University of St.

La Salle
College of Nursing

Nutritional Status Assessment

Date of Assessment: September 17,2021

Last Name: Matula First Name: Rochel
Sex: Female Age: 36
I. NUTRITIONAL/DIETARY ASSESSMENT
Dietary History
Income:
___ P 1,000 - 1,500/week ___ P 1,500 - ___ P 15,000 - ___ P 30,000
3,500/week 30,000/month up/month
Physical Activity
Occupation: Communication Specialist Hours of Sleep/Day: 7 hours
Form of Exercise: Walking, jogging, work out on gym
___ None
Ethnic and Cultural Background
Religion: Born Again Highest Educational Attainment: College
Home Life and Meal Patterns
No. of household members: 5 Person who does marketing: Rochel
Person who does cooking and relationship Type of housing: concrete
with this person: rochel-self
Appetite
___ Good ___ Poor Any changes:
Factors that affect appetite:
Food Allergies: None
Dental and Oral Health
Problems with eating: none Foods that cannot be eaten: none
Gastrointestinal Concerns
___ Heartburn ___ Diarrhea ___ Constipation Others: colic
Frequency of Problems: ___ 1x or 2 - ___ 1x or 2 - ___ 1x or 2 -3x/year
3x/week 3x/month
Home remedies: Warm Water
Chronic Diseases: None
Treatment: None Length of time of treatment: None
Dietary modification: protein foods, vegetables and fruits
Medication
Vitamins/Minerals: vitamin C, Zinc Ascorbate
Medications: None
Food Diary
Write down everything your client eats or drinks for a certain time period. Three days,
particularly two weekdays and one weekend day.
Before Breakfast
Water Description and 200ml
Preparation
Breakfast
Coffee, egg and rice Fried egg and coffee with 1 serving of rice, 1 piece of
milk egg and 200ml of coffe
Mid- Morning Snacks
Water and biscuits Water and chocolate 250ml of water and 1 pcs
biscuits chocolate biscuits
Lunch
Water and chicken Tinolang chicken and water 1 serving of viand, 1
serving of rice and 250ml
water
Afternoon Snacks
None None None

Midnight Snacks
Food/Drink Description and Amount
Preparation
Meat or chicken Adobong 1 serving of viand
Baboy
Fish or seafood
Eggs
Milk or milk products Warm Milk 250ml
Fruit or fruit juice
Green, leafy vegetables
Yellow or orange
vegetables or fruits(sweet
potatoes, mangoes,
pawpaw, pumpkin, carrots,
yams)
Other vegetables
Roots or tubers(potatoes,
cassava)
Cereals (ugali, bread, rice,
biscuits)
Beans or nuts

Sugar or honey
Alcohol
Sweetened beverages
Oils or fats
Coffee or tea
II. Biochemical Assessment
Skin, Hair, and Nails:
Head and Neck:
Eyes:
Mouth and Throat:
Musculoskeletal System:
Nervous System:
Cardiovascular System:
Gastrointestinal System:
IV. Anthropometric Measurements
Weight (kg: 62
Mid-arm Circumference:
Skinfold thickness
Subscapular: Suprailiac:
Sugar 2 table spoon
Coffee 1 table spoon
III. Clinical Assessment
The client have fair skin, no edema and lesion seen, her
hair is healthy and long and her nails shape are all
normal
The skin on the head and neck is fair and symmetrical.
There were no lumps or lesions to be found. Facial
expressions were quite normal. When requested to flex,
extend, hyperextend, lateral flex, and rotate the head,
the client felt no pain.
Size and location of the eyes are symmetrical. The color
of both eyes is brown. The eyelashes were evenly
distributed on both eyes.
The client's lips were symmetrical, colored, and free of
lesions. There are no anomalies in the upper or lower
teeth. There were no dental cavities or tartar. The gums
were pink, the tongue is symmetrical, pink, wet, and
silky. The tonsils and uvula were not swollen.
When walking, the client's gait is normal and she is
balanced. The muscles and joints are both symmetrical.
The skin around the muscles and joints looks completely
normal. There were no signs of edema, pain, deformity,
or erythema. When moving, the client stated that she felt
no pain or difficulties.
The client is conscious, aware, and receptive to the
person, time, and location. The client was able to
demonstrate typical reflexes and detect and explain
important sensations.
The chest measurement looks to be equal There were
no murmurs detected. The client's heart rate reached 87
beats per minute, which is considered normal.
The client has bowel movements on a regular basis. It is
usual for her to defecate once or twice a day.
Height (cm): 175 BMI: 20.2
Triceps: 20 cm Biceps: 20 cm