Keywords. All patients underwent dysphagia rehabilitation for 6 months with the objective of resuming oral intake. Dysphagia is the inability to chew or swallow normally or to transfer liquid or solid foods from the oral cavity to the stomach. However, some patients have difficulty swallowing beyond six months. This study aimed to investigate the outcome of an oral care protocol. 1. 7,8. Handout: Oral Care and Aspiration Pneumonia. 1994, Priefer and Robbins 1997, Wada, Nakajoh et al. 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. Many patients regain their ability to swallow spontaneously within the first month following a stroke. Special Purpose To know the nursing care for patients who experience such as : Definition of Dysphagia. 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. Dysphagia is not a disease, but rather a symptom or condition. Screening for dysphagia may be conducted by a speech-language pathologist or other member of the patient's care team. Design. 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. It is recommended that oral care be completed at least ___ times per day. They may need to eat using compensatory postures or techniques such as turning or tilting their head in a certain direction. How frequently should it be done for a patient who has dysphagia? 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. How does oral care play a role in preventing aspiration pneumonia? Oral care completion may dictate a patient's success with participating in dysphagia treatment. 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. Purpose 1. 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). Dysphagia patients are susceptible to aspiration pneumonia, and are also more likely to be malnourished. 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. 2001, Garon, Sierzant et al. 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) Knowing nursing care in patients with Dysphagia. Patients with dysphagia often have multiple underlying conditions, which are more likely to become severe in conjunction with infection by SARS-CoV-2. Answer Aspiration, in and of itself, does not necessarily lead to pneumonia. True. 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. Introduction. Oral care is frequently overlooked in hospital, rehabilitation, and long-term care settings. 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. Conclusion: A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. 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. 2009, Humbert, McLaren et al. The care plans for many patients include changes to fluid thickness to maintain safe intake of oral fluids. Is there excess secretion? J Neurosciences 45(3):139- 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. Here is a handout I created that addresses dysphagia, aspiration, aspiration pneumonia, and oral cares (dental hygiene) in a Q&A format. When recommendations are made, they are also documented in the medical notes, and the nursing staff responsible for the patients’ care are informed. 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. Many patients must eat slowly and carefully to avoid choking and aspirating while maintaining a nutritious diet. General Purpose. Patients with dysphagia are at increased risk of developing aspiration pneumonia as a result of food, liquid, ... Swal-QOL and Swal-CARE, and the Functional Oral Intake Scale. 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). 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. 3. This is to minimise their risk of aspirating harmful bacteria and any fluid that may be pooling in the mouth. 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. increase safety risk. 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). The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. 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. As society ages the number of dysphagia patients and elderly people who cannot independently manage oral care will also increase. We want to do what is best for our patients in intensive care units (ICU) around the world. You can also factor increased consideration of oral hygiene into your own work with older patients with dysphagia. 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. Sørensen RT1, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. (2013)Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. A lack of individualized oral care program may _____. There is no standardised protocol for oral care within government hospitals in South Africa. -Oral Moisturizer. Effective nutritional management is crucial to the health of patients with swallowing difficulties, writes Roslyn Tarrant. Acute ischemic stroke; Dysphagia; Glasgow Coma Score. 1992, Horner, Alberts et al. 2. 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). 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. 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. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers. 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. (b) patients with profound dysphagia (or who are nil by mouth), and (c) patients who have sialorrhea (drooling). 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). Etiology of Disphagya. Handout: How to Complete Oral Care. 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. 1.Sit the patient in an upright and elevated position to help avert aspiration during the oral care/mouth cleaning procedure. Pathophysiology of Disphagya. Types of foods that cause dysphagia can provide information regarding disorders that occur. Dysphagia and behavioral eating deficits are common in Alzheimer’s disease and other dementias (Feinberg, Ekberg et al. Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. Are there protocols to help address oral care for the aspiration risk patient? 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. 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. Dysphagia can also lead to isolation and depression. 2009, Suh, Kim et al. Abstract: Patient compliance and safety is now prominent on the agenda of healthcare companies. 2010, Affoo, Foley et al. Dysphagia is associated with nutritional deficits, especially following a stroke, and increased risk of pneumonia. 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