ADIME Medical Nutrition Therapy Note

Resident Name: Arthur Pendelton

Date: 19/05/2026

Time: 10:15

RD Name: Sarah Jenkins, APD, AN

(A) Assessment

Age: 78 years

Gender: Male

Weight: 61.5 kg

Height: 175 cm

Body Mass Index (BMI): 20.1 kg/m²

Usual Body Weight (UBW): 68.0 kg

Weight History:

• 19/04/2026 (30 days): 63.0 kg (-2.4% loss in 30 days)
• 18/02/2026 (90 days): 65.5 kg (-6.1% loss in 90 days)
• 20/11/2025 (180 days): 68.0 kg (-9.6% loss in 180 days)

IBW/%IBW: 70.0 kg / 87.9% IBW

Appetite: Fair to poor; reports early satiety and post-physiotherapy fatigue.

Food Allergies/Intolerance: Lactose intolerance

Food Preferences: Prefers warm breakfasts (porridge), roast meats, and soft cooked vegetables; dislikes fish and cold sandwiches.

Adaptive Devices: Built-up cutlery and non-slip place mat due to mild right-sided weakness.

Current diet order: High Energy High Protein (HEHP), Soft & Bite-Sized (IDDSI Level 6), Thin fluids (IDDSI Level 0), Low Lactose.

% intake of meals: 50% to 60% of main meals over the past 7 days.

Supplement order: Ensure Plus® (lactose-free) 237 ml PO BD (at 10:00 and 15:00).

% intake of supplement: 75%

Chewing or swallowing difficulty: Mildly delayed oral transit phase; cleared for IDDSI Level 6 solids and Level 0 fluids by Speech Pathology.

Feeding Assistance: Set-up assistance and verbal encouragement required.

Skin condition: Intact; healing superficial abrasion to right shin.

Medical diagnosis: Status post left neck of femur (NOF) fracture ORIF (02/04/2026), Osteoporosis, Sarcopenia, Mild Cognitive Impairment (MCI), Hypertension.

Pertinent labs: Albumin 31 g/L (low), CRP 12 mg/L (elevated), 25-OH Vitamin D 42 nmol/L (insufficient), Hb 118 g/L (low), eGFR 68 mL/min/1.73m².

Pertinent medications: colecalciferol 25 mcg (1,000 IU) PO daily, calcium carbonate 1,250 mg PO daily, macrogol 3350 (Movicol®) 1 sachet PO daily, perindopril 5 mg PO daily, paracetamol 1,000 mg PO QID PRN.

Nutritional Focused Physical Exam (NFPE)

Appearance: Frail, thin elderly male; alert and cooperative, sitting in armchair post-physiotherapy session.

Body Fat: Mild to moderate generalised depletion.

Orbital: Mild

Triceps: Moderate

Fat overlying ribs: Moderate

Muscle Mass

Temple: Moderate

Pectoralis: Moderate

Delt: Moderate

Hand: Moderate

Back: Mild

Thigh: Moderate

Hydration Status: Well hydrated; moist mucous membranes, normal skin turgor, urine output adequate and pale yellow.

Malnutrition Status: Moderate protein-energy malnutrition in the context of subacute recovery post-NOF fracture. Mini Nutritional Assessment - Short Form (MNA-SF) score: 6/14 (Malnourished).

Daily Estimated Nutrition Needs: Per actual body weight (61.5 kg)

Total calories (kcal): 1,850 to 2,150 kcal/day (30 to 35 kcal/kg/day for weight maintenance/repletion and rehabilitation demands)

Total protein (g/kg): 74 to 92 g/day (1.2 to 1.5 g/kg/day for post-operative healing and sarcopenia management)

Total fluids (ml): 1,850 ml/day (30 ml/kg/day)

Does current meal and supplement intake meet estimated needs? No

(D) Nutrition Diagnosis

Inadequate protein-energy intake related to poor appetite, early satiety, and increased metabolic demands post-hip fracture repair and physical rehabilitation as evidenced by estimated intake of 50-60% of meals, 6.1% weight loss in 90 days, BMI 20.1 kg/m², and moderate muscle wasting on NFPE.

Nutrition goals (SMART)

• Resident will maintain current weight of 61.5 kg (+/- 1.0 kg) or demonstrate gradual weight gain of 0.25-0.5 kg/month over the next 30 days to support physical rehabilitation.
• Resident will consume >= 75% of offered meals and >= 80% of prescribed oral nutrition supplements daily over the next 30 days.

The care plan reflects the current nutrition goals.

(I) Nutrition Interventions/Recommendations

• Continue High Energy High Protein (HEHP), Soft & Bite-Sized (IDDSI Level 6), Thin fluids (IDDSI Level 0), Low Lactose diet.
• Adjust oral nutrition supplement timing: Change Ensure Plus® 237 ml BD to 120 ml QID (Medication Pass Program at 08:00, 12:00, 16:00, 20:00) to reduce volume fatigue and improve compliance.
• Provide fortified warm porridge with lactose-free milk and protein powder (Beneprotein® 1 scoop) at breakfast daily.
• Coordinate with Physiotherapy team to avoid scheduling intensive therapy sessions immediately prior to lunch to minimise mealtime fatigue.
• Continue colecalciferol and calcium supplementation as charted to support bone health.

RD interventions and recommendations were communicated to Nursing staff and Physician.

The care plan reflects the current RD interventions and recommendations.

(M/E) Monitoring and Evaluation Plan

• Monitor weight weekly x 4 weeks, then monthly once stable; alert RD if weight loss > 1 kg in a week.
• Nursing staff to record daily meal and Med-Pass supplement intake percentages in the electronic chart.
• Review FBC, U&Es, Albumin, and Vitamin D levels in 4 weeks.
• RD to review resident in 2 weeks to evaluate tolerance and compliance with the Med-Pass supplement regimen and assess weight trajectory.