Identifying A Problem: Dysphagia Screening In Stroke

Dysphagia Screening

Many patients who suffer from a stroke will exhibit some form of dysphagia or difficulty swallowing. Within the acute care hospital setting it is the responsibility of nurses to ensure screening for swallowing occurs before anything including water is given orally (NPO). Within the current state of medicine there is no screening tool based on best practices and evidence endorsed by a accrediting entity. This leaves hospitals and nurse research leaders to determine amongst the many published hospital-based studies the best screening tool to utilize in their clinical setting. Nurses must be educated on the importance of conducting within their facility an evidenced-based swallow screen in order to prevent aspiration pneumonia in the vulnerable ischemic stroke population.

Describing the Issue

The ability to swallow is an intricate process that includes the coordinated effort of cranial nerves and multiple muscles. Pathophysiology of aspiration is such that, food or liquid is misdirected down the respiratory pathway. In most cases aspiration will occur as it travels via the straighter path to the right main bronchus and onward to the right lower lobe of the lung (Eisenstadt, 2010). Dysphagia’s incidence after a stroke varies due to the location of the stroke and occurs between 28%-79% of the time (Lakshminarayan et al., 2010). Current state has bodies of authority without an approved dysphagia measure based on evidenced. These entities hospitals would look to for consensus and guidance are the American Heart Association (AHA), Centers for Disease Control (CDC), and The Joint Commission (TJC) (Solis, n.d.). Without the endorsement of a screening tool, hospitals may not be persistently utilizing a dys...

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...). Dysphagia and aspiration pneumonia in older adults. Journal Of The

American Academy Of Nurse Practitioners, 22(1), 17-22. doi:10.1111/j.1745-

7599.2009.00470.x

Lakshminarayan, K. Tsai, A.W., Tong, X. Vazquez, G., Peacock, J., George, M., Luepker, R.

V., Anderson, D. (2010). Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke, 41, 2849-2854

Solis, P. (n.d.). Stroke as a core measure: American heart association: What’s coming down the pike and what your institution should know. Retrieved from http://www.thenecc.org/images/Solis.pdf Titsworth, W. L., Abram, Fullerton, J. A., Hester, J., Guin, P., Waters. M., Mocco, J. (2013).

Hospital-acquired pneumonia prevalence in patients with stroke prospective quality initiative to maximize dysphagia screening reduces. Stroke, 44,

3154-3160