Patient:

Referred for:

FoodandNutritionRelatedHistory:Ptcurrentlytoleratingcardiacdietandreportshavingeggsandcereal forbreakfast. Ptstatesappetitehas remainedthesameandhashadconsistentintakesperRNreport. Pthas+3bilateral legandftedemariflpurpletoes. Athomepttypicallyeats cereal w/ milk and juice for B, turkey sandwich for L, meat/starch/veggie for D. Since becoming sick, husband has been doing shopping and does not read food labels well. Pt admits to having canned foods and frozen dinners regularly, as well as deli meats daily. Pt was provided w/ DASH diet/lowNadieteducationandsubstitutesforfavoritehighNaproductswerediscussed. CHFfluidrestrictionwasalsocovered.
Anthropometric Measurements
Age: 82 years

Gender: Female

Ht: 64"

Wt:200#
Wt Hx: % Wt chanpe:

BMI: 34.3 (obese)

Biomedical Data, MedicalTests & Procedures Glucose HbAIC Labs/Date I Albumin 2/5174

BUN

Crat

Na+

K+

Heb

Hct

MCV

Other
NT-PRO BNP

31f

7087+
Medical Diagnosis/PMH/Relevant Conditions: CHF, A-Fib, hyperlipidemia, anemia, breast cancer, bladder problems, arthritis Fam Hx: mother died @ 37 from unknown causes {possiblv malignancy), father died @ 80 from Ml Pertinent Medications: Coumadin 5ms/dav
Skin

status: X tntact n Pressure

Ulcer/Non-healing wound; comments:

Phvsical Assessment:

Estimated Nutritional Needs Based on Comparative Standards: Protei n : 1..O-1..2g/ ke Calories: Mifflin St. Jeor x 1.3 activity factor 91-109s/dav 1768-2068kcal/dav Diet Order: Feeding Ability Regular; Cardiac Diet X lndependent

Fluid: 20ml/kg

1.8l/dav
Oral Problems lntake

n tr n tr
P

Limited Assistance Extensive/Total Assistance

N/A

tr tr n X

Chewing Problem Swallowing Problern

Mouth Pain
None

ofthe Above

tr X n n
N

Good (> 75%) rair (approx. 50%)

Poor (<50%)

Minimal
NPO

(<25%)

No Nutritional Diasnosis at this

time

Proceed

to Nutrition Diagnosis Below

(problem): Undesirable food choices (NB-1.7) related to:

P

E (Etiology) Iack of prior exposure to nutritionrelated information for CHF as evidenced by:

S (Signs & Symptoms): Pt intervlew of high Na foods and NT-PRO BNP of 7087

(problem) related to:

{Etiolosy)
as evidenced by:

S (Signs

& Symptoms)

Nutrition Prescription: Modified Diet: cardiac diet to provide 1768-2168kcal/daV,91-lo9gpro/day, fluid restriction of 1.81/day
Food or Nutrient Delivery: Meals and Snacks: DASH diet/low sodium

diet

Nutrition education: verbal/written DASH diet, sodium restriction, and fluid restriction education
Coordination of Care (refer to): n/a

Nutrition Counseling: n/a

Goal(s): Pt to adhere

to recommended diet modifications

Criteria:
Pt chooses low sodium products at meals and snacks

ndicators: Dietary recall

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2013

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