modified menus Flashcards
Diet Modification of a Normal Diet
3 types
The types of modifications that may have to be made are as follows:
1. In diet texture/consistency (ex. wired jaw)
- In nutrient content
3.In interval and frequency of feeding
(example 5 small meals)
Texture/Consistency Modifications
Texture modification is indicated for many different conditions including :
poor dentition (few/no teeth)
ill-fitting dentures, etc.
mouth sores
impaired swallowing /Dysphagia
oral motor problems oral surgery (jaw wired, etc.)
Goals for Nutritional Management
Prevent aspiration
Formal assessment of speech pathologist
Diet modification, patient positioning (sitting up, laying down), use of adaptive equipment, mealtime supervision (important for dysphagia)
Provide adequate nutrition
Use of dietary supplements and protein-rich food, energy dense foods
Short-term or long-term support may be necessary
Must consider family and patient wishes
Dietitians role in nutritional management
Risk screening
Education
Menu review
Nutrition (process) review
stage 1,2,3,4
1: pureed diet
2: minced diet
3: sental soft diet
4: regular diet
Other terms of classification:
Dysphagia Pureed- Pureed
Dysphagia Mechanically Altered- Minced
Dysphagia Advanced Diet- Soft
breakfast diet example for soft, minced, purree
breakfast for soft is fine
pureed - yes would work
minced- might half issue with muffin- add milk, butter
lunch example
soft: pull apart the pork, cut it up (mince it) and add soft gravy, for the potatoes- cut it up- add butter- take her time, brocoli: make sure its cooked properly and soft, whole wheat bread - take off the crust add some sauces- butter jam
mince (same as above)
puree- wopuld be fine
Soft Diet- Stage 3
Mainly used for patients with chewing problems related to dysphagia, mouth sores or poor dentition.
All foods must be in a soft form that is easily chewed.
Requires more chewing ability.
some degree of variability in terms of what some patients can & cannot chew.
Easy-to-cut meats, fruits, vegetables.
Excludes hard, crunchy fruits & vegetables, sticky foods, very dry foods.
Minced Diet – Stage 2
Often used with patients who have dysphagia or severe mouth sores or dentition problems.
They may also be offered as a progression from a pureed diet for a patient with mild swallowing difficulties.
Requires some chewing ability.
Foods on this diet require less cutting & chewing than those offered on a dental soft diet.
Should be processed to a particle size that allows passage through a 6 mm (1/4 inch) mesh screen
Should be prepared to achieve a moist & cohesive product
Minced /ground food should have no water separation.
Ground or minced meats with fork-mashable fruits & vegetables.
Excludes most bread products, crackers, & other dry foods.
(might miss out of nutrients- try to ad moistures)
Pureed diets
Needed for patients with Dysphagia, severe oral motor problems like jaw surgery or fracture
Processed until there are no visible particles (particle size of~1mm)
puree should be one homogenous color.
Pureed foods should have no water separation, when first scooped onto the plate.
Line Spread Test of less than 3 cm is recommended.
Requiring no chewing
Cohesive, pudding-like
Pureed Diets
Foods should not have coarse textures such as nuts, seeds, raw fruits or vegetables.
Pureed foods should be able to pass through a screen with a 2 mm mesh.
Sticky foods such as melted cheeses or peanut butter are not allowed.
Eg: apple sauce, pudding, smooth mashed potato, pureed scrambled eggs & cheese
why avoid oatmesl
can get sticky- should have cream of wheat instead
Equipment
Robot-Coupe Blixer Speed- 3450 rpm(max) Traditional blender-1750rpm (max) Strainers/mesh Various sizes
Breads
bread restriction
modified bread
mixed consistency
Bread Restrictions: Can be ordered in addition to other texture modifications. It is generally required for patients with swallowing difficulties whose needs fall between dental soft, minced and pureed diets. Avoid: bread, toast, cakes, crackers, rolls, cookies, cold cereal, buns, and muffins.
Modified Bread: Includes moistened bread products that can form a cohesive bolus!!!!! in the mouth. (examples: Salad sandwiches with crusts trimmed, pancakes or waffles with extra syrup, cake with cream or icing) These foods will sometimes be allowed in a diet that would otherwise exclude bread products.
Mixed Consistency: Includes foods that are made of two separate textures - a fluid and a solid. Examples include: Cereal with milk, soup with crackers or noodles, and fruit cocktail with juice. These foods pose additional challenges and should be avoided by individuals who have swallowing difficulties.
Thickened Fluids
Usually ordered with one of the other texture modified diets. It may also be ordered as “no thin liquids”.
Two reasons:
1) thickened liquids slow the progress of food down the throat in patients who have difficulty swallowing in order to give them greater control over the eating process
2) Keeps the fluids in a liquid diet from flowing down the trachea instead of the esophagus, possibly causing pneumonia to develop in the lungs
Other General Recommendations:
Do NOT allow items that will melt (ice cream, sherbet) for patients on thickened fluids
Do not send thickened milk unless requested; Blended soups with a thickening product are allowed
Do not send mixed textures/consistencies (e.g. soup with vegetables) if patient has dysphagia;
All fruit must be drained.
Levels of Consistency
Pudding thick pudding thick fluids are not often recommended due to the potential increased risk in dehydration.
Ex. Thickened applesauce, thick milk pudding.
Honey thick liquid should be the thickness of a pour-able honey.
Ex. Yogurt, tomato sauce, honey.
Nectar thick liquid should be thickened to a “nectar” consistency. Some fluids are naturally nectar thick.
Ex. Cold tomato soup, resource 2.0, nectar juices.
Thickened beverage with inulin…
read this
Objectives: We wanted to develop thickened beverages that contain soluble fiber (inulin) with acceptable consistency, taste, and texture & to determine the effects of these beverages on bone resorption markers (to determine calcium retention), bowel frequency, & indicators of gastrointestinal function in institutionalized adults bound to wheelchairs.
Results: Sensory panelists were unable to detect a difference between beverages thickened with modified starch and those fortified with inulin. Few differences were found between the control and inulin-fortified beverages for sensory descriptors. No significant difference was found in frequency of bowel movements between treatments; however, weighted bowel movement frequency increased by 13% with inulin (P < 0.01), whereas enema and laxative administration decreased by 13% (P < 0.05). Bone resorption, as an indicator of calcium retention, remained unchanged.
Conclusions: Inulin was incorporated into thickened beverages, with no decrease in acceptability; when consumed, perceived stool output increased in residents of long-term care facilities
Modification in Consistency
Clear Liquid (clear fluid) diet
made up of only clear fluids and foods that turn to clear fluids when they are at room temperature.
includes things like clear broth, tea, cranberry juice (other juice without pulps), Jell-O, and Popsicles
Diet is easier to digest than other foods.
Gives important fluids, salts, and minerals that you need for energy.
Eating only a clear liquid diet generally gives you enough nutrition for 3 to 4 days.
Full fluid diet (semi solids)-
A full fluid diet is used short term as a step between a clear fluid and a regular diet. Usually, the full fluid diet is used after surgery or if a person is having difficulties chewing or swallowing solid foods. A full fluid diet can be adequate in energy, protein, minerals and fibre without using supplements
Food Allowed (full fluid contd.)
Milk, buttermilk, milkshakes, smooth yogurt, cream
Cream of wheat
Strained fruit or vegetable juices
Pureed soups, clear broths, strained cream soups
Puddings, custard, Jell-O™, ice cream, sherbet
Nutritional supplements such as Ensure™ or Boost™
Sugar, syrup, molasses, hard candies
Modification in diet
Modification in interval and frequency of feeding
Refers to increases and/ or decreases in the number of times a meal is taken and/ or portion size
5-6 meals/ day; 125 ml of juice/ fruit
Persons whose requirement may be unable to increase quantity of the original meal
Instead increase in number of meals
Often lead to in-between meal snacks
Modification in Nutrients/ Therapeutic Diets
Modifications of normal diet used to improve specific health conditions
Normally prescribed by doctor and planned by dietician
The person who is ill often has parts of the body malfunctioning; nutritional need of the sick person changes
Feeding a patient a therapeutic diet serves to best nourish the patient while in hospital, but also to acquaint them with a pattern of eating that they may be able to adopt when they are discharged.
E.g. diabetes
Pancreas produce little or no insulin to ingest sugar
Excess sugar consumed may be harmful to the system
Therapeutic Diets
Diabetic Low fat diet Low fibre diet High fibre diet Gastric diet Gluten-free diet Cardiac Diet High Protein/ High Calorie Diet Low lactose diet Milk free diet Liver failure diet Renal diet Sodium restricted diet
