Clinical Skills Pearl Vol 2 (#13): Dysphagia

Dysphagia, defined as difficulty in swallowing, can vary in severity, with symptoms ranging from mild throat discomfort to an inability to eat (Galvan, 2001). Perry (2001) described findings of dysphagia that included drooling, difficulty chewing, food pocketing, slow swallowing,coughing, choking, wet-sounding voice, food sticking in the throat,weight loss, heartburn, nasal regurgitation, and aspiration pneumonia.

Dysphagia is a condition that is associated with numerous neurological and neuromuscular diseases. Kayser-Jones and Pengilly (1999) identified stroke, Huntington's chorea, medications with anticholinergic effects (e.g., antidepressants and antihistamines), phenothiazines, and poor dentition as being associated with dysphagia. Myasthenia gravis, cerebral palsy, poliomyelitis, toxic or inflammatory encephalopathy, amyotrophic lateral sclerosis, injury from radiation or surgical procedures for head and neck cancer, and cleft palate also have been identified as contributing to dysphagia (Galvan, 2001). Alzheimer's disease, traumatic brain injury, Guillain- Barre syndrome, tonsillitis, dental caries, xerostomia, and chronic gastroesophageal reflux are other conditions that contribute to dysphagia (Perry, 2001).

It is difficult to comprehend the full extent of this major health problem. Doggett et al. (2001) estimated there are 300,000–600,000 new dysphagia cases each year. The reported mortality rates due to aspiration pneumonia are as high as 6% in the first year after a stroke. (Teasell, McRae, Marchuk, Hillel, & Finestone, 1996). This is a noteworthy finding, considering that nearly half of all stroke patients experience dysphagia (Smithard et al., 1996). According to Galvan (2001), 30%–60% of persons with stroke history have dysphagia. The incidence of dysphagia in Parkinson's disease may be as high as 50% (Galvan, 2001).

Nurses have an important role in identifying dysphagia patients. According to Travers (1999), nurses are the professionals who most often are present at the bedside, particularly at mealtime, and are the first members of the healthcare team to observe signs and symptoms of dysphagia. By recognizing dysphagia early, nurses can help to prevent complications and decrease the number of deaths associated with dysphagia in those who have had a stroke (Travers, 1999).

According to the Canadian Stroke Guidelines all patients diagnosed with a CVA should recieve a swallowing assessment before being fed.

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