Expanding My Scope of Practice

http://quizlet.com/3420134/dysphagia-flash-cards/



I found this link for flashcards. I particularly like the cards for pediatric dysphagia. I don't have a great deal of experience working with dysphagia in children. It is very different. I will be looking for opportunities to learn about this aspect of my field.

Sometimes It's Hard To Swallow

Dysphagia is a condition I provide therapy for. It means your swallow is not effective and you are at risk for aspiration or choking. This condition can send an elderly person to the hospital in respiratory distress within an hour after eating. When a patient comes to the hospital following a stroke or the the skilled nursing facility because they can no longer care for themselves, I evaluate their ability to swallow. The way it works is……..; you get hungry…….this gives you an "appetite" All of your senses are involved. (e.g., smell, sight, sound, taste, touch). These sensory messages cause stomach contractions and thus begins the search of food. What can go wrong?

1. brain damage decreases senses therefore decreasing appetite
2. pharmacologic interference (too many drugs on board) or those that can cause swallowing problems.
3. febrile states (a significant increase in body temperature accompanied by increased pulse and respiration rates, anorexia, constipation, insomnia, headache, pains, and irritability.)
4. G.I. disorders
5. vitamin deficiencies

The result is often ((pneumonia)) most commonly bacterial….caused by aspiration ((the result of an infection in the alveoli (the little sacks in your lungs….they fill up with fluids and there's no room for oxygen….this is very bad:(

The symptoms of pneumonia are;

1. shaking chills
2. fever (101-105)
3. weakness/malaise
4. difficulty breathing
5. increased coughing

Now for the causes…..There are many things that can go wrong and it goes something like this;

1. impaired respiration/swallow coordination
2. silent aspiration (this is pretty common) patients are experiencing foreign material entering their lungs and there are no outward symptoms.
3. impaired vocal folds. They either don't open and close at the right time or not at all
4. impaired epiglottis (the little flap that covers your airway as the food slides down)
5. liquid pools in the valeccula and/or the pyriform sinuses. (little pockets on either side of your airway that can hold liquid. This can spillover into your airway when you're not ready to swallow and your airway is not protected.
6. decreased ability to cough due to weakness, (congestive heart failure)
7. the whole timing thing could be off…..
8. impaired function of the soft palate( causing food and fluid to go up your nose
9. damage to the nerves can decrease sensation of the oral articulators (lips, cheeks, jaw, tongue, pharynx)
10. muscles responsible for chewing are too weak
11. no teeth at all for chewing
12. decreased saliva
13. dizziness/difficulty balancing body in space
14. damage to the Vagus nerve resulting in impaired (respiration, phonation, resonation, heart, G.I. tract)
15. neck injuries decreasing the ability to tilt the head
16. decreased alertness and/or arousal
17. decreased ability to feed self
18. decreased cognitive awareness (as in Alzheimer's)

It is usually a combination of these factors that impair someone's swallowing ability. This gives you an idea of what my primary responsibility is within acute care and the SNF's

What Does It Feel Like To Have A Stroke

Jill Bolte Taylor is a neuroscientist. She was in a unique position in her research when she experienced a stroke first hand. Her story is amazing and what she discovers has opened up the possibilities for how we fit into the cosmos.

Think FAST for stroke

Professor Stephen Davis’ public talk highlighted the importance of recognising the signs of stroke. Time is of the essence for effective treatment, so just remember the word “FAST”, as recommended by the Stroke Foundation of New Zealand. Each one of the letters in FAST stands for a word which you can use to uncover a symptom of stroke and get help.

F=Face - Ask the person to smile. If one side of the face appears crooked or drooping this person may be having a stroke

A=Arms - Ask the person to lift both of his or her arms in the air--if he or she has difficulty with one arm this too might be a sign that this person is having a stroke

S=Speech - Ask the person to speak. If his or her words are slurred or they are unable to speak, they might be having a stroke

T=Time. If any of the above symptoms are present you must call 111 immediately in order to make sure that this person reaches the hospital FAST.

taken from the autumn issue 2011 e-book for The Center for Brain Research. This center is located in Auckland, New Zeland.at the Auckland University

http://www.fmhs.auckland.ac.nz/faculty/cbr/news/_docs/newsletter/CBRconnections_autumn11_web.pdf

Speaking of Language

The symbols of language communicate to us the feelings thoughts and desires of another. How you organize these symbols then deliver them with your voice, your pen or your body in space, determines your intent. Through reactions, shared knowledge and feelings, the listener reads these symbols and responds.