Brain Dump: Liquid Diets & Dysphagia Diets

I'm mostly doing this  to review for the DTR exam.  Feel free to skip this post or learn a little something about some clinical diet orders

Let's start with the liquid diets.  Liquid diets may be utilized for patients who are NPO (nothing by mouth).  A diet progression for this would go from Clear Liquid (CL) to Full Liquid (FL) to a soft diet (pureed foods) to a regular diet.

• Clear Liquids: broth, clear juices, jello, popsicles, coffee (no cream), tea.  You might not think of jello or popsicles as a liquid, but since both can be liquid if not chilled they are considered a clear liquid. This diet is usually short term since it isn't nutritionally adequate (not much protein or fat).  Reserved for situations such as post-op or bowel rest since it doesn't require much digestion or work from the GI tract (low residual)
• Full Liquids: cream soups, cream of wheat, custard, all juice, plain ice cream, pudding, butter, margarine, milk, yogurt.  These are all also liquid at room temp.  It is usually used as a transition from CL to a regular diet.  It contains more protein and energy than CL but still may not be able to provide enough overall energy.  Since most of the protein in this diet comes from dairy products, may be a problem for those with an intolerance.  

Since working, I do see a lot of CL's (posicles, Italian icees, jello, and broth which is always a soup option for lunch and dinner.  (There is low Na broth for cardiac diets).  As far as FL's, I see ice cream (sugar free and regular, both when appropriate), yogurt, milk, cream of wheat, vanilla pudding.  

Dysphagia diets are for those who have difficulty swallowing.  The primary complication with dysphagia is aspiration (which could affect the lungs and cause pneumonia) although weight loss and malnutrition may also occur because the patient is physically unable to intake regular foods or may not have an appetite for dysphagia appropriate foods.

There are 3 levels in the National Dysphagia diet (standard as of 2002)

• National Dysphagia Diet 1 (NDD-1) "Dysphagia Pureed" (I see this as Dys-1 on charts or heard verbally as pureed at work): food is pureed or pudding like, for example pureed meat or veggies, mashed potatoes with gravy (gravy helps make it moist and easier to eat, also adds flavor), applesauce.  NOT ok: jello(too thin), yogurt with fruit pieces (choking hazard), eggs, chunky cottage cheese, fried/hard-boiled eggs 
• National Dysphagia Diet 2 (NDD-2) "Dysphagia Mechanically Altered"  meats have been cut up using mechanical means such as a grinder/knife, vegetables may be steamed, soft or canned fruit, moistened cereals.  For example scrambled eggs, pancakes with syrup, banana, cereal flakes with milk, thickened beverages (ie OJ plus a thickener suck as Thicken up) NOT ok: bread, cake, rice, corn, peas, cheese cubes

ALSO: "Dysphagia Mixed" is a diet that uses NDD-1 plus one NDD-2 item (example menu: OJ, yogurt, cream of wheat, scrambled egg)

ALSO: "Mechanical Soft" is NDD-2 that allows bread, cake, and rice (example menu diced chicken+gravy, steamed rice, beets, pound cake, strawberries)

• National Dysphagia Diet 3 (NDD-3) "Dysphagia Advanced" for the most part, a regular diet, except patient must stay away from hard/sticky/crunchy items.  I like to call this the braces or retainer diet (remember back in the day of orthodontics when you had to stay away from caramel, gum, popcorm, corn nuts)  For example vegetable soup, shredded lettuce salad, sanwhich, melon, cookie (no nuts).  NOT ok: hard fruits and vegetables (apples, carrots), corn skins, nuts, seeds

Also good to know the progression of liquid terminology from thickets to thinnest: spoon thick, honey-like, nectar-like, thing liquids. (Thin liquid= water, ice, milk, milk shakes, coffee, tea, ice cream, jello; basically CL and FL)