Swallowing difficulties

Patients with the following conditions should use laxatives only under the supervision of a health care provider (1) colostomy (2) diabetes mellitus (some laxatives contain large amounts of sugars such as dextrose, galactose, and/or sucrose (3) heart disease (some products contain sodium (4) kidney disease and (5) swallowing difficulty (bulk-formers may produce esophageal obstruction). 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

Swallowing difficulty blurred vision, bloated feeling, impotence, urinary hesitancy Ophthalmic Mydriasis, blurred vision, photophobia, decreased visual acuity tearing, dry eyes or dry conjunctiva, eye irritation, crusting of eyelid Rare... 

Impaired swallowing with risk of aspiration and pneumonia is common in drowsy patients with severe hemispheric strokes, and those with brainstem strokes. It almost always gets better in days or weeks (Hamdy et al. 1997). Swallowing difficulty is tested by asking the patient to sip some water, observing any tendency to choke in the next minute or so, and for added sensitivity using simple quantification (Mari et al. 1997 Hinds and Wiles 1998). 

In ALS patients, sialorrhea can be a major symptom as bulbar weakness worsens. Wliich of these medications is ideal for a patient with swallowing difficulty ... 

A 49-year-old man developed uvular deviation as a result of palatal muscle paralysis following intraoral mandibular block of the inferior alveolar nerve with 1.8 ml of 2% lidocaine with adrenaline 1 in 100 000 (96). A few minutes after injection he had swallowing difficulties and a foreign body sensation in his throat. There was paralysis of the velum palatinum, with deviation of the uvula towards the non-paralysed side opposite the point of anesthetic infiltration. This resolved after the anesthetic had worn off. 

Occasional Swallowing difficulty, blurred vision, bloated feeling, impotence, urinary hesitancy... 

However in certain cases liquids are required, particularly where a patient has swallowing difficulties or is a young child. 

That liquid formulations be provided to the elderly with swallowing difficulties. 

This route can be used in patients with swallowing difficulties. 

Pharynx and larynx. Are there swallowing difficulties, cough, stridor, hoarseness, or aphonia How long after exposure did symptoms occur minutes, hours, days ... 

DeMatteo C, Matovich D, Hjartarson A (2005) Comparison of clinical and video fluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child... 

Toxicity Orally administered C-T. I is only poorly absorbed and rapidly eliminated. On parenteral administration it is highly toxic, like other structurally related bisindole alkaloids. LDjq (mouse i.v.) 0.01 to 0.06 mg/kg. Overdoses result in muscle paralysis that starts in the face and spreads through the neck, back, and stomach, followed by visual impairments, swallowing difficulties, disorders of circulation and respiration. The main therapeutic interventions are treatment with cholinesterase inhibitors and mechanical ventilation. 

Individualised oral liquids from solids (active ingredient in ora-sweet or ora-blend or ora-blend vehicle) [83] Patients with swallowing difficulties or dose determining with children... 

A patient, who got crushed medicines because of swallowing difficulties, was referred to a speech therapist at the request of a new nursing home doctor. The speech therapist investigated the patient s swallowing and noticed that the swallowing function was all right but that the patient was afraid of tablets getting stuck in the throat. The fear was overcome by exercises and the medicines did not needed to be crushed anymore. 

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