A Tough Act to Swallow

By Christine Moffa, MS, RN, AJN clinical editor

For most people, eating is a simple pleasure that they usually take for granted. However, for patients recovering from stroke or esophageal disease, getting food down is a pretty big deal. Patients with dysphagia are at increased risk for malnutrition (which can lead to impaired healing), dehydration, and aspiration pneumonia. Unfortunately, liquid, soft, and pureed diets are not only unappealing and unappetizing for many patients, but they also mean different things at different hospitals. Have you ever seen a health worker “prepare” a liquid diet tray for a patient by taking the milk, juice, and mashed potatoes and mixing them together, then wondering why it’s taking an hour to get the patient to eat it?

This lack of standardized care can put patients in danger. The authors of  this month’s CE feature, “Managing Dysphagia Through Diet Modifications,” Jane Mertz Garcia, PhD, CCC-SLP, and Edgar Chambers IV, PhD, recommend diet modifications be implemented by an interdisciplinary team that includes a nurse. They also provide the following list of things to consider:

* Educate and inform patients, their loved ones, and caregivers about the importance of dietary modifications. Bear in mind that the attitudes of nurses and other caregivers about patients’ diet can influence patients’ consumption.

* Become well-informed about modification practices at your facility. Although this article focused on the National Dysphagia Diet (NDD), know that labels and descriptions tend to vary from one care setting to another.

* Recognize that some consistencies are simply less safe than others. For example, thin fluids such as coffee or juice may be the most dangerous consistency for a patient with dysphagia. Similarly, some food textures, including those that are noncohesive or that easily separate (such as rice and chunky soup), as well as “sticky” foods (such as peanut butter or dry mashed potatoes), may be harmful.

* Remember that not all thickening agents are the same. Ask the speech-language pathologist and the dietitian about the thickening products served to patients. Make sure that fluids are thickened appropriately and prepared in a manner consistent with product guidelines. Bear in mind that thicker is not necessarily better for patients with impaired swallowing.

* Training is essential. It’s been shown that when implementing the NDD, ongoing training in dysphagia management, including how liquids should be thickened, results in higher caloric intake by patients, greater acceptance of some foods, and fewer calls questioning the diet modifications.

* Monitor a patient’s status and advocate for systematic reevaluation. Maintain communication with other members of the dysphagia team to determine if, and when, additional assessment or modifications are indicated. The nursing staff can help to ensure that patients receive liquids and foods appropriate to their needs.

* Be an active part of the dysphagia team. The ability to eat and drink greatly contributes to a patient’s physical and emotional well-being.

Does your facility have standardized dietary modifications for patients with dysphagia?