When Can You Start Them On a Regular Diet after A CHF or Stroke

[Student199]

Hello,

I cannot find it in a book or any definitive answers from my professors when I ask them "when is it appropriate for the patient to resume eating after a stroke or CHF."

Because I have had two recent experience where patients were not fed for up to 6 days. I asked the nurse and their responses are "we have to watch for fluid volume overload, or it is up to the doctor, dietician," and when I ask my instructors they say as long as they have a gag reflex they can be started on heart healthy diet."

I don't disagree with that, what I'm concerned about is the wait time period being that long. Does it need to be 6 days when these things can be assessed at least by the 2nd or 3rd day in my opinion?

[Rose_Queen, BSN, MSN, RN]

I think the reason you aren't finding a definitive answer is because there isn't one. It completely depends on what the patient assessment shows, and no two patients are going to have the same assessment. Those patients who weren't fed for up to 6 days- did they receive nutrition via another route, such as a feeding tube, PEG tube, or IV nutrition? As for the "as long as they have a gag reflex" comment, well, not really. There has to be a physician order for a diet. Heart healthy doesn't take into account other things, such as thickened liquids, other chronic conditions that affect diet (diabetic, renal, etc), and other things.

[Student199]

Thank you, I appreciate it.

[MendedHeart]

The patient should have a Dysphagia screen. It's actually a requirement post CVA along with the NIHSS. The bedside RN can do this, however the patient may then need a swallow study and in that case, a Speech therapist is needed.

[Here.I.Stand, BSN, RN]

Agreed with the above. Well actually, a CHF exacerbation by itself isn't typically an indication to make NPO...fluid volume status is monitored w/ daily weights, I&O, CVP (central venous pressure) monitoring if in the ICU. Pts will usually have a fluid restriction, but we don't correct fluid volume excesses with keeping strict NPO; the provider will order diuretics if needed. Strict NPO is a temporary thing for dysphagia, impending OR, anatomical issues which preclude PO intake (e.g. a tear in the esophagus.)

Post stroke, it really does depend. Having a gag reflex does not guarantee that they are safe to take PO; in fact, the reason someone would not have a gag is their neuro status is so altered they'd need to be on a ventilator. Anybody else will have a gag reflex.

Brain injuries are incredibly varied as far as course and outcomes go. It depends what part of the brain is affected, amount of bleeding, whether there is hydrocephalus (can develop post injury), whether or not there are vasospasms, whether anoxia is involved...........

Some people's swallow is never altered, and some never eat/drink again.

Often times, once the pt is awake and following commands, the RN can do a simplified swallow evaluation. If the pt "passes," the pt is go for PO. Sometimes if there is strong suspicion of dysphagia, the MD will order a SLP evaluate and skip the RN bedside swallow eval. Sometimes they will order a FEES study if there is concern for silent aspiration.

Clear as mud?