Oropharyngeal dysphagia in acute stroke patients: Results of nursing assessment

Abstract

Introduction: Oropharyngeal dysphagia (OD) after stroke is underestimated and underdiagnosed as a cause of major nutritional and respiratory complications. We aimed to analyze the clinical impact of the diagnosis of OD following nursing assessment in patients with acute stroke. Material and Methods: 98 patients with stroke (53 % women; 81 years median age) were consecutively admitted to the neurological unit of the hospital during 7 months. Clinical assessment of OD by the volume-viscosity swallow test (V-VST), clinical data, stroke type and topography, Barthel Index, Canadian Neurological Scale and nursing processes during admission were collected. Results: 93 % patients presented an ischemic stroke (51.6 % in MCA and 13.3 % in vertebrobasilar territory). Barthel index following admission was 30 and Canadian scale 7. V-VST was performed during the first 24 h in 50.8 % patients and later in the rest. 61.1 % patients presented clinical signs of OD and 56.3 % signs of impaired safety. Up to 15.3 % required tube feeding. Nursing procedures following detection of OD were: (a) dietary restrictions (93.2 %); adaptation of texture (75 %) and bolus volume (83.9 %); use of bedside pictograms (79.7 %); weight control (79.9 %); (b) patientfamily education on OD (84.7 %); (c) SLP (84.7 %) and dietitian consultancy (25.5 %); (d) diagnosis of OD in clinical nursing records (100 %) and follow-up during admission (61 %). Conclusions: Up to 2/3 patients with acute stroke presented OD and more than 50 % signs of impaired safety. Nurses play a major role in the multidisciplinary dysphagia team by early identification of patients at risk for OD, selection and follow up of dietary adaptations and care of NG tubes, education of families and monitoring of patients during admission.