ASSESSMENT OF NUTRITIONAL STATUS

Goal :
After doing the skill lab of the assessment of nutritional status,
1. students can practice themselves
2. students can make interpretations for the results of their assessment.
NUTRITIONAL STATUS
I. Identification
Name
: Ratih Riesafitri
Age
: 19 years old
Sex
: female

Resident
Education
Job

:
:
:

II. History
A. Medical History:
1. a. The highest weight ever reached/when : 45 kg/June 2008
b. the lowest weight ever reached/when : 41 kg/November 2007
2. for the last 3 month
a. sick or illness
- Anorexia : no
- Vomitus
: no
- Diarrhea : no
b. weight gain/ when started
: May 2008
c. weight lost/ when started
:d. additional information :
- Anemia
: no
- gastrointestinal disorder/surgical treatment
: no
- infection
: no
- chronic illness
: no
- congenital malformation
: no
- food allergy
: no
- drugs and special food previously used
:
fludexin and antibiotic
B. Diet History:
1. what kind of food usually consumed
Rice
: yes, one portion
Meat
: yes, one
Tahu
: yes,
Tempe
: no
Vegetable : yes
Fruits
: yes, two
Milk
: once (morning)
Others
:
2. what kind of food always consumed
3. what kind of food never consumed
4. what kind of food seldom consumed
5. meals usually taken perday
Once
:
Twice
:
Three times :

:
: sambal, jeroan, hati.
: fat food, rendang,
:

6. snacks
: never/seldom/often/everyday
: seldom
Kind of snack usually consumed
: chiki, wafer, biscuit,
kripik, kemplang.
7. vitamins or minerals consumed : when/waht : 8. food intake for specific meals within the past 24 hours :
III. Physical Examination -> list of signs attributed to nutritional status (see
appendix III)
IV. Anthropometry:
1. Height
: 155 cm
2. Weight
: 45 kg
3. Height weight index
:4. Weight height index
:5. Body mass index
: 18, 7
6. Skin-fold thickness
:
7. Circumference
:
- Head circumference
:- Mid-upper arm circumference
: 24, 6 cm
- Abdominal circumference
: 64, 5 cm
- Pelvic circumference
: 84 cm
- Abdominal pelvic circumference ratio : 0,76
V. Laboratory examination
:VI. Additional examination
:Such as Radiology, bio-electrical impedance, etc
VII. Interpretation
:
1. Height weight index (see : appendix I)
Height weight index
:
Weight height index
:
2. Body Mass index
Severe undernutrition
Mild undernutition
Normal
Overweight
Obese

:
:
: yes
:
:

3. Skin fold thickness (see : Appendix II)

Iswahyudi
Triceps and subscapular
: 7 and 6
Mid-upper circumference :
Head circumference
:
Raden Ikhsan
Triceps and subscapular
Mid-upper circumference
Head circumference
Reza Arlas
Triceps and subscapular
Mid-upper circumference

: 6 and 8
:
:
: 6 and 7
:

Head circumference

4. Abdominal pelvic circumference ratio

Male
:
Female
:
5. Laboratory evaluation of nutritional status index
(see appendix IV)