Blenderized Diet . . . Fractured Jaw Diet . . . No Chewing Allowed

(See below at bottom fourth of the article, I have a number of links to reliable websites for those needing to temporarily follow a blenderized diet.)

For some reason a former patient popped into my mind a while ago. I was working at the pre-op clinic when this slender young teen was about to commence her summer vacation by undergoing corrective jaw surgery that would require her to follow a blenderized, or fractured jaw, diet for at least 4 weeks.

Her mother was concerned about keeping weight on the young lady's size-zero frame during the recovery phase. The purpose of our pre-op teaching and health-history-gathering was to deal with specific issues and concerns such as these. The dietitian was unable to join our meeting, but we did put in a consult for her expert advice for the period in which the patient was to be in the hospital. However, advance planning was also in order.

Our hospital's hand-out on blenderized diets was woefully disappointing to the mother. This many-times-over photocopied, one-page handout was meant to help a patient determine how they would take oral sustenance for 6 weeks . . . The mom was right, our information sheet lacked so much that it was embarrassing. The good news is, better resources are available online.

Fractured Jaw or Jaw Surgery

We rest a broken jaw in order for the bones to knit, just as we rest a fractured arm or leg. Stressing the healing bones with chewing is painful and interferes with healing. Often during the recovery phase, the jaw is wired closed for a period of weeks. Some hospitals are better than others at providing good information about the importance of continuing oral care as well as providing specific suggestions for promoting optimal nutrition when a liquid diet is required during convalescence.

Advanced preparation--more than purchasing a blender

Before I was a nurse, my husband had jaw surgery. Advance preparation for the procedure included purchasing a blender. We were given a very simple handout from the surgeon's office with a few suggestions. There was no Internet to go to for advice, so my husband's blenderized diet was boring, repetitive and did not provide him with the level of calories and protein he needed. He lost a LOT of weight during the recovery phase--and he didn't have any extra weight to spare . . .

What am I going to feed [my kid, myself, my spouse, etc.] on a blenderized diet?

I want to begin by stressing the absolute necessity of consulting with a dietitian at the hospital if you or your loved one has special, underlying nutritional issues such as the need to also follow other diet restrictions including gluten-free, diabetic, vegetarian, bariatric,  etc.

The American Association of Oral and Maxillofacial Surgeons (AAOMS) addresses post-operative nutritional concerns on their website. They specifically caution about the importance of taking in adequate amounts of free water and calories. The AAOMS recommends keeping a journal to record fluid volumes taken in and calories consumed to ensure these needs are being properly met. They also suggest planning blenderized meals in advance. It's hard to "wing it" unless you have all sorts of options available in your kitchen to make the blenderized meal appealing.

When restricted to a blenderized died, it's important to understand that liquids are digested more quickly than solids. In order to maintain energy and keep up with the body's metabolism during recuperation, blenderized meals should be given more frequently than a standard diet. (It may be necessary to take a blenderized meal from 4 to 6 times daily). Protein shakes are recommended for all blenderized diets. (I have some links to follow below for specific recipes.)

For the lactose intolerant, the milk-based tendency for blenderized diets may seem a bit disconcerting at first glance, but there are lactose-free options in the form of soy milk, and nutritional supplements such as Ensure, Boost, or Osmolite.

Web pages with blenderized diet information

I recommend looking at every one of these. They all offer good advice, but you will find some great suggestions that are unique to each specific site.

1. Dartmough-Hitchcock Medical Center fractured jaw diet
2. Dartmough-Hitchcock Medical Center blenderized diet information
3. Aspirus-Wausau Hospital Diet for Jaw Surgery (Blenderized Diet)
4. Ohio State University Medical Center Blenderized Diet for Jaw Wiring
5. Kaiser-Permanente, "No Chewing Required," Blenderized Diet

Interesting products

I have no commercial interest in any medical products and don't receive or seek any income or favors from anything I've written on my blog. In looking for my fractured-jaw, blenderized diet information, I learned about commercial products that assist the wired-jaw patient take nutrition without sucking through a straw.  Actually the products do have straws, but the liquid-filled bag or bottle is squeezed with the hand to force the contents up through the straw and into the mouth.  These products can be used to clean and rinse the mouth as well as to easily take in fluids. This product looks like it would be very useful, particularly in the first few post-operative days.  Check out a variety of nutrition squeeze pouches and squeeze bottles at Craino Rehab.com (their NutriSqueeze bottles look good) and Dinner Through a Straw.net. 

Do you have suggestions?

Please let me know of other good tips and sources of information for people on blenderized diets. I'll be happy to post your suggestions or links here. I'd particularly like to know about blenderized diet recommendations and resources for individuals on special diets like gluten-free and diabetic diets.
Please click on the comments section to read Shirley Taylor's comments and suggestion. Thank you, Shirley!


.. . .

Bloody nose: Stop a nosebleed and prevent recurrent bleeding

Why do nosebleeds occur?

In medical terminology, a nosebleed is properly called "epistaxis." Trauma from an injury is probably the most common way to develop a nosebleed. Dry weather and irritation from fingers in the nose are also commonly associated with nosebleeds. Anyone who takes blood thinning medication (such as Coumadin) or even some vitamins and supplements(such as fish oil, vitamin E, etc.) are more susceptible. Cancer patients undergoing chemotherapy may have nosebleeds due to loss of clotting factors called platelets that are destroyed by the chemo. Patients who receive oxygen therapy by means of a nasal cannula (also called "nasal prongs") may suffer nosebleeds because of the dry stream of air against the nasal tissue unless some humidity is added to the oxygen set-up. Uncommon reasons such as inherited problems of the blood vessels are disorders such as Osler-Weber-Rendu Syndrome (Hereditary Hemorrhagic Telangiectasia) or an inherited blood clotting disorders such as a type of hemophilia.

How to Stop a Nosebleed:

1. Sit or stand the person with the bleeding nose UPRIGHT with their head tilted FORWARD. This keeps the blood from going down the back of the throat and into the stomach which will cause irritation and often results in vomiting. Allow the blood to flow into a basin or onto a cloth if available. Stopping a bloody nose is the priority--you can worry about cleaning a mess later.

2. Have the person with the bleeding nose breathe through their mouth as they (or you) pinch the nose together to apply pressure. You'll know that you are doing this correctly if there is no longer visible blood coming out while you are applying the pressure. Make sure to pinch the soft part of the nose to apply pressure--the lower third of the nose, just above where the nose flares outward. Obviously if you try to pinch against the bony part of the nose you won't really be applying any pressure to the blood vessels underneath. Remember to encourage them to sit upright with their head tilted forward. In addition to applying pressure, you can also put an ice pack over the bony bridge of the nose to constrict the blood vessels even more.

3. Don't let up the pressure for at least 5 minutes--not even to take "a peek." Time this by the clock, don't wing it. You are trying to establish a clot in the bleeding vessels--steady, constant pressure is important in doing this. After 5 minutes of direct pressure, check for bleeding. If the nose is still bleeding, repeat step 2, only this time keep the steady continuous pressure going for at least 10 minutes.

4. Have you done all this with no improvement? In that case, it's time to visit the doctor or ER. Don't forget to continue pressure during transport and in the waiting room. Depending on the circumstances the ER doctor may have to resort to nasal cautery to stop the bleeding, by packing the nose with a gauze "nasal tampon," or by some other means to apply compression to the bleeding vessels.

5. All fixed? What now? After the nosebleed ask the patient to rest in a reclining position with the head elevated above the heart, limit strenuous activity for the rest of the day, and avoid bending and heavy lifting. It's okay to gently sniff, but avoid blowing the nose and if the patient must sneeze--encourage them to do so with an open mouth to minimize pressure through the nose.

6. What if the nosebleed starts up again?

• Follow steps 1-3 again.
• If unsuccessful in stopping the bleeding, or if the patient is experiencing any associated symptoms such as severe headache, body sweats, weakness, or shortness of breath--it's time to go to the ER. Remember to ensure that pressure is maintained in an effort to control the bleeding during the ride to the ER.
• If the patient has already seen the doctor--review the discharge instructions and follow the written advice the physician gave--phone the doctor's office for any questions or concerns. Proceed to the ER if indicated.
• On their website, the Ear, Nose, and Throat Associates of Corpus Christi suggest this additional advice for recurrent nosebleed: "Clear nose of all blood clots by sniffing in forcefully," and "Spray nose four times on both sides with decongestant spray (such as Afrin,® Duration,® Neo-Synephrine,® etc.)"

Quick sources for additional reading:
Ask Dr. Sears: About Nosebleeds
The Children's Hospital, Aurora, Colorado



Below: Jay Dolitsky, MD, Clinical Professor and Director of Pediatric Otolaryngolgy at the NY Eye and Ear Infirmary offers his expert opinion about nosebleeds in this YouTube video.

Tracheostomy Care and Suctioning

A link to a very remarkable video series crossed my path today: "Breath of Life: a caregiver's guide to pediatric tracheostomy care." When their infant daughter Elizabeth needed a tracheostomy due to severe laryngomalacia and tracheal stenosis, Matt and Melanie Dragovits used their professional backgrounds in video production and education, respectively, to produce this video which also features expert advice from respiratory therapist Ron Barrows. The caliber of tracheostomy care training Matt and Melanie received in the hospital after Elizabeth's surgery inspired this educational video, because they were left with the feeling that "more could have been done to help them take Elizabeth home." After watching this well-produced, professional video, I'm convinced that adult tracheostomy patients would also benefit greatly by watching this video.

Breath of Life is available free online, but can also be purchased as a DVD for those without internet access.

Among the patients assigned to my care in the hospital recently have been two adults with new tracheostomies. Both of these tracheostomies were intended for long-term (probably permanent) treatment of the underlying condition. In one case, a cancerous tumor was encroaching on the airway, while the other "trach" was necessary because severe injury damaged tissue in the upper airway.

Once upon a time . . . it was commonplace for an RN to provide comprehensive health teaching on a regular, shift-to-shift basis in the hospital . . . this education and evaluation of the patient's/family member's understanding was an emphatic component of the care provided to patients who were about to leave the hospital and embark on a life-altering course of complicated self-care . . . It was with shame and remorse that these recollections crossed my mind regarding these two patients--meanwhile, the obligations of the patient load as a whole whirled me away from contributing to reinforcement of the essential teaching points.

The consequences of poor tracheostomy care and suctioning can mean the difference between life and death. In Echo Heron's nursing anthology, Tending Lives, Diane C., a home health nurse, wrote a chilling account of poor trach care that haunts me to this day. A few years ago while working in an outpatient care center, a foster mother brought her toddler with a trach in to provide a mucus sample to determine the nature of the child's chronic lung infections. I was glad that I decided to observe the mother suctioning the trach to obtain the specimen. Her technique was so utterly wrong that she grossly contamintated the child's lungs with each suctioning that she'd performed during the months that the child was in her care. I remember literally feeling faint with the shock of what I was seeing. This foster mother meant no harm--but she was truly misinformed to a degree that could have certainly resulted in fatal harm to the child had it continued.

Most of us are visual learners who retain new information best when we can watch a demonstration--often more than one time. As inhabitants of the modern Western hemisphere, we've been influenced by many, many years of television viewing which have reinforced our visual learning preferences. It's also possible to find YouTube videos about tracheostomy care. Granted, they are not the same quality as professionally produced videos, but these amateur videos can definitely provide some helpful, additional visual images of trach care.

Once we have the visual image of the procedure clear in our mind, it's much easier to process the excellent written instruction instructions provided by Cincinnati Children's Tracheotomy Care Handbook and at tracheostomy.com. (These are just two of the many excellent resources for trach information that I selected based on my online trach patient information search.)

It's imperative that you follow the advice of your physician, home health nurse and respiratory therapist and immediately consult them with any questions or problems about your loved ones tracheostomy.