Running Head: DYSPHAGIA IN STROKE PATIENTS

Journal Article Review: Hughes, S.M. (2011). Management of Dysphagia in Stroke Patients.
Nursing Older People.

Danna Gonzalez
820 794 378
Submitted March 4, 2015

DYSPHAGIA IN STROKE PATIENTS

Journal Article Review: Hughes, S.M. (2011). Management of Dysphagia in Stroke Patients.
Nursing Older People.
According to the article, Management of dysphagia in stroke patients (Hughes, 2011),
stroke is defined as the damage in neurological function due to sudden and sometimes fatal
alteration in blood flow to the brain (p.21). As explained by Sarah Hughes (2011), a stroke can
occur in two different ways: ischemic stroke, which is caused by a blood clot that impairs the
delivery of blood to the brain; and hemorrhagic stroke, which is caused by abnormal bleeding
within or around the brain that causes enough pressure to damage tissue function (p.21). When
this cerebrovascular accident occurs to any individual, not only are his or her physiological
functions affected, but also the lives of the people around them. Depending on the severity of the
cerebral damage, a person may have to rely on others to perform their simple daily activities
such as eating, getting dressed, and taking a bath.
For example, the article provides a case study on a patient, Richard Smith, who had an
ischemic stroke with a past medical history (Hughes, 2011, p. 22). The first and most important
part of providing care to a stroke patient is to assess the ability to swallow (Hughes, 2011, p. 22).
This helps health care providers to determine how well a person can still swallow on their own to
eat and obtain enough nutrition (Hughes, 2011, p. 22). Two other important things to consider
when helping to rehabilitate a stroke patient is to make sure that they are eating in the right
position, and that oral hygiene is monitored (Hughes, 2011, p. 22). It is safer for patients with
dysphagia to swallow sitting upright with their head tilting forward because it reduces that
chances of aspiration occurring (Hughes, 2011, p.23). Monitoring the patients mouth status is
also important because it tells us not only how hydrated the individual is, but also to determine if

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there are any infections that may affect the persons appetite to eat, and in turn, risk affecting
their nutrition status (Hughes, 2011, p. 23).
I chose to review this article because it focuses mainly on making sure that a patient (who
is impaired due to a stroke) is able to receive the right amount of nutrition. According to
Maslows hierarchy of human needs, nutrition falls under the first and most fundamental
category to surviving: biological and physiological integrity (Touhy et al, 2012, p. 28). Other
biological needs that are interconnected with nutrition are air, fluids, comfort, activity,
elimination, and skin integrity; if one of these needs were to be compromised, the health and well
being of an individual will decrease (Touhy et al, 2012, p. 28). As a first year practical nursing
student working through my first clinical placement in a long term care facility, I feel that it is
important that students are aware and value the importance of nutrition in older adults.
Discussion
The first nursing implication the article provides is the assessment of patients. It is
important to assess a stroke patient as soon as they are admitted into the hospital because it helps
determine the presence of previous complications, contributing factors that may have led to the
cerebrovascular accident, and what the most pressing problems are (Hughes, 2011, p. 22). In the
case of Richard Smith, he had a history of bipolar disorder, diverticular disease, and he used to
smoke for two years (Hughes, 2011, p. 22). After his ischemic stroke he was incontinent, unable
to move as a result of weakness, and suffered from dysphagia and dysarthria; therefore, Richard
became dependent of others around him (Hughes, 2011, p.22). Because of the assessment that
was done on Richard, we as the readers are able to recognize that dysphagia is a problem that is
considered important and can be managed through rehabilitation (Hughes, 2011, 22). Hughes
article taught me that assessment is an ongoing process because nurses and other health care

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providers need to find out whether or not the care they are implementing is improving Richards
health. For instance, a speech and language therapist is responsible for assessing Richards
ability to swallow in order to figure out the consistency of foods he is allowed to eat, which was
determined to be soft diet and normal fluids (Hughes, 2011, p. 22). Nurses caring for Richard
must also assess for the position that he eats because they want to reduce his chances of
aspirating any food and fluids (Hughes, 2011, p. 23). No matter how severe the stroke affects a
patient, we as health care providers must always try alternatives in providing nutrition as part of
the rehabilitation process.
Hughes also emphasized the importance of making sure that stroke patients receive a
good amount of nutrition every day in order to help them become stronger (Hughes, 2011, p. 23).
The malnutrition universal screening tool (MUST) is a nutritional screening tool that gives health
care providers an insight into how much nutrition the patient is receiving upon arrival to the
hospital (Hughes, 2011, p. 23). I personally did not know about this screening tool until I read
Hughes article, and I believe that this is something that I should consider looking more into,
especially because I am working with residents who had previous strokes and heart attacks.
When cerebrovascular accidents result in muscle paralysis, many patients lose the ability
to swallow, putting them at risk for an imbalanced nutrition. Hutchinson and Wilson (2013)
mentioned in their article that nasogastric and gastrostomy feedings are the alternatives to
feeding patients who have little to no swallowing abilities (p. 28). I believe that this is very
important to consider because tube feedings are more invasive compared to simple spoonfeeding on a daily basis. Therefore it is imperative that nurses achieve a nurse-client relationship
to ensure a timely, safe, and efficient rehabilitation (College of Nurses of Ontario, 2006, p. 3). If
a stroke patient needs to have a nasogastric or gastrostomy tube inserted and be fed through those

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tubes, the patient should feel as comfortable as they can. So far I have not had the opportunity to
insert or feed someone through a nasogastric or gastrostomy tube, but one of the first things I
would consider doing is to explain the procedure of how I will be inserting the tube, and how
uncomfortable it will be for them (College of Nurses of Ontario, 2006, p. 6). This not only makes
me knowledgeable and competent, but I want to be able to show patients that maintaining their
trust, comfort and safety is my priority.
Last but not least, the collaborative work of an interdisciplinary team is important to
ensure that stroke patients receive holistic care during the rehabilitation process. For example,
speech and language therapists are responsible for assessing the patients abilities to swallow to
determine the consistency of foods they are allowed to eat (Hughes, 2011, p. 22). The
examination consists of checking the function of cranial nerves associated with swallowing, and
oral hygiene. (Hutchinson & Wilson, 2013, p. 27). A dietitian can also be involved with
determining the kinds of foods patients should eat and drink in order to receive adequate
nutrition during their stay in the hospital, rehab centre, or long term care facility (Hughes, 2011,
p. 23). I believe that speech and language therapists, along with dieticians, nurses and physicians
are important to patient care because it ensures that the patient is being taken care of from
different points of view. From my personal experience at my clinical placement, I was able to sit
through my residents echocardiogram lab with a cardiologist. Because my resident had previous
heart attacks and strokes, it was important that his heart function was being monitored to ensure
that the medications he was taking were actually working. In addition, my resident was recently
discharged from receiving physiotherapy, which further emphasizes the need for contribution of
other health care professionals. I learned that interdisciplinary care not only provides a holistic

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care to patients, but it also incorporates communication, trust, and accountability between the
health care professionals (College of Nurses of Ontario, 2002, pp. 4, 11).
Reviewing Hughes article on managing dysphagia with stroke patients gave me an
overview of what the most important aspects of dysphagia that nurses and other health care
professionals should consider: assessment, adequate nutrition, and the collaboration of an
interdisciplinary team (Hughes, 2011, p. 24). Before reading this article, I only considered
procedures that I had to implement in order to keep stroke patients from aspirating food and
drinks, as well as reduce their risks of getting pressure ulcers due to long periods of immobility.
After reading more about managing dysphagia, nutrition and overall health in stroke patients, I
learned that there is a lot more work that goes into taking care of one person. Because the human
body is so dynamic with its metabolic processes, it is no wonder to me that it takes more than
one health care professional to contribute in the plan of care.

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7
Reference

College of Nurses of Ontario. (2002). Professional standards, revised 2002.

College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship, revised 2006.
Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3),
21-24
Hutchinson, E., Wilson, N. (2013). Acute stroke, dysphagia and nutritional support. Nutrition,
26-29
Touhy, T.A., Jett, K. F., Boscart, V., McCleary, L. (2012). Gerontological nursing and healthy
aging. Toronto, ON: Elsevier Canada.