Name: Haleema Wasif Date: May 19, 2021

PATIENT DATA
Name: Gull Nafees

Address: Street#2 cavalry ground cantt Lahore

Marital Status: married

Sex: Female

Occupation --------×-----------

Age: 51yrs

ANTHROPOMETERY
Ht: 5’4” Wt.: 65kgs

IBW/ABW: 55.8kgs

%IBW/ABW: 116.48%

Usual Wt.: 70kgs.

% Usual Wt.: 92.8%

BMI: 24.6

Goal Wt.: 60kgs.

Obesity adjustment: 58.1kg

Medical Diagnosis: Gestational diabetes, depression and hypertension

Past Medical History: fluctuations in BP

Social/ Family History: father had diabetes

Medicines/Supplements:

Drug Mode of Action

Famot 20 mg For intestine problems
Extor Treats hypertension
Alp 0.5 mg For anxiety, sleep deprivation and relaxes nerves
Deprel 50 mg Depression, improve mood and appetite
Trivia 50 mg Control high sugar level
 Getryl 1mg Stimulates release of insulin
Gabica 100mg Treat pain cause by nerve damage due to diabetes
Polypep 20mg Treat and prevent ulcer in stomach and intestine

Diagnostic Test:

Test Result Normal value Interpretation

HbA1c 9.45 Less than 6.4 ANL

Sugar tolerance 150 Less than 140mg/Dl ANL
test
Fasting blood 120 Less than 100mg/Dl ANL
sugar test
Random blood 240 Less than 200mg/Dl ANL
sugar test
Brief Disease Review:

Mrs. Gull Nafees was diagnosed with gestational diabetes after her 4th pregnancy. The process of
birth was not normal but the baby was healthy. Gestational diabetes is high blood sugar (glucose)
that develops during pregnancy and usually disappears after giving birth. It can happen at any
stage of pregnancy, but is more common in the second or third trimester. It happens when your
body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet
your extra needs in pregnancy.

Physical Exam Findings (based on your clinical observations)

Hydration : dehydration

Skin/mucosal changes

Body System Findings What the findings may reflect

Hair Dull Decreased level of biotin
Nails Not very hard Decreased level of biotin
Tongue Normal --------------
Skin Pale, dry Due to hypertension
Eyes Normal --------------
Urine infections Due to diabetes
Muscle ache Due diabetes
Swelling of feet Due to diabetes
GI Function: Normal/Diarrhea/Constipation/ Slow digestion/ Flatulence

Appetite: reduced Taste: altered

Digestion: normal Bowel frequency: 1/day

Medical Nutrition Therapy
Estimated Needs (show calculations)

Total Kcal Requirement Total Protein Fluids Other

BEE: Requirements 1500 mL + Na:2400mg
(0.8- 1.2) x [weight (kg) x SF 7%
= 655.1+(9.6*65) +(1.9*162.5cm) ABW 20 ml/kg/day] Fiber
-(4.7*51) = -22.32 kcals 1ml=1kcal 20g/day
AMDR Eg: 1800 x 1=
= 655.1+624+308.75-239.7 CHO (40%) 1800ml
=539.25kcals =2800ml/kg/
= 1348.13kcals/day FAT (30%) day
=404.4kcals
PROTIEN
(20%)
=269.6Kcals

Kcal: 1348.13kcals

Carbohydrate: 134.8g Fat: 44.9g Proteins: 67.4g

Fluids: 2800ml/kg/day other: normal

Physical Activity: active (1.27)

Diet Instructions:
Diet order: low fat/high protein diet

Total Kcal: 1348.13kcals

Carbohydrate: 134.8g

Protein: 67.4g

Fat: 44.9g

Fluid: 2800ml/kg/day

Meal/Snack/Time
Food Break Sn Lun Sn Din Sn Tota CH Prot F Kca
Grou fast ack ch ack ner ack l O ein (g) ls
p servi (g) (g)
ng/
Day
Starch 2 2 2 6
es

Fruit 1 1 2

Milk 1 1 2

Veget 1 1 1 3 4
able

Meats 1 2 3 6
/
Substi
tute

Fats 1 1 2 4

CHO Tota
Choic l
es gra
ms
Calories/gram Tota
l
Kcal
Percent calories

Diet Plan:

Timings Menu/Diet Serving CH Protein Fat Othe Kca

size/ O r l
Amount (g) Na
mg
6:30 AM Porridge 1 serving 15g 3g 1g 24mg 80
(1\2 cup) 0g

8:30 AM
Bran bread 2 servings (2 15g 3g 1g 62mg 160
slices) 0g 7g 6g 0 75
Egg boiled 1 serving
0g

43mg
 11:00Am
Apple medium peeled 1 serving 25g 0.g 0g 0g 120

2 :00PM Rice boiled 1\3 cup 15g 3g 1g 80

Chicken 1\2 ounce 0g 7g 5g 0g 75
Lentils 1cup 15g 7g 3g 125
Oil 1tbsp. 0g 0g 5g 1mg 45
cucumber 1 cup 5g 2g 0g 25

4:00PM Apple peel 1 serving 25g 0.g 0g 0g 120

Green tea with lemon 1 cup 0g 0g 2mg
7:00PM Chapatti 1 serving 15g 3g 1g 0 160
Beef 1 ounce 0g 7g 5g 40mg 150
Raddish 1\2 cup 5g 2g 0g 0g 25
2tsp 0g 0g 10g 45
oil 0g

9:00PM milk 1 cup 15g 8g 8g 0mg 160

Total 150 52 46 1370

Nutritional Assessment Information

Form A

S: Diet/ Lifestyle/ Medical/ Learning and motivational related

The client has a very unhealthy lifestyle, and her diet is mostly junk foods. She does not take
enough nutrients to complete body needs and eats sweetened and packaged foods a lot. Her body
cannot produce enough insulin and junk foods inside her body are worsening her conditions

Her sugar level as evidence by biochemical reports is above normal, her Hba1c is 9.45 and her
sugar tolerance test is also 150mg/dl which is above normal. This is what is causing urine
infections, nerve damage, muscle ache and swelling of feet
She needs a proper diet plan with diet according to patients of diabetes and she needs to change
her lifestyle to live healthy

O: age/ gender/ ht/ wt/ BMI/ any anthropometry/ lab results

Age: 51years

Gender: female

Weight: 65kg

Height: 5.4

BMI: 24.6
HbA1c 9.45
Sugar tolerance 150
test
Chest: 36m

Hips: 38m

Arm length: 22m

A: Nutrition Diagnosis

PES Statements

Pregnancy and high sugar intake related to diabetes characterized by dull hair, pale
dry skin, frequent urine infection and muscle ache

P: (Nutrition Intervention) Goals/Education

Diet plan Nutrition Education
Kcal= Physical Activity
CHO Na intake
p

Nutrition Management Plan

Form B
Nutritional Problem Intervention
High glucose level To keep the blood sugar as normal as possible without serious high
or low blood sugars.

Tissue damage To prevent tissue damage caused by too much sugar in the blood
stream.

Inappropriate production  Hyperinsulinism may also refer to forms of hypoglycemia

of insulin caused by excessive insulin secretion.
 We inject the insulin injection to patient
 Brisk walk daily at night
Anxiety ,depression  Play with children and avoid stress
 Try to see green grass and walk on green grass
Educational Goals

Increase physical activity By the pedometer and required daily steps starts from 2000steps
and increased to 10000 steps per day in a week
Avoid the fast food from market and replace it with leafy green
Avoid junk food vegetables that are full of nutrients

Increased fiber in diet Add fruits ,vegetables, cereals in our diet

Assessment of Educational Needs

Form C
Nutritional Objectives Nutrition Intervention
Maintain sugar level avoid methai/sweets and sugar intake in chai/coffee etc.
eat less dessert
To able to reduce Consume 6 servings of whole grain from cereal. Take one chapatti
caloric intake without oil in breakfast with egg cooked in 1 tsp oil only.
Limit cooking of fat to 4 tsp/day
Use 2c of low -fat milk/yogurt

Walking to avoid thinking

Avoid stress and Watching dramas a
depression Manipulating your mind
Taking anti- depressions as prescribed
Exercise daily
Muscle ache Take supplements properly
Sleep properly Adapt healthy sleeping habits
Avoid urine infections Avoid junk foods, sweets and introduce fiber in diet

24 Hour Recall

Form D

24 hour recall Date:21 Patient Name: Gull Nafees

may,2021
Time Foods and Beverages Amount/serving Exchanges Groups
size
Breakfast Paratha(bread) 1 serving · hardboiled egg Cereals
Oil 2 tsp. · One whole Oil and fat
Yogurt 1 cup Wheat chapatti Milk and its
with oil(paratha) products
Egg 1 cup meat
oil
· tea/coffee

Mid- Chips (lays) 3 serving Vegetables miscellaneous

morning Pepsi 1 cup salad food
Snack

Lunch Chicken gravy 5oz a cup of rice (try Meat

brown rice
Oil 2 tsp a cup of oil
Chapatti 2 cauliflower or cereals
broccoli
Pepsi
 1 cup oil miscellaneous
food

Afternoo Golgappy 1 serving fruit miscellaneous

n Snack Juice with sugar 1cup food

Dinner Okra 1 cup Chapatti Vegetables

Oil 1 tbsp. Chicken breast Oil
Tomato 1 cup Cucumber Vegetables
Onion 1 serving Vegetables
cucumber 1 cup Vegetables

Bread Cereals
milk Dairy and its
products

Food Frequency
Form E
Form E
Food Category 7 6 5 4 3 2 1 0
Meats 
Beef 
Poultry 
Fish 
Dairy 
Eggs 
Whole milk 
Fat-free milk 
Butter milk 
Yogurt 
Cheese 
Ice-cream 
Milkshakes 
Fried Foods 
Nuggets/French fries etc. 
Baked Goods 
Biscuits/Cake/Pastries/Doughnuts 
Convenience Foods(canned/packaged/frozen 
Pizza/Pasta/Burgers/Cream soups 
Table Fats 
Butter 
Margarine 
Oil 
Mayonnaise 
Cream 
Snacks 
Candy 
Chips 
Nuts 
Fruits 
Fruit (anyone) 
Fruit juices 
Vegetables, leafy 
Pulses 
Rice 
Others 
Methai/Sweets 
Carbonated drinks 

Summary of 24 hr Recall

Food groups recommendation Actual Intake Assessment

Grains 6-11 4 low
vegetable 3-5 5 good
Fruits 2-4 2 moderate
Dairy products 2-3 2 moderate
Meat Group 5-7 ounces 3 Very low
Sugar - 8 Very High
Fat - 7 excess

Dietary Diagnosis:
Not eating proper meals, inadequate intake from all food groups and excessive CHO lead to high sugar in blood.

Stress, hypertension and depression lead to worsening of condition of the client which resulted in frequent

urime infection and muscle ache. She needs to eat a low fat high protein diet, increase her fiber intake. Take a

walk regularly and increase water intake. She should avoid cold and sweet things .

Average Daily Energy and Nutrition Intakes and its comparison with
Standard Intake (from HOFood Composition Table)

Category Amount Standard amount Assessment (√,

consumed
Energy (Kcal) Kcal

Protein (g) g

Carb (g) g

Fiber (g) g

Fat (g) g

Sat Fat (g) g

MUFA (g) g

PUFA (g) g

Chol (g) 150 g

Calcium (mg) 500 mg

Iron (mg) 5 mg

Sodium (mg) 2200 mg

Potassium (mg) 2500 mg

Zinc (mg) 7 mg

Vitamin A (RE) 400 RE

Thiamine (mg) 0.5 mg

Riboflavin (mg) 0.8 mg

Vitamin C (mg) 35 mg