Kuvuta Kumeza (Dysphagia), Silent Aspiration Pneumonia, ndi Kudyetsa Motetezedwa¶

Kumeza madzi kapena kulumidwa ndi chakudya kumafuna kulumikizana kwachiwiri kwa magulu opitilira 30 a minofu ndi minyewa isanu ndi umodzi yapakhosi kuti atseke zingwe, pindani epiglottis pansi pamphepo yamkuntho (trachea), ndikuyendetsa bolus kukhosi. Okalamba omwe akukhala ndi matenda a stroke, matenda a Parkinson, Alzheimer's or vascular dementia, amyotrophic lateral sclerosis (ALS), kufooka, kapena kulowetsedwa kwachipatala posachedwa, reflex iyi imachepetsa kapena kulephera, matenda omwe amadziwika kuti ** oropharyngeal dysphagia **. Zamadzimadzi zopyapyala kapena zinyenyeswazi zazakudya zikatsika kudutsa epiglottis ndikugwera m'mapapo m'malo mwa m'mimba (**aspiration **), zimanyamula mabakiteriya amkamwa mamiliyoni ambiri kupita nawo m'mphepete mwa mpweya, zomwe zimayambitsa chibayo cha chibayo, chomwe chimayambitsa kufa kwachipatala kwa odwala omwe ali ndi vuto la dementia ndi minyewa.

Choopsa kwambiri kuposa kutsokomola patebulo la chakudya chamadzulo ndi "kulakalaka mwakachetechete," kumene kuwonongeka kwa mitsempha pammero kumapangitsa kuti chifuwacho chikhale chochepa kwambiri moti madzi amathira m'mapapo popanda mkulu kutsokomola kamodzi kapena kuchotsa kukhosi. Kupewa kutsamwitsidwa koopsa ndi chibayo kunyumba kapena kumalo osamalirako kumafuna kuzindikira zizindikiro zobisika zapakama (monga "mawu onyowa, ogontha" mutatha kumwa), kuchita njira zopulumutsira zokokera panjinga za olumala, kusakaniza chakudya ndi madzi kuti ndendende *International Dysphagia Diet Standardization Initiative (IDDSI) pakukulitsa malo okhwima, ndi maburashi okhwima.

Chitani izi tsopano¶

1. Mumenyeni msana nthawi yomweyo ndi kukankhana m’mimba/chifuwa ngati wachikulireyo akukanika kwambiri ndipo satha kulankhula, kutsokomola, kapena kupuma. Ngati wachikulire agwira pakhosi, amasanduka abuluu, ndipo satulutsa mawu kapena phokoso lalikulu, pemphani wina kuti ayimbire foni nambala yazadzidzi ya kwanuko (911 ku United States ndi Canada, 112 ku European Union, 999 ku United Kingdom) kapena onani zathu manambala angozi kalozerani pamene mukupereka mikwingwirima 5 yakuthwa yakumbuyo pakati pa mapewa akutsatiridwa ndi 5 kuloza m'mimba kupita m'mwamba (kapena kukankha pachifuwa ngati kuli pa njinga ya olumala) mpaka chinthucho chituluke.
2. *Ikani zakudya zonse zapakamwa, madzi, ndi mapiritsi nthawi yomweyo ngati munthu wamkulu akuwodzera, akumalankhula mosatekeseka, kapena akutsokomola nthawi zonse. Musayesetse kuthira madzi kapena msuzi wa supuni m'kamwa mwa munthu wachikulire yemwe akugona tulo, wosudzulidwa, kapena wokomoka. Kudyetsa wodwala wolumala kumatsimikizira kukhumba kwa mapapu mwamsanga.
3. *Mukhazikitseni munthuyo molunjika pamakona a digirii 90 musanamupatse chakumwa chilichonse, chakudya, kapena mankhwala, ndipo muwasunge mowongoka kwa mphindi 30 mpaka 45. Musalole kuti munthu wachikulire amwe modutsa muudzu kapena kudya mutakhala pabedi kapena pampando wapampando wa madigiri 30 kapena 45, amene amapendeketsa chitoliro kuseri kwa lilime.
4. Osagwiritsa ntchito udzu wakumwa kapena spouts ngati munthu akutsokomola ndi zakumwa zopyapyala. Kuyamwa madzi kudzera muudzu kumatulutsa jeti yamadzi yothamanga kwambiri yolunjika kumbuyo kwa mmero ubongo usanazindikire kuti madzi ali mkamwa. Nthawi zonse perekani zakumwa kuchokera mu kapu yotsegula (kapena kapu yodulidwa mphuno ya dysphagia kuti asamatembenuze mitu yawo cham'mbuyo) m'kapu yaing'ono, ya supuni imodzi.
5. Tsukani mano, mkamwa, ndi lilime la munthu wamkulu kawiri pa tsiku, ngakhale alibe mano kapena adyetsedwa machubu. Chibayo cha aspiration sichimayambika makamaka chifukwa cha madzi osabala kapena chakudya choyeretsedwa, koma ndi mabakiteriya owopsa a m’kamwa amene amakhala m’kamwa kosatsuka ndipo amalowetsedwa m’mapapu ndi malovu usiku wonse.
6. Pitani ku dipatimenti yazadzidzidzi ngati muwona zizindikiro za Silent Aspiration Pneumonia patatha maola 12 mpaka 72 mutatha kutsokomola. Kwa okalamba, chibayo sichimayambitsa kutentha thupi kwambiri poyamba: yang'anani **kusokonezeka kwadzidzidzi kwatsopano kapena delirium **, kupuma mozama (kuposa 24 kupuma pa mphindi), kugunda kwa oximeter kumatsika pansi **92 peresenti ya chifuwa, kudya mwadzidzidzi.

flowchart TD
    A["Akuluakulu Ovutika Kumeza Chakudya, Zamadzimadzi, Kapena Mapiritsi"] --> B{"Kodi Ndege Yatsekeredwa Pakalipano (Sitingathe Kuyankhula, Kutsokomola, Kapena Kupuma)?"}
    B -->|"Inde: Kukankhidwa Kwadzidzidzi Kwadzidzidzi"| C["Imbani 911 / 112 / 999 Nthawi yomweyo: Perekani Zikwapu 5 Zam'mbuyo + 5 Ziphuphu Zam'mimba / Zaku Wheelchair"]
    B -->|"Ayi: Kutsokomola, Mawu a Gurgly Wet, kapena Kuyika Chakudya M'masaya"| D{"Kodi Senior Wide Ali Maso, Alert, ndi Kukhala 90 Degrees Mowongoka?"}
    D -->|"Ayi: Kuwodzera, Lethargic, kapena Kugwa"| E["IMANI ZONSE ZONSE ZONSE ZONSE ZONSE MWANTHAWI YOMWEYO: Osapereka Madzi kapena Mapiritsi Mpaka Muyesedwe."]
    D -->|"Inde: Chenjerani ndi Kukhala Madigiri 90 Mowongoka"| F["Imitsani Zamadzimadzi Zoonda kudzera pa Udzu: Pemphani Katswiri Wolankhula Chilankhulo (SLP) Kumeza Phunziro"]
    F --> G["Tsatirani Mulingo Wazakudya wa IDDSI + Mlingo wa Chin-Tuck + 5 mL supuni ya tiyi ya Boli"]
    G --> H["Khalani Owongoka Mphindi 30-45 Mutatha Kudya ndikutsuka Mano/Pakamwa Kuti Mupewe Chibayo"]

Thandizo loyamba ladzidzidzi kwa wamkulu wotsamwitsidwa (wayimirira, wofooka, kapena panjinga ya olumala)¶

Akuluakulu achikulire amakhala ndi chiopsezo chachikulu cha kutsekeka kwa mayendedwe a mpweya (kutsekeka kwambiri / "café coronary") kuchokera ku nyama zowuma, buledi, batala wa mtedza, chakudya chosatafunidwa bwino pansi pa mano otayirira, kapena mapiritsi akuluakulu a calcium/potassium.

Momwe mungasiyanitsire "Kutsokomola Kosagwira Ntchito (Kutsamwitsidwa Koona)" ndi "Kukhosomola Kwambiri"¶

• Ngati wachikulire akutsokomola mwamphamvu komanso mwamphamvu, amatha kulankhula kapena kubuula, ndipo akupuma pakati pa chifuwa: OSATI kumenya msana wake kapena kugwedeza m'mimba. Kutsokomola kwamphamvu komanso kokweza kwambiri kumapangitsa kuti munthu azithamanga kwambiri munjira ya mpweya kuposa kukankhira kunja kulikonse. Alimbikitseni kuti kutsamira patsogolo ndi kumatsokomola mwamphamvu kuti abweretse chakudyacho, ndi kukhala pafupi nawo ngati njira yodutsa mpweya itatsekeka.
• Chifuwa chikakhala chete/chofooka, sangathe kulankhula mawu, sangathe kupuma, kapena milomo yawo imasanduka buluu: Mphepo yamkuntho yatsekeka. Chitanipo kanthu nthawi yomweyo.

Kupulumutsira pang'onopang'ono kwa woyimilira kapena wokhala pansi / womangidwa panjinga¶

Tsatirani mndandanda wapadziko lonse lapansi wa Red Cross / UK Resuscitation Council / AHA, wokonzedwera okalamba ofooka kapena anthu okhala panjinga ya olumala omwe sangathe kuyimirira:

1. Perekani Miliri 5 Yakuthwa Kumbuyo:
   • Ngati muyimirira, imani kumbali ndi kumbuyo pang'ono kwa wamkulu; ngati ali papanjinga*, tsekani mabuleki onse akuma wheelchair nthawi yomweyo kuti mpando usagubuduze kuchoka pa mphamvu yanu.
   • Thandizani chifuwa chawo ndi dzanja limodzi, kutsamira thunthu lawo lakumtunda ** kutsogolo bwino ** (kotero mphamvu yokoka imathandiza kuti chakudya chotayika chigwe * kunja * m'kamwa m'malo motsetsereka mozama pansi pa mphepo yamkuntho), ndipo perekani ** 5 kuphulika koopsa, kolimba pakati pa mapewa ** pogwiritsa ntchito chidendene cha dzanja lanu lina.
2. Peretsani Ziphuphu 5 Zam'mimba (Heimlich) KAPENA 5 Ziphuphu Zapachifuwa:
   • Kwa munthu wamkulu amene waimirira kapena wokhazikika wokhala pansi: Imani kapena kugwada kumbuyo kwawo (kukulunga manja anu m'chiuno mwawo, kapena kuzungulira kumbuyo kwa mpando wopanda manja), pangani chibakera ndi dzanja limodzi ndikuyika chala chachikulu chapakati pa mimba yawo kumtunda kwa mchombo komanso pansi pa nsonga ya m'munsi mwa fupa la pachifuwa (njira ya xiphoid), gwirani dzanja lanu, gwirani dzanja lanu mwachangu, gwira dzanja lanu, ndi dzanja lanu mwachangu kuponya **.
   • Nthawi yomwe mungagwiritse ntchito CHEST THUSTS m'malo mopondereza m'mimba panjinga ya olumala kapena wamkulu wofooka: Ngati chikukucho chili ndi zida zam'mbali zazitali, zosachotsedwa kapena zolimba zam'mbuyo zomwe zimakulepheretsani kufika mozungulira pamimba, kapena ngati wamkuluyo ali wonenepa, ali ndi opareshoni yam'mimba, chotupa cham'mimba, chotupa cham'mimba, chotupa chachikulu kuzungulira chifuwa cham'mwamba mwachindunji pansi pa makhwapa awo, ikani chala chachikulu cha nkhonya yanu pa pakati pa fupa la pachifuwa (sternum) (osati pa nsonga yosalimba ya m'munsi kapena nthiti), ndipo kukoka ** molunjika chakumbuyo** mwamphamvu kasanu.
3. Kukwapula kwina 5 Kumbuyo ndi Kuwombera Kasanu mpaka njira yapampweya itayera kapena kukomoka:
   • Ngati wamkulu wakomoka ndi kufooka, atsitseni mosamala pamalo olimba, ophwanyika, nthawi yomweyo yambani ** CPR chifuwa compression ** (30 compressions pa 100 mpaka 120 pa mphindi), ndipo nthawi iliyonse mukatsegula pakamwa kuti mupereke mpweya, yang'anani m'kamwa: ** ngati muwona bwino chidutswa cholimba cha chakudya, chigwirizanitse ndi chala chanu ** (*** sungani chala chanu ngati simungathe kuwona chinthu ngati simungathe kuwona) chala chanu chidzalowetsa chakudya m'mawu).

Kuzindikira Oropharyngeal Dysphagia ndi "Silent Aspiration" pambali pa kama¶

Kufikira 50 peresenti ya achikulire omwe amalakalaka kumwa zakumwa m'mapapo pambuyo pa sitiroko kapena matenda a Parkinson's/dementia amakhala "Silent Aspirators." Chifukwa chakuti minyewa ya m'mphuno (bokosi la mawu) imawonongeka, madzi amatuluka molunjika kudzera m'mapapo awo akukhala mwakachetechete akumwetulira patebulo popanda kutsokomola.

Gwiritsani ntchito tebulo lofanizira lazizindikirozi kuti muwone zonse poyera dysphagia ndi kulakalaka mwakachetechete:

Chifukwa chiyani zakumwa zoonda (madzi, tiyi, khofi, msuzi) zimakhala zovuta kumeza kuposa pudding¶

Kaŵirikaŵiri osamalira mabanja amadabwa pamene Katswiri wa Matenda a Chilankhulo (SLP) akunena kuti: “Atate wanu angadye mbatata zokhuthala ndi pudding mosungika, koma madzi ang’onoang’ono ndi msuzi wankhuku wakupha ndi zakupha.”

Chifukwa ndi kuthamanga kwamadzi motsutsana ndi nthawi ya minyewa:

• Zakumwa zoonda (IDDSI Level 0) zimayenda ngati mphezi. Madzi apompopompo amakhudza kumbuyo kwa lilime, mphamvu yokoka imakokera pansi mu pharynx mu ** zosakwana masekondi 0.2 **. Kwa akuluakulu omwe ali ndi stroke, dementia, kapena Parkinson's disease, ubongo umatenga ** 0.5 mpaka 1.5 masekondi ** kutumiza chizindikiro cha mitsempha chomwe chimatseka epiglottis pamwamba pa mphepo yamkuntho. Pamene ma epiglottis amatseka, madzi owondawo amakhala atalowa kale m'mapapo otseguka.
• Zakumwa zokhuthala ndi ma purees (IDDSI Levels 2, 3, and 4) yendani pang'onopang'ono komanso mogwirizana ngati uchi kapena pudding. Kuthamanga kwapang'onopang'ono kumeneko kumapangitsa kuti wamkuluyo achedwe kumeza reflex yowonjezera theka la sekondi yomwe imafunika kuti itseke chitoliro champhepo madzi asadafike.

Kumvetsetsa International Dysphagia Diet Standardization Initiative (IDDSI)¶

Pofuna kupewa chisokonezo chakupha pakati pa zipatala, nyumba zosungira anthu okalamba, ndi osamalira kunyumba (komwe "tizilo ta timadzi tating'ono" tinkatanthauza zinthu zosiyanasiyana m'mayiko osiyanasiyana), zochitika zachipatala padziko lonse lapansi tsopano zikutsatira 8-level International Dysphagia Diet Standardization Initiative (IDDSI) piramidi (**Levels 0 mpaka 4 kwa Zakumwa **, ndi ** 7 kwa Chakudya *) .

flowchart TD
    A["IDDSI Global Dysphagia Diet Framework"] --> B["LIQUID LEVELS (0 mpaka 4): Kuyezedwa ndi 10 mL Syringe Flow Test"]
    A --> C["ZOYENERA KUKHALA CHAKUDYA (3 mpaka 7): Kuyesedwa ndi Mayeso a Fork Pressure & Spoon Tilt"]
    B --> D["Gawo 0: Woonda (Madzi, Tiyi, Khofi, Mkaka)"]
    B --> E["Gawo 1: Wokhuthala pang'ono (Wokhuthala kuposa madzi, amayenda muudzu; makamaka ana)"]
    B --> F["Gawo 2: Wokhuthala pang'ono / 'Nectar Thick' (Imathira mwachangu kuchokera ku supuni, yothira mu kapu)"]
    B --> G["Gawo 3: Wokhuthala pang'ono / 'Honey Thick' (Imadontha pang'onopang'ono mu zidole; imadyedwa ndi supuni kapena chikho)"]
    B --> H["Gawo 4: Wokhuthala Kwambiri / 'Pudding Thick' (Amakhala ndi mawonekedwe pa spoon; AYENERA kudyedwa ndi supuni)"]
    C --> I["Gawo 4: Pureed (Yosalala, yopanda chotupa, yosafuna kutafuna, siyimalekanitsa kukhala madzi)"]
    C --> J["Level 5: Minced & Monyowa (4 mm tinthu ting'onoting'ono tofewa, tosendedwa mosavuta ndi lilime, osaluma)"]
    C --> K["Level 6: Yofewa & Yakuluma (1.5 cm / 0.6 inch tender cubes; squashes flat under pressure for foloko)"]

Momwe mungayesere kapangidwe ka chakudya cha IDDSI kunyumba pogwiritsa ntchito mphanda wosavuta wakukhitchini ndi supuni¶

Simufunikira zida za labotale kuti mutsimikizire ngati chakudya chomwe mwaphika kunyumba chili choyenera malinga ndi muyezo wa IDDSI woperekedwa ndi kholo lanu. Gwiritsani ntchito yovomerezeka ya IDDSI Fork Pressure Test ndi Mayeso a Spoon Tilt:

Malamulo ofunikira osakaniza zakumwa zokhuthala (Gum-Based vs. Starch-Based Thickeners)¶

Ngati Katswiri wa Chilankhulo Chachilankhulidwe akufotokozera IDDSI Level 2 (Mildly Thick / Nectar) kapena IDDSI Level 3 (Moderately Thick / Honey) zakumwa, tsatirani malamulowa mukamagwiritsa ntchito zokometsera zamalonda (monga SimplyThick, ThickenUp Clear, kapena Thick-It)

1. Nthawi zonse mumakonda Xanthan Gum-Based Gel/Powder Thickeners kuposa Cornstarch Thickeners:
   • Zachikale zokhuthala chimanga zimaoneka zamtambo, zimalawa chalky, zimachuluka pakapita nthawi (kusandutsa chakumwa cha Level 2 timadzi tokoma kukhala cholimba mutakhala patebulo kwa mphindi 20), ndipo ngati dontho la malovu la munthu lakhudza chikho kapena supuni, enzyme ya **amylase yomwe ili m'malovu imaphwanya madzi owopsa mkati mwa chikhomo.
   • Masiku ano xanthan chingamu-based thickeners (makamaka mapaketi a gel osakaniza amadzimadzi) amakhala osalala m'madzi, khofi, ndi madzi, amasunga makulidwe ake enieni a IDDSI tsiku lonse popanda kukhuthala, ndipo amalimbana ndi amylase yamalovu.
2. Chenjerani ndi "Zamadzimadzi Zobisika Zobisika" zomwe zimasungunuka mkamwa mofunda (Ice Cream, Jell-O, ndi Watermelon):

1. Kodi "Frazier Free Water Protocol" ndi chiyani (ndipo chifukwa chiyani kutsuka mkamwa kumakhala koyambirira)?
   • Okalamba ambiri amadana ndi mmene madzi okhuthala amachitira ndipo amakana kumwa, zomwe zimachititsa kuti madzi asamawonongeke kwambiri, ayambe kudwala impso, ndiponso matenda a mkodzo.
   • Pansi pa umboni wozikidwa Frazier Free Water Protocol (povomerezedwa ndi Speech-Language Pathologist), odwala ena a dysphagia amaloledwa kumwa madzi osavuta, osaneneka POKHA pakati pa chakudya ** pansi pamikhalidwe itatu yolimba: (1) mkamwa ndi mano ziyenera ** kutsukidwa bwino ndikutsukidwa zotsalira zonse zazakudya ndi zolembera (2) adikire osachepera mphindi 30 ATAmaliza kudya asanamwe madzi osasamba (kuti madzi asachotse chakudya chotsalira kuchokera kukhosi kupita m'mapapo); ndipo (3) zakumwa zonse zanthawi yachakudya, timadziti, mkaka, khofi, ndi maswiti amankhwala ziyenera kukhala zokhuthala.

Njira zotetezedwa zodyera pambali pa bedi, kaimidwe, ndi njira zomeza mapiritsi¶

Ngakhale chakudya chabwino kwambiri chimayambitsa chilakolako ngati chidyetsedwa mofulumira kwambiri kapena molakwika. Tsatirani izi pazachipatala pazakudya zilizonse:

• Ikani molunjika ma degree 90 ndi mutu wopindika patsogolo pang'ono ("Chin Tuck"): Khalani wamkulu pampando wodyera kapena atseke bedi lawo lachipatala pamalo oongoka a digirii 90 ndi mitsamiro kuseri kwa msana ndi mapewa kuti asagwere cham'mbali. Auzeni kuti alowetse chibwano chawo pansi pang'ono cha pachifuwa chawo (the Chin-Tuck maneuver) pomwe akumeza, zomwe zimatsekereza khomo la chimphepo ndikukulitsa kummero. Osawalola kupendeketsa mutu wawo chammbuyo kuti akhetse pansi pa kapu.
• Khalani PA KAPENA PAMSI PA mlingo wa diso la wamkulu pamene mukuthandizira kudyetsa: Ngati wosamalira atayima pamwamba pa wamkulu yemwe wakhala pansi atanyamula supuni mmwamba, wamkuluyo mwachibadwa amapendekera mutu wake chambuyo kuyang'ana mmwamba kwa wowasamalira ndikutsegula pakamwa pake, zomwe zimakoka mphepo yamkuntho. Kokani mpando ndikukhala pansi pang'ono kumunsi kwa diso lawo kuti chibwano chawo chikhale chokhazikika pansi.
• Gwiritsani ntchito kasupuni kakang'ono kachitsulo ka mamililita 5 (supuni imodzi) ndipo dikirani kuti ameze onse musanamulumenso: Musagwiritse ntchito spoons zazikulu kapena masupuni, zomwe zimadzaza mkamwa mofooka. Yang'anani kapena mumve pang'onopang'ono kukwera ndi kugwa kwa kholingo la wamkulu (apulo wa Adamu) kuti atsimikizire kuti ameza kuluma kotheratu, ndipo afunseni kuti ** ameze kachiwiri ("kumeza youma")** pambuyo pa kulumidwa kawiri konse kuti achotse zotsalira zapakhosi.
• Chotsani zododometsa ndi kuyankhula mukamatafuna: Zimitsani wailesi yakanema pa nthawi ya chakudya ndipo pewani kufunsa mafunso omwe amafuna kuti akuluakulu alankhule pamene chakudya chili mkamwa. Kulankhula kumatsegula kwambiri zingwe zapakhosi, zomwe zimapangitsa kuti chakudya chapakhosi chigwere molunjika ku trachea.
• Osasakaniza mapiritsi onse m'madzi owonda, ndipo yang'anani mndandanda wa "Osaphwanya" musanaphwanye mankhwala:
  • Kumeza piritsi lolimba ndi madzi ochepa kwambiri kumafuna mgwirizano wovuta wa magawo awiri omwe odwala dysphagia sangathe kuchita.
  • Ngati wodwala akumwa zamadzimadzi zokhuthala kapena puree, mezani mapiritsi ** imodzi panthawi ** ophatikizidwa mkati mwa ** supuni ya tiyi ya maapulosi osalala, yogurt, pudding, kapena gel osakaniza mapiritsi (*Phazix / Gloup *) **.
  • Musanaphwanye mapiritsi aliwonse kukhala puree, funsani ndi wamankhwala (onani kalozera wathu polypharmacy, mankhwala osokoneza bongo, ndi zolakwika za olinganiza mapiritsi): MUSAPWEZE KUTENGA KWAMBIRI (ER, XR, SR, LA, CD) kapena Mapiritsi a Enteric-Coated (EC) (monga metoprolol succinate ER, potassium chloride ER, nifedipine XL, oxycodone ER, kapena enteric aspirin), monga kuphwanya kumawononga matrix-2-dumps lethaasel-dumps. kulowa m'magazi nthawi yomweyo. Funsani dokotala kuti ayimitse madzi, mapiritsi osungunuka pakamwa (ODTs), kapena zigamba za transdermal m'malo mwake.
• Tsimikizirani Lamulo Lowongoka la mphindi 30 mpaka 45 ndikusesa pamasaya mukatha kudya:
  • Sungani wamkulu atakhala molunjika pa madigiri 90 (kapena osachepera 60 madigiri) kwa ** 30 mpaka 45 mphindi mutatha kudya kapena kudyetsa chubu **. Kugona chathyathyathya mutangotha ​​kudya kumapangitsa kuti asidi m'mimba mwachete komanso chakudya chiziyenderera cham'mero ​​ndi kukhuthukira m'mapapo.
  • Asanakhale, yang'anani m'kamwa mwawo ndi tochi yaing'ono ndipo gwiritsani ntchito swab ya siponji yonyowa (Toothette) kapena chala choyera choyera kuti musese chakudya chilichonse chomwe chili m'thumba m'masaya awo, kenako kutsuka mano, mano, ndi lilime bwino.

Machubu odyetsera (PEG / NG machubu) ndi "Comfort Feeding Only" mu dementia yapamwamba¶

Munthu wachikulire akayamba kudwala kwambiri matenda a dysphagia ndikukumana ndi chibayo mobwerezabwereza kapena kuchepa thupi, zipatala nthawi zambiri zimafunsa banjalo funso losautsa mtima: * "Kodi tiyenera kuika chubu yodyetsera ya percutaneous endoscopic gastrostomy (PEG) m'mimba mwawo?

Kumvetsetsa kusiyana kwachipatala pakati pa kuvulala kosinthika kosinthika kwamisala ndi kudwala matenda amisala kumathandiza mabanja kupanga chisankho chozikidwa pa umboni, mwachifundo:

Momwe "Kudyetsa M'manja Mosamala (Kutonthoza Kudyetsa Kokha)" kumagwirira ntchito kumapeto kwa moyo¶

Pamene munthu wachikulire yemwe ali ndi matenda a maganizo ochititsa munthu kusinthasintha maganizo kapena ofooka kwambiri sangathe kumeza bwinobwino ngakhale pa IDDSI Level 4 purees, mabanja ndi madokotala akhoza kukhazikitsa mwambo "Kutonthoza Kudyetsa Kokha" (kapena "Kudya ndi Kumwa ndi Chiwopsezo Chovomerezeka" ku UK) dongosolo la chisamaliro m'malo mokakamiza njala / kanthu-pakamwa (NPO) kapena kuikapo opaleshoni:

• The senior is offered small, pleasurable tastes of favorite smooth textures or sips on a sponge swab only when awake, alert, and showing desire to eat.
• Wowasamalira amaima nthawi yomweyo pamene mkuluyo atembenuza mutu, kutseka milomo yawo, kapena kutsokomola, popanda kukakamiza calorie quotas.
• Care focuses on keeping the lips and oral mucosa moist and comfortable with damp swabs and lip balm, combined with palliative comfort care.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi pali kusiyana kotani pakati pa bedi la "Clinical Swallow Evaluation" ndi "Modified Barium Swallow Study (VFSS)" kapena "FEES"?¶

Pamene Katswiri wa Matenda Olankhula Chilankhulo (SLP) ayang'ana kholo lanu pafupi ndi bedi powamwetsa madzi ndi kumva kukhosi kwawo, ndiko Kuwunika kwa Kumeza Pamphepete mwa Bedi; ngakhale zothandiza, mayeso a pambali pa bedi popanda makamera amaphonya mpaka 40 peresenti ya "kulakalaka mwakachetechete" chifukwa palibe njira yowonera khungu la khosi kuti mudziwe ngati madzi akuyenda mwakachetechete mumphepo yamkuntho. Kuti muwonetsetse kuti mukulakalaka mwakachetechete ndikuwona makulidwe ake enieni a IDDSI kapena chibwano-tuck chomwe chimalepheretsa madzi kulowa m'mapapo, funsani dokotala kuti ayitanitsa **Instrumental Swallow Study**: mwina **Videofluoroscopic Swallow Study (VFSS / Modified Barium Swallow)**, yomwe imatenga kanema wosuntha wa X-ray pomwe wamkulu akumeza chakudya cham'mimba, kapena chakudya cham'mimba. Endoscopic Evaluation of Swallowing (FEES)**, yomwe imadutsa kachingwe kakang'ono kakang'ono ka kamera kupyola mphuno pafupi ndi bedi kuti muwone zingwe za mawu mwachindunji munthawi yeniyeni.

Chifukwa chiyani kholo langa limangokhalira kutsokomola pawokha ngakhale sakudya kapena kumwa chilichonse?¶

Akuluakulu athanzi amameza malovu awo mosazindikira kamodzi mphindi iliyonse (ka 1,000 patsiku). M'mikhalidwe monga matenda a Parkinson, Lewy body dementia, ALS, kapena sitiroko yoopsa, kumeza pafupipafupi kumatsika pang'onopang'ono pomwe malovu mkamwa (sialorrhea) amayenda ndikudutsa zingwe zotulutsa mawu, zomwe zimapangitsa kutsokomola kosalekeza. Choyamba, sungani thupi lawo pamwamba pa madigiri 30 mpaka 45 pamene akupuma ndikutsuka mano ndi lilime kawiri tsiku lililonse kotero kuti malovu okhumba amanyamula mabakiteriya ochepa. Chachiwiri, funsani akatswiri awo a zaubongo kapena geriatrician za chithandizo chamankhwala chomwe akuchifuna kuti achepetse pang'onopang'ono kupanga malovu ochulukirapo popanda kusokoneza kwambiri, monga **ipratropium bromide nasal spray yomwe imagwiritsidwa ntchito mosagwirizana**, **glycopyrrolate** (yomwe siyiwoloka chotchinga chamagazi-muubongo monga scopolamine kapena atropine), kapena **jekeseni ya salivarytox ya salivarytox.

Kodi ndingapewe bwanji munthu wamkulu yemwe ali ndi zakumwa zokhuthala kuti asakhale opanda madzi m'thupi?¶

Kuperewera kwa madzi m'thupi ndikowopsa kwambiri pazakudya zokhuthala chifukwa zakumwa zokhuthala zimamva zolemetsa ndikudzaza m'mimba ndipo sizitha ludzu lapakamwa mwachangu ngati madzi ozizira ochepa. Kuti mukwaniritse cholinga cha tsiku ndi tsiku cha malita 1.5 (makapu 6) amadzimadzi osadzaza: (1) perekani magawo ang'onoang'ono a 60 mpaka 90 mL (2 mpaka 3 ounce) ola lililonse tsiku lonse osati magalasi akuluakulu atatu pa chakudya; (2) gwiritsani ntchito **xanthan-gum thickeners** m'malo mwa ufa wa chimanga chalky, ndikupatseni zakumwa zokhuthala **zoziziritsa kapena zofunda** (monga madzi oundana a kiranberi, mandimu wokhuthala, kapena msuzi/tiyi wotentha), monga kununkhira kwamphamvu ndi kuzizira/kutentha kumapangitsa kuti madzi akumeze akhale bwino kuposa funda; (3) kuwerengera zakudya za IDDSI Level 4 zamadzi ambiri ku cholinga chawo chamadzimadzi chatsiku ndi tsiku, kuphatikizapo yoghurt yosalala, maapuloauce, mbale za zipatso zopukutidwa, custard, ndi makapu amalonda omwe amadziwitsidwa kale; ndi (4) funsani a SLP ngati kholo lanu likuyenerera kutsata **Frazier Free Water Protocol** mutatha kutsukidwa m'mano pakati pa chakudya.

Kodi nditulutse mano a makolo anga kapena kuwasiya m'kati nthawi ya chakudya ngati mano awo atuluka?¶

Zimatengera kutayikira kwawo komanso momwe IDDSI kholo lanu likudya. Ma mano oyenerera bwino amathandiza munthu wamkulu kutafuna zakudya za IDDSI Level 6 (Zofewa & Zokuluma) ndipo zimathandiza lilime kukanikiza padenga la kamwa kuti bolus ibwerere kumbuyo. Komabe, ngati kholo lanu lataya kulemera kwa ma kilogalamu 10 (mapaundi 22) posachedwa ndipo mano awo tsopano amasuka kwambiri moti **kudina, kugwedera mmwamba ndi pansi, kapena kugwera pa lilime pamene akudya**, mano otayirira amakhala oopsa otsekereza lilime kuti atseke ndipo amatchera chakudya chosameza pansi pa mbale ya acrylic. Ngati mano akugwedezeka ndipo sangathe kukhazikika ndi kadontho kakang'ono ka zomatira zopanda zinki, nthawi zambiri zimakhala zotetezeka **kuchotsa mano otayirira pazakudya ** ndikupereka **IDDSI Level 4 (Pureed) kapena Level 5 (Minced & Moist)** zakudya zomwe zimafuna kuluma dzino ziro, ndipo dokotala wa mano atha kutulutsanso **IDDSI Level 4 (Pureed) kapena Level 5 (Minced & Moist)** kugona**.

Magwero afufuzidwa¶

• International Dysphagia Diet Standardisation Initiative (IDDSI, International): Complete IDDSI Framework and Detailed Definitions (Version 2.0): Testing Methods for Liquid Levels 0 to 4 and Food Texture Levels 3 to 7 (Syringe Flow Test, Fork Pressure Test, and Spoon Tilt Test).
• American Speech-Language-Hearing Association (ASHA, United States): *Practice Portal on Adult Dysphagia: Clinical vs. Instrumental Assessment (VFSS ndi FEES), Compensatory Postural Maneuvers, ndi Frazier Free Water Protocol *.
• American Geriatrics Society (AGS) ndi Kusankha Mwanzeru Kampeni (United States): Chidziwitso cha Udindo Wachipatala pa Machubu Odyetsera mu Dementia Yapamwamba (Malangizo Otsutsana ndi Machubu Odyetsera Osauka mu Dementia Yapamwamba Pokonda Kudyetsa Manja Mosamala).
• American Heart Association (AHA), Red Cross, and Resuscitation Council UK (International): Basic Life Support Guidelines for Relief of Foreign-Body Airway Obstruction (Choking): Back Blows, Abdominal Thrusts, and Chest Thrust Modifications for Seated/Wheelchair Patients.
• National Institute for Health and Care Excellence (NICE) and Royal College of Speech and Language Therapists (RCSLT, United Kingdom): Guidance on Eating and Drinking with Acknowledged Risk (EDAR), Oral Hygiene for Aspiration Pneumonia Prevention, and Safe Medication Administration in Dysphagia.

Maupangiri ogwirizana¶

• Hospital delirium and medical advocacy for seniors
• Challenging an unsafe hospital or rehab discharge
• Nursing home abuse, neglect, and eviction defense
• Polypharmacy, medication overdose, missed doses, and pill organizer errors
• Pressure ulcers, bedsores, stage 3-4 infection, and immobile patient turning
• Nambala zangozi