Literature Review - Dehydration and Dysphagia After a Stroke

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Dysphagia and dehydration after a Stroke: A Literature Review

Background. Stroke is a major cause of mortality in the United Kingdom; it is the third biggest killer in the UK (National audit office 2005) around 53,000 people die every year from this long term condition. (Scarborough et al 2009) In people under the age of 75 it is a main cause of premature mortality with 1 in 20 dying because of an acute stroke and the complications that arise. In socially deprived areas a person is 3 times more likely to suffer from a stroke than in the least deprived areas of the UK. Dehydration is preventable but is unfortunately very common; there is a method of early identification that could stop a patient becoming increasingly unwell in a short space of time. What is the best and safest method for the patient when replacing lost fluids? Dysphagia, a person who has problems with swallowing, is another common concern with people who have suffered a stroke. Most issues resolve themselves within a few weeks after the stoke, but for an unfortunate few problems persist and more complications arise in up to 19% of patients (Rowat 2011) including dehydration, nutritional problems because of a poor dietary intake and depression perhaps due to embarrassment of the effects of the stroke Search Terms. The keywords used in this literature review were, ‘stroke’, ‘dehydration’, ‘nursing’ ‘dysphagia’ and ‘literature review’. The keywords were used in a variety of ways to see as many different articles of interest. The databases used were Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scorpus and Google Scholar. The search has included worldwide journals and papers with the date limitations of 2001 to 2012 to ensure that all evidence and information is current. Only those articles published in English and available through the University of Dundee library were considered for inclusion. Findings. Morris (2008) states a stroke has a far greater effect on a person’s ability to function in a way that would be deemed normal in society; it has a larger impact on a person than any other medical condition. (Morris 2008) Dehydration after a stroke is very common (Rowat 2012) between 50% and 60% of patients display some degree of dehydration during their hospital stay. A Rowat (2011) paper states that there is no gold standard of assessment to measure the estimation or the frequency of this problem. Rowat (2011) in addition states that dehydration after a stroke has been associated with an increase in blood viscosity or the measure of the bloods thickness as it flows through the body and an increase in stroke mortality. In addition Morris (2008) adds that the fatality rate among patients who have had a stroke and the added complication of problems with dysphagia, have increased the chances of death significantly. Earlier identification of dehydration may allow the nurse to prevent significant development of any complications and improve patient outcomes. Forster’s review (2011) states that orophrangeal dysphagia is often underestimated, this type of dysphasia is characterised as an alteration in the swallowing dynamics which may lead to associated swallowing issues. This may significantly impair the patient and cause malnutrition and dehydration. Patients’ symptoms are seldom mentioned due to embarrassment or lack of awareness. Forster (2011) feels a bedside screening test would select the patients in need of more investigations, these tests could be individualised to suit each patient as they require. However, due to staffing levels and time constraints this rarely appears to happen during the first 72 hours of admission. (Forster 2011) Rowat (2011) states that 50% of patients have some degree of dysphagia after the onset of stroke and that most problems do resolve themselves, but 19% of patients problems do persist. Rowat (2011) in addition states that dehydration is common and is caused by a lack of fluid intake that can...
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