Protocol
T or F -Your patient does not need to seen by SLP if they passed their swallow screen.
False- if your patient passed their swallow screen but still has cognitive or language deficits, speech should be following the patient.
A wet or gurgly voice after swallowing may be a sign of this.
Aspiration
Your patient has a Right sided CVA. They are more or less likely to have dysphagia.
They are MORE likely. Although they can experience dysphagia with both, L-sided is more connected to language while R-sided is more connected to impaired coordination and motor control.
You see your patient drooling from one side of the mouth and frequently clearing their throat. They passed their swallow screen yesterday. Do you repeat the swallow screen?
yes-New signs of dysphagia warrant reassessment, regardless of prior screen.
Who is responsible for completing the swallow screen?
A stroke-trained RN that is either the patient's primary RN, or the RN that is assuming care of the patient. Be sure to report the swallow screen status at handoff
T or F- If a patient is not coughing after swallowing, they are not aspirating.
False- Silent aspiration occurs when food or liquid enters the airway without a cough reflex. Check for frequent throat clearing, changes in voice, and drooling.
Classic symptoms of Large Vessel Occlusions predominantly include what 3 symptoms?
Severe hemiparesis, aphasia, facial droop. These patients typically always fail a swallow screen.
You are told your 87y/o patient is alert and oriented. While assessing the patient you notice they are a little delayed with their answers yet still tend to answer most correct. You also notice they forget the month or their spouses name when asked. At that age it's possible the patient is forgetful. How do you proceed?
Assess the patient for aphasia and activate an RRT/Stroke Alert for possible stroke. Keep the patient NPO. -Altered mental status can present subtly and may be confused with aphasia or dysarthria, further evaluation is needed to rule out language deficits or cognitive changes
Swallow screens can be repeated under what circumstances?
Only if the patient has a decline or worsening of symptoms. If the patient "improves" but had failed at time of screen, they must remain NPO until evaluated by SLP
A patient has aphasia at baseline but no difficulty swallowing per the family's report. What is the next thing you should do?
Determine what (acute) symptoms brought them in for evaluation. ex) Is it leg numbness or a new facial droop?
A stroke occurring in what area of the brain results in dangerous and devastating forms of a dysphagia?
The brainstem. Responsible for motor, function, and coordination. A stroke occurring in posterior circulation affects multiple cranial nerves and most likely to require PEG tube or advanced rehab.
A patient presents with an acute pontine stroke. On assessment, they have right-sided weakness, are alert, but demonstrate difficulty following commands and completing simple tasks. The physician requests a bedside swallow so the patient can receive aspirin. What is the most appropriate next step?
Fail the patient and defer to SLP on the criteria that they are not following commands by selecting "Unable to complete PO trials." -Patients must be able to reliably follow commands for a swallow screen to be valid. Proceeding may increase aspiration risk.
Your patient fails their swallow screening and is now NPO. What is the 2 best things you can do to improve our patient's experience?
1. Educate the patient and family on the swallow screen protocol and risk for aspiration
2. Send a voalte message to the SLP signed in. Even when the speech eval is ordered in Epic, direct communication to a team member can expedite care and get a diet ordered sooner.
A patient had symptoms of aphasia and facial droop that completely resolved in CT scan. You get back to the room and go to perform the swallow screen and their NIHSS is 0. How do you proceed?
Pass the patient provided there are no other symptoms. Be sure to document that the symptoms completely resolved and also reach out to speech, so they are aware.
Which hemisphere's motor cortex is typically dominant for coordinating complex, volitional components of swallowing
Left Hemisphere
A patient with a cerebellar stroke shows ataxia and vomiting, but no signs of coughing or choking when eating. Are they at low risk for dysphagia
No- Cerebellar strokes can disrupt coordination of the swallowing muscles even if overt symptoms aren’t initially present