Community teaching plan

Education Topic is Flu Prevention/Vaccinations

Population children and adults ages 12 and up

NSG 4411 Community Intervention/Teaching 1

NSG 4411

COMMUNITY INTERVENTION, TEACHING, EVALUATION

GRADING RUBRIC

Name: Date:

Criteria

Comments

Possible

Points

Actual

Points

I. Plan:

a. Aggregate

need- realistic

b. Goal

c. 2 Outcomes

d. Measurement

10

II. Actual Teaching

a. Design

b. Market/Fund

10


III. Lesson Plan

a. Objectives

(outcomes)

Realistic

Measurable

Appropriate

b. Content outline

Clear, consistent

with objectives

c. Teaching Activity

Consistent with

Objectives/outline

30

IV. PowerPoint Presentation (see separate rubric)

50

V.
Deductions up to 10%: Paper is written using correct grammar, punctuation, spelling, sentence structure (0.25 points will be deducted for each error)

Deductions up to 10%: APA format (0.25 points will be deducted for each error)

Late penalty

5% one day, 10 % two days, 15% three days

Zero over four days

Grade

100%

Comments:

NSG 4411 Community Intervention/Teaching

COMMUNITY INTERVENTION, TEACHING PLAN, and EVALUATION

A major component of population health nursing is teaching of health promotion activities and prevention strategies after assessing health needs of an aggregate. This teaching project will help the student design a teaching strategy for health promotion. The teaching project must be approved by your clinical faculty prior to the presentation. The topic of the Teaching Project must be submitted to the faculty for approval before planning and implementing.

The topic must be related to your population not to your workplace. The plan will be described by defining who will receive the teaching, how the teaching will occur, how the teaching project will be marketed and funded, and how the outcomes of the teaching will be measured. A basic outline of the teaching plan will be submitted.

This assignment is not a formal paper, but proper grammar, spelling, sentence structure, and punctuation is required. The Community Intervention/Teaching is a word document, so you can download the form, type in the answers to the questions and fill in the teaching plan
using this form only. Of course, if any references are used, references will be listed in the PowerPoint in correct APA format. See course schedule for the due date.

The student is required to read Chapter 11 in:

Rector, C. (2022).
Community & public health nursing: Promoting the public’s health (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Make sure you pay attention to Chapter 11, pages 314-329.

Rubric

Teaching Plan 10 %

Teaching 10 %

Lesson Plan 30 %

PowerPoint 50 %

See page 2 for the start of the Community Intervention/Teaching

Teaching Plan, Implementation, & Evaluation

I. Teaching Plan:

A. Identify aggregate and need.

B. Goal of teaching.

C. Give two measurable outcomes related to

the teaching plan.

D. How will you measure the outcome?

When will you measure? How often?

What will you measure?

II. Actual Teaching:

A. Design of Plan: Who (audience), what (was taught), when, where.

B. How will you market & fund your teaching plan?

III. Lesson Plan:

A. Objectives (outcomes) for teaching
(at least two)

(Example: After attending a 1 hour lecture about incorporating

exercise in the everyday classroom activities the teacher

will:

1. List at least 5 activities that can be used to increase

children’s physical exercise during regular classroom

hours.

B. Supply Lesson Plan: Can fill in a table: (This is an example and not completed-

see rubric for grading instructions).

Objective/Outcome

Topical Outline- Content

Teaching Strategy

a. Incorporate exercise into classroom activities

b.

1. Benefits of exercise

Increase learning

Decrease obesity

Habit forming

2. List ideas about how to do during

class time

3. Demonstration of exercise

Lecture

Video clips

Actual demonstration & participation

IV. Attach PowerPoint presentation file:

Voice over PowerPoint Presentation for Teaching Project

1) Prepare a PowerPoint presentation of your Teaching Project (minimum of 10 slides, not including the title slide and the reference page slide).

2) Be sure to include all pertinent information about the topic as outline in the Teaching paper criteria. This information can be condensed but explained in your voice over.

3)
Review the grading rubric on the content, design, presentation, and evaluation of your PowerPoint presentation.

4) Text needs to be clear and contain some graphics.

5) References need to be in correct APA format.

6) Follow the directions as given in the instructions for how to do a voice over PowerPoint.

7) Attach PowerPoint file.

Case management roles

 Case Management Roles  

Graves’s disease case study

Please read attachment for instructions

Case Study

A 35-year-old female presents to the clinic with bulging eyes, hand tremors and unexplained weight loss. The final diagnosis is Grave’s Disease.

Answer the following questions

1.     Compare and contrast Grave’s Disease and Hashimoto’s Disease.

2.     Would you expect this patient’s TSH, T3 and T4 to be high or low? Explain your reasoning. 

3.     Discuss the significance of Hürthle cells in thyroid disease.


Expectations

Initial Post:

APA format with intext citations

Word count minimum of 250, not including references.

References: 2 high-level scholarly references within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

40 assignment 3

Annotated bib

!””#””$#%&'(‘)%”&*+,&-.%”/’01-2#%,#345″#2’6*.7.”58’5%2

!%%.&5&#2’4-98-.:*57;<‘.%’=#,;%.8.:<‘-%’>+*”-%:
! !”#$%

&'()*+,+-./+0,1*+,223),)*4+5(56(31′,078+97*’*+83:+(4*2)(;8+0**’.’*<(*9*4+0:56(=,)(32>+)7,)+0’3?3)*+)7*
:>*+3;+,+>*6*=)*4+)*=7236318+)3+*27,2=*[email protected]:,6()8+,24+>,;*)8+>),24,’4>+(2+2:’>(21A

)%&*.2+,&-.%

B*;3’*+83:+5*1(2+)3+4*<*630+)7*+,>>*>>?*2)+83:+,’*+*2=3:’,1*4+)3+=3?06*)*+)7*+C223),)*4+B(56(31′,078
D3′?,)(<*+C>>*>>?*2)A+E3?06*)(21+)7(>+,=)(<()8+9(66+7*60+83:+>:==**4+9()7+)7*+,>>*>>?*2)+,24+=3:2)>
)39,’4>+=3:’>*+*21,1*?*2)A

“,0(4+=7,21*>+(2+(2;3′?,)(32+)*=7236318+13+7,24.(2.7,24+9()7+0’31’*>>+([email protected]:,6()8+7*,6)7+=,’*+4*6(<*’8F
2:’>(21+0′,=)(=*F+,24+(2)*’4(>=(06(2,’8+)*,?+=366,53′,)(32A+%7*+;36639(21+,’*+3268+,+;*9+*G,?06*>+3;+739+)7*
7*,6)7+=,’*+;(*64+:>*>+)*=7236318+)3+0’3<(4*+=,’*+)3+0,)(*2)>+,=’3>>+?:6)(06*+>*))(21>H

!,)(*2)+?32()3′(21+4*<(=*>A
“353)(=>A
I6*=)’32(=+?*4(=,6+’*=3’4>A
J,),+?,2,1*?*2)+’*>3:’=*>A
“*,48+,==*>>+)3+=:”*2)+>=(*2=*A

%*=7236318+(>+*>>*2)(,6+)3+)7*+,4<,2=*?*2)+3;+)7*+2:’>(21+0’3;*>>(32F+?,(2),(2([email protected]:,6()8+=,’*+3:)=3?*>F
0,)(*2)+>,;*)8F+,24+’*>*,’=7A

%7(>+,>>*>>?*2)+9(66+1(<*+83:+)7*+3003′):2()8+)3+4**0*2+83:’+K2396*41*+3;+739+)*=7236318+=,2+*27,2=*
@:,6()8+,24+>,;*)8+>),24,’4>+(2+2:’>(21A+L3:+9(66+0’*0,’*+,2+,223),)*4+5(56(31′,078+32+)*=7236318+(2
2:’>(21A+C+9*66.0’*0,’*4+,223),)*4+5(56(31′,078+(>+,+=3?0’*7*2>(<*+=3??*2),’8+32+)7*+=32)*2)+3;
>=736,’68+0:56(=,)(32>+,24+3)7*’+>3:’=*>+3;+*<(4*2=*+,53:)+,+>*6*=)*4+2:’>(21.’*6,)*4+)*=7236318A+C
5(56(31′,078+3;+)7(>+)80*+0’3<(4*>+,+<*7(=6*+;3’+93’K06,=*+4(>=:>>(32+)3+,44’*>>+1,0>+(2+2:’>(21+0′,=)(=*+,24
)3+(?0’3<*+0,)(*2)+=,’*+3:)=3?*>A+C>+2:’>*>+5*=3?*+?3’*+,==3:2),56*+(2+)7*(‘+0’,=)(=*F+)7*8+,’*+5*(21
=,66*4+:032+)3+*G0,24+)7*(‘+’36*+3;+=,’*1(<*’+,24+,4<3=,)*+)3+(2=6:4*+;3>)*'(21+’*>*,’=7+,24+>=736,’>7(0+)3
,4<,2=*+2:’>(21+0′,=)(=*A+C2+,223),)*4+5(56(31′,078+>)(?:6,)*>+(223<,)(<*+)7(2K(21+)3+;(24+>36:)(32>+,24
,00’3,=7*>+)3+*;;*=)(<*68+,24+*;;(=(*2)68+,44’*>>+)7*>*+(>>:*>A

6*#75*5&-.%

%3+>:==*>>;:668+=3?06*)*+)7(>+,>>*>>?*2)F+0*’;3′?+)7*+;36639(21+0’*0,’,)3’8+,=)(<()(*>H

M*6*=)+,+M#$NOI+4(‘*=)+3’+(24(‘*=)+0,)(*2)+=,’*+)*=7236318+)7,)+(>+’*6*<,2)+)3+83:’+=:”*2)+0’,=)(=*+3’+3;
(2)*’*>)+)3+83:A+!”#$%&’0,)(*2)+=,’*+)*=723631(*>+’*@:(‘*+,2+(2)*’,=)(32F+3’+4(‘*=)+=32),=)F+5*)9**2+)7*
2:’>*+,24+0,)(*2)A+$:’>*>+:>*+4(‘*=)+0,)(*2)+=,’*+)*=723631(*>+*<*’8+4,8+97*2+4*6(<*'(21+=,’*+)3
0,)(*2)>A+I6*=)’32(=+)7*’?3?*)*’>+3’+0:6>*+3G(?*)*’>+,’*+*G,?06*>+3;+4(‘*=)+0,)(*2)+=,’*+)*=723631(*>A
()*”#$%&+0,)(*2)+=,’*+)*=723631(*>F+32+)7*+3)7*’+7,24F+,’*+)73>*+*?0638*4+32+5*7,6;+3;+)7*+0,)(*2)A
%7*8+43+23)+’*@:(‘*+(2)*’,=)(32F+3’+4(‘*=)+=32),=)F+5*)9**2+)7*+2:’>*+,24+0,)(*2)A+C+7,247*64+4*<(=*
;3’+0,)(*2)+43=:?*2),)(32+(>+,2+*G,?06*+3;+,2+(24(‘*=)+0,)(*2)+=,’*+)*=7236318A+IG,?06*>+3;+)30(=>+)3
=32>(4*’+;3’+83:’+,223),)*4+5(56(31’,078+(2=6:4*H

J*6(<*’8+’353)>A
I6*=)’32(=+?*4(=,)(32+,4?(2(>)’,)(32+9()7+5,’=34(21A
I6*=)’32(=+=6(2(=,6+43=:?*2),)(32+9()7+=6(2(=,6+4*=(>(32+>:003′)A
!,)(*2)+>*2>3’+4*<(=*>P9(‘*6*>>+=3??:2(=,)(32+>36:)(32>A
“*,6.)(?*+63=,)(32+>8>)*?>A
“*?3)*+0,)(*2)+?32()3′(21A
C’)(;(=(,6+(2)*66(1*2=*A
%*6*7*,6)7A
%*6*>)’3K*A
%*6*.(=:A
%*6*.0>8=7(,)’8A
%*6*.1*2*)(=>A
&3’K;639+?,2,1*?*2)+>8>)*?>A

E324:=)+,+6(5′,’8+>*,’=7+:>(21+)7*+<,'(3:>+*6*=)’32(=+4,),5,>*>+,<,(6,56*+)7’3:17+)7*+E,0*66,+Q2(<*’>()8
O(5′,’8A

E32>:6)+)7*+BM$+!’31’,?+O(5′,’8+”*>*,’=7+N:(4*+;3’+7*60+(2+(4*2)(;8(21+>=736,’68+,24P3′
,:)73′(),)(<*+>3:’=*>A
C==*>>+)7*+$RM+O*,’2*’+M:==*>>+O,5F+6(2K*4+(2+)7*+=3:’>*’33?+2,<(1,)(32+?*2:F+;3’+,44()(32,6
‘*>3:’=*>A

M=,2+)7*+>*,’=7+’*>:6)>+’*6,)*4+)3+83:’+=73>*2+)*=7236318A
M*6*=)++,-#+0**’.’*<(*9*4+0:56(=,)(32>+;3=:>*4+32+83:’+>*6*=)*4+)30(=+)7,)+,’*+)7*+?3>)+(2)*’*>)(21+)3
83:A
I<,6:,)*+)7*+(?0,=)+3;+0,)(*2)+=,’*+)*=723631(*>+32+4*>(‘*4+3:)=3?*>A

C2,68S*+=:”*2)+*<(4*2=*+32+)7*+(?0,=)+3;+,+>*6*=)*4+0,)(*2)+=,’*+)*=7236318+32+0,)(*2)+>,;*)8F
@:,6()8+3;+=,’*F+,24+)7*+(2)*’4(>=(06(2,’8+)*,?A
#2)*1′,)*+=:”*2)+*<(4*2=*+,53:)+)7*+(?0,=)+3;+,+>*6*=)*4+0,)(*2)+=,’*+)*=7236318+32+0,)(*2)
>,;*)[email protected]:,6()8+3;+=,’*F+,24+)7*+(2)*’4(>=(06(2,’8+)*,?+(2)3+,+’*=3??*24,)(32A

.,&$/

!:56(=,)(32>+?,8+5*+’*>*,’=7+>):4(*>+3’+’*<(*9+,’)(=6*>+;’3?+,+0’3;*>>(32,6+>3:’=*A+$*9>0,0*’>F
?,1,S(2*>F+,24+5631>+,’*+23)+=32>(4*’*4+0’3;*>>(32,6+>3:’=*>A
L3:’+>*6*=)(32>+2**4+)3+5*+=:”*2)T9()7(2+)7*+6,>)+;(<*+8*,’>A

!%’01-2#%,#395″#2′?#,.$$#%25&-.%’@.*’A#8#,&#2’=#,;%.8.:<

)$78#$#%&5&-.%

!’*0,’*+,+-U/+0,1*+0,0*’+(2+97(=7+83:+(2)’34:=*+83:’+>*6*=)*4+)*=7236318V,24+4*>='(5*+,)+6*,>)+;3:’+0**’.
‘*<(*9*4+0:56(=,)(32>+)7,)+0’3?3)*+)7*+:>*+3;+83:’+>*6*=)*4+)*=7236318+)3+*27,2=*[email protected]:,6()8+,24+>,;*)8
>),24,’4>+(2+2:’>(21A+L3:+9(66+=32=6:4*+83:’+0,0*’+58+>:??,'(S(21+978+83:+’*=3??*24+,+0,’)(=:6,’
)*=7236318+58+:24*’>=3′(21+)7*+*<(4*2=*.5,>*4+’*>3:’=*>+83:+0’*>*2)*4A+B*+>:’*+)7,)+83:’+0,0*’+(2=6:4*>
,66+3;+)7*+;36639(21+*6*?*2)>H

()&#,*-%&”,)’&,’&0$’1$2$%&$*’3$%0),2,45’3,6″%

&7,)+(>+83:’+’,)(32,6*+;3’+>*6*=)(21+)7(>+0,’)(=:6,’+)*=7236318+)30(=W+&78+,’*+83:+(2)*’*>)*4+(2
)7(>W
&7,)+’*>*,’=7+0’3=*>>+4(4+83:+*?0638W

&7(=7+4,),5,>*>+4(4+83:+:>*W
&7(=7+>*,’=7+)*’?>+4(4+83:+:>*W
.,&$7+#2+)7(>+>*=)(32+3;+83:’+5(56(31′,078F+83:+?,8+:>*+;(‘>).0*’>32+>(2=*+83:+,’*+,>K*4+)3
4*>='(5*+83:’+’,)(32,6*+;3’+>*6*=)(21+)7*+)30(=+,24+)7*+’*>*,’=7+>)’,)*1(*>+83:+*?0638*4A
Q>*+)7(‘4+0*’>32+(2+)7*+’*>)+3;+)7*+5(56(31′,078F+739*<*’A

8)),&9&”,)’:2$;$)&/

D3’+*,=7+’*>3:’=*F+(2=6:4*+)7*+;:66+’*;*’*2=*+;36639*4+58+)7*+,223),)(32A
IG06,(2+)7*+;3=:>+3;+)7*+’*>*,’=7+3’+’*<(*9+,’)(=6*+83:+=73>*A
!’3<(4*+,+>:??,’8+3<*'<(*9+3;+)7*+0:56(=,)(32A

C==3’4(21+)3+)7(>+>3:’=*F+97,)+(>+)7*+(?0,=)+3;+)7(>+)*=7236318+32+0,)(*2)+>,;*)8+,[email protected]:,6()8
3;+=,’*W
C==3’4(21+)3+)7(>+>3:’=*F+97,)+(>+)7*+’*6*<,2=*+3;+)7(>+)*=7236318+)3+2:’>(21+0′,=)(=*+,24+)7*
93’K+3;+)7*+(2)*’4(>=(06(2,’8+7*,6)7+=,’*+)*,?W
&78+4(4+83:+>*6*=)+)7(>+0:56(=,)(32+)3+9′()*+,53:)+3:)+3;+)7*+?,28+03>>(56*+30)(32>W+#2+3)7*’
93’4>F+?,K*+)7*+=,>*+,>+)3+978+)7(>+’*>3:’=*+(>+(?03′),2)+;3’+7*,6)7+=,’*+0′,=)()(32*’>+)3
‘*,4A

1-;;9#5′,+'<$%,;;$)*9&”,)

R39+93:64+83:+)(*+)31*)7*’+)7*+K*8+6*,’2(21>+;’3?+*,=7+3;+)7*+;3:’+0:56(=,)(32>+83:+*G,?(2*4W
&7,)+3’1,2(S,)(32,6+;,=)3′>+(2;6:*2=*+)7*+>*6*=)(32+3;+,+)*=7236318+(2+,+7*,6)7+=,’*+>*))(21W
E32>(4*’+>:=7+;,=)3′>+,>+3’1,2(S,)(32,6+036(=(*>F+’*>3:’=*>F+=:6):’*P>3=(,6+23′?>F+=3??()?*2)F
)’,(2(21+0’31’,?>F+,24P3’+*?0638**+*?039*’?*2)A
R39+93:64+83:+X:>)(;8+)7*+(?06*?*2),)(32+,24+:>*+3;+)7*+)*=7236318+(2+,+7*,6)7+=,’*
>*))(21WV%7(>+(>+)7*+>*=)(32+97*’*V83:+9(66+X:>)(;8+Y0’3<*Z+)7,)V)7*+(?06*?*2),)(32+3;+)7*
0,)(*2)+=,’*+)*=7236318V(>V,00’30′(,)*+3’+23)AV%7*+*<(4*2=*+>73:64+5*+=()*4+;’3?+)7*+6()*’,):’*
)7,)+9,>+23)*4+(2+)7*+,223),)*4+5(56(31′,078A

E32>(4*’+)7*+(?0,=)+3;+)7*+)*=7236318+32+)7*+7*,6)7+=,’*+3’1,2(S,)(32F
0,)(*2)=,’*P>,)(>;,=)(32F+,24+(2)*’4(>=(06(2,’8+)*,?+0’34:=)(<()8F+>,)(>;,=)(32F+,24+’*)*2)(32A

:=9;62$’8//$//;$)&H+L3:+?,8+:>*+)7*+;36639(21+)3+1(<*+83:+,2+(4*,+3;+97,)+,+!’3;(=(*2)+3’+7(17*’+’,)(21+32
)7*+>=3′(21+1:(4*+93:64+633K+6(K*H

C>>*>>?*2)+[+IG,?06*+!JD]A

8**”&”,)92′<$>-“#$;$)&/

?#”&&$)’%,;;-)”%9&”,)7’I2>:’*+9′())*2+=3??:2(=,)(32+(>+;’**+3;+*”3′>+)7,)+4*)’,=)+;’3?+)7*+3<*’,66
?*>>,1*A
@$)4&07+-U/.)80*4F+43:56*.>0,=*4+0,1*>A
.-;A$#’,+’#$/,-#%$/7+E()*+,+;”)”;-;’3;+;3:’+0**’.’*<(*9*4+0:56(=,)(32>F+23)+9*5>()*>A
B,)&’9)*’+,)&’/”C$7+Q>*+%(?*>+$*9+”3?,2F+^_+03(2)A
8D87’D36639+C!C+>)86*+,24+;3′?,))(21+1:(4*6(2*>+;3’+,66+5(56(31′,07(=+*2)'(*>EV”*;*’+)3+I<(4*2=*+,24
C!C+,>+2**4*4A

B.$7#&#%,-#”‘C#5″+*#2

B8+>:==*>>;:668+=3?06*)(21+)7(>+,>>*>>?*2)F+83:+9(66+4*?32>)’,)*+83:’+0’3;(=(*2=8+(2+)7*+;36639(21+=3:’>*
=3?0*)*2=(*>+,24+>=3′(21+1:(4*+='()*'(,H

E3?0*)*2=8+[H+I<,6:,)*+)7*+(?0,=)+3;+0,)(*2)+=,’*+)*=723631(*>+32+4*>(‘*4+3:)=3?*>A
C2,68S*+=:”*2)+*<(4*2=*+32+)7*+(?0,=)+3;+,+>*6*=)*4+0,)(*2)+=,’*+)*=7236318+32+0,)(*2)+>,;*)8F
@:,6()8+3;+=,’*F+,24+)7*+(2)*’4(>=(06(2,’8+)*,?A
#2)*1’,)*+=:”*2)+*<(4*2=*+,53:)+)7*+(?0,=)+3;+,+>*6*=)*4+0,)(*2)+=,’*+)*=7236318+32+0,)(*2)
>,;*)[email protected]:,6()8+3;+=,’*F+,24+)7*+(2)*’4(>=(06(2,’8+)*,?+(2)3+,+’*=3??*24,)(32A

E3?0*)*2=8+-H+”*=3??*24+)7*+:>*+3;+,+)*=7236318+)3+*27,2=*[email protected]:,6()8+,24+>,;*)8+>),24,’4>+;3′
0,)(*2)>A

J*>='(5*+3’1,2(S,)(32,6+;,=)3′>+(2;6:*2=(21+)7*+>*6*=)(32+3;+,+)*=7236318+(2+)7*+7*,6)7+=,’*
>*))(21A
`:>)(;8+)7*+(?06*?*2),)(32+,24+:>*+3;+,+>*6*=)*4+)*=7236318+(2+,+7*,6)7+=,’*+>*))(21A

E3?0*)*2=8+aH+C0068+0’3;*>>(32,6F+>=736,’68+=3??:2(=,)(32+)3+;,=(6(),)*+:>*+3;+7*,6)7+(2;3′?,)(32+,24
0,)(*2)+=,’*+)*=723631(*>A

E’*,)*+,+=6*,’F+9*66.3’1,2(S*4F+,24+0’3;*>>(32,6+,223),)*4+5(56(31′,078+)7,)+(>+1*2*’,668+;’**+;’3?
*”3′>+(2+1′,??,’F+0:2=):,)(32F+,24+>0*66(21A
D36639+C!C+>)86*+,24+;3′?,))(21+1:(4*6(2*>+;3’+,66+5(56(31′,07(=+*2)'(*>A

1FG<(.H’HI(!:

Q>*+)7*+>=3′(21+1:(4*+)3+:24*’>),24+739+83:’+,>>*>>?*2)+9(66+5*+*<,6:,)*4A

J(:?’1FG<(.H’HI(!: “

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED

Analyze current evidence on the
impact of a selected patient care
technology on patient safety,
quality of care, and the
interdisciplinary team.

Does not analyze current
evidence on the impact of a
selected patient care
technology on patient
safety, quality of care, and
the interdisciplinary team.

Identifies but does not
analyze current evidence
on the impact of a selected
patient care technology on
patient safety, quality of
care, and the
interdisciplinary team.

Analyzes current evidence
on the impact of a selected
patient care technology on
patient safety, quality of
care, and the
interdisciplinary team.

Provides a rigorous,
scholarly, and perceptive
analysis of current
evidence on the impact of a
selected patient care
technology on patient
safety, quality of care, and
the interdisciplinary team.

Integrate current evidence about
the impact of a selected patient
care technology on patient safety,
quality of care, and the
interdisciplinary team into a
recommendation.

Does not integrate current
evidence about the impact
of a selected patient care
technology on patient
safety, quality of care, and
the interdisciplinary team
into a recommendation.

Integrates some evidence
about the impact of a
selected patient care
technology on patient
safety, quality of care, and
the interdisciplinary team
into a recommendation, but
the work lacks detail or is
missing critical information.

Integrates current evidence
about the impact of a
selected patient care
technology on patient
safety, quality of care, and
the interdisciplinary team
into a recommendation.

Integrates well-researched
and current evidence about
the impact of a selected
innovative patient care
technology on patient
safety, quality of care, and
the interdisciplinary team
into a recommendation.
Provides clear insight into
the potential implications of
the technology on patient
safety and quality of care.

Describe organizational factors
influencing the selection of a
technology in the health care
setting.

Does not describe
organizational factors
influencing the selection of
a technology in the health
care setting.

Identifies but does not fully
describe organizational
factors influencing the
selection of a technology in
the health care setting.

Describes organizational
factors influencing the
selection of a technology in
the health care setting.

Provides a scholarly,
comprehensive, and well-
researched description of
organizational factors
influencing the selection of
a technology in the health
care setting.

Justify the implementation and
use of a selected technology in a
health care setting.

Does not justify the
implementation and use of
a selected technology in a
health care setting.

Explains but does not
justify the implementation
and use of a selected
technology in a health care
setting.

Justifies the implementation
and use of a selected
technology in a health care
setting.

Justifies the implementation
and use of a selected
technology in a health care
setting. Provides an in-
depth and well-researched
analysis of the impact of
the technology on quality
care and patient safety.

Create a clear, well-organized,
and professional annotated
bibliography that is generally free
from errors in grammar,
punctuation, and spelling.

Does not create a clear,
well-organized, and
professional annotated
bibliography that is
generally free from errors in
grammar, punctuation, and
spelling.

Provides an annotated
bibliography that has errors
in grammar, punctuation,
and spelling and exhibits a
lack of preparation.

Creates a clear, well-
organized, and professional
annotated bibliography that
is generally free from errors
in grammar, punctuation,
and spelling.

Creates a clear, well-
organized, and professional
annotated bibliography that
is free from errors in
grammar, punctuation, and
spelling.

Follow APA style and formatting
guidelines for all bibliographic
entries.

Does not follow APA style
and formatting guidelines
for citations and references.

Partially follows APA style
and formatting guidelines
for citations and references.

Follows APA style and
formatting guidelines for all
bibliographic entries.

Follows APA style and
formatting guidelines for
citations and references
with flawless precision and
accuracy.

Print
Evidence-Based Proposal and Annotated Bibliography on Technology in Nursing Scoring Guide

Healthy people discussion

See guidelines. 

NSG 4410 Fall 2020

Population Health Nursing

Instructions for the Healthy People

The purpose of this discussion is to apply research-based, public health objectives to a selected community aggregate. The documents
Healthy People 2020, and
Healthy People Midcourse Review 2010- Healthy People 2020 will be used by the students. This assignment is based on the aggregate in the community where the students did their preceptorship. The discussion is also based on the community assessment that the students completed in NSG 4411. The point distribution is listed below. The instructions on how to develop the discussion following
APA format on the next page.

Points Description

6.5 Describe the community where the aggregate lives and then describe the

aggregate using demographic data and characteristics. Discuss some

social, economic, and environmental factors determining health status.

7 Describe the leading causes of death, extent of disability, and morbidity

for this aggregate.

7 Describe the health risk factors and/or stressors facing this aggregate.

30 Discuss three
Healthy People 2020 objectives, which apply to this aggregate.

7.5 According to the
Healthy People 2010 Midcourse Review – Healthy People 2020, what, if any, progress has been made toward achievement of each
Healthy People 2020 objectives cited?

12 Identify the Healthy People 2020 objective you feel to be the most pertinent to your aggregate, identify, and discuss a strategy to promote health for this aggregate through inter-and intra-professional communication.

30 Use three peer reviewed scholarly-based articles (within last 5 years) to

validate possible interventions for improving the health status of the

assigned aggregate based on your chosen Healthy People 2020 objective.

The following websites are helpful for use in this project:

https://www.healthypeople.gov/

https://www.healthypeople.gov/2020/topics-objectives

http://www.publichealthreviews.eu/upload/pdf_files/13/00_Fielding.pdf

http://www.healthypeople.gov/2010/data/midcourse/

http://www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf

https://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf

https://www.healthypeople.gov/2020/About-Healthy-People

https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-

8#safe=strict&q=healthy+people+2020+leading+health+indicators

Instructions on How to Develop Following APA Format

1. The must be typed in scholarly format (Refer to the BSN Guide for Scholarly Papers) and the APA manual (7th edition):

a. no less than 5 pages and no more than 8 pages (excluding title page and reference page).

b. double-spaced, Times New Roman font, size 12 with 1” margins.

c. Do not write in first, second or third person.

d. Use of proper grammar, spelling, sentence structure, and punctuation is required.

e. Do not start sentences with numbers or acronyms.

f. A paragraph contains at least 3 sentences. Do not add a space between paragraphs.

g. Use headings. (Refer to the APA manual).

h.
No quotes. Paraphrase in your own words.

i. Correctly cite all information. When in doubt, cite. (Refer to APA manual 7th edition).

j. Do not copy and paste from the source or from other assignments. (See syllabus regarding plagiarism).

k. References on separate page.

2. Submit under the Assignments tab through Turnitin.

NSG 4410

Population Health Nursing

Guidelines for the Healthy People

The subject of this is the AGGREGATE (vulnerable population) and the community that the aggregate lives in. For example, the aggregate could be children living in poverty, maybe in the rural community of Hurtsboro, AL. The students will be working with the aggregate population they chose during the preceptorship experience from NSG 4411. Some of the information from the NSG 4411 Community Assessment Project may be useful in writing this , however, do not cut and paste directly from the previous assignment. (See below)

The discussion has seven parts to it:

1. a. Describe the aggregate’s location using demographic data: You may pull in any

demographics you used from your Community Assessment, such as population, averages,

most common occupations, race, and education and income levels. Remember to

paraphrase the information you have previously written. You should also briefly

describe the aggregate. The idea is to give a snapshot of this aggregate and where this

aggregate lives.

A very helpful website to access is
http://factfinder.census.gov/ go to fast access, enter

your community (city, state) then click on “fact sheet” and “people” for details about your

community. You will need to cite this information and list in your references.

b. The environmental and economic conditions really do affect the aggregates’ health care

needs. What are some of the social, economic, and environmental factors that determines

the health status of your aggregate population?

2. Describe the leading causes of death, extent of disability, and morbidity-(illness) for this

aggregate-might not find death for children but could be adults such as heart disease for

obese children. This may be based on census data that you find on the web for this

aggregate, or your own observations of people in that community.

3. Describe the health risk factors or stressors facing this aggregate: This is based on your

own observations and research findings (such as incidence or prevalence of poverty of

children in rural areas and any health risk conditions such as lack of immunizations or

dental care).

4. Discuss three
Healthy People 2020 objectives (not topics) which apply to your aggregate:

Go to the
https://www.healthypeople.gov/2020/topics-objectives website and you will see

a list of topics from A-Z. Each topic area will direct you to a list of objectives. List three

objectives that you identify as health risks facing your aggregate and discuss how they

apply to your aggregate. For example, if one of the topics you identify is “Access to Health

Services”, then search under the topic the objective that applies to your aggregate.

Objective AHS-3, “Increase the proportion of persons with a usual primary care provider”

because the aggregate population lives in a rural community and there are limited

healthcare providers, the nearest facility is….

5. According to the
Healthy People Midcourse Reviews 2010 and Healthy People 2020 ,

what, if any, progress has been made toward achievement of each
Healthy People

2020 objective? Go to
https://www.healthypeople.gov/2020/data-search/midcourse-review

to find this information by clicking on
All Topic Areas and find your topic. You can then

click on the + sign to the right and expand the area to see more about the Midcourse

Review progress data specific to the objectives that you choose. (This information can also

Be accessed this from the Healthy People 2020 website by clicking on
Data Search tab.

6. Identify the one Healthy People 2020 objective
(from the 3 you chose) you feel to be

the
most pertinent to your aggregate, identify, and discuss a strategy to promote health for

this aggregate through inter- and intra-professional communication. You would select the

objective that
most closely applies to your aggregate and discuss a plan of action to be

optimized through communication practices that would benefit your aggregate population.

7. Using
three research-based articles from peer-reviewed Journals published within the last

five (5) years (see examples of research under APA information). Cite
three (3)

interventions for improving the health status of the residents of your assigned aggregate

based on the Healthy People 2020 objective you chose as the
most pertinent.

Example: Objective AHS-3 was the most pertinent, what interventions are being done to

improve access or reduce costs? The Healthy People 2020 website (#4) also provides some

of this information under the
Interventions & Resources tab.

Nursing

 Explain the term scope of practice and the importance of understanding your scope of
practice as a Registered Practical Nurse.
 Explore ONE of the listed specialties where RPN’s practice.
o Palliative care, Medicine, Peri-Operative, Geriatrics, Primary Care, Mental
health, Maternal Child, Pediatric, Community Care (Homecare), Public Health 

Designing budget models using systems thinking

 

Included in the AONE Future Patient Care Delivery Guiding Principles is:

Utilize systems thinking to design models around episodes of care (aligned with reimbursement) that focus on care facilitation, education, outcomes management, illness prevention, and health promotion utilizing high-level functions of integration, problem-solving, and coordination with a strong foundation of interdisciplinary teamwork.

Design models around episodes of care using systems thinking aligned with reimbursement.

Include the following aspects in the discussion:

Note: When faced with problems, you are not quite certain you understand well enough to answer, remember, start at the beginning, and break it into pieces.

Article 6

Please review article. Submit a 1 page summary on three take-aways from the article. Review the framework and describe 3 different levels and combinations. 

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0| July, 2019

Complete IDDSI Framework
Detailed definitions

2.0 | 2019

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

2

INTRODUCTION

The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded in 2013 with the goal of
developing new international standardised terminology and definitions to describe texture modified foods and
thickened liquids used for individuals with dysphagia of all ages, in all care settings, and all cultures.

Three years of work by the International Dysphagia Diet Standardisation Committee culminated in the 2016
release and 2017 publication of the IDDSI Framework consisting of a continuum of 8 levels (0-7). Levels are
identified by numbers, text labels and colour codes. [Reference: Cichero JAY, Lam P, Steele CM, Hanson B, Chen J,
Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S. (2017) Development of
international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia
management: The IDDSI Framework. Dysphagia, 32:293-314. https://link.springer.com/article/10.1007/s00455-
016-9758-y]

The Complete IDDSI Framework Detailed Definitions 2019 is an update to the 2016 document. The Complete
IDDSI Framework Detailed Definitions document provides detailed descriptors for all levels of the IDDSI
Framework. Descriptors are supported by simple measurement methods that can be used by people with
dysphagia or by caregivers, clinicians, food service professionals or industry to confirm the level a food or drink
fits into.

This document is to be read in conjunction with IDDSI Testing Methods 2019, IDDSI Evidence 2016 and IDDSI
Frequently Asked Questions (FAQs) documents ( https://iddsi.org/framework/).

The IDDSI Framework provides a common terminology to describe food textures and drink thickness. IDDSI tests
are intended to confirm the flow or textural characteristics of a particular product at the time of testing. Testing
should be done on foods and drinks under the intended serving conditions (especially temperature). The clinician
has the responsibility to make recommendations for foods or drinks for a particular patient based on their
comprehensive clinical assessment.

IDDSI would like to acknowledge the interest and participation of the global community including patients,
caregivers, health professionals, industry, professional associations and researchers. We would also like to thank
our sponsors for their generous support.

Please visit https://iddsi.org/ for further information.

The IDDSI Board:

The IDDSI Board are a group of volunteers who do not draw a salary from IDDSI. They offer their knowledge,
expertise and time for the benefit of the international community.

Co-Chairs: Peter Lam (CAN) & Julie Cichero (AUS);

Board Members: Jianshe Chen (CHN), Roberto Dantas (BRA), Janice Duivestein (CAN), Ben Hanson (UK),
Jun Kayashita (JPN), Mershen Pillay (ZAF), Luis Riquelme (USA), Catriona Steele (CAN),
Jan Vanderwegen (BE).

Past Board Members: Joseph Murray (USA), Caroline Lecko (UK), Soenke Stanschus (GER)

The International Dysphagia Diet Standardisation Initiative Inc. (IDDSI) is independent and operates as a not-for-
profit entity. IDDSI is grateful to a large number of agencies, organizations and industry partners for financial and
other support. Sponsors have not been involved with the design or development of the IDDSI framework.

Implementation of the IDDSI framework is in progress. IDDSI is extremely grateful to all sponsors supporting
implementation https://iddsi.org/about-us/sponsors/

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

3

Description/
Characteristics

• Flows like water
• Fast flow
• Can drink through any type of teat/nipple, cup or straw as

appropriate for age and skills

Physiological rationale for this
level of thickness

• Functional ability to safely manage liquids of all types

Although descriptions are provided, use IDDSI Testing methods to decide if the liquid meets IDDSI Level 0.
TESTING METHOD
See also IDDSI Testing Methods document or https://iddsi.org/framework/drink-testing-methods/

IDDSI Flow Test*

• Less than 1 mL remaining in the 10 mL slip tip syringe# after 10 seconds

of flow (see IDDSI Flow Test instructions*)

IDDSI FLOW TEST INSTRUCTIONS

#Before you test …
You must check your
syringe length
because there are
differences in syringe
lengths. Your syringe
should look like this

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

4

Description/
Characteristics

• Thicker than water
• Requires a little more effort to drink than thin liquids
• Flows through a straw, syringe, teat/nipple
• Similar to the thickness of most commercially available

‘Anti-regurgitation’ (AR) infant formulas

Physiological rationale for this
level of thickness

• Often used in the paediatric population as a thickened drink that
reduces speed of flow yet is still able to flow through an infant
teat/nipple. Consideration to flow through a teat/nipple should be
determined on a case-by-case basis.

• Also used in adult populations where thin drinks flow too fast to be
controlled safely. These slightly thick liquids will flow at a slightly
slower rate.

Although descriptions are provided, use IDDSI Testing methods to decide if the liquid meets IDDSI Level 1.

TESTING METHOD

See also IDDSI Testing Methods document or https://iddsi.org/framework/drink-testing-methods/

IDDSI Flow Test*

• Test liquid flows through a 10 mL slip tip syringe# leaving 1-4 mL in the
syringe after 10 seconds (see IDDSI Flow Test instructions*)

IDDSI FLOW TEST INSTRUCTIONS

#Before you test…
You must check your
syringe length
because there are
differences in syringe
lengths. Your syringe

should look like this

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

5

Description/
Characteristics

• Flows off a spoon
• Sippable, pours quickly from a spoon, but slower than thin drinks
• Mild effort is required to drink this thickness through standard bore

straw (standard bore straw = 0.209 inch or 5.3 mm diameter)

Physiological rationale for this
level of thickness

• If thin drinks flow too fast to be controlled safely, these Mildly Thick
liquids will flow at a slightly slower rate

• May be suitable if tongue control is slightly reduced.

Although descriptions are provided, use IDDSI Testing methods to decide if the liquid meets IDDSI Level 2.

TESTING METHOD

See also IDDSI Testing Methods document or https://iddsi.org/framework/drink-testing-methods/

IDDSI Flow Test*

• Test liquid flows through a 10 mL slip tip syringe leaving 4 to 8 ml in
the syringe after 10 seconds (see IDDSI Flow Test instructions*)

IDDSI FLOW TEST INSTRUCTIONS

#Before you test…
You must check your
syringe length
because there are
differences in syringe
lengths. Your syringe

should look like this

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

6

Description/characteristics

• Can be drunk from a cup
• Moderate effort is required to suck through a standard bore or wide

bore straw (wide bore straw = 0.275 inch or 6.9 mm)
• Cannot be piped, layered or molded on a plate because it will not

retain its shape
• Cannot be eaten with a fork because it drips slowly in dollops

through the prongs
• Can be eaten with a spoon
• No oral processing or chewing required – can be swallowed directly
• Smooth texture with no ‘bits’ (lumps, fibers, bits of shell or skin,

husk, particles of gristle or bone)

Physiological rationale for this
level of thickness

• If tongue control is insufficient to manage Mildly Thick drinks (Level 2),
this Liquidised/Moderately thick level may be suitable

• Allows more time for oral control
• Needs some tongue propulsion effort
• Pain on swallowing

Although descriptions are provided, use IDDSI Testing methods to decide if the food/liquid meets IDDSI Level 3.

TESTING METHODS

See also IDDSI Testing Methods document or https://iddsi.org/framework/drink-testing-methods/ and

https://iddsi.org/framework/food-testing-methods/

IDDSI Flow Test*

• Test liquid flows through a 10 ml slip tip syringe leaving > 8 ml in the
syringe after 10 seconds (see IDDSI Flow Test Guide*)

Fork Drip Test

• Drips slowly in dollops through the prongs of a fork

• When a fork is pressed on the surface of Level 3 Moderately Thick
Liquid/Liquidised food, the tines/prongs of a fork do not leave a clear
pattern on the surface

• Spreads out if spilled onto a flat surface

Spoon Tilt Test • Easily pours from spoon when tilted; does not stick to spoon

Where forks are not available
Chopstick Test

• Chopsticks are not suitable for this texture

Where forks are not available
Finger Test

• It is not possible to hold a sample of this food texture using fingers,
however, this texture slides smoothly and easily between the thumb
and fingers, leaving a coating

Food specific or
Other examples
(NB. this list is not exhaustive)

The following items may fit into IDDSI Level 3:
• Infant “first foods” (runny rice cereal or runny pureed fruit)
• Some sauces and gravies, as confirmed by IDDSI Flow Test

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

7

• Some syrups, as confirmed by IDDSI Flow Test

Drips slowly or in dollops/strands
through the slots of a fork

IDDSI FLOW TEST INSTRUCTIONS

#Before you test…
You must check your
syringe length
because there are
differences in syringe
lengths. Your syringe

should look like this

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

8

Description/characteristics

• Usually eaten with a spoon (a fork is possible)
• Cannot be drunk from a cup because it does not flow easily
• Cannot be sucked through a straw
• Does not require chewing
• Can be piped, layered or molded because it retains its shape, but

should not require chewing if presented in this form
• Shows some very slow movement under gravity but cannot be

poured
• Falls off spoon in a single spoonful when tilted and continues to

hold shape on a plate
• No lumps
• Not sticky
• Liquid must not separate from solid

Physiological rationale for this level
of thickness

• If tongue control is significantly reduced, this category may be easiest
to control

• Requires less propulsion effort than Minced & Moist (level 5), Soft &
Bite-Sized (Level 6) and Regular and Regular Easy to Chew (Level 7)
but more than Liquidised/Moderately thick (Level 3)

• No biting or chewing is required
• Increased oral and/or pharyngeal residue is a risk if too sticky
• Any food that requires chewing, controlled manipulation or bolus

formation are not suitable
• Pain on chewing or swallowing
• Missing teeth, poorly fitting dentures

Although descriptions are provided, use IDDSI Testing methods to decide if the food/liquid meets IDDSI Level 4.

TESTING METHODS

See also IDDSI Testing Methods document or https://iddsi.org/framework/food-testing-methods/

IDDSI Flow test • n/a. The IDDSI Flow test is not applicable, please use the Fork Drip
Test and Spoon Tilt Test

Fork Pressure test • Smooth with no lumps and minimal granulation
• When a fork is pressed on the surface of Level 4 Extremely Thick

Liquid/Pureed food, the tines/prongs of a fork can make a clear
pattern on the surface, and/or the food retains the indentation from
the fork

Fork Drip test
Fork Drip test contd.

• Sample sits in a mound/pile above the fork; a small amount may flow
through and form a short tail below the fork tines/prongs, but it does
not flow or drip continuously through the prongs of a fork (see

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

9

picture below)

Spoon Tilt test

• Cohesive enough to hold its shape on the spoon
• A full spoonful must plop off the spoon if the spoon is titled or turned

sideways; a very gentle flick (using only fingers and wrist) may be
necessary to dislodge the sample from the spoon, but the sample
should slide off easily with very little food left on the spoon. A thin
film remaining on the spoon after the Spoon Tilt Test is acceptable,
however, you should still be able to see the spoon through the thin
film; i.e. the sample should not be firm and sticky

• May spread out slightly or slump very slowly on a flat plate

Where forks are not available
Chopstick test

• Chopsticks are not suitable for this texture

Where forks are not available
Finger test

• It is just possible to hold a sample of this texture using fingers. The
texture slides smoothly and easily between the fingers and leaves
noticeable coating

Indicators that a sample is too thick • Does not fall off the spoon when tilted
• Sticks to spoon

FOOD SPECIFIC OR OTHER EXAMPLES

The following item may be suitable for IDDSI Level 4:

• Purees suitable for infants (e.g. pureed meat, thick cereal)

Spoon Tilt Test: Holds shape on spoon; not firm and sticky; little food left on spoon

Sits in a mound or
pile above the fork

A small amount may flow through and form a short tail below the fork

Does not dollop, flow or drip continuously through the fork prongs

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

10

Spoon Tilt Test: SAFE: Holds shape on spoon; not firm and sticky; little food left on spoon

The following images show examples of foods that would be suitable or unsuitable for
Level 4 according to the IDDSI Spoon Tilt Test

þ

þ þ þ

þ þ

Spoon Tilt Test: SAFE: Holds shape on spoon; not firm and sticky; little food left on spoon

Spoon Tilt Test: UNSAFE:Holds shape on spoon; FIRM AND STICKY; LOTS OF food left on spoon

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

11

Description/characteristics

• Can be eaten with a fork or spoon
• Could be eaten with chopsticks in some cases, if the individual has

very good hand control
• Can be scooped and shaped (e.g. into a ball shape) on a plate
• Soft and moist with no separate thin liquid
• Small lumps visible within the food

Ø Paediatric, equal to or less than 2 mm width and no longer than
8mm in length

Ø Adult, equal to or less than 4mm width and no longer than
15mm in length

• Lumps are easy to squash with tongue

Physiological rationale for this level
of thickness

• Biting is not required
• Minimal chewing is required
• Tongue force alone can be used to separate the soft small particles in

this texture
• Tongue force is required to move the bolus
• Pain or fatigue on chewing
• Missing teeth, poorly fitting dentures

Although descriptions are provided, use IDDSI Testing methods to decide if the food meets IDDSI Level 5.

TESTING METHODS

See also IDDSI Testing Methods document or https://iddsi.org/framework/food-testing-methods/

Fork Pressure test • When pressed with a fork the particles should easily be separated
between and come through the tines/prongs of a fork

• Can be easily mashed with little pressure from a fork [pressure
should not make the thumb nail blanch to white]

Fork Drip test • When a sample is scooped with a fork it sits in a pile or can mound on
the fork and does not easily or completely flow or fall through the
tines/prongs of a fork

Spoon Tilt test

• Cohesive enough to hold its shape on the spoon
• A full spoonful must slide/pour off/fall off the spoon if the spoon is

tilted or turned sideways or shaken lightly; the sample should slide
off easily with very little food left on the spoon; i.e. the sample
should not be sticky

• A scooped mound may spread or slump very slightly on a plate

Where forks are not available
Chopstick test

• Chopsticks can be used to scoop or hold this texture if the sample is
moist and cohesive and the person has very good hand control to use
chopsticks

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

12

Where forks are not available
Finger test

• It is possible to easily hold a sample of this texture using fingers;
small, soft, smooth, rounded particles can be easily separated using
fingers. The material will feel moist and leave fingers wet.

FOOD SPECIFIC OR OTHER EXAMPLES https://iddsi.org/framework/food-testing-methods/

MEAT
• Finely minced* or chopped*, soft mince

o Paediatric, equal to or less than 2mm width
and no longer than 8mm in length

o Adult, equal to or less than 4mm width and no
more than 15mm in length

• Serve in mildly, moderately or extremely thick,
smooth, sauce or gravy, draining excess

• *If texture cannot be finely minced it should be pureed

FISH
• Finely mashed in mildly, moderately or extremely thick

smooth, sauce or gravy, draining excess
o Paediatric, equal to or less than 2mm width

and no longer than 8mm in length
o Adult, equal to or less than 4mm width and no

more than 15mm in length
FRUIT
• Serve finely minced or chopped or mashed
• Drain excess juice
• If needed, serve in mildly, moderately or extremely

thick smooth sauce or gravy AND drain excess liquid.
No thin liquid should separate from food

o Paediatric, equal to or less than 2mm width and
no longer than 8mm in length

o Adult, equal to or less than 4mm width and no
more than 15mm in length

VEGETABLES
• Serve finely minced or chopped or mashed
• Drain any liquid
• If needed, serve in mildly, moderately or extremely thick

smooth sauce or gravy AND drain excess liquid. No thin
liquid should separate from food

o Paediatric, equal to or less than 2mm width and no longer than 8mm in length
o Adult, equal to or less than 4mm width and no more than 15mm in length

CEREAL
• Thick and smooth with small soft lumps

o Paediatric, equal to or less than 2mm width and no longer than 8mm in length
o Adult, equal to or less than 4mm width and no more than 15mm in length

• Texture fully softened
• Any milk/fluid must not separate away from cereal. Drain any excess fluid before serving

Use slot between fork prongs (4mm) to
determine whether minced pieces are the

correct or incorrect size

T

R

Note – lump size requirements for all
foods in Level 5 Minced & Moist:

Ø Paediatric, equal to or less than
2mm width and no more than
8mm in length

Ø Adult, equal to or less than 4mm
width and no more than 15mm
in length

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

13

BREAD
• No regular, dry bread, sandwiches or toast of any kind
• Use IDDSI Level 5 Minced & Moist sandwich recipe video

https://www.youtube.com/watch?v=W7bOufqmz18
• Pre-gelled ‘soaked’ breads that are very moist and gelled

through the entire thickness

RICE, COUSCOUS, QUINOA (and similar food textures)
• Not sticky or glutinous
• Should not be particulate or separate into individual grains when cooked and served
• Serve with smooth mildly, moderately or extremely thick sauce AND Sauce must not separate away from rice,

couscous, quinoa (and similar food textures). Drain excess fluid before serving

IDDSI Spoon Tilt Test
Sample holds its shape on
the spoon and falls off
fairly easily if the spoon is
tilted or lightly flicked

Sample should not be firm
or sticky

IDDSI Fork Test
Paediatric, equal to or less than
2mm width and no more than
8mm in length

Adult, equal to or less than
4mm width and no more than
15mm in length

4mm is about the gap between
the prongs of a standard dinner

fork

Minced & Moist food must
pass all three tests!

Soft enough to
squash easily with
fork or spoon

Don’t need thumb
nail to blanch
white

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

14

Description/characteristics

• Can be eaten with a fork, spoon or chopsticks
• Can be mashed/broken down with pressure from fork, spoon or

chopsticks
• A knife is not required to cut this food, but may be used to help

load a fork or spoon
• Soft, tender and moist throughout but with no separate thin liquid
• Chewing is required before swallowing
• ‘Bite-sized’ pieces as appropriate for size and oral processing skills

Ø Paediatric, 8mm pieces (no larger than)
Ø Adults, 15 mm = 1.5 cm pieces (no larger than)

Physiological rationale for this level
of thickness

• Biting is not required
• Chewing is required
• Food piece sizes designed to minimize choking risk
• Tongue force and control is required to move the food and keep it

within the mouth for chewing and oral processing
• Tongue force is required to move the bolus for swallowing
• Pain or fatigue on chewing
• Missing teeth, poorly fitting dentures

Although descriptions are provided, use IDDSI Testing methods to decide if the food meets IDDSI Level 6.

TESTING METHODS

See also IDDSI Testing Methods document or https://iddsi.org/framework/food-testing-methods/

Fork Pressure test

• Pressure from a fork held on its side can be used to ‘cut’ or break
apart or flake this texture into smaller pieces

• When a sample the size of a thumb nail (1.5×1.5 cm) is pressed with
the tines of a fork to a pressure where the thumb nail blanches to
white, the sample squashes, breaks apart, changes shape, and does
not return to its original shape when the fork is removed.

Spoon Pressure test

• Pressure from a spoon held on its side can be used to ‘cut’ or break
this texture into smaller pieces.

• When a sample the size of a thumb nail (1.5 cm x1.5 cm) is pressed
with the base of a spoon, the sample squashes, breaks apart,
changes shape, and does not return to its original shape when the
spoon is removed.

Where forks are not available
Chopstick test

• Chopsticks can be used to break this texture into smaller pieces or
puncture food

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

15

Where forks are not available
Finger test

• Use a sample the size of a thumb nail (1.5 cm x 1.5 cm). It is
possible to squash a sample of this texture using finger pressure
such that the thumb and index finger nails blanch to white. The
sample breaks apart and will not return to its initial shape once
pressure is released.

FOOD SPECIFIC OR OTHER EXAMPLES

MEAT
• Cooked, tender meat no bigger than

• Paediatric, 8mm pieces
• Adults, 15 mm = 1.5 x 1.5 cm pieces
• If texture cannot be served soft and tender at 1.5

cm x 1.5 cm (as confirmed with fork/ spoon
pressure test), serve minced and moist

FISH
• Soft enough cooked fish to break into small pieces with fork, spoon or chopsticks no larger than

• Paediatric, 8mm pieces
• Adults, 15 mm = 1.5 cm pieces

• No bones or tough skins

CASSEROLE/STEW/CURRY
• Liquid portion (e.g. sauce) must be thick (as per clinician recommendations)
• Can contain meat, fish or vegetables if final cooked pieces are soft and tender and no larger than

• Paediatric, 8mm pieces
• Adults, 15 mm = 1.5 cm pieces

• No hard lumps

FRUIT
• Serve minced or mashed if cannot be cut to soft & bite-sized pieces

• Paediatric, 8mm pieces
• Adults, 15 mm = 1.5 cm pieces

• Fibrous parts of fruit are not suitable
• Drain excess juice
• Assess individual ability to manage fruit with high water content (e.g. watermelon) where juice separates

from solid in the mouth during chewing

VEGETABLES
• Steamed or boiled vegetables with final cooked size of

• Paediatric, 8mm pieces
• Adults, 15 mm = 1.5 cm pieces

• Stir fried vegetables may be too firm and are not soft or tender. Check softness with fork/spoon pressure
test

CEREAL
• Smooth with soft tender lumps no bigger than

• Paediatric, 8mm pieces
• Adults, 15 mm = 1.5 cm pieces

• Texture fully softened
• Any excess milk or liquid must be drained and/or thickened to thickness level recommended by clinician

Note – food size requirements for all
foods in Level 6 Soft & Bite-sized:

Ø Paediatric, 8mm pieces
Ø Adult, 15mm = 1.5cm pieces

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

16

BREAD
• No regular dry bread, sandwiches or toast of any kind
• Use IDDSI Level 5 Minced & Moist sandwich recipe video to

prepare bread and add to filling that meets Level 6 Soft & Bite-
sized requirements

• Pre-gelled ‘soaked’ breads that are very moist and gelled through
the entire thickness

RICE, COUCOUS, QUINOA (and similar food textures)
• Not particulate/grainy, sticky or glutinous

Thumb nail blanched
to white

Sample squashes and does not return
to its original shape when pressure is

released

Food pieces no
bigger than 8mm x
8mm lump size for

children

Food pieces no bigger than
1.5cm x 1.5cm bite size

for adults Soft & Bite-Sized food
must pass both

food piece size and
softness tests!

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

17

Description/characteristics

• Normal, everyday foods of soft/tender textures that are
developmentally and age appropriate

• Any method may be used to eat these foods
• Sample size is not restricted at Level 7, therefore, foods may be of a

range of sizes
Ø Smaller or greater than 8mm pieces (Paediatric)
Ø Smaller or greater than 15 mm = 1.5 cm pieces (Adults)

• Does not include: hard, tough, chewy, fibrous, stringy, crunchy, or
crumbly bits, pips, seeds, fibrous parts of fruit, husks or bones

• May include ‘dual consistency’ or ‘mixed consistency’ foods and liquids
if also safe for Level 0, and at clinician discretion. If unsafe for Level 0
Thin, liquid portion can be thickened to clinician’s recommended
thickness level

Physiological rationale for this
level of thickness

• Requires the ability to bite soft foods and chew and orally process food
for long enough that the person forms a soft cohesive ball/bolus that is
‘swallow ready’. Does not necessarily require teeth.

• Requires the ability to chew and orally process soft/tender foods
without tiring easily

• May be suitable for people who find hard and/or chewy foods difficult
or painful to chew and swallow

• This level could present a choking risk for people with clinically
identified increased risk of choking, because food pieces can be of any
size. Restricting food piece sizes aims to minimize choking risk (e.g.
Level 4 Pureed, Level 5 Minced & Moist, Level 6 Soft & Bite-sized have
food piece size restrictions to minimize choking risk)

• This level may be used by qualified clinicians for developmental
teaching, or progression to foods that need more advanced chewing
skills

• If the person needs supervision to eat safely, before using this
texture level consult a qualified clinician to determine the person’s
food texture needs, and meal time plan for safety

• People can be unsafe to eat without supervision due to
chewing and swallowing problems and/or unsafe mealtime
behaviours. Examples of unsafe mealtime behaviors include:
not chewing very well, putting too much food into the mouth,
eating too fast or swallowing large mouthfuls of food, inability
to self-monitor chewing ability.

• Clinicians should be consulted for specific advice for patient
needs, requests and requirements for supervision.

• Where mealtime supervision is needed, this level should only
be used under the strict recommendation and written
guidance of a qualified clinician

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

18

Although descriptions are provided, use IDDSI Testing methods to decide if the food meets IDDSI Level 7 Easy to
Chew.

TESTING METHODS
See also IDDSI Testing Methods document or https://iddsi.org/framework/food-testing-methods/

Fork Pressure Test • Pressure from a fork held on its side can be used to ‘cut’ or break apart
or flake this texture into smaller pieces

• When a sample the size of a thumb nail (1.5×1.5cm) is pressed with the
tines of a fork to a pressure where the thumb nail blanches to white,
the sample squashes, breaks apart, changes shape and does not return
to its original shape when the fork is removed.

Spoon Pressure Test • Pressure from a spoon held on its side can be used to ‘cut’ or break or
flake this texture into smaller pieces

• When a sample the size of a thumb nail (1.5×1.5cm) is pressed with the
base of a spoon to a pressure where the thumb nail blanches to white,
the sample squashes, breaks apart, changes shape and does not return
to its original shape when the spoon is removed.

Where forks are not available
Chopstick Test

• Chopsticks can be used to puncture this texture

Where forks are not available
Finger test

• Use a sample the size of a thumb nail (1.5×1.5cm). It is possible to
squash a sample of this texture using finger pressure such that the
thumb and index finger nails blanch to white. The sample squashes
and breaks apart and will not return to its initial shape once pressure is
released.

FOOD SPECIFIC OR OTHER EXAMPLES

MEAT
• Cooked until tender.
• If texture cannot be served soft and tender, serve minced and moist

FISH
• Soft enough cooked fish to break into small pieces with the side fork, spoon or chopsticks

CASSEROLE/STEW/CURRY
• Can contain meat, fish, vegetables, or combinations of these if final cooked pieces are soft and tender
• Serve in mildly, moderately of extremely thick sauce AND drain excess liquid
• No hard lumps

FRUIT
• Soft enough to be cut broken apart into smaller pieces with the side of a fork or spoon. Do not use the

fibrous parts of fruit (e.g. the white part of an orange).

VEGETABLES
• Steam or boil vegetables until tender. Stir fried vegetables may be too firm for this level. Check softness

with fork/spoon pressure test

CEREAL
• Served with texture softened
• Drain excess milk or liquid and/or thicken to thickness level recommended by clinician

BREAD

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

19

• Bread, sandwiches and toast that can be cut or broken apart into smaller pieces with the side of a fork or
spoon can be provided at clinician discretion

RICE, COUSCOUS, QUINOA (and similar food textures)
• No special instructions

Must be able to break
food apart easily with

the side of a fork or
spoon

IDDSI Fork Pressure Test

To make sure the food is soft enough,
press down on the fork until the
thumbnail blanches to white, then lift
the fork to see that the food is
completely squashed and does not
regain its shape

Easy to Chew foods must
break apart easily with
the side of a fork or
spoon and pass Fork
Pressure Test

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

20

Description/characteristics

There are NO texture restrictions
at this level

• Normal, everyday foods of various textures that are developmentally
and age appropriate

• Any method may be used to eat these foods
• Foods may be hard and crunchy or naturally soft
• Sample size is not restricted at Level 7, therefore, foods may be of a

range of sizes
Ø Smaller or greater than 8mm pieces (Paediatric)
Ø Smaller or greater than 15 mm = 1.5 cm pieces (Adults)

• Includes hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy, or
crumbly bits

• Includes food that contains pips, seeds, pith inside skin, husks or bones
• Includes ‘dual consistency’ or ‘mixed consistency’ foods and liquids

Physiological rationale for this
level of thickness

• Ability to bite hard or soft foods and chew them for long enough that
they form a soft cohesive ball/bolus that is ‘swallow ready’

• An ability to chew all food textures without tiring easily
• An ability to remove bone or gristle that cannot be swallowed safely

from the mouth

TESTING METHOD

• Not Applicable

EASY TO CHEW

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

21

Description/characteristics

• Food that starts as one texture (e.g. firm solid) and changes into
another texture specifically when moisture (e.g. water or saliva) is
applied, or when a change in temperature occurs (e.g. heating)

Physiological rationale for this level
of thickness

• Biting not required
• Minimal chewing required
• Tongue can be used to break these foods once altered by

temperature or with addition of moisture/saliva

Ø May be used for developmental teaching or rehabilitation of
chewing skills (e.g. development of chewing in the paediatric
population and developmental disability population; rehabilitation
of chewing function post stroke)

Although descriptions are provided, use IDDSI Testing methods to decide if the food meets the requirements
for Transitional foods.

TESTING METHOD

See also IDDSI Testing Methods document or https://iddsi.org/framework/food-testing-methods/

Fork pressure test

• After moisture or temperature has been applied, the sample can be
easily deformed and does not recover its shape when the force is
lifted.

• Use a sample the size of the thumb nail (1.5 cm x 1.5 cm), place
1 ml of water on the sample and wait one minute. Apply fork
pressure using the tines of the fork until the thumbnail blanches to
white. The sample is a transitional food texture if after removing
the fork pressure:

• The sample has been squashed and disintegrated and no
longer looks like its original state

• Or it has melted significantly and no longer looks like its
original state (e.g. ice chips).

Spoon pressure test

• As above, using the base of the spoon in place of the fork

Where forks are not available
Chopstick test

• Use a sample the size of the thumb nail (1.5 cm x 1.5 cm), place 1 ml
of water on the sample and wait one minute. The sample should be
easily broken apart using chopsticks with minimal pressure.

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

22

Where forks are not available
Finger test

• Use a sample the size of the thumb nail (1.5 cm x 1.5 cm), place 1 ml
of water on the sample and wait one minute. The sample will break
apart completely by rubbing the sample between the thumb and
index finger. The sample will not return to its initial shape

FOOD SPECIFIC OR OTHER EXAMPLES

IDDSI Transitional Foods may include and are not limited to:

• Ice chips
• Ice cream/Sherbet if assessed as suitable by a Dysphagia specialist
• Japanese Dysphagia Training Jelly sliced 1 mm x 15 mm
• Wafers (also includes Religious Communion wafer)
• Waffle cones used to hold ice cream
• Some biscuits/ cookies/ crackers
• Some potato crisps – only ones made or formed from mashed potato (e.g. Pringles)
• Shortbread
• Prawn crisps

Specific examples used in paediatric or adult disability dysphagia management

Commercially available foods# that are transitional foods textures include but are not limited to:

• Veggie Stix™
• Cheeto Puffs™
• Rice Puffs™
• Baby Mum Mums™
• Gerber Graduate Puffs™

#The mention of certain manufacturers’ products does not imply that they are endorsed or recommended in
preference to others of a similar nature that are not mentioned.

Thumb nail blanched
to white

Sample squashes and fractures,
and does not return to its original
shape when pressure is released

• Apply 1 ml of water to sample
• Wait 1 minute

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

23

Hard or dry textures are a choking risk because they require good chewing ability to break down and
mix with saliva to make them moist enough to be safe to swallow.
Examples of hard or dry textures: nuts, raw carrots, crackling, hard crusty rolls

Fibrous or tough textures are a choking risk because they require good chewing ability, and sustained
chewing ability to break down to small enough pieces that are safe to swallow.
Examples of fibrous or tough textures: steak, pineapple

Chewy textures are a choking risk because they are sticky and can become stuck to the roof of the
mouth, the teeth or cheeks and fall into the airway
Examples of chewy textures: candies/lollies/sweets, cheese chunks, marshmallows, chewing gum, sticky
mashed potato

Crispy textures are a choking risk because they require good chewing ability to break down and mix
with saliva to make them soft, rounded and moist enough to be safe to swallow.
Examples of crispy textures: crackling, crisp bacon, some dry cereals

Crunchy textures are a choking risk because they require good chewing ability, and sustained
chewing ability to break them into small enough pieces and mix with saliva so that they are safe to
swallow.
Examples of crunchy textures: raw carrot, raw apple, popcorn

Sharp or spiky textures are a choking risk because they require good chewing ability to break them
into small enough, soft, rounded pieces and moist enough to be safe to swallow.
Example of sharp or spiky textures: dry corn chips

Crumbly textures are a choking risk because they need good tongue control to bring crumbly pieces
together and mix with enough saliva to hold together to be moist and safe to swallow.
Examples of crumbly textures: crumbly dry cakes, dry cookies, dry biscuits or scones

Pips, seeds, and the white parts of fruit are a choking risk because they are hard and part of other
hard or fibrous textures, making it a complex process to separate and remove them from the mouth
Examples of pips, seeds and white parts of fruit include apple or pumpkin seeds, the white part of oranges

Skins, husks or outer shells are a choking risk because the pieces are often fibrous, spiky, and dry
needing good chewing skills to make the pieces smaller, and enough saliva to make it moist, OR
enough skill to remove the pieces from the mouth. These small pieces become stuck to teeth and
gums and catch in the throat when swallowed.
Examples of skins, husks or outer shells include pea shells, grape skin, bran, psyllium

FOOD TEXTURES THAT POSE A CHOKING
RISK Examples are drawn from international autopsy reports

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

24

Bone or gristle is a choking risk because these pieces are hard and not usually chewed and
swallowed. They require good tongue skills to remove them from the food texture they are attached
to, and then remove the bone or gristle from the mouth.
Examples of bone or gristle includes chicken bones, fish bones

Round, or long shaped foods are a choking risk because if they are not chewed into small pieces and
are swallowed whole they are a shape that can completely block the airway causing choking
Examples of round or long shaped foods include sausages, grapes

Sticky or gummy textures are a choking risk because they are sticky and can become stuck to the
roof of the mouth, the teeth or cheeks and fall into the airway. They require sustained and good
chewing ability to reduce stickiness by adding saliva to make them safe to swallow.
Examples of chewy textures: nut butter, overcooked oatmeal, edible gelatin, Konjac containing jelly, sticky rice
cakes, candy

Stringy textures are a choking risk because the string can be difficult to break and the flesh can
become trapped with part in the mouth and part in the throat tied together by the stringy texture.
Examples of stringy textures include: green string beans, rhubarb

Mixed thin-thick textures are a choking risk because they require an ability to hold the solid piece in
the mouth while the thin liquid portion is swallowed. After the liquid portion is swallowed the solid
pieces are chewed and swallowed. This is a very complex oral task.
Examples of mixed thin-thick textures include: soup with food pieces, cereal pieces with milk, bubble tea

Complex food textures are a choking risk because they require an ability to chew and manipulate a
variety of food textures in one mouthful.
Examples of complex food textures include: hamburger, hot dog, sandwich, meatballs and spaghetti, pizza

Floppy textures are a choking risk because if they are not chewed into small pieces they become thin
and wet and can form a covering over the opening of the airway, stopping air from flowing.
Examples of floppy textures include: lettuce, thin sliced cucumber, baby spinach leaves

Juicy food textures where the juice separates from the food when chewing is a choking risk because
it needs the person to be able to swallow the juice while controlling the solid piece in the mouth,
Once the juice has been swallowed good chewing skills are needed to break the food into smaller
pieces for safe swallowing. It is a complex oral task.
Example of juicy food textures include: watermelon

Hard skins or crusts formed during cooking or heating are a choking risk because they require good
chewing skills to break them down into smaller pieces while mixed with other food textures not
affected by the heating process.

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

25

Foods that pose a choking risk – Autopsy report references:

Berzlanovich, A.M., Muhm, M., Sim, E., and Bauer, G. (1999) ‘Foreign body asphyxiation – an autopsy study’,
American Journal of Medicine, 107, 351-355.

Berzlanovich, A.M., Fazeny-Dorner, B., Waldhoer, T., and Fasching, P. (2005) ‘Foreign body asphyxia: A
preventable cause of death in the elderly’, American Journal of Preventive Medicine, 28, 65-69.

Centre for Disease control and prevention (2002) Non-fatal choking related episodes among children, United
States 2001. Morbidity and Mortality Weekly Report, 51: 945-948.

Dolkas, L., Stanley C., Smith, A.M., Vilke G.M. (2007) Deaths associated with choking in San Diego. Journal of
Forensic Science, 52, 176-179.

Ekberg, O. and Feinberg, M. (1992) ‘Clinical and demographic data in 75 patients with near-fatal choking
episodes’, Dysphagia, 7, 205-208.

Wick, R., Gilbert, J.D., and Byard, R.W. (2006) ‘Café coronary syndrome-fatal choking on food: An autopsy
approach.’, Journal of Clinical Forensic Medicine, 13, 135-138.

Food Safety Commission, Japan (2010) Risk Assessment Report: Choking accidents caused by foods.
https://www.fsc.go.jp/english/topics/choking_accidents_caused_by_foods.pdf (accessed June 2019).

Harris C.A., Baker, S.P., Smith, G.A., Harris R.M. (1984) Childhood asphyxiation by food: A national analysis and
overview. JAMA, 251, 2231-2235.

Irwin, R.S., Ashba, J.K., Braman, S.S., Lee, H.Y., and Corrao, W.M. (1977) ‘Food asphyxiation in hospitalized
patients’, JAMA, 237,2744-2745.

J.T.’s Law (New York State, Department of Health Legislation) 2007, Choking Prevention for Children
https://www.health.ny.gov/prevention/injury_prevention/choking_prevention_for_children.htm

Kramarow E., Warner, M., Chen L-H. (2014) Food-related choking deaths among the elderly, 20: 200-203.

Morley RE, Ludemann JP, Moxham JP, Kozak FK, Riding KH (2004) Foreign body aspiration in infants and toddlers:
Recent trends in British Columbia. The Journal of Otolaryngology, 33(1): 37-41.

Samuels R & Chadwick DD (2006). Predictors of asphyxiation risk in adults with intellectual disability and
dysphagia. Journal of Intellectual Disability Research, 50(5): 362-370.

Wolach B, Raz, A, Weinberg J, Mikulski Y, Ben Ari J, Sadan N (1994) Aspirated bodies in the respiratory tract of
children: Eleven years’ experience with 127 patients. International Journal of Pediatric Otorhinolaryngology, 30:
1-10.

*Accompanying documents https://iddsi.org/framework/
Ø IDDSI Testing Methods
Ø IDDSI Evidence
Ø IDDSI Frequently Asked Questions (FAQs)

The IDDSI Framework and Descriptors are licensed under the
CreativeCommons Attribution-Sharealike 4.0 International License

https://creativecommons.org/licenses/by-sa/4.0/
IDDSI 2.0 | July, 2019

26

Acknowledgements
Development of the IDDSI framework (2012-2015)
IDDSI would like to thank and acknowledge the following sponsors for their generous support in the development
of the IDDSI framework:

• Nestlé Nutrition Institute (2012-2015)
• Nutricia Advanced Medical Nutrition (2013-2014)
• Hormel Thick & Easy (2014-2015)
• Campbell’s Food Service (2013-2015)
• apetito (2013-2015)
• Trisco (2013-2015)
• Food Care Co. Ltd. Japan (2015)
• Flavour Creations (2013-2015)
• Simply Thick (2015)
• Lyons (2015)

Patho discussion 1

instructions attached


Discussion 1

J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea. 

Past Medical History (PMH): 
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day. 

Labs: 
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl. 


Diagnostic test: 
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma. 

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?

2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?

3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?

4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.

5. Describe the carcinogenesis phase when a tumor metastasizes.

6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer. 

Submission Instructions:

· Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 3 academic sources. 

Change – leadership and management

How do you typically respond to change? Do you embrace it? Seek it out? Accept it reluctantly?