Transcript SafeStaff - Nutrition411

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Purees That Please,
Part 1
Contributed by Judy Schlager, RD, LD
Review Date 3/11 G-1559
The Dysphagia Diet
• Choosing the correct diet:
– Must individualize
– Goal: Rehabilitate to the highest
practical level of the dysphagia diet
progression
– Must use collaborative effort to reach
decision
– Must have careful swallow evaluation by
a qualified therapist
Dysphagia Diet
Progression
National Dysphagia Diet (NDD) 1—
pureed:
• Pureed, homogenous, and cohesive foods
• Pudding-like foods
• No coarse textures, raw fruits or
vegetables, nuts, etc
• All foods requiring bolus formation,
controlled manipulation or mastication are
excluded
Dysphagia Diet
Progression (cont’d)
NDD 1—pureed:
• Rationale: This diet is designed for
people who have moderate to severe
dysphagia, with poor oral phase
abilities, and reduced ability to protect
their airway
• Close or complete supervision and
alternate feeding methods sometimes
are required
The Pureed Diet
The pureed diet has only one purpose:
• To enable the patient/resident to ingest
adequate nutrition in comfort and safety
• Modification is in texture only
• Further modifications merely impose
further complications
Dysphagia Diet
Progression
NDD 2—mechanically altered:
• Foods are moist, soft textured, and
easily formed into a bolus
• Meats are ground or minced, not
larger than ¼ pieces—still moist with
some cohesion
• All foods from Level 1 are acceptable
at this level
Dysphagia Diet
Progression (cont’d)
NDD 2—mechanically altered:
• Rationale: This diet is a transition
from the pureed textures to more
solid textures
• Chewing ability is required
• Textures are appropriate for
individuals with mild to moderate oral
and/or pharyngeal dysphagia
Dysphagia Diet
Progression (cont’d)
NDD 2—mechanically altered:
• Assess patients for tolerance to mixed
textures
• Expect that some mixed textures are
tolerated in this diet
Dysphagia Diet
Progression (cont’d)
NDD 3—dysphagia advanced:
• Foods are of nearly regular textures,
with the exception of very hard,
sticky, or crunchy foods
• Foods still are moist and in bite-size
pieces at the oral phase of the
swallow
Dysphagia Diet
Progression (cont’d)
NDD 3—dysphagia advanced:
• Rationale: This diet is a transition to a
regular diet
• Adequate dentition and mastication
are required
• Textures of this diet are appropriate
for individuals with mild oral and/or
pharyngeal phase dysphagia
Dysphagia Diet
Progression (cont’d)
NDD 3—dysphagia advanced:
• Assess patients for tolerance of mixed
textures
• Expect that mixed textures are
tolerated on this diet
Dysphagia Diet
Progression (cont’d)
NDD 4—regular:
• Any solid texture food
• All beverages are included
Characteristics of
Pureed Foods
For dysphagic diets:
• Puree consistency should support straw
when placed in center of food
• Foods are dense in relation to volume
• Temperatures are cold or hot, not tepid
• Thicken liquids PRN
• Textures uniform—no combined textures
• Smooth, not sticky
• Foods to avoid—seeds, nuts, crunchy foods
Foods for Dysphagic
Patients
Foods must form a cohesive bolus:
• Use sauces and gravies
• Avoid rice, cottage cheese, and ground
meats without sauces or gravies
• Liquids usually are thickened
Commercial Thickeners
in Liquids
Properties of starch thickeners:
• Pregelatinized and agglomerated to
instantize
• Only the water portion of the item is
thickened
• Normal metabolism reverses the
thickening process, thus releasing the
water to make it available for hydration
Commercial Thickeners
in Liquids (cont’d)
Properties of gum thickeners:
• Indigestible in upper gastrointestinal
tract
• Low susceptibility to enzymatic
hydrolysis
• High water-binding capability
• Good fiber source
• Good bulk for colon
Facility-Thickened vs
Prethickened Liquids
Facility thickened:
• Advantages:
– For use with all liquids
– Less costly
• Disadvantages:
–
–
–
–
Unsafe=lumps
Inaccurate measuring=inconsistent results
Constant training of staff members
Risk of fines because of improper viscosity
levels
Facility-Thickened vs
Prethickened Liquids
(cont’d)
Prethickened:
• Advantages:
– Safer=no lumps
– No staff training
• Disadvantages:
– More costly
– Not all necessary liquids available
– Flavors sometimes not as good as with
facility-thickened liquids
Viscosity Borders and
Ranges
For thickened liquids:
• Thin=1−50 centipoise (cP)
• Nectar-like=51−350 cP
• Honey-like=351−1750 cP
• Spoon thick=>1750 cP