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Critical care nursing dysphagia

Martin Christensen, Michaela Trapl
Post-extubation dysphagia is a condition that is becoming a growing concern. The condition occurs in 3-62% of extubated patients and can be related to mixed aetiologies, such as neuromuscular impairment, critical illness and laryngeal damage. The risk factors for developing dysphagia in critically ill patients are under-diagnosed and perhaps underestimated. Recent studies recommend the implementation of a standardized swallowing screen to prevent aspiration and decrease pneumonia rate and mortality. The aim of this quality improvement initiative was the development of a bedside swallowing screening tool to assess effective swallowing post-endotracheal extubation...
March 2018: Nursing in Critical Care
Joerg C Schefold, David Berger, Patrick Zürcher, Michael Lensch, Andrea Perren, Stephan M Jakob, Ilkka Parviainen, Jukka Takala
OBJECTIVES: Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN: Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS: ICU of a tertiary care academic center...
December 2017: Critical Care Medicine
Lise Birgitte Austbø Holteng, Christina Tølbøl Frøiland, Anne Corbett, Ingelin Testad
BACKGROUND: Dysphagia and dementia are conditions, which combined, can lead to complications for the person and require good nutritional care. There is very little evidence-based literature regarding nutritional care for people with dysphagia and dementia. It is clear that care staff plays a vital role, and that communication and informed decision-making are critical to the process, yet little is known regarding the use of available interventions such as texture modified food (TMF), and their acceptability and feasibility for care staff and residents...
October 2017: Annals of Palliative Medicine
Kay Choong See, Si Yu Peng, Jason Phua, Chew Lai Sum, Johncy Concepcion
BACKGROUND: Swallowing difficulties are common, and dysphagia occurs frequently in intensive care unit (ICU) patients after extubation. Yet, no guidelines on postextubation swallowing assessment exist. We aimed to investigate the safety and effectiveness of nurse-performed screening (NPS) for postextubation dysphagia in the medical ICU. METHODS: We conducted a retrospective cohort study of mechanically ventilated patients who were extubated in a 20-bed medical ICU...
October 12, 2016: Critical Care: the Official Journal of the Critical Care Forum
Julian Bösel
Patients with severe ischemic and hemorrhagic stroke may require tracheostomy in the course of their disease. This may apply to stroke unit patients whose deficits include a severe dysphagia posing such risk of aspiration as it cannot be sufficiently counteracted by tube feeding and swallowing therapy alone. More often, however, tracheostomy is performed in stroke patients so severely afflicted that they require intensive care unit treatment and mechanical ventilation. In these, long-term ventilation and prolonged insufficient airway protection are the main indications for tracheostomy...
January 2014: Current Treatment Options in Neurology
Bruce K Tamura, Christina L Bell, Kamal H Masaki, Elaine J Amella
BACKGROUND: Weight loss and poor nutrition are important quality measures in long term care. Long term care professionals need to identify factors associated with weight loss and poor nutrition to target high-risk patients. METHODS: The authors systematically searched Medline and CINAHL databases and included English language studies with more than 100 subjects analyzed, published after January 1, 1990, with data on factors associated with at least one of the following: weight loss, low body mass index (BMI), low Mini-Nutritional Assessment (MNA) score, or other standard measure of malnutrition...
September 2013: Journal of the American Medical Directors Association
Stephanie K Daniels, Jane A Anderson, Nancy J Petersen
Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse-administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses' adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers...
2013: Nursing Research and Practice
Joseph D Burns, Deborah M Green, Helena Lau, Michael Winter, Feliks Koyfman, Christina M DeFusco, James W Holsapple, Carlos S Kase
BACKGROUND: Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. METHODS: We retrospectively identified all patients admitted to our institution with intracerebral hemorrhage (ICH) in two 12-month periods: immediately before the arrival of the first neurointensivist ("before") and after the neurocritical care service was established ("after")...
June 2013: Neurocritical Care
Kathie Clarke, Todd Levine
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, causes a progressive wasting and loss of the upper and lower motor neurons that facilitate the movement of body parts. At onset, ALS patients may show symptoms such as muscle weakness, atrophy, hyperreflexia, or bulbar symptoms such as dysphagia or dysarthria. Deterioration progresses rapidly, and the later stages of ALS are characterized by severely limited mobility and respiratory failure, which is the primary cause of death. There is no specific diagnostic test for ALS, and there are a number of other conditions that may resemble ALS, making a diagnosis difficult...
August 2011: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Makoto Toyota, Yuka Sasaki
Tuberculosis in the elderly remains a health burden in Japan. Most of the elderly aged more than 70 years in Japan had become infected with Mycobacterium tuberculosis in their youth, and the elderly represent a population at a special high risk for developing tuberculosis owing to comorbidity and age-related immunosuppression. The characteristics of tuberculosis in the elderly are different from young patients. To reduce active tuberculosis in the elderly, treatment of latent tuberculosis infection for compromised host could be strengthened, however its impact might be limited...
December 2010: Kekkaku: [Tuberculosis]
Uta Gaidys, Martina Mann, Dietmar Smidt
This paper describes a study which was carried out within a project regarding the assessment of dysphagia for patients who had suffered a stroke. The aim of this investigation was to evaluate formatively the implementation of an assessment instrument for the care of patients with dysphagia. By means of a qualitative study semi-structured interviews with six nurses of a stroke unit were carried out. The interviews were analysed using content-analysis described by Mayring. The analysis illustrated that the interviewed nurses perceived the therapeutical value of nursing for patients with dysphagia...
February 2010: Pflege Zeitschrift
Sally Batty
BACKGROUND: It is not uncommon for patients requiring a period of time in the intensive care unit (ICU) to experience difficulties with communication and/or swallowing, either as a result of their illness or as a result of the treatments they receive. These difficulties can be both short term and long term and require timely and appropriate intervention in order to improve the patient's experience and expedite recovery/rehabilitation. AIMS: The purpose of this article is to provide critical care nurses with an update on aspects of communication, swallowing and feeding in the ICU...
July 2009: Nursing in Critical Care
Julie A Y Cichero, Sarah Heaton, Lynell Bassett
AIMS AND OBJECTIVES: To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme. BACKGROUND: Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse-screening tools have focused on stroke. However, many other conditions are associated with dysphagia...
June 2009: Journal of Clinical Nursing
James L Coyle, Lori A Davis, Caryn Easterling, Darlene E Graner, Susan Langmore, Steven B Leder, Maureen A Lefton-Greif, Paula Leslie, Jeri A Logemann, Linda Mackay, Bonnie Martin-Harris, Joseph T Murray, Barbara Sonies, Catriona M Steele
In September 2008, an article was published in the Journal of the American Medical Directors Association criticizing current dysphagia assessment and management practices performed by speech-language pathologists in Long-Term Care (LTC) settings. In the same issue, an editorial invited dialogue on the points raised by Campbell-Taylor. We are responding to this call for dialogue. We find Campbell-Taylor's interpretation of the literature to be incomplete and one-sided, leading to misleading and pessimistic conclusions...
January 2009: Journal of the American Medical Directors Association
Christina A Baumgartner, Emily Bewyer, Diane Bruner
Patients in adult, pediatric, and neonatal intensive care settings often require the services of a speech-language pathologist. It is common practice to consult a speech pathologist to determine whether a patient is ready to initiate oral intake or help a patient with an artificial airway communicate. Assessments for dysphagia are initially clinical and conducted at bedside. Results from the clinical evaluation help determine if and when an instrumental examination should be completed. Patients who are tracheostomized, or had been, and those who were intubated for a prolonged period are at risk for aspiration...
October 2008: AACN Advanced Critical Care
JoAnne Robbins, Stephanie Kays, Shirley McCallum
The capacity to swallow effectively and safely is a basic human need, yet nearly 40% of Americans over age 60 experience dysphagia. Since the resources in acute-care hospitals often are unavailable in institutional settings, the daily involvement of nursing and the dietitian's screening and continuous assessment are critical to timely, effective dysphagia identification, referral, and management. Upon referral, the speech pathologist executes comprehensive evaluation, leading the design and implementation of a team treatment plan...
2007: Journal of Nutrition for the Elderly
Jirí Klempír, Olga Klempírova, Natasa Spacková, Jana Zidovská, Jan Roth
The purpose of this study was to test the usefulness of the Unified Huntington's Disease Rating Scale (UHDRS) in clinical practice. The UHDRS was used to examine 45 persons with genetically diagnosed Huntington's disease (HD) in various stages. The rate of motor involvement, cognitive deficit and reliance on nursing care rose in linear proportion to HD duration. The severity of motor involvement correlated significantly with all UHDRS subscales except for that of behavioral disorders, the rate of these disorders being unrelated to any of the parameters under study...
October 2006: Functional Neurology
Elaine J Amella
All cultures dictate the need to feed the hungry and create rituals for almost every life passage around the consumption of food and beverage. Yet, in old age and among those who cannot advocate for themselves, mealtime is medicalized and demoted to an insignificant event without dignity or regard for individualized needs. Attention must be paid to not only what people eat, but how they eat, and how they are supported in that process. Kayser-Jones summarized the extensive findings of several ethnographic studies in nursing homes by noting the multi-factorial issues involved in delivering excellent care to all residents, especially those lacking an advocate...
September 2004: Nursing Clinics of North America
Nathalie Rodrigue, Robert Côté, Connie Kirsch, Chantal Germain, Céline Couturier, Roxanne Fraser
Dysphagia is a common problem with individuals who have experienced a stroke. The interdisciplinary stroke team noted delays in clinical decision-making, or in implementing plans for patients with severe dysphagia requiring an alternative method to oral feeding, such as enteral feeding via Dobhoff (naso-jejunum) or PEG (percutaneous endoscopic gastrostomy) tubes, occurred because protocols had not been established. This resulted in undernourishment, which in turn contributed to clinical problems, such as infections and confusion, which delayed rehabilitation and contributed to excess disability...
March 2002: L' Axone
K Wasson, H Tate, C Hayes
Food refusal poses difficulties for nurses and care staff and can place older patients with dementia at risk of undernutrition. The dangers of and reasons for food refusal in these patients are explored and the fundamental ethical and legal issues raised in caring for these patients are examined. Practical guidance and solutions are offered through dietetics and speech and language therapy with the aim of helping nurses and care staff, as well as professional carers in palliative care, and explore ways of critically examining and coping with these dilemmas...
October 2001: International Journal of Palliative Nursing
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