A Case Study Presentation

Nutritional Management of
Cerebero Vascular Accident (CVA)
or
Stroke
Presenters

Memoona Khalid
Food Science and Human Nutrition Department
Kinnaird College for Women Lahore
 Case Presentation
70Year-Old Woman
Medical History
 Diabetes mellitus Type II
 Hypertension
 Hyperlipidemia
Medications
 Metformin, Hydrochlorothiazide, Simvastatin
 History and Symptoms

At 2:30 pm, the patient’s spouse returned home to find his wife on
the floor. He last saw her normal when he left for the store at 1:00
pm. The patient showed signs of slurred speech, aphasia and
paralysis of the right arm and leg. There were no signs of trauma to
the patient. EMS was contacted and arrived on scene at 2:40 pm.
EMS personnel suspected stroke and took the patient to the nearest
hospital.
 Pathophysiology
What is CVA?

It is a disease that affects the arteries leading to and within the

brain. CVA is also named as Stroke
A stroke occurs when a blood vessel that carries
oxygen and nutrients to the brain is either blocked by a clot
or bursts (or ruptures). When that happens, part of the brain
cannot get the blood (and oxygen) it needs, so it and brain
cells die.
 Pathophysiology (Cont’d)

Major cause of CVA

 Atherosclerosis
Thrombus formation
 Abnormal filtration of lipids in the intimal layer of the arterial wall
 Plaque develops & locations of increased turbulence of blood -
 Platelets & fibrin adhere to the plaque
 Narrowing or blockage of an artery by thrombus
 Cerebral Infarction: blocked artery with blood supply cut off beyond the
blockage

 Temporary focal loss of neurologic function

 The patient showed the following signs and
symptoms

Slurred speech
Aphasia
Paralysis of the right arm and leg.
 There were no signs of trauma to the patient
Management of the Case based on
symptoms

The management of Cerebrovascular Accident is as

follows:

1. Nutritional Care Plan

2. Speech Therapy
3. Physiotherapy
 NCP: Assessment
 Nutrition Assessment was based on the following five
categories:

 Dietary History: 24 hours recall indicating excessive

dietary energy intake (i.e. 2060kcals/day), high fat intake
( 50%/day): recommended is 30%.
 Anthropometrics: height & weight was taken to assess
BMI (i.e. 37 kg/m2 – obese
 Biochemical data: Low HDL levels & high cholesterol
levels.
 NCP: Assessment
The following nutrient deficiencies were determined in the
case via biochemical assessment
 NCP:Assessment
( cont’d)
 Clinical examination : Edentulous , pale eyes ,
cracked lips and white tongue , loss of balance,
trouble walking and dizziness.

 GI Functioning : Dysphagia.
 NCP - Diagnosis
The nutritional diagnoses of the patient were as follows :

 Chewing difficulty
 Increased Energy Expenditure
 Inadequate oral food and beverage intake
 Physical inactivity
 Poor nutritional quality of life
 Self feeding difficulty
 Swallowing difficulty
 NCP- Intervention

 The core goals for this case were to :

1. Assess and manage Dysphagia

2. Maintain Adequate Nutrition
3. Provision of vitamin and mineral supplement
4. Lifestyle modification
 Dysphagia
 A swallowing disorder called dysphagia often occurs
as a result of stroke. It may occur in up to 65 percent
of stroke patients.
 All patients are at risk for malnutrition due to
compromised eating abilities and difficulty
swallowing (dysphagia).
 Guidelines for Management of
Different Levels of Dysphagia
 Level 1: Severe Dysphagia  NPO
 Level 2: Moderately severe dysphagia  Partial nutrition by
mouth only
 Level 3: Moderate Dysphagia  Modified textured diet
 Level 4: Mild-moderate dysphagia  Consistency modified
diet
 Level 5: Mild Dysphagia  Pureed Diet
 Level 6: Full Oral Intake of a Normal Diet
 Level 7: Normal Diet in all Situations
 Management
 The patient was diagnosed with Dysphagia Level 3 by the
physicians and therefore Modified Textured Diet was prescribed
by the dietitian.
 “A texture modified diet is one in which the textures of solid foods
and/or the liquid consistency are altered to better align with an
individual’s swallowing ability’
 It provides the following health benefits:
 Safe swallowing to prevent consequences of dysphagia and
aspiration including: malnutrition,
 dehydration and aspiration pneumonia.
 Appropriate management and treatment plan.
 Management ( Cont’d)
Dysphagia Level 3
Important points to consider
 All foods must be ground in a
machine to “small curd” cottage
cheese consistency.
 Foods must be moist and liquids
may be added to get the desired
consistency.
 Foods that are dry, crumbly,
sticky, gummy, hard or chewy
should be avoided.
Dietary Prescription for Dysphagia
Level 3
FOOD GROUP ALLOWED AVOID

BREAD Blenderized bread, Can add

milk, broth, etc. for fluid to All other breads, rolls,
soak through the product crackers, biscuits,
and make it spoon able. pancakes, waffles, French
toast .

VEGETABLES Blenderized vegetables All other vegetables that

without chunks, lumps, have not been pureed.
pulp, or seeds. Tomato sauce with seeds,
Tomato paste or sauce thin tomato juice.
without seeds.
Tomato or vegetable juice
Dietary Prescription for Dysphagia
Level 3

FOOD GROUP ALLOWED AVOID

FRUITS Well mashed fresh Whole fruits (fresh, frozen,
bananas. Fruit juices of all canned or dried)
kinds without chunks or
pulp

MILK Smooth puddings, None

custards, yogurt, pureed
desserts & soufflés.
FOOD GROUP ALLOWED AVOID
Pureed meats. Whole or ground meats,
MEAT & MEAT Meat broth without chunks. fish or poultry.
SUBSITUTES Hummus or other pureed Non pureed lentils or
legume spread. legumes.
Cheese, cottage cheese.
Peanut butter, unless
pureed into foods correctly.
Nonpureed fried, scrambled
or hard cooked eggs
 NCP - Evaluation

 The patient was monitored during her complete

hospitalization period i.e 2 weeks.

 The energy intake was maintained between 1600- 2000 kcals

per day.

 Food was taken from five food groups.

 Her cholesterol and blood glucose levels were with in normal

ranges most of the days.
 Conclusion

 The nutrition care plan successfully improved the

outcomes of the nutrition intervention.

 Future nutrition education plan and guidelines were

provided for follow up.
 Nutrition Education Plan for
Follow- up

 The following aspects play significant role in

prevention of stroke:

 Daily consumption of fresh fruits

 Flavonoids consumption >4.7 cups green tea daily
 Fish Consumption and Fish Oil use
 High HDL Cholesterol
 Symptoms to Minimize Risks

Caregivers need to be conscious of the following signs and

symptoms, to minimize risk of respiratory infections, dehydration
and malnutrition:
Drooling/poor management of oral secretions
Coughing and/or choking when eating or drinking
Pocketing of food in cheeks
Facial weakness
Gurgly, hoarse voice or lots of throat clearing
Multiple swallows for each bolus
Symptoms to Minimize Risks (Cont’d)

Decline in respiratory status

Prolonged meal times
Weight loss or malnutrition
Increasing avoidance of multiple foods and/or liquids
Reoccurring chest colds
Pain with swallowing
Thank You