national-clinical-guidelines-for-stroke-fourth-edition

6.22.2 Sources
A Brady et al 2006
B Consensus
C Brady et al 2006
6.23 Nutrition: assessment and management
Malnutrition, poor dietary intake and dehydration are common after stroke, being
present in up to 30% of patients (Davis et al 2004; FOOD Trial Collaboration 2003;
Martineau et al 2005; Yoo et al 2008). The risk of malnutrition increases with increasing
hospital stay (Yoo et al 2008). Malnutrition and dehydration are associated with a worse
outcome and a slower rate of recovery (Davis et al 2004; FOOD Trial Collaboration 2003;
Yoo et al 2008) and stroke patients with dysphagia are more at risk due to the multiple
impairments associated with difficulty/inability to eat and drink normally (Crary et al
2006; Martineau et al 2005).
6.23.1 Recommendations
A All stroke patients, on admission, should be screened for malnutrition and the risk of
malnutrition by a trained person using a validated procedure (eg Malnutrition
Universal Screening Tool (MUST)).
B Screening for malnutrition in stroke patients should be repeated:
● weekly for hospital inpatients
● at first appointment in outpatients
● on admission and where there is clinical concern in care homes or rehabilitation units.
C Nutritional support should be initiated for all stroke patients identified as
malnourished or at risk of malnutrition. This may include specialist dietary advice,
oral nutrition supplements, and/or tube feeding.
D Fluid balance and nutritional intake should be monitored in all stroke patients who
are at high risk of malnutrition, are malnourished and/or have swallowing problems.
6.23.2 Sources
A National Institute for Health and Clinical Excellence 2006a; Mead et al 2006
B National Institute for Health and Clinical Excellence 2006a
C National Institute for Health and Clinical Excellence 2006a; Ha et al 2010; Rabadi et al
2008
D Consensus
6.24 Bowel and bladder impairment
6 Recovery phase from impairments and limited activities: rehabilitation
Disturbance of control of excretion is common in the acute phase of stroke and it
remains a problem for a significant minority of patients. Incontinence has many
consequences: it causes stress for carers and patients; it greatly increases the risk of skin
pressure ulceration; and it can be distressing for the patient.
© Royal College of Physicians 2012 103