Medical history: 70 year old female with DMII, sepsis, respiratory failure – s/p trach/vent, pneumonia, renal failure, COPD, HTN, heart failure, bowel obstruction, s/p diverting ileostomy, GERD, UTI, and glaucoma. Pt had a cuffless Shiley #6 track in place, receiving 40% O2 via trach collar.

Current diet:  NPO/PEG

HINTS

Watch the video, then open the VIEW HINTS tab to see any available hints prior to viewing the results.

HINTS: 

Notice how bulky the lingual tonsils are?

VIEW RESULTS 

Open the VIEW RESULTS tab below after making your own interpretation.

Summary: 

 

Patient-9-Summary

Pt was seen sitting upright in chair. Primary SLP was present for exam. Pt demonstrated a pharyngeal swallow that was within functional limits. No laryngeal penetration or aspiration was observed. The use of straws did not appear to negatively impact swallow function. No significant pharyngeal residue was present after the swallow. Mastication was prolonged, yet functional. Laryngeal edema was noted, which may be suggestive of laryngopharyngeal reflux (LPR). Also, lingual tonsil hypertrophy was noted. Glottic closure appeared to be adequate during phonatory tasks. Passy Muir Valve was in place throughout exam.

Recommendations:
Diet:  Regular/Thin Liquids
1. Sit upright with all intake. Remain upright for 20-30 minutes.
2. Frequent oral care to minimize risk of aspiration pneumonia.
3. Continue reflux management including reflux diet, behavioral changes, and medication, as appropriate.
4. Ongoing skilled SLP intervention to ensure diet tolerance.