MSH|^~\&|ITS|ARH|||202001211507||ORU^R01|4151246|D|2.3|||AL|NE
PID|1|FHATVIG0011043|AB00008240|AB8134|ITSTEST^DRAGGONBUB||19940919|F||||||||||AB000486/19|
PV1|1|I
OBR|1|||||202001211503|20200121|202001211503||||||||||||FNS|INPTAX||||D||||||
OBX|1|TX|||          \H\NAME\N\:   ITSTEST,DRAGGONBUB           
OBX|2|TX|||         \H\ACCT#\N\:   AB000486/19    \H\UNIT#\N\:  AB00008240     
OBX|3|TX|||         \H\ADM DT\N\:   19/09/19    \H\PHN\N\:       
OBX|4|TX|||\H\Food \T\ Nutrition Services\N\         \H\LOC\N\:   AB-SH    \H\RM/B\N\:  ABSH-01-16     
OBX|5|TX|||\H\In-Pt Nutrition Assessment\N\         \H\DOB\N\:   19/09/1994    \H\A/S\N\:  25 F     
OBX|6|TX|||         \H\REG CAT\N\:   AB.ACU           
OBX|7|TX|||         \H\ATT DR\N\:   ZTESTDOC,IM/IT Use ONLY           
OBX|8|TX|||         \H\FAM DR\N\:   ZTESTDOC,IM/IT Use ONLY           
OBX|9|TX|||\ZU\                                                                                                                                                                     \N\                       
OBX|10|TX|||\H\  
OBX|11|TX|||DATE: \N\21/01/20  
OBX|12|TX|||  
OBX|13|TX|||\H\Reason For Assessment:\N\ High Risk Diagnosis  
OBX|14|TX|||\H\  
OBX|15|TX|||\ZHU\NUTRITION ASSESSMENT  
OBX|16|TX|||\H\  
OBX|17|TX|||\ZHU\Relevant Medical Information  
OBX|18|TX|||\H\Diagnosis/Medical Progress:\N\ TEST  
OBX|19|TX|||\H\Medical Hx:\N\ TEST  
OBX|20|TX|||\H\Medications:\N\ TEST4  
OBX|21|TX|||\H\Biochemical Data:\N\ TEST  
OBX|22|TX|||\H\Social Hx:\N\ TEST  
OBX|23|TX|||  
OBX|24|TX|||\ZHU\Food/Nutrition Related Information  
OBX|25|TX|||\H\Current Diet:\N\ TEST  
OBX|26|TX|||\H\Intakes:\N\ TEST  
OBX|27|TX|||\H\Diet Hx:\N\ TEST  
OBX|28|TX|||\H\Food Allergies/Intolerances:\N\ No Known Food Allergies  
OBX|29|TX|||  
OBX|30|TX|||\ZHU\Nutrition Focused Physical Findings  
OBX|31|TX|||\N\-TEST  
OBX|32|TX|||\ZHU\  
OBX|33|TX|||Anthropometrics  
OBX|34|TX||| 2  
OBX|35|TX|||  
OBX|36|TX|||\H\Current Wt:\N\ 75 kg (Estimated) \H\Ht:\N\  172 cm (Estimated) \H\BMI=\N\ 20  
OBX|37|TX|||   
OBX|38|TX|||\H\Usual Wt:\N\ 70 kg \H\Ideal Wt:\N\ 70 kg (based on BMI of 25)   
OBX|39|TX|||   
OBX|40|TX|||\H\Adjusted Wt\N\ (for Obesity): 50 kg \H\Wt Hx:\N\ Significant Loss. 20% change over 30   
OBX|41|TX|||  
OBX|42|TX|||\ZHU\  
OBX|43|TX|||Current Nutrition Status\N\ as per Subjective Global Ax (SGA):   
OBX|44|TX|||Well-nourished / Normal (SGA A - see ax tool in EMR dated TEST)  
OBX|45|TX|||Mild/Moderately malnourished / Some progressive nutritional loss (or suspected of being) malnourished (SGA B - see ax tool in EMR dated TEST)  
OBX|46|TX|||Severely malnourished / Evidence of wasting and progressive symptoms (SGA C - see ax tool in EMR dated TEST)  
OBX|47|TX|||  
OBX|48|TX|||\ZHU\Refeeding Risk:\N\ Yes  
OBX|49|TX|||  
OBX|50|TX|||\ZHU\Estimated Requirements  
OBX|51|TX|||   \H\Energy: \N\TEST kcal/d ([*])  
OBX|52|TX|||\H\   Protein: \N\[*] g/d ([*])  
OBX|53|TX|||\H\   Max CHO: \N\[*] g per day (7 g/kg/d)  
OBX|54|TX|||\H\   Max Fat: \N\[*] g per day (1 g/kg/d)  
OBX|55|TX|||\H\   Sodium: \N\[*]-[*] mmol per day (1-2 mmol/kg/d)  
OBX|56|TX|||\H\   Potassium: \N\[*]-[*] mmol per day (1-2 mmol/kg/d)  
OBX|57|TX|||\H\   Magnesium: \N\4-10 mmol/d  
OBX|58|TX|||\H\   Phosphorus: \N\20-40 mmol/d  
OBX|59|TX|||\H\   Calcium: \N\5-8 mmol/d  
OBX|60|TX|||\H\  
OBX|61|TX|||\ZHU\NUTRITION PROBLEM\H\: \N\[*] related to [*] as evidenced by [*]  
OBX|62|TX|||\ZHU\  
OBX|63|TX|||\N\____________________________________________________________________________      
OBX|64|TX|||  
OBX|65|TX|||\ZHU\NUTRITION INTERVENTION  
OBX|66|TX|||\H\  
OBX|67|TX|||\ZHU\Goals:\N\ Meet estimated needs, Electrolyte balance, Optimize micronutrients  
OBX|68|TX|||  
OBX|69|TX|||\ZHU\Implementation:\N\   
OBX|70|TX|||- Provide central parenteral nutrition guidelines.  
OBX|71|TX|||- Request add-on B/W: [*].  
OBX|72|TX|||  
OBX|73|TX|||\H\Parenteral Nutrition \N\(via central line)  
OBX|74|TX|||\ZHU\Initial Order  
OBX|75|TX|||\N\- [*] mL [*] % amino acid / [*] % dextrose  
OBX|76|TX|||- [*] mL 20% [*] lipid every 48h  
OBX|77|TX|||Provides: [*] kcal and [*] g of protein per day  
OBX|78|TX|||Additives:  
OBX|79|TX||| 3  
OBX|80|TX|||  
OBX|81|TX||| [*] mmol Sodium Acetate     [*] mmol Sodium Chloride  
OBX|82|TX|||   
OBX|83|TX||| [*] mmol Potassium Acetate   [*] mmol Potassium Chloride  
OBX|84|TX|||   
OBX|85|TX||| [*] mmol Sodium Phosphate     [*] mmol Magnesium Sulfate  
OBX|86|TX|||   
OBX|87|TX||| [*] mmol Calcium Gluconate   [*] mg Zinc Sulfate  
OBX|88|TX|||   
OBX|89|TX||| [*] mg Folic Acid   
OBX|90|TX|||  
OBX|91|TX|||Provides: [*] mmol Sodium, [*] mmol Potassium, [*] mmol Acetate and [*] mmol Chloride per day  
OBX|92|TX|||\ZHU\  
OBX|93|TX|||Goal Order\H\ \N\(once ready for progression):  
OBX|94|TX|||- [*] mL [*] % amino acid / [*] % dextrose  
OBX|95|TX|||- [*] mL 20% [*] lipid every 48h  
OBX|96|TX|||Provides: [*] kcal and [*] g of protein per day  
OBX|97|TX|||Additives to be adjusted depending on labs / medical issues.  
OBX|98|TX|||\H\  
OBX|99|TX|||Enteral Nutrition  
OBX|100|TX|||\ZU\Goal\N\: [*] at [*] mL/h nocturnal with [*] protein packs/d  
OBX|101|TX|||\ZU\Initial Rate\N\: [*] mL/h  
OBX|102|TX|||\ZU\Progression\N\: increase by [*] mL every [*] hours as tolerated  
OBX|103|TX|||\ZU\Provides\N\: [*] kcal, [*] g of protein and [*] mL of free water per day  
OBX|104|TX|||\ZU\Flushes\N\: [*] mL q4h when no IVs \ZHU\or\N\ [*] mL q4h while on IVs  
OBX|105|TX|||\H\  
OBX|106|TX|||Oral Nutrition\N\: [*] diet with texture modifications/supplements as required when safe to swallow and/or GI tract viable.  
OBX|107|TX|||  
OBX|108|TX|||Consent Obtained: Implied  
OBX|109|TX|||____________________________________________________________________________      
OBX|110|TX|||\H\  
OBX|111|TX|||\ZHU\NUTRITION MONITORING AND EVALUATION  
OBX|112|TX|||  
OBX|113|TX|||\N\Follow-up regularly, to monitor diet initiation, TF initiation/tolerance, TF rate progression with further detailed charting when/if nutrition plan changes.  
OBX|114|TX|||  
OBX|115|TX|||  
OBX|116|TX|||  
OBX|117|TX|||\H\Ryan De Los Santos, RD  
OBX|118|TX|||\N\Date/Time:  21/01/20  1503