The management of dysphagia in stroke patients whether in long term or acute care is an important care delivery that nurses must pay close attention to. Nurses must take the time to assess stroke patients for dysphagia in order to prevent or reduce the risk of nutritional and hydration deficiency. Stroke occurs when there is inadequate blood flow (ischemia) the brain or hemorrhaging around the brain resulting in death of brain cells (Lewis, 2010).
When a person suffers a stroke, parts of the body become paralyzed or weakened, fortunately with a rigorous rehabilitation programs the chance of recovery and return to normal activities of daily life are achievable. Lewis defines dysphagia as “any impairment in eating, drinking or swallowing” (p. 1029, 2010) and it is a serious problem which can lead to numerous negative consequences including weight loss, dehydration and aspiration (Touhy & Jett, 2010, p. 120).
Patient with this problem lose their appetite and refuse to eat because they experience pain or discomfort while swallowing. As a result, patients with dysphagia become malnourished, and they need to be placed on IV solution or on GT feeding in order to provide them with essential nutrients thereby helping them maintain a healthy body weight. The purpose of this paper is to provide information about dysphagia management and rehabilitation by using the case study of Mr Richard Smith to illustrate the complexity of problems stroke patients face.
The study further highlights the criticality of timelines in the assessments and immediate implementation of nutrition and hydration procedures by the health care team. According to Sarah Michelle Hughes, the author of “Management of dysphagia in stroke patient,” patients who suffer from stroke are often times affected by complication like dysphagia and dysphagia. Management of dysphagia is crucial during rehabilitation so because it can reduce if not prevent the risk of aspiration pneumonia, morbidity and mortality.
Hughes emphasized health care personnel to be cognizant of the patient’s position when swallowing, oral hygiene and nutritional assessment, since these are significant factors that can easily be observed to ensure the most favourable recovery and evaluate the effectiveness rehab services are provided. There are two types of strokes, ischemic and haemorrhagic stroke. People who have had stroke suffer from and that there are physical, psychological, emotional and financial implications. In the article it is noted that normal swallowing happens in three stages and that when a stroke ccurs each of these stages could be affected as a result of neurological and muscular changes dysphagia (Hughes, 2011, p. 21-22).
Even though Mr Richard Smith suffered other effect resulting from the stroke, Hughes -author of article – kept her focus on dysphagia management and rehabilitation. The keys point drawn from the article was the assessment of swallow, positioning, and nutritional assessment. It was important for a swallowing assessment to be done on the patient to see if there will be a need to modify the texture of his food and fluids.
The article stated the Mr Smith had become prune to “pocketing” his food in his left cheek, due to weakness resulting from his stroke (Hughes, 2011), as a result his dietary recommendation was changed. Because the swallowing assessment was done, the nurses were able to identify that Mr Smith was not able to have normal meal anymore; therefore, thickened fluids, pureed meals and supplement were to be given to him. Later on he was able to consume regular meals once again. Next point was positioning.
The safest position for a patient with dysphagia is sitting upright. This is essential so as to reduce the risk of aspiration due to the neurological and physical changes experienced by the patient. Incorrect position can lead to choking and even death. Nutritional assessment and oral hygiene were the next points. Nutritional assessment give a detailed overview on the patient nutritional status, which includes blood result and patient’s history and oral hygiene assessment seeks out signs of infection and dehydration of the mouth.
I think oral hygiene and nutritional assessment goes together because if there is poor oral hygiene, the patient may feel pain when eating or contract an infection and will refuse to eat. Oral hygiene should be assessed regularly by the nurses to prevent infection and discomfort for patient when eating and with proper oral care/ hygiene; the patient will be at a lower risk for malnutrition and weight loss. All these assessments have to be done in order to prevent any complication that may put the patient at risk and preventing a productive and speedy recovery.
The findings presented in the article can be utilized in my clinical setting as it clearly place accountability on the healthcare team for the patient’s diagnosis, assessment and care. The lines of communication must be open not only with all the health care teams involved but also including family members. By doing this, there will be effective care giving to the patient and there will be little room for confusion and miscommunication.
Also, ensuring that all required preliminary evaluations are done, especially a swallowing assessment, the risk for further complications will be greatly reduced. The less the complications or risks, the more successful the rehabilitation and recovery for the client and that is the priority. The primary responsibility is getting the patient back to be comfortably state where they are able to fulfill their essential needs independently or with minimal assistant.
In conclusion, the assessment of dysphagia plays an important role in the management and rehabilitation of stroke patients. Assessment of swallowing, positioning, oral hygiene and nutritional assessment are keys factors used in assessing a stroke patient for optimum results. After reading this article and writing this paper, the importance of immediate assessment and treatment of a stroke victim is clearly evident as the difference between recovery and disability.
January 9, 2018
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