STUDY - Technical - New Dacian's Medicine
Pharyngeal
(gag) reflex, abnormal (Classical / Allopathic Medicine)
The gag reflex - a
protective mechanism that prevents aspiration of food, fluid,
and vomitus - can usually be elicited by touching the
posterior wall of the oropharynx with a tongue depressor or by
suctioning the throat. Prompt elevation of the palate,
constriction of the pharyngeal musculature, and a sensation of
gagging indicate a normal gag reflex. An abnormal gag reflex -
either decreased or absent - interferes with the ability to
swallow and, more important, increases susceptibility to
life-threatening aspiration.
An impaired gag
reflex can result from any lesion that affects its mediators -
cranial nerves IX (glossopharyngeal) and X (vagus) or the pons
or medulla. It can also occur during a coma; with muscle
diseases, such as severe myasthenia gravis; or as a temporary
result of anesthesia.
ALERT:
If you detect an abnormal gag reflex:
- quickly evaluate the patient's level of consciousness - if decreased, place him in a side-lying position to prevent aspiration; if not, place him in Fowler's position
- take steps to prevent aspiration by not allowing oral intake.
After the patient has been stabilized, perform a focused assessment.
If you detect an abnormal gag reflex:
- quickly evaluate the patient's level of consciousness - if decreased, place him in a side-lying position to prevent aspiration; if not, place him in Fowler's position
- take steps to prevent aspiration by not allowing oral intake.
After the patient has been stabilized, perform a focused assessment.
HISTORY:
Ask the patient (or a family member if the patient can't communicate) about the onset and duration of swallowing difficulties.
Ask the patient if liquids are more difficult to swallow than solids.
Ask the patient if swallowing is more difficult at certain times of the day.
Ask the patient if he also has trouble chewing. If so, suspect more widespread neurologic involvement because chewing involves different cranial nerves.
Review the patient's medical history for vascular and degenerative disorders.
Ask the patient (or a family member if the patient can't communicate) about the onset and duration of swallowing difficulties.
Ask the patient if liquids are more difficult to swallow than solids.
Ask the patient if swallowing is more difficult at certain times of the day.
Ask the patient if he also has trouble chewing. If so, suspect more widespread neurologic involvement because chewing involves different cranial nerves.
Review the patient's medical history for vascular and degenerative disorders.
PHYSICAL
ASSESSMENT:
Assess the patient's respiratory status for evidence of aspiration.
Perform a neurologic examination.
Assess the patient's respiratory status for evidence of aspiration.
Perform a neurologic examination.
SPECIAL
CONSIDERATIONS:
Continually assess the patient's ability to swallow. If his gag reflex is absent, provide tube feedings; if it's diminished, the patient may attempt pureed foods, with supervision. Assess his nutritional status daily.
Continually assess the patient's ability to swallow. If his gag reflex is absent, provide tube feedings; if it's diminished, the patient may attempt pureed foods, with supervision. Assess his nutritional status daily.
PEDIATRIC
POINTERS:
Brain stem glioma is a major cause of abnormal gag reflexes in children.
Brain stem glioma is a major cause of abnormal gag reflexes in children.
PATIENT
COUNSELING:
Advise the patient to eat small meals. Also, tell him to chew slowly while sitting or in a high Fowler's position.
Advise the patient to eat small meals. Also, tell him to chew slowly while sitting or in a high Fowler's position.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)