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Nutrition and Dysphagia

March 2012

Charity Shelton

on 16 March 2012

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Transcript of Nutrition and Dysphagia

Nutrition and Dysphagia
Charity Shelton, MS, CCC-SLP, CBIST
Speech-Language Pathologist
Missouri Rehabilitation Center
Dysphagia = Swallowing disorder marked by an impaired ability to chew or swallow solid or liquid substances.
Dysphagia Treatment Team
NURSING staff observes signs of dysphagia before and after diet change
DIETARY ensures prescribed diet is delivered to patient.
PHYSICIAN orders swallow evaluation and writes orders for recommended diet/liquids
SPEECH THERAPIST completes eval and makes diet recommendations; conducts swallowing treatment
PATIENT with Dysphagia
(cc) image by nuonsolarteam on Flickr
3 Phases of Swallowing/ Dysphagia
Oral phase swallowing problems: difficulty chewing and moving food or liquid from the mouth to the throat.
Pharyngeal phase swallowing problems: difficulty triggering the swallow, squeezing food or liquid down the throat, closing the airway so food and liquid don’t go the wrong way.
Esophageal phase swallowing problems: difficulty with food entering the esophagus and moving to the stomach.
3 Types of Swallowing Assessments
Modified Barium Swallow
Regular diet
Nectar consistency liquids
Normal swallow
Aspiration: when food or liquid enters the airway
FEES exam
DIETICIAN ensures patient is receiving adequate nutrition
Honey consistency liquids
Bedside Swallow Evaluation
nothing by mouth
PUREED DIET: all foods are pureed consistency
MECHANICAL SOFT DIET: fruits/veggies generally not modified; no hard or crunchy foods; meats are whole soft, chopped, or ground
REGULAR DIET: includes all foods; all inclusive; not restricted
Solid Diet Levels
Why modify solids?
1. Weak facial muscles
2. Slow rate of eating
3. Easily fatigued while eating
HONEY CONSISTENCY LIQUIDS: as thick as honey or milkshake
NECTAR CONSISTENCY LIQUIDS: the thickness of pulpy tomato or V8 juice
THIN LIQUIDS: water, juice, soda, tea, coffee, juice from fruit, melted ice cream, etc.
Why thicken
1. To slow liquids in order to:
2. Prevent aspiration

BEDSIDE SWALLOW EVAL: ST evaluates a patient while they are eating/during a meal.
2 Consistency Foods
2 Consistency Foods
Cereal & Milk
Soups & Stews
Foods that have both solid and liquid components.
These are often restricted for patients on thickened liquids.
Also restricted are foods that start as solids and turn to liquids (i.e., Jello, ice cream).
Improving Asthetics and Taste of Modified Foods
Pureed foods
Pureed Food Molds
Consistency of pureed foods should have thicker texture versus "soup" thickness.
Other options: pre-thickened coffee, ice cream, water, dinks. You can make your own...
OUR ULTIMATE GOAL: to ensure our patients are swallowing safely.
Good nutrition and swallow safety = maintaining good health and/or maximizing rehabilitation.
Swallow evaluation
Thickened liquids are better with gel based versus powder based thickeners.
Full transcript