ADIME Note
Name: Hannah Bodenhamer
A: Chief Complaint: COVID-19 Diagnosis
FOOD/NUTRITION-RELATED HISTORY
Food and Nutrient Intake: Pt oral intake is only 10% 2/2 to anosmia, nausea, and pain. Pt
consumes a very low caloric diet with poor nutrient density and no reported supplementation.
Energy and Macronutrient Intake: (From 24 hour recall) pt diet consists of 714 calories,
144.1g of carbohydrates (71%), 33.4g of protein (17%), and 11g of fat (12%).
Fluid/Beverage Intake: (From 24 hour recall) pt consumes about 44 ounces of water containing
beverages each day.
Diet Order: Pt NPO d/t feeding tube and ventilator with 2200 kcals w/ no supplements.
Physical Activity and Function: Pt has the physical ability to self feed but does very little meal
preparation. Pt is physically inactive and is mostly sedentary.
Medications: Pt is taking Lisinopril, Simvastatin, Lasix, Metformin extended release 500 mg
twice per day. Pt does not take nutritional supplements.
ANTHROPOMETRIC MEASUREMENTS
Ht: 5’7” Wt: 126 lb Frame size: Small
Wt change: Pt experienced severe (21%) weight loss within two weeks with moderate
loss of subcutaneous fat in shoulders and chest. Pt is 79% of UBW and is predicted to be
severely malnourished.
BMI: 19.7 km/m2, within normal weight range.
BIOCHEMICAL DATA, MEDICAL TESTS AND PROCEDURES Pt presents severe
hyperglycemia aeb BG 324 mg/dL (>99 mg/dL) and azotemia aeb BUN 39 mg/dL (>25 mg/dL).
NUTRITION-FOCUSED PHYSICAL FINDINGS Pt presents as severely malnourished c/w SGA
rating of C aeb 21% weight loss, moderate depletion of subcutaneous fat, and poor dietary
habits relating to decreased appetite. Physical findings include pale skin, yellow tinted eyes, dry
mouth, slightly distended abdomen, and hair loss. Pt c/o stiffness, shortness of breath, nausea,
anosmia, chronic pain, and intermittent constipation and diarrhea.
CLIENT HISTORY
Personal Hx: Pt is a 81 y/o asian male with a hx of TD2M x 5 yrs, HTN, and CKD stage 4
admitted for severe respiratory symptoms c/w COVID-19. Pt’s wife does most of the food
preparation and reports that the pt is physically inactive and has a poor appetite 2/2 nausea.
W:
COMPARATIVE STANDARDS
Total Energy Estimated Needs: 1595 kcal/d (Penn State 2003b)
Total Protein Estimated Needs: 57 g/day (1.0 g/kg)
Total Fluid Estimated Needs: 1.595 L/d (1 mL/kcal)
IBW: 134 lb (small frame)
D:
1) Inadequate oral intake (NI-2.1) related to poor appetite and pt reported nausea as evidenced
by reported poor oral intake (PO 10%) and calculated calorie deficit (≈881 kcal/d).
2) Intake of types of carbohydrate inconsistent with needs (NI-5.8.3) related to undesirable food
choices as evidenced by high blood glucose levels BG 324 mg/dL (>99 mg/dL) and
consumption of 36 oz of high-sugar sports drink per day.
3) Unintended weight loss (NC-3.2) related to decreased ability to consume sufficient energy d/t
COVID-19 symptoms as evidenced by moderate depletion of subcutaneous fat and severe 21%
weight loss.
I: Nutrition Rx: 2,095 Kcals; 40g protein (0.7 g/kg protein restriction), 2,095 mL of water
1. Meals and Snacks: Increase protein diet (ND-1.2.3.2)
Goal: increase protein consumption to 40g/day to fit needs of protein restriction
while allowing pt to gain muscle mass.
2. Meals and Snacks: Increased energy diet (ND-1.2.2.1)
Goal: Increase diet +500 calories per day (2095 cal total) to allow for weight gain
of one pound per week.
3. Meals and Snacks: Increased fluid diet (ND-1.2.8.1)
Goal: Increase fluid daily fluid intake by 500 mL per day to improve hydration
status from severe weight loss.
M & E:
1. Monitor pt tolerance to tube feeding formula with stool consistency on nurse’s report
2. Monitor albumin and prealbumin levels every other week
3. Monitor protein daily to ensure protein restriction needs are met
4. Monitor glucose levels twice daily using fasting glucose tests
5. Monitor pt fluid intakes to ensure proper hydration
6. Monitor tube feeding formulas to ensure pt energy needs are being exceeded
7. Monitor weight weekly to keep on track with weight gain of 1 lb/week
Signature: Hannah Bodenhamer
