Dambudziko rekumedza (Dysphagia), Silent Aspiration Pneumonia, uye Kudyisa Kwakachengeteka¶

Kumedza kunwa mvura kana kurumwa kwechikafu kunoda kupatsanurwa kwechipiri-chechipiri kuwirirana kwemhasuru dzinopfuura makumi matatu uye tsinga nhanhatu dzemugotsi kuti udambure tambo dzezwi, kupeta epiglottis pasi pamusoro pepopi yemhepo (trachea), uye kufambisa bolus mugurokuro. Muvanhu vakwegura vanorarama nekurohwa nesitiroko, chirwere cheParkinson, Alzheimer's or vascular dementia, amyotrophic lateral sclerosis (ALS), frailty, kana intubation yechipatara ichangobva kuitika, iyi reflex inononoka kana kukundikana, chirwere chinozivikanwa nekliniki se ** oropharyngeal dysphagia **. Kana zvinwiwa zvitete kana zvimedu zvechikafu zvinotsvedza zvichipfuura epiglottis uye zvichidonha mumapapu panzvimbo yemudumbu (**aspiration **), zvinotakura mamirioni emabhakitiriya emumuromo mumhepo yakatetepa yemhepo, zvichikonzera ** aspiration pneumonia **, iyo imwe chete inotungamira yerufu rwechipatara muvarwere vane dementia uye neurological kusagadzikana.

Zvinotonyanya kuipa pane kukosora kuri pachena patafura yechirairo "kuchiva chinyararire," uko kukuvadzwa kwetsinga pahuro kunopedza chikosoro chose zvekuti mvura inodirana yakananga mumapapu pasina mukuru ambokosora kana kubvisa huro. Kudzivirira kudzipwa kunouraya uye kuvavarira mabayo kumba kana munzvimbo inochengetwa kunoda kuziva zviratidzo zveyambiro zvepamubhedha (zvakadai se "inzwi rakanyorova, rinotyisa" mushure mekunwa), kuita matsimba ekununura anoenderana newiricheya, kusanganisa chikafu nemvura kuti zvienderane *International Dysphagia Diet Standardization Initiative (IDDSI) yekusimudzira nzvimbo uye bhurasho.

Ita izvi ikozvino¶

1. Kurumidza kumurova nekumashure uye nekurovera mudumbu/pachipfuva kana mukuru achikachidzwa uye asingakwanisi kutaura, kukosora, kana kufema. Kana munhu mukuru akabata pahuro, kucheneruka kana kuita bhuruu, uye asinganzwi kana kuridza mhere, ita kuti mumwe munhu afonere nhamba yenzvimbo yako yechimbichimbi (911 muUnited States neCanada, 112 muEuropean Union, 999 muUnited Kingdom) kana tarisa yedu nhamba dze emergency dhairekitori paunenge uchiendesa ** mabhodhoro mashanu ekumashure akapinza ** pakati pemapendekete achiteverwa ne 5 kumusoro kwedumbu kurovera kwedumbu (kana kurovera pachipfuva kana pawiricheya) kusvika chinhu chabuda.
2. Misa zvokudya zvose zvinonwiwa, mvura, uye mapiritsi nokukurumidza kana mukuru akabatwa nehope, achitaura asinganzwisisi, kana kuti akosora pose pose. Usamboedza kudira mvura kana kuti muto wechipunu mumukanwa momunhu mukuru akakotsira, ane dzungu, kana kuti anenge asingazivi. Kudyisa murwere akaneta kunovimbisa kukurumidza kushuva kwemapapu.
3. Gadzirisa munhu wacho akati twasu pakona yemadhigirii 90 usati wamupa chero chinwiwa, chekudya, kana kuti mushonga, uye zvichengete zvakamira kwemaminetsi 30 kusvika ku45 zvadaro. Usamborega munhu mukuru achinwa nemusonga kana kudya akatsenhama pamubhedha kana pacheya yakatsamira, iyo inorerekera mhepo yakavhurika yakananga kuseri kwerurimi.
4. Usamboshandisa mashanga ekunwira kana kuti spouts dzemabhodhoro kana munhu akosora pazvinwiwa zvitete. Kusveta mvura nemumashanga kunopfura jeti remhepo rinomhanya zvikuru rakananga kuseri kwehuro uropi husati hwaziva kuti mvura iri mumuromo. Gara uchipa zvinwiwa kubva mukapu yakazaruka (kananosey cut-out dysphagia cup kuitira kuti vasazotendeudzira misoro yavo kumashure) mudiki, chipunu chimwe chete.
5. Geza mazino, mazamu, uye rurimi zvemukweguru kaviri pazuva, kunyange vasina mazino kana kuti vakadyiswa nechubhu. Mabayo ekufema haakonzerwi zvikuru nemvura isina utachiona kana zvokudya zvakacheneswa pachazvo, asi neutachiona hunotyisa hwemazino hunogara mumukanwa usina kukweshwa unogezeswa mumapapu nemate usiku hwose.
6. Enda kudhipatimendi rekukurumidzira kana ukaona zviratidzo zveSilent Aspiration Pneumonia maawa gumi nemaviri kusvika makumi manomwe nemaviri mushure mekukosora. Muvanhu vakuru, mabayo haawanzokonzeresa kupisa kwakanyanya kwekutanga: tarisa **kamwe kamwe kuvhiringika kutsva kana delirium **, kukurumidza kudzika kufema (kupfuura 24 kufema paminiti), pulse oximeter inodonha pazasi **92 muzana wechipfuva kana kudya kamwe kamwe.

flowchart TD
    A["Vakuru Vane Dambudziko Kumedza Chikafu, Zvinwiwa, kana Mapiritsi"] --> B{"Iyo Airway Yakavharwa Zvakakwana Parizvino (Haugone Kutaura, Kukosora, kana Kufema)?"}
    B -->|"Hongu: Kunyarara Kukachidza Emergency"| C["Fonera 911 / 112 / 999 Pakarepo: Nunura 5 Mabhoti ekumashure + 5 Mudumbu/Mavhiri eWheelchair"]
    B -->|"Kwete: Kukosora, Izwi reGurgly rakanyorova, kana Kuisa Chikafu mumatama"| D{"Iye Mukuru Akamuka, Akasvinura, uye Akagara 90 Madhigirii Akarurama?"}
    D -->|"Kwete: Kurara, Lethargic, kana Slumped"| E["MIRA KUDZWA KWESE MUNHU PAMBERI: Usape Mvura kana Mapiritsi Kusvikira Waongororwa."]
    D -->|"Hongu: Yambiro uye Kugara 90 Madhigirii Akatwasuka"| F["Misa Zvinwiwa zvakatetepa kuburikidza nemashanga: Kumbira Kutaura-Mutauro Pathologist (SLP) Kumedza Chidzidzo."]
    F --> G["Tevera Yakanyorerwa IDDSI Diet Level + Chin-Tuck Posture + 5 mL Teaspoon Boli"]
    G --> H["Ramba Wakatwasuka 30-45 Maminitsi Mushure meKudya uye Geza Mazino/Muromo Kudzivirira Pneumonia."]

Emergency rubatsiro rwekutanga kune mukuru anodzipwa (akamira, asina simba, kana ari pawiricheya)¶

Vakuru vakura vakatarisana nenjodzi yakakwira ye mechanical kuvharirwa kwemhepo (acute choking / "café coronary") kubva kunyama yakaoma, chingwa, peanut butter, chikafu chisina kunyatsotsengwa pasi pemazino asina kusimba, kana mapiritsi makuru ecalcium/potassium.

Nzira yekusiyanisa "Kusakosora Kusingashande (Kukachidzwa Kwechokwadi)" kubva ku "Loud Clearing Coughs"¶

• Kana mukuru ari kukosora zvine mutsindo uye zvine simba, anogona kutaura kana kugomera, uye achifemera pakati pechikosoro: USATAVAGA mbama kumusana kana kupuruzira mudumbu. Chikosoro chakasimba, chine ruzha chinowanzoitika chinoita kuti munhu adzingwe nemhepo kupfuura chero munhu anzwa. Vakurudzire kuti vasendamire kumberi uye varambe vachikosora zvakasimba kuti vauye nechikafu, uye garai padivi pavo kuitira kuti nzira yekufema ivhare zvachose.
• Kana chikosoro chikanyarara/chisina simba, havagone kutaura shoko, havagone kufema, kana kuti miromo yavo ikaita blue: Mhepo yakavharika zvachose. Ita izvozvi.

Nhanho-ne-nhanho kudzipwa kununura kune akamira kana akagara / akasungwa newiricheya mukuru¶

Tevedza iyo yepasirese Red Cross / UK Resuscitation Council / AHA kutevedzana, yakagadziridzwa vakura vasina simba kana vanhu vakagara muwiricheya vasingagone kusimuka:

1. Nyoresa 5 Yakapinza Kumashure Inorova:
   • Kana wakamira, mira parutivi uye zvishoma kumashure kwemukuru; kana vari muwiricheya, **kiya mabhureki ese ari maviri ewiricheya nekukasika ** kuitira kuti chigaro chisakunguruke kubva pachisimba chako.
   • Tsigira chipfuva chavo neruoko rumwe, tsigira torso yavo yepamusoro ** zvakanaka kumberi ** (saka giravhiti rinobatsira chikafu chakadzingwa kudonha * kunze* kwemuromo pane kutsvedza zvakadzika pasi nepombi yemhepo), uye ipa ** 5 kuvhuvhuta kwakasimba, kwakasimba pakati pemafudzi ** uchishandisa chitsitsinho cherumwe ruoko rwako.
2. Nyoresa 5 maAbdominal Thrusts (Heimlich) KANA 5 Wheelchair Thrusts:
   • Kumunhu mukuru akagara kana kugadzikana akagara: Mira kana kupfugama kuseri kwavo (kuputira maoko ako muchiuno chavo, kana kutenderedza kuseri kwecheya isina maoko), gadzira chibhakera neruoko rumwe woisa chigunwe nechepakati pedumbu ravo pamusoro peguvhu nepasi pezasi pepfupa rezamu (xiphoid process), bata ruoko rwako,* uye kurumidza kubata chibhakera chako nechepazasi peguvhu. kusunda **.
   • Pakushandisa CHEST TRUSTS pachinzvimbo chemudumbu kurovera pawiricheya kana mukuru asina simba: Kana wiricheya iine makumbo akareba, asingabvisike padivi kana kuti yakakwira yakasimba backrest inoita kuti usasvike pedyo nedumbu ravo, kana kuti kana mukuru akafuta, ane abdominal surgical place, osteoporosis yechubhu (osteoporosis) uchitenderedza chipfuva chepamusoro chakananga pasi pehapwa dzavo, isa chigumwe-rutivi rwechibhakera chako papakati pepfupa repazamu (sternum) (usambofa pamuromo wezasi usina kusimba kana mbabvu), uye dhonza ** zvakananga kumashure** zvakapinza ka5.
3. Alternate 5 Back Blows and 5thrusts kusvika mhepo yachena kana kuti vafenda:
   • Kana mukuru akarasikirwa nekuziva uye akaremara, adzike zvakanaka pauriri hwakasimba, hwakatsetseka, pakarepo tanga CPR chest compressions ** (30 compressions pa 100 kusvika 120 paminiti), uye nguva imwe neimwe paunozarura muromo kuti upe mweya, tarisa mukati memuromo: ** kana iwe ukaona zvakajeka chimedu chakasimba chechikafu, chikochekere kunze nemunwe wako ** ( * penya, tsvaira kana chigunwe chako usingakwanisi kuona chinhu. chigunwe chako chichaita gondohwe chekudya mukati mezwi).

Kuziva Oropharyngeal Dysphagia uye "Silent Aspiration" padivi pemubhedha¶

Kusvika ku ** 50 muzana yevakura vanosvira zvinwiwa mumapapu avo mushure mesitiroko kana kuti vane Parkinson's/dementia yakanyanya "Silent Aspirators."** Nekuti tsinga dzenzwa dziri mukati medokoriro yavo (voice box) dzakuvadzwa, mvura inoyerera yakananga nemumatauriro avo ichipinda mumapapu avo ivo vakagara chinyararire vachinyemwerera patafura vasingakosori kamwe chete.

Shandisa iyi tafura yechiratidzo chekiriniki yekufananidza kuona zvese ** overt dysphagia ** uye ** chinyararire aspiration **:

Sei zvinwiwa zvitete (mvura, tii, kofi, muto) zvakaoma kumedza kupfuura pudding¶

Vatarisiri vemhuri vanowanzokatyamadzwa apo Nyanzvi yeSpeech-Language Pathologist (SLP) inoti: “Baba vako vanogona kudya mbatatisi dzakakoshwa nepudding zvakakotsekana, asi mvura yakachena nomuto wehuku wakajeka zvinovauraya.”

Chikonzero ndechekuti fluid velocity vs. Neurological reaction time:

• Zvinwiwa zvitete (IDDSI Level 0) zvinoyerera semheni. Mvura yekukurumidza inobata kuseri kwerurimi, simba rinokwevera pasi richidzika mu pharynx mu **pasi pe 0.2 seconds **. Mune mukuru ane sitiroko, dementia, kana chirwere cheParkinson, uropi hunotora ** 0.5 kusvika 1.5 seconds ** kutumira chiratidzo chetsinga chinovhara epiglottis pamusoro pemhepo. Panguva inozovhara epiglottis, mvura nhete inenge yatopfachukira yakananga mumapapu akashama.
• Zvinwiwa zvakakobvu nemapuree (IDDSI Level 2, 3, ne4) famba zvishoma nezvishoma uye zvakabatana sehuchi kana pudding. Kuyerera kunononoka uku kunopa mukuru akanonoka kumedza reflex imwe hafu-yechipiri inoda kuvhara mhepo mvura isati yasvika.

Kunzwisisa iyo International Dysphagia Diet Standardization Initiative (IDDSI)¶

Kudzivirira kuvhiringidzika kunouraya pakati pezvipatara, misha yevakwegura, uye vatarisiri vemisha (apo "nectar thick" yaireva zvinhu zvakasiyana-siyana munyika dzakasiyana-siyana), maitiro ekurapa munyika yose ikozvino anotevera ** 8-level International Dysphagia Diet Standardization Initiative (IDDSI)** piramidhi (**Mazinga 0 kusvika ku4 eZvinwiwa **, uye 7 Nhamba yeZvokudya * 3).

flowchart TD
    A["IDDSI Global Dysphagia Diet Framework"] --> B["LIQUID LEVELS (0 kusvika 4): Kuyerwa ne10 mL Syringe Flow Test"]
    A --> C["FOOD TEXTURE LEVELS (3 kusvika 7): Yakayerwa neFork Pressure & Spoon Tilt Tests"]
    B --> D["Level 0: Mutete (Mvura, Tea, Kofi, Mukaka)"]
    B --> E["Level 1: Yakakora zvishoma (Yakakora kudarika mvura, inoyerera nemumashanga; kunyanya evana)"]
    B --> F["Level 2: Zvinyoro Gobvu / 'Nectar Gobvu' (Inodururwa nekukurumidza kubva mupunu, inonwiwa kubva mumukombe)"]
    B --> G["Level 3: Huchi huri pakati nepakati / 'Huchi hwakakora' (Inodonha zvishoma nezvishoma mumadhoropi; inodyiwa nechipunu kana mukombe)"]
    B --> H["Level 4: Yakanyanya Gobvu / 'Pudding Gobvu' (Inobata chimiro pachipunu; INOFANIRA kudyiwa nechipunu)"]
    C --> I["Nhamba 4: Yakanatswa (Yakapfava, isina bundu, hapana kutsenga kunodiwa, haina kupatsanurwa kuita mvura)"]
    C --> J["Level 5: Yakagayiwa & Yakanyorova (4 mm madiki madiki mapundu, akamenywa zviri nyore nerurimi, pasina kuruma)"]
    C --> K["Level 6: Yakapfava & Yakaruma-Size (1.5 cm / 0.6 inch nyoro cubes; squashes flat pasi pekumanikidzwa kweforogo)"]

Maitiro ekuyedza IDDSI chikafu mameseji kumba uchishandisa nyore kicheni forogo uye chipunu¶

Iwe haudi midziyo yemurabhoritari kuti uone kana chikafu chawabika kumba chakachengeteka pachiyero chekudya chakapihwa nemubereki IDDSI. Shandisa zviri pamutemo IDDSI Fork Pressure Test uye Spoon Tilt Test:

Mitemo yakakosha yekusanganisa zvinwiwa zvakakora (Gum-Based vs. Starch-Based Thickeners)¶

Kana Nyanzvi yeMutauro-Mutauro inorayira IDDSI Level 2 (Mildly Thick / Nectar) kana IDDSI Level 3 (Moderately Gobvu / Honey) zvinwiwa, tevera mitemo iyi paunenge uchishandisa zvekutengesa thickeners (se SimplyThick, ThickenUp Clear, kana Thick-It)

1. Gara uchisarudza Xanthan Gum-Based Gel/Powder Thickeners pane Cornstarch Thickeners:
   • Yechinyakare Mateshi echibage anoita kunge makore, anoravira chalky, ramba wakakora nekufamba kwenguva (kushandura chinwiwa cheLevel 2 nekita kuita chivharo chakasimba mushure mekugara patafura kwemaminetsi makumi maviri), uye kana donhwe re mate remunhu richigunzva kapu kana chipunu, *amylase enzyme iri mumate inopwanya mvura yechibage ine ngozi mukati memukombe.
   • Mazuva ano ** xanthan gum-based thickeners ** (kunyanya pre-yakayerwa mvura gel packets) inogara yakachena mumvura, kofi, uye muto, chengetedza iwo chaiwo IDDSI ukobvu zuva rese pasina kukora, uye inoshingirira kune salivary amylase.
2. Chenjera kune "Yakavanzika Yakatetepa Liquids" inonyungudika mumuromo unodziya (Ice Cream, Jell-O, uye Watermelon):

1. Chii chinonzi "Frazier Yemahara Mvura Protocol" (uye nei kugeza nemuromo kuchiuya pekutanga)?
   • Vazhinji vakuru vanovenga magadzirirwo emvura yakakora uye vanoramba kunwa, zvichikonzera kupera simba kwakanyanya, kutadza kushanda kweitsvo, uye zvirwere zveweti.
   • Pasi peuchapupu-hwakavakirwa ** Frazier Yemahara Mvura Protocol ** (kana yakabvumidzwa neMutauro-Mutauro Pathologist wako), vamwe varwere vedysphagia vanobvumidzwa kusveta ** yakajeka, isina kuvharwa mvura CHETE pakati pekudya ** pasi pemamiriro matatu akaomarara: (1) muromo wavo nemazino zvinofanirwa kunge ** zvakanyatsokweshwa uye kugezwa zvakachena kubva kune zvese zvakasvibiswa zvekudya uye plaque** (2) vanofanira kumirira maminetsi angangoita 30 VApedza kudya vasati vasveta mvura yakachena (kuti mvura isageze zvidimbu zvekudya zvinenge zvasara zvichibuda muhuro zvichienda mumapapu); uye (3) zvinwiwa zvese zvenguva yekudya, muto, mukaka, kofi, uye mushonga sips zvinofanira kuramba zvakakora.

Michina yekudyisa padivi pemubhedha yakachengeteka, maitiro, uye nzira dzekumedza mapiritsi¶

Kunyangwe chikafu chakanyanya kucheneswa chinokonzeresa chido kana chikadyiswa nekukurumidza kana pakona isiriyo. Tevedza iyi kiriniki yekutarisa yekudya kwega kwega:

• Kumira pakona yakatwasuka 90-degree musoro wakatarisa kumberi zvishoma ("Chin Tuck"): Gara mukuru pacheya yekudyira kana kukiya mubhedha wavo wemuchipatara pakazara 90-madhigirii akatwasuka nemapiro akaiswa kuseri kwezasi kwemusana nemapendekete kuti asadonhe nedivi. Itai kuti vaise chirebvu chavo pasi zvishoma kuchipfuva chavo (the Chin-Tuck maneuver) chaimo pavanenge vachimedza, izvo zvinoita kuti pese pese paburitse pepopopopipe nekukudza gurokuro. Usambofa wakavarega vakarereka musoro wavo kumashure kuti vadonhe pasi pekapu.
• Gara PA KANA PASI pezinga reziso remukuru paunenge uchibatsira pakudyisa: Kana muchengeti akamira pamusoro pemukuru akagara akabata chipunu mudenga, mukuru anogadzika musoro wake kumashure kuti atarise kumusoro kumutarisiri uye akashama muromo, izvo zvinodhonza mhepo. Dhonza chigaro uye ugare zvishoma pazasi pachiyero cheziso ravo kuti chirebvu chavo chigare chakanyura pasi.
• Shandisa 5-milliliter diki (1-teapuni) yesimbi chipunu womirira kumedza zvachose usati wapa kuruma kunotevera: Usambofa washandisa zvipunu zvesopu hombe kana zvipunu, zvinoremedza muromo usina simba. Tarisa kana kuti unzwe zvinyoronyoro kusimuka nekudonha kwegororo yevakuru (apuro raAdam) kuratidza kuti vakamedza kurumwa zvachose, uye vakumbire kuti medze kechipiri ("dry swallow") mushure mekurumwa kaviri kuti vabvise zvakasara pahuro.
• Bvisa zvinovhiringidza uye kutaura uchitsenga: Dzima terevhizheni panguva yekudya uye usabvunza mibvunzo inoda kuti mukuru ataure chikafu chiri mukanwa. Kutaura kunovhura tambo dzezwi dzakafara, zvichiita kuti chikafu chiri muhuro chidonhe chakananga mutrachea.
• ** Usambofa wakavhenganisa mapiritsi akazara mumvura mutete, uye tarisa "Usapwanya" runyorwa usati wapwanya mishonga:**
  • Kumedza piritsi rakaoma rine gulp remvura yakaonda kunoda kuoma kwezvikamu zviviri zvekumedza kurongeka izvo varwere ve dysphagia vasingagoni kuita.
  • Kana murwere ari pazvinwiwa zvakakora kana kuti puree, medza mapiritsi **rimwe panguva ** akaiswa mukati tepuni yeapurosi yakatsetseka, yogati, pudding, kana gel rekutengesa mapiritsi-kumedza (Phazix / Gloup).
  • Usati wapwanya chero piritsi kuita puree, tarisa kune wezvemishonga ** (ona gwara redu pa polypharmacy, kuwandisa kwemishonga, uye zvikanganiso zvemurongi wemapiritsi): ** Usambopwanya Kuwedzerwa-Kusunungurwa (ER, XR, SR, LA, CD) kana Enteric-Coated (EC) mapiritsi (akadai se metoprolol succinate ER, potassium chloride ER, nifedipine XL, oxycodone ER, kana enteric aspirin), sezvo kupwanya kunoparadza matrix-dumps lethaseur-2 nguva uye matrix. muropa pakarepo. Bvunza chiremba kuti akupe mvura yekumisikidza, mapiritsi anoparadza nemuromo (ODTs), kana zvigamba zvetransdermal pane kudaro.
• Simbisa iyo 30-ku-45-Minuti Yakarurama Rule uye Cheek Tsvaira mushure mekudya kwese:
  • Chengetedza mukuru akagara akatwasuka pa90 madhigirii (kana angangoita 60 madhigirii) kwe ** 30 kusvika 45 maminetsi mushure mekupedza kudya kwese kana chubhu kudyisa **. Kurara wakatambarara mushure mekudya kunobvumira chinyararire gastroesophageal reflux yeasidhi yemudumbu uye chikafu kuti chiyerere nechekumashure kumusoro kugurokuro uye kuchidira mumapapu.
  • Vasati vagara, tarisa mukati memuromo wavo netochi diki uye shandisa chipanji chakanyorova (Toothette) kana kuti chigunwe chegirovhosi chakachena kutsvaira chero chikafu chiri muhomwe kubva pamatama avo, uye kweshesa mazino avo, mazino emazino, uye rurimi.

Kufambisa machubhu ekudyisa (PEG / NG machubhu) uye "Nyaradzo Kudyisa Chete" mudementia yepamusoro.¶

Kana munhu mukuru akura achikura zvakanyanya dysphagia uye akasangana nekudzokororwa kweaspiration pneumonia kana kuora muviri, zvipatara zvinowanzobvunza mhuri mubvunzo unorwadza: * "Tinofanira kuvhiya here percutaneous endoscopic gastrostomy (PEG) yekudyisa chubhu mudumbu ravo?"*

Kunzwisisa mutsauko wekurapa pakati pe ** acute reversible neurological injury ** uye ** danho rekupedzisira dementia ** inobatsira mhuri kuita humbowo-hwakavakirwa, sarudzo yetsitsi:

"Kuchenjerera Kudyisa Maoko (Kunyaradza Kudyisa Chete)" kunoshanda pakupera kwehupenyu¶

Kana munhu mukuru ane chirwere chedementia chepamusoro kana kupera simba kusingachakwanisi kumedza zvakachengetedzeka kunyange paIDDSI Level 4 purees, mhuri uye vanachiremba vanogona kugadza yepamutemo ** "Kunyaradza Kudyisa Chete" (kana kuti "Kudya uye Kunwa Nengozi Inobvumirwa" muUK) ** chirongwa chekutarisira pane kumanikidza nzara yakakwana / hapana-ne-muromo (NPO) kuiswa kwechubhu:

• Mukuru anopihwa zvidiki, zvinofadza zvinonaka zveanofarira akatsetseka mavara kana kunwa pasponji swab ** chete kana akamuka, akasvinura, uye achiratidza chido chekudya **.
• Muchengeti anomira pakarepo apo mukuru paanotendeuka musoro, ovhara miromo yavo, kana kukosora, pasina kumanikidza calorie quotas.
• Kuchengetedza kunotarisa pakuchengeta miromo uye mucosa yemukanwa yakanyorova uye yakagadzika neyakanyorova swabs uye lip balm, yakasanganiswa ne palliative comfort care.

Mibvunzo inowanzo bvunzwa¶

Ndeupi musiyano uripo pakati pemubhedha "Clinical Swallow Evaluation" uye "Modified Barium Swallow Study (VFSS)" kana "FEES"?¶

Kana Mutauriri Wemutauro Wekutaura (SLP) akaongorora mubereki wako ari padivi pemubhedha nekuvapa mvura yekunwa uye kunzwa huro yavo, ndiyo Clinical Bedside Swallow Evaluation; nepo zvichibatsira, bvunzo yepadivi pemubhedha isina makamera inopotsa kusvika 40 muzana ye "silent aspiration" nekuti hapana nzira yekuona nepamutsipa weganda kuti uzive kana mvura iri kuyerera chinyararire mumhepo. Kuti unyatsoongorora chishuwo chekunyarara uye kuona kuti ndechipi chaicho IDDSI ukobvu kana chin-tuck chimiro chinomisa mvura kupinda mumapapu, kumbira chiremba kuti araire **Instrumental Swallow Study**: ingave **Vhidhiyo fluoroscopic Swallow Study (VFSS / Modified Barium Swallow)**, iyo inotora mhenyu inofamba yeX-ray bhaisikopo uku-inomedza chikafu chakasiyana-inomedza chikafu chakasiyana. Endoscopic Evaluation yeKumedza (FEES)**, iyo inopfuudza kashinda kadiki kanochinjika kamera nemumhino padivi pemubhedha kuti utarise tambo dzenzwi zvakananga munguva chaiyo.

Sei mubereki wangu achiramba achikosora nemate ega nyangwe pasina chaadya kana kunwa?¶

Vakuru vane hutano vanomedza mate avo vasingazive kamwe paminiti yega yega (kanopfuura ka1,000 pazuva). Mumamiriro ezvinhu akaita sechirwere cheParkinson, Lewy body dementia, ALS, kana sitiroko yakakomba, iyo otomatiki yekumedza frequency inodzikira zvakanyanya apo madziva emate mumuromo (sialorrhea) uye anoyerera achipfuura tambo dzezwi, zvichikonzera kukosora kwemvura nguva dzose. Chekutanga, chengeta muviri wavo wepamusoro wakasimudzwa kanenge 30 kusvika 45 madhigirii pavanenge vachizorora uye vachikwesha mazino avo nerurimi kaviri pazuva kuitira kuti mate anoshuvira atakure mabhakitiriya mashoma. Chechipiri, bvunza chiremba wetsinga kana geriatrician nezve kurapwa kwakanangwa kuti zvinyoro zvideredze kugadzirwa kwemate zvakanyanya pasina kukonzeresa kuvhiringidzika kwakanyanya, se **ipratropium bromide nasal spray inoshandiswa sublingual **, **glycopyrrolate** (iyo isingadariki chivharo cheropa-brain se scopolamine kana atropine), kana **ipratropium bromide nasal spray yakaiswa sublingally**, **glycopyrrolate** (iyo isingayambuke ropa-brain barriers se scopolamine kana atropine), kana **ipratropium bromide nasal spray yakaiswa sublingally**, **glycopyrrolate** (iyo isingadariki chivharo cheropa-brain se scopolamine kana atropine), kana **ipratropium bromide nasal spray.

Ndingadzivise sei munhu mukuru pane zvinwiwa zvakakora kubva pakupererwa nemvura zvakanyanya?¶

Kupera mvura mumuviri injodzi huru pakudya kwakakora-mvura nekuti zvinwiwa zvakakora zvinonzwa kurema uye kuzadza mudumbu uye hazvipedze nyota yemumuromo nekukurumidza semvura inotonhora yakatetepa. Kurova chinangwa chezuva nezuva che1.5 litres (6 makapu) emvura isina kuwandisa: (1) ipa diki 60 kusvika 90 mL (2 kusvika 3 aunzi) zvikamu awa yega zuva rese kwete magirazi mahombe matatu pakudya; (2) shandisa ** xanthan-gum gel thickeners ** panzvimbo pechalky cornstarch powder, uye shandisa zvinwiwa zvakakora ** zvinotonhora kana kudziya ** (zvakadai seyakakora iced cranberry juice, lemonade yakakobvu, kana kudziya yakakora muto/tii), sekunhuhwirira kwakasimba uye kutonhora / kudziya kunomutsa mvura inomedza zviri nani pane inodziya; (3) kuverenga yemvura yakakwira IDDSI Level 4 chikafu kuchinangwa chavo chezuva nezuva chemvura, kusanganisira yakatsetseka yogati, applesauce, pureed michero ndiro, custard, uye yekutengesa pre-thickened hydration cups; uye (4) bvunza SLP kana mubereki wako achikodzera **Frazier Yemahara Mvura Protocol** mushure mekunyatsokweshwa mazino pakati pekudya.

Ndinofanira kubvisa mazino emubereki wangu kunze here kana kuti kuasiya mukati panguva yekudya kana mazino avo akasununguka?¶

Zvinoenderana nekuti vakasununguka sei uye kuti IDDSI magadzirirwo ari kudyiwa nemubereki wako. Mazino emazino anonyatsokodzera anobatsira munhu mukuru kutsenga IDDSI Level 6 (Zvakapfava & Kuruma-Size) uye anobatsira rurimi kudzvanya padenga remukanwa kuti bhora ridzokere kumashure. Zvisinei, kana mubereki wako arasikirwa nemakirogiramu gumi (22 pounds) ehuremu nguva pfupi yadarika uye mazino avo aregedzeka zvekuti ** kudzvanya, kuzuzuma nekudzika, kana kudonhera parurimi paanenge achidya **, mazino asina kusimba anova njodzi yekudzipwa ine ngozi inovhara rurimi kuti isavharwe uye kuteya chikafu chisina kumedzwa pasi peiyo acrylic plate. Kana mazino emazino ari kuzunguzika uye asingakwanise kudzikamiswa nekadoti kadiki kezinc-isina mazino adhesive, kazhinji zvakachengeteka ku **kubvisa mazino akasununguka pakudya ** uye kupa **IDDSI Level 4 (Pureed) kana Level 5 (Minced & Moist)** chikafu chinoda zero mazino kuruma, uye mazino asati abvisa mazino kurara**.

Kwatariswa¶

• International Dysphagia Diet Standardization Initiative (IDDSI, International): *Yakazara IDDSI Framework uye Detailed Definitions (Version 2.0): Nzira dzekuedza dzeLiquid Levels 0 kusvika 4 uye Food Texture Level 3 kusvika 7 (Siringe Flow Test, Fork Pressure Test, uye Spoon Test)
• American Speech-Language-Hearing Association (ASHA, United States): Practice Portal paAdult Dysphagia: Clinical vs. Instrumental Assessment (VFSS uye FEES), Compensatory Postural Maneuvers, uye Frazier Free Water Protocol.
• American Geriatrics Society (AGS) uye Kusarudza Nokuchenjera Mushandirapamwe (United States): Chirevo cheClinical Position pamusoro peMachubhu eKudyisa muDementia Yepamusoro (Kurudziro Inopesana NePercutaneous Feeding Tubes muDementia Yakakura Mukufara Kungwarira Kudyisa Maoko).
• American Heart Association (AHA), Red Cross, uye Resuscitation Council UK (International): Basic Life Support Guidelines for Relief of Foreign-Body Airway Obstruction (Choking): Back Blows, Abdominal Thrusts, uye Chest Thrust Modifications for Sed/Wheelchair Patients.
• National Institute for Health and Care Excellence (NICE) uye Royal College of Speech and Language Therapists (RCSLT, United Kingdom): Nhungamiro yeKudya uye Kunwa neAcknowledged Risk (EDAR), Oral Hygiene for Aspiration Pneumonia Prevention, uye Safe Medication Administration muDysphagia.

Mazano anoenderana¶

• Chipatara delirium uye kumiririra kurapwa kune vakuru
• Kudenha chipatara chisina kuchengetedzeka kana kuburitsa rehab
• Kushungurudzwa kwemba yevakoti, kuregeredzwa, uye kudzivirira kudzingwa
• Polypharmacy, kuwandisa kwemishonga, kupotsa dosi, uye zvikanganiso zvemurongi wemapiritsi
• Pressure maronda, bedsores, stage 3-4 kutapukira, uye immobile murwere kutendeuka
• Nhamba dze emergency