swallow before next mouthfulExamine mouth at end of mealUnhurried mealtimeIf facial paralysis is present offer the food to the non-affected side.Check that they have swallowed each mouthful offered.Ensure that there is no food left in the mouth before you leave the person unattended.Maintain upright position 1/2 hour post meal