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Dysphagia Management in Stroke Patients

Student: Joshua Troy Luyun
821-482-601
Date Submitted: Feb 28 2013
NURS 260 01
PN Program Humber College

There are three stages of normal swallowing, the first stage is the oral stage in which the
food is formed into a bolus by the teeth, tongue and saliva which then pushes it to the back of the

pharynx where the second stage of swallowing begins, the pharyngeal stage which is an
involuntary process that ensures the epiglottis is closed, for the food to not go in the trachea in
order for the bolus to be guided in the G.I tact. The third stage is the esophageal stage which
ensures that peristaltic waves guide the food to the stomach. When a person suffers from stroke,
these 3 stages are affected negatively due to the neurological and muscular dysfunction that they
get from stroke, which leads us to dysphagia. Dysphagia is difficulty swallowing due to the
weakening of the esophageal muscles associated with neurological dysfunction such as stroke.
Upon suffering from dysphagia an individual can be hindered to communicate properly and can
result to a negative impact on the persons daily living. In this essay I will compare the article
Management of dysphagia in stroke patients by Sarah Michelle Hughes and Dysphagia after
stroke and its management by Martino, Rosemary, MSc, PhD; Martin, Ruth E, MHSc,
PhD; Black, Sandra, MD. This will be done by comparatively examining the main focuses of
each article, mainly for S.M. Hughess article, she focused on the nutritional status to rehabilitate
dysphagia caused by stroke in which the nurse is supposed to know while in the article of
Rosemary Martino, MSc, PhD et al, the focus was centralized on the importance of early
detection of dysphagia to minimize negative consequences and maximize recovery by the help of
physical therapy such as swallowing exercises to facilitate the rehabilitation of stroke related
dysphagia. Also in this essay, I will talk about how both authors looked at the holistic care for the
patient in order to rehabilitate dysphagia, not just trying concentrate on how can they treat the
ailment but try to look at the whole person in order to rehabilitate the ailment (dysphagia).

In the first article, S.M. Hughes focused on nursing implementations that concentrated on
how improving the nutritional status of the patient plays a big part in rehabilitating dysphagia. I

learned that it is important to assess people's swallowing status within 24 hours of admission to
hospital to ensure their nutrition and hydration needs are promptly managed (NICE 2008).
Although Speech and Language therapists (SLTS) is the common one who assesses swallowing,
there is a need for nurses to learn this skill in order to give full care to the patient specially to
their swallowing in order for them to be properly hydrated and fed according to their swallowing
ability. Oral hygiene was also included in the article as well as nutritional assessments. Assessing
these things can eventually rehabilitate dysphagia, it is not the cure but it plays a big role in
improving speech and swallowing of a person that has dysphagia. Learning all these, as a
student, can help me to deal with patients in the future that are suffering from dysphagia,
teaching me not just about proper skills to help them but also giving me the right mindset and
thought process to provide care.

In the second article from Rosemary Martino, MSc, PhD et al, the nursing
implementations that they focused on are more hands on, very detailed and organized
assessments. They mentioned that in order to maximize rehabilitation and minimize undesirable
consequences, early detection is essential for this process. Several approaches for management of
dysphagia have become well established in clinical practice for stroke, including compensatory
approaches such as enteral feeding, dietary modifications, posturing for feeding, advice on safe
eating, and oral hygiene, as well as behavioral maneuvers such as voluntary airway protection
and effortful swallowing.(Rosemary Martino, MSc, PhD et al, 2012) It is also stated in the article
that constantly using therapies is a very effective way to rehabilitate stroke related dysphagia.
For example, when compared with usual swallowing therapy (5 sessions averaging 16 minutes
each), high-intensity therapy (12 sessions averaging 24 minutes each) offered in the acute phase

produced greater recovery of swallowing ability and return to a normal diet at six months. (R.
Martino, MSc, PhD et al, 2012) Pharyngeal electrical stimulation has been reported to de - crease
aspiration, and increase cortical excitability, in patients with dysphagia after stroke. (R. Martino,
MSc, PhD et al, 2012) With these things being said in this article, I have learned that there are
quite a number of therapies that can help maximize the rehabilitation of dysphagia, it is not
curing them from stroke but it guides them in a way that when dysphagia is properly
rehabilitated, it will help the patient by positively impacting their speech, food intake, hygiene
and social life leading to rehabilitation of dysphagia that can potentially lead to recovery from
stroke. Learning and studying further more about these nursing implementations will eventually
help me in the future, and by knowing these skills I will not be only a skilled nurse but a nurse
that can provide proper and rehabilitative care.

The third nursing implementation that I will be talking about is how both authors of the
articles used the holistic approach in order to rehabilitate dysphagia, both also shared a goal that
the priority of dysphagia management is to reduce risk of aspiration pneumonia. Both authors
also talked about communication and how important it is to have effective communication
between the patient and the healthcare team, in this way the team can approach the patient more
of like a human being that is in need of care rather than a patient seeking for cure. Effective
communication also means that the team is oriented with the changes about the patient to help
them understand the patients situation which means that the team meets regularly and talks
about the needs of the patient and also giving feedback to each other to improve the care that
they are giving to the patient, which then leads to better care plans that can maximize the
rehabilitation an ailment that a patient is suffering from which in this case is dysphagia. These

approaches can help with my nursing practice not only to have a good and effective
communication and knowledge about my patient but also to help my team improve by giving
feedback and proper reports about my patient.

In conclusion, dysphagia caused by stroke can be approached in three different but fairly
similar ways. There is the approach of caring for the nutritional needs of patient, hydration and
oral hygiene. Next is the approach through hands on and very detailed therapies, constant and
frequent therapies produce situations in which patient is improving in rehabilitating against
dysphagia. And lastly, dysphagia can be approached holistically by looking at the needs of the
patient for care and not just looking for a cure for the patient. This is also the time where
effective communication comes into play, proper communication between the team and the
patient and communication between the team members themselves is very essential in order help
the patient rehabilitate dysphagia.

REFERENCES

Martino, Rosemary, MSc, PhD; Martin, Ruth E, MHSc, PhD; Black, Sandra, MD, (2012). .
dysphagia after stroke and its mangement. 184 (), pp.1127-8

Hughes, Sarah Michelle, (2011). NursingHughes, Sarah Michelle, (2011). Nursing Older People.
Management of dysphagia in stroke patients. 23 (), pp.21-4

National Institute for Health and Clinical Excellence (2008) Stroke. Diagnosis and Initial
Management of Acute Stroke and Transient Ischaemic Attack (TIA). NICE, London.