Evaluation of Diet Orders (Nutrition Prescriptions): List diet orders in chronological order. Complete hospital diet history-include all diet orders from date of admission Is Diet Order Changes Indicated and Date of Diet Order Appropriate? Supporting Rationale Diet EN/PN/PPN/oral/supplements Why or Why Not? Explain if change in estimated needs. to choking event, -Veteran had not this diet would be officially been diagnosed appropriate for the with ESRD at this point Veteran. It provides and therefore had CKD adequate protein and without any type of renal calories and is limited in replacement therapy. sodium which would -His needs at this point help with fluid overload. were 2169-2531 kcal/d, 2100 kcal American -The VA does an 80-101 g pro/d, and 6/20/16 Heart Association (AHA) AHA/ADA combination fluids as indicated by Diet diet order; however the physician due to volume only major differences overload. (30-35 kcal/kg are fruit items for dessert and 1.1-1.4 g/kg based on verses sweets. Since the weight of 72.3 kg) Veteran has a poor appetite, double restrictions might further exacerbate the issue of overall poor oral intake. -This diet is appropriate -The results of the since the Veteran had a bedside swallow choking event and needs concluded the Veteran to undergo a swallow needed a soft diet NPO 6/21/16 study to determine what consistency. He could Waiting for Speech to AM consistency is safe. continue to drink thin Evaluate -However a diet order of liquids as tolerated. NPO is not appropriate for anything longer than 3 days. -This diet is appropriate -Chocolate Ensure in terms of calories, Muscle Health provides consistency, and blood 160 calories, 16 grams of Soft, 2200 kcal American glucose control. The protein, and 19 grams of 6/21/16 Diabetes Association commercial oral nutrition carbohydrate compared PM (ADA) Diet + – supplements were to Ensure Plus which has 6/27/16 Chocolate Ensure Muscle implemented to provide 350 calories, 13 grams of PM Health three times daily additional protein protein, and 51 grams of between meals without impacting blood carbohydrate. This will glucose. help with blood glucose control.15
Evaluation of Diet Orders (Nutrition Prescriptions): List diet orders in chronological order. Complete hospital diet history-include all diet orders from date of admission Date of Diet Diet Order EN/PN/PPN/oral/supplements Is Diet Order Appropriate? Why or Why Not? Explain if change in estimated needs. Changes Indicated and Supporting Rationale 6/20/16 2100 kcal American Heart Association (AHA) Diet to choking event, this diet would be appropriate for the Veteran. It provides adequate protein and calories and is limited in sodium which would help with fluid overload. -The VA does an AHA/ADA combination diet order; however the only major differences are fruit items for dessert verses sweets. Since the Veteran has a poor appetite, double restrictions might further exacerbate the issue of overall poor oral intake. -Veteran had not officially been diagnosed with ESRD at this point and therefore had CKD without any type of renal replacement therapy. -His needs at this point were 2169-2531 kcal/d, 80-101 g pro/d, and fluids as indicated by physician due to volume overload. (30-35 kcal/kg and 1.1-1.4 g/kg based on weight of 72.3 kg) 6/21/16 AM NPO Waiting for Speech to Evaluate -This diet is appropriate since the Veteran had a choking event and needs to undergo a swallow study to determine what consistency is safe. -However a diet order of NPO is not appropriate for anything longer than 3 days. -The results of the bedside swallow concluded the Veteran needed a soft diet consistency. He could continue to drink thin liquids as tolerated. 6/21/16 PM – 6/27/16 PM Soft, 2200 kcal American Diabetes Association (ADA) Diet + Chocolate Ensure Muscle Health three times daily between meals -This diet is appropriate in terms of calories, consistency, and blood glucose control. The commercial oral nutrition supplements were implemented to provide additional protein without impacting blood glucose. -Chocolate Ensure Muscle Health provides 160 calories, 16 grams of protein, and 19 grams of carbohydrate compared to Ensure Plus which has 350 calories, 13 grams of protein, and 51 grams of carbohydrate. This will help with blood glucose control.15
allison_k_fassler_clinical_case_study.docx