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Running head: DIET ORDER SHEET
1
Diet Order Sheet
Name
Institution Affiliation
DIET ORDER SHEET
2
Full lipids diets
A full lipid diet involves lipids that are allowed on the clear diet of lipid which includes
small amounts of fiber and milk.
Indications: This diet is essential in the short term for transitioning steps in gastrointestinal
procedures of surgery
Contradiction: any specification that may be on demand by an individual.
The level of calories is 1400-1760
Foods to include and to exclude
Foods to include
Foods not to exclude
All food is included
None
Sample serving size
Food group
Serving/day
Example of 1 serving
Calories
Milk and its products
2-4 servings
1 cup of milkshakes,
250
1 cup frozen yogurt,
custard
vegetables
4-8 servings
1 cup of cooked
120-150
veggies; 2 cups of
leafy greens
Grains and bread
6-8 servings
One slice of bread; ½
cup of rice;1 ounce
ready to eat cereal
485- 640
DIET ORDER SHEET
Fats and oils
3
6-7 servings
Oil, mayo, margarine, 320
1tsp of salad dressing
Discretionary calories
200-400
Clear lipids
It contains plain gelatin, broth, and water and helps to maintain adequate hydration by
providing electrolytes.
Indications: This diet is essential in the short term use before tests, surgeries which require food
in the intestines.
Contradiction: any specification that may be on demand by an individual.
The level of calories is 1000-1100
Foods to include and to exclude
Food to include
Food to exclude
All food is included
None
Sample of serving diet
Food group
Service/ day
Example of 1 serving
Calories
Vegetables
4-8 servings
1 cup of strained
tomato; 1 cup of
vegetable juice
150
DIET ORDER SHEET
4
Grains
4-6 servings
1 ounce ready to eat
cereal; seeds or nuts
Water
8-12 servings
2 cups of plain water,
2 cups of flavored or
carbonated water
Fruits
4-6 servings
1 cup of fruit juice
without pulp; 1 cup
of flavored beverages
450-650
230-300
Blenderized-Straw diet
The diet contains lipids and foods which have been thinned of the process to be taken
using straw, spoon, and cups.
Indications: It is essential for the individual who can not swallow or chew any solid food such as
those who have mouth pain, face surgery among others.
Contradiction: any specification that may be on demand by an individual.
The level of calories is 1200-1410
Foods to include and to exclude
Foods to include
Foods to exclude
All foods to be included
None
Sample for serving
Food group
Service/ day
Example of 1 serving
Calories
Vegetables
4-6 servings
Canned vegetables
without skins or
seeds
120-150
Grains
3-7 servings
½ cup of rice, pasta
or the noodles
450-640
DIET ORDER SHEET
5
Fats and oil
4-8 servings
Melted butter or
margarine; salad
dressing
320
Fruits
4-6 servings
Canned vegetables
that do not have skins
or seed
230-300
Post-Surgical diet
These are the types of diet adding calories as well as nutrients for an individual to recover
quickly
Indications: It is essential for the individual since it enables a reduction in the risk of infection as
well as increasing the speed of healing.
Contradiction: any specification that may be on demand by an individual.
The level of calories is 500-695
Foods to include
Foods to exclude
All foods
Lactose-free
Sample of serving food
Food group
Service/day
Example of 1 serving
Calories
Milk and its products
8-12 servings
1 cup of yogurt; kefir
270
Fruits
3-6 servings
Blueberies;
strawberies;
pomegranates
280
Vegetables
3-6 servings
Cabbage; brussels
sprouts
145
DIET ORDER SHEET
6
High Ostomy Output
The diet contains lipids and foods as well as fluids for absorbing enough nutrition in the
body
Indications: It is essential for the individual to control the stool output.
Contradiction: any specification that may be on demand by an individual.
The level of calories is 1000-1135
Food to include
Food to exclude
All foods to be included
Honey; beverages having caffeine
Sample for serving
Food groups
Servings/ day
Example of 1 serving
Calories
Grains
5-6 servings
460-640
Dairy
Three servings
One slice of bread; ½
cup cooked rice,
pasta, oatmeal; 1ounce ready-to-eat
cereal
1 ½ ounces of natural
cheese; 2 ounces of
processed cheese
Fruits
3 servings
Bananas
230
265
DIET ORDER SHEET
7
Cardiac diet
The diet contains all food groups as well as fluids to receive enough nutrition and a lower
level of calories
Indications: It is essential to improve the level of blood pressure and cholesterol.
Contradiction: any specification that may be on demand by an individual
Foods to be included and excluded
Foods to be included
Foods not to be excluded
All groups of food to be included
Level of calories is 1200-1345
Food groups
Service/ day
Example of 1 service
Calories
Fruits
3 services
Grapes, apples
bananas, blueberries
203-300
Nuts
Four services
400-650
Dairy
Three services
Unsalted sunflower
seeds; cashews
unsalted, walnuts
unsalted.
Fat-free cheese; a
lower fat yogurt;...