Guidelines
QH FEEDS Stroke dietetic support process |
2020 Stroke Foundation Clinical Guidelines for Stroke Management (nutrition pg 5) |
2021 European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia |
Stroke types
Ischemic |
Blood clot in brain (more common). Sudden. |
Haemorrhagic |
Vessel rupture, bleeding (eg trauma, HTN). Sudden. |
Transient ischaemic attack (TIA) mini stroke |
Temporary blockage of blood flow to the brain.↑ chance of stroke. Symptoms usually resolve 1/7 |
S/S
tingling in hand |
hoarse voice |
drooping eye (ptosis) |
ataxia (impaired coordination) |
headache |
↓ sensation (pain, temperature) – one side of body |
FAST = Face (droop?), Arms (one side weaker?), Speech (sluring?), Time (seek help fast) |
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NIS
reduced oral intake |
taste changes |
swallowing difficulties (neurological dysphagia) |
motor function – ability to self-feed |
aspiration risk |
dehydration |
Nut Reqs
CVA (cerebrovascular) simple ratio, or |
Repletion (clinical judgement) |
Intervention
Screen for malnutrition (MNA) |
Maintaining weight and muscle mass during rehabilitation |
Preventing malnutrition |
EN - Consider when below 65% of needs. NG. |
Intentional weight loss is not recommended in the early post-stroke period |
Refer: Speechie & OT - Swallowing & cognitive assessment. Texture modification. Assistive cutlery. |
Consider: food preferences, appearance, variation, medications, consulting with family, living situation, access to ONS, support?, location |
Don’t focus on diabetes – medical management. Malnut is more important. |
Outpatient: encourage heart healthy diet. 5Fs - Fibre, fish, fats, fitness, phytosterols |
Outpatient: Weight loss if obesity-related comorbidities |
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Example PESS
Inadequate oral intake (NI2.1), due to chewing and swallowing difficulties in relation to recent stroke, as evidenced by NBM |
Strategies
HPHE - mid meal snacks, finger foods, ONS, smaller meals more frequently, favourite foods, HE swaps, social eating |
Education: reducing risk of further incidents – comorbidities. General healthy eating and weight management. Seeing outpatient APD. |
Outpatient |
Increase plant foods, mod intake of low fat dairy products |
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EVOO as main oil |
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Fish/legume recipes |
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Low intake of processed and red meat and sugary foods |
Monitoring
Malnut screen weekly (MNA). If malnut, SGA |
Biochem – dehydration |
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