English French Notes Complete/Exclude ADJUSTED MEASURED Average Daily Meals/Adj Measured FTEE FTEE Summary Enter Cumulative Total on the 830 Report of Costs REQUIRED FIELD! Tech (1019) Dietitians (1018) Wageboard (1008) Clerical (1002) Total Personal Cost Subsistence (2610) Operating Supp (2660) All Other COST PER MEAL Average Cost Per Meal COST PER DIEM Avg Tot Personal Services Select SURVEY CATEGORY Select one of the questions on the Dietetic Survey. Select SERVICE Enter the Service you want to enter or edit. Enter Rating String Enter More Rating String for another service ? Two spaces found in input Illegal String Specification in No number surveyed for Illegal entry in rating cannot be greater than 9999 used more than once. There are only 5 ratings. List the numbers surveyed by specifying which rating it belongs to and separated by a single space. Example: E20 V40 G40 F3 U1 E = Excellent, V = Very Good, G = Good, F = Fair and U = Unacceptable Omit if none surveyed for a certain rating. Appetizing Foods Preferred Hot Enough Cold Enough Courteous Preferences Discussed Timeliness Enough Time to Eat Nutritional Info Overall GM&S DIETETIC SURVEY YTD Rtng Num Rtng ToT Avg Print the Dietetic Annual Report This is a very long and time consuming report, it must be queued to print. October^January January^April April^July July^October Error! Wrong Qtr Qtr FY Already Purged to Purge To The Year: CANNOT PURGE TO YEAR THAT IS GREATER THAN THE DEFAULT! NUTRITION CLASSIFICATIONS NUTRITION PLANS ENCOUNTER TYPES Enter a NEW Encounter (Y/N)? DATE/TIME OF ENCOUNTER: Enter Date of Encounter you want to edit: CHOOSE CLINICIAN or PATIENT Select CLINICIAN: No encounter on file on this date Select number you want: Select only a number no greater than or press or a return to exit. Patient has expired. No Encounter on file for this patient. Is this correct? Y// Answer YES or NO You can ONLY DELETE an encounter that is entered by you. Want to delete encounter? N// Statistics for ALL Clinicians? Y// Break-down by Clinician? Y// List Individual Patient Encounters? N// [Cannot Start after Today!] [Must Not enter date greater than Today!] TOTAL ENCOUNTERS Subtotal Number Inpatients Outpatients Others Total Pat Col Units Pat Col Units Persn Units Persn Units [ Patient has expired. ] No Encounters on file for this patient. Display Encounters Since: No Encounters recorded since Clinician: Individual Entered : Reviewed : You may enter an A to calculate weight anthropometrically. Date Weight Taken: Usual Weight: Enter height as: 6' 2 or 74IN or 6FT 2 IN or 30CM Add an S if height is stated rather than measured. Add a K if value is a Knee Height measurement. Height should be between 12 Enter Weight as 150# or 150# 6OZ or 800G or 70KG Add an S if weight is stated rather than measured. Enter an A to determine weight anthropometrically. Weight should be between 0 Lbs and 750 Lbs. Enter Patient's Name: Enter Patient's Name to be printed on the report. Enter Age Less Than 124 in Years or Months (followed by M) but Not Both Wrist Circumference (cm): Value should be between 2 and 50cm.; press RETURN to bypass. Small Medium Large Frame Size (SMALL,MEDIUM,LARGE) MED// Calculation of Ideal Body Weight S Spinal Cord Injury E Enter Manually You Must Choose from the List Above Does Patient have an Amputation? NO// Amputee Types: (may be multiple, e.g: 2,2,5) 2 Total Leg (16.1%) 3 Total Arm (4.9%) 5 Forearm and Hand (2.3%) 6 Calf and Foot (5.8%) Amputee Types: Total Amputee %: Total % of amputations should be .5% to 50% Select IBW after Amputee Correction: Enter a string of types (e.g: 1,1,4); no digit can exceed 6. Enter Ideal Body Weight: heels and clothes weighing 5# for men and 3# for women. Extent of Injury: Select: Only P or Q are Valid Choices Select Ideal Weight ( No data for your Age Group, the Group was used. Need Arm & Calf Circumference, at a minimum, to compute weight. Calculated Weight: Can only calculate knee height for persons aged 60 or older Select Ideal Body Weight: Do you wish Anthropometric Assessment? NO// Enter YES if you have Anthropometric measurements; Otherwise NO Triceps Skin Fold (mm): Enter value between 1 and 100; outside values should be assessed manually Subscapular Skinfold (mm): Arm Circumference (cm): Enter number between 5 and 100; outside values should be assessed manually Calf Circumference (cm): Enter value between 10 and 250; outside values should be assessed manually Collecting laboratory data ... LO= HI= Energy Calculate Energy Needs by: 3 Enter Manually Choose: Choose Either 1, 2, or 3 Enter Energy Requirements (Kcal/day): KCAL must be greater than 0 Is patient confined to bed (Y/N)? (Activity Factor = Injury/Stress Factors Skeletal Trauma Major Sepsis Severe Burn Blunt Trauma Trauma w/ Steroid Starvation Trauma on Ventilator Mild Infection 0-20% BSA Burn Moderate Infection 20-40% BSA Burn Long Bone Fracture >40% BSA Burn Peritonitis Stress - Low Anabolism Cancer BEE = Select Energy Factor: Energy Factor must be Between .7 and 2.5 Caloric Factors Basal Energy Ambulatory w/ Weight Maint. Malnutrition w/ Mild Sepsis Injuries/ Sepsis - Severe Burn - Extensive Non-Dialysis Renal Failure Dialysis Dialysis w/ Diabetes Enter Kcal/Kg (10-100): Kcal/Kg Must be Between 10 and 100 Enter Caloric Requirements (Kcal/day): Enter a value between 1-10000 Requirements Based On: 1 Actual Body Weight 2 Ideal Body Weight 3 Obese Calculation Choose either 1 or 2 Calculate Fluid Requirements By: Adolescent (40-60 ml/kg/day) Children (70-110 ml/kg/day) Infant (100-150 ml/kg/day) 2) 100 ml/kg first 10 kg + 50 ml/kg second 10 kg + 25 ml/kg remaining kg 4) 0.5 ml/Kcal (Fluid Overload) 5) 1500 ml/sq meter 6) Set Your Own Fluid Level 7) Omit Calculation Choose: Choose 1 - 7 Only Fluid Select Level Between Fluid Level is not within range. Enter Fluid Requirements (ml/day): Level must be between 0-10000 ml/day Select Fluid Requirements (ml/day): Protein Protein Requirements (g/kg) Acute Burn, Injury, Trauma Convalescent Burn, Injury Trauma Malabsorption Syndrome Ulcerative Colitis Ileocolostomy Chronic Liver Disease Acute Encephalopathy Chronic Renal Failure Nephrotic Syndrome Burn Protein-Sparing Enter Protein Level (g/kg) Level must be .4 to 4.0 Enter Protein Requirements (gm/day): Enter a value greater than 0 but not more than 400. % of KCAL Do you want to do a NITROGEN BALANCE? NO// Enter Protein Intake (gm/24hr): Enter 0-200 grams of protein intake Enter Urinary Nitrogen Output (gm/24hr): Enter 0-30 gms of Urinary Nitrogen output (24 hr UUN) Enter Insensible Nitrogen Output (gm/24hr): 4// Insensible Nitrogen output should be between 0-10 grams Nitrogen Balance: Appearance: Enter Physical Appearance of patient; cannot exceed 60 characters. Do you wish to FILE this Assessment Y// Nutrition Status: No Nutrition Assessments on file SELECT Assessment Date: ADT SEX AGE HGT HGP WGT WGP DWGT UWGT IBW FRM AMP X X X KCAL PRO FLD RC XD BMI BMIP TSF TSFP SCA SCAP ACIR ACIRP CCIR CCIRP BFAMA BFAMAP Age Date of Assessment: Height: knee hgt Weight: Weight Taken: Weight/Usual Wt: Ideal Weight: Weight/IBW: Ideal weight adjusted for amputation Frame Size: Body Mass Index: Anthropometric Measurements Triceps Skinfold (mm) Arm Circumference (cm) Subscapular Skinfold (mm) Bone-free AMA (cm2) Calf Circumference (cm) Laboratory Data Result units Ref. range No laboratory data available last Energy Requirements: Kcal:N Protein Requirements: NPC:N Fluid Requirements: Nutrition Class: Comments Entered by: NUTRITION ASSESSMENT VAF 10-9034 (Vice SF 509) Press RETURN to continue. Enter a RETURN to Continue. NUTRITION STATUS Is this a re-screen (Y/N)? Print by CLINICIAN or WARD? WARD// Answer with C or W I II III IV UNC Select one to Display #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################