NUTRITION ASSESSMENT Client history CH Personal data 5

NUTRITION ASSESSMENT Client history (CH) �Personal data 先生/女士，○歲 教育程度 家庭/職業狀況 菸酒檳…… 運動…… 5

NUTRITION ASSESSMENT �Medical history …… …… …… 6

NUTRITION ASSESSMENT l Medicine 藥物 劑量 頻率 用途 7

NUTRITION ASSESSMENT l Anthropometric Measurement (AD) Height？Body weight ？ BMI ？WC（腰圍）？ IBW ？ 近期體重改變？ l. Nutrition-Focused Physical Findings (PD) 水腫？排便？牙口狀況？ 8

NUTRITION ASSESSMENT l Biochemical Data, Medical Tests and Procedures (BD)（＊生化數據依個案個別狀況選擇適當項目放入） 年/月 AC (mg/dl ) Alb (mg/dl ) BUN (mg/dl ) Cr (mg/dl ) Na (m. Eq/ L) P (mg/dl ) K Hb WBC (m. Eq/L) (g/dl) (mm 3) CRP (mg/l ) l 目前治療方式: 9

NUTRITION ASSESSMENT �Food/Nutrition-Related History (FH) 2018/01/03 2018/08/26 2018/04/04 2019/03/13 2018/9/7 飲食醫囑？ ************* 10

NUTRITION ASSESSMENT �Comparative Standards (CS) Estimated energy needs (CS-1. 1) Mifflin-St Jeor equation？ 估算法 (rule of thumb)？ 其他？ Estimated protein needs (CS-2. 2) 其他，如：DASH飲食型態 Energy：*** kcal Protein：*** g/d 12

NUTRITION DIAGNOSIS 營養問題 (P) 病因(E) 病徵／症狀 (S) 13

NUTRITION INTERVENTION 依據營養診斷中的病因介入 � Nutrition education 說明此次教育重點？ 15

NUTRITION REASSESSMENT 此階段是依據追蹤項目、設定的目標收集資料，再予持續的監測與評值。 Anthropometric Measurement (AD) 體重？Kg，下降？％ BMI？，腰圍？ Biochemical Data, Medical Tests and Procedures (BD) （＊生化數據依個案個別狀況選擇適當項目放入） 年/月 AC Alb BUN Cr (mg/dl) Na (m. Eq/ L) P (mg/dl) K (m. Eq/L) Hb (g/dl ) WBC (mm 3) CRP (mg/l) / / 22