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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