当前课程知识点:老年护理学(Gerontological Nursing) > CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases > 6.2 Dysphagia in the Elderly > Dysphagia in the Elderly
返回《老年护理学(Gerontological Nursing)》慕课在线视频课程列表
返回《老年护理学(Gerontological Nursing)》慕课在线视频列表
同学们大家好
今天我们一起来学习一下
吞咽功能障碍的识别和护理要点
说起吞咽障碍
我们首先要来看一下正常人吞咽的过程
食物由口腔而入
在舌头 咽喉及口腔肌群的共同协作下
将食团顺利的送入食管上端
而期间会厌部关闭
至此完成吞咽的全过程
而吞咽障碍
顾名思义就是食物或者液体
从口腔运送到胃的过程中发生的障碍
可以在准备期 口腔期
咽期或食管期的任何一个阶段发生
是临床常见的老年综合症之一
研究发现
老年住院患者中
吞咽障碍的发生率可以高达55%
这也造成了这部分人群
需要长期照护的需求和风险
由于吞咽障碍的出现
可能会引起患者营养不良 脱水
吸入性肺炎 窒息甚至死亡
也会带来心理上的障碍
严重影响了老年人的健康
对于疑似有吞咽问题的患者或老人
应该进行吞咽障碍的筛查
筛查一般由护士完成
其他专业人员也可以参与
需要强调的是
筛查并非用于量化吞咽障碍的风险程度
或指导吞咽障碍的管理
筛查不能取代临床功能评估和仪器检查
目前
吞咽造影检查
和软式喉内镜吞咽功能检查
是确认吞咽障碍的金标准
应用这些设备的检查能更直观
准确地评估
口腔期 咽期和食管期的吞咽情况
了解吞咽气道保护功能完整情况
对于诊断 干预手段选择
和咽期吞咽障碍的管理意义重大
对吞咽障碍的评估流程
我们可以参考以下流程进行
那么
我们如何对于吞咽功能进行评估呢
临床上最常用的筛查方法包括
反复唾液吞咽试验
或饮水试验来检测患者的吞咽情况
一 反复唾液吞咽试验
患者取端坐位
检查者将食指置于患者的下颌窝
中指至于舌骨
无名指和小指
分别放在甲状软骨和环状软骨上
让其快速反复的吞咽
感受舌骨随吞咽的运动
观察喉部能否上升 下降2公分
一般高龄患者30秒内
完成次数少于3次
即可去认定为存在吞咽功能异常
二 饮水试验
同样
患者取端坐位
喝下30ml的温开水
观察所需的时间及呛咳情况
具体的评价标准为
1级 5s内能够一次顺利地将水咽下
为正常
2级 5s内分2次以上将水咽下而无呛咳
可疑异常
3级 5s内一次咽下但出现呛咳
4级 5s~10s分两次以上咽下并有呛咳
5级 10s内不能将水全部咽下
并频繁的呛咳
3~5级皆为吞咽异常
除了做基本的筛查外
还要对造成吞咽障碍的
相关影响因素做全面的评估
如进食过程的评估 进餐习惯的评估
营养风险的评估
其他功能状态的评估等等
以上评估的意义在于确定
是否存在吞咽障碍
帮助识别患者特定的吞咽相关危险因素
同时提供护理人员改变营养方式的依据
为吞咽障碍进一步检查和治疗提供实证
由于吞咽障碍导致噎呛的患者
常被误认为心绞痛发作
而延误最佳的抢救时机
所以一定要正确的评估 及时判断
在进食时患者是否表现出突然不说话
欲说无声 面部涨红
并有呛咳反射
出现胸闷 窒息感
两手乱抓 两眼发直
食物吐不出
随后导致满头大汗 面色苍白
突然意识不清或者烦躁不安
出现以上情况则提示食物已经误入了气管
如若不及时解除很有可能会造成死亡
在最新的
《中国吞咽障碍评估与治疗专家共识
(2017版)》中
对吞咽障碍的治疗已经达成了共识
其中
吞咽康复训练是我们必须掌握的护理措施
吞咽障碍康复训练可以分为
间接训练和直接训练
间接训练是指不用食物
主要为了预防废用性功能低下
改善吞咽相关器官的运动及协调动作入手
其安全性好
适用于从轻度到中度的各类吞咽困难者
包括口唇闭锁练习
下颌运动训练
舌运动训练
冷刺激 构音和声带内收训练等等
直接训练是指应用食物
通过调整进食的体位和食物的形状
并指导应用辅助吞咽动作
改善吞咽功能的摄食训练
包括选择密度均匀 黏度适当
不易松散 通过咽和食管
易变形且很少在黏膜上残留的糊状食物
调整一口进食量和进食的速度
一般呢正常人每口量糊状的食物为3-5ml
流质为1-20ml左右
可以从少量开始渐渐地增加
最好定时 定量
坐姿进食
尽量不要躺着或在床边进食
保持安静的进食环境
和良好的进食习惯
避免因分心而影响吞咽
当然
在进食的前后一定要清洁口腔及排痰
因为进食后残留在口腔及咽部的食物
容易随呼吸进入呼吸道
导致进食后潜在性的肺部感染
因此
口腔和肺部的清洁对于吞咽障碍患者
预防肺部感染尤为重要
好了
以上就是本章节学习的全部内容
谢谢大家
-1.1 Human Life Expectancy and Age Classification of the Elderly
--Human Life Expectancy and Age Classification of the Elderly
--【Vedio Recommendation】 How do we measure life expectancy ?
-1.2 Population Aging
--【Literature Recommendation】World Report on Ageing and Health: 2015
-1.3 Influence and Countermeasures of Population Aging
--Influence and Countermeasures of Population Aging
--【Literature Recommendation】World Population Ageing Highlights:2019
-1.4 Goals and Principles of Elderly Care
--Goals and Principles of Elderly Care
--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice
-1.5 Theories Related to Elderly Care
--1.5.1 Personality Development Theory and Life Review
--1.5.2 Disengagement Theory and Activity Theory
--1.5.3 Self-efficacy and Chronic Disease Management
--【Vedio Recommendation】8 Stages of Development by Erik Erikson
--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging
--【Book Recommendation】Self-Efficacy in Changing Societies
-1.6 Elderly Support and Elderly Care
--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care
--1.6.2 Home-based Elderly Care Model
--1.6.3 Institutional Elderly Care Model
--1.6.4 Integrated Medical and Nursing Care Model
--【Vedio Recommendation】Day in the Life of Home Care
--【Website Recommendation】Official Website of the National Institutes of Health
-Concept Map
--【Concept Map】General Introduction to Geronological Nursing
-【Test】CHAPTER 1
-2.1 Aging Changes in the Elderly
--2.1.1 Aging of the Respiratory System
--2.1.2 Aging of the Cardiovascular System
--2.1.3 Aging of the Digestive System
--2.1.4 Aging of the Urinary System
--2.1.5 Aging of the Endocrine System
--2.1.6 Aging of the Motor System
--2.1.7 Aging of the Nervous System
--2.1.8 Aging of the Sensory System
--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging
--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology
-2.2 Comprehensive Health Assessment of the Elderly
--Comprehensive Health Assessment of the Elderly
--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review
-2.3 Principles of Elderly Health Assessment
--Principles of Elderly Health Assessment
-2.4 Assessment of the Functional Status of the Elderly
--Assessment of the Functional Status of the Elderly
--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale
-2.5 Assessment of Cognitive Function in the Elderly
--Assessment of Cognitive Function in the Elderly
-2.6 Assessment and Adjustment of the Living Environment for the Elderly
--Assessment and Adjustment of the Living Environment for the Elderly
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-3.1 Overview of the Psychological Characteristics of the Elderly
--Overview of the Psychological Characteristics of the Elderly
-3.2 Influencing Factors of Psychological Changes in the Elderly
--Influencing Factors of Psychological Changes in the Elderly
-3.3 Common Psychological Issues and Their Management in the Elderly
--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)
--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)
--【Book Recommendation】Development Through the Lifespan
-3.4 Depression in the Elderly
--3.4.1 Overview of Depression in the Elderly
--3.4.2 Clinical Symptoms of Depression in the Elderly
--3.4.3 Caring for Elderly Patients with Depression
--【Documentary Recommendation】Depression:Out of the Shadows
-3.5 Elderly Patients with Dementia
--3.5.1 Identification of Dementia Symptoms in the Elderly
--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia
--3.5.3 Safety Care of Elderly Patients with Dementia
--【Website Recommendation】The Global Voice on Demaentia
-Concept Map
--【Concept Map】Elderly Mental Health and Mental Health Care
-【Test】CHAPTER 3
-4.1 Precautions for Daily Care of the Elderly
--Precautions for Daily Care of the Elderly
-4.2 General Care of Elderly Skin
--4.2.1 Characteristics and General Care of Elderly Skin
--4.2.2 Skin Itching and Its Management in the Elderly
--【Website Recommendation】American Academy of Dermatology
-4.3 Clothing Hygiene for the Elderly
--Clothing Hygiene for the Elderly
--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly
-4.4 Dietary Care for the Elderly
--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs
--4.4.2 Dietary Care for the Elderly
--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics
--【Website Recommendation】Nutrition for older persons
-4.5 Sleep Guidance for the Elderly
--4.5.1 Sleep Characteristics of the Elderly
--4.5.2 Sleep Guidance for the Elderly
--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems
--【Website Recommendation】American Academy of Sleep Medicine
-4.6 Exercises Guidance for the Elderly
--4.6.1 Evaluation of Exercise Intensity in the Elderly
--4.6.2 Precautions Elderly Undertaking Exercises
--【Website Recommendation】American College of Sport Medicine
--【Book Recommendation】Handbook of Activities for the Elderly
-Concept Map
--【Concept Map】Elderly Daily Care
-【Test】CHAPTER 4
-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--【Website Recommendation】How Drugs Work In the Elderly
-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly
--Common Adverse Drug Reactions and Their Causes in the Elderly
-5.3 The Principles of the Use of Medications in the Elderly
--The Principles of the Use of Medications in the Elderly
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-5.5 Medication Compliance in the Elderly
--Medication Compliance in the Elderly
-Concept Map
--【Concept Map】Medication Safety and Care for the Elderly
-【Test】CHAPTER 5
-6.1 Falls in the Elderly
--6.1.1 Epidemiological Characteristics of Elderly Falls
--6.1.2 Risk Factors for Falls in the Elderly
--6.1.3 Prevention of Falls in the Elderly
--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)
-6.2 Dysphagia in the Elderly
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 Dry Mouth in the Elderly
--【Website Recommendation】Academy of Nutrition and Dietetics
-6.6 Elderly Nutritional Deficiencies
--Elderly Nutritional Deficiencies - emaciation
-6.7 Visual Impairment in the Elderly
--Visual Impairment in the Elderly
--【Website Recommendation】Senior Eye Exams
-6.8 Senile Deafness
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【Book Recommendation】The Meaning of Death by Herman Feife
-7.3 Nursing for Pain in the Dying Elderly
--Nursing for Pain in the Dying Elderly
-7.4 Nursing for Major Bleeding in the Dying Elderly
--Nursing for Major Bleeding in the Dying Elderly
-7.5 Nursing for Delirium in the Dying Elderly
--Nursing for Delirium in the Dying Elderly
-7.6 Nursing for Dyspnea in the Dying Elderly
--Nursing for Dyspnea in the Dying Elderly
--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA
-7.7 Psychological Problems and Nursing in the Dying Elderly
--Psychological Problems and Nursing in the Dying Elderly
--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross
-7.8 Grief Counseling for the Widowed Elderly
--Grief Counseling for the Widowed Elderly
--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela
-Concept Map
--【Concept Map】Hospice Care for the Elderly
-【Test】CHAPTER 7