Every patient must have a diet order written in the chart within 8 hours of admission.
Oral Diets Modified Consistencies Indicated for patients with problems chewing and/or swallowing All diets are of a regular consistency unless otherwise specified (i.e. mechanical soft or puree) Modified consistency liquids ordered as needed per swallow evaluation recommendations Speech Pathologists/Dysphagia Team are available for bedside swallow evaluations and modified barium swallow studies (MBSS) Disease Specific Modifications(liberalize restrictions for patients with poor oral intake)
Coronary Artery Disease: Sodium: 3-4gm Na Total/saturated fat and cholesterol: order Low Fat, Low Cholesterol
Congestive Heart Failure: Sodium: 2 gm Na restriction Fluid: 1.5-2.0 L fluid restriction
Diabetes: Carbohydrate controlled diet
Renal Failure: Sodium (based on urine output, edema, and fluid status) Potassium (based on K+ (with corrected acidosis) levels and renal function) Phosphorus (only in face of calciphylaxis; if phos elevated should be on phosphorus binder) Protein (restrict only if severely uremic/pre-dialysis) Fluid (restriction based on urine output, edema and fluid status)
Liver Failure: Sodium (2 gm or 3-4 gm based on severity of ascites and fluid retention) Fluid (only if progressive ascites and/or hyponatremia) Protein (only if encephalopathic) Nutritional Supplements (order these for patients with poor oral intake or poor nutritional status) Boost (general; lactose free) OR Carnation Instant Breakfast (general; milk-containing) Nepro (Renal failure/Dialysis) Suplena (Renal failure/Pre-dialysis) Glucerna (Diabetic) Can order "Snack TID" and patient can choose
Enteral Nutrition (see enteral feeding order form) "If the gut works, use it!" Consult dietitian for assessment prior to initiation of enteral feeds and for assistance with management of feeding as needed. See Nutrition notes in Essentris for diet recommendations. Specify route of administration (type of tube) on order form. Available enteral formulas summarized on order form
Aspiration precautions: head of bed elevated at least 30 degrees, blue coloring added to feeds
Parenteral Nutrition(see TPN order form and UCLA Enteral/Parenteral Handbook) Consult dietitian for nutritional assessment prior to initiating PPN/TPN. Indications Bowel obstruction and unable to feed distal to obstruction, bowel ischemia/necrotic bowel, true small bowel ileus, malabsorption, enteral feeding intolerance/high gastric residuals with failure of jejunal feedings, intractable vomiting Peripheral Parenteral Nutrition (PPN)
Incomplete nutritional needs: short term use 5-7 days. Can be administered via peripheral line, with standard concentration of D10 and 3.5% AA plus Intralipid Intralipid 20% (soybean oil based), 2 kcal/ml (available in 100 ml, 250 ml, and 500 ml) Total Parenteral Nutrition (TPN) Longer term use >1 week to months. Must have central line access, standard concentration D25, 4.25% AA or D28 6% AA Intralipid 20% (soybean oil based), 2 kcal/ml (available in 100 ml, 250 ml, and 500 ml)
Approved Diet Orders For Westwood, Santa Monica, and RNPH UCLA Medical Centers
$No diabetic clear liquid tray: The American Dietetic Association recommends that "patients requiring a clear liquid diet should receive approximately 200 grams of carbohydrates per day in equally divided amounts, at meals and snack times. Liquids should not be sugar free. Patients require carbohydrates and calories, and sugar free liquids do not meet these needs. Diabetes medications may need to be adjusted to achieve and maintain metabolic control."
Diet orders no longer accepted: advance diet as tolerated (ADAT), resume diet, ADA, Diabetic, Renal, Cardiac, CCU, 1 gm Na, Liver diet, No Salt, No Concentrated Sweets, No fat, Soft and Full Liquid.