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Provided Courtesy of RD411.com Where health care professionals go for information. 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

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slide1

Provided Courtesy of RD411.com

Where health care professionals gofor information

Purees That Please, Part 1

Contributed by Judy Schlager, RD, LD

Review Date 3/11 G-1559

slide2

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
slide3

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
slide4

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
slide5

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
slide6

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
slide7

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
slide8

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
slide9

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
slide10

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
slide11

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
slide12

Dysphagia Diet Progression (cont’d)

  • NDD 4—regular:
  • Any solid texture food
  • All beverages are included
slide13

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
slide14

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
slide15

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
slide16

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
slide17

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
slide18

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
slide19

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