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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_936_Библиотеки_им_академика_М_И_Перельмана

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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Touma, E., & Bisharat, N. (2019). Trends in
admission serum albumin and mortality in patients with hospital readmission.
International Journal of Clinical Practice, 73(6), e13314.
Traylor, D., Gorissen, S., & Phillips, S.
(2018). Perspective: protein requirements and optimal intakes in aging: Are we ready to recommend more than the rec­ommended daily allowance? Advances in Nutrition, 9, 171–182.
White, J. V., Guenter, P., Jensen, G., Malone,
A., Schofield, M., & Academy Malnu-
trition Work Group. (2012). Consensus statement: Academy of Nutrition and Dietetics and American Society for Par­enteral and Enteral Nutrition: Character­istics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN Journal of Paren- teral and Enteral Nutrition, 36, 275–283.
Zhang, Z., Pereira, S., Luo, M., & Matheson,
E. M. (2017). Evaluation of blood bio­markers associated with risk of malnutri­tion in older adults: A systematic review of meta-analysis. Nutrients, 9, 829–849.
APPENDIX 13–A
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Recording Food Intakes
315
Soft Foods +
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Chopped Meat
Soft Foods +
Ground Meat
Puree Foods +
Ground Meat
APPENDIX 13–B
cereal dry
bacon
sausage
eggs, all types
ham, ground
sausage, ground
Canadian
cooked oatmeal
regular
scrambled eggs
ham, ground
cooked Cream
of Wheat
pureed
scrambled eggs
biscuit
bread
bacon, ground
sausage, ground
Canadian
pregelled,
slurried breads
crackers
pancakes
bacon, ground
on French toast
toast
muffins
waffle
pregelled,
entrée meat,
roast beef,
ground
slurried breads
pureed
chicken,
chopped
fish
roast pork,
ground
or French toast
entrée meat,
mashed
potatoes, yams
hamburger patty
hot dog
meatloaf
Salisbury steak
ground
mashed
mashed winter
squash
roasts, chopped
rice
sandwiches:
stew, pieces <1/2
inch
noodles
potatoes
potatoes, yams
mashed winter
squash
pureed cooked
pureed cooked
vegetables
soups, blended
smooth
tuna, egg,
bologna,
pasta entrees
vegetables
chicken salad,
cheese
Food Texture Continuum Matrix
Slippery Puree
Puree
Thin Liquid Thick Liquid
thin Cream of
Wheat
NECTAR-LIKE
4 oz. juice
water
coffee, tea
baby puree
meat
+ ~1 Tbsp
commercial
broth
custard
thickener
juice:
pudding
Commercially
made
apple
cranberry
316
pureed fruit
juices
nectar-like:
grape
orange
milk
water
tomato juice
nectar
nonfat
soft drinks
milk:
lowfat
whole
chocolate
buttermilk
cooked
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Soft Foods +
Soft Foods +
Puree Foods +
vegetables:
Chopped Meat
soups
Ground Meat
Ground Meat
canned beets
soups, blended
smooth
pudding
custard
broccoli,
cauliflower,
green beans
tomato, fresh
carrot coins,
vegetables:
custard
yogurt with fruit
pureed fruit
peas, spinach,
pieces
soft cooked
pudding
yogurt, smooth
(no fruit pieces)
sliced
green lettuce
salad
zucchini
canned fruit, no
pureed fruit
cottage cheese,
banana,
melon (cut
fruit, fresh:
banana,
pineapple
fruit, fresh:
small curd
up), orange
strawberries,
kiwi
(sectioned),
pear
cake
graham crackers
vanilla wafers
pie, bottom crust
only
cookies, no nuts
Slippery Puree
Puree
Thin Liquid Thick Liquid
pureed cooked
vegetables (no
potatoes, yams)
HONEY-LIKE
Generally, 4
oz. thin liquids
Instant Breakfast
commercial
+ ~2 Tbsp
commercial
thickener
supplement
fruit ice
sherbet
ice cream
Jell-O
317
APPENDIX 13–Ca
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Thickeners
Patients who need to restrict liquids to a thicker consistency will find that the use of either commercial thickening products or the addition of certain foods and products found in the kitchen cupboard at home will allow them to increase the variety of liquids and foods that they are able to eat.
The amount of thickener added will allow thickening from nectar-like to honey­like, or to an even stiffer spoon-thick consistency. Thickeners can be used to stiffen a pureed food item that may be too thin. Some products work better in hot liquids. Others are supplemented with vitamins and minerals. It is important to compare the amount of product needed to achieve the desired consistency — some products have greater thickening power and, as a result, require less product. Manufactur­ers recommend different amounts of their product to obtain a nectar-like, honey­like, or spoon-thick consistency. The amount of product needed also may differ depending on the temperature, acidity (pH), and amount of sugars and other solids present in solution. Individual product websites provide information on product use and recipes. Some of the newer gel-based thickeners have less altera­tion in taste and clarity of the liquid being thickened, which for some individuals, improves acceptability and effectiveness.
Following is a list of some search term suggestions and, some websites, though by no means meant to imply endorsement or a complete list. New products are being developed. Some products are intended (usually gels or powders) to be added to existing fluids at hand to thicken to desired viscosity. Other products can be purchased in a ready-to-consume container with a stated viscosity of nectar-like or honey-like. Currently, there is little standardization between company products as to what viscosity is obtained by following package directions using one of the powder or gel products added to foods at home. Additionally, the viscosity will be altered in the individual’s mouth based, in part, on dilution with saliva, length of retention in the mouth, and mix of other food in the mouth. Material in the cup may not maintain the same characteristics as it moves through an individual patient’s oral-pharyngeal structures!
Prices vary depending on where purchased and amount ordered. Some compa­nies provide mail order shipping directly to the consumer. Hospital-based speech departments may be able to order through their Food Service, thereby accessing commercial vendors. The local drug store usually stocks a thickening product. If not found on the shelves or behind the counter, the pharmacy can order it.
Some suggested Web-based search terms: “Thickeners-dysphagia” and
“therapeutic liquid thickeners.” “Precision Foods Thick It,” “Thick-It,”
“Hormel labs–Thick & Easy” (product more likely found in Food Service
operations than commercial retail); “Bernard Foods Thixx thickeners.”
318
Some Websites, not intended to be all-inclusive or endorsed:
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http://www.nestlenutrition.com/us or http://www.nestlehealthscience.us
Go to “Product & Applications” then “ Modified Consistencies/Dysphagia”
Multiple products available from commercial, “ready-to-drink” thickened
products to gel-based and powder thickener. Product names include:
Resource brand of thickened juices, milk, water; “ThickenUp
corn starch), and “ThickenUp
Also: http://www.nestlenutritionstore.com
®
Clear, (non-starch based thickening powder).
Select category: “Swallowing
®
” (modified
difficulties”
http://www.SimplyThick.com (gel–gum based product)
http://www.ThickItRetail.com (powder based product and gum based
AquaCareH2Os). Made by Precision.
http://www.HormelHealthLabs.com Order from: http://www.HomeCare
Nutrition.com (Products: Thick and Easy
®
(powder) and Thick & Easy®Clear Instant Food & Beverage Thickener, as well as other specialized food products for altered texture needs.)
KITCHEN CUPBOARD RESOURCES:
Dehydrated potato flakes Baby instant rice cereal Pureed vegetables and fruits Dehydrated baby food Bread crumbs Unflavored gelatin
— powder needs to be put into solution by heating in liquid,
then cooled.
Keep in Mind!
The goal for every patient is a nutritional plan that optimizes recommendations from an experienced dysphagia clinician regarding what foods are most likely to be appropriate, given the details of impairment. Ideally, the nutrition plan should include foods that meet texture and viscosity restrictions, are nutrition­ally adequate and, to the extent possible, are acceptable to the patient.
Appendices 12–Cb (Thick Liquids) and 12–Cc (Trouble Eating) include examples of patient education materials developed by dietitians at the University of Cali­fornia–Davis Health System.
319
APPENDIX 13–Cb
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Clinical Dietitians & Dietetic Interns, Food & Nutrition Services, UC Davis Medical Center (9/10) ¤ 2010 The Regents of the Universi ty of California. All Right s Reserved.
321
APPENDIX 13–Cc
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Eating a balanced diet may be difficult if you have:
Trouble chewing your food due to mouth pain, dental problems, or other issues.
Trouble swallowing, which can cause coughing, choking, or longer time to finish a meal.
Shortness of breath or other breathing issues.
Poor appetite.
Higher calorie needs for weight gain or to prevent weight loss.
Other ___________________________________________________________
Tips to include all of the food groups and increase calories:
Grains
(6 servings)
Meat & Other Proteins
(5-6 oz)
Vegetables
(2 cups)
Fruits
(2 cups)
Milk & Dairy
(2 cups or more)
To increase calories:
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Hot cereal (cream of wheat, oatmeal, grits) or cold cereal with butter, Half and Half, honey, and/or sugar Toast with butter, jelly, cream cheese, honey, or peanut butter Milk toast (soak toast in hot milk, and add sugar, cinnamon, melted butter) Pancakes or French toast with extra butter and syrup Mashed potatoes with extra butter, cream cheese, heavy cream, sour cream, or cheese Pasta with butter, oil, or cream sauce Rice with butter or oil Potato soup Bread pudding Canned fish (tuna, salmon),Vienna sausage, canned or soft meats in sauce Meat, tuna, or cheese casserole Stew, chili, lentil soup, split pea soup, or other soups with meat or beans Lentils, canned or refried beans with cheese Tofu or other soy products (add to soups, casseroles, sauces, etc) Eggs (such as soft-boiled, poached, or scrambled with cheese, bacon, or avocado) Fresh, canned, or cooked vegetables with melted cheese, butter, mayonnaise, or salad dressing Tomato or vegetable juice Homemade or canned vegetable soups Pureed yams, pureed winter squash 100% fruit juice or fruit nectar Fresh, canned, or stewed fruits (can add whipped cream) Pureed fruits (such as applesauce) Fruit smoothies Milk, Lactaid Hot chocolate made with milk Milk shakes or smoothies made with ice cream, frozen yogurt, or whole milk (can add peanut butter or flavored syrup) Yogurt, pudding, custard, ice cream Cream soups (such as chicken, mushroom, or asparagus) Cheeses (such as cream cheese, Laughing Cow dishes) Cottage cheese (can add fruits, honey, or flavored syrup) Add avocado, butter, mayonnaise, sour cream, cheese, cream cheese, salad dressing, olive oil, canola oil, Half and Half, whipped cream, honey, sugar, flavored syrup, peanut butter
£
milk, flavored milk , soymilk (choose 2% or whole milk to increase calories)
£
cheese, soft cheeses like Brie, or melted cheese
If you still are not able to eat enough...
Add a nutrition supplement such as Carnation Instant Breakfast
£
Fast
, or store brand equivalents. Ask a pharmacy clerk to help you select or order the product you want.
Clinical Dietitians, Food & Nutrition Services, UC Davis Medical Center (4/09) ¤ 2009 The Regents of the Universi ty of California. All Right s Reserved.
322
£
, Ensure£, Ensure Plus£, Boost£, Slim
Other Tips:
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If you have pain, be sure to tell your Doctor. There may be medications to help with the pain. If your pain is controlled, you will likely eat more.
If solid food is hard to chew or swallow:
ƕ Foods can be put in a food processor or blender – let the machine do your chewing!
Add broth, gravy, or other liquids to add moisture when blending.
ƕ Add Instant Breakfast to milk, Lactaid ƕ Increase calories in your Instant Breakfast drink by adding ice cream to make a milkshake. ƕ Store-bought nutrition supplements (Ensure Plus
£
milk, or soymilk.
£
, Boost£, Slim Fast£) are useful if you do not
tolerate milk (look for generic brands, which cost less).
Soups are a favorite. Choose higher calorie soups such as split pea, lentil, chili, clam chowder, or creamed soups made with milk. Cream-based soups are usually higher in calories than broth-based soups.
ƕ To add more protein to soups or other foods, mix in whey protein
powder or powdered milk. Start by adding 1-2 Tbsp and increase according to taste.
Breakfast foods can be eaten at any time of the day. Eggs are easy to chew and high in protein. Eggs can be prepared in different ways to give variety. Try eggs in French toast, quiche, or bread pudding.
Eat more frequently. You should eat even if your appetite is poor.
ƕ Aim for 6-8 small meals (snack-sized), instead of 3 regular meals.
- A snack can be a carton of yogurt, cottage cheese and fruit, an ice cream sandwich, or a nutrition supplement (such as Ensure
Take a complete multivitamin supplement everyday. If it is hard to swallow a pill, try a children’s
£
).
chewable vitamin. If this is hard to chew, crush the multivitamin and eat with applesauce or pudding, or choose a liquid vitamin. Make sure your multivitamin has zinc and iron.
If you are constipated, you may not eat as much. Constipation can be caused by pain pills, not enough water or fiber, or less physical activity. Talk with your Doctor about medication for constipation, or talk with your Dietitian for ideas to prevent constipation.
NOTES:
Clinical Dietitians, Food & Nutrition Services, UC Davis Medical Center (4/09) ¤ 2009 The Regents of the Universi ty of California. All Right s Reserved.
323