1. 123 No chewing Smooth with no chunks or hard pieces Moist and not runny Pureed fruit Smooth soup Pureed rice and gravy Custard Pureed eggs Pureed (specialty) pancakes with syrup Mechanical Altered Requires little to no chewing Soft food <1/4 in Easily broken up with fork Soft banana Mac and cheese Ground meat and gravy Moist lasagna with pasta sauce Scrambled eggs Advanced Mechanical Soft Requires some chewing Easily squashed with fork Moist with plenty of gravy Thin turkey or meatloaf with gravy Beans Yogurt with fruit at bottom Cottage cheese Smooth PB Pears, peaches, and applesauce Pureed

2.  Dysphagia means “difficulty swallowing.” Problem could be because of pain or issues with mouth, throat, or esophagus. How is it diagnosed? Speech language pathologists perform a barium swallow test. Patient drinks a dye and then a video x-ray watches as you swallow it. Shows if dye gets stuck anywhere which could mean they have a swallowing problem.

3.  PATIENT SAFETY!!! Patients could choke or aspirate Who is at risk for dysphagia? Stroke victims Parkinson's or Alzheimer's GERD (esophageal problems)

4.  Pureed and smooth foods only. Recommend: Avoid:

6.  Bite size and moist food (most like regular texture) Recommend: Avoid:

7.  For patients who can safely swallow thin liquids

8. Purpose:  Slows down process of swallowing liquid so they have more control to prevent choking.  Prevents liquids from going down “wrong pipe.” Can cause pneumonia.  Most patients start at honey then switch to nectar once swallowing issues improve. Less pourable and drizzle from a spoon. Do not add ice to drinks. Ice cream/milkshakes should be avoided as it melts and becomes a thin liquid.

9. Purpose:  Slows down process of liquid going down their throat so they have more control to prevent choking.  Prevents liquids from going down “wrong pipe.” Can cause pneumonia.

10. 1. Can patients on dysphagia 1 have regular oatmeal with brown sugar? True or False?

11.  False. On dysphagia 1 oatmeal is not allowed Brown sugar can be mixed in well with cream of wheat if desired.

12. 2. Which menus would be okay for a patient on a dysphagia 2 diet? A: Ground beef and smooth mashed potatoes with gravy, corn, applesauce, orange juice with no pulp, and gelatin. B: Grits, low fat milk, pureed eggs, banana baby food, butter, salt, coffee, creamers, and sugar. C: Chunky tomato soup, steamed carrots, canned peach cup, cottage cheese, and vanilla milkshake. D: Scrambled eggs, soft pancake with syrup, cream of wheat, hot tea, creamer, lemon, and butter.

13.  Correct menus: B: Grits, low fat milk, pureed eggs, banana baby food, butter, salt, coffee, creamers, and sugar. D: Scrambled eggs, soft pancake with syrup, cream of wheat, hot tea, creamer, lemon, and butter.  Incorrect menus: A: Corn C: FH Chunky tomato soup

14.  Which item could you serve on a dysphagia 3 tray? A. Pineapple canned fruit cup. B. Chicken noodle soup. C. Cheese omelet. D. Bread pudding with raisins.

15. C. Cheese omelet IS allowed. NOT ALLOWED: Pineapple in any form (cooked, fresh, canned) is not allowed on Dysphagia 3 diet. Chicken noodle soup must be smoothed. No bread is allowed on the dysphagia diets.

16.  If doctor ordered honey thick liquids, we could send the patient a milkshake if we add extra ice cream to make it thicker? True or False?

17.  FALSE! Milkhakes will melt and become thin liquids and this is a serious risk for patient safety.

18.  We can serve fruit cups to patients who are on a thick liquid diet. True or False?

19.  False! The liquid in the fruit cups is thin and not allowed on the nectar or honey thick diet.

20.  Soft pancakes moistened with syrup are only for Dysphagia 3 patients? TRUE or FALSE?

21.  FALSE!  Dysphagia 2 and 3 patients can have the soft pancake moistened with syrup.  Dysphagia 1 must have pureed (specialty) pancakes.

22.  Academy of Nutrition and Dietetics. Nutrition Care Manual®. Dyspaghia1, 2, &3. http://nutritioncaremanual.org/topic.cfm ?ncm_heading=Nutrition%20Care&ncm_ toc_id=255550. Accessed 10/1/13.