K.22 Medical Nutrition Therapy for Stroke
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Transcript of K.22 Medical Nutrition Therapy for Stroke
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Medical Nutrition Therapy for
Stroke
Nutrition Department
Medical Faculty of Sumatera Utara University
Brain and Mind System
2011
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Stroke
Stroke effects in nutrition problem
Symptom that affecting nutrition therapy
depend on the area brain affected
Severe neurologic impairements often
compromise the mechamisms and
cognitive abilities needed adequate
nourishment
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Risk factor for stroke
The most significant risk factor: old age
Modifiable risk factor:
Hypertension
Smoking
Obesity
Coronary heart disesase
Diabetes Physical inactivity
Genetic
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Nutrition-related factors
BMI > 27 kg/m2 in women
Weight gain > 11 kg over 16 years in
women
Waist to hip ratio > 0.92 in men
Diabetes
HypertensionCholesterol
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Protective factors for stroke
Total dietary fat (20-25%)
Daily consumption of fresh fruit (fiber and
antioxidant)
Flavonoid consumption (antioxidant)
Fish consumption (omega-3)
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Medical nutrition therapy as a
prevention for stroke
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Medical Nutrition Therapy
Primary prevention cornerstone for
managing stroke
Prevention including lifestyle behaviour
NCEP ATP III updated:
Healthy lifestyle habits
Therapeutic Lifestyle Changes
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Healthy lifestyle habit
Healthy weight (BMI
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Macronutrient recommendations
(Therapeutic lifestyle changes)
PUFA: up to 10% of total calories
MUFA: up to 20% of total caloriesTotal fat: 20-25% of total calories
(PERKENI 2006)
Carbohydrate: 50-60% of total caloriesDietary fiber: 20-30 grams per day
Protein: 10-15% of total calories
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Essential components
SAFA: less than 7% of total calories
Dietary cholesterol: less than 200 mg/day
Plant stanols/sterols: 2 grams/dayViscous (soluble) fiber: 10-25 grams/day
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Antioxidant
Docosahexaenoic acids (DHA) and
Eicosapentaenoic acids (EPA) omega-3 fatty
acids
Sources: all seafood, fatty fishes (salmon, tuna, andtrout)
Fruits and vegetables
Sources: Flavonoid (green tea/cathecin, quercetin,
revestratol, curcumin, anthocyanin)
Vitamin A, C, E, B12, Zinc, grapeseed, gingko
biloba, selenium, and gluthation
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Medical nutrition therapy for stroke
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Problems in managing stroke: malnutrition
Malnutrition predicts a poor outcome
Feeding difficulties are determined by theextent of the stroke and the area of the
brain affected
DYSPHAGIA
main problem
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Nutrition Management
Maintain adequate nutrition
Assess and manage dysphagia
Vitamin dan mineral supplementationEnteral nutrition support
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Problems related consuming food
in stroke
Declined in function resulting decreasing
the ability for self care
Need enteral nutrition support for period of
time until several function improves and
eating process can be resumed
Losing enjoyment of eating meal
preparation
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Problem 1. Presentation of food to the
mouth
Hemiparesis is weakness on one side of thebody that causes the body to slump toward theaffected side; it may icrease a patientss risk ofaspiration
Patient sit as upright (at a 90- degree angel) aspossible
If the patient must be in bed during mealtime,pillow can be used to bank and support theparetic side
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Hemianopsia is blindness for one half of the
field of vision
A patient may eat only half of the contents of ameal because the patient recognizes only half of
it
Need assistance during the mealtime
Apraxia is inability to perform purposeful
movement although no sensory or motor
impairment exist
Need demonstration and assistance action to
practice
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Problem 2. The oral process
Dysphagia (difficulty swallowing)
Symptom:
drooling, choking, or coughing during or following
meals Inability to suck from a straw
A gurgly voice quality
Holding pockets of food in the buccal recesses
Absent gag reflex
Chronic upper respiratory infection
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Dysphagia inadequate intakemalnutrition
Caused by tongue, facial, and masticatormuscle weakness
Environmental distraction and
conversations during mealtime increasethe risk for aspiration and should becurtailed
National dysphagia diet:
Level 1: pureed
Leval 2: mechanically altered characteristics
Level 3: transition to regular diet
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Level 1: designed for people who have moderate to severe dysphagia,
with poor oral phase abilities
pureed, homogenous, and cohesive foods Should be pudding like
Level 2: Transition from pureed textures to more solid texture, chewing
abilitiy is required
Moist, soft texture, easily form into bolus
Meats are ground or are minced, still moist with some cohesion
Level 3: Transition to a regular diet, adequate dentition and mastication
are required
Nearly regular textures with the exception of very hard, sticky orcrunchy foods
Foods still need to be moist and should be in bite size pieces atthe oral phase of the swallow
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Level 2
Level 3
Level 1
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Problem 3. Swallowing
Proper position for effective swallowing:
sitting bolt upright with the head in a chin-
down position
Process of swallowing organized into three
phases:
Oral phase
Pharyngeal phase
Esophageal phase
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1. Oral phase:
food in mouth saliva chewedbolusswallowing
Intracranial damage and weakened lipmuscles hard to complete this phase
Facial weakness food can become
pocketed in the buccal recesses2. Pharyngeal phase:
Bolus is propelled past the faucial arches
Symptoms of poor coordination during thisphaseinclude gagging, choking, andnasopharingeal regurgitation
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3. Esophageal phase :
Bolus through the esophagus into the
stomach
Problems: impaired peristalsis caused bybrainstem infarct
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Problem 4. Liquids
Liquids as thin consistency such as juice or
water needs more coordination and control
Caused aspiration life threatening event
(aspiration pneumonia, even from sterile water)If difficulty occurs: suggest thickening liquids
Thickened product: nonfat dry milk powder,
cornstarch, modular carbohydrate supplementsMilk associated with increased phlegm flush
the throat with clear thickened liquids
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Problem 5. Textures
Food consistency mechanically soft or
pureed consistency reduce the need for
oral manipulation and to conserve energy
while eating
Small and frequent meals
Suggest: 3T (tasty, texture, and
temperature)
Cool temperature facilitates swallowing
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Nutrition support from enteral
feeding
If risk of aspiration from oral intake is high
If the patient cannot eat enough to meet
nutritional needs
Options: Nasogastric tube (short term option)
Percutaneous endoscopic gastrostomy (PEG)/
gastrostomy-jejunostomy (PEG/J) tube (long term
option)
Needs to appropriate training for taking care the
enteral feeding
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NGTPEG
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