Community and Work Re-Entry

 

Nursing and Nutrition Needs

Nurses and dietitians are important team participants in the stroke recovery process. Whether you are in acute care, inpatient rehab or skilled nursing, nurses and dietitians will serve and educate you to ensure a safe and speedy recovery process. Following is an overview of the areas they will focus on and assist you with.

Skin

Your skin is one of the most important organs of your body. It regulates body fluids and temperature, protects the body and provides sensation for touch, temperature and pain. After a stroke, your skin is at risk for breaking down, and it may become unable to perform the vital function of protecting the body. This can be due to: weakness or inability to move, loss of feeling, damp skin due to urine or stool against the skin, possible presence of diabetes and use of anticoagulents (blood thinning medicine).

Therefore, the main goal for nursing in regards to skin care is to prevent possible pressure sores or skin breakdown. Nurses will help educate caregivers on the following:

  • Daily skin observation and care
  • Weight shifting for relief of pressure on the bottom
  • Turning in bed
  • Diet/proper hydration
  • Avoidance of skin injuries
  • Wearing of well fitted clothing/shoes
  • Ensuring correct donning of braces and splints

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Bladder

Following a stroke, it may be difficult to pass urine or there may be difficulty with incontinence (control). This may be due to neurologic changes from the stroke or due to urological problems, such as infection or obstruction. Other factors that can cause bladder problems are impaired mobility to get to the bathroom, impaired cognition or thinking, aphasia or language difficulties, and pre-existing urinary problems.

There are many ways in which bladder problems are managed. Here are some possibilities:

  • Time voids -- a set schedule is used to allow the patient to empty his/her bladder at regular intervals
  • Use of a medication which contracts the bladder to assist with retention
  • Use of an indwelling or intermittent catheter to empty the bladder
  • Use of an external condom catheter for incontinence
  • Use of an adult brief for incontinence

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Urinary Tract Infections

Urinary tract infections (UTI) are primarily caused from bacteria. Use of indwelling catheters or intermittently catheterizing to empty the bladder, poor hygiene and incomplete emptying of the bladder can introduce bacteria into the urinary tract.

Signs and symptoms can include:

  • Cloudy, foul smelling or bloody urine
  • Pain or burning
  • Increased frequency of urination or incontinence
  • Chills, nausea or fever

UTI’s can be prevented by drinking adequate fluids, routinely emptying the bladder (time void), using appropriate hygiene and following proper catheter care. If you do experience any of these symptoms, you should call your doctor.

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Bowel

Following a stroke, a person may have difficulty with constipation or incontinence/diarrhea. Again, factors that may affect this are an inability to get to the bathroom, difficulty thinking, difficulty communicating and/or pre-existing bowel problems. Possible ways to manage bowel problems include:

  • Cleaning out the bowels by using an enema
  • Adjusting frequency for use of the bathroom
  • Altering diet or fluid intake
  • Providing privacy for toileting
  • Managing body positioning when needed to assist with bowel management
  • Use of medications when necessary

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Prevention of Blood Clots

Sometimes after a stroke or with any impaired mobility, a blood clot (also called a DVT - deep vein thrombosis) may form in one of the limbs. Because the nursing staff is aware of this possibility, they may monitor for any of the following symptoms: redness, swelling, increased warmth along the path of the vein and increased oral temperature. Upon noting these symptoms, the doctor may order what is called a “Doppler study” to investigate whether or not there is a clot. Possible prevention and treatment approaches include:

  • Adequate fluid intake
  • Wearing compression stockings
  • Daily range of motion exercises in the immobile limb or limbs
  • Use of anticoagulent medications (blood thinning medicines, such as coumadin)
  • Bedrest with affected limb elevated
  • IV blood thinning medications (heparin)

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Managing Diabetes

Many persons who have had a stroke have also been diagnosed with diabetes. Diabetes is an illness in which the body has difficulty changing food properly into energy that the body can use. Persons who suffer from diabetes are unable to control the amount of glucose (or sugar) in their blood.

Common symptoms of diabetes include:

  • Increased glucose (blood sugar) levels
  • Fatigue
  • Often overly thirsty
  • Increased frequency of urination
  • Weight loss
  • Slow healing sores
  • Blurred vision

The nursing staff will assist with monitoring blood-glucose levels. Most common treatments are diet, exercise, use of medications and use of insulin. Complications of diabetes may be early development of plaque build-up in the blood vessels, difficulty with vision due to retinal disease or cataracts, and kidney or bladder infections.

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Nutrition

In the early stages following a stroke, the nutrition goal is to provide adequate energy and protein from well-selected foods to increase energy level for daily activities, keep muscles strong and working well, allow the body to fight infection, and to feel well, both in mind and body. Good nutrition following a stroke improves a stroke survivor’s ability to benefit from therapy.

Immediately following a stroke, impairments such as chewing and/or swallowing problems, reduced appetite, change in sense of taste or smell, inability to self-feed, ill-fitting dentures, memory loss and communication difficulty can occur and impact a patient’s ability to consume adequate nutrition and make proper choices. Due to these impairments, stroke patients often require altered texture diets that are easier to swallow, assistance with eating and assistance in completing menu selection. Nutritional supplement beverages and snacks may also help the patient meet their nutritional needs until they are able to consume enough of their regular meals.

Following a stroke, research indicates that a low fat, low salt, low cholesterol, low sugar, high fiber diet can help prevent a recurrent stroke. High blood pressure, high cholesterol, diabetes and obesity are risk factors, and may increase the chances of experiencing another stroke. Healthy dietary modifications may help control blood pressure, cholesterol levels, weight and reduce complications from diabetes.

Be sure to ask the dietitian about specific issues related to nutrition that you or your family member are experiencing, and please discuss any drastic changes in your diet or any vitamin and mineral supplementation with your doctor.

For more detailed information on nutrition recommendations, please refer to the Patient & Family Stroke Education Handbook.

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200 Abraham Flexner Way•Louisville, KY•40202

Last Updated: 9/6/2013