Dysphagia (swallowing dysfunction) is common in general populations and more common in elderly institutionalized patients and persons in long-term care facilities due to significant primary illnesses, including cerebrovascular accidents, neurodegenerative disorders, head and neck cancer, or head injury. Effective nutritional management is crucial to the health of patients with swallowing difficulties, writes Roslyn Tarrant. Types of foods that cause dysphagia can provide information regarding disorders that occur. increase safety risk. Special Purpose To know the nursing care for patients who experience such as : Definition of Dysphagia. Answer Aspiration, in and of itself, does not necessarily lead to pneumonia. Let’s start with a description of the HFNC: It is an oxygen delivery device with a wide-bore silicon nasal cannula (filling about 50% of the internal diameter of the nares per Parke, et al., 2009). There is no standardised protocol for oral care within government hospitals in South Africa. Swallowing impairment (dysphagia) involves difficulties transferring saliva, food and liquids from the oral cavity to the stomach and is a common and troublesome condition in the general population, primarily among individuals over 60 years old (circa 40%) [].Dysphagia may afflict patients with neurological disease, vascular disease (i.e. Nurses provide various forms of care to patients with dysphagia, such as oral care, and indirect/direct swallowing exercises as dysphagia therapy, meal support, and oral or tracheal suctioning. Many patients regain their ability to swallow spontaneously within the first month following a stroke. Is there excess secretion? At the same time, it is related to improving eating and swallowing function and preventing dehydration and malnutrition. All patients with dysphagia have a clearly written ‘Swallow Advice Sheet’ placed behind their bed, which contains all the key recommendations made by the SLT looking after that patient. Oral care is frequently overlooked in hospital, rehabilitation, and long-term care settings. Keywords. Dysphagia and behavioral eating deficits are common in Alzheimer’s disease and other dementias (Feinberg, Ekberg et al. 1994, Priefer and Robbins 1997, Wada, Nakajoh et al. Swallowing is a complex function resulting from dysfunctions of the oral, pharynx, larynx, oesophagus, and respiratory muscles with other structures [].A swallowing disorder or decrease in swallowing ability is called dysphagia [].Dysphagia can be a life-threatening symptom in patients with stroke. 2009, Humbert, McLaren et al. They may need to eat using compensatory postures or techniques such as turning or tilting their head in a certain direction. A lack of individualized oral care program may _____. Abstract: Patient compliance and safety is now prominent on the agenda of healthcare companies. Knowing nursing care in patients with Dysphagia. Dysphagia can also lead to isolation and depression. Oral care for dysphagia patients does not involve simply cleaning the oral cavity, but also preventing aspiration pneumonia, which can be fatal. It covers easy to understand explanations, the importance of oral cares, and how to do oral cares on (a) a person who cannot perform oral hygiene, (b) someone on a restricted or dysphagia diet, and (c) someone with resisting behavior (i.e. True. 2.Explore the patient’s mouth-This includes inspecting the lip,cheeks,gums,teeth, mouth roof,mucosa floor, and even the tongue.-Check the degree of saliva pooling. Conclusion: A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. 5.6 Oral Care Interventions ... Table 5.8 Low Risk Feeding Strategies in Stroke Patients with Dysphagia Table 5.9 Five Postures to Improve Swallowing Function (Logemann, 2008) Table 5.10 A Description of Four Levels of Diets Table 5.11 Diet Levels as Defined by a Canadian Hospital (Parkwood Institute-SJHC) Point out that staff assist dependent older patients with regular toileting schedules, so the same can be done with an oral care routine—every four hours, for example, or at least once a shift. Pathophysiology of Disphagya. Dysphagia patients are susceptible to aspiration pneumonia, and are also more likely to be malnourished. (b) patients with profound dysphagia (or who are nil by mouth), and (c) patients who have sialorrhea (drooling). J Neurosciences 45(3):139- Serving patients improperly prepared beverages may contribute to medical complications such as dehydration if patients consume less fluid, or aspiration of overly thin or thickened liquids, which may increase the risk of pneumonia. Screening does not provide a detailed description of the patient's swallow function but, rather, identifies individuals who are likely to have swallowing impairments related to function, activity, and/or participation as defined by the World Health Organization (WHO, 2001). Sørensen RT1, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. (2013)Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. Handout designed for Speech-Language Pathologists to provide to staff, patients, and family to help communicate the importance of oral care to prevent aspiration pneumonia. Acute ischemic stroke; Dysphagia; Glasgow Coma Score. If the dysphagia is caused by cancer, the patient will be referred to an oncologist for treatment and may need surgical removal of the tumor. However, some patients have difficulty swallowing beyond six months. 1.Sit the patient in an upright and elevated position to help avert aspiration during the oral care/mouth cleaning procedure. This is to minimise their risk of aspirating harmful bacteria and any fluid that may be pooling in the mouth. The rising incidence of dysphagia for older people in hospitals, particularly those over 80 years of age (Leder and Suiter 2009) has many health implications including: malnutrition, dehydration, poor oral hygiene, choking, aspiration pneumonia, and increased need for institutionalised care (Marik and Kaplan 2003, Ney et al 2009). Patients with dysphagia often have multiple underlying conditions, which are more likely to become severe in conjunction with infection by SARS-CoV-2. Handout: How to Complete Oral Care. Dysphagia is the inability to chew or swallow normally or to transfer liquid or solid foods from the oral cavity to the stomach. Etiology of Disphagya. 1992, Horner, Alberts et al. When recommendations are made, they are also documented in the medical notes, and the nursing staff responsible for the patients’ care are informed. You can also factor increased consideration of oral hygiene into your own work with older patients with dysphagia. Screening for dysphagia may be conducted by a speech-language pathologist or other member of the patient's care team. It is recommended that oral care be completed at least ___ times per day. AB - We aimed at summarizing current evidence on age-related changes in swallowing, the impact of selected medications on swallowing, and the management of oral drug therapy in older patients with dysphagia. General Purpose. Maintaining or improving proper swallowing and oral functions is an important issue from the perspective of retaining quality of life (QOL) and motivation in living. How frequently should it be done for a patient who has dysphagia? Oral care should be performed at least twice a day morning and night, but people with dysphagia may need extra oral care before and after meals. The care plans for many patients include changes to fluid thickness to maintain safe intake of oral fluids. -Oral Moisturizer. 2010, Affoo, Foley et al. The Q-Care Continue Care and Suction Systems provide suction toothbrushes with mouthwash and oral moisturizers, which are sufficient for dependent patients on the medical and surgical floors. 1. Handout: Oral Care and Aspiration Pneumonia. Purpose 1. Oral health assessments and oral hygiene regimes that are simple to implement by the interdisciplinary team can be incorporated into standard stroke care with positive effect. A hospital could at least purchase the single-use suction toothbrush packets (order#6572), which cost less than $2.00 each, but may save the hospital over $50,000 in Hospital Acquired Pneumonia costs! Here is a handout I created that addresses dysphagia, aspiration, aspiration pneumonia, and oral cares (dental hygiene) in a Q&A format. The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. Oral Care Tools: Toothbrush (on suction if available), swabs (on suction if available), extra toothettes/swabs to apply mouthwash and moisturizer, Yankauer-oral suction, mouthwash, oral moisturizer, water-based lip moisturizer, gloves, and Chlorhexidine * measured out in medicine cup if prescribed by doctor. Many patients must eat slowly and carefully to avoid choking and aspirating while maintaining a nutritious diet. 2. 7,8. The participants were 116 patients aged ≥65 years (66 men and 50 women, mean age 79.7 ± 8.9 years) who were receiving home nursing care and not eating by mouth because of dysphagia. 2009, Suh, Kim et al. This study aimed to investigate the outcome of an oral care protocol. Dysphagia is associated with nutritional deficits, especially following a stroke, and increased risk of pneumonia. The implementation of guidelines for management of oral drug therapy in dysphagic patients may contribute to improve the quality of care provided to this very frail population. We want to do what is best for our patients in intensive care units (ICU) around the world. Two modifiable risk factors that could lead to the development of community-acquired pneumonia are patients’ oral care and swallowing difficulties (dysphagia) (Langmore et al, 2002). Oral care completion may dictate a patient's success with participating in dysphagia treatment. Although taking good care of your teeth won't directly relieve dysphagia, good oral care is a crucial part of preventing and minimizing swallowing issues. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers. The oral phase of swallowing depends on the number of teeth you have and how healthy those teeth are, concludes a review published in Current Physical Medicine and Rehabilitation Reports. Introduction. All patients underwent dysphagia rehabilitation for 6 months with the objective of resuming oral intake. How does oral care play a role in preventing aspiration pneumonia? Are there protocols to help address oral care for the aspiration risk patient? Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. 3. Dysphagia is not a disease, but rather a symptom or condition. As society ages the number of dysphagia patients and elderly people who cannot independently manage oral care will also increase. 2001, Garon, Sierzant et al. Oral care and dysphagia Poor oral care has been linked to community-acquired pneumonia (Terpenning et al, 2001; Shay, 2002; El-Sohl et al, 2004). 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