Nursing
Older People, 23(3), 21-24.
Sally Jirjodhan
Humber College
NUR260
Franklin Gorospe
Monday, February 24, 2014
Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3), 21-24.
Sally Jirjodhan
The topic chosen for this essay is Management of dysphagia in stroke patients By
Hughes, S.M. (2011). Amongst many patients in health care facilities we are frequently
discovering more and more patients who are developing dysphagia. Whether they are sick or
have suffered through a stroke, we find that as the population ages, dysphagia is becoming quite
prevalent. Dysphagia is when there is difficulty when swallowing. This is a quite common issue
particularly amongst the elderly and stroke patients. Stroke patients have experienced a lack of
blood supply to a certain area of the brain resulting in lack of oxygen and loss of some bodily
functions. Due to the impairment of many bodily functions, many issues around swallowing start
to arise. When dealing with a patient with dysphagia, particularly one whom has suffered
through a stroke, it requires great involvement from a wide variety of people. The nurse at hand
should have an understanding that she is accountable for assisting the patient in getting a proper
diet as well as the necessary medications. The nurse is also responsible for having the knowledge
to provide the necessary care and information for and to the patient in order to provide adequate
care to the patient. Surrounding dysphagia there are many safety concerns regarding it, therefore
the nurse is responsible for the clients well-being. Lastly, for any patient requiring care, it is
always beneficial, especially in a particular case such as this, to collaborate with the patient,
physician, family, nurse, etc. in order to provide the best care possible for the patient. Due to the
prevalence of stroke victims, it is beneficial to the health care system and public to ensure that
there is accountability for all actions; safety is among the top priorities for the patient, and
collaboration with the necessary persons.
Within the article we note that studies from the UK show that there is a stroke victim
every five minutes (Hughes, 2011). With that in mind, though this is a study of about merely
0.9% of the worlds population, we can see the rate of recurrence of a stroke occurring within
Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3), 21-24.
Sally Jirjodhan
this population is still quite high and if the worlds population of stroke victims was observed it
would most likely result in mass numbers. As previously stated, dysphagia is a primary issue
amongst stroke victims. Therefor as a nurse caring for a stroke victim with dysphagia should
have a vast knowledge base of the issues at hand as well as an understanding that whatever
actions that may or may not take place, they are fully accountable. The knowledge they possess
would allow them to make logical and reasonable decisions when providing patient care (College
of Nurses, Practice standards, 2002). Regarding oral care, the nurse must know and understand
the reasoning behind the importance of good oral hygiene as this greatly affects the swallowing
process (Hughes, 2011). Assessing and promoting good oral hygiene can allow more effective
swallowing as they cause no additional issues along with the dysphagia as well as reducing the
chances of having a dry oral mucosa (Assessment and Early Diagnosis of Dysphagia, 2008). The
nurse at hand must be able to provide the necessary assistance when aiding the patient in eating
as well as taking medications. The knowledge a nurse must possess will allow them to make
critical judgement decisions when deciding what the best or most effective method of providing
foods or medications to the patient would be. In the health care field, the knowledge you possess
is the only thing that will allow you to do your job and do it well. Without the proper knowledge
a nurse is jeopardizing her career as well as the safety of the patient.
The safety of a patient is always a top priority in the health care field. A patient can
refuse care or treatment at their discretion but it is the health care professionals duty to offer the
best care possible. In regards to dysphagia, the term safety applies to the nurses ability to
prevent any choking, suffocation, misdirection of food, etc. Keeping a patient safe from such
factors is quite difficult due to the fact that there are many areas within the swallowing process
which can be affected by a stroke. To provide the safest methods of food and medication
Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3), 21-24.
Sally Jirjodhan
administration, pinpointing the primary affected area due to the stroke will allow the nurse to use
her critical thinking skills in determining the best method to do so. Aspiration pneumonia is a
leading cause of mortality in people with dysphagia (Hughes, 2011). Determining whether it is
lack of tongue action propelling the food back or the glottis not closing and allowing food to
enter the trachea are all areas that need to be assessed. In any phase of the swallowing process, if
any impairment occurs, difficulty chewing will occur as well as overflow of aspiration after
swallowing (Assessment and Early Diagnosis of Dysphagia, 2008). Along with the safety of the
patient, a nurse is also assessing the patients well-being and trying to take the best actions in
order to aid the patient to the best that they can (CNO, 2002). Before taking any alternative
actions to treat and aid in the care of the patient, research and critical thinking must take place
and consent from the patient must be confirmed. Depending on where the impairment is in the
swallowing process, any alternative methods used to cope with the impairment need to be
thoroughly explained to the patient and require consent. Though patient care is primarily up to
the nurse client care does not end with just the patient and nurse.
Primary care of a patient starts in the health care facility but does not end there. Patient
care goes past the health care facility and well beyond discharge (Hughes, 2011). In order for
such care to take place the nurse needs to collaborate with the patient, physician, family, friends,
etc. whoever is involved with the patient in order to provide the best care plan for them during
their stay at the hospital and well after that. Together they would work together as a team to
enhance outcomes through concentrated interventions (Assessment and Early Diagnosis of
Dysphagia, 2008). For a stroke patient with dysphagia, the health care facility cannot simply just
discharge them without providing health care teachings to them and the family/friends. Working
with the physician, family, etc. they can develop and care plan for the duration of the patients
Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3), 21-24.
Sally Jirjodhan
hospital stay as well as after the discharge. It is the nurses duty to provide the necessary care
information due to the severity of the dysphagia, any inability to monitor the patient while eating
or such can result in harm or mortality. When planning a care plan or an approach to aiding the
patient, the initial assessment of the patient should be used in order to determine the best method
of caring for the patient (CNO, 2002). Patient care goes beyond just the patient-nurse
relationship and beyond the time of discharge. Rehabilitation is self-determined based on an
individuals progress and may require the input of a variety of people in order to improve that.
As a nurse, it is their duty to possess the required knowledge base to care and assess a
patient, make sure the patient is safe and the necessary steps are taken to promote safety, and
lastly the collaboration amongst colleagues and patient and family in order to provide the best
care. Knowing where the main problem area is will be the best way to determine what action to
take against it and whatever actions that may or may not take place by the nurse; they (nurse) are
still accountable. A patient suffering from a stroke and dysphagia can only do so much for
themselves so it is up to those around them to aid in their rehabilitation no matter how long that
may be.