Note from Andrew Shamp, MPH, RD at 1991-10-17 12:30

S: Spoke with patient's wife, she reports husband receiving prev, instruction on ADA diet (not exchange/rather modificaions only i.e. decrease simple CHO, limit cal, etc.) Reports husband had 10-12 lbs weight loss PTA (1-2 mo) secondary decrease in appetite.

O: 74 yo WN adm with 4mo hx nonhealing ulcer on right malleolus.  s/p 6m-6m bpg (10116), s/p partial right amputation 85 secondary PVD.  PMHx: 1DDM, x20 years PVD, Glaucoma

       Pt. t/c Hem 2500 Unit (10/16/91)

       Diet: 1500 ADA (presently CL secondary nausea)

       HT- N/A (visually estimated 5'10-5'11), Wt- 162#

       Est IBW- 166# +/- 10, 90 est. IBW 97.90

       UBW= 172#, 90 UBW-94.90

       6/u (10/16) 152/152. Alb- 2.8 (pre-op), BUN-20, Creat- 1.1 Chol- 191, Trig-320 increase

A1P: Est needs: 1800-2000 kcal, 85-95g Pro/day

      Pt 94.90 UBW= recent 10-12# wt. loss A lb (pre-op) indicating moderate visceral pro depletion.  Currently on CL diet (1500 ADA prev. ordered)

*Rec advance to 1800 ADA as tolerated to meet est needs

-Pt's wife said with previous diet teaching.  Do not plan to provide further instruction unless otherwise requested per pt/wife.

-Will continue to monitor

AShamp, MPH,RD

Signed by Andrew Shamp, MPH, RD at 1991-10-17 12:30