Flowchart on the Use of Interview Guide
& Screening Tools for Nutrition
SUBJECT PROFILE
Code Name: Mrs. M
Date of Interview: 11/1/2021
Age: 43
Time of Interview: 11:00 a.m.
Gender: Female
Height: 5’2 feet / 157 cm / 1.57 m
Address: Angeles City, Pampanga
Weight: 66 kg
DIET HISTORY
ECONOMICS
PHYSICAL ACTIVITY
ETHNIC
& CULTURAL
BACKGROUND
Home Life
& Meal
Patterns
Appetite
Allergies,
Intolerances,
Amount of money for food: Approximately 2000 pesos per week
Individual perception: Variation of food is very important. Have vegetables and meat every other day
Occupation: Housewife
Exercise: None
Sleep: 6 – 8 hours/day
Influence on eating habits: Family Practices
Religion: Roman Catholic
Education: Junior High School Graduate
Number of household members: 5
Shopper; Ability to shop and prepare food: The patient
Cook: The patient
Storage and facility: Has a refrigerator, and stove; complete cooking equipment
Good appetite; no changes
Factors that affect appetite: Advertisements and media
Taste and smell perception: Fond of sour and salty foods. Likes the smell of pastries
Foods avoided and reason: None; just tries to avoid excess consuming of pork
Length of time of avoidance: None
Avoidances
Dental and Oral
Health
Gastrointestinal
Concerns
Foods avoided and reason: None; just tries to avoid excess consuming of pork
Length of time of avoidance: None
Problems with heartburn due to acid reflux
Frequency: When eating only fruits
Antacids: Gaviscon
Chronic Diseases
NONE
Medications
NONE
Nutritional Assessment Statement
Score: 0
Interpretation: The patient’s nutritional score is good and is not at
risk of malnutrition
NCP: Learn about the patient’s eating habits and provide teachings
if needed. Re-check after 6 months.
BODY MASS INDEX
Formula: kg/m^2
Solution: 66 kg/1.572
Answer: 26.77 / 26.8
Interpretation: Obese I
MUST SCORE
BMI score: 0
Weight loss score: 0
Acute Disease Effect Score: 0
Overall Risk of Malnutrition: 0
Interpretation: Low risk for malnutrition
Nursing Care process
(Education and recommendations)
Discuss the importance of sleep, especially having an 8-hour sleep per night.
Discuss the frequency of heartburn, and recommend to improve diet rather than continuously taking
antacids.
The patient is currently Obese I, advice the patient the usual foods everyday and recommend ways to
improve habits.
There is no such thing as bad or good food. Emphasize that food is good as long as it is kept at a limit.
Re-check nutritional assessment after 6 months
To assure that patient will not have risk for malnutrition, MUST be taken again weekly.