Geri Paper

Geri Nutritional Assessment 1

Running Head: Geriatric Nutritional Assessment Worksheet

Geriatric Nutrition Assessment Worksheet

                                                                                              Geri Nutritional Assessment 2

El Camino College
Geriatric Nutritional Assessment Worksheet

Clients initials   W.B                                               Age 71
Dates of Care     11/2/2007                                       Sex   F
Ethnicity           Swedish American                         Education/Occupation   Retired
Health Status     Poor                                                 Religion   N/A
Affiliative         Married, lives with her husband

History
In the last six to twelve months:

Have your experienced any changes in weight? Yes, I have gained about 10 pounds since this summer.

Has your appetite or dietary habits changed? Yes, my appetite has decreased a little bit since I was admitted in hospital.

Do you have any difficulty in feeding self, eating, chewing, or swallowing? Yes, I have only difficulty
holding utensils. Therefore, I needs help being fed.

Have you experienced any nausea, vomiting or diarrhea? No.

Do you ever have constipation?   No.

What is your food likes or dislikes? Swedish pea soup, fried chicken. I don’t like hospital foods.

Do you eat alone or with a family group? At home, I eat with my husband.

Do you take any vitamins or supplements? (liquid diets) Yes, I take Iron supplements, and multi-vitamins.

Do you follow a particular diet? No. (At the hospital she is on a 1800 ADA diet).

Do you have any especially strong craving? No.

Do you have any familial risk factors such as obesity, high cholesterol, diabetes mellitus, hypertension,
Coronary artery disease, cerebrovascular accident or cancer? Yes, I have DM.

What nutritional concerns would you like to discuss? None. Ms. W.S states that she enjoys every food but is having difficulty cooking food...