Swallowing (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides GI Changes Oropharyngeal Swallowing Nursing.pdf
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    00:01 So I love what we made for you here. Right? How this works and you've done this probably even before you watched this video today.

    00:10 The teeth are the ones that, first, your front teeth, right, you bite into something.

    00:14 And then as it moves back in your mouth, they grind and chop the food into tiny pieces.

    00:19 Now, that's really important. That's why we cut up babies' food because they don't have teeth for a while. And then when they do have teeth, they may not take the care that they need to so they don't choke.

    00:32 So that's why we cut their food into tiny pieces. As an adult, your teeth should do that.

    00:37 And if you take your time with chewing before you swallow, this shouldn't be a problem.

    00:43 Now, as you're doing that, what happens to the glands in your mouth? Pause and think back to that picture that we looked at. Ah, there was three glands.

    00:52 Remember where they were? And can you remember their names? Excellent. Hey, I'm not going to give you the answer because I want you to make sure you go back and look at that and practice remembering that.

    01:05 So I've taken a bite, I'm chewing it. Now, it's getting moistened with saliva from those glands we already discussed.

    01:11 Then my tongue is going to push that food or we sometimes call it a bolus.

    01:16 That does not sound delicious. I mean, if I'm eating something good, I'd rather think of it as food than a bolus. But that's the professional term for it.

    01:25 So I bite it. I chew it. I grind it. I moisten it.

    01:28 My tongue pushes it to the back of my throat and down into my esophagus.

    01:34 That is the rule. That's where I want it to go.

    01:37 Now, if I somehow get it in my trachea, that's my airway, and I'm really going to start coughing.

    01:42 But how it's supposed to go, chew it up, grind it up, moisten it up so it's easier to swallow that food or bolus.

    01:50 You're going to push it to the back of your throat and into your esophagus because we know from there, it's going to go into the stomach and throughout the rest of the GI system.

    01:59 Now, let's watch that swallowing process again.

    02:02 I love how we animated this for you to kind of help this really make sense.

    02:09 Now, why does Jose have some slight problems here? Well, as we age, let's look at some landmarks first.

    02:15 Your swallowing becomes a little slower and less efficient.

    02:19 But let's dig down and show you why.

    02:21 Now, you have two sphincters, upper sphincter and the lower sphincter.

    02:26 Yeah, we - really clever naming, isn't it? But thank goodness it's easier to remember than some of the million bones you had to memorize in your anatomy classes.

    02:34 But you have an upper esophageal sphincter and a lower esophageal sphincter.

    02:39 So what these do, they're kind of gatekeepers.

    02:42 They keep them moving down and the way they should go.

    02:45 And as peristalsis is happening, you want food to come in here and continue to go all the way down.

    02:51 Now, you see that esophagus is what's in between your mouth and your stomach.

    02:56 So it's important you have that visualization.

    02:59 We could talk forever about all of the things that can go wrong with an esophagus, but we're not going to go down that bunny trail.

    03:06 I just want you to focus on the safety factors.

    03:09 We're talking about oropharyngeal and swallowing.

    03:13 So upper sphincter, lower sphincter, esophagus in the middle.

    03:18 Swallowing becomes a little slower and a little less efficient because you have a decrease in both the upper and lower esophageal sphincter pressure.

    03:26 Okay. So they don't function quite as well, not as good at relaxing and they have issues with decreased peristalsis.

    03:33 So those are kind of normal changes with aging. But this shouldn't be extremely problematic.

    03:39 Like, this shouldn't be a risk. You just need to know that you want to be careful.

    03:43 And it's a good idea for everyone to be careful when they're eating to chew their food up.

    03:48 Make sure that it's easy to swallow, and then it moves on through.

    03:52 So here's Jose. He is our poster child. Right? For everything that's good about normal aging, this is how it should be.

    04:00 We're just going to educate him that, "Hey, you may have noticed that your mouth is a little drier than it used to be.

    04:05 Or it's a little more difficult to chew than it used to be." Or he may not notice those changes at all.

    04:11 You and I just know that that is a likely occurrence.

    04:15 But when we move from normal aging, now, you know what we're going to do.

    04:22 We're going to pick on poor Enrique again because his is not normal aging.

    04:26 So we've got Jose. He's giving us a thumbs up. Swallowing is slower and less efficient.

    04:32 Can you list the reasons why? Okay. I hope you've talked about, "Oh, remember the lower esophageal sphincter, upper esophageal sphincter not working as well.

    04:45 All that's going on in there. Listing those specific reasons because when you're studying, I want you to think like you're a toddler. You are bright and intelligent. I know that.

    04:57 But always ask why? You know, that's what toddlers say all the time, "Why? Why? Why? Why?" That's what I want you to say. I don't want you to just memorize that older people have slower and less efficient swallowing.

    05:11 That is so boring. Your brain will never - that will never stick in your brain.

    05:16 But if you ask yourself, yeah, it's slower and less efficient.

    05:19 Why? Then you're going to remember. Now, keep in mind, for Jose, he's not really going to have issues with dysphagia.

    05:28 Okay. That's a pretty cool sounding word. I really liked medical terminology class.

    05:32 I took it early on in nursing school, and it was super fun.

    05:35 But you can take a lot from this lesson and apply it to other exam questions and other content. D-Y-S always means difficulty.

    05:44 Phasia means swallowing. So, this means difficulty swallowing.

    05:49 But if I put D-Y-S in front of any of those medical terms, it's going to mean difficulty.

    05:55 Things aren't going well. So Jose is not going to have a problem with dysphagia.

    05:59 We're not as concerned about him aspirating in normal aging.

    06:03 And our little friend Enrique, right? He's got the aging with comorbidities and we keep going over that and over that because I want you to know, if you're in an acute care setting, you're going to see the elderly who likely have comorbidities, or they likely wouldn't be in the hospital with you.

    06:22 But in the community, you're going to see lots of normal aging Jose's. Right? You're going to see people who are healthy, and they're doing fine, and things are going okay.

    06:33 So don't assume just because you're a geriatric client that everyone is going to be like Enrique.

    06:40 That's not accurate. And that's why this series is so important.

    06:44 But, again, our little friend Enrique, right? So he's going to have even bigger issues with swallowing which can make taking medications traumatic.

    06:53 Our geriatric population is on far more medications than the younger population.

    06:59 In fact, CVS and Walgreens or whatever the drug store is in your town, they love old people because they spend the most money in their stores.

    07:10 Enrique would be one of them.

    07:12 So if he has a lot of pills to take, and if they're large pills, that can be really problematic for him if he has difficulty swallowing, trying to get large pills down.

    07:23 So you may consider what you can cut in half if he's having difficulty, and other ways to facilitate his swallowing.

    07:30 So he does have the risk of dysphagia and aspirations.

    07:36 The thinner the liquid, the easier it is to aspirate.

    07:40 So when you're with patients that have a thickened diet ordered, like, we could put this powder in things. It's - it's - we call it thick it.

    07:48 But that's just the name where you put this powder in like a cup of coffee or a glass of water and it makes it thicker like syrupy.

    07:56 And it just grosses me out because it just makes me think like it's rotten or something.

    08:02 But it really doesn't have much of a flavor and it can make it so they can enjoy a cup of coffee and lower their risk of aspiration.

    08:10 But that's why we're watching this video.

    08:12 There are lots of things that you can do to make the quality of life better.

    08:18 I don't know about you. I want to take really good care of my mouth and make sure that I don't have difficulty swallowing.

    08:23 Because I don't want to drink thick coffee or tea.

    About the Lecture

    The lecture Swallowing (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. Swallowing becomes faster.
    2. Swallowing becomes less efficient.
    3. Esophageal sphincter pressure decreases.
    4. Saliva production decreases.
    1. Dysphagia
    2. Dysarthria
    3. Dysphasia
    4. Dysphonia
    1. “Normal aging rarely causes aspiration or dysphagia.”
    2. “Swallowing is one of the only parts of the gastrointestinal system not affected by aging.”
    3. “Medical co-morbidities can lead to a decreased risk of dysphagia.”
    4. “Aspiration is the most common age-related swallowing complication.”
    1. Review which client's medications can be crushed before administration.
    2. Instruct to avoid thickened fluids to prevent aspiration.
    3. Encourage the client to chew food thoroughly and slowly.
    4. Monitor the client while taking the medications for any signs of distress.
    5. Ensure the client is in an upright position while taking medications.

    Author of lecture Swallowing (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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