Purees That Please, Part 1

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Dysphagia Diet Progression (cont’d) • NDD 4—regular: • Any solid texture food • All beverages are included

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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