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Adime Note Template
Adime Note Template
Adime Note Template
FSHN 429
Diabetes ADIME Note
Carle Hospital
Diabetes Clinic
Mr. Robertson
11111
09/20/1952
65
11/07/2017
Nutrition Assessment:
This is a 30-minute face-to-face Medical Nutrition Therapy visit. Patient is a 65-year-old male
referred for dietary counseling by Dr. Smith.
Diagnosis and medical history: Type 2 diabetes, history of obesity and hypertension.
Weight History:
Height: 5in/9cm; Current weight: 187lb/ 78.18 kg current BMI is 27.6kg/m2.
Usual body weight: 172lbs/78.18kg; % usual body weight: 108% usual body weight
Mr. Robertson gained weight in his retirement years. He has lost 11 pounds since his last visit
with a dietitian.
Fatigue, excessive need to urinate.
Food Intake:
Activities and Function: Rides bike for 20 minutes 2 days a week. Bowls once a week with
friends and spends time in garden.
Social history: 1full strength beer 6 days/week. Goes grocery shopping with his wife and she
does the cooking. Goes bowling with friends 1 day per week. Family history of type 2 diabetes
and CVD.
Nutrition Diagnosis:
Overweight, obesity related to excessive energy intake and sedentary lifestyle post-
retirement as evidenced by a BMI of 27.6
Undesirable food choices related to continued consumption of occasional foods and
alcohol as evidenced by inability to meet weight loss goals.
Nutrition Intervention:
Estimated Nutrition Requirements
1. 1925-2550 kcals per day 24.6 32.6 kcal/kg Actual BW)
2. 22.08 g protein per day (0.8 g/kg Actual BW)
3. 1,954.5 2,736.3 ml fluid per day (25 - 35 ml/kg Actual BW)
Implementation of Intervention
1. Choose reduced/no fat and reduced /no sodium options at the grocery store.
2. Count carbohydrates at every meal by reading nutrition labels
3. Check blood glucose every morning, night, and before/after meals or exercising
4. Weigh self every Monday morning and keep track of weight changes.
Medical Nutrition Therapy provided using the 2016 evidence based practice guidelines from
the American Academy of Nutrition and Dietetics.
Emily Simo