Management of Dysphagia in Stroke Patients

Management of Dysphagia in Stroke Patients

Sarah Michelle Hughes
Nursing Older People (April 2011)
By Ralph Pangan
826-298-333
March 6, 2015

Management of Dysphagia in Stroke Patients

The experiences of having a stroke and its effects on the human body presents a significant impact
on the physical health of a patient. Not only does the effects of a stroke affect a person physically, but
it also does affect a patient emotionally. Such problems of patients who are victims of stroke encounter
cognitive problems, difficulty in communicating, depression, visual problems and etc. The focus of
this paper, however, is the care given to a patient experiencing dysphagia after a stroke. In the article,
Management of Dysphagia in Stroke Patients, written by Sarah Michelle Hughes, the article solely
focuses on a case study of Richard Smith to help demonstrate the experiences of stroke patients living
with difficulty in swallowing. I chose this topic because this topic is relatable to my own personal life
as I was assigned to a patient who had a stroke and is not able to swallow easily. It would be
interesting to learn more about this topic as it is beneficial to myself since my clinical placement is
currently in a rehabilitation facility, where I could encounter more patients with a past history of stroke
that deals with dysphagia. The articles direct and useful information clearly gave me an insight on the
routine and the actions of the MDT (multidisciplinary team) that comes with managing a patient who
is unable to swallow with ease.. More importantly, the article focuses on the crucial aspects of
dysphagia management of Mr. Smith where adequate nutrition and oral hygiene is prioritized, nurses
are educated about the proper care given to patients who are affected by dysphagia, and where nurses
are able to assess the patients ability to swallow.
Patients who are diagnosed with dysphagia needs to receive oral hygiene followed by an adequate
nutrition. These two nursing interventions goes a long way for a patient in rehabilitation as prioritizing
these will preserve and promote the health of the affected patient. Oral hygiene is essential to patients
who has this swallowing disorder because according to the The BDA (2009), ...mouth care should be
considered when assessing and managing patients with dysphagia as the swallowing process relies on
good oral hygiene and hydration. (Hughes, 2011, par. 15) Good oral hygiene and hydration is needed
as a clean mouth, which is free of food, can eliminate the risk of bacterial growth within the mouth
and hydration is necessary in order for the food to breakdown and allows the patient for smooth
swallowing. Mainly, oral hygiene should be prioritized and treated with care because if neglected or
left untreated, the patient is at risk for more problems. Dysphagia can develop into aspiration

Management of Dysphagia in Stroke Patients

pneumonia, an infection that increases the catabolic condition of the patient and requires more energy
and an increase in nutritional demand.... malnutrition, dehydration, and infection are common
consequences of dysphagia. (Shaker and Geenen, 2011) An adequate nutrition is also a priority;
possessing dysphagia will alter the diet intake of the patient and can become at risk for malnutrition.
Patients with this disorder will likely have their nutritional intake decreased due to requirements
doctors have ordered. Another reason why a patient might be at risk for malnutrition is the stress and
depression that comes with experiencing stroke and dysphagia. Going through such a difficult time
such as experiencing a stroke will cause an emotional distress on the patient since the effects of stroke
can affect their every day routine as their activities of daily living and appetite are greatly modified;
this condition is known as poststroke depression. Patients who needs their diet to be changed, due to
dysphagia, may go through poststroke depression as the foods that have been ordered by the doctor
can be unsatisfying and patients would refuse to consume their food, which will eventually result to
malnutrition. Therefore, oral hygiene and adequate nutrition cannot be neglected as doing so will have
negative outcomes for the patient.
The nurses should be educated about the proper care given to patients diagnosed with dysphagia.
When treating a patient who has dysphagia, there are many precautions and actions to be kept in mind
to further promote the patients health and prevent undesired consequences. One of these actions are
the type of care the patient needs, which includes what actions should a nurse consider if a patient is
on a feeding tube versus a patient who feeds by mouth. If a patient feeds by mouth, the nurse should
make sure the patient is positioned upright (90 degrees) to prevent aspiration; it is suggested to
position the patient 30 minutes prior to feeding to ease the patient of difficulty swallowing. Also, the
nurses should review the patients conditions if he/she has hemiplegia regarding to weakness on either
side of the face due to stroke. If the patient has right sided weakness, the nurse should Place small
bites of food on the stronger side of the patient's mouth. (Potter and Perry, 2013, pg. 1080) Lastly, the
nurse should determine the food viscosity that is best tolerated by the patient. For example, some
patients are able to swallow thickened fluids than thin fluids. On the other hand, patients who are on a

Management of Dysphagia in Stroke Patients

feeding tube should be positioned at least 30 degrees during continuous feedings. Patients who are on
continuous feedings should also be checked on the position of their tube at least every 4 hours. If the
patient is receiving intermittent feedings, the position of the tube should be checked before each
feeding. If all of these actions are implemented by the nurse, further complications can be avoided and
the health of the patient will significantly be improved.
Ultimately, to successfully manage a patient diagnosed with dysphagia, a nurse must be able to
assess a patients ability to swallow. Nurses are responsible for assessing the appropriateness
including the potential benefit and harmof all interventions before providing the intervention.
(CNO, 2014) In the case of dysphagia, a nurse should be able to determine the patients ability to
swallow before a speech language pathologist can assess the patient formally. This is important as
nurses interacts with patients more frequently than a speech language pathologist does. Also, it is
crucial that within the first 24 hours of admission into the hospital, the patients ability to swallow has
to be assessed in order for the proper diet that suites the patients needs. This will ensure their
nutrition and hydration needs are promptly managed. (Hughes, 2011) The assessments that nurses
should keep in mind are: the quality of swallowing (what is the degree of difficulty the patient is
having with swallowing), the type of foods the patient is able to swallow (e.g. thickened fluids or
pureed), and the patients mental status (making sure he can voluntarily cough, clear his throat and
swallow saliva). These assessments helps speed up the process of rehabilitating a patient to his/her
normal condition as determining the patients ability to swallow will allow the MDT (multidisciplinary
team) to detect if the patients condition has improved. Also, discovering the type of foods the patient
is able to swallow will aid in prevention of aspiration and will allow the muscles of the esophagus to
swallow easier; lastly, determining the patients mental status will also assist in preventing a patient
from aspiring. In summary, evaluating a patients ability to swallow will help in rehabilitating a patient
to his/her regular condition.
In conclusion, managing a stroke patient with dysphagia involves providing the patient with a
sufficient amount of nutrients and performing oral hygiene, the appropriate care given to different

Management of Dysphagia in Stroke Patients

patients with dysphagia, and the assessment of the patients ability to swallow evaluated by the nurse.
It is important for nurses to be educated about how to manage certain conditions as being ignorant on
how to treat the patients health status can delay or worsen the patients rehabilitation process to
normal health. The articles method of presenting the case study of Mr. Smith and his disorder of
dysphagia was a perfect demonstration of how to effectively care for a patient who has trouble
swallowing; the concise information given will definitely aid in my performance in the rehabilitation
unit as I will most likely come across another stroke patient with the problem of dysphagia.

References
Complementary Therapies. (2014, July 1). Retrieved March 6, 2015, from
http://www.cno.org/Global/docs/prac/41021_CompTherapies.pdf

Management of Dysphagia in Stroke Patients

Hughes, S. M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3),
21-4. Retrieved from

http://search.proquest.com/docview/860038578?accountid=11530

Potter, Patricia, Anne Perry, Janet Ross-Kerr, Marilynn Wood, Barbara Astle, Wendy
Duggleby. Canadian Fundamentals of Nursing, 5th Edition. Mosby Canada, 2014.
VitalBook file.
Shaker, R., & Geenen, J. E. (2011). Management of Dysphagia in Stroke Patients.
& Hepatology, 7(5), 308332.

Gastroenterology