STROKE CARE PATHWAY

 
   

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TUTORIALS

 

 

SWALLOWING ASSESSMENT

  • Note that the gag reflex is an unreliable way of assessing whether a patient can swallow safely
  • Rationale for assessment of all patients: about a third of acute stroke patients have dysphagia, & aspiration occurs in half of these.
  • Pneumonia is a complication of aspiration & accounts for a third of stroke deaths.
  • Assessment & management of dysphagia reduces aspiration complications and length of hospital stay
  • This assessment will be found on page 10, in the red section of the pathway folder:-

 

TO BE COMPLETED BY ADMITTING DOCTOR/TRAINED NURSE

SWALLOW SCREENING

BEFORE YOU BEGIN:

      Is the patient alert?

      Can they cough effectively?

      Can they be sat fully upright?

 

 

 

 

NO

 

 

A.

DO NOT REFER TO S&LT YET

KEEP NBM & REPEAT SWALLOW SCREENING EVERY 24 HOURS USING A FRESH FORM

 

 

 

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

1. GIVE TEASPOON OF

WATER

MAJOR PROBLEMS?

e.g. no attempt to swallow

water leaks out of mouth

 

 

 

 

 

 

 

 

SOME ATTEMPT TO SWALLOW.

NO PROBLEMS

 

 

 

 

 

 

 

 

 

 

 

 

2. GIVE SECOND

TEASPOON OF WATER

 

 

 

 

B.

PATIENT NBM

REFER TO S&LT

 

 

 

 

 

 

 

NO PROBLEMS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. GIVE THIRD TEASPOON OF WATER

 

 

 

 

PROBLEMS?

 

 

PLEASE CLARIFY:

Coughing 

Choking 

Breathlessness 

Gurgly voice 

Other (state) 

 

 

 

 

 

 

 

 

NO PROBLEMS

 

 

 

 

 

 

 

 

 

 

 

 

4. GIVE HALF

GLASS WATER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO PROBLEMS

 

 

 

 

 

 

 

 

 

 

 

 

COMMENCE FREE FLUID

 

 

 

 

 

 

 

 

 

 

 

 

5. OBSERVE PATIENT

EATING SOFT

FOOD

 

PROBLEMS?

COUGHING/THROAT CLEARING.

VERY SLOW. POOR MOTIVATION

C. FOR NBM & IV FLUIDS. REFER TO S&LT AND/OR

DIETITIAN

 

 

 

 

 

 

NO PROBLEMS

 

 

 

 

D. COMMENCE NORMAL DIET & FLUIDS & COMPLETE NUTRITIONAL SCREEN

 

RESULT

CODE

COMMENTS

Outcome? (please circle)

A B C D

 

Where did problems arise? (please circle)

1 2 3 4 5

 

Referred to S&LT? (please delete)

Y N

If Y Date:

Referred to Dietitian? (please delete)

 

Y N

If Y Date:

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Copyright ©Nikki Devitt 2002, on behalf of the WAHT Stroke Pathway Group

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Date of last review: 25th April 2002

Date of next review:25th October 2002