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STROKE CARE PLAN: HYDRATION, MEAL ASSISTANCE, SPECIAL DIETS
All interventions must be monitored, evaluated and documented as per Home policy
Any changes (improvements or deterioration) must be reported to the RN/RPN
FOCUS
GOAL(S)
Resident is reluctant to drink fluids
and is at risk of dehydration due to
swallowing problems related to
stroke.
Resident will drink minimum of
1500 mls of fluid per day (or
other amount as prescribed)
Resident will not show signs of
dehydration:
 Dark, concentrated, or
strong-smelling urine
 Decreased urine output
 Frequent urinary tract or
bladder infections
 Thick, stringy saliva
 Constipation
 Dizziness when sitting up
or standing
 Confusion or a change in
mental status
 Weight loss of 3.5 pounds
(1.5 kg) in less than 7 days
 Fever
 Decreased skin elasticity
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Determine resident’s preferred fluids on
admission.
Dietary
Offer resident’s preferred fluids between
meals and snacks.
PSW/HCA
Limit caffeine intake to 2 to 3 cups or
less per day
PSW/HCA
Track and record fluid intake for all
meals and snack times
PSW/HCA &
Registered Staff
Review and evaluate intake every 24
hours
Registered Staff
Track and record output at request of
nursing or dietitian. Report any changes
in colour of urine.
PSW/HCA &
Registered Staff
Observe for signs & symptoms of
dehydration (dry mouth, coated tongue,
& report to registered staff
PSW/HCA
Observe for signs of constipation and
report to registered staff
PSW/HCA
Assess need for adaptive devices for
drinking.
Dietary/OT
Use adapted devices for all meals,
snacks and medication administration to
reduce the risk of aspiration.
PSW/HCA &
Registered Staff
Educate resident/family on dehydration
risks and prevention and use of adaptive
devices.
PSW/HCA/Registered
Staff/Dietary
December 2011
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Tips and Tools for Everyday Living (Heart and Stroke Foundation of Ontario, 2010)
Page 1 of 3
STROKE CARE PLAN: HYDRATION, MEAL ASSISTANCE, SPECIAL DIETS
All interventions must be monitored, evaluated and documented as per Home policy
Any changes (improvements or deterioration) must be reported to the RN/RPN
FOCUS
Impaired nutritional status
related to recent stroke as
evidenced by:
 Impaired swallowing or
chewing
 Cough or choking during
and after meals
 Shortness of breath
at mealtimes
 Little or no swallowing
reflex
 Drooling
 Poor lip closure
 Loss of food from mouth
 Wet or gurgling voice
 Pocketing of food
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Resident will not choke while
eating or drinking.
Assess resident’s swallowing function
Speech Language
Pathologist
Resident will remain free of
aspiration pneumonia
Provide__________diet texture for
foods
Dietary, Registered
Staff
Resident will have adequate
nutritional intake as specified
by dietitian.
Provide__________diet texture for
fluids.
Resident score on the PURS
scale will be ____
Perform oral care before and after all
meals & snacks
PSW/HCA
Perform positioning assessment
OT/PT
Position resident properly during all
meals (upper body upright at 60 – 90
stabilized with pillows with head in
midline and flexed forward)
PSW/HCA
Dietary, Registered
Staff
PSW/HCA
Offer small, frequent meals to
encourage intake.
PSW/HCA
Offer fluids after each mouthful.
Dietary/OT
Assess resident’s need for adaptive
devices for eating
PSW/HCA
PSW/HCA
Use adaptive devices to allow resident
to feed self
PSW/HCA
Seat resident in an upright position for
minimum of 30 minutes following all
meals.
Feed resident using ½ to 1 teaspoon.
Cue resident to swallow after each
mouthful.
PSW/HCA
PSW/HCA/Registered
Staff/Dietary
December 2011
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Tips and Tools for Everyday Living (Heart and Stroke Foundation of Ontario, 2010)
Page 2 of 3
STROKE CARE PLAN: HYDRATION, MEAL ASSISTANCE, SPECIAL DIETS
All interventions must be monitored, evaluated and documented as per Home policy
Any changes (improvements or deterioration) must be reported to the RN/RPN
FOCUS
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Supervise at all meals and snacks.
Educate resident/family re safe eating
and nutrition
December 2011
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Tips and Tools for Everyday Living (Heart and Stroke Foundation of Ontario, 2010)
Page 3 of 3