NK8e, Nursing Bedside Swallow Screen for Stroke … Nursing Bedside Swallow Screen for Stroke patietns PowerPoint.pdf 4 For the swallow response to occur, sensory and motor information

NK8e, Nursing Bedside Swallow Screen for Stroke patietns PowerPoint.pdf

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Dysphagia (impairment in swallowing) occurs in 30% to 64% of patients in the acute phase of stroke recovery and in 37% to 78% of the general stroke population

Dysphagia after stroke carries a threefold increased mortality risk and a sixfold to sevenfold fold increased risk of aspiration pneumonia.

Dysphagia has also been associated with poorer ability to complete ADLs, greater caregiver burden, and more frequent nursing home placement.

All patients with a clinical diagnosis of stroke should be screened for dysphagia.

Miller et al. (2010) Comprehensive Overview of Nursing care of the Stroke Patient. Stroke.


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Aspiration (inhaling food or drink) is a common problem for people with dysphagia.

It occurs when material a person is swallowing enters their airway and lungs; pneumonia ay develop.

Normally, aspiration would cause a violent cough, but a stroke

can reduce sensation.

After a stroke, food or liquid could enter the airway/lungs without the survivor being aware of it. This is called silent aspiration.

2- 25% acute stroke patients may aspirate silently i.e. without any outward signs of swallowing difficulty. Martino, R. et al. (2006) Dysphagia

After Stroke. Stroke


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For the swallow response to occur, sensory and motor information are necessary.

Sensory feedback comes from the trigeminal, facial and glossopharyngeal nerves to help initiate a swallow. Information about motor movement is received from the muscle spindles in the tongue via the hypoglossal nerve.

Sensory and motor information is carried to the swallowing center, which is believed to be located in the medulla.

When the swallow response is initiated, this center causes messages to be sent to the glossopharyngeal, the vagus, and the hypoglossal nerves. The glossopharyngeal is considered the major nerve for the swallowing center.

Six of the cranial nerves provide the innervations for both swallowing and speech.

Martino, R. et al. (2006) Dysphagia After Stroke. Stroke


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Six of the cranial nerves provide the innervations for both swallowing and speech ◦ CN. V The Trigeminal Nerve ◦ CN. VII The Facial Nerve ◦ CN. IX The Glossopharygeal Nerve ◦ CN. X The Vagus Nerve ◦ CN. XI The Spinal Accessory Nerve ◦ CN. XII The Hypoglossal Nerve


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IX

V

XII

X XI

XII


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• Interrupt voluntary control of mastication and bolus transport during the oral phase.

• May produce contralateral impairment in facial, lip, and tongue motor control, and contralateral compromise in pharyngeal peristalsis.

• Impairments in cognitive function such as concentration or selective attention may also impair control of swallowing.

• Affect sensation of the mouth, tongue, and cheek, timing in the trigger of the pharyngeal swallow, laryngeal elevation, glottic closure, and cricopharyngeal relaxation.

Martino, R. et al. (2006) Dysphagia After Stroke. Stroke


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“As soon as an acute stroke has been diagnosed and emergency treatment provided, stroke survivors who are awake and alert should be screened for dysphagia before oral intake is allowed.”

“Survivors who fail the screen are allowed to eat or drink nothing orally until they receive a more

comprehensive assessment.”

Miller et al. (2010) Comprehensive Overview of Nursing care of the Stroke Patient. Stroke.


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Documents

NK8e, Nursing Bedside Swallow Screen for Stroke … Nursing Bedside Swallow Screen for Stroke patietns PowerPoint.pdf 4 For the swallow response to occur, sensory and motor information