Dysphagia

Question 1

What is the difference between a swallow screening vs. a swallow eval?

Answer 1

Swallow screening:

• Identifies signs and symptoms of dysphagia
• Nurses are allowed to do a screening

Swallow Evaluation:

• Defines anatomy and physiology
  
  • The outcome includes formal recommendations

Question 2

Describe the 3 oz water test

Answer 2

Many facilities allow nurses to do these.

• Individuals are required to drink 3 oz of water without break
• Any coughing, choking, caughing = refer to FEES

Question 3

Describe the components of a clinical bedside swallow evaluation, not including textures used.

Answer 3

Prepare several consistencies, and look for pharyngeal red flags.

• MAKE SURE YOU PERFORM AN OME before beginning.
• Perform in as naturalistic setting as possible.
• 90 degree angle
• Say “ah” after each consistency to ensure client has swallowed and to assess voice quality.
• How long is it taking client to break down the food?
• Watch for 0₂ levels ( > or = 90)
• Check for burping (might be indicative of GER)

Question 4

What are some consistencies to use during a clinical bedside swallow evaluation (in order), and how do they differ from MBS?

Answer 4

1. Thin liquids
2. Nectar thick
3. Puree (apple sauce)
4. Wet soft (fruit cup)
5. Dry soft (sliced bread)
6. Dry crumbly (saltine cracker)
7. Meat

Same, really. Only difference is that these are mixed/coated with barium for an MBS.

Question 5

What are some questions you might ask the client before performing MBS?

Answer 5

• What’s going on with your swallow?
• Does it get stuck?
• Do you have dry mouth?
• How long has this problem been going on?
• Have their been any changes?

Question 6

What are tertiary contractions?

Answer 6

These are esophageal contractions associated with a normal swallow.

Question 7

You note that the client has residue in the valecula during an MBS. What do you do??!

Answer 7

• Have the client do head turns and swallow
• Repeat extra swallows
• Alternate solids and liquids
• Chin tuck

Record most successful strategy and present in recommendations.

Question 8

What is VFSE?

Answer 8

This is aka MBS and stands for Videoflouroscopic Swallow Evaluation

Question 9

What are the types of red flags you’re looking for?

Answer 9

1. Medical
2. Pharyngeal
3. Esophageal
4. Oral