Diet History

Appetite: poor appetite

Allergies: None

Anthropometry: Height- 5’4”

Weight- 64

Age- 60

Maintenance Medications: •Isoniazid.

•Rifampin(Rifadin, Rimactane)

•Ethambutol(Myambutol)

•Purazinamide

* 4 tabs before breakfast

Food Frequency Checklist/: Breakfast : 1 cup of rice 1-2 scramble egg and 2 orange
24 Hour Dietary Recall Lunch : 1 cup of rice, 1 fish and 3 serving
vegetable
Dinner: 1 cup of rice 3 servings vegetables

Food Preference: Low salt,high in energy and high prevalence of Vit. D

Habits: Reading, watching and walking

Evaluate Dental or Oral Health Problems: Good oral health- don’t have problems regarding for
swallowing.

Evaluate Physical Activity: Exercise twice a day for full 20 mins. Maintaining
8hours of sleep a day

Determine Home Life and Meal Patterns: Cleaning the surroundings , taking nap in the afternoon
and reading news paper
 * 8 in the morning, 12 in the afternoon and 6 in the
evening

Assess Gastrointestinal Conditions: None

Consider Presence of Chronic Disease: Tuberculosis

Evaluate Recent Weight Change: From 75-64kg in just 4 weeks