Family Education Sheet on ASPIRATION
Family Education Sheet
ASPIRATION
Aspiration – Aspiration occurs when material such as gastric contents, saliva, food, nasopharyngeal secretions are inhaled into the airway or upper respiratory tract. In a healthy population, micro aspiration is common and pulmonary secretions seldom occur. In the unhealthy population risk for pneumonia is higher due to levels of consciousness, altered airway defenses, and depressed immune function. Aspiration may be silent or with overt symptoms. How much is too much aspiration??
Not enough research exists to definitively answer this question. Until more research is available, the SLP should use clinical judgment and assume that the least amount of aspiration is safest for the patient (Hardy & Robinson, 1999). The amount of aspiration will also depend on the patient’s current medical condition and varying diagnoses involved.
Aspiration Pneumonia –Pneumonia occurs when bacteria that normally exist in the oral, nasopharyngeal and gastrointestinal tract or food and/or liquid are aspirate into the lungs. A chest X-ray that may show infiltrates or pneumonia confirms diagnosis of pneumonia, most consistently in the right lower lobe. A bronchoscopy can give a definitive diagnosis.
High Risk Diagnosis
- Stroke
- TBI – Traumatic Brain Injury
- Movement Disorders –Parkinson ’s disease, Huntington Chorea, Myasthenia Gravis, Multiple Sclerosis, Wallenburg Syndrome, Friedreich’s ataxia, Wilson’s Disease, Shy Drager Syndrome, Gulliane Barre Syndrome
- Alzhiemer’s or Dementia in its progressive state
- Multiple Sclerosis – High risk disorders include many neuromuscular weakness diagnosis’ as well such as Huntington’s Chorea, ALS, Shy Dreger Syndrome, Tardive dyskinesia
- Myasthenia Gravis
- Tracheostomy or Laryngectomy
- Head or neck surgery
- Elderly patients
- Cerebral Palsy and other movement disorders
- Disorders in the cervical esophagus aspect of deglutition
- Pulmonary – COPD, Respiratory Failure, vent dependent
- Systematic Diseases – AIDS, Lupus, Sjogrens Syndrome, Scleroderma
- Acquired Peripheral Disorder – Carcinoma, Diabetes (uncontrolled)
- Other –Tori, Cervical Fusion, Radiation, Osteophytes, Zenker’s Diverticulum, Esophageal Obstruction, , Renal Failure, Wallenburg, Meningitis, Lyme disease, Creutzfeldt-Jakob Disease, Torticollis, Goiters, Chagas Disease, Spinal injury, Mental Retardation, Vitamin B-12 deficiency, GERD
Dysphagia Indicators, Signs and Symptoms
Swallowing difficulty – influenced by solids or liquids
Associated Symptoms
1. Coughing, choking, and or excessive throat clearing
2. Excessive sneezing
3. Runny nose and/or watery eyes – equivalent to a cough in the elderly
4. Multiple swallows during any PO
5. Pain in swallowing
6. Feeling as if something is “stuck” in the throat. Referred to as s globus sensation
7. Pulmonary Status change
8. Complaints of fullness in the neck
9. Pocketing food
10. Wet -gurgly phonation/voice or respirations
11. Excessive secretions, drooling
12. Audible swallow
13. Mouth odor
14. Nasal regurgitation
15. Heartburn or chest pain during and or after PO
Ancillary Symptoms
1. Weight loss – malnutrition and/or dehydration
2. Change in eating habits or appetite
3. Voice changes
4. Decreased sleep
5. Taste changes
6. Dry mouth or saliva consistency changes
Medical History
1. Medical or psychiatric history – anorexia, bulimia, globus hystericus
2. Medications
3. Radiation treatment for CA
4. General health and current status
5. Recurrent Pneumonia
Clinical Observation
1. Nutritional and hydration status
2. Mental status and behavior, cognition. Feeding difficulties
3. Posture
4. Trach or open stoma
5. Nasal gastric tubes
Clinical Examination
1. Oral Mucosa
2. Dentures
3. Sensation
4. Reflexes
5. Oral anatomy
Normal Changes in Advance Age:
· Decreased salivation
· Decreased taste
· Decreased smell
· Decreased pliability of the epiglottis
· Decreased elasticity and strength of lung muscles
· Decreased muscle tone of the laryngeal & pharyngeal muscles
· Increased threshold for a cough reflex
· Increased threshold for a swallow reflex
· Incidence of esophageal disease and reflux
· Increased chest wall stiffness
· Changes in ossification of cartilages
· Degeneration of bony structures
· Changes in dentition
· Larynx lowers to level of 6-7 of the cervical spine
· Fatigue
· 10% reduction in brain weight
· 30% decline in the speed of action
TUBE FEEDING What one person considers “quality of life”, someone else may think differently. Artificial supplied nutrition and hydration are a medical treatment to be considered in the same light as other technological procedures and not considered life support in the medical field. Literature supports PEG placement in patients recovering from a traumatic accident or expected to make a recovery process. It is considered a medical intervention, not obligatory care. Tube feeding is an art and a science that is increasingly used in our aging society as more people become physically incapacitated or have dementia. Properly used it can be helpful.
Types of Nonoral Feeding
- NG Tube – thin flexible tube inserted into the nasal cavity through the pharynx, esophagus, down into the stomach.
- PEG – Percutaneous Endoscopic Gastrostomy – surgical procedure that creates an external opening in the abdomen that leads to the stomach.