The management of dysphagia in stroke

Abstract

People who have strokes suffer a variety of problems, depending on the site and severity of brain damage. A particularly unpleasant and dangerous one is dysphagia which, if not properly assessed and managed, can prevent the patient receiving adequate nutrition to enable him or her to participate fully in a rigorous rehabilitation programme, or which may even cause his or her death through aspiration of food. The authors describe an appropriate nursing response to the problem, and advocate a multidisciplinary approach to the management of nutrition in the care of patients with strokes.

Management of dysphagia in stroke patients

“…When someone pockets their food this can indicate that their textured dietary requirements need to be reassessed (Corcoran 2005). Beadle et al (1995) state that people's nutritional needs should not purely be met by a textured diet and that fortified supplements are prescribed and offered to patients with dysphagia. thickened fluids should be used after a thorough assessment of patients and their swallowing status.…”

“…Mr smith's oral assessment was combined with an assessment of his nutrition. Beadle et al (1995) explain that this enables the MDt to establish a baseline of nutritional needs and regular reassessment means changes can be made to meet those needs. However, nutritional screening is carried out by nurses in day-to-day practice.…”

Poststroke Dysphagia: Implications for Nurses

“…Coughing : Clients with dysphagia may cough while eating or drinking. This can occur as a result of a weakness in the tongue that causes food to fall over the base of tongue into the unprotected airway (Lugger, 1994) or as a result of a delay in the swallowing reflex that allows food to enter the airway (Beadle et al, 1995). Nurses can note whether clients cough during meals.…”

“…Pocketing food : Food remaining in the buccal cavity after swallowing has occurred is termed pocketing . A loss of sensation on the affected side of the mouth and hemiparesis of the tongue can contribute to this symptom (Beadle et al 1995). The nurse can assess for pocketing of food by inspecting the client's mouths after he or she has swallowed.…”

“…Difficulty with swallowing, or dysphagia, occurs in 30%–65% of clients who have had a stroke (Roth & Harvey, 1996) and places clients at risk for numerous complications, such as aspiration pneumonia (Beadle, Townsend, & Palmer, 1995; DePippo, Holas, & Reding, 1994; Gauwitz, 1995; Lugger, 1994; Negus, 1994; Roth & Harvey; Smithard et al, 1996), dehydration (Fayad & Brass, 1991; Lugger; Smithard et al), malnutrition (Beadle et al; Fayad & Brass; Lugger; Smithard et al), and depression (Beadle et al; Lugger), and can even cause death (Lugger). The ability to diagnosis and manage dysphagia requires a consistent and logical approach from the interdisciplinary team (Negus).…”