HLTEN504A - INCP

Swallowing Difficulties

Dysphagia

Is a problem or difficulty with swallowing

Swallowing • During 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.

Swallowing• During 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.

Swallowing • Once 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.

Swallowing 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

Causes of dysphagia

These may develop suddenly or develop slowly over an extended period of timeSevere pain • Trauma/accident• Surgery• RadiationObstruction • Structural defects • Radiation

Causes of dysphagia (cont)

Abnormal peristalsis • Neuromuscular • Degenerative diseases • Metabolic/toxic

Impaired gag reflex • Neurological• Degenerative diseases • Unconscious states• Metabolic/toxic

Excessive, scant, or thick oral secretions

Some conditions that cause dysphagia

Stroke

Closed head injury

Parkinson’s disease

Motor neuron disease

Huntington’s disease

Clinical manifestations of impaired swallowing

Patient reports difficulty

Coughing with food or liquid intake

Longer time taken with meals than other people

Drooling, constantly open mouth, constantly mopping mouth

"Gurgly" voice

Food remaining in mouth after meals

Choking or asphyxiation with oral intake

Clinical manifestations of impaired swallowing

Diminished or absent coughDiminished or absent gag reflexWeight lossPneumoniaX-Ray evidence of aspirationFluctuating levels of consciousnessTracheostomyNaso-gastric feeding tube

To prevent aspiration/choking

Sit person upright to assist gravity. Sometimes the person needs to sit out of bed for all meals.• Maintain slight neck flexion• Ensure 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

To prevent aspiration /choking

Offer food and fluid at a rate that the person can cope with – prevents aspiration• One mouthful at a time• Effective swallow before next mouthful• Examine mouth at end of meal• Unhurried mealtime

If 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