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Ruth Noland Ischemic Stroke
Transcript of Ruth Noland Ischemic Stroke
Risk factors: HTN, CVD, DM Type II, Smoking, Alcohol use, Dyslipedemia, Diet, Gender, Age, Ethnicity, Genetics, Family History, and Obesity
Signs & Symptoms
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)
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%
Elderly Female, unable to speak, unable to move right side, pale skin
Abnormal lipid panel
High LDL, TG, Total Cholesterol, LDL/HDL ratio
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.
Rupturing of a weakened blood vessel that supplies the blood and nutrients to the brain
Major cause is uncontrolled HTN
Obstruction within a blood vessel that supplies the brain with blood and nutrients
Majority of strokes are ischemic
Generally occurring from a blood clot
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
Right Sided Hemiparesis
Decreased Esophageal Peristalsis
Monitoring and Evaluation
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
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
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
1. Oral Preparation
2. Oral transit
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 dysphagia status
Monitor lab values
Lipid levels, glucose
24 hour recall
chicken tortellini soup