IPCA

It is use for patients counseling.

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IPCA

It is use for patients counseling.

Uploaded by

dhyaneepurohit

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as DOCX, PDF, TXT or read online on Scribd

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Nutritional Assessment Form

Patient’s Name: Diagnosis:

Height: Body Mass Index:

Weight: Doctor’s Name:

Age:

Patient’s History:

Medical History:

Vegetarian / Non vegetarian:

Food Allergy:

Lifestyle: Sedentary/ Moderate/ Active

Do you drink alcohol, Yes or No?

Do you smoke, Yes or No?

How often do you eat from outside/restaurants? Daily OR Weekly OR Fortnightly OR Monthly

Biochemical Parameters:

HbA1c [%]:

Fasting blood glucose [mg/dl]:

Post Prandial blood glucose [mg/dl]:

Any other significant values:

DIET PLAN:
Early Morning:

Breakfast:

Mid-Morning:

Lunch:

Evening Meal:

Dinner:

GUIDELINES FOR HEALTHY LIFESTYLE

 Eat a variety of foods to ensure a balanced diet.
 Ensure provision of extra food and health care to pregnant and lactating women.
 Promote exclusive breastfeeding for 6 months and encourage breastfeeding until 2 years or as long as
possible.
 Feed home-based semi-solid foods to the infant after 6 months.
 Ensure adequate and appropriate diets for children and adolescents, both in health and sickness.
 Eat plenty of vegetables and fruits.
 Ensure moderate use of edible oils and animal foods and use a minimum of ghee/butter/vanaspati.
 Avoid overeating to prevent overweight and obesity.
 Exercise regularly and be physically active to maintain ideal body weight.
 Restrict salt intake to a minimum.
 Ensure the use of safe and clean foods.
 Adopt the right pre-cooking processes and appropriate cooking methods.
 Drink plenty of water and take beverages in moderation.
 Minimize the use of processed foods rich in salt, sugar and fats.
 Include micronutrient-rich foods in the diets of elderly people to enable them to be fit and active.

PHYSICAL ACTIVITY GUIDELINES

It is recommended to carry out at least 45 minutes of physical activity of moderate intensity for at least 5 days a week.
This amount of physical activity may reduce the risk of some chronic diseases.
To lose weight, experts recommend that at least 60 minutes of moderate- to vigorous-intensity physical activity be
taken on most days of the week.

The Centre for Disease Control (CDC) gives a list of moderate and light-intensity exercises, which can include:
Aerobic Exercises:
 Brisk Walking
 Swimming
 Riding a Bicycle
 House and Yard Work
 Playing Physically Intense Games Such as Baseball, Softball, or Basketball Bone
Strengthening Exercises:
 Hopping, Skipping, or Jumping
 Jogging or Running
 Yoga
Light Intensity Activities:
 Walking Slowly
 Washing Dishes
 Gardening
Moderate Intensity Activities:
 Tennis
 Dancing
 Boxing
If a physical activity does not increase the heart rate, it is not intense enough to be counted in the category of “45
minutes of exercise a day”. Activities that do not increase the heart rate include walking at a casual pace, grocery
shopping, and doing light household chores. For children, the CDC recommends 60+ minutes of aerobic activity per
day and extra bone and muscle-strengthening activities.

Guide to a Home Exercise Program [for older patients]

Strength Training: Perform the following exercises 2 times per week.

1. Sit to stand. Start with 10 and progress up to 30 as you tolerate.
2. Chair squats. Start with 10 and progress up to 30 as you tolerate.
3. Heel and toe raises. Start with 10 and progress up to 30 as you tolerate.
WARNING: If you experience chest pain, shortness of breath, or prolonged muscle soreness during exercise, consult
your physician before continuing your program.

References: Matsuda, Patricia Noritake, P.T., D.P.T., Shumway-Cook, A., & Ciol, M. A., PhD. (2010). The effects of
a home-based exercise program on physical function in frail older adults. Journal of Geriatric Physical Therapy, 33(2),

Shubert, Tiffany E,M.P.T., PhD. (2011). Evidence-based exercise prescription for balance and falls prevention: A
current review of the literature. Journal of Geriatric Physical Therapy, 34(3).