Nutrition and Stroke Patients - Essay Example

TABLE OF CONTENT CONTENT PAGE Introduction 1 Search Strategy: -----------------------------------------------------------------------1-1 Nutrition and Malnutrition: ----------------------------------------------------------2-4 Assessment of Nutrition and Stroke: -----------------------------------------------4-5 Nurse’s Role: --------------------------------------------------------------------------5-6 Patient’s Role: -------------------------------------------------------------------------6-7 Conclusion: ----------------------------------------------------------------------------7-7 Reference: ------------------------------------------------------------------------------8-11 Nutrition and Stroke Patients Introduction Health mainly relies on the appropriate intake of nutrition. It is the role of nutrition that enables a human body to function its work in a natural way as the nutrients provide both growth and energy to all human body parts. Consequently, human body experiences normal and routine growth. However, the recent experience highlights that malnutrition cases are being reported throughout the United Kingdom and the rest of the world. Because of malnutrition, many health problems including stroke, are being reported in hospitals and in health care facilities. And the severity of malnutrition presence can be depicted by the fact that direct health expenditure of £2.8 billion annually and non-formal care consumes £2.4 billion; £1.8 billion are also paid as productivity loss caused by the stroke and its related complications in the United Kingdom (Mant et al., 2004). Search Strategy The CINAHL Plus database was used for collecting information. For this purpose, the Anglia Ruskin library was used for accessing this database. Due to its global recognition for providing a wide variety of articles and other information on the issues relating to nursing, this database was the most useful for accessing to the information. In order to search for the related information, first the key word “Nutrition” was used for searching out the relevant articles; simultaneously, in that search activity, it was required that relevant period should be mentioned so that the database should be able to generate the expected and required level of articles. As a result, the selected period was from 1939 to 2014. The subsequent results revealed more than 67 thousands publications including books, magazine articles and articles in nursing and other journals were displayed by the search. However, only recent articles were required for this purpose, the research was further narrowed down in which articles published from 2008 to 2014 were selected and consequently, this search generated 82 articles. However, only those articles which were mainly related to the UK were only selected and which were 10 articles that reported the UK statistics. This essay will mainly highlight nutrition, stroke and the relationship between stroke and nutrition. In the initial part of this essay, first nutrition and malnutrition difference will be highlighted in which a clear difference and their effects on the human body will be elaborated and discussed as well. Subsequently, this essay will carry out assessment between nutrition and stroke in which their interaction will be evaluated. Additionally, the essay will also explain the role of nurse and the role of patient. Nutrition and Malnutrition Nutrition refers to food intake measured by keeping in view body’s dietary requirements (World Health Organization, 2014). World Health Organization (WHO) (2014) further elaborates that good nutrition encompasses sufficient and well balanced diet inclusive of regular physical activity whereas the poor nutrition diminishes body immunity and productivity, increases disease chances besides damaging mental and physical normal growth. Additionally, Dass (2004) defines that nutrition is identified as the availability of energy nutrients to the body cells particularly with regard to body requirements. This definition clearly highlights that the amount, type of nutrition are not the same for all but they vary from person to person, patient to patient and from gender to gender as well. On the other hand, malnutrition has been defined as a state of deficiency of nutrients including energy, vitamins, proteins, minerals and this deficiency put substantial negative effect on body function, composition and clinical outcome as well (National Institute for Health and Care Excellence, 2012). Similarly, it has been highlighted that malnutrition refers to undesirable kind of nutrition that encompasses both overnutrition and undernutrition as well (Mudambi and Rajagopal, 2001). Certain symptoms have been identified as sources of malnutrition: eating disorder, sore mouth, poor dentition, sensory loss, and psychological situation, such as depression, tensions, stress, and other types of mental illnesses (Patient, 2014). The patients, facing the problem of inadequate nutrition of proteins for a considerably period of time, are more prone to the chances of developing malnutrition, signifying that such patients should be closely monitored by the clinicians (Scharver et al., 2009; Foley et al., 2009; Prosser-Loose et al., 2010). Moreover, poor oral hygiene, facial weakness and diminished level of consciousness are among those factors that also contribute to poor nutrition (Mould, 2009). Within this context, Bouziana and Tziomalos (2011) mention that post-stroke depression diminishes appetite and making it hard to recover fast and get back to routine life structure. And in order to recover faster, such patients are prescribed to take antidepressants for reducing the effects of the stroke (Yang, 2009). In addition, malnourished stroke patients also encounter the problems, such as stress, pressure ulcers, and respiratory infections and pass longer time hospitalization duration and face greater chances of death (Kang et al., 2010). In addition, BAPEN (2014) has identified specific conditions relating to the occurrence and appearance of malnutrition: loss of appetite, poor concentration, loss of energy, depression and laziness, unable to perform routine activities, loose clothes in the shape of weight loss and abnormal or insufficient physical and mental growth in children. The use of Malnutrition Universal Screening Tool (MUST) has been commonly used in almost all health care settings; this tool diagnoses and categorises patients into three broad categories such as low risk, medium risk and high risk of malnutrition (Jones, 2006). In a different screening manner, this tool has been used to detect protein-energy malnutrition along with taking into account the measure of Body Mass index (BMI) (Delegge, 2008). On the other hand, Evans (2014) has highlighted a separate diagnosis procedure for malnutrition in which malnutrition cases can be treated through providing first-line dietary advice; similarly, it has also been mentioned that social issues need to be addressed. In this regard, it is significant to highlight that both food intake and psychological well-being (which is mainly influenced and treated through social interaction) should be appropriately managed. In addition, the British Association of Parenteral and Enteral Nutrition (BAPEN) highlights that malnutrition is a common problem as it affects one in four adults brought to hospital; and more than 33 per cent adults admitted to care homes and 20 per cent of total patients admitted to mental health units and this entire situation has identified the UK having more than three million people diagnosed with malnutrition (Evans, 2014). The problem of dysphagia has also increased in the recent nutritional history. The word “dysphagia” has been taken from the Greek and it is a combination of two different terms; the first word is “dys” which refers to “difficult” and the word “phagein” highlights “to eat”; collectively, they refer to having difficulty while eating (Stein et al., 2009). For screening and assessing this problem, it is the responsibility of nurse to diagnose dysphagia in stroke patients and this assessment will require the subsequent step in which the patient is referred to speech-language pathologist for the purpose of assessment (Stein et al., 2009). Subsequently, for managing dysphagia, health care experts should put in place multidisciplinary input from the step of assessment till recovery for post-stroke patients (Barness et al., 2005). Additionally, some non-dietary therapeutic methods for managing the problem of dysphagia have been developed including the use of palatal training instruments for facilitating the process of swallowing (Caballero et al., 2005). Assessment of Nutrition and Stroke Stroke is referred as a clinical syndrome which represents signs of cerebral functions and these signs continue their presence for more than 24 hours or causing the occurrence of on spot death (World Health Organization, 1978). In other words, stroke has two types of symptoms: first it can continue its effect on the affected patient in which the patient continue to experience the presence of different direct and indirect symptoms relating to the stroke; second, the second manifestation highlights that the maximum severe impact of stroke in which patience does not maintain its normal physical and mental activity and the absence of such activity leads to death. In this regard, research reflects that stroke on average affects 195 persons per 100,000 people in the United Kingdom every year (Mant et al., 2004). In other words, the presence of stroke and its related complications exist throughout the United Kingdom and they are severely affecting the economy as well. For example, Mant et al., (2004) also mention that the direct health expenditure to the NHS is £2.8 billion annually and non-formal care consumes £2.4 billion and disability and productivity decrease also takes away £1.8 billion every year. this clearly highlights that the stroke and its overall impact on the health index are severe from health point of view and from the cost and expenditure aspect as well; both expenditures clearly demonstrates that the prevalence and chances of stroke are not only affecting the normal human life but also contributing by diminishing the expected productivity level. Within this context, it has been mentioned that the cerebral infarction causes around 85 per cent of total strokes whereas 5 per cent and 10 per cent are caused by subarachnoid haemorrhage and primary haemorrhage respectively (Intercollegiate Stroke Working Party, 2012). Also, Mohan et al., (2011) elucidate that the chances of reoccurrence of stroke are around 26 per cent within span of five year period and within a 10 year period, that percentage reaches 39 per cent. More clearly, the severe symptoms of stroke are consisted of paralysis, numbness, severe headache, confusion and blurred vision (National Institute for Health and Care Excellence, 2008). In this regard, Bales et al., (2009) mention that malnutrition generally takes place before and after the occurrence of stroke. And in support to the assessment and diagnosis of Bales et al., it has also observed that fatigue, energy shortage, exhaustion are some of the symptoms commonly reported by the patients particularly after the attack of stroke (Fisher, 2009). In addition to that, Schwab et al., (2014) highlight that malnutrition has been more associated with excessive hospitalisation stay and presence of complications are some of the frequent reasons that are reported. On the other hand, it has also been observed that pre-existing malnutrition along with sub-clinical swallowing problem can collectively increase the chances of nutritional risk particularly after the occurrence of stroke (Bales et al., 2009). Clinical experience has been different for admitted and discharged stroke patients. Axelsson et al., (1988) state that eating disorders, such as anorexia and dysphagia have been commonly found in stroke patients and the percentage of malnutrition patients has been more on discharge than on admission. Within this context, Ha et al. (2010) mention that on admission, the prevalence of numerous diseases, such as functional disability, eating disorders and poly-pharmacy, are closely attached with the possibility of increased chances of malnutrition, especially in elderly patients. And they have been mainly caused by the diseases, like diabetes, which directly increase the risk of malnutrition subsequently lead to the occurrence of the stroke (Corrigan et al., 2011; Chai et al., 2008). Additionally, Sanchez-Moreno (2009) elaborates that inadequacy of antioxidant vitamins, Vitamin B and D, and zinc tend to include their share to vasculature changes in the relevant part of the brain; consequently, such situation increases the chances and risk of stroke including the possibility of cognitive impairment especially in the elderly patients. Moreover, it has also been emphasized that the post-stroke weight level and body composition experience different changes and it is highly essential that such changes must be taken into account through measuring them regularly during the phase of rehabilitation (Bouziana and Tziomalos, 2011). In this regard, it has also been provided that weight loss should be avoided while attempting to reduce the impact of malnutrition and in this process swallowable diet should be used as a remedy (Mertl-Rotzer, 2009; Ha et al., 2010). And the related feeding standards are normally available and such guidelines should be strictly followed by the clinicians (Heyland et al., 2010; Bankhead et al., 2009). Nurse’s Role Nurse role is pivotal for screening nutrition in health care facilities (Watson, 2001). For this purpose, it has been highlighted that the nurse should assess the health and conduct risk analysis and identification through different screening programs (Watson, 2001). At the same time, Tolson et al. (2011) emphasize that the nurse should, after the initial screening, provide a personal care plan which should increase the nutritional status of the affected person. In support to this view, it has also been provided that although the dietitian is the food expert and prescribe remedy for a malnourished patient, the role of nurse cannot be undermined under any condition (Dudek and Dudek, 2013). And they further mention that the nurses directly involve in all dimensions of nutritional care. In this regard, nurse’s duties also encompass determining patient nutritional preferences, nutritional assessment, diet menu, meal timings, ascertaining actual diet impact and expected or required diet effect are some of the important duties that are needed to be carried out (Sullivan and Atlas, 1998). In addition, Best (2008) states that it is the duty of a nurse to screen patients on admission and the subsequent outcome of screening must be attached with the procedures to be adopted for the course of action. Also, it has also been mentioned that nurses have duty to take essential measures for protecting patients from the possibility of getting affected by undernourishment. Additionally, it has also been mentioned that nurse has more important role than the role played by physician or dietitian as it is the work of nurse to look after and ensure the implementation of prescription recommended by the physician or dietitian (John and Jenifer, 2008). This clearly highlights that the role of nurse is more inclusive and comprehensive when it is compared with the role of others, such as doctor. Within this context, it has been provided that the nutrition nurse’s role is more important and it is highly recommended that an experienced and highly competent nurse should be posted at the senior level, such as ward nurse (Payne-James et al., 2001). And at that level, the ward nurse will be in a better position to talk with nurse of smaller cadre (Payne-James et al., 2001). Furthermore, Nix (2013) mentions that a skilled nurse is a capable of tying the work of all health care workers into a team. In other words, it is function of nurse to work as a coordinator between doctor and patient (Nix, 2013). At the same time, it has been highlighted that the problem of chronic malnutrition has been spreading throughout the world; and due to this increases, many cases of inappropriate physical and mental growth are being reported in both developed and developing countries as well (Basavanthappa, 2008). Consequently, the role of nurse has increased considerably and it requires that the nurse should carefully read the patient’s nutritional history and develop plans to reduce the nutritional insufficiency. In this regard, it has been stated that malnutrition can have severe effects on the psychological, economic, mental aspects of patients; however, historically the role of nurse has not been to address both psychological and mental aspects of patients but it was only limited to the affected body part of patient (Acton, 2012). Within this context, some comparison has been made between the role of a nurse and a dietitian in which it has been highlighted that the dietitian assesses malnutrition through assessing body composition and mid-arm muscle circumference whereas the nurse takes into account patient’s weight, height and mid-arm circumference along with referring to the related specialist dietitian as well (Mahon et al., 2013). Patient’s Role For healthy nutrition, the role of patient is also critical. In this regard, it has been suggested that during the initial diagnosis process, patient should be informed and guided concerning eating disorders and simultaneously the patient should be encouraged to share difficulties faced; at the same time, it is also significant that nutritional education should not only be limited to patient but it is highly recommended that the patient’s family members should also be involved so that they should be able to understand the current nature of malnutrition and how it will be remedied (Bloch, 1990). Thereby, it can be deduced that this point indicates that patient and patient’s family are also important for decreasing the effects of malnutrition in which coordination between patient, nurse and patient’s family members is highly essential. Additionally, nutrition education handouts should also be developed and should be provided to patient as it will enable the patient to play his/her part in addressing the effects of malnutrition along with retaining and reinforcing comprehensive diet plan throughout the recovery period (Behan, 2006). Conclusion The paper highlights the effects of malnutrition on stroke. For this purpose, definition of both terms (nutrition and stroke) has been provided and analyzed. Within the United Kingdom, to prevent the occurrence and to treat the stroke patients, around £2.8 billion and £2.4 billion are provided to health expenditure and informal care respectively. Before going to treat the stroke patients, it is highly recommended that nutritional assessment must be carried out so that the actual nutrition level of patients should be measured properly. Eating disorders, anorexia and dysphagia, are some of the causes and effects which are common in stroke patients. Some studies highlight that stroke patients suffer higher malnutrition after the hospitalization. On the other hand, other studies reveal that insufficient food intake, which mainly causes malnutrition, also pose direct threat to such patients and they are at higher risk. The role of nurse is mainly important as he/she will be directly looking after the stroke patients and record the recovery process. Nurse carries out the screening process in which risk analysis is conducted. For stroke patients, the role of nurse is critical as the nurse is directly involved for providing nutritional care to the patients besides maintaining patient’s nutritional preferences, meal timings, diet menu and nutritional assessment. While admitting a patient, it is the duty of nurse to screen patient and record the current status of nutrition and health of the patient. Simultaneously, it is the role of patient to obtain nutrition handouts and develop a comprehensive diet plan. 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