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The importance of proper diet after stroke. By Theresa O'Toole
Limiting the intake of sodium and fat, controlling body weight through diet and exercise and controlling high blood pressure are prudent measures to prevent a stroke. But too often, the relationship between diet and stroke is examined only in terms of RISK FACTORS. Nutrition is equally important AFTER a stroke. Stroke victims, their families and health care professionals need to be aware of the vital role of diet in the restoration of health and rehabilitation.
Restoration of Health
Normal nutritional requirements are altered with any trauma or illness. After a stroke, modification of diet may be necessary to meet the greater demands for nutrients required by the body for energy production and tissue maintenance. The focus, in the acute care stage and throughout rehabilitation, is to meet the demand for these nutrients, especially protein and calories, by providing an adequate daily intake through meals. Although each individual has specific needs, there are some common considerations for stroke patients that affect the accomplishment of this goal.
Ability to eat
Chewing or swallowing difficulties obviously will interfere with adequate intake. Often the patient receives the same food items that are easy to eat (mashed potatoes, pudding, etc.). If the patient's ability to eat is to improve, then emphasis must be placed on what he eats. Dietary involvement is necessary to ensure a variety of foods that will meet daily requirements.
Poor Appetite
This is common with stroke patients. Constant encouragement to eat may be needed.
Visual Perception
Part of the tray/food items may be out of the field of vision. Assistance may be needed, especially with tray set-up.
Length of Time
Many patients take a long time to eat. If assistance is required, there may not always be staff or family available. Smaller, more frequent feedings with greater focus on the nutrient quality of foods consumed is beneficial.
Diet in Rehabilitation
Being aware of the special nutritional needs of stroke patients can assist in recovery/rehabilitation. The nutritional status of the patient can affect therapy in many ways. Two examples of nutritional conditions are:
- Malnourishment - poor intake of the nutrients necessary to meet the energy demands of extensive therapy. This should always be considered with patients who demonstrate low motivation, apathy, or tire easily.
- Overweight / Obesity - can affect transfers, mobility, etc. These patients need to reduce caloric intake but still get the daily nutrients essential for good health and activity.
It is important to realize that it is possible to be overweight AND malnourished. Therefore, statements such as, "It's all right that she hasn't eaten for five days, she needs to lose weight," are inaccurate.
Nutritional Care
Dietary management is an essential part of patient care, whether performed by the dietition, diet technician, nurse or family. A nutritional care plan should include the following components.
- Identify Individual Needs - No standard menu or diet will apply to everyone.
- Obtain Relevant Background Information - Many social/cultural factors affect eating habits. Consider these factors in adapting the diet to the patient's preference.
- Monitor Intake - Observe and record the patient's acceptance and tolerance of food items.
- Inform and Instruct Patient on Diet - Understanding the diet will help the patient continue to follow it.
- Be realistic in developing a nutritional care plan - Most patients have set eating habits that will be difficult to change.
For some, mealtimes will be the highlight of their day and strictly enforced dietary limitations may be more detrimental than helpful. It is important to work with the patients:
to encourage, not force;
teach, not demand good eating habits.
Be aware that eating meals is not something that takes place between health care but is an essential part of health care.
Theresa O'Toole Director of Dietary Services Spalding Rehabilitation Hospital Denver, Colorado.
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