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Edit Clinical Notes AOHC - Adult Nutrition

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Vital Signs:

c Premature d e f g graph sheet

HT:

graph sheet

WT:

Add BP CM KG

percentile:

Mother's Stature

percentile:

Father's Stature

HT/WT:

percentile:

BMI:

percentile:

Add PEFR CM CM

Status:

BSA: graph sheet

Systolic

graph sheet

CM

WC:

BP:

Diastolic

Limb

HR:

BPM:

Rhythm:

graph sheet

RR:

BPM:

Desc:

graph sheet

T:

graph sheet

SpO2:

째C

5

2

2013

^ DD/MM/YYYY

Desc:

Location:

L/min

PEFR:

Date

Adult

/

graph sheet

graph sheet

Cuff Size

n pre-bronchodilator m i j k l m n post-bronchodilator j k l

graph mmol/L BS: sheet Current Nutritional Issues:

5

2

2013

^

DD/MM/YYYY

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Referral Reason:

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6 Aspiration/Dysphagia: g c d e f Aspiration/Dysphagia Comments:

Bloating:

Heart Healthy: g c d e f Heart Healthy Comments:

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5

6

6 Low Iron: g c d e f

c d e f g

Bloating Comments:

Changes in Appetite:

Low Iron Comments:

c d e f g

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5

6

6 Mouth

c d e f g


Changes in Appetite:

Mouth Sores: Mouth Sores Comments:

c d e f g Changes in Appetite Comments: 5

c d e f g

5

6 Chronic Constipation: g c d e f Chronic Constipation Comments:

Gas: f g c d e Gas Comments:

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GU: g c d e f GU Comments:

Nausea: g c d e f Nausea Comments:

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Constitutional SN/A: g c d e f Constitutional SN/A Comments:

Pain: g c d e f Pain Comments:

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Dentition/Difficulty Chewing: g c d e f Dentition/Difficulty Chewing Comments:

Prenatal Nutrition: g c d e f Prenatal Nutrition Comments:

5

5

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6

Diarrhea: g c d e f Diarrhea Comments:

Reflux/Heartburn:

c d e f g

Reflux/Heartburn Comments:

5

5

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6

Disease Management: f g c d e Disease Management Comments:

Disease Prevention: f g c d e Disease Prevention Comments:

6

Sport Nutrition: g c d e f Sport Nutrition Comments:

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6

6 TPN/Tube Feeding: g c d e f TPN/Tube


Disease Prevention Comments:

TPN/Tube

5 Feeding

Comments:

5

6 Edema: g c d e f

6

Vomiting: g c d e f Vomiting Comments:

Edema Comments:

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6

Emotional Eating: g c d e f Emotional Eating Comments:

Weight Gain: g c d e f Weight Gain Comments:

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Fatigue/Weakness: f g c d e Fatigue/Weakness Comments:

Weight Loss: g c d e f Weight Loss Comments:

5

5

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6

Other Nutritional Issues:

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6

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Nutritional Risk Factors:

Sepsis: g c d e f Sepsis Comments:

Age: g c d e f Age Comments:

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Cognitive Deficit/Impairment: g c d e f Cognitive Deficit/Impairment Comments:

Fever: g c d e f Fever Comments:

Cardiac Disease: g c d e f Cardiac Disease Comments:

5

5

6

6 Respiratory Disease: g c d e f Respiratory


Fever Comments:

5

Respiratory Disease Comments:

5 6 Albumin<35: g c d e f Albumin<35 Comments:

Surgery/Procedures: g c d e f Surgery/Procedures Comments:

5

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6

Compromised Nutritional Status: g c d e f Compromised Nutritional Status Comments:

CVA: g c d e f CVA Comments:

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6

Severe Infection: g c d e f Severe Infection Comments:

Skin Breakdown/Wound: g c d e f Skin Breakdown/Wound Comments:

5

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Cancer: g c d e f Cancer Comments:

GI Disorders/Diseases: g c d e f GI Disorders/Diseases Comments:

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HIV: g c d e f HIV Comments:

Diabetes: g c d e f Diabetes Comments:

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5

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6

Hypercholesterolemia: g c d e f Hypercholesterolemia Comments:

Hypertrigylceridemia: f g c d e Hypertrigylceridemia Comments:

6

Dehydration: g c d e f Dehydration Comments:

5

5

6

6 Renal Failure: g c d e f Renal

5 Failure Comments:

5


5 Comments: 5 6 Hypertension: g c d e f Hypertension Comments:

Disordered Eating Patterns: g c d e f Disordered Eating Patterns Comments:

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Vitamin/Mineral Deficiency: g c d e f Vitamin/Mineral Deficiency Comments:

Eating Disorder: f g c d e Eating Disorder Comments:

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Iron deficiency (without anemia): g c d e f Iron deficiency (without anemia) Comments:

Bulimia Nervosa: g c d e f Bulimia Nervosa Comments:

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6

Iron deficinecy (anemia): g c d e f Iron deficinecy (anemia) Comments:

GERD: g c d e f GERD Comments:

Anorexia Nervosa: g c d e f Anorexia Nervosa Comments:

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6 Binge Eating Disorder: g c d e f Binge Eating Disorder Comments:

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Allergies: g c d e f Allergies Comments:

Intolerances: g c d e f Intolerances Comments:

6

Obesity: g c d e f Obesity Comments:

5

5

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6

Other

5 Comments:

5


6

6

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Dietitian Database:

Goal Weight:

KG/M²: Normal Under WT Over WT Obese

Do you mind if we talk about your weight? Yes No

Usual Body Weight:

Realistic? Yes No

Daily Energy Requirement:

5

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6

Adjusted Body Weight:

Daily Protein Requirement:

5

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Weight History:

Daily Fluid Requirement:

5

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Mobility/ADLs:

HN/A Weight Management Methods:

5

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6 Current Weight Management Methods:

Bioelectrical Impedance Analysis: Yes No

5

6

Simple Table Harris Benedict Equation (HBE x Activity Factor = Total Energy Expenditure) Weight (kg) Male Female

Height (cm)

Age (yrs)

HBE

65 + (13.7 x

) + (5.00 x

) - ( 6.76 x

=

X

65.5 + (9.56 x

) + (1.85 x

) - ( 4.68 x

=

X

Ideal Body Weight Range: % Weight Change:

Fat Mass


Mass Fat Free Mass (pounds): (pounds): Total Body Water (pounds):

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Physical Activity: Physical Activity:

Activity 1 Type:

5

Activity 1 Intensity Level: Low Moderate High

6 Activity 1 Duration:

Activity 1 Frequency:

5

5

6

6

Activity 2 Type:

5 Activity 2 Intensity Level: Low Moderate High

Activity 2 Duration:

6

Activity 2 Frequency:

5

5

6

6

Activity 3 Type:

5 Activity 3 Intensity Level: Low Moderate High

Activity 3 Duration:

6

Activity 3 Frequency:

5

5

6

6

Activity 4 Type:

5

Activity 4 Intensity Level: Low Moderate High


Activity 4 Duration:

6 Activity 4 Frequency:

5

5

6

6

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Evaluation of Previous Goals: Evaluation of Previous Goals N/A (first visit): g c d e f Success of Implementing Goals:

Follow Up Plan:

Challenges of Implementing Goals:

5

5

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6

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Follow Up Plan / To be discussed next time:

5

6


Aohc adult nutrition