Early Nutritional Intervention

and its Benefits for Stroke Patients

Dimas Cortez Breanna Schmidt Cady Latshaw amp Jessie Sypinski

MISSION MOMENT

bull httpswwwyoutubecomwatchv=YN1M2t4Gf-Q

MISSION MOMENT

bull httpswwwyoutubecomwatchv=YN1M2t4Gf-Q

PICO QUESTION

bull In acute stroke patients on a medical-surgical floor what is the benefit of early nutritional screening and support on recovery after

stroke

bull POPULATION Acute stroke patients on a medical-surgical floor

bull INTERVENTION Early nutritional screening and support

bull COMPARISION Prolonging nutritional assessment

bull OUTCOME Recovery after stroke

LEARNING OBJECTIVES

1 The learner will develop a clear understanding of the impact of early nutritional

screening on outcomes for patients after a stroke

2 The learner will be able to identify stroke deficits that would hinder appropriate

nutritional intake

3 The learner will be able to recognize multiple feeding strategies in order to obtain

optimal nutritional status in patients that suffered from a stroke

4 The learner will be able to compare and contrast different nutritional assessment tools

for the use of dysphagia screening

DEFICITS THAT IMPAIR EATING

bull Inability to maintain upright posture

bull Loss of upper extremity movement or sensation

bull Problems with chewing or swallowing

bull Communication deficits

bull Visual deficits

bull Depression

(Perry et al 2012)

wwwhealth24com

SIGNIFICANCE TO PRACTICE

bull The reported frequency of malnutrition after stroke has varied from 8 to 34 (American Heart Association 2003)

bull Studies have shown that malnutrition increases the risk of several complications including infections pressure ulcers and gastrointestinal bleeding It is also associated with lower functional ability and mortality (Mosselman et al 2013)

bull Although the effects of malnutrition are well-recognized nutritional intervention is not considered a priority (Perry et al 2012)

bull Tools such as the Mini Nutritional Assessment (MNA) identified that malnutrition post-stroke ranged from 16 to 26 within the first week (Creasey 2012)

bull Post-stroke patients often suffer from a range of disabilities that effect nutritional intake like postural upper limb and visual impairments (Nip et al 2011)

CURRENT PRACTICE

Literature bull There is a lack of standardization of

assessment of nutritional status (American Heart Association 2003)

bull The screening of nutritional status and support is not a standard of practice depsite known complications for malnutrition (Mosselman 2013)

bull There is a lack of nutrition-related information in nursing literature (Mosselman 2013)

bull The nursing role in nutrition is often thought of mealtime management and enteral tube feedings (Perry et al 2012)

Good Samaritanbull During a stroke admission there is no

specific nutritional assessment done

bull The admitting nurse does a quick swallowing evaluation

bull Nutritional consults are only given automatically to patients presenting with low Braden scores

bull A full nutritional assessment is usually not done for several days post-admission

CURRENT PRACTICEbull No standardization among

assessment tools

bull Different parameters for use

bull None specific to stroke and dysphagia patients

wwwcancerworldorg

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

LEARNING OBJECTIVES

1 The learner will develop a clear understanding of the impact of early nutritional

screening on outcomes for patients after a stroke

2 The learner will be able to identify stroke deficits that would hinder appropriate

nutritional intake

3 The learner will be able to recognize multiple feeding strategies in order to obtain

optimal nutritional status in patients that suffered from a stroke

4 The learner will be able to compare and contrast different nutritional assessment tools

for the use of dysphagia screening

DEFICITS THAT IMPAIR EATING

bull Inability to maintain upright posture

bull Loss of upper extremity movement or sensation

bull Problems with chewing or swallowing

bull Communication deficits

bull Visual deficits

bull Depression

(Perry et al 2012)

wwwhealth24com

SIGNIFICANCE TO PRACTICE

bull The reported frequency of malnutrition after stroke has varied from 8 to 34 (American Heart Association 2003)

bull Studies have shown that malnutrition increases the risk of several complications including infections pressure ulcers and gastrointestinal bleeding It is also associated with lower functional ability and mortality (Mosselman et al 2013)

bull Although the effects of malnutrition are well-recognized nutritional intervention is not considered a priority (Perry et al 2012)

bull Tools such as the Mini Nutritional Assessment (MNA) identified that malnutrition post-stroke ranged from 16 to 26 within the first week (Creasey 2012)

bull Post-stroke patients often suffer from a range of disabilities that effect nutritional intake like postural upper limb and visual impairments (Nip et al 2011)

CURRENT PRACTICE

Literature bull There is a lack of standardization of

assessment of nutritional status (American Heart Association 2003)

bull The screening of nutritional status and support is not a standard of practice depsite known complications for malnutrition (Mosselman 2013)

bull There is a lack of nutrition-related information in nursing literature (Mosselman 2013)

bull The nursing role in nutrition is often thought of mealtime management and enteral tube feedings (Perry et al 2012)

Good Samaritanbull During a stroke admission there is no

specific nutritional assessment done

bull The admitting nurse does a quick swallowing evaluation

bull Nutritional consults are only given automatically to patients presenting with low Braden scores

bull A full nutritional assessment is usually not done for several days post-admission

CURRENT PRACTICEbull No standardization among

assessment tools

bull Different parameters for use

bull None specific to stroke and dysphagia patients

wwwcancerworldorg

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

DEFICITS THAT IMPAIR EATING

bull Inability to maintain upright posture

bull Loss of upper extremity movement or sensation

bull Problems with chewing or swallowing

bull Communication deficits

bull Visual deficits

bull Depression

(Perry et al 2012)

wwwhealth24com

SIGNIFICANCE TO PRACTICE

bull The reported frequency of malnutrition after stroke has varied from 8 to 34 (American Heart Association 2003)

bull Studies have shown that malnutrition increases the risk of several complications including infections pressure ulcers and gastrointestinal bleeding It is also associated with lower functional ability and mortality (Mosselman et al 2013)

bull Although the effects of malnutrition are well-recognized nutritional intervention is not considered a priority (Perry et al 2012)

bull Tools such as the Mini Nutritional Assessment (MNA) identified that malnutrition post-stroke ranged from 16 to 26 within the first week (Creasey 2012)

bull Post-stroke patients often suffer from a range of disabilities that effect nutritional intake like postural upper limb and visual impairments (Nip et al 2011)

CURRENT PRACTICE

Literature bull There is a lack of standardization of

assessment of nutritional status (American Heart Association 2003)

bull The screening of nutritional status and support is not a standard of practice depsite known complications for malnutrition (Mosselman 2013)

bull There is a lack of nutrition-related information in nursing literature (Mosselman 2013)

bull The nursing role in nutrition is often thought of mealtime management and enteral tube feedings (Perry et al 2012)

Good Samaritanbull During a stroke admission there is no

specific nutritional assessment done

bull The admitting nurse does a quick swallowing evaluation

bull Nutritional consults are only given automatically to patients presenting with low Braden scores

bull A full nutritional assessment is usually not done for several days post-admission

CURRENT PRACTICEbull No standardization among

assessment tools

bull Different parameters for use

bull None specific to stroke and dysphagia patients

wwwcancerworldorg

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

SIGNIFICANCE TO PRACTICE

bull The reported frequency of malnutrition after stroke has varied from 8 to 34 (American Heart Association 2003)

bull Studies have shown that malnutrition increases the risk of several complications including infections pressure ulcers and gastrointestinal bleeding It is also associated with lower functional ability and mortality (Mosselman et al 2013)

bull Although the effects of malnutrition are well-recognized nutritional intervention is not considered a priority (Perry et al 2012)

bull Tools such as the Mini Nutritional Assessment (MNA) identified that malnutrition post-stroke ranged from 16 to 26 within the first week (Creasey 2012)

bull Post-stroke patients often suffer from a range of disabilities that effect nutritional intake like postural upper limb and visual impairments (Nip et al 2011)

CURRENT PRACTICE

Literature bull There is a lack of standardization of

assessment of nutritional status (American Heart Association 2003)

bull The screening of nutritional status and support is not a standard of practice depsite known complications for malnutrition (Mosselman 2013)

bull There is a lack of nutrition-related information in nursing literature (Mosselman 2013)

bull The nursing role in nutrition is often thought of mealtime management and enteral tube feedings (Perry et al 2012)

Good Samaritanbull During a stroke admission there is no

specific nutritional assessment done

bull The admitting nurse does a quick swallowing evaluation

bull Nutritional consults are only given automatically to patients presenting with low Braden scores

bull A full nutritional assessment is usually not done for several days post-admission

CURRENT PRACTICEbull No standardization among

assessment tools

bull Different parameters for use

bull None specific to stroke and dysphagia patients

wwwcancerworldorg

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

CURRENT PRACTICE

Literature bull There is a lack of standardization of

assessment of nutritional status (American Heart Association 2003)

bull The screening of nutritional status and support is not a standard of practice depsite known complications for malnutrition (Mosselman 2013)

bull There is a lack of nutrition-related information in nursing literature (Mosselman 2013)

bull The nursing role in nutrition is often thought of mealtime management and enteral tube feedings (Perry et al 2012)

Good Samaritanbull During a stroke admission there is no

specific nutritional assessment done

bull The admitting nurse does a quick swallowing evaluation

bull Nutritional consults are only given automatically to patients presenting with low Braden scores

bull A full nutritional assessment is usually not done for several days post-admission

CURRENT PRACTICEbull No standardization among

assessment tools

bull Different parameters for use

bull None specific to stroke and dysphagia patients

wwwcancerworldorg

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

CURRENT PRACTICEbull No standardization among

assessment tools

bull Different parameters for use

bull None specific to stroke and dysphagia patients

wwwcancerworldorg

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

LITERATURE REVIEW

bull Databases searched EBSCO Health Google Scholar PubMed Cochrane Library Medline Plus

bull Keywords used nutrition stroke outcome prognosis acute cerebrovascular accident malnutrition dysphagia nursing feeding eating eating difficulties outcomes risk factors early nutritional supplementation

bull Year limits 2003- 2013

bull Other search limits used clinical guidelines systematic review meta-analysis randomized controlled trial

bull Number of articles reviewed 12 articles reviewed

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

SUMMARY OF EVIDENCE

bull Early nutritional support can decrease morbidity and mortality reduce complications and reduce further risks and deterioration of patient (Wang et al 2013)

bull Early nutritional status is associated with long term outcomes (Garibella 2003)

bull There is an increased prevalence of dysphagia that is consistent among stroke patients (Martino et al 2005)

bull Nutritional supplementation decreased the prevalence of pressure sores in the majority amount of patients in a study that included over 6000 patients (Geeganage Beavan Ellender amp Bath 2012)

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

SUMMARY OF EVIDENCE hellipCONTINUED

bull Nutritional Supplementation that started earlier rather than later revealed a lower end-of study fatality percentage (Geeganage Beavan Ellender amp Bath 2012)

bull Acute stroke patients nutritional needs should be the primary focus with a special focus on the delivery of protein (Creasey 2012)

bull A dietician consult should be implemented in order to provide adequate nutrition (Wirth et al 2013)

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

CONSIDERATIONS FOR PRACTICE

bull The use of behavioral interventions and acupuncture reduced dysphagia and pharyngeal electrical stimulation decreased pharyngeal transit time (Geeganage Beavan Ellender amp Bath 2012)

bull Women become more malnourished after experiencing a stroke compared to men (Medin et al 2011)

bull Stroke patients should have more supervision during mealtimes and assessments on food consumption should be utilized (Medin et al 2011)

bull Dysphagia should not be the only eating difficulty that is assessed in stroke patients Stroke patients should also be assessed for arm movement lip closure and the ability to swallow (Westergren 2006)

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

RECOMMENDATIONS FOR NURSING PRACTICE

bull Early nutritional assessment and detection is recommended to ensure safe swallowing (Westergren 2006)

bull For patients requiring long-term nutritional support PEG feeding results in decreased complications (Geeganage 2012)

bull Evaluating food consumption and how patients manage food on a plate would help decrease the prevalence of malnutrition (Medin et al 2011)

bull Early screening of malnutrition risks should be completed within the first 10 days of admission (Mosselman et al 2013)

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

REFERENCES

bull American Heart Association (2003) Poor nutritional status on admission predicts poor outcomes after stroke Observational data from the FOOD trial Stroke 34 1450-1456 doi 10116101S TR0000074037491978C

bull Crary M Humphrey J Carnaby-Mann G Sambandam R Miller L amp Silliman S (2009) Dysphagia Nutrition and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care Dysphagia 69-76 doi

101007s00455-012-9414-0

bull Creasey L (2012) Impact of nutrition practice on acute ischemic stroke outcome Support Line 34 20-26 http0-webaebscohostcomalviniiicomehostdetaildetailvid=4ampsid=5d239db9-2e7b-4542-af79-bb10155c48bc40sessionmgr4001amphid=4106ampbdata=JnNjb3BlPXNpdGU3ddb=c8hampAN=2011513393

bull Geeganage C Beavan J Ellender S Bath PMW (2012) Interventions for dysphagia and nutritional support in acute and subacute stroke (Review) The Cochrane Collaboration 10 1-16 httpwwwbibliotecacochranecompdfCD000323pdf

bull Martino R Foley N Bhogal S Diamant N Speechley M amp Teasell R (2005) Dysphagia After Stroke Incidence Diagnosis and Pulmonary Complications Stroke36 2756-2763 doi

10116101STR000019005676543eb

bull Medin J Windahl J Magnus A Tham K Wredling R (2011) Eating difficulties among stroke patients in the acute state A descriptive cross-sectional comparative study Journal of Clinical Nursing 20 2563-2572 httpdoi101111j1365-2702201103812x

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14

REFERENCES

bullMosselman M Kruitwagen C Schuurmans M amp Hafsteinsdottir T (2013) Malnutrition and risk of malnutrition in patients with stroke Prevalence during hospital stay Journal of Neuroscience Nursing 194-204 doi 101097JNN0b013e31829863cb

bullNip W F R Perry L McLaren S amp Mackenzie A (2011) Dietary intake nutritional status and rehabilitation outcomes of stroke patients in hospital Journal of Human Nutrition and Dietetics 24 460-469 httpdoi101111j1365- 277X201101173x

bullPerry L Hamilton S Williams J amp Jones S (2012) Nursing interventions for improving nutritional status and outcomes of stroke patients Descriptive reviews of processes and outcomes World views on Evidence-Based Nursing 17-39 httpdoi101111j1741-6787201200255x

bullWang X Dong Y Han X Qi X Huang C Hou L amp Kline A (2013) Nutritional support for patients sustaining traumatic brain injury A systematic review and meta-analysis of prospective studies PLOS ONE 8(3)

Retrieved from wwwplosoneorg

bullWestergren A (2006) Detection of eating difficulties after stroke A systematic review International Nursing Review 53 143-149 doi101111j1365-2648200804915x

bullWirth R Smoliner C Jaumlger M Warnecke T Leischker A amp Dziewas R (2013) Guideline clinical nutrition in patients with stroke Experimental amp Translational Stroke Medicine 5(14) 14-14 doi1011862040-7378-

5-14