Explain the following Diet Orders and give the rationale for each.
NPO- Nothin by mouth used anytime there is a ? abt GI fx, Pre & Post operatively, necessary for certain tests or they may be receiving parenternal nutrition.
Clear Fluid- include broth, bullion, coffee (w/o milk or cream), tea, carbonated beverages, clear fruit juices, gelatins &/or popsicles. They are used in preparation for certain diagnostic tests, pre-operatively or for pt's who are just restarting oral nutrition. The only source of calories for these pt's are sugars.
Full Liquid- Allows for the above diet plus smooth textured dairy products, custards, refined cooked cereals, vegetables, pureed veggies and all fruit juices. They can be given thru a PEG tube, NG tube or drank. A pt can receive a full nutrient diet this way.
Pureed- Allows for the above diet with the addition of scrambled eggs, pureed meats, vegetables, fruits, mashed potatoes and gravy. They tend to be the consistency of baby food.
Mechanical Soft- Allows for the above diets with the addition of ground or finely diced meats, flaked fish, cottage cheese, rice, potatoes, pancakes, bread, cooked veggies, canned fruit, soups and peanut butter. It is softer than a regular soft diet and can be done w/o teeth, it looks like more normal food and uses a small amt of energy to eat.
- Soft- Allows for the above diets with the addition of moist tender meats, poultry, fish, casseroles, soft fresh fruits, cakes and cookies w/o nuts. It required minimal chewing and is ordered for pt's who are debilitated or have mild GI problems.
- High Fiber- as above plus the addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal and dried fruits.
Regular- No restrictions unless specified.
Low Fat & Low Cholesterol- Indicated for pt's c heart disease, gallbladder disease, obesity and hypertension. To lower cholesterol avoid cheese, milk, meats, fats and baked goods. CHO = < 300mg/d and Na = < 2400mg/d. This is often called the "Cardiac Diet"
Diabetic Diet- follows the ADA guidelines, 50-60% of intake is in the form of carbs that is divided throughout each meal to keep a consistent carb intake, this helps avoid peaks and valleys. Calorie limits will be ordered specifically.
Renal Diet- ordered for pt's c kidney disease, there are restrictions on protein, fluid, K, Na and phosphorus (P) bc the kidneys aren't working and therefore excretion is hindered so we reduce the intake. This diet needs to come with a very specific order from the MD.
Dysphagia Diet- Ordered for pt's who have trouble swallowing or eating. It is not a nutrition problem it is a problem c consistency, so thin liquids are restricted bc they are hard to control. Liquids must me semi-thick to thick to avoid aspiration or choking.
Na Restriction- Ordered for pt's c HBP or heart failure. "No Salt Added" allows for a 4g/d of sodium. Normal restriction is 2-3g/d but may be restricted to 500mg for certain pt's.
Fluid Restriction- Ordered is the amt of fluid intake for a 24hr period, strict I&O and includes IV fluids. This is ordered for pt's who have renal (inability to excrete can cause a backup) or heart (decrease the workload on the heart) disease.
4 Levels of Liquid Diet; thin liquids (low viscosity), nectar-like liquids (medium viscosity), honey-like liquids (viscosity of honey) and spoon-thick liquids (viscosity of pudding)