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A staged nursing pathway reduced feeding intolerance after ischemic stroke

Medical Science Monitor (PubMed)Jul 29, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a single-center randomized trial of older adults with ischemic stroke, dysphagia, and post-pyloric feeding tubes, a staged nursing pathway reduced 7-day feeding intolerance versus usual care (adjusted RR 0.61).

What NurseJet pulled from the source

The pathway used repeated assessment of feeding tolerance and aspiration risk to guide staged post-pyloric nutrition. Compared with usual care, it was associated with lower feeding intolerance, faster achievement of at least 80% of the energy target (adjusted HR 1.65), more target-achieving days, and lower aspiration-related pneumonia risk (adjusted RR 0.54). Feeding-related hypoxemia, tube displacement, upper gastrointestinal bleeding, and electrolyte disturbances did not differ significantly.

Why this matters for nurses

Stroke-related dysphagia makes enteral feeding a balance between nutritional delivery and aspiration risk, and bedside nurses repeatedly observe the tolerance signals that guide that balance. This trial directly evaluated a structured nursing workflow rather than a single feeding product or device.

Bedside takeaway

A staged nursing pathway reduced feeding intolerance and accelerated nutritional delivery in older adults with stroke-related dysphagia.

How This Applies in Practice

Use this when: Caring for an older adult with acute ischemic stroke, dysphagia, and ordered post-pyloric enteral nutrition.

On your shift

Complete the approved feeding-tolerance and aspiration-risk assessments at the intervals specified by the enteral-nutrition pathway.
Trend delivered nutrition, gastrointestinal tolerance findings, oxygenation changes, and signs of aspiration in the designated record.
Escalate intolerance, respiratory change, tube-position concern, or failure to progress toward the ordered target through the clinical team.

Keep in mind: The trial tested one single-center pathway in a defined post-pyloric population. Follow the enteral-feeding protocol, facility policy, and patient-specific provider orders.

Key takeaways

The parallel randomized trial compared a staged nursing pathway with usual care in older adults with acute ischemic stroke, dysphagia, and post-pyloric tubes.
Seven-day feeding intolerance was lower with the pathway (adjusted RR 0.61, 95% CI 0.47 to 0.81).
Patients reached at least 80% of their energy target sooner, and aspiration-related pneumonia risk was lower (adjusted RR 0.54).
The measured feeding and tube safety outcomes did not differ significantly between groups.

Practice implications

For eligible stroke patients receiving post-pyloric feeding, use the facility-approved tolerance and aspiration-risk assessments, document trends and delivered nutrition, and escalate intolerance or respiratory changes through the ordered pathway. Do not generalize the trial to other feeding routes or populations without local review.

Limitations & cautions

This was a single-center trial limited to older adults with acute ischemic stroke, dysphagia, and post-pyloric tubes. The abstract does not report the enrollment size, blinding, longer-term outcomes, or whether the pathway transfers to other settings, ages, diagnoses, or feeding routes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Medical Science Monitor (PubMed)

Medical Science Monitor (PubMed). Impact of a Staged Enteral Nutrition Nursing Pathway Based on Dynamic Assessment of Tolerance and Aspiration Risk vs Usual Care on Feeding Intolerance in Older Adult Patients With Acute Ischemic Stroke and Dysphagia: A Single-Center Randomized Controlled Trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42522175/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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AI-summarized from the linked source. Review the original article before applying to practice.

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The trial randomized 500 adults. Moderate-to-severe PACU pain occurred in 145 of 242 assessed participants in the fentanyl group and 138 of 233 in the dexmedetomidine group, with no significant difference.

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Intraoperative rescue fentanyl use did not differ significantly between groups.
Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
Other in-hospital outcomes were similar between the two regimens.

Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

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A prospective Dutch nursing-home cohort found clinically important differences in illness burden across respiratory viruses, with influenza and human metapneumovirus standing out.

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Among 3,195 residents at 15 nursing homes, 526 suspected acute respiratory-infection episodes were recorded and a virus was identified in 291. Influenza A was associated with delayed recovery, oxygen use, and threefold secondary-bacterial-pneumonia risk; hMPV was linked to fourfold more time in bed.

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Why this matters on shift

Frailty can amplify respiratory-infection consequences, and the causative virus may help anticipate recovery, oxygen, mobility, and secondary-infection needs.

Bedside takeaway

Trend oxygen needs, mobility, recovery, and secondary-pneumonia signs during nursing-home respiratory infections.

Nursing implications

During outbreaks or suspected infection, trend oxygen needs, mobility and time in bed, recovery, and signs of bacterial pneumonia according to facility protocols.

Limitations & cautions

Abstract-only summary. Data came from 15 Dutch nursing homes, the overall suspected-infection risk estimate was imprecise, and virus-outcome comparisons may be affected by confounding and small subgroup counts.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of the American Medical Directors Association (PubMed). Clinical Impact of Acute Respiratory Virus Infections in Nursing Home Residents.

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How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

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