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Ruth Noland Ischemic Stroke

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by

Amy Richter

on 16 December 2013

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Transcript of Ruth Noland Ischemic Stroke

Ruth Noland - Ischemic Stroke
Stroke
Incidence
Risk factors: HTN, CVD, DM Type II, Smoking, Alcohol use, Dyslipedemia, Diet, Gender, Age, Ethnicity, Genetics, Family History, and Obesity
Signs & Symptoms
Intervention
Energy Demand:1875 calories
Using ASPEN for BMI >30
Fluid Demand: 1875-2600
Protein Requirement: 100 grams
2 grams/ kg ideal body weight (50 kg)
Assessment
Age 77 Ht 5'2" Wt 165# BMI 30.2
Hypertension (10 yr) and Hyperlipidemia (2 yr)
Temperature 98.8 Pulse 91
Respiration rate 19 Blood Pressure 138/88
IBW 110# %IBW 150%

General Appearance:
Elderly Female, unable to speak, unable to move right side, pale skin

Abnormal lipid panel
High LDL, TG, Total Cholesterol, LDL/HDL ratio
Low HDL
Chief Complaint
Husband states his wife woke up with everything pretty normal, but mid-morning she became dizzy and then she couldn't talk or move one side of her body.
Hemorrhagic
Rupturing of a weakened blood vessel that supplies the blood and nutrients to the brain
Major cause is uncontrolled HTN
*Intracerebral Hemorrhage
*Subarachnoid

Ischemic
Obstruction within a blood vessel that supplies the brain with blood and nutrients
Majority of strokes are ischemic
Generally occurring from a blood clot
*Embolic
*Thrombotic
Dysarthria with tongue deviation
Right sided face, leg and arm weakness
Cranial nerves III, V, VII, and XII
General weakness and impaired sensation
Signs and Symptoms
Slurred Speech
Right Sided Hemiparesis
Decreased Esophageal Peristalsis
Diagnosis
Monitoring and Evaluation
Goals
Increased energy expenditure (NI-1.1)
related to critical illness from lacunar ischemic stroke as evidenced by noncontrast CT confirmed diagnosis of moderate level of stroke with NIH stroke scale score of 14.

Swallowing difficulty (NC-1.1)
related to declining neurological function including dysarthria with tongue deviation as evidenced by reduced esophageal peristalsis.
Following the DASH diet she should consume nutrient dense foods that will help regulate blood pressure
Minerals to emphasize- K, Ca, Mg
Limit Na and saturated fat
Increase fiber
Neurological Symptoms
Multidisciplinary Approach
rtPA 0.6 mg/kg over an hour
Diet: NPO except meds for 24 hours
Noncontrast CT scan
Bedside swallowing assessment - Modified barium swallow
Dysphagia diet determined via Speech-language pathologist & RD
Dysphagia Diets
Thickened Liquids
Level 1 Puree
Level 2 Mechanically Altered or Fork Mashable
Level 3 Advanced or Mechanical Soft
Thin like water or juice
Nectar slightly thick like a milkshake
Honey coats the spoon and falls off spoon like honey
Spoon-like is like pudding
Stages of Swallowing
Voluntary
1. Oral Preparation
2. Oral transit

Involuntary
3. Pharyngeal
4. Esophageal
References
American Stroke Association. (2013). Types of strokes. Retrieved from http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-Stroke_UCM_308531_SubHomePage.jsp#.
Chernoff, R. (2014). Geriatric Nutrition: The health professional's handbook (14th Edition). Burlington, MA: Jones & Bartlett Learning.
Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2012) Krause’s Food and the Nutrition Care Process (13th Edition). Elsevier Saunders.
National Stroke Association. (2013). Warning signs of stroke. Retrieved from http://www.stroke.org/site/PageServer?pagename=SYMP.
Monitor weight
Monitor dysphagia status
Monitor hydration
Monitor lab values
Lipid levels, glucose

24 hour recall
orange juice
raisin bran
chicken tortellini soup
canned pears
saltine crackers
Nutrition History
Full transcript