RUNNING HEAD: Dysphasia In Stroke Patients

Paige Lacy

Scholarly Assignment: Journal Article Review

Article One: Management of Dysphagia in Stroke Patients
Author: Sarah Michelle Hughes
Journal Information:
Date of Publication: April 2011
Article Two: Dysphagia After Stroke and its Management
Authors: Rosemary Martino, Ruth E. Martin and Sandra Black
Journal Information:
Date of Publication: July 2010

Paige Lacy
Student No. N00835668
March 6, 2015

Dysphagia In Stroke Patients

Paige Lacy

It is estimated that every year in Canada there are 21 000 new

elderly patients with dysphagia after stroke and 200 000 in the United
States (Rosemary, 2012). In both articles, Management of Dysphagia
in Stroke Patients by Sarah Michelle Hughes and Dysphagia After
Stroke And Its Managements, by Rosemary Martino, Ruth E. Martin
and Sandra Black, focuses on the steps to managing and caring for
stroke patients who are experiencing dysphagia. I selected this article
topic because the title intrigued me and I craved to learn more. Due to
the predictable rise of strokes since the aging of our population, it gave
me a desire to learn more about the upcoming events within the
population. From reading these two articles the three nursing
implications that were presented remained very focused on assessing
dysphagia. The implications that were highlighted the most were, to
assess the patients swallowing ability status, nutritional status and to
provide oral hygiene.
It is important for a nurse to assess the swallowing status of a
patient who has experienced dysphagia after a stroke within the first
24 hours they are admitted to the hospital; this is crucial for a nurse to
assess and to confirm the patients ability to swallow. Speech and
language therapists also assess a patients ability to swallow during
their daily assessments (Hughes, 2011). By assessing a patients ability
to swallow allows nurses and staff the ability to monitor the patient
and their level of risk for malnutrition and aspiration pneumonia.

Dysphagia In Stroke Patients

Paige Lacy

Without being able to swallow a patient will not be getting the nutrition
required for a fast recovery. The CNO says that when assessing a
patient it is necessary to communicate and incorporate the
psychosocial needs of clients and their significant others into the plan
of care (CNO, infection prevention). From this nursing implication I
have learned how important it is to determine the swallowing status of
a stoke patient with dysphagia as well as communicate with the
patient to ensure that it is the fastest recovery as possible, if
dysphagia is not treated it could lead to aspiration pneumonia or
death. Reports of pneumonia in patients with dysphagia after stroke
range from 7% to 33%, with conservative estimates at 18% (Rosemary,
2012).
As a second implication, nutrition is essential for recovery from
dysphagia in a stroke patient. In 2009, the British Dietetic Association
launched a program of national descriptors for all adults requiring
modified textures in food and fluids (Hughes, 2011). Assessing a
patients ability to swallow permits the staff team to modify the
textures in food and fluid to accommodate the patients nutritional
needs by either providing soft diet, pureed diet, normal fluids,
thickened fluids, etc. While a patient is eating a nurse should always
assess how the patient is eating, some people tend to pocket their
food in the cheek. When someone pockets their food this can indicate
that their textured dietary requirements need to be reassessed

Dysphagia In Stroke Patients

Paige Lacy

(Hughes, 2011). By pocketing the food in their cheek the patient is not
reaching the nutritional status that is required for a fast recovery.
Another important assessment while caring for patients with dysphagia
after stroke is the proper positioning while feeding. A pilot study by
Kelly et al concluded that there are significant differences in the
swallowing-related muscles when people are horizontal and when they
are sitting upright; the study concluded that sitting upright is the safest
position (Hughes, 2011). I consider nutrition as a key aspect to
assisting a stoke patient to recover from dysphagia because it allows
them to regain strength and energy to restore health quickly. Another
nursing implication for patients who suffer from dysphagia after stroke
is providing oral hygiene.
The BDA states that 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). Oral
hygiene assessments are critical to provide a baseline, by assessing
how moist the lips are, mucous membranes and tongue to determine if
the patient is dehydrated. The CNO website states: nursing is the
therapeutic relationship that enables the client to attain, maintain or
regain optimal function by promoting the clients health through
assessing, providing care for and treating the clients health conditions
(CNO, ethics). By providing oral hygiene it allows to assess a persons
hydration, which is fundamental to a patients health status. A patient

Dysphagia In Stroke Patients

Paige Lacy

can (word) an infection by build up of bacteria in the mouth by not

providing oral hygiene, an infection in the oral cavity can also cause
further problems in other areas of the body as well as their nutritional
intake. Sarah states: Nutritional assessment poor hygiene can result
in reduced social interaction and reduced nutritional intake because of
pain or infection in the oral cavity (Hughes, 2011). I believe that oral
hygiene is an essential nursing implication with patients who face
dysphagia after stroke because by providing oral hygiene it allows a
nurse to assess the condition of a patient; dehydration can result in
death and many complications down the road. Assessing the oral
cavity frequently lets the nurse decide if a patient requires more or less
fluid intake to prevent dehydration in the body.
In conclusion, I believe that the three nursing implications that
will improve nursing practice with patients who experience dysphagia
after stroke is to assess the patients swallowing status within the first
24 hours of admission, assessing the patients nutritional status and
providing oral hygiene on a regular basis. By reviewing these two
articles I have realized how important swallowing and nutritional
assessments of a patient are as well as how big of a part oral hygiene
plays in this situation. These three implications all work together to
regain ideal function within a patient after a stroke, an initial
assessment as well as many additional assessments play a part in this
because a patients status could change which would result in changes

Dysphagia In Stroke Patients

Paige Lacy

in their swallowing and nutritional status. Overall, I agree with these

two articles and the topics they decided to touch on. It is very
important that all nurses and team members knows how to assess
these conditions to ensure a patient is safe at all times.

References