Swallowing

The Physiology of Swallowing Process

The physiological process behind swallowing initially involves voluntary control, but as the food enters your oesophagus, it becomes an involuntary action controlled by the autonomic nervous system.

• The first stage is the oral stage, where food is prepared for swallowing. Your teeth chew food, while the tongue positions it for the next stage.

• Next is the pharyngeal stage, a reflex action where the larynx closes and food is pushed into the oesophagus.

• Finally, in the oesophageal stage, food is transported to the stomach via peristalsis, a series of wave-like muscle contractions.

Breakdown of Swallowing Mechanism

The orchestration of nerves and muscles during this process is the mechanics of swallowing. This cooperation ensures efficient and safe transportation of food or liquids past the respiratory tracting, preventing aspiration.

How Swallowing Functions in the Body

Swallowing plays an essential role in the body beyond simply delivering food to the stomach. It also allows for effective communication and expression, and helps maintain hydration and nutrition levels in the body.

Swallowing Assessment in Nursing

The task of a nurse often goes beyond the expected duties, encompassing several vital functions such as swallowing assessment. Understanding and evaluating the swallowing function in patients can significantly improve the quality of care and lead to more successful outcomes.

Importance of Swallowing Assessment in Nursing

Swallowing assessment plays a crucial role in nursing, particularly when caring for patients with conditions affecting the mouth, throat, or digestive system, and older adults. It ensures that the patient can safely consume food and drink without the risk of aspiration or choking.

Dysphagia, or difficulty swallowing, can lead to malnutrition, dehydration, and increased risk of aspiration pneumonia. By conducting a swallowing assessment, nurses can identify any problems and intervene appropriately, ensuring the patient receives suitable nutritional care.

Techniques for Swallowing Assessment in Healthcare

Several techniques can be used to assess a patient's swallowing function. These include non-instrumental evaluations such as bedside swallowing assessments, and instrumental evaluations such as video fluoroscopic swallow studies and fiberoptic endoscopic evaluation of swallowing.

Instrumental evaluations like video fluoroscopy or endoscopy provide a more detailed image of the swallowing process, highlighting what happens from the moment food enters the mouth to when it reaches the stomach.

Here is a summary of the different techniques:

• Bedside Swallowing Assessment – Observes signs of difficulty swallowing.

• Video Fluoroscopic Swallowing Studies (VFSS) - X-ray videos of swallowing process.

• Fiberoptic Endoscopic Evaluation of Swallowing (FEES) – Use of a thin, flexible scope inserted through the nose providing direct visualisation of the swallow.

Confronting Difficulty Swallowing – Dysphagia

Dysphagia, or difficulty swallowing, is a problem that can occur due to various conditions and issues. It is an aspect of health that nurses must be equipped to handle and manage appropriately.

Causes of Difficulty Swallowing in Patients

The causes of difficulty swallowing or dysphagia can be grouped into two categories: oropharyngeal dysphagia and oesophageal dysphagia.

Causes associated with oropharyngeal dysphagia include neurological disorders like Parkinson's disease and multiple sclerosis, muscular conditions such as myasthenia gravis, and injuries that affect nervous control.

Oesophageal dysphagia can be traced to conditions like Gastroesophageal Reflux Disease (GERD), esophageal cancers, or strictures in the oesophagus due to injury or inflammation.

• Oropharyngeal Dysphagia – Parkinson's disease, multiple sclerosis, myasthenia gravis, nerve injuries.

• Oesophageal Dysphagia – Gastroesophageal Reflux Disease (GERD), strictures, esophageal cancers.

Nursing Approach to Dysphagia

In dealing with dysphagia, nursing professionals must have an individualised and comprehensive approach. Assessment, monitoring, and management should all be tailored to the specific patient's needs and situation.

Addressing the swallowing problems of patients starts with a thorough and diligent physical examination, medical history, and an understanding of their capabilities. By gathering this vital information, the nurse can determine what might be causing the dysphagia and identify the right intervention.

In intervention, a nurse may facilitate therapy, prescribe medication, or refer the patient to a specialist. It is also crucial that they educate patients and their families on various swallowing techniques, safe eating habits, and exercises to assist in improving swallowing function.

Managing Swallowing Problems in Nursing Care

Management approaches for dysphagia are primarily focused on mitigating risks, alleviating discomfort, and improving quality of life.

A key management strategy is modifying the patient's diet. Foods can be thickened, or a diet consisting of softer foods can be recommended to ensure easy swallowing. Monitoring the hydration level is also vital due to the high risk of dehydration in patients struggling with dysphagia.

Nursing care also involves providing emotional and psychological support as individuals dealing with swallowing difficulties often experience stress and frustration. They may even become withdrawn due to the fear of choking or aspirating, hence, providing empathy and assurance is as crucial as medical intervention.