speech therapy intern study gudie
TRANSCRIPT
Grand Strand Regional Medical
Speech Therapy Department
Intern Overview Packet & Study Guide
Table of Contents
Patient Assessment/Status………….…………………………………………………………2 Aphasia……………………………….………………………………………………………….3 Swallowing Mechanism……………………………………….……………………………..…4 Dysphagia…………………………………………,………………………….……………….57 Cognitive Diagnostic Tests………………………………………………….……………...612 Stroke………………………………………………..………………………………………1315 Brain Function & Brain Injury………………………………………………………….….1623 Vocabulary and Abbreviations……………………………………………………..……..2429
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Patient Assessment/Status
Level of Consciousness
Awake (A), Alert (A), Oriented (O): Normally a person is awake, alert, and oriented knowing who they are, where they are, the date, the time, and what has happened or the current situation. When a patient is assessed in the hospital their level of consciousness is measured by their AAO on the scale shown below:
AAOX4 The person knows person, place, time and situation.
AAOX3 The person knows person, place and time, but not situation.
AAOX2 The person knows person and place, but not time and situation.
AAOX1 The person knows person, but not place, time and situation.
AAOX0 The person is awake and alert, but is disoriented.
http://www.nols.edu/alumni/leader/02summer/patientassessment.shtml
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Aphasia
Definition
Communication disorder that causes difficulty in speaking, listening, and reading. Individuals who suffer from aphasia do not decline cognitively and most likely still have the ability to understand others, but they have difficulty speaking fluently or finding and saying the appropriate words. There are various causes, symptoms, and types of aphasia.
Causes:
Stroke, Brain Injury, Neurological Disorder, Dementia
Types:
Expressive/Nonfluent/Broca’s Aphasia: The person has difficulty saying exactly what they want to say however, they know what they want to stay and understand language. Receptive Aphasia/Fluent/Wernicke’s Aphasia: The person has difficulty understanding and comprehending the meaning of spoken words. The patient can speak fluently but the words often do not make sense. Anomic Aphasia: These individuals have difficulty with wordfinding and have a hard time saying what they want to say. Global Aphasia: These individuals have difficulty speaking and understanding as well as inability to read or write. This is the most severe type of aphasia and is often seen immediately following a stroke. Primary Progressive Aphasia: These individuals slowly lose their ability to read, write, talk, and understand. http://www.webmd.com/brain/aphasiacausessymptomstypestreatments
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Swallowing Mechanism
Swallowing Stages 1. Oral Phase: Food is chewed and mixed with saliva to form a bolus. The tongue
is responsible for propelling the bolus from the front to the back of the mouth. 2. Pharyngeal Phase: The food has reached the upper throat area and the
following occurs: a. The soft palate rises b. The epiglottis closes off the trachea to prevent food from entering the
airway. 3. Esophageal Stage: The bolus reaches the esophagus and is propelled down to
the stomach through muscle contractions.
http://www.uwhealth.org/voiceswallow/stagesofswallowing/11463
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Dysphagia
Definition
Difficulty chewing or swallowing foods or liquids in different phases of the swallowing process. Poor swallow function can lead to aspiration which can then lead to pneumonia making it extremely important to diagnose dysphagia and alter the individual’s food and liquid intake until swallow function improves.
Common Causes
Stroke, Brain or Spinal Cord Injury, Parkinson’s disease, Multiple Sclerosis, Cerebral Palsy, ALS, Alzheimer's Disease, Neck Injury, Throat or Mouth Cancer.
Types
Oropharyngeal: Difficulty in the initial stage of the swallowing process Oral Difficulties
Difficulty sucking from a straw Difficulty forming a bolus Difficulty moving the bolus to the back of the mouth
Pharyngeal Difficulties: Difficulty closing off the airways properly causing food or liquid to move
toward the trachea Difficulty holding food or liquid in the mouth causing food or liquid to reach
the throat before the swallow is triggered. Esophageal:
Food or liquid does not reach the stomach properly and often stops in the esophagus
Aspiration: When food or liquid enters the airway (trachea) below the vocal folds. A SLP’s responsibility is to evaluate a patient’s swallow to determine whether or not they are showing signs and symptoms of aspiration. The patient is given a variety of liquids and solids of different viscosities and consistencies to determine the safest diet for the patient. The dysphagia solid and liquid levels are outlined below. Signs and Symptoms
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Coughing after swallowing food or liquid Throat clearing after swallowing food or liquid Difficulty breathing (fast, slow, gurgling lung sounds) A change in voice Fever (dizzy, sweating, chill)
Dysphagia Diets Liquids:
Thin: These are liquids of normal or everyday thickness such as: Water Coffee Juice Broth Milk Soda Tea Ice Cream
NectarThick: Mildly Thick These are thin liquids that have been thickened using a nectar thickening
packet
HoneyThick: Moderately Thick
These are thin liquids that have been thickened using a honey thickening packet.
Pudding Thick: Extra Thick
Solids: 6
Regular: No restrictions Reduced Level 1: Mechanical Soft Diet
Easy to chew foods Avoid dry, crunchy, chewy or hard foods
Reduced Level 2: Pureed Diet Puddinglike consistency; no chewing Anything that is pureed or blended
Evaluation:
To test the patient’s ability to swallow liquids the SLP often gives the patient the following liquids in the following order. If the patient shows signs or symptoms of aspiration the SLP will thicken the liquid as listed below:
1. Thin Water 2. Nectar Thickened Water 3. Honey Thickened Water
To test the patient’s ability to chew and swallow solids the SLP often gives the
patient the following food items in the following order. If the patient shows signs or symptoms of aspiration the SLP will often not test further
1. Reduced Level 2: Applesauce, Pudding 2. Reduced Level 1: Fruit Cup 3. Regular: Graham Cracker, Granola Bar
Further Testing Methods
Modified Barium Swallow: This procedure is performed in radiology and the patient eats and drinks foods/liquids that are covered in barium paste. The swallowing process is visible as a video xray.
FEES: Fiberoptic Endoscopic Evaluation of Swallow A scope is inserted through the nose and rests near the esophagus. The swallow
can be viewed on a screen while the procedure is done at the patient’s bedside. http://www.asha.org/public/speech/swallowing/SwallowingDisordersinAdults/#signs
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Cognitive Diagnostic Tests
ROSS Information Processing Assessment Second Edition (RIPA)
Subtest 1: Immediate Memory “Say these after me: 437”
Subtest 2: Recent Memory “How long have you been in the hospital?”
Subtest 3: Temporal Memory (Recent Memory) “What year is it?”
Subtest 4: Temporal Orientation (Remote Memory) “What are the days of the week?”
Subtest 5: Spatial Orientation “What city are you in now?”
Subtest 6: Orientation to Environment “Who is your doctor?”
Subtest 7: Recall of General Information “Who is our president?”
Subtest 8: Problem Solving and Abstract Reasoning “You are driving on the highway and run out of gas. What do you do?”
Subtest 9: Auditory Processing and Retention “Name as many animals as you can in one minute.” “What are birds, cats, and camels?”
Subtest 10: Problem Solving and Concrete Reasoning “Does it take longer to put on a hat than shoes?”
ROSS Information Processing Assessment Geriatric (RIPAG)
Subtest 1: Immediate Memory “Say these numbers after me: 5248”
Subtest 2: Recent Memory “How many children do you have?”
Subtest 3: Temporal Orientation “What year is it?”
Subtest 4: Spatial Orientation “Where were you born?”
Subtest 5: Orientation to Environment “What meals have you eaten today?”
Subtest 6: Recall of General Information
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“Who was your favorite president?” Subtest 7: Problem Solving and Abstract Reasoning
“What would you do if you needed to go to the bathroom?” Subtest 8: Organization of Information
“Name as many animals as you can in one minute.” “What are cats, dogs, birds?”
Subtest 9: Auditory Processing and Comprehension “Does a sheet go over a blanket?”
Subtest 10: Problem Solving and Concrete Reasoning What can you do if a piece of food is too large?”
http://overlake.virtualspace.net/SLP/RG.pdf
Galveston Orientation Amnesia Test (GOAT)
The GOAT is administered to measure attention and orientation. The GOAT is often used to determine whether or not a patient suffers from amnesia after a traumatic brain injury. A score of 78 or more on 2 consecutive occasions is considered to indicate posttraumatic amnesia (PTA). Scoring 76100: Normal 6675: Borderline <66: Impaired
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http://scalelibrary.com/pdf/Galveston_Orientation_Amnesia_Test.pdf
Montreal Cognitive Assessment Test (MOCA)
The MOCA is used as a quick screening tool for mild cognitive dysfunction. The test takes about 10 minutes to administer. Scoring: 2630: Normal Assesses:
Attention and Concentration Executive Functioning Memory Language Visuoconstructional Skills Conceptual Thinking
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Calculations Orientation
http://www.parkinsons.va.gov/Consortium/MoCA.asp
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MiniMental State Examination (MMSE):
The MMSE is used to measure cognitive impairment and often used for dementia. The MMSE is best used to follow progress over time and notice change due to treatment. The test takes approximately 510 minutes to administer. Scoring: 15 and below: Absolute Dementia 20 and below: Dementia 2125: Borderline 26>: Normal Assesses:
Registration Attention and Calculation Recall Language Ability to Follow Commands Orientation
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Stroke Definition: A stroke occurs when one of the arteries that supplies blood to the brain is blocked. This alters or inhibits blood flow to the brain causing brain malfunctions and alterations. A stroke normally happens on one side of brain which affects coordination and control of the opposite side of the body. Overview of the Effects of a Stroke
Dysphagia: Swallowing difficulty Dysarthria
Mild Slurred Speech Severe Inability to coordinate speech; cannot be understood
Hemiparesis: Weakness or paralysis on one side of the body Memory Problems Loss of Judgement Increased Impulsivity Loss of Sensation Vision Problems Difficulty with thinking, attention, learning, comprehension
If the stroke occurs on the right side of the body:
Paralysis or loss of coordination and function on the left side of the body Vision problems and difficulty Quick, abrupt behavior Memory loss
If the stroke occurs on the right side of the body: Paralysis or loss of coordination and unction on the right side of the body Speech/language problems Slow behavior Memory loss
Types TIA: Transient Ischemic Attack/MiniStroke
A TIA occurs when blood flow to the brain is only blocked for a short amount of time causing temporary problems.
Ischemic Stroke: Occurs when an artery in the brain is blocked Embolic: A blood clot forms somewhere outside of the brain, but eventually travels to
the brain and blocks an artery. Thrombosis: A blood clot forms in an artery that is directly supplying blood to the brain.
Hemorrhagic Stroke: Occurs when a blood vessel in the brain bursts Intracerebral: Occurs when a blood vessel bursts and bleeds into brain tissue causing
decline in this area of the brain
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Subarachnoid: Occurs when a blood vessel bursts near the brain and then leaks into the space between the brain and the skull.
http://www.allinahealth.org/Healthconditionsandtreatments/Healthlibrary/Patienteducation/UnderstandingStroke/Effectsofstroke/Physicaleffectsoneithersideofthebrain/ The link below provides more information on strokes and their effect on the body and function. https://www.stroke.org/sites/default/files/resources/ExplainingStrokeBrochure.pdf
NIH Stroke Scale
Assesses: Consciousness Brain Function Vision Sensation Movement Speech Language
Scoring: 0= No Stroke 14= Minor Stroke 515= Moderate Stroke 1520= Moderate/Severe Stroke 2142= Severe Stroke
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The Brain
Brain Sections
Cerebrum: The largest part of the brain that is responsible for majority of the brain’s function.
Divided into 4 Lobes: Frontal Lobe: Selfawareness, creative thought, problem solving,
intellect, judgement, reasoning, behavior, attention, abstract thinking, physical reactions, coordinated movements, smell, personality, decision making
Broca’s Area: Language processing and comprehension, speech
Parietal Lobe: Visual function, language, reading, internal stimuli, tactile sensation, and sensory comprehension
Sensory Cortex: Receives information relayed from the spinal cord related to the position of body parts and their movement.
Motor Cortex: Monitors and controls movement throughout the body
Temporal Lobe:Visual and auditory memories, speech and hearing capabilities, behavior, and language.
Wernicke’s Area: Controls expressive language Occipital Lobe: Controls vision
Cerebellum: Regulation and coordination of movement, posture, and balance Limbic System: Controls and relays emotions
Amygdala: Helps the body respond to emotions, memories, and fear Hippocampus: Controls learning memory and the conversion of temporary
memories into permanent memories Thalamus: Controls attention span and sensations.
Brainstem: Controls basic life functions; heart rate, blood pressure, breathing Midbrain Pons Medulla Oblongata
Spinal Cord: Carries messages between the brain and the rest of the body. Blood Vessels: Carry blood to the brain
http://www.mdhealth.com/PartsOfTheBrainAndFunction.html
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Brain Injury
Brain Injury Types
Traumatic Brain Injury: Change in brain function caused by an external force Falling, motor vehicle accident, object penetrating skull
NonTraumatic Brain Injury: Caused by an illness or disruption/lack of oxygen flow to the brain
Strokes, aneurysms, cardiac arrest, drowning, tumors, infections
Possible Effects of Brain Injury
Frontal Lobe
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Difficulty making decisions, focusing attention on tasks, planning tasks and problem solving.
Easily distracted Stubborn Personality changes Difficulty maintaining socially appropriate behavior Repeats the same action or words over and over without realizing it Mood swings Word finding problems
Parietal Lobes Difficulty with handeye coordination Inability to recognize touch sensation on the opposite side of the body Right Side
Difficulty drawing Lack of awareness of certain body parts
Left Side Difficulty naming objects, doing math problems, writing words
Temporal Lobes Memory problems Changes in sexual interest Aggressive behavior Right Side
Difficulty recognizing faces, understanding spoken words, recognizing music
Persistent talking Left Side: Wernicke’s Area
Inability to read or understand what someone is saying Occipital Lobe
Difficulty in vision, locating objects, recognizing colors, reading and writing Inability to recognize words or accurately see objects
*For further information seek Grand Strand Regional Medical Center: Guide to Brain Injury
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Right vs. Left
Injury to Right Side
Difficulty in understanding language, speaking Depression and anxiety Impaired logic Inability to sequence events Decreased control over the right side of body
Injury to Left Side Visual impairment Inattention to left side of body Altered creativity Loss of big picture type thinking Decreased control of left side of body
http://brainmadesimple.com/leftandrighthemispheres.html
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Diagnosing Severity of Brain Injury Glascow Coma Scale: Estimates and categorizes the outcome of brain injury based on motor, verbal, and eye opening responses. Eye Opening Response • Spontaneousopen with blinking at baseline 4 points • To verbal stimuli, command, speech 3 points • To pain only (not applied to face) 2 points • No response 1 point Verbal Response • Oriented 5 points • Confused conversation, but able to answer questions 4 points • Inappropriate words 3 points • Incomprehensible speech 2 points • No response 1 point Motor Response • Obeys commands for movement 6 points • Purposeful movement to painful stimulus 5 points • Withdraws in response to pain 4 points • Flexion in response to pain (decorticate posturing) 3 points • Extension response in response to pain (decerebrate posturing) 2 points • No response 1 point Categorization: Coma: No eye opening, no ability to follow commands, no word verbalizations (38) Severe Head InjuryGCS score of 8 or less Moderate Head InjuryGCS score of 9 to 12 Mild Head InjuryGCS score of 13 to 15 http://www.cdc.gov/masstrauma/resources/gcs.pdf
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Ranchos Los Amigos Scale: Used to determine the patient’s level of activity following brain injury by measuring levels of awareness, cognition, behavior, and environmental interaction.
Level 1: No reaction The braininjured person is unconscious. They appear to be sleeping. They do not react to any stimuli. This comatose state can last for seconds, minutes, hours, days, weeks or months.
Level 2: Generalized reaction The braininjured person will react but inconsistent and without purpose. The reaction is often broad body movement or garbled words and the reaction is usually the same regardless of what the stimulus is. The first reaction is usually to deep pain.
Level 3: Localized reaction The braininjured person is improving. They will react more specifically to different stimuli but the reaction is different each time. For example, they may occasionally turn their head in the direction of a speaker's voice. They may have a vague awareness of their body. They may sometimes follow simple commands such as "close your eyes" or "squeeze my hand".
Level 4: Confused/Agitated The braininjured person has become very active but they are not yet able to understand what's going on. The behavior might become bizarre. They might cry out or try to remove the feeding tube. They may be hostile and uncooperative but they are not acting out of anger or fear. This is a reaction to their confusion.
Level 5: Confused/Inappropriate The braininjured person has become less agitated. They react to simple commands in a more consistent manner. If the commands are more complicated, they get confused and react incorrectly. They may become agitated if they are in a noisy or "busy" environment. They will not take the first step. They will react best to body aches and pains, to their own comfort and to close family members. Memory is severely damaged and they are unable to learn new information. At this level, they are in danger of "wandering off."
Level 6: Confused/Appropriate Things are looking up. The braininjured person is motivated but still depends on others to lead the way. Reactions will be more appropriate. If they are uncomfortable, they will complain. They are beginning to recognize therapy staff and are much more aware of self and family. They can easily follow simple directions. Memory of the past has improved greatly but memory of recent events is still damaged.
Level 7: Automatic/Appropriate The braininjured person seems to act appropriately in the hospital and at home. They know who they are, where they are, the date and time. All seems well but things are still not completely right. They go through daily routines automatically like a robot. Although they can dress, wash and feed themselves without help, they need guidance to stay safe.
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Judgment and problemsolving skills are still damaged and they cannot make realistic plans for the future.
Level 8: Purposeful/Appropriate At last! The braininjured person remember show the past fits with the future. They are independent and can function well in society. They may still have some difficulty with reasoning, judgment and learning, especially in high stress, unusual or emergency situations. They may be actively involved in a vocational rehabilitation program, learning a new way to live.
http://www.mc.vanderbilt.edu/documents/traumasurvivors/files/The%20Rancho%20Los%20Amigos%20Scale.pdf
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Vocabulary AAC (Augmentative and Alternative Communication): All forms of communication
other than oral speech. Aided AAC: Rely on the user’s body to convey the message such as body
or sign language Unaided AAC: Requires the use of tools or equipment in addition to
gestures or body language ranging from paper/pencil to communication boards, or electronic devices to create messages.
Agnosia: Inability to recognize objects when using a specific sense such as visual, auditory, and touch
Agraphia: Inability to produce written language Amnesia: Loss of memory due to brain injury, shock or illness.
Anterograde: Loss of memories that were formed before the injury. Retrograde: Loss of ability to form new memories after the injury. Post Traumatic Amnesia: State of confusion immediately following
traumatic brain injury. During PTA the individual cannot store new events in memory or remember events that occur after the injury and is often confused and disoriented.
Anosognosia: The denial or unawareness of one’s neurological deficits Aphasia: Difficulty understanding, speaking, reading, and writing while cognitive
function is normally intact. Normally caused by damage to the left side of the brain Types:
Expressive: Have trouble speaking and writing; also known as Broca’s Aphasia
Only able to say 1 or 2 words at a time Have trouble thinking of the words they want to say Leave words out of sentences Have problems spelling Have trouble putting together sentences that make sense
Receptive: Have trouble reading and understanding; also known as Wernicke’s Aphasia
Only able to follow simple directions Trouble following a conversation Need to have information repeated Need visual or touch cues to help them understand Have trouble understanding what they read
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Say words that don’t make sense but don’t know that others can’t understand them.
Global: Have trouble with speaking, writing, reading, and understanding Aphonia: Loss of voice Apraxia: The inability to perform a movement or sequence of movements
despite intact sensation and understanding of the task; difficulty controlling mouth to speak clearly
Mix up sounds in words Say the wrong sounds Say words and sounds differently each time Struggle to say sounds
Articulation: Producing speech sounds Aspiration: Inhaling of a liquid or object into the airway
Signs and Symptoms Coughing after swallowing food or liquid Throat clearing after swallowing food or liquid Difficulty breathing (fast, slow, gurgling lung sounds) A change in voice Fever (dizzy, sweating, chill)
Ataxia: Lack of coordination fine and gross motor activity Bolus: Mass of food prepared by the mouth for swallowing (after chewing). CABG: A surgical procedure that improves and restores normal blood flow to the
heart for people with coronary heart disease. Cerebrovascular Accident: Decreased blood flow to the brain caused by a
blocked artery that results in the death of brain cells, also known as a stroke. Cerebral Palsy: Neurological disorder that permanently affects body movement,
muscle coordination, and balance. CognitiveCommunication Disorders: Problems with memory, reasoning,
problemsolving, and attention Dysarthria: Slurred quiet speech caused by muscle weakness Dysphagia: Difficulty chewing and swallowing food and drink Esophageal Dysphagia: Occurs when foods or liquids do not reach the stomach
properly commonly caused by the backing up of stomach acid into the esophagus due to reflux problems making it harder for the esophagus to pass foods to the stomach.
Oropharyngeal Dysphagia: Difficulty with the initial stage of the swallowing process resulting problems moving food from the front to the back of the mouth.
Dysphasia: Impairment of speech due to brain damage. Dyspnea: Shortness of breath
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Edema: Medical term for swelling or when blood vessels release fluid into nearby tissues
Embolus: A blood clot that has been carried in the bloodstream and eventually lodges into a blood vessel in a new location to cause a stroke
Encephalopathy: General term for brain disease or brain damage; symptoms include memory loss, altered mental state, personality changes, dementia, seizures, or coma.
Endotracheal Intubation: A procedure in which a tube is placed into the trachea through the mouth or nose to support breathing and open the airway to give oxygen.
Fluoroscopy: Xray study of moving body structures; used to watch a patient’s swallow.
Hematoma: The collection of blood outside of the vessel most commonly due to damage to the vessel wall. These look like bruises under the skin but can also happen in places that are not visible.
Hemorrhage: An escape of blood from a ruptured blood vessel; rapid, uncontrollable loss of blood.
Brain Hemorrhage: Localized bleeding in the brain due to the bursting of an artery in the brain. This causes swelling in the brain and increases the pressure in the brain, which kills brain cells.
Hydrocephalus: Abnormal accumulation of cerebrospinal fluid in the brain that causes it to swell. It can lead to brain damage and physical, developmental, and cognitive impairments.
Hyperlipidemia: High number of lipids or fats, most commonly referred to as high cholesterol
Infarct: An area of dead tissue resulting from lack of blood supply Ischemic Stroke: Occurs when blood vessels connected to the brain are
clogged or blocked. A clot forms and blocks the flow of blood to certain areas of the brain causing the stroke to occur.
Labial: Pertaining to the lips. Language: Words we use and understand Larynx : Valve structure between the trachea (windpipe) and the pharynx (the
upper throat) that is the primary organ of voice production Lesion: A region or zone of an organ or tissue that has suffered damage. Lingual: Pertaining to the tongue Modified Barium Swallow: The use of videofluoroscopy to evaluate a patient’s
swallow. Multiple Sclerosis (MS): A disease of the central nervous system affecting the
brain and the spinal cord.
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Muscle Atrophy: The loss of muscle ability due to underuse or neglect. Myalgia: Muscle pain Nasal Emission: Airflow through the nose, usually audible and indicative of an
incomplete seal between the nasal and oral cavities Necrosis: Death of most or all of the cells in an organ or tissue Paraesthesia: An abnormal tingling/numbness (pins and needles) sensation
usually in upper and lower extremities Paresis: Muscle weakness. Parkinson’s Disease: A progressive disease that disrupts movement.
Symptoms include tremors, slowed movement impaired posture and balance, decreased ability to perform automatic movements, speech and writing changes.
Perseveration: Repetition of a particular response (word or phrase) and repeatedly bringing up a topic that is no longer appropriate
Phonics: The relationships between written letters and their spoken sounds “Phone” spelled with a /ph/, not an /f/ as in “fone” Phonological Awareness: Awareness of individual sounds in spoken words as
well as how those sounds go together and how they can be changed to make new words
Phonology: How speech sounds go together/follow patterns to make words Speech: How we say sounds and put them together into word Thrombus: A blood clot that forms within the vascular system. Tracheostomy: A procedure done to create an opening in the trachea to provide
an airway and remove lung secretions. Often used in patients who have an object blocking the airway, or lack of ability to breathe.
Total Parenteral Nutrition (TPN): All nutritional needs are met through an IV or intravenously.
Abbreviations: A/P: anteriorposterior A&O: alert and oriented ad lib: as much as needed ADL: activities of daily living ARDS: acute respiratory distress syndrome bm: bowel movement BS: breath sounds c: with C/O: complaining of c/o: complains of CA: cancer
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CABG: coronary artery bypass grafting CN: cranial nerves CNS: central nervous system COLD: chronic obstructive lung disease COPD: chronic obstructive pulmonary disease CP: chest pain CPAP: continuous positive airway pressure CSF: cerebrospinal fluid CVA: cerebrovascular accident CXR: chest xray DAI: diffuse axonal injury DAT: diet as tolerated DC: discharge DJD: degenerative joint disease DM: diabetes mellitus DNR: do not resuscitate DOA: dead on arrival DOE: dyspnea on exertion DVT: deep venous thrombosis DX: diagnosis ECG: electrocardiogram EMT: eyes, motor, verbal response ENT: ears, nose, throat ETT: endotracheal tube FTT: failure to thrive FU: followup FVC: forced vital capacity Fx: fracture HA: headache HBP: high blood pressure HO: history of HOB: head of bed HPI: history of present illness HTN: hypertension Hx: history LLL: left lower lobe LLQ: left lower quadrant LML: left middle lobe LOC: level of consciousness
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LP: lumbar puncture LUL: left upper lobe LUQ: left upper quadrant MVA: motor vehicle accident NAD: no active disease NAS: no added salt NG: nasogastric NKA: no known allergies NPO: nothing by mouth NT: nasotracheal OPPT: oriented to person place and time PMH: previous medical history PO: by mouth PRN: as needed Pt: patient PTA: posttraumatic amnesia qd: everyday RLL: right lower lobe RLQ: right lower quadrant RML: right middle lobe ROM: range of motion RUL: right upper lobe RUQ: left upper quadrant RV: residual volume Rx: treatment s: without s/s: signs and symptoms SCI: spinal cord injury SOAP: Subjective, Objective, Assessment, Plan SOB: shortness of breath Sx: symptoms TLC: total lung capacity TPN: total parenteral nutrition TV: tidal volume Tx: treatment UGI: upper gastrointestinal VC: vital capacity VO: verbal or voice disorder VSS: vital signs stable
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WF: white female WM: white male WN: well nourished WNL: within normal limits yo: year old
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