Patient Care Unit

(Reviewer)

Forms
1. Patient List - per ward, with total census, room number, code, patients name, diet
and remarks
2. NAPR (Nutrition Assessment and Progress Record) - for In-Patient
I. Personal Data
- Name, Category, Date of Birth, Age, Gender, Address and Diagnosis)
II. Anthropometric Data
- Height, Weight, DBW, BMI
III. Additional Assessment
- Appetite, Food Allergies, Dentition, Mastication, Bowel Habit, PAL,
Physical Appearance
IV. Personal and Social History
V. Patients Medical History
VI. Biomedical Data
- Date, Blood Constituents, Value
VII. Dietary Management
- Date, Physician's Diet Order, Remarks, Code, Recommendations
3. Dietitian's Notes
- SOAP (Subjective, Objective, Assessment, Plan)
- S - observed, interview based, eating problems, based on Addition
Assessment
- O - Diet Order, Anthropometry, Lab results (with date), Medical History (if
needed for justification)
- A - Justification for diet modifications, nutritional status (BMI classification)
- P - Diet Recommendations (always start with verb - provide, follow up, serve)
*Dietitian's Progress Notes - for updates
4. Diet Cards
Pink - Renal
Blue - Diabetic
5. Clinical Dietitians Daily Accomplishment Report
- Name of patient, Ward, Diet, Old or New NAPR, Instruct, Inform, Soaped,
Computed, Updated

Chart Forms
1. Admission Form (for Personal Data)
2. Problem List (for Diagnosis)
3. Physician's Order Sheet (for Diet Order, and Diagnosis if no Problem List)
Laboratory Values

Reference Interval
Blood Component Unit
Male Female

HbA1C (Hemoglobin % 4-6

A1C)

FBS (Fasting Blood mmol/L 4.1 - 5.9

Sugar)

BUN (Blood Urea mmol/L 2.1 - 8.2

Nitrogen)

Creatinine umol/L 58-110 46-92

Sodium mmol/L 137 - 145

Potassium mmol/L 3.5 - 5.1

Chloride mmol/L 98 - 107

Total Calcium mmol/L 2.10 - 2.55

Inorganic mmol/L 0.81 - 1.45

Phosphorus

Magnesium mmol/L 0.70 - 1.05

Albumin g/L 35 -50

Hemoglobin g/L 140-180 120-160

Hematocrit - 0.40-0.54 0.37-0.47

Red Blood Cells x10^12/L 4.5-6.2 4.2-6.2

White Blood Cells x10^9/L 5-10

Platelets x10^9/L 150-450

SGPT/ALT (Alanine U/L 0 - 41

Aminotransferase)

SGOT/AST U/L 0 - 40
(Aspartate
Aminotransferase)
NDAP Protein Requirement by Age Group

Renal Diseases and Diet Computations

RENAL DISEASE (from NDAP book)
- Diet emphasis adjustments on;
- Protein (compute for Glomerular Filtration Rate, refer to NDAP Diet Manual)
- Sodium and potassium equilibrium (Sodium Restriction of 2000-3000 mg/day,
K requirements is 2000-4000 mg/day)
- Calcium and phosphorus balance (take calcium rich foods with prescribed
phosphate binders)
- Fluids (for urinary outputs, refer to estimated fluid retention by age group in
manual)
- Calories
- Vitamin requirement and control in cholesterol

Chronic Renal Failure (CRF) - fluid restrictions along with sodium intake, if hyperkalemia
then restrict potassium, blood phosphate should be kept at 1.9 mmol/l by phosphate binder
End Stage Renal Failure (EDCF) - diet must prevent protein depletion
Acute Renal Failure (ARF) - determine first if condition is catabolic or anabolic
Nephrotic Syndrome - adjust protein, salt and fat intake
Renal Transplantation - depending on patients tolerance for oral food intake

Computations
● House Formula
60-20-20
Consider for adjusting distribution:
- If elderly, 65 years old and above
- Body composition
- Metabolic condition
- Medical condition
● For Elderly
60-15-25
- Old age causes slow metabolism
- Consider use of non-cholesterol food for fat
● For Pulmo (COPD & DB)
50-20-20
- For COPD specific reduced carbs on diet
● For Cardiac
60-20-20
● For Gestational DM
40-20-40
● For Renal
- Pre-dialysis
CHON - 0.6-0.8 g/kg DBW
Depending on level of Creatinine
Normal - 35 kcal/kg DBW
Underweight - 36 or more kcal/kg DBW
 Overweight - 30 kcal/kg DBW
- Hemodialysis
CHON - 1.2-1.4 g/kg DBW
- Peritoneal Dialysis
CHON - 1.2-1.5 g/kg DBW
NPC (Non-Protein Calorie)
Protein Requirement
AKI - ≤ 1.0 g/DBW
CKD (no Dialysis) - 0.6-0.8 g/DBW
CKD (w Dialysis) - 1.2 g/DBW (NDAP)
1.1-1.4 g/DBW (VMMC) - depending on Crea levels
If dialysis
Female, small (w high Crea) 1.1 g CHON/DBW
Male (w or w/o high Crea) 1.2 g CHON/DBW
Tall patient (w or w/o high Crea) 1.2 - 1.4 g CHON/DBW
TER
DBW x 30 (for maintenance)
x 35 (with dialysis, <65 y/o)
x 30 (for advance age, >65 y/o)
AMDR (renal)
DB patient 65 ; 35
Non- DB 70 ; 30

Acronyms
● NAPR - Nutrition Assessment and Progress Record
● QID - "quarter in dies" , four times a day.
● TID - "ter in die" , three times a day
● BID - "bis in die" , twice a day
● QD - "quaque die" , once a day
● q - “quaque” , every
● NPO - "nil per os" , nothing by mouth
●
Differentiation
- Ex. Low Fiber diet vs. Low Residue diet
● Low Residue Diet (page 77 NDAP book)
- Similar to Low Fiber diet but typically includes restriction of foods that
increase bowel activity (milk, milk products, prune juice)
- Residue is not the same as fiber, this term refers to the end result of
digestive, secretory, absorptive and fermentative process
- Contains less than 10-15g fiber
- Used as transition diet to regular diet from soft to full diet
● Low Fiber Diet (page 85 NDAP Book)
- Contains less than 10-15g of fiber per day, eliminates foods to increase the
amount of stool
- Can be done by removing seeds, skin of fruits and vegs and, cut of gristle and
connective tissue in meat, omit leafy vegetables, fibrous and dried fruits, nuts,
seeds and legumes, and refined cereals and bread
 - Used for constipation, gastrointestinal surgeries, peptic ulcer disease,
diarrhea, etc.

Standards for Nutritional Status (aside from WHO)