Nursing care in Stroke patient with dysphagia : Comparative case study

Abstract

          Dysphagia in stroke patients is a common problem. It can lead to aspiration pneumonia Affect the infection in the bloodstream and can die. The objective  was to study  the nursing practice of swallowing assessment and swallowing practice in stroke patients with neurological symptoms of balance, speech and tongue control differed in swallowing ability who were admitted at Chao Phraya Yommarat Hospital. Data were collected from July 2020 to January 2021, selected samples of 2 subjects, and the data collected from the beginning, distributed from  patients relatives, nurses, multidisciplinary teams, and data records from the patient's medical records . Uusing  conceptual framework Gordon's health stereotypes It is a tool for collecting information.

Results of two case  studies  were  male   had cerebrovascular disease , high intracranial pressure and dysphagia. Patient 1: Age 36 years , E2V2M5,  arm - right leg weak  grade 0, High blood pressure. Underwent craniotomy surgery After surgery, using artificial respiration, can off  Endotracheal tube after surgery Day 3 and   evaluation of swallowing after surgery Day 4  not ready to practice swallowing. Have high intracranial pressure are at risk for ventilator-associated pneumonia. Risk of recurrent bleeding in the brain and convulsion. Risk of aspiration pneumonia, the patient's stay in the hospital for 22 days.

            Patient 2: Age 57 years, E4V1M5, arm - right leg weak grade1, Hypertension, Underwent cranial perforation surgery, Assessment of swallowing Day 26 not ready to practice, High intracranial pressure, Risk of recurrent bleeding in the brain, Risk of aspiration pneumonia, the patient's stay in the hospital for 33 days. Both patients were monitored for vital signs and neurological symptoms. Get a swallowing assessment, Has discharge  planning   with multidisciplinary. Results of swallowing assessment and swallowing practice: Patient 1 was able to practice swallowing successfully after surgery on Day 16. Remove the feeding tube before go home. Patient 2 On nasogastric feeding tube, Continuous swallowing practice  at home and able to practice swallowing successfully after go   home on Day 7.

          Assessment of swallowing and practice swallowing in cerebrovascular disease with balance, speech, tongue control, Can practice swallowing successfully at different stages. This is important to prevent complications from aspiration pneumonia. To reduce the incidence of bed-addicted patients