Download Available Diet Orders at the University of Michigan Health Systems

University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Available Diet Orders at the University of Michigan Health Systems
Diet Order
Purpose & Indications
General Description & Principles
Further Details
General Diet
When no dietary modification is
needed and solid foods can be
tolerated.
No dietary restrictions.
General Pediatric
Diet
When no dietary modification is
needed but restrictions indicated
based on age limitations.
Dietary restrictions based on age
limitations.
Anti-Dumping Diet
Used post-gastric surgery for
patients exhibiting symptoms of
dumping syndrome (nausea,
vomiting, diarrhea, etc) following
PO intake.
This diet does not allow foods high
in sugar and liquids will be provided
separate from meals. Smaller,
more frequent meals are
encouraged.
Nutrition Care Manual
Bariatric Diet
There are four diets that fall under
the bariatric diet, each is a stepwise
progression to a discharge diet.
These restrictions are placed to
facilitate weight loss and
maintenance, to avoid dehydration,
and to avoid distention of the gastric
pouch.
All the diets have the following
restrictions: no concentrated
sweets, low-fat, no caffeine, no
carbonated beverages and no
straws.
Nutrition Care Manual
Bland Diet
The bland diet is designed to avoid
irritation of the gastrointestinal tract.
It is appropriate for people with
peptic ulcer disease, chronic
gastritis, reflux esophagitis or
dyspepsia.
The bland diet consists of foods that
are easily digestible and mildly
seasoned. Fried foods, highly
seasoned foods and most raw or
gas-forming fruits and vegetables
are eliminated.
Revised 3/07
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
This diet is typically used for
controlling diarrhea and provides
low fiber, low residue foods that are
easier for the intestines to digest.
A bland diet consisting of ripe
Bananas, Rice, Applesauce, and
Toast. This diet is intended for a
very short duration (3 days or less)
due to nutritional inadequacies.
Calorie Controlled
Diet
Used to promote weight loss.
This diet allows all foods but limits
total calorie intake to the designated
amount.
Cardiac Diet
This diet order is typical for patients
with cardiovascular illnesses. Its
purpose is to reduce serum
cholesterol and lipid levels, to avoid
and prevent excessive sodium
intake and to reduce heart disease
risk. This diet controls for total
dietary fat, saturated fat, cholesterol
and salt (3-4 gm sodium/day).
Limits red meat, cheese, whole
milk, butter, and egg yolks, as well
as high sodium foods and
condiments. It promotes whole
grains, beans, vegetables and
fruits.
Low Cholesterol
Diet
To reduce serum cholesterol and
lipid levels, usually combined with a
low fat diet restriction. Used
commonly with hyperlipidemia, CAD
and other cardiovascular illnesses.
This diet limits cholesterol intake to
200-300 mg/day by limiting red
meat, cheese, whole milk, butter
and egg yolks.
Clear Liquid Diet
This diet is used for pre-op and
immediately post-op situations, or
for acute episodes of nausea and
vomiting to promote bowel rest.
Allows visually clear and minimum
residue liquids. Intended for a very
short durations (3 days or less) due
to nutritional inadequacies.
BRAT Diet
Revised 3/07
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Consistent
Carbohydrate,
Pediatric
Diabetic Diet
Dysphagia Diets
Revised 3/07
To provide consistent
carbohydrates, based on patient
age, at meals and an HS snack to
aid in glucose management.
A specified number of
carbohydrates, based on age, will
be provided at each meal to ensure
consistent carbohydrate intake,
simulating a carbohydrate counting
diet.
Nutrition Care Manual
To provide consistent
carbohydrates, based on calorie
level range, at meals and an HS
snack to aid in glucose
management.
A specified number of
carbohydrates, based on calorie
range, will be provided at each meal
to ensure consistent carbohydrate
intake, simulating a carbohydrate
counting diet.
Nutrition Care Manual
To decrease the risk of aspiration
related to neurological,
neuromuscular or other etiology of
swallowing impairment. Prescribed
by Speech Pathologist after a
swallow evaluation has been
conducted.
There are four levels of this diet.
Each requires both a diet level and
liquid consistency to be designated
to be a valid diet order. Level 1 –
Provides pureed food/meats. Level
2 – Provides ground meats. Level 3
– Equivalent to Mechanical Soft
diet. Level 4 – This is a general diet
but still requires a liquid consistency
per Speech Pathology
recommendations.
Nutrition Care Manual
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
The eating disorder diet is indicated
for individuals diagnosed according
to the Diagnostic Statistical Criteria
(DSM-IV) with anorexia nervosa,
bulimia nervosa or an eating
disorder not otherwise specified and
treated in the University of Michigan
Eating Disorder Diet Eating Disorder Program.
This diet is calorie controlled, with
periodic increases in calories to
goal. Typically 4 meals/day are
served.
The fat-restricted diet is indicated
for individuals with maldigestion,
malabsorption and disorders in
transport of dietary lipids. To
provide no more than 60 gm fat/day
for malabsorption issues related to
GI disease, pancreatitis, and some
types of liver disease.
Lower fat menu items are provided
in place of full fat items.
Nutrition Care Manual
High Fiber Diet High Residue
Used for certain GI conditions to
promote gut health.
Focuses on whole grains, beans,
vegetables and fruits to increase
fiber content of diet.
Nutrition Care Manual
Low Fiber Diet Low Residue
Used for certain GI conditions when
high fiber diets can aggravate
symptoms.
Limits use of whole grains, beans,
vegetables and fruits to lower fiber
content of diet.
Nutrition Care Manual
Low Fat Diet (60
gm/day)
Revised 3/07
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
This diet is used for patients with
edema and fluid control issues such
Fluid Restricted Diet as kidney disease, CHF, etc.
Total amount of fluid (including IVF,
fluid taken with medication pushes,
mealtime/snack time PO intake, etc)
is recorded to not exceed
designated level. If no kitchen fluid
restrictions indicated, ½ of total
daily allotment will be allowed by
the kitchen. Note: the fluid content
of solid foods is not included in the
estimation of total fluid intake.
Full Liquid Diet
To limit solid foods when digestion
may be compromised. For post-op
transition from clear liquids to solid
foods, for severe GI strictures, or for
wired jaw conditions.
Allows any liquids or liquidifed
foods. Also permits smooth,
strained foods of pudding
consistency.
Gluten Free Diet
This diet is for gluten sensitive
individuals or those individuals
diagnosed as having Celiac
Disease.
A diet free of products containing
gluten (wheat, barley, and rye).
GVHD#1
This is the initial diet for patients
who have developed Graft versus
Host Disease of the gastrointestinal
tract. The foods allowed on this diet
are low in acid, fat, lactose,
caffeine, and fiber to minimize GI
irritation and promote wound
healing.
Foods are included one at a time to
check for tolerance and start with
foods such as broth, Pedialyte, JellO, and popsicles.
Revised 3/07
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
This diet is for patients with Graft
versus Host Disease of the
gastrointestinal tract who have
tolerated the limited GVHD #1 diet
without worsening GI symptoms.
This selective diet provides foods
moderately low in indigestible
carbohydrates, and restricted fat
and lactose. New foods are added
one at a time to check for tolerance.
Nutrition Care Manual
High Calorie, High
Protein
For use with patient who have
failure to thrive, significant weight
loss or poor appetite/PO for
extended period of time.
Foods that are high in protein and
calories are provided, such as
whole milk, ice cream, butter,
peanut butter, etc. This diet should
be accompanied by a "nutrition
supplement of choice" order.
Nutrition Care Manual
Ketogenic Diet
Used with some patients for the
treatment of epilepsy. The dietary
restriction of this diet makes the
body burn fat for energy instead of
glucose.
It is a diet very high in fats and low
in carbohydrates.
Nutrition Care Manual
A kosher diet is indicated for
individuals of Jewish faith who
adhere to the Jewish dietary laws,
known as Kashruth. This diet order
will provide the patient with
specially prepared meals that fit
standard Kosher guidelines.
The University of Michigan Medical
Center does not have a kosher food
service. The following options are
offered to individuals who wish to
keep kosher while in the hospital:
commercially prepared kosher
dinners, disposable dishes and
flatware, and assistance with menu
selections.
GVHD#2
Kosher Diet
Revised 3/07
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Lactose Restricted
Diet
MCHC Room
Service Patient
Requires Menu
Assistance
Mechanical Soft
Diet
Revised 3/07
This diet is for individuals who are
lactose intolerant or whom lactose
is temporarily restricted for GI
related issues.
Currently Room Service is only
available in MCHC. If a patient is
unable to use the Room Service
phone in menu ordering, this diet
order will ensure a member of the
Room Service staff will come assist
the patient in ordering food
preferences.
The mechanical soft diet is
indicated for individuals who have
difficulty with mastication due to
conditions such as absence of
teeth, loose dentures, and sore
gums. It may be useful for
individuals with varices,
inflammation or strictures of the
esophagus, and following radiation
therapy to the oral, pharyngeal, or
laryngeal areas.
Lactose free milk products, such as
Lactaid milk, and milk alternatives,
such as soy milk, are provided in
place of lactose containing foods.
N/A
It consists of foods which are
minced, chopped, or ground
according to individual need.
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Modified Microbial
Diet
This diet is indicated for patients
with suppressed immune function or
neutropenia (an absolute neutrophil
count below 1000/mm3). Its goal
is to decrease the amount of
bacteria in the diet since a food
product with a high microbial count
may lead to colonization of the
gastrointestinal tract, thereby
increasing the risk of developing an
infection.
Mushy Soft, 6 Small
Meals
This diet is intended for patients
who are post-esophogectomy. The
diet consistency is modified for
comfort and to reduce blockage
post surgery, as well as more
providing smaller, more frequent
meals.
No Fat Diet
This diet is used for chyle
leaks/chylous effusions.
Revised 3/07
It excludes fresh fruits and
vegetables, with the exception of
bananas, oranges and apples
(assuming each will be peeled).
Hot and cold foods should be eaten
within 1-2 hours of tray delivery,
otherwise these foods should be
discarded. Other foods with high
microbial content are also excluded.
The diet is designed to eliminate
foods that might be too coarse to
pass through a partially obstructed
esophagus or healing esophageal
anastomosis. Carbonated
beverages are avoided to minimize
intrathoracic gastric distention.
Fat-free options of standard foods
will be provided as available. MCT
oil may be needed to provide
essential fatty acids and meet
caloric needs.
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Low Phosphorus
Diet
This diet is typically part of a renal
diet order but is also used with any
individual with elevated phosphorus
levels resulting from dietary intake
of phosphorus. It restricts intake of
high phosphorus foods such as milk
products, poultry, fish, meat, eggs,
grains and legumes.
It restricts intake of high
phosphorus foods such as milk
products, poultry, fish, meat, eggs,
grains and legumes.
Potassium
Restricted Diet
This diet is typically used with the
renal population, but is also used
with any individual with elevated
potassium levels resulting from
dietary intake of potassium. There
are three levels of restriction
available with 80 mEq/day being the
most liberal and 60 mEq/d being the
most restrictive.
High potassium foods are restricted,
degree of restriction is dictated by
designated mEq/day level. Foods
that are restricted include bran
flakes, dried beans and peas, nuts,
milk, and several fruits and
vegetables.
Dietary protein modifications may
be indicated for individuals who
have renal failure or hepatic
encephalopathy. Nutritional
management will depend on the
type and stage of the disease.
Protein restriction should be based
on a dietitian’s recommendations to
ensure nutrition needs. Fifty
percent of the protein intake should
be of high-biological value protein
(i.e. eggs, meat, milk), to ensure
sufficient intake of essential amino
acids.
Protein Restricted
Diet
Revised 3/07
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Nutrition Care Manual
University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Pureed Diet
A pureed diet is indicated for
individuals who are unable to chew
solid foods related to poorly fitting
dentures, mouth or throat pain, etc.
The foods included in the pureed
diet require no mastication.
The pureed diet consists of liquid
and semi-liquid foods. Individual
food tolerances must be considered
in food selection. The individual’s
condition should determine the
restrictions of the diet.
Nutrition Care Manual
Renal Diet
A renal diet is intended for
individuals with impaired renal
function and entails the following
restrictions: 70 mEq potassium, no
added salt, low phosphorus diet.
This diet limits foods and
condiments high in sodium, as well
as bran, dried bean and peas, nuts
and several fruits and vegetables.
Nutrition Care Manual
Soft Diet
To decrease peristalsis and limit
stimulation of the GI tract, typically
used with PUD and GERD. Often
used as a transitional diet after
surgery, as well.
Includes easily digestible foods
there are low fiber, mildly seasoned,
and tender. Omits caffeine and
alcohol.
Nutrition Care Manual
Sodium Restricted
Diet
Indicated for individuals with
hypertension or fluid retention often
resulting from cardiovascular, renal
or liver disease.
Restricts foods high in sodium
(cured, processed) and eliminated
high sodium condiments (salt, soy
sauce, MSG). Note: No added salt
diet provides ~3-4 gm Na/day.
Nutrition Care Manual
Tonsil and
Adenoids Diet
For use with patient who have had
recent tonsillectomy and/or
adenoidectomy.
Usually a diet advancement from
clear liquid diet to general as
tolerated, with no red dyes or red
foods allowed.
Revised 3/07
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University of Michigan Health System
Patient Food and Nutrition Services
Nutrition Care Manual and Pediatric Diet Manual Administrators
Email: FANS-NCMAdministrators@med.umich.edu
Vegetarian Diet
Vegetarian diets are used by
individuals who abstain from eating
all or specific foods of animal origin.
Dietary restrictions based on
patients own restrictive practices.
Meat alternatives and soy products
are provided in place of meat and
dairy.
Wired Jaw Diet
Indicated for individuals who have
had jaw reconstruction, traumatic
injury with fixation,
temporomandibular joint (TMJ)
repair, or surgical resection of the
jaw for treatment of head and neck
cancer, and are unable to chew
while the jaws are immobilized or
until the surgical site heals.
This diet is a liquid or liquefied diet.
Six to eight small liquid meals per
day are encouraged to provide
sufficient intake of energy, nutrients,
and fluids. An energy-dense, highprotein liquid supplement should be
included daily
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Nutrition Care Manual