NUTRITION CARE PROCESS

ADIME NOTE

Name: Karli Sullivan

Admitting Dx: Morbid Obesity,

uncontrolled diabetes

Patient Initials: NA

Age: 27

Gender: Male

NUTRITION ASSESSMENT Complete as applicable:

Past Med/Surgical
Poorly controlled diabetes and hypertension, morbid obesity
History:
Current Diet Order:

Carbohydrate controlled diet, 2200 kcal/day

Nutrition Support:

NA

Anthropometric Data
Height
Admit weight
BMI
BMI Assessment
IBW

62 (74 in) (187.9 cm)

178 kg (391.6 lb)
50.4 kg/m^2
Class 3 Obesity
190 lb (86.3 kg)

% IBW
206%
% IBW reference
NA
Food/Nutrition Related History:
Current Food & Fluid Intake:
Average intake of 100% of meals
given. Carb control diet of about
2200 kcals and about 100g
protein

UBW
NA
% UBW
NA
%UBW reference
NA
Adjusted IBW
109 kg (240 lb)
Wt change: provide time 208 lb intentional weight
reference
loss 35% weight loss
Evaluation of wt. change Not significant

ESTIMATE ENERGY, PROTEIN, FLUID NEEDS-make sure

to provide measurements in kg, g, mL. Provide reference-E.g.
current/ admit wt, UBW, IBW, Adjusted IBW, etc. AND your
method.
Calories/day: 20kcal*109kg=2180 25kcal*109kg=2725
2180-2725 kcals/day (Empirical 20-25 kcal/kg using Adj. IBW)

Food and Fluid Intake

History:
3800 kcals per day
180g protein per day
615g carbohydrates per day

Grams Protein/day: 1.1g*86.3kg=97 1.3g*86.3kg=112

97-112g protein/day (1.1-1.3 g/kg using IBW)
Milliliters of fluid/day: 25mL*109kg=2725 30mL*109kg=3270
2725-3270mL/day (Empirical 25-30 mL/kg using Adj. IBW)

NUTRITION CARE PROCESS

ADIME NOTE

Nutrition Focused Physical Findings:

Relevant Medical Tests and Procedures:

NA

NA

Nutrition-Related Labs: Glucose (H), capillary glucose (H), Hemoglobin A1c (H)
Nutrition-Related Meds: Metformin, Humalog, Levemir
Summary of Nutrition Assessment:
adequately
nourished

obese

at risk for
malnutrition

moderate
malnutrition

severe
malnutrition

NUTRITION DIAGNOSIS: (Problem, Etiology, Signs/Symptoms Statement)

Excessive carbohydrate intake related to food and nutrition related knowledge deficit as evidenced by
intake of 158% of calorie needs and excess CHO choices compared to recommendations from usual
diet recall.
NUTRITION INTERVENTION: Recommendations/Plan (Diet and/or nutrition support,
collaboration/referrals of care):
1. Meals and snacks: Eat three meals per day at consistent times, which include 5 carb choices.
2. Nutrition Education: Provide education on weight loss for diabetics using physical activity and
nutrition.
3. Nutrition Counseling: Counsel patient on carbohydrate counting and optimal BG levels.
GOALS:
1. Consume 15 carbohydrate choices (5 choices over 3 meals) each day.
2. 1-2 pound weight loss per week with 30 minutes of moderate exercise 3 times per week.
3. SMBG daily to determine whether blood glucose is WNL every day.

MONITORING/EVALUATION:
1. Blood Glucose level
2. Weight
3. Glycated hemoglobin assays (A1C)

NUTRITION CARE PROCESS

ADIME NOTE