Nutrition Management for Acute Stroke with Right-Sided Hemiparesis: A Case Study
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dysphagia, enteral nutrition, malnutrition, post-stroke nutrition, stroke
Abstract
This case study aims to report on the nutrition management of acute stroke with right-sided hemiparesis using an approach of early enteral feeding intervention to prevent malnutrition. Mr. R, a 77-year-old Malay man was admitted to the hospital due to an acute stroke with right hemiparesis with underlying disease of Atrial Fibrillation (AF), hypertension, type 2 Diabetes Mellitus (DM), Chronic Kidney Disease (CKD) stage 3b, and significant Peripheral Artery Disease (PAD). His BMI was 24kg/m2 with a weight of 67kg and height of 1.67m, and he was presented with abnormal blood results. All his vital signs were normal, and he appeared lethargic. The patient was on bolus Nasogastric (NG) feeding via Ryle’s tube with polymeric formula. Inadequate enteral nutrition infusion related to infusion volume not yet reached, as evidenced by a 47% energy and 60% protein adequacy feeding history. The polymeric formula was changed to a diabetic-specific formula for better blood sugar control, and feeding was given according to the patient's needs. Mr. R required at least 70% of 1,675 kcal of energy and 53.6 g of protein (0.8 g/kg body weight) to prevent malnutrition. The patient was still on Ryle’s tube feeding and already achieved the targeted energy and protein requirements. Before being discharged, the patient was allowed orally, and a sample menu was given as guidance to avoid weight loss and muscle wasting during longterm recovery. This case highlights the importance of early enteral feeding support in stroke recovery and the need to prioritize meeting nutritional needs in stroke patient care. Mr. R showed improvement in health and nutrition and concluded that early and focused enteral nutrition support can lead to improved results and better quality of life for stroke survivors.
References
Boehme AK, Esenwa C, Elkind MS. 2017. Stroke Risk factors, genetics, and prevention. Circ Res 120(3):472–495. https://doi.org/10.1161/CIRCRESAHA.116.308398
Grossmann I, Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, Patel GS, Sange I. 2021. Stroke and pneumonia: Mechanisms, risk factors, management, and prevention. Cureus 13(11). https://doi.org/10.7759/cureus.19912
Hien NTT, Thong TH, Tung LT, Khoi VH, Hoai DTT, Tinh TT, Van Huy N, Kien VD. 2022. Dysphagia and associated factors among patients with acute ischemic stroke in Vietnam. Ann Med Surg 84:104887. https://doi.org/10.1016/j.amsu.2022.104887
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, Fouque D, Friedman AN, Ghaddar S, Goldstein-Fuchs et al. 2020. KDOQI clinical practice guideline for nutrition in CKD: 2020 Update. Am J Kidney Dis 76(3):S1–S107. https://doi.org/10.1053/j.ajkd.2020.05.006
Koontalay A, Suksatan W, Teranuch A. 2021. Early enteral nutrition met calories goals led by nurse on improve clinical outcome: A systematic scoping review. Iran. J. Nurs. Midwifery Res 26(5):392–398. https://doi.org/10.4103/ijnmr.IJNMR_421_20
Kuriakose D, Xiao Z. 2020. Pathophysiology and treatment of stroke: Present status and future perspectives. Int J Mol Sci 21(20):7609. https://doi.org/10.3390/ijms21207609
Lee YC, Chiu EC. 2021. Nutritional status as a predictor of comprehensive activities of daily living function and quality of life in patients with stroke. Neuro Rehabilitation 48(3):337–343. https://doi.org/10.3233/NRE-201540
Musuka TD, Wilton SB, Traboulsi M, Hill MD. 2015. Diagnosis and management of acute ischemic stroke: Speed is critical. Can Med Assoc 187(12):887–893. https://doi.org/10.1503/cmaj.140355
Ojo O, Brooke J. 2016. The use of enteral nutrition in the management of stroke. Nutrients 8(12):827. https://doi.org/10.3390/nu8120827
Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, Fruhwald S, Hiesmayr M, Ichai C, Jakob SM et al. 2017. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med 43(3):380–398. https://doi.org/10.1007/s00134-016-4665-0
Sabbouh T, Torbey MT. 2018. Malnutrition in stroke patients: Risk factors, assessment, and management. Neurocritical Care 29(3):374–384. https://doi.org/10.1007/s12028-017-0436-1
Scherbakov N, Von Haehling S, Anker SD, Dirnagl U, Doehner W. 2013. Stroke induced sarcopenia: Muscle wasting and disability after stroke. Int J Cardiol 170(2):89–94. https://doi.org/10.1016/j.ijcard.2013.10.031
Shiraishi A, Yoshimura Y, Wakabayashi H, Tsuji Y. 2018. Prevalence of stroke-related sarcopenia and its association with poor oral status in post-acute stroke patients: Implications for oral sarcopenia. Clin Nutr 37(1):204–207. https://doi.org/10.1016/j.clnu.2016.12.002
Spence JD. 2018. Diet for stroke prevention. Stroke Vasc Neurol 3(2):44–50. https://doi.org/10.1136/svn-2017-000130
Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. 2014. BMI and all-cause mortality in older adults: A meta-analysis. Am J Clin Nutr 99(4):875–890. https://doi.org/10.3945/ajcn.113.068122
Wischmeyer PE. 2021. Overcoming challenges to enteral nutrition delivery in critical care. Curr Opin Crit Care 27(2):169–176. https://doi.org/10.1097/MCC.0000000000000801
[WHO] World Health Organization. 2019. ICD-10 Version 2019. https://icd.who.int/browse10/2019/en#/R13 [Accessed 11th August 2023].
Yuan F, Yang F, Zhang W, Jia Y, Ma Y, Qu Y, Wang X, Huo K, Wang C, Yuan X et al. 2019. Optimizing Early Enteral Nutrition in Severe Stroke (OPENS): protocol for a multicentre randomized controlled trial. BMC Neurol 19(1):1–8. https://doi.org/10.1186/s12883-019-1253-2
Zheng T, Zhu X, Liang H, Huang H, Yang J, Wang S. 2015. Impact of early enteral nutrition on short term prognosis after acute stroke. J Clin Neurosci 22(9):1473–1476. https://doi.org/10.1016/j.jocn.2015.03.028
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