Running head: MANAGEMENT OF DYSPHAGIA IN STROKE PATIENTS

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Management of Dysphagia in Stroke Patients

Rajinder Kaur
821-332-236
Humber Institute of Technology & Advanced Learning
NURS 260: Practical Nursing Theory 2
Judy Martin
March 8, 2013

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Management of Dysphagia i
I

Stroke is medical emergency in which an individual undergoes the loss of

cerebral function. There are many problems that an individual faces after stroke.
Dysphagia is the most common problem. Therefore, rehabilitation of dysphagia is very
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important as it can lead to some other health complications. In order to rehabilitate a

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patient with dysphagia, assessment of swallowing and positioning, form of diet, nutrition

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status, and oral hygiene should be maintained. Health care providers and family members

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work together to achieve the best results.

a stroke an individual is able to chew the food in the mouth and make a

bolus- a ball like pel~f

food and push it into the back of the mouth towards pharynx. It

is a voluntary action (Hughes, 2011). Due to neurological and muscular changes the
involuntary actions performed by the muscles of pharynx and esophagus which ensure
that food enters gastrointestinal tract; muscles of larynx which close the epiglottis and
vocal cords that prevent food from entering the trache~cles

of esophagus which

ensure peristalsis movement to make bolus of food enter into the stomach are affected.~
Hence, it becomes important to check if the individual is choking or coughing while

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swallowing. It should be noted t~t if individual' s swallowin~

delayed, initially

swallowing with difficulty, feels food is sticking in the throat, and gagging (Hughes,
2011). Any type of swallowing difficulty due to reduced muscle tone or paralysis can
lead to aspiration pneumonia, in which food or fluids pass into trachea and lungs. In order
to eliminate the risk of aspiration pneumonia, positioning of the patient should be correct

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such' as sitting upright. A study has been conducted (Hughes, 2011) which states that
there is a significant difference in swallowing-related muscles when people are in

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Management of Dysphagia ieatients

horizontal position or sitting upright. Sitting upright was concluded as the safest position.
Hence, as a nurse it is very essential to know the physiological changes, signs and
symptoms in a patient suffering from stroke. It will help the nurse to determine the right
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)position

for the patient while eating~is

and choking incidents. According ~tional

reduces the chances of aspiration pneumonia

Patient Safety Agency (2007), 58 percent

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Of

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choking incidenm~

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from inpatient services.

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for stroke patients should be according to person's

~ ~~~ 7. swallowing status. One of the problems after stroke is paralysis. Anyone side right orleft
t.ci50'vj can get affected. Patient can start pocketing food in cheek on the affected side. Texture of
the diet can be soft diet and normal (thin) fluids or pureed diet and thickened fluids.
Apart from textured three meals, patients need additional nutrition through supplements.
Nutritional assessment should start from the time of admission to a healthc:"",, setting an~

should be checked at regular intervals till the patient is in the hosPit~itio~

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assessment can help in establishing a baseline nutritional needs of a patient and regular
check at intervals can help in establishing goals for the changes to be made. Textured diet,
supplements, nutritional assessment, everything works good if the patient accepts the
condition and co-operates with the situation. However, it is the duty of the nurse to
mainta~t's

nutritional status by carrying out nutritional screening in day-to-day

practice.

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Finally, just as it is important to establish baseline for nutritional status, it is

equally important to create baseline for oral hygiene. The swallowing process relies on

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Managementof DysphagiaiBatients

good oral hygiene and hYdratiO~ghes,

2011). Oral assessmentat the time of

admission to a healthcare setting helps in creating a baseline by assessing the moisture of

lips, mucus membrane and tongue; it helps in determining the signs of dehydration and
infection. Dental hygiene helps in knowing other disease processes or interventions
which can interfere with person's oral hygiene. As a nurse, it is important to kn~at
oral hygiene is an important factor in the management of dysphagia.
In conclusion, swallowing and positionin~~m

of diet and nutrition~atus

and

oral hygiene are the important aspects in managing dysphagia after stroke. Thus, a nurse
with a deep knowledge of pathophysiology of stroke and its effects on the person, can
work with other healthcare providers such as doctors, physiotherapists, speech and
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language therapist~ dentisSand take care of the patient in a safe and holistic manner.

Management of Dysphagia in Stoke Patients

References

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Hughes, S. (2011). Management of dysphagia in stroke patients. Nursing Older People,

23(3),21-24.