1. Understanding the Therapeutic Diet: Food Consistency By Hailey Vickers & Abbie Page

2. What is Food Consistency What are some common consistencies? – Crunchy, milky, smooth, buttery, lumpy, frothy, mushy, tough, chewy, etc.

3. Why Does Food Consistency Matter? Pleasure/ preference Availability Health Issues

4. Why We Need to Texture-Modify Diets “It’s estimated that in nursing homes, food textures are modified for 31% to 48% of patients.” – http://www.nursingcenter.com/pdf.asp?AID=1080 406

5. Common Difficulties of Swallowing Simple narrowing or blockage Occurs commonly in patients with strokes which disturb the nerve supply to the throat. Occurs in patients with cancer, and due to scarring after longstanding reflux of acid into the esophagus, often in association with a hiatus hernia. Poor coordination of the muscular contractions

6. Dysphagia What is Dysphagia? - Swallowing difficulties. - "dysphagia" comes from the Greek root word dys which means "difficulty or disordered", and phagia meaning "to eat". Symptoms - Pain in the mouth, choking when eating, coughing when swallowing, drooling, stomach acid backing up into the throat, heartburn, hoarseness, unexplained weight loss, difficulty controlling food in the mouth, sensation of food getting stuck in mouth or throat. - Some patients be unaware they have dysphagia if they do not experience multiple symptoms.

7. Dangers of Dysphagia Patients Pneumonia and upper respiratory infections - specifically aspiration pneumonia which can occur when you swallow something down the wrong way and it enters the lungs. Malnutrition - this is especially the case with people who are not aware of their dysphagia and are not being treated for it. They may simply not be getting enough vital nutrients for good health. Dehydration - if you cannot drink properly, your fluid intake may be undermined, leading to dehydration (shortage of liquid in the body).

8. Causes of Dysphagia There are two different clinical classifications of Dysphagia 1.Oropharyngeal: Difficulty with initial swallowing in either the oral or pharyngeal phases (chewing, propelling food through pharynx to the esophagus). Usually neurologic or structural issues. 2.Esophageal: Difficulty passing food down the esophagus. Onset of symptoms occur after swallowing. Patients normally complain

9. Causes of Dysphagia Some causes of Oropharyngeal Dysphagia Stroke, Parkinson’s Disease, motor neuron disorders, or Muscular Distrophy. Some Causes of Esophageal Dysphagia Esophageal cancer, Lower esophageal rings, enlarged left atrium, thoracic tumor, or Caustic ingestion.

10. National Dysphagia Diet Levels There are mainly 3 Diet Levels that will guide us to giving properly prepared meals to our Dysphagia patients. Level 1 Dysphagia Diet – This level is for the most extreme cases of dysphagia patients – At this level everything must be purreed until the meal has a mashed potato-like consistency.

11. National Dysphagia Diet Levels Level 2 Dysphagia Diet – This level is for patients that can tolerate some chewable meals, but still have difficulty swallowing and chewing. – Thickening liquids is good for this level. There are various thickening agents used for this – Some solid food can be given to these patients but they must be minced or chopped into pieces that are smaller than 1/8 th of an inch. – Low fiber is recommended due to the course texture of high-fiber foods.

12. National Dysphagia Diet Levels Level 3 Dysphagia Diet – At this level, patients can consume many solid foods, but must be monitored and fairly soft. – Patients should be able to chew very tender, small cuts of meat, soft cereals, soft pastas, and soft breads. – Nothing hard, crunchy, sticky, or deep fried should be given to theses patients.

13. Altering Solids Techniques Pureeing Foods – Ensure that patients with swallowing issues mainly, Dysphagia Level 3, are able to safely consume food and maintain proper nutrition and food intake. How are purreed foods best prepared ? Food processors are the best way to prepare the foods. Blenders may also be used. Tasting the food before giving it to a patient is important. We want our patients to be happy with their food. Sometimes some sugar, butter, or gravy may need to be added to help liven up the flavor! Do the spoon test to check for too sticky or too runny products!

14. Altering Solids Techniques Mincing Dicing

15. Preparing the Plate Making the plate presentable before serving the patients is VERY important – NO MUSH PILED ON A PLATE PLEASE! – Presenting the pureed or altered foods as if they are not altered is a good idea. – Example:

16. Resources http://www.utmb.edu/otoref/grnds/esoph-dysphagia-080206/esoph- dysphagia-slides-080206.pdf http://www.utmb.edu/otoref/grnds/esoph-dysphagia-080206/esoph- dysphagia-slides-080206.pdf http://www.merckmanuals.com/professional/gastrointestinal_disorders/e sophageal_and_swallowing_disorders/dysphagia.html http://www.merckmanuals.com/professional/gastrointestinal_disorders/e sophageal_and_swallowing_disorders/dysphagia.html http://med- pass.com/Docs/Products/Samples/National_Dysphagia_Diet_Levels.pdf http://med- pass.com/Docs/Products/Samples/National_Dysphagia_Diet_Levels.pdf http://www.nursingcenter.com/pdf.asp?AID=1080406 http://edis.ifas.ufl.edu/pdffiles/FS/FS16800.pdf http://www.ddc.musc.edu/public/problems/symptoms/swallowing.cfm (common difficulties of swallowing) http://www.ddc.musc.edu/public/problems/symptoms/swallowing.cfm http://www.medicalnewstoday.com/articles/177473.php (symptoms and dangers) http://www.medicalnewstoday.com/articles/177473.php