Swallowing disorders can occur in all age groups resulting from congenital abnormalities, structural damage, and / or medical condition. in patients who have had a stroke, and in patients who are admitted hospital acute or chronic care facilities.
Dysphagia is classified into two major groups, namely oropharyngeal dysphagia (or transfer dysphagia) and esophageal dysphagia.
1. Oropharyngeal dysphagia
Oropharyngeal dysphagia arises from abnormalities in the oral cavity, pharynx, and esophagus, can be caused by stroke, Parkinson's disease, neurological disorders, muscular dystrophy Oculopharyngeal, decreased flow of saliva, xerostomia, dental problems, oral mucosal abnormalities, mechanical obstruction (malignancy, osteofi, increasing the upper esophageal sphincter tone, radiotherapy, infection, and drugs (sedatives, anticonvulsants, antihistamines). oropharyngeal dysphagia symptoms are difficulty swallowing, including the inability to recognize food, difficulty putting food in the mouth, inability to control food and saliva in the mouth, difficulty to start swallowing, coughing and choking during swallowing, weight loss is not clear why, changes in eating habits, recurrent pneumonia, voice alteration (wet voice), nasal regurgitation. Upon examination, treatment can be done with techniques postural, swallowing maneuvers, dietary modification, environmental modification, oral sensory awareness technique, vitalstim therapy, and surgery. Bilatidak untreated, dysphagia can lead to aspiration pneumonia, malnutrition, or dehydration.
2 . Esophageal dysphagia
Esophageal dysphagia arises from abnormalities in the corpus of the esophagus , the lower esophageal sphincter , or gastric cardia . Usually caused by esophageal stricture , esophageal malignancy , esophageal rings and webs , achalasia , scleroderma , spastic motility disorders including diffuse esophageal spasm and non-specific esophageal motility disorders . Food is usually held some time after ingestion , and it will be as high as suprasternal notch or behind the sternum as the site of obstruction , oral or pharyngeal regurgitation , changes in eating habits , and recurrent pneumonia . If there is a solid and liquid food dysphagia , most likely a motility problem . When the patient initially experienced solid food dysphagia , but subsequently with liquid food dysphagia , it is most likely a mechanical obstruction . After being able to distinguish between problems motility and mechanical obstruction , it is important to pay attention to whether temporary or progressive dysphagia . Dysphagia can be caused motility while diffuse esophageal spasm or nonspecific esophageal motility disorder . Progressive motility dysphagia can be caused by scleroderma or achalasia with a burning sensation in the area of chronic heartburn , regurgitation , respiratory problems , or weight loss . Dysphagia can be caused by temporary mechanical esophageal ring . And progressive mechanical dysphagia can be caused by esophageal stricture or esophageal malignancy . When it can be concluded that the disorder is esophageal dysphagia , then the next step is a barium examination or upper endoscopy . Barium examination should be performed before endoscopy to avoid perforation . When the suspected presence of achalasia on barium examination , then performed manometry for diagnosis of achalasia . When suspected esophageal strictures , then endoscopy . If no abnormalities are suspected as above , the endoscope can be done prior to barium examination . Normal endoscopy , should be continued denganmanometri , and if manometry is also normal , then the diagnosis is functional dysphagia . Thorax is simple to pneumonia.CT examination and MRI scans provide a good overview of structural abnormalities , especially when used to evaluate patients with dysphagia who is suspected due to central nervous system disorders . Having known the diagnosis , the patient is usually sent to the ENT , gastrointestinal , pulmonary , or oncology , depending on the cause . Consultation with a dietician is also necessary , as most patients will need your dietary modification .
Nursing Assessment for Dysphagia
Nursing Assessment is necessary in patients with impaired swallowing or disphagya include:
- History of previous illness
- History of stroke
- History of use of medical devices: tracheostomy, NGT, mayo tube, ETT, post endoscopy examination
- History surgery laryx blood, pharynx, esophagus, thyroid
- Postoperative oral region
- Physical examination
- Mouth shape is not symmetrical
- Seemed an inflammation of the pharynx
- Presence of candida in oral / mouth
- Pharyngeal edema
Nursing Diagnosis for Dysphagia
1. Impaired Swallowing
2. Risk for Imbalanced Nutrition: less than body requirements
3. Risk for aspiration
Nursing Management for Dysphagia