Introduction

The patient interaction protocol mandates strict adherence to hand hygiene before patient contact. Before engaging with patients, the dietitian emphasizes hand hygiene and evaluates the need for additional personal protective equipment (PPE). Refer to the the WHO hand-washing technique here.
Next the dietitian introduces themselves and verifies the patient's identity using two forms of identification: the patient's chart and verbal confirmation. Consider cultural sensitivity and the patient's emotional well-being. Please take a moment now to practice your patient introduction technique. Practice introducing yourself and explaining the purpose of your visit to August. Watch the Dietitian's Introduction with Patient here. 

Background
August is a 48-year-old Zulu-speaking man who lives with his wife and two sons in an informal settlement 5 km from the Dr. George Mukhari Hospital, close to Sefako Makgatho Health Sciences University Hospital (SMHSU) where you work as a clinical dietitian. August was diagnosed with human immunodeficiency virus (HIV) at the age of 28 (horizontal transmission) and is currently on fixed-dose combination regimen of tenofovir, lamivudine and dolutegravir. He reports to be compliant with treatment.  He is admitted SMHSU hospital with a clinical picture of parapneumonic effusion with a possible etiology of streptococcus pneumonia. This is his first consultation with a dietitian. He has received no dietary advice in the past. 

Click here for the patient's self-assesment questionnaire.

August presented to emergency 3 days ago with fever, shortness of breath, and severe left upper-quadrant pain. His chart notes mucositis with oral candidiasis and mouth ulcers, dysgeusia, and a lack of appetite. He reports a persistent cough, weakness, and a general malaise over the past 3 weeks, with disinterest in usual activities and spending most of the day resting in bed. On admission, oral pain and altered taste made eating and drinking uncomfortable; however, over the last 48–72 hours his appetite, intake, and oral pain have begun to improve. He remains tired but is now more willing to sit up in a chair and engage with the care team.
 

Click here for August's 24-hour Hospital Intake
 

August is unemployed and receives a disability grant of R2090 ($170 AUD) per month, from the South African Social Security Agency (SASSA). August’s wife is employed as a cleaner at the local school and earns a monthly salary of R6000 ($500 AUD). August’s children contribute R7500 ($600 AUD) to the household monthly income. Together, this income covers the living expenses of four people. Typically, 60% of this sum is spent on food, while the remainder goes towards transportation and household expenses. 

Food and Nutrition-Related History (FH)

Diet history, intake patterns, access, culture, preferences, symptoms.
The dietary history is a retrospective, structured interview designed to assess habitual intake from the core food groups. It also explores dietary behaviours, including meal patterns, cultural practices, and nutrition impact factors. This method is particularly useful for identifying usual intake and long-term dietary habits over a defined period. In August’s case, the dietitian considers his usual intake over the preceding six months, corresponding with the onset of weight loss. Evaluating dietary patterns during this period enables identification of nutrient deficiencies or imbalances contributing to malnutrition, thereby informing a comprehensive nutrition assessment and the development of a targeted intervention plan. Use the information in the videos below with August's Diet History to gather information for the Activity 18.1 Completing Nutrition Analysis.THe dietitian also considers August's dietary intake during the hospital admission. See August's Medical Chart.

Anthropometry

Medications, Tests & Procedures

Nutrition-Focused Physical Findings (NFPF) & Symptoms

Client History