Nutrition and Feeding

Diets, dysphagia, and enteral tube feeding

Fundamentals

Texture diets

Clear liquid	Water, clear broth, apple juice, gelatin, popsicles, tea or coffee without milk
Full liquid	Clear liquids + milk, pudding, yogurt, ice cream, cream soups, strained cereals
Pureed / mechanical soft	For chewing or swallowing problems

IDDSI levels Updated

Drinks: 0 thin · 1 slightly thick · 2 mildly thick · 3 moderately thick. Foods: 3 liquidized · 4 pureed (also extremely thick drinks) · 5 minced and moist · 6 soft and bite-sized · 7 regular. These replace the old "nectar-thick" and "honey-thick" terms.

Therapeutic diets

Cardiac	Low sodium, low saturated fat
Renal (CKD)	Limit sodium, potassium, phosphorus; protein as prescribed; fluid limit on dialysis
Diabetic	Consistent carbohydrate
Low residue	Flare of IBD, before colonoscopy
High fiber	Constipation, diverticulosis
Low purine	Gout: limit organ meats, shellfish, beer
Gluten-free	Celiac: no wheat, barley, rye ("BROW": also avoid oats unless certified gluten-free)

Dysphagia and aspiration precautions

Swallow screen before food, fluid or oral meds after stroke or extubation.
Sit upright at 90°; stay up 30 min after meals.
Chin tuck when swallowing; small bites; no rushing; check for pocketing.
Thickened liquids at the ordered IDDSI level; straws only if allowed.
Signs of aspiration: coughing, wet voice, drooling, ↓ SpO₂.

Enteral (tube) feeding

X-ray confirms placement of a blindly placed tube before first use. Then mark the tube at the exit point and check length each time; aspirate pH ≤5 supports gastric placement. Auscultating air is not reliable.
HOB ≥30–45° during feeding (always, for continuous feeds).
Flush with water (often 30 mL) every 4 h and before and after each medication. Give meds separately; use liquids; never crush ER or enteric-coated drugs.
Gastric residual checks are no longer routine in many ICUs: follow policy.
Diarrhea, cramping: check rate, formula, medications (sorbitol), C. diff.

Nutrition markers

BMI = kg ÷ m². <18.5 underweight · 18.5–24.9 healthy · 25–29.9 overweight · ≥30 obesity. Albumin and prealbumin fall with inflammation, so they're poor nutrition markers on their own; use weight change and intake.

Priority Coughing or respiratory distress during a tube feeding → stop the feeding, keep the head up, suction if needed, check SpO₂, notify.