Effect of Implementing Fever, Hyperglycemia & Dysphagia Management Protocol on Selected Outcomes among Acute Ischemic Stroke Patients

Abstract

Background: Literatures had cited that, Fever, hyperglycemia, and dysphagia are common yet often underestimated complications that can significantly impact stroke outcomes. As healthcare systems seek to optimize care, there is growing interest in standardized protocols addressing these complications.

Purpose: is to evaluate the effect of implementing a designed nurse-initiated fever, hyperglycemia & dysphagia management protocol on selected outcomes among acute ischemic stroke patients.

Methods: A quasi-expremental study was conducted in a stroke unit affiliated to private health care sector, involving 70 male & female adult patients with acute ischemic stroke at a stroke (35 matched subjects in each study and control groups). Four tools were used to collect data pertinent to this study. The study group received the designed protocol of care in adition to the routine hospital care. Follow-up assessments evaluated patient outcomes including length of stay, frequency of complications, functional dependency, and disability after stroke.The study hypothesized that the implementation of the protocol would result in improving outcomes for the study group patients as compared to the control group ones.

Results: The majority of both groups were females, married and their age was more than 60 years old in percentages of 71.4%, 74.2% & 54.3% respectively. The most prominent cormbidites in both groups were Hypertension, Diabetes Mellitus and history of smoking in percentages of 76%, 39% and 39% respectively. The study group showed a significant improvements in temperature and blood glucose levels control with the following t and p values  (t = 2.6, p = 0.01) & (t = 2.05, p = 0.04) respectively  which can support the 1^st two hypotheses. The 4^th and 5^th hypotheses also can be supported as the study group showed a shorter length of stay and improved functional dependency scores with the following t and p values (t = 2.07, p = 0.04) and (t = -2.16, p = 0.03) respectively. Moreover, the frequcency of complications were lower in the study group in the frequency of aspiration pneumonia and pressure ulcers with the following χ² and p values (χ² = 4.242, p = 0.039) and (χ² = 3.968, p = 0.04) respectively, which also can support the 7^th hypothesis. However, the second hypothesis regarding malnutrition and dehydration can not be supported, as there were no significant differences in discharge BMI and cumulative balance with the following χ² and p values  (χ² = 7.06, p = 0.07) and  (χ² = 0.324, p = 0.56) respectively . Similarly, the 6^th  hypothesis related to disability degree can not be supported as there were no significant differences in modified Rankin scores between both groups (χ² = 7.06, p = 0.07). 

Conclusion: Implementing fever, hyperglycemia and dysphagia protocol can reduce the frequency of complications among acute ischemic stroke patients and enhance their clinical outcomes.

Recommendations: Monitoring & controlling of fever, hyperglycemia and dysphagia among acute ischemic stroke patients need to be highly considered within the routine management frameworks of such patients. Morever, further research studies have to be conducted on a larger probability sample and different geographical locations.