Labs Report And Forms > Nutritionmonthlynote1

HD NUTRITION MONTHLY NOTE: 2006 DIET ORDER: П Per Initial or Annual Assessment

SIGNIFICANT COMORBIDS:

□DM Month

1

□ CHF 2 3 4

□ ASCVD 5 6 7

Weight/ Weight Change: EDW (kg) Actual Weight Change IDWG (avg) Hospitalized: Infection/Inflammation (antibiotics) GI Symptoms: Anorexia / ↓Appetite Nausea(N)/Vomiting(V)/Gastroparesis(G) Diarrhea (D) / Constipation (C) Abdominal Pain SIGNIFICANT LAB RESULTS: Normal Laboratory Value

√ indicates WNL

Kt/V enPCR Albumin >3.8 K+ 3.5-6.0 cCa 8.4-9.5 PO4 3.5-5.5 iPTH 100-300 Hgb A1C <7.5 MALNUTITION ASSESSMENT FOR PATIENTS WITH ALBUMIN <3.5 (N) enPCR<0.8 (NN) enPCR 0.8- >1.3 (B) enPCR <0.8 or <usual MONTHLY RD ACTION: Review Binder Rx Review IDWG w/ Patient / Caregiver Review Labs w/ Patient / Caregiver Correlated Intake w/ high K or high PO4: Coordinated Nutritional Care via RD-SNF/B&C/Family/IHSS Confer with: RN/SW/RNNP/MD MEDICATIONS REVIEWED: Vitamin D- Zemplar Epogen □Enteral Supplement □ Renaplex □ Zinc □ Other Vitamin ASSESSMENT OF TEACHING: Receptive to diet teaching Verbalizes principles & Restrictions Understanding of menu planning Needs teaching reinforced Not adhering to prescribed plan RD Initials & Date

8

ADDRESSOGRAPH □ Other 9 10 11 12