Nutritional Management for Stroke Patients: Addressing Diarrhea Issues

Enteral feeding for patients with cerebrovascular embolic stroke?

My grandmother was hospitalized for a left cerebral artery embolic stroke on August 30 and was discharged home after one month.
She is unable to stand or speak and requires repositioning and back patting every two hours.
Currently, she is being fed with canned food, but she has been experiencing deep dark green watery stools.
The attending physician prescribed an antidiarrheal medication, and after taking two tablets daily, her stools are no longer watery.
However, after switching to Abbott's Ensure, she is now passing a light yellow transparent liquid.
Is her diarrhea still not improved? Should she continue taking the antidiarrheal medication? What brand or type of canned food would be more appropriate for her?

Zhuang, 40~49 year old female. Ask Date: 2004/10/12

Dr. Cai Xiuwen reply Nutrition

Hello! The situation of diarrhea should be assessed based on the frequency, volume, and characteristics of the stools.
It is advisable to consult the attending physician to evaluate whether a stool softener is necessary.
Abbott's Ensure is a high-nitrogen, low-residue nutritional product.
The pale yellow liquid output may result from minimal residue after digestion, leaving only digestive fluids.
Diarrhea can occur due to factors such as rapid feeding, high concentration, or bacterial growth.
It is recommended to slow down the feeding rate and ensure the cleanliness of the feeding tube, as well as monitor the temperature and duration of milk storage.
If you have a follow-up appointment, it would be beneficial to ask a nutritionist to assess your grandmother's health status and the nutritional composition and quantity of the supplements.
This approach will likely provide better nutritional support for your grandmother! This response is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Department of Health.
Wishing you good health!

Reply Date: 2004/10/12

More Info

Nutritional management for stroke patients, particularly those who have experienced a cerebrovascular accident (CVA) like your grandmother, is crucial for recovery and overall health. Given your grandmother's condition—having suffered a left brain embolic stroke and requiring assistance with basic activities—her nutritional needs must be carefully addressed, especially in light of her recent diarrhea issues.

Firstly, the change in stool consistency to a deep green, watery form can be indicative of several factors. The green color may be due to the rapid transit of food through the intestines, which can happen when the digestive system is not processing food properly. The introduction of a new enteral formula, such as Abbott's Ensure, which is high in nitrogen and low in residue, could also contribute to changes in bowel movements. The fact that her stool has transitioned to a light yellow, transparent liquid suggests that her body may not be absorbing nutrients effectively, which can be a common issue in patients receiving enteral feeding.

The use of anti-diarrheal medication, as prescribed by her physician, should be monitored closely. If the diarrhea has improved with the medication, it may not be necessary to continue its use indefinitely. However, if the stool remains liquid or if there are any signs of dehydration or electrolyte imbalance, it is essential to consult her healthcare provider for further evaluation. The frequency of bowel movements, the presence of any accompanying symptoms (such as abdominal pain or fever), and her overall hydration status should guide the decision on whether to continue the anti-diarrheal medication.

Regarding the choice of enteral nutrition products, it is essential to select formulas that are appropriate for her specific needs. Given her condition, a formula that is designed for patients with swallowing difficulties or those who require tube feeding is advisable. Products like Ensure, Boost, or specialized formulas for renal or diabetic patients (if applicable) can be considered. It is also important to ensure that the feeding is administered at a proper rate to prevent gastrointestinal distress, which can lead to diarrhea. Slowing down the feeding rate and ensuring that the feeding tube is clean and properly maintained can help mitigate these issues.

In addition to the nutritional aspects, it is crucial to monitor her overall health and recovery. Regular follow-ups with her healthcare team, including a dietitian, can provide tailored advice and adjustments to her feeding regimen based on her progress. The dietitian can also help assess her caloric and protein needs, ensuring she receives adequate nutrition to support her recovery.

Lastly, consider the psychological and emotional aspects of her care. Stroke patients often experience changes in mood and cognitive function, which can affect their appetite and willingness to eat. Engaging her in meal planning or offering her favorite foods (if they are safe and appropriate) can help improve her interest in eating.

In summary, managing your grandmother's nutrition post-stroke involves careful monitoring of her bowel movements, appropriate use of medications, and selecting the right enteral nutrition products. Regular consultations with healthcare professionals will ensure that her nutritional needs are met and adjusted as her condition evolves.

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