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    Weight Management Form

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    api-302841502
    1) Patient 1 is a 41 year old female who was referred for weight loss counseling by her doctor. She has a history of weight fluctuations and trying various diets over 20 years with limited success. 2) Her current diet consists of high calorie and high fat foods. An analysis estimates her daily calorie intake at 2800 calories. She is overweight with a BMI of 28.79. 3) The nutrition diagnosis identifies problems of excessive oral calorie intake and excessive fat intake related to a knowledge deficit. Goals are set to educate the patient on appropriate food choices and portion sizes to reduce calorie intake to 2300 calories per day and facilitate weight loss.

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    Weight Management Form

    Uploaded by

    api-302841502
    120 views2 pages
    1) Patient 1 is a 41 year old female who was referred for weight loss counseling by her doctor. She has a history of weight fluctuations and trying various diets over 20 years with limited success. 2) Her current diet consists of high calorie and high fat foods. An analysis estimates her daily calorie intake at 2800 calories. She is overweight with a BMI of 28.79. 3) The nutrition diagnosis identifies problems of excessive oral calorie intake and excessive fat intake related to a knowledge deficit. Goals are set to educate the patient on appropriate food choices and portion sizes to reduce calorie intake to 2300 calories per day and facilitate weight loss.

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    1) Patient 1 is a 41 year old female who was referred for weight loss counseling by her doctor. She has a history of weight fluctuations and trying various diets over 20 years with limited success. 2) Her current diet consists of high calorie and high fat foods. An analysis estimates her daily calorie intake at 2800 calories. She is overweight with a BMI of 28.79. 3) The nutrition diagnosis identifies problems of excessive oral calorie intake and excessive fat intake related to a knowledge deficit. Goals are set to educate the patient on appropriate food choices and portion sizes to reduce calorie intake to 2300 calories per day and facilitate weight loss.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    120 views2 pages

    Weight Management Form

    Uploaded by

    api-302841502
    1) Patient 1 is a 41 year old female who was referred for weight loss counseling by her doctor. She has a history of weight fluctuations and trying various diets over 20 years with limited success. 2) Her current diet consists of high calorie and high fat foods. An analysis estimates her daily calorie intake at 2800 calories. She is overweight with a BMI of 28.79. 3) The nutrition diagnosis identifies problems of excessive oral calorie intake and excessive fat intake related to a knowledge deficit. Goals are set to educate the patient on appropriate food choices and portion sizes to reduce calorie intake to 2300 calories per day and facilitate weight loss.

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    Sage Dietetic Internship OUTPATIENT NCP Form

    Patient Name: Patient 1

    Reason for Nutrition Referral: Weight Loss Recommendation by


    Doctor

    DOB: 4/1/1974

    NUTRITION ASSESSMENT
    Food and Nutrition Related History:
    Pt reports weight fluctuations related to childbirth and trying various diets throughout past 20 years with limited
    adherence. Pt consumes peanut butter & jelly on white bread and fruit for lunch, and dinner consists of a protein,
    starch, and salad topped with ranch dressing. Pt consumes snacks and dessert of a donut, cookies, ice
    cream/pudding/Jell-O, and chips and dip. Coffee drink, 2% milk, cola, water, and juice consumed throughout the day.
    Diet analysis software estimates daily kcal consumption of 2800. Pt takes one-a-day multivitamin.

    Physical Assessment:
    Well-nourished
    Pt reports low energy
    Anthropometric Measurements
    Age:
    Gender

    Ht:

    Current Wt: 80.9 kg


    Admit Wt: 80.9 kg
    41
    F
    167.64 cm
    IBW: 59.1 kg
    Wt Hx (specify time frame):
    20 years
    % Wt change: 21%
    UBW: 63.63 kg
    Biomedical Data (list only pertinent nutrition-related labs)
    Labs
    Date
    HDL
    Triglycerid
    es
    9/1/15
    38 mg/dL
    189
    mg/dL
    PMH:
    Not applicable
    Pertinent Medications & Dosage
    None
    Estimated Nutritional Needs based on
    80.9
    kg
    Calories (kcal/kg & total kcal/day)
    Protein (g/kg & total g/day)
    23.9-30 kcal/kg = 1941-2427 kcal/day
    1g/kg = 80.9g/day

    BMI:
    28.79
    BMI Classification:
    Overweight

    Fluid (ml/kg & total ml/day)


    30-35 ml/kg = 2427-2831.5 ml/day

    NUTRITION DIAGNOSIS (include IDNT codes)


    P (problem) NI-2.2 Excessive Oral
    Intake related to:

    E (Etiology) food and nutrition related


    knowledge deficit concerning
    appropriate oral food/beverage
    intake as evidenced by:

    P (problem) NI-5.6.2 Excessive Fat


    Intake related to:

    E (Etiology) food and nutrition related


    knowledge deficit concerning
    appropriate amount of dietary fat as
    evidenced by:

    S (Signs & Symptoms) 21% weight


    gain in 20 years, pt reported intake of
    high caloric-density food/beverages
    (coffee-drinks, donuts, cookies, ice
    cream, soda, juice), estimated intake
    exceeding estimated needs by 40%,
    BMI of 28.79 indicating pt is
    overweight.
    S (Signs & Symptoms) HDL
    cholesterol less than 50 mg/dL
    (38mg/dL), triglycerides greater than
    150 mg/dL (189 mg/dL), fat intake
    42% total energy intake, frequent
    portions of high-fat foods (donuts,
    cookies, ice cream).

    INTERVENTION
    Educate patient on appropriate food choices to provide 2300 kcal per day (a 500kcal deficit from usual intake) to
    facilitate weight loss. Give patient examples of nutrient-dense foods to choose over the caloric-dense, high-fat foods
    that she typically consumes.
    See patient back in 4 weeks for follow-up to measure progress and reassess energy needs based on weight-loss.

    2014

    SGS DI

    MONITORING & EVALUATION


    Indicators (marker):
    Weight
    Reported food/beverage intake
    Estimated energy intake

    Criteria (SMART Goal specific to marker):


    1. Pt will lose 1.8 kg before next follow-up appointment.
    2. Patient will report intake of 1 or less caloric-dense
    food/beverage per day.
    Daily food journal entries will reflect daily energy intake
    of 2300kcal (+/- 100kcal)

    Ashley M Prendergast

    9/6/2015

    ______________________________________________________________________________________
    Interns Signature
    Date

    2014

    Date

    Preceptors Signature

    SGS DI

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