fluid thickeners
TRANSCRIPT
FLUID THICKENERS
Clinical Analysis on Fluid Thickeners and its Administration
Aswathy GS NairCAP Student
Contents
Introduction Evidences Used Definition and Types Formulation Clinical Indication Analysis RN Responsibility Conclusion
Introduction◦ At any times in care homes, there will be
residents with impaired ability to eat and drink safely.
◦ Dysphagia also put people at risk of malnutrition, dehydration, aspiration pneumonia and chocking.
◦ Normal aging reduces muscle tone in pharynx and oesophagus
◦ Residents with dementia may even forget some of their daily living activities including chewing and swallowing
Evidences
Penny B (2014); Use of fluid thickener o reduce dysphagia risk; Nursing Times Vol 110 No 12, 19-03-2014
Zuckerman D (2013); Thickeners and other ways to help older adults with swallowing problems
Hines S et al (2010); Thickened fluids for people with dementia in residential aged care facilities; School of Nursing, Queensland University of Technology, Australia
Cichero J (2013); Thickening agents used for dysphagia management; effect of bioavailability of water, medication and feeling of satiety; School of pharmacy, Queensland, Australia
Definition
Thickened fluids are formulations that have a thickener added to
make them thicker.
Thickener is a substance which can increase the viscosity of a
liquid without substantially changing its other properties.
The goal of using thickeners is to make all liquids, including
beverages into a thicker consistency that is less likely to cause
aspiration
Types
Mildly Thick Moderately Thick Extremely Thick
Nectar Thick Can be drink out of a cup
Honey Thick Often consumed with a spoon but still retain its liquid texture
Pudding Thick Extra thick and to be eaten with spoon
30% to 60%* 18% to 33%* • 6% to 12%*
*Cichero J (2013); Thickening agent used for dysphagia management
FORMULATION Most of the commercially available thickening
powders include directions for use for getting right consistency
General Guidelines
Nectar thick – 1.0 teaspoon powder to 0.5 cup of thin liquid Honey thick – 1.5 teaspoon powder to 0.5 cup of thin liquid Pudding thick- 2.0 teaspoon powder to 0.5 cup of thin liquid
FORMULATION
*Adapted from Australian standardised definitions and terminology for texture-Modified foods and fluids, Nutrition & Dietetics 2007
COMMON THICKENERS Home made thickeners
Banana flakes, cooked cereals, cornstarch, custard mix, mashed potatoes, pureed fruits & vegetables etc
Commercially available thickeners
Stir in Thickener Blended Thickener
Karicare Quik Thik RD Thickener East Thick
Thick plus Keltrol Nutulis Viscaid
Clinical Indications Dyspagia Dysphagia can occur due to
Old age & Dementia Neurological conditions
Parkinson's disease, reflex disease, stroke, head or spinal cord injury
Cancer of head, neck or oesophagus
(Actual name and identification details of residents are withheld to adhere to the privacy policy)
Analysis
Clinical Facility West Harbour Lodge
No of Residents 2
Assessed by RN with dietician / speech therapist
Thickener Prescribed Nutilis
ResultAssessment Criteria Ms Alpha Ms Beta
Clinical Condition Chronic renal impairment, Cognitive impairment
Advanced senile dimentia
Clinical History COPD, Type 2 Diabetics, Left Hemiplegic, Hypertension
Osteo arthritis, raynaud’s disease, supra nuclear palsy, anaemia, rheumatic fever, scoliosis
Reason for administration of thickened fluid
Palliative care Palliative care
Manifestations Dysphagia Chocking
Thickener used Nutilis Nutilis
Grade used Moderately thick Moderately thick
Reason for withdrawal Reassessment of improvement in condition
Reassessment of improvement in condition
RN Responsibility
RN Responsibility
RN in collaboration with dietician assess the resident for bed
side swallowing screen
Plan diet for resident with right consistency in accordance to
the findings of swallowing screen
Fluid thickeners are to be prescribed by GP or dietician
Document each administration including any specific
changes or preferences required by the resident or relatives.
Educate health care staffs, chefs and relatives of residents
regarding the importance of thickened fluid diets
RN Responsibility
Oceania Group Policy The fluid consistency must be recorded on
PCCP eating and drinking section Dietary requirement form
On any sight specific lists detailing beverages or food requirements.
To be clearly stated on PCCP whether the thickened fluid is a short term intervention or not, and if so the next date of review.