Wahalar hadiyewa (Dysphagia), Ciwon huhu na Shiru, da Safe Ciyarwa¶

Haɗewar ruwa ko cizon abinci yana buƙatar daidaitawa na biyu na sama da nau'i-nau'i 30 na tsokoki da jijiyoyi na cranial guda shida don kama igiyoyin muryar murya, ninka epiglottis ƙasa a kan bututun iska (trachea), da kuma tura bolus zuwa cikin esophagus. A cikin tsofaffi da ke zaune tare da bugun jini, cutar Parkinson, Alzheimer's ko vascular dementia, amyotrophic lateral sclerosis (ALS), rashin ƙarfi, ko intubation na asibiti kwanan nan, wannan reflex yana raguwa ko kasawa, yanayin da aka sani a asibiti kamar oropharyngeal dysphagia . Lokacin da siririn ruwaye ko ƙumburi na abinci ya wuce epiglottis kuma su faɗo cikin huhu maimakon ciki ( buri), suna ɗaukar miliyoyin ƙwayoyin cuta na baka zuwa cikin ƙananan hanyoyin iska, suna haifar da ** buri ciwon huhu ***, dalilin mutuwar asibiti guda ɗaya a cikin marasa lafiya masu ciwon hauka da cututtukan jijiyoyin jini.

Koda mafi hatsari fiye da tari a fili a teburin cin abincin shine "buri shiru," inda lalacewar jijiyoyi a makogwaro ke dusar da tari ta yadda gaba daya ruwa ya zubo cikin huhu ba tare da manyan sun yi tari ko share makogwaronsu ba. Hana maƙarƙashiya da ciwon huhu a gida ko a cikin wurin kulawa yana buƙatar gane alamun gargaɗin gefen gado (kamar "rigar, murya mai laushi" bayan sha), yin motsin ceton keken hannu, haɗa abinci da ruwa zuwa daidai ** International Dysphagia Diet Standardization Initiative (IDDSI) goge baki.

Yi wannan yanzu¶

1. Yi bugun baya nan take da bugun ciki/kirji idan babba yana shakewa sosai kuma baya iya magana, tari, ko numfashi. Idan babba ya kama makogwaronsa, ya koma kodadde ko shudi, kuma bai yi sauti ko kara mai karfi ba, a sa wani ya kira lambar gaggawa ta gida911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a Burtaniya) ko duba mu lambobin gaggawa directory yayin da kuke isarwa 5 bugun baya mai kaifi tsakanin duwawun kafada da 5 bugun ciki na sama (ko bugun kirji idan an daure keken hannu) har sai abin ya fito.
2. A daina duk wani abinci na baka, ruwa, da kwayoyin cuta nan da nan idan babba ya ji barci, yana zazzage magana, ko tari a kowane shashashi. Kada a yi ƙoƙarin zuba ruwa ko miya ta cokali a cikin bakin babba mai barci, mai ruɗi, ko mara hankali. Ciyar da mara lafiya mai rauni yana ba da tabbacin buri na huhu nan da nan.
3. **Zaunawa mutum tsaye a kusurwar digiri 90 kafin ya ba da kowane abin sha, abinci, ko magani, sannan a ajiye shi na tsawon mintuna 30 zuwa 45 bayan haka.
4. Kada a yi amfani da bambaro ko tulin kwalbar wasanni idan mutum ya yi tari akan siraran ruwa. Tsotsar ruwa ta bambaro yana harba wani ruwa mai saurin gaske zuwa bayan makogwaro kafin kwakwalwa ta gane ruwa yana cikin baki. Koyaushe ku ba da abubuwan sha daga ** buɗaɗɗen kofi ** (ko ** nosey cut-out dysphagia cup** don kada su mayar da kawunansu baya) a cikin ƙananan sips na cokali ɗaya.
5. A rinka goge hakora da danko da harshen manya sau biyu a rana koda basu da hakora ko kuma ana shayar dasu Cutar ciwon huhu ba ta samo asali ne ta hanyar ruwa mai tsafta ko tsaftataccen abinci da kanta ba, sai dai ta hanyar Virulent plaque plaque na hakora da ke zaune a cikin bakin da ba a goge ba, sai a wanke ta cikin huhu da yau daddare.
6. Jeki sashen gaggawa idan kaga alamun ciwon huhu na Silent Aspiration awanni 12 zuwa 72 bayan an yi tari. A cikin manya, ciwon huhu ba kasafai yake haifar da zazzabi mai zafi ba da farko: kalli ** sabon rudani ko rashi**, saurin numfashi mara zurfi (fiye da numfashi 24 a cikin minti daya), bugun jini na bugun jini, bugun kirji, koma bayan kashi 92 cikin dari. ci.

flowchart TD
    A["Manya Masu Wahalar Hadiya Abinci, Ruwayoyi, Ko Kwayoyin Kwayoyi"] --> B{"Ana Katange Jirgin Sama Gabaɗaya Yanzu (Ba Zai Iya Magana, Tari, Ko Numfashi ba)?"}
    B -->|"Ee: Gaggawa Maƙarƙashiya"| C["Kira 911/112/999 Nan da nan: Isar da Buga 5 Baya + 5 Ƙirji na Ciki/Tayaya"]
    B -->|"A'a: Tari, Rigar Muryar Murya, ko Aljihu Abinci a kunci"| D{"Shin Babban Faɗin Farkawa, Faɗakarwa, da Zama Digiri 90 Daidai ne?"}
    D -->|"A'a: Drowsy, Lehargic, ko Rushewa"| E["KA DAINA DUKKAN CIYAR BAKI NAN TAKE: Kada a Bada Ruwa ko Kwayoyin Kwayoyi Har sai an tantance."]
    D -->|"Ee: Faɗakarwa da Zama 90 Digiri tsaye"| F["Dakatar da Liquid Sirara ta Hannu: Neman Nazarin Haɗiye na Magana-Language (SLP)"]
    F --> G["Bi Matsayin Abincin Abinci na IDDSI da aka Kayyade + Matsayin Chin-Tuck + 5 ml Teaspoon Boli"]
    G --> H["Tsaya Tsaye Tsakanin Minti 30-45 Bayan Cin Abinci sannan a goge Hakora/Baki don Hana Ciwon huhu"]

Taimakon farko na gaggawa ga tsoho mai shakewa (tsaye, rauni, ko a cikin keken hannu)¶

Manya tsofaffi suna fuskantar babban haɗarin ** toshewar hanyar iska (m shaƙewa / "café coronary")** daga busassun nama, burodi, man gyada, abinci mara kyau a ƙarƙashin saƙon haƙora, ko manyan ƙwayoyin calcium/potassium gabaɗaya.

Yadda za a bambance "Tari mara Amfani (True Choking)" da "Ƙarar Ciwon Tari"¶

• Idan babba yana tari da karfi da karfi, yana iya magana ko nishi, kuma yana numfashi a tsakanin tari: Kada ku mari bayansu ko yin bugun ciki tukuna. Tari mai karfi da karfi yana haifar da matsananciyar fitar iska fiye da duk wani bugun waje. Karfafa su su juya gaba* da ci gaba da tari da karfi don kawo abincin, kuma su tsaya kusa da su idan hanyar iska ta toshe gaba daya.
• Idan tari ya yi shiru/rauni, ba za su iya magana ba, ba za su iya numfashi ba, ko labbansu sun yi shudi: An toshe bututun iska gaba daya. Ayi gaggawar aiki.

Ceto-mataki-mataki na shakewa ga babba mai ɗaure a tsaye ko zaune/kujera¶

Bi tsarin ** Red Cross / UK Resuscitation Council / AHA**, wanda aka daidaita don tsofaffi marasa ƙarfi ko mutanen da ke zaune a cikin keken hannu waɗanda ba za su iya tashi ba:

1. Bayar da bugun baya guda 5:
   • Idan tsaye, tsaya a gefe kuma dan kadan a bayan babban; idan suna cikin ** wheelchair*******Ku kulle birkunan keken guragu nan da nan don haka kujerar ba zata iya jujjuya karfin ku ba.
   • Tallafa ƙirjinsu da hannu ɗaya, karkatar da jikinsu na sama ** da kyau gaba** (don haka nauyi yana taimakawa abincin da ba a kwance ba ya fado fito daga baki maimakon zurfafa zurfafa cikin bututun iska), sannan a ba 5 kaifi mai ƙarfi a tsakanin kafaɗar kafaɗa ta amfani da diddigin ɗayan hannunka.
2. Isar da Ciki 5 (Heimlich) KO Ƙirjin Ƙirji 5:
   • Ga Baligi a tsaye ko a tsaye: Tsaya ko durkusa a bayansu (nannade hannuwanku a kugu, ko kuma bayan wata karamar kujera mara hannu), yi hannu da hannu ɗaya sannan ku sanya gefen babban yatsa a tsakiyar cikinsu ** kawai sama da cibiya kuma ƙasa da ƙasan ƙashin ƙashin ƙirjin (tsarin xiphoid), riƙe hannunka, da sauri, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu, da hannu da hannu, turawa.
   • Lokacin da za'a yi amfani da KIJIN KIRJI maimakon bugun ciki a keken guragu ko babba mai rauni: Idan kujerar guragu tana da tsayin daka, maras cirewa, ko kuma madaidaicin madaidaicin baya wanda ke hana ku kaiwa ga ciki, ko kuma idan babba ya yi kiba, yana da tiyatar ciki, bututun ciyarwa (PEG tuber), ko sanya hannayensu mai tsanani a kusa da kirjin ku. Hannun hannu**, sanya gefen babban yatsan hannun hannun ku akan cibiyar kashin nono (sternum) (kada ku taɓa kan ƙashin ƙashin ƙasa mai rauni ko haƙarƙari), sannan ku ja madaidaici baya da ƙarfi sau 5.
3. A madadin busa baya 5 da turawa 5 har sai hanyar iska ta fita ko kuma sun sume:
   • Idan babba ya rasa hayyacinsa kuma ya yi rauni, sai a sauke su a hankali a kan wani katafaren bene mai lebur, nan da nan za a fara ** CPR damtse kirji ** (matsawa 30 a 100 zuwa 120 a cikin minti daya), kuma duk lokacin da kuka bude baki don ba da numfashi, duba cikin bakin: ** idan kun ga tsattsauran abincin, toshe shi da yatsansa kamar yadda ba zai taba ganin yatsa ba. ram abinci mai zurfi a cikin igiyoyin murya).

Gane Oropharyngeal Dysphagia da "Silent Aspiration" a gefen gado¶

Har zuwa ** kashi 50 cikin 100 na tsofaffi waɗanda ke sha'awar ruwa a cikin huhu bayan bugun jini ko tare da ci gaba na Parkinson's / dementia sune "Silent Aspirators."** Saboda jijiyoyi masu hankali a cikin makogwaronsu (akwatin murya) sun lalace, ruwa yana zazzagewa ta cikin muryar muryar su zuwa cikin huhu yayin da suke zaune cikin nutsuwa suna murmushi a teburin ba tare da tari sau ɗaya ba.

Yi amfani da wannan tebur kwatankwacin alamun asibiti don gano duka ** dysphagia bayyananne ** da ** buri shiru ***:

Me yasa ruwa mai bakin ciki (ruwa, shayi, kofi, broth) ya fi wuya a haɗiye fiye da pudding¶

Masu kula da iyali sukan yi mamaki sa’ad da wani Masanin ilimin harshe da harshe (SLP) ya ce: * “Mahaifinka zai iya cin dankali mai kauri da kauri da kauri da kauri, amma ruwa mai kauri da naman kaji na kashe shi.”*

Dalilin shine ** saurin ruwa vs. lokacin amsawar jijiya ***:

• Maɗaukakin ruwa (IDSI Level 0) suna gudana kamar walƙiya. Ruwan nan take yana taɓa bayan harshe, nauyi ya ja shi zuwa cikin pharynx cikin ** kasa da daƙiƙa 0.2**. A cikin babban da ke da bugun jini, ciwon hauka, ko cutar Parkinson, ƙwaƙwalwa yana ɗaukar 0.5 zuwa 1.5 seconds don aika siginar jijiya wanda ke rufe epiglottis akan bututun iska. A lokacin da epiglottis ya ƙare a ƙarshe, ruwan siririn ya riga ya fantsama kai tsaye zuwa cikin huhu.
• ** Ruwa mai kauri da zalla (IDDSI Levels 2, 3, and 4)** suna motsawa a hankali tare da haɗin kai kamar zuma ko pudding. Wannan jinkirin kwarara yana ba wa babban tsoho jinkirin haɗiye reflex ɗin karin rabin daƙiƙa yana buƙatar rufe bututun iska kafin ruwan ya iso.

Fahimtar Ƙirƙirar Daidaitaccen Abincin Abinci na Duniya (IDDSI)¶

Don hana rikicewar rikice-rikice tsakanin asibitoci, gidajen jinya, da masu kula da gida (inda "nectar lokacin farin ciki" ke nufin abubuwa daban-daban a cikin ƙasashe daban-daban), aikin likita a duk duniya yanzu yana bin ** 8-level International Dysphagia Diet Standardization Initiative (IDDSI)** dala (Levels 0 to 4 for Drinks*, and **Levels 3 through 7 Foods).

flowchart TD
    A["Tsarin Abinci na IDDSI Global Dysphagia"] --> B["RUWAN RUWAN (0 zuwa 4): Ana aunawa tare da Gwajin Gudun Sirinjin 10 ml"]
    A --> C["MATAKAN RUWAN ABINCI (3 zuwa 7): Ana aunawa tare da Matsin cokali mai yatsa & Gwajin karkatar da Cokali"]
    B --> D["Mataki na 0: Bakin ciki (Ruwa, Tea, Kofi, Madara)"]
    B --> E["Mataki na 1: Kauri kaɗan (Yafi Kauri fiye da ruwa, yana gudana ta bambaro; galibin yara)"]
    B --> F["Mataki na 2: Kauri Mai Kauri / 'Nectar Kauri' (Za a zuba da sauri daga cokali, ana iya siffata daga kofi)"]
    B --> G["Mataki na 3: Maɗaukaki Mai Kauri / 'Kauri na zuma' (yana digo a hankali a cikin 'yar tsana, ana ci da cokali ko kofi)"]
    B --> H["Mataki na 4: Maƙarƙashiya Mai Kauri / 'Pudding Kauri' (Yana riƙe siffa akan cokali; DOLE a ci da cokali)"]
    C --> I["Mataki na 4: Tsarkakewa (mai laushi, mara dunƙulewa, babu buƙatar tauna, baya rabuwa cikin ruwa)"]
    C --> J["Mataki na 5: Nikakken da ɗanɗano (ƙananan dunƙule masu laushi 4 mm, an goge su cikin sauƙi da harshe, babu cizo)"]
    C --> K["Mataki na 6: Girman Taushi & Cizo (1.5 cm / 0.6 cubes m cubes; squashes lebur ƙarƙashin cokali mai yatsa)"]

Yadda ake gwada laushin abinci na IDDSI a gida ta amfani da cokali mai yatsa na dafa abinci da cokali¶

Ba kwa buƙatar kayan aikin dakin gwaje-gwaje don tabbatar da ko abincin da kuka dafa a gida yana da lafiya ga matakin abincin IDDSI da iyayenku suka tsara. Yi amfani da hukuma ** IDDSI Gwajin Matsi na cokali mai yatsu** da ** Gwajin karkatar da Cokali ***:

Mahimman ƙa'idodi don haɗa ruwa mai kauri (Gum-Based vs. Starch-Based Thickeners)¶

Idan Likitan Ilimin Harshen Magana ya rubuta ** matakin IDDSI 2 (Maɗaukaki Mai Kauri / Nectar)** ko ** IDDSI Level 3 (Madaidaicin Kauri / zuma)** ruwa, bi waɗannan ƙa'idodin lokacin amfani da kauri na kasuwanci (kamar SimplyThick, ThickenUp Clear,ko*)

1. Koyaushe fifita Xanthan Gum-Based Gel/Foda Kauri akan Kawar masara:
   • Tsofaffi masu kaurin masara gasu gajimare, dandanon alli, cigaba da yin kauri (a juye shaye-shaye na Level 2 ya zama kaffara bayan ya zauna akan tebur na tsawon mintuna 20), idan digon dan adam saliva ya taba kofin ko cokali, amylase enzyme din dake cikin miya ya karye, sai a mayar da ruwan masara mai hatsarin gaske.
   • Na zamani ** xanthan danko mai kauri** (musamman fakitin gel na ruwa da aka auna kafin a auna) suna tsayawa a sarari a cikin ruwa, kofi, da ruwan 'ya'yan itace, suna kiyaye ainihin kauri na IDDSI duk rana ba tare da yin kauri ba, kuma suna da juriya ga amylase salivary.
2. Hattara da "Boyayyen Liquid Liquid" masu narkewa a cikin dumin baki (Ice Cream, Jell-O, and Kankana):

1. Mene ne "Ƙa'idar Ruwa na Kyauta" (kuma me yasa ake fara goge baki)?
   • Manya da yawa suna ƙin nau'in ruwa mai kauri kuma sun ƙi sha, suna haifar da rashin ruwa mai tsanani, gazawar koda, da cututtukan urinary fili.
   • Karkashin tushen shaida Frazier Free Water Protocol (lokacin da Masanin Ilimin Harshenku ya yarda da su), an ba wa wasu marasa lafiyar dysphagia damar shan ** bayyananne, ruwa marar kauri KAWAI tsakanin abinci** ƙarƙashin tsauraran sharuɗɗa guda uku: (1) bakinsu da haƙoransu dole ne a goge su sosai kuma a wanke su da tsabta daga duk tarkacen abinci da plaque**; (2) Dole ne su jira ** aƙalla mintuna 30 BAYAN sun gama cin abinci** kafin su sha ruwa mai laushi (don haka ruwa ba zai iya wanke ragowar abinci daga makogwaro zuwa huhu ba); da (3) duk abubuwan sha na lokacin cin abinci, ruwan 'ya'yan itace, madara, kofi, da ** sips ɗin magani** dole ne a ƙara su.

Amintaccen ciyarwar kanikanci, matsayi, da dabarun hadiye kwaya¶

Ko da mafi kyawun abinci mai tsafta zai haifar da buri idan an ciyar da shi da sauri ko kuma a kusurwa mara kyau. Bi wannan lissafin binciken asibiti don kowane abinci guda:

• Matsayi a madaidaiciyar kusurwa mai tsayi 90-digiri tare da kai ɗan jujjuya gaba ("Chin Tuck"): Zauna babba a kujeran cin abinci ko kulle gadon asibitinsu a madaidaiciyar matsayi na 90-digiri tare da matashin kai a bayan bayansu na baya da kafadu don kada su faɗi gefe. Ka sa su danƙaɗa haɓoɓinsu zuwa ƙirjinsu (masanin Chin-Tuck) daidai lokacin da suke haɗiye, wanda a zahiri yana ƙunshe ƙofar bututun iska kuma yana faɗaɗa haƙori. Kada su karkatar da kawunansu baya don yaye gindin kofi.
• Zauna A KO KASA IDAN TSOHO A Lokacin Taimakawa wajen ciyarwa: Idan mai kulawa ya tsaya tsayin daka sama da babba a zaune yana rike da cokali mai tsayi a iska, babba yakan karkatar da kansa * baya* don su kalli mai kulawa su bude baki, wanda hakan ya jawo bututun iska a bude. Janye kujera ya zauna kadan kasa matakin idon su don haka hakinsu ya tsaya a kasa a kasa.
• Ayi amfani da karamin cokali na karfe 5-milliter (cokali 1) sai a dakata gabaki daya kafin ayi cizo na gaba. Kalle ko a hankali a hankali tashi da faɗuwar makogwaron babba (Apple Adamu) don tabbatar da sun shanye cizon gaba ɗaya, sannan a umarce su da su * hadiye a karo na biyu ("bushe baki") bayan kowane cizo biyu don share ragowar daga makogwaro.
• Kawar da abubuwan da ke ɗauke da hankali da magana yayin da ake taunawa: Kashe talabijin yayin cin abinci kuma a guji yin tambayoyin da ke buƙatar manyan mutane suyi magana yayin da abinci ke cikin bakinsu. Yin magana yana buɗe muryoyin murya mai faɗi, yana barin abinci a cikin makogwaro ya faɗi kai tsaye cikin trachea.
• Kada a haɗa duka kwayoyi cikin ruwa mai sirara, sannan a duba jerin "Kada ku murƙushe" kafin a murƙushe magunguna:
  • Hadiye kwamfutar hannu mai wuya tare da ruwa mai bakin ciki yana buƙatar hadaddun haddi na kashi biyu wanda marasa lafiya dysphagia ba za su iya yi ba.
  • Idan majiyyaci yana kan ruwa mai kauri ko puree, hadiye kwayoyi ** daya bayan daya** wanda aka sanya a cikin teapọn cokali na applesauce, yogurt, pudding, ko gel-swallowing pill (Phazix / Gloup).
  • Kafin murkushe kowane kwaya zuwa puree, duba tare da mai harhada magunguna (duba jagorarmu akan polypharmacy, yawan shan magani, da kurakurai masu shirya kwaya): ** KADA KA murkushe Extended-Release (ER, XR, SR, LA, CD)** ko Enteric-Coated (EC) Allunan (irin su metoprolol succinate ER, potassium chloride ER, nifedipine XL, oxycodone ER, ko enteric aspirin), kamar yadda murkushewa ya lalata lokaci-2-release a cikin matrix. jini lokaci guda. Tambayi likita don dakatarwar ruwa, allunan tarwatsa baki (ODTs), ko faci mai canzawa maimakon.
• Tabbatar da Dokar Tsaya ta Minti 30 zuwa 45 da kuma share kunci bayan kowane abinci:*
  • Ci gaba da zama babba a tsaye a digiri 90 (ko aƙalla digiri 60) na ** 30 zuwa 45 mintuna bayan kammala kowane abinci ko ciyarwar bututu ***. Kwanciya kai tsaye bayan cin abinci yana ba da damar yin shuru na gastroesophageal reflux na acid ciki da abinci zuwa baya sama da esophagus da zube cikin huhu.
  • Kafin su kishingida sai a kalli cikin bakinsu da dan karamin fitila sannan a yi amfani da danshi soso swab (Toothette) ko kuma tsaftataccen yatsan safar hannu don share duk wani abinci da ke aljihu daga kuncinsu, sannan ** goge hakora da hakora da harshe sosai**.

Kewayawa bututun ciyarwa (PEG / NG tubes) da "Ciyarwar Ta'aziyya Kawai" a cikin ci gaba na hauka¶

Lokacin da wani dattijo ya kamu da rashin lafiya mai tsanani kuma ya sha fama da ciwon huhu ko kuma asarar nauyi, asibitoci sukan yi wa iyali wata tambaya mai ban tausayi: * "Ya kamata mu sanya wani bututun ciyarwa na endoscopic gastrostomy (PEG) ta hanyar tiyata a cikin ciki?"*

Fahimtar bambance-bambancen likita tsakanin ** matsanancin raunin jijiya mai iya jujjuyawa ** da ** ciwon hauka na ƙarshe na ƙarshe ** yana taimaka wa iyalai su yanke shawara na tushen shaida, tausayi:

Yadda "Ciyarwar Hannu Mai Kulawa (Ciyarwar Ta'aziyya Kawai)" ke aiki a ƙarshen rayuwa¶

Lokacin da wani dattijo da ke da ciwon hauka ko rashin ƙarfi na ƙarshe ba zai iya haɗiye lafiya ba ko da a kan matakin IDDSI 4 purees, iyalai da likitoci za su iya kafa tsari na yau da kullum "Ciyar da Ta'aziyya kawai" (ko "Ci da Sha tare da Hadarin Amincewa" a cikin Burtaniya) tsarin kulawa maimakon tilasta cikakken yunwar / babu wani wuri-by-by-by

• Ana ba wa babban ɗan ƙaramin ɗanɗano, ɗanɗano mai daɗi na fi so mai laushi ko sips akan swab soso ** kawai lokacin farkawa, faɗakarwa, da nuna sha'awar ci**.
• Mai ba da kulawa yana tsayawa nan da nan lokacin da manyan suka juya kansu, rufe leɓunansu, ko tari, ba tare da tilasta adadin kuzari ba.
• Kulawa yana mai da hankali kan kiyaye leɓuna da mucosa na baki da ɗanɗano da kwanciyar hankali tare da swabs da ruwan leɓe, haɗe tare da kula da ta'aziyya.

Tambayoyin da ake yawan yi¶

Menene bambanci tsakanin gefen gado "Kimiyyar Swallow Evaluation" da "Nazarin Swallow na Barium (VFSS) da aka gyara" ko "FEES"?¶

Lokacin da Masanin Ilimin Harshen Magana (SLP) ya bincika iyayenku a gefen gado ta hanyar ba su sips na ruwa kuma suna jin makogwaronsu, wato Clinical Bedside Swallow Evaluation; yayin da yake taimakawa, jarrabawar gado ba tare da kyamarori ba ya rasa kashi 40 cikin 100 na "buri shiru" saboda babu yadda za a iya gani ta cikin fatar wuyan don sanin ko ruwa yana shiga cikin bututun iska. Don tantance ainihin buri na shiru kuma ganin wane ainihin kauri na IDDSI ko chin-tuck ya dakatar da ruwa daga shiga cikin huhu, tambayi likita don yin odar ** Nazarin hadiye kayan aiki **: ko dai Nazarin Swallow na Bidiyo (VFSS / Modified Barium Swallow)**, wanda ke ɗaukar fim ɗin rayuwa daban-daban. kauri, ko ** Fiberoptic Endoscopic Evaluing of Swallowing (FEES)**, wanda ke wucewa da ɗan ƙaramin zaren kamara mai sassauƙa ta hanci a gefen gado don kallon igiyoyin murya kai tsaye a ainihin lokacin.

Me yasa iyayena ke ci gaba da yin tari da kan su ko da ba su ci ko shan wani abu ba?¶

Manya masu lafiya ba tare da sani ba suna haɗiye nasu ruwa kusan sau ɗaya a kowane minti (sama da sau 1,000 a rana). A cikin yanayi kamar cutar Parkinson, Lewy body dementia, ALS, ko bugun jini mai tsanani, mitar hadiye ta atomatik tana raguwa sosai yayin da tafki a cikin bakin (sialorrhea) kuma yana wucewa ta igiyoyin murya, yana haifar da tari akai-akai. Na farko, kiyaye jikinsu na sama sama aƙalla digiri 30 zuwa 45 lokacin hutawa kuma a goge haƙoransu da harshensu sau biyu a kullum don haka ƙoƙon da ake nema yana ɗaukar ƙwayoyin cuta kaɗan. Na biyu, tambayi likitan jijiyar su ko likitan likitancin su game da maganin da aka yi niyya don rage yawan samar da miya a hankali ba tare da haifar da rudani mai tsanani ba, kamar ** ipratropium bromide nasal spray da ake shafa sublingually **, ** glycopyrrolate ** (wanda ba ya ketare shingen kwakwalwar jini kamar scopolamine ko atropine), ko ** botulinum toxins * (Botox).

Ta yaya zan iya hana babba a cikin ruwa mai kauri zama mai tsananin bushewa?¶

Rashin ruwa babban hatsari ne akan abinci mai kauri saboda yawan abin sha yana jin nauyi da cika ciki kuma baya kashe kishirwa da sauri kamar ruwan sanyi. Don buga burin yau da kullun na lita 1.5 (kofuna 6) na ruwa ba tare da yin nauyi ba: (1) ba da ƙananan 60 zuwa 90 ml (2 zuwa 3 ounce) rabo kowace sa'a a cikin yini maimakon gilashin giant uku a abinci; (2) a yi amfani da **xanthan-gum gel thickeners** maimakon alli na masarar masara, sannan a ba da abubuwan sha masu kauri ** sanyi ko dumi** (kamar ruwan 'ya'yan itacen cranberry mai kauri, ruwan lemo mai kauri, ko broth/tea mai kauri), kamar yadda ƙaƙƙarfan ɗanɗano da sanyi/dumi zazzaɓi ke motsa motsin hadiyewa fiye da ruwa mai kauri; (3) kirga abinci mai girma IDDSI Level 4 abinci zuwa ga burinsu na yau da kullun, gami da yoghurt mai santsi, applesauce, ɗigon ƴaƴan ƴaƴan ƴaƴan ƴaƴan, custard, da kofuna masu kauri na kasuwanci; da (4) tambayi SLP idan iyayenku sun cancanci ** Frazier Free Water Protocol** bayan goge goge baki tsakanin abinci.

Shin zan fitar da haƙoran mahaifana ko in bar su a lokacin cin abinci idan haƙoransu ya ɓace?¶

Ya dogara da yadda suke da sako-sako da kuma irin rubutun IDDSI da iyayenku ke ci. Kayan hakoran da suka dace suna taimakawa babban tauna abinci na IDDSI Level 6 (Laushi & Cizon Girma) kuma yana taimakawa harshe danna kan rufin baki don korar bolus baya. Duk da haka, idan iyayenku sun yi asarar kilo 10 (kilo 22) na nauyi kwanan nan kuma hakoran haƙoran su yanzu sun yi sako-sako har suna dannawa, tsalle sama da ƙasa, ko fadowa kan harshe yayin cin abinci**, hakoran haƙora na zama haɗari mai haɗari mai haɗari wanda ke toshe harshe daga rufewa da kuma kama abincin da ba a haɗi ba a ƙarƙashin farantin acrylic. Idan haƙoran haƙora suna girgiza kuma ba za a iya daidaita su da ƙaramin digo na mannen haƙoran haƙoran da ba su da zinc, sau da yawa yana da aminci don **cire haƙoran haƙoran don cin abinci** sannan a yi amfani da ** IDSI Level 4 (Pureed) ko Level 5 (Minced & Moist)** abincin da ke buƙatar cizon haƙori na sifiri har sai da likitan haƙori zai iya ja da baya.

An duba tushe¶

• International Dysphagia Diet Standardization Initiative (IDDSI, International): * Cikakken Tsarin IDDSI da Cikakkun Ma'anoni (Sigar 2.0): Hanyoyin Gwaji don Matakan Liquid 0 zuwa 4 da Matakan Rubutun Abinci 3 zuwa 7 (Gwajin Gudun Sirinjin, Gwajin Ƙunƙarar cokali mai yatsa, da)*on.
• Ƙungiyar Ji Magana-Harshen-Amurka (ASHA, Amurka): Tsarin Ayyuka akan Adult Dysphagia: Clinical vs. Instrumental Assessment (VFSS da FEES), Rarraba Maneuvers Postural, da Frazier Free Water Protocol.
• Ma'aikatan Geriatrics na Amurka (AGS) da Zabar Yakin Neman Hikima (Amurka): Bayanin Matsayin Likita akan Ciyarwar Tubus a cikin Cigaban Ciwon Ciki (Shawarwari akan Bututun Ciyar da Percutaneous a cikin Ci gaban Dementia cikin Ni'imar Ciyarwar Hannu a hankali).
• ** Ƙungiyar Zuciya ta Amirka (AHA), Red Cross, da Resuscitation Council UK (International):** * Ka'idodin Taimakon Rayuwa na asali don Taimakon Taimakon Taimakon Jirgin Sama na Ƙasashen Waje (Choking): Busa Baya, Ciki, da Gyaran Ƙarji don Majiyoyin Zazzagewa / Wuta.
• ** Cibiyar Kula da Lafiya ta Kasa (NICE) da Royal College of Speech and Language Therapists (RCSLT, United Kingdom):** Jagora kan Ci da Sha tare da Haɗarin Amincewa (EDAR), Tsabtace Baki don Rigakafin Ciwon huhu, da Kula da Lafiyar Magunguna a cikin Dysphagia.

Jagora masu alaƙa¶

• Lalacewar asibiti da shawarwarin likitanci ga tsofaffi
• Kalubalanci asibiti mara lafiya ko sallamar gyara
• Cin zarafi na gidan jinya, sakaci, da kare kora
• Polypharmacy, wuce gona da iri na magani, allurai da aka rasa, da kurakuran masu shirya kwaya
• Ciwon matsi, ciwon gadaje, kamuwa da cuta mataki na 3-4, da jujjuyawar haƙuri mara motsi
• Lambobin gaggawa