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A Paper on:

“Multiple Physical Injury Secondary to Motor Vehicle Accident”

In partial fulfillment of the requirements of the course

ND90- Medical Nutrition Therapy I

For the degree

BACHELOR OF SCIENCE IN NUTRITION AND DIETETICS

Submitted by:
Estonilo, Excel Marie
Garrido, Jo Hana
Ilagan, Gwynneth Eiza
Naparota, Christine Pauline
Vidamo, Jericho

Submitted to:
Asst. Prof. ALVYN KLEIN A. MANA-AY
Course Instructor

January 2019
TABLE OF CONTENTS
PART 1: OVERVIEW....................................................................................................................................... 3
I. Introduction........................................................................................................................................... 3
II. Patient Profile....................................................................................................................................... 4
III. Pathophysiology .................................................................................................................................. 6
Nature of the disease, condition, or disorder ..................................................................................... 6
Signs and symptoms ............................................................................................................................. 8
Etiology ................................................................................................................................................. 9
Pathogenesis....................................................................................................................................... 10
PART 2: THE NUTRITION CARE PROCESS ................................................................................................... 11
IV. Assessment ....................................................................................................................................... 11
Food and Nutrition – Related History................................................................................................ 11
Anthropometric Measurements ........................................................................................................ 11
Biochemical data, Medical test, and Procedures .............................................................................. 11
Nutrition – Focused Physical Findings ............................................................................................... 11
Client History ...................................................................................................................................... 11
V. Diagnosis ............................................................................................................................................ 12
VI. Intervention ...................................................................................................................................... 12
VII. Monitoring and Evaluation .............................................................................................................. 14
VIII. Summary and Conclusions ............................................................................................................. 15
IX. References ......................................................................................................................................... 16
X. Appendices ......................................................................................................................................... 17

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PART 1: OVERVIEW
I. Introduction
Motorcycle is the most common means of transportation nowadays. “However, per
vehicle-mile travelled, a motorcyclist is 37 times more likely to die in a crash and 9 times
more likely to be injured (NHTSA 2008f).” As Newton’s First Law of Motion states that an
object in motion will remain in motion until acted on by another force, thus, the
motorcycle in motion will continue to move until such time that a brake, tree, another
vehicle or some other force causes it to slow down, stop or change direction. The damage
is dependent on the change of speed and how fast the change occurs.
Multiple physical injuries are physical insults or injuries occurring simultaneously
in several parts of the body which usually sustained multiple traumatic injuries to the
body, affecting different organs and body systems. The multi-injured patient may have a
head injury, multiple fractures, and injury to the internal organs of the chest or abdomen
and other minor injuries. The more body systems involved usually indicates more serious
complications. Physical injury or wound that’s inflicted by an external or violent act, it
maybe intentional or unintentional, involve injuries to more than one body area or organ.
Multiple system injury of any type should be considered multiple trauma.
Laceration is the cut that goes all way through the skin. The goals of laceration
repair are to achieve hemostasis and optimal cosmetic results without increasing the risk
of infection. Skin avulsion is a wound that happens when skin is torn from your body
during an accident or other injury. The torn skin may be lost or too damaged to be
repaired, and it must be removed. A wound of this type cannot be stitched closed because
there is tissue missing. Avulsion wounds are usually bigger and have more scars because
of the missing tissue.
The impact from motor vehicle accidents can often cause chipping and/or
fracturing of the teeth. Fracturing can occur at a variety of severities. Teeth can also
become dislodged in a car accident. If your teeth hit a hard surface it is possible that the
impact may have caused one or more of your teeth to dislodge from their sockets. Neck
area, Zone II is found between the cricoid cartilage and the angle of the mandible. You

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can find the carotid and vertebral arteries, the internal jugular veins, trachea, and the
esophagus in this certain area.
The significance of this study is advancing future researchers about this particular
topic, the medical scientific knowledge and understanding of etiology, pathogenesis,
pathophysiology, natural history, and treatment about these kinds of multiple traumas.
It also provides information for the researchers about the proper management and care
for patients with this condition. This study is significant to help future researchers that
have almost the same topic for them to have a basis about these kinds of multiple
traumas. These multiple injuries maybe considered as multiple trauma since they
happened simultaneously.

II. Patient Profile

The patient is a 27-year-old male, experiencing multiple physical injury, laceration,
avulsed wound, neck area, zone II secondary to motor vehicle accident. The patient also
has difficulty chewing (mechanical problem) and is suffering from severe trauma, with
dental damages due to the MVA.
He has an inadequate food intake resulting to lack of amount eaten as evidenced
by diet history. He also has excessive consumption of salty and sweet food resulting to
food preference of salty and sweet food evidenced by diet history. Hence the patient is
advised to consume soft diet orally with nutrition counseling on salt and sugar.
Since the patient is suffering from multiple injury, laceration and avulsed wound,
neck area, zone II due to motor vehicle accident, the patient has difficulty chewing
(mechanical problem), he is advised for soft diet with strict aspiration precaution. He is
also suffering from severe trauma, with dental damages due to the impact that happened
during the MVA. Multiple traumas may also include hematoma, which is the collection of
blood outside the blood vessel.
In relation to the patients food preferences, high sugar content in the body may
lead to poor wound healing since too much sugar in the blood may lead to the stiffening
of the cell walls which then impairs the blood flow throughout the small vessels located
at the surface of the wound, on the other hand, high intake of salt may lead to

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hypertension which the patient is also prone to since his mother has a hypertension as
seen in the data available.
The patient has dental damage that could hinder his ability to chew and
mechanically break down food hence he is advised for a soft diet to support his nutritional
needs. Due to the motor vehicle accident the patient has low RBC, HCT, low hemoglobin,
low lymphocyte and high WBC. Increase iron rich food intake for blood production and
vitamin c to hasten absorption of iron.
Admission details, diagnosis, prognosis
Multiple physical injuries, lacerations, avulsed wound zone II, neck area secondary
to motor vehicle accident due to driving under the influence of alcohol. Patient’s
lacerations may swell and be infected. The optimal time interval from injury to laceration
is not clearly defined. Anatomic location of the wound, health of the patient, mechanism
of injury and wound contamination factor into the decision when to repair the laceration.
Regardless of location, these older lacerations can be repaired with loose, single
interrupted sutures that are sufficient to close the wound. Alternatively, if no wound
infection develops the wound may be packed for 3 to 5 days followed by delayed primary
closure. If infection occurs, the wound should be allowed to heal by secondary intention.
Avulsed wounds may take longer to heal because they cannot be closed with tape or
stiches. It has high risk of infection: lesions are always contaminated due to the
mechanism of injury (mostly vehicle accidents).
Injuries to permanent teeth are common results of falls, motor vehicle accidents,
sports injuries, and violence. Avulsions are characterized by complete displacement of
the tooth from the socket. Avulsed permanent teeth are considered a dental emergency
and should be replanted by the first individual capable of doing so. If immediate
replantation is not possible, the tooth should be stored in cold animal or human milk; it
also can be stored in the mouth, adjacent to the buccal mucosa, if the patient is capable
of doing so. Water should be avoided as a storage medium because it impedes healing
of the periodontal ligament, but storage in water is superior to dry storage. All patients
with dental trauma should follow up promptly with a dentist. Patients presenting with

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chronic dental pain without an obvious treatable etiology will benefit from ongoing
support from their family physicians.

Treatment initial diagnostic tests will be completed, typically in the form of x-rays
or magnetic resonance imaging (MRI), to determine if an avulsion injury has occurred
within the body. Superficial avulsions that involve the skin or cartilage like the ears would
normally not require these tests, unless an internal structure is potentially damaged as
well. For superficial avulsions, wound care and stitches may be required depending on
the severity of the avulsion. For smaller skin avulsions, stitches can be used to reattach
the loose skin back to the healthy skin. This will facilitate a faster, more effective healing.
For larger skin avulsions that may have resulted in most if not all of the tissue being
detached, stitches will not be used as there wouldn't be enough remaining healthy tissue
to reattach. In these cases, it is essential for proper cleaning and dressing of the wound
to limit infection and to promote healing. In some severe cases, a skin graft would be
used to cover the area where the skin has been removed. This requires surgery and is a
common procedure in injuries involving a large amount of tissue loss. In all situations,
cleaning the wound and the use of antibiotic medications in the form of ointments or pills
will likely be used to prevent infection.

The subsequent long-term hospitalization adds an additional risk for nosocomial

infections.

III. Pathophysiology
Nature of the disease, condition, or disorder

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 Motorcycle stopped or changed
Motorcycle in
direction due to impact caused by Body hits another object
motion
another object

Physical damages may occur due

Due to trauma, to impact (laceration, avulsion,
Bleeding
dental damages, hematoma may
damage occurs
also occur

Injury Tissue Swelling Increased compartment pressure

Cell membrane damage Local hypoxia Decreased perfusion pressure

Laceration

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 Activation of clotting cascade/ Endothelial damage
complement cascade

Activation of neutrophil
granulocytes

Increased permeability

Edema

Ischemia

Tissue necrosis

Signs and symptoms

Lacerations causes inflammation and pain. If infection happens, redness, swelling
of the wound may be visible. Avulsed wounds cause bleeding, swelling, redness and pain.

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Dental Damage causes avulsions which is characterized by complete displacement of
tooth from the socket.

Etiology
Laceration is a physical injury that happens when the 3 layers of the skin and the
soft tissue underneath it is damaged. This may be caused by injury with a sharp object
or by impact injury from a blunt object or force. Avulsed wound is when the skin is torn
or separated from the body due to an accident or injury. This torn skin needs removal
since it may be too damaged that some of its tissue is lost hence stitching is impossible
to repair it, or it might be that the torn skin itself is lost due to the accident or injury. The
patient also suffered from dental damage which gave him difficulty in mechanically
breaking down his food hence he was advised for soft diet with SAP.
Avulsed wound is a torn skin during an accident. Is a wound where the skin is torn
from the body during an accident or other injury. The avulsed skin is severely damaged
that some of its tissues are missing. It cannot be restored even if stitched and removal
of the skin is necessary. Avulsion wounds are usually bigger and have more scars

because of the missing tissue.

Traumatic dental injuries often occur as a result of an accident or sports injury.
The majority of these injuries are minor - chipped teeth. It’s less common to dislodge
your tooth or have it knocked completely out but these injuries are more severe.
Treatment depends on the type, location and severity of each injury. Regardless of the
extent of the injury, your tooth requires immediate examination by a dentist or an
endodontist. Sometimes, your neighboring teeth suffer an additional unnoticed injury.
Multiple injuries are impact during motor vehicle accident. It is also a multiple
trauma where the patient has several serious injuries from an accident occurring in any
part of the body.

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Pathogenesis (patient-based)
Laceration, tearing of the skin that results in an irregular wound. Lacerations may
be caused by injury with a sharp object or by impact injury from a blunt object or force.
They may occur anywhere on the body. In most cases, tissue injury is minimal, and
infections are uncommon. However, severe lacerations may extend through the full
thickness of the skin and into subcutaneous tissues, including underlying muscle, internal
organs, or bone. Severe lacerations often are accompanied by significant bleeding and
pain.

An avulsion is the pulling away or the detaching of a structure within the body. An
avulsion is caused in two main ways: a traumatic injury creating a forceful event that
results in the structure being detached, or surgically, when the surgeon detaches the
structure manually in order to resolve some other underlying issue.

After getting a cut, scratch, or abrasion, your skin may start bleeding. This
happens because the injury breaks or tears the tiny blood vessels, which are right
under the skin's surface. Your body wants to stop the bleeding so the in your blood
come to the rescue. At the site of a wound, which is another word for injury, platelets
stick together, like glue. This is called clotting, which works like a plug to keep blood
and other fluids from leaking out. A scab, a hardened and dried clot, forms a crust over
the wound. This protects the area so the skin cells underneath can have time to heal.
Underneath the scab, new skin cells multiply to repair the wound. Damaged blood
vessels are repaired, and infection-fighting white blood cells attack any germs that may
have gotten into the wound. You can't see it under the scab, but a new layer of skin is
forming. And when the new skin is ready, the scab falls off. A scab usually falls off
within a week or two. If you pick at a scab, the new skin underneath can be ripped and
the wound will take longer to heal and may leave a scar.

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PART 2: THE NUTRITION CARE PROCESS
IV. Assessment
Food and Nutrition – Related History
Based on the given data, the patient prefers to consume salty and sweet foods.
He has sub-optimal food intake, lack amount eaten as evidence by diet history.

Anthropometric Measurements
The patient’s estimated Height is 5 ft and 4 inches and his estimated weight is 57
kg. his BMI is 21.27 which is classified Normal by FAO/WHO chart.

Biochemical data, Medical test, and Procedures

Based on the patient’s complete blood count test results, it indicates that he has
Low total lymphocytes which is 7.30, Low hematocrit 37.10, Low hemoglobin 124, Low
RBC 4.15 and High WBC 16.86.

Nutrition – Focused Physical Findings

Evaluation of potential nutrition risk screening to assess the risk of nutritional
depletion. As of patients screening criteria for potential nutritional risk, there is no physical
signs of malnutrition yet subjective data’s details showed that he has sub-optimal food
intake. The patient is expected to stay in the hospital for not more than 2 weeks which
makes his functional capacity in bed but mobile. He has chewing difficulties due to dental
damage with risk of aspirations.

Client History
Based on the patient’s record, he prefers eating salty and sweet foods. His
mother’s side has hypertension.

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V. Diagnosis
Inadequate food intake resulting to lack of amount eaten as evidenced by diet
history.
Excessive consumption of salty food and sweet food resulting to food preference
of salty and sweet food as evidenced by diet history.

VI. Intervention
Inadequate food intake: supplement soft diet with milk to increase caloric value
of meal.
Early oral nutrition is a critical part in care of multiple injured patients’ current
recommendation is to provide early enteral nutrition to patient with functional GI tracts.
The goal is to support of early hypermetabolism associated with injury and prevention of
protein calorie malnutrition that occurs within 1—2 days of injury.
High protein soft diet food for tissue damage repair and to help boost the immune
system to prevent infection. Milk fortified with iron to increase caloric value of meal. Iron
to increase hemoglobin and RBC count, vitamin C to hasten iron absorption, boost
immune system reduce/control the intake of sweet foods to avoid decelerating the
process of wound healing. Reduce/control the intake of salty foods to avoid hypertension.
Nutritional supplementation if nutrition requirements cannot be achieved by dietary
intake. Arginine is needed to help improve circulation increase carbohydrate intake for
protein anabolism. Increase Vitamin A to stimulates inflammatory response therefore
promoting collagen synthesis and supports healthy wound healing. Vitamin B to
metabolize carbohydrates and proteins to produce energy which is essential for cell
growth. Oral rehydration should be closely monitored to replace fluid loss and prevent
dehydration.

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 Excessive consumption of salty and sweet food: nutrition counseling of patient on
salt and sugar.

Nutrition Prescription
Hospital Diet
Due to the accident, he suffered dental damages which resulted to chewing
impairment. He is given a soft diet with strict aspiration precaution. Soft diet consists of
foods that are tender but not ground or pureed. Type of feeding: Oral feeding.

Total Energy Requirement

= 2,000 kcal
Percentage Distribution
CHO: 2,000 kcal x 65 = 1300/ 4 = 325g
CHON: 2,000 kcal x 15 = 300/ 4 = 75g
FAT: 2,000 kcal x 20 = 400/ 9 = 45g

Diet Rx: 2,000 kcal; 325g CHO; 75g CHON; 45g FAT
Maintenance Diet
Since the patient has dental damage, he is given soft diet until he is able to chew
properly. This aims to provide oral feedings that will promote return to a normal intake
of food. Maintenance diet consist of mechanically soft diet of high caloric foods and high
protein.
Desirable Body Weight (DBW)
= 61 kg
Total Energy Requirement
=2,450 kcal
Percentage Distribution
CHO: 2,450 kcal x 65 = 1592.5/ 4 = 400g

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 CHON: 2,450 kcal x 15 =367.5/ 4 = 91g
FAT: 2,450 kcal x 20 = 490/ 9 = 55g

Diet Rx: 2,450 kcal; 400g CHO; 91g CHON; 55g FAT

VII. Monitoring and Evaluation

Medical nutrition therapy including the nutrition intervention is closely monitored
and evaluated for health progress of our patient, making sure it is suitable and implied.
Daily
 Monitor patient’s daily diet intake
 Monitor medications regularly to hasten recovery
 Monitor oral rehydration intake to prevent dehydration and replace fluid
losses
 Monitor the patient’s physical activity
 To infection, open wounds should be regularly cleaned
Weekly
 Monitor patient’s complete blood count
 Monitor patient’s biochemical data to see if there are changes
 Monitor physical appearance (muscle wasting)
 Monitor patient’s anthropometric measures
 Monitor patient’s recovery if there are changes in diet prescription
Monthly
 Monitor laboratory results to determine if there are any changes or progress
EVALUATION
 Patient has met the normal complete blood count.
 Patient has recovered from muscle wasting as seen in his physical
appearance.
 Patient’s lacerations are healed.
 Patient is able to chew properly and soft diet is not needed anymore.

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  Patient has achieved normal BMI

VIII. Summary and Conclusions

Motor vehicle accident is one of the most common accidents that usually
cause multiple injury lacerations, avulsed wounds, dental damage, and physical trauma.
Because of the said complications, patient’s nutrient requirements are monitored closely
from time to time to hasten recovery. High biological value protein for tissue damage
repair, iron to increase hemoglobin count, vitamin C to hasten iron absorption, arginine
for improvement of circulation and zinc for wound healing. The patient is also given
supplements to assure nutrient requirements are met if diet is not enough. The patient
may hasten recovery with the supplementation of milk with addition of zinc. Vitamins as
an important factor in fighting harmful elements avoiding further infections. Proper food
intake to restore strength and tissue damages.
Oral rehydration should be given priority to replace fluid losses and avoid
dehydration. Patients medical and biochemical results is closely monitored to assure
patients medical progress, if there are no improvement, then medical nutrition therapy
should be revised.

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IX. References
Black, J. (2005) Medical-Surgical nursing: clinical management for positive outcomes, 7th
edition. Sounders

Williams, S. (nd) Nutrition and Diet Therapy, 6th edition.

Ruiz, A., Claudio, V., Diamonon, G. (nd) Nutrition Therapy for Nursing.

Barker, H. (nd) Nutrition and Dietetics for Health Care, 10th edition.

Adin, M. (2019). Home. [online] Eatrightny.org. Available at: https://www.eatrightny.org/

von Rüden, C., Woltmann, A., Röse, M., Wurm, S., Rüger, M., Hierholzer, C. and Bühren,
V. (2019). Outcome after severe multiple trauma: a retrospective analysis.

AI, M. (2019). Oral health: treatment of dental trauma and pain. - PubMed - NCBI.
[online] Ncbi.nlm.nih.gov. Available at:
https://www.ncbi.nlm.nih.gov/pubmed/25594450

American Association of Endodontists. (2019). Traumatic Dental Injuries | American

Association of Endodontists. [online] Available at: https://www.aae.org/patients/dental-

symptoms/traumatic-dental-injuries/
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 X. Appendices

Appendix A

Laboratory Reference
Parameter Results Range Description Interpretation

Hematocrit 38.3 – 48.6 % Insufficient supply of red blood

37.10 Below Normal cells
(HCT) (male)

Hemoglobin level is below

Hemoglobin 124 138 – 172 grams Below Normal
normal range
(HGB) per liter (male)
The total Lymphocytes level in
Total LYM 7.3 20- 45 g/dL Below Normal the blood is below normal
range
The WBC count is higher
4 – 11 million
WBC 16.86 Above Normal compared within normal range
mcL

The RBC count is lower

4.5 – 6.5 million
RBC count 4.15 Below Normal compared within normal range
mcL

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Appendix B
Hospital Diet:
BMI:
a. = (5 ft x 12 in.) + 4
= 64 x 2.54
= 67.56/ 100
= 1.6256m
b. BMI: 57 kg/ 1.6256 m2
= 57 kg/ 2.6425
= 21.57
FAO/WHO Classification: Normal

TER= 57 kg (Current Weight) x 35 (In bed but mobile Pa)

= 1995 kcal or 2, 000 kcal

NO. OF
FOOD CHO CHON FAT ENERGY
EXCHANGES
Veg. A 2 3 1 16
Veg. B 1 3 1 16
Fruit 2 20 80
Milk(whole) 2 24 16 20 340
Rice 11 253 22 1100
meat LF 2 16 2 82
MF 2 16 12 172

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 HF
Sugar 4 20 80
Fat 2 1/2 12.5 112.5
TOTAL 323g 72g 46.5g 1998.5

# B AM L PM D MN

I. Veg. A 2 2

II. Veg. B 1 1

III. Fruit 2 ½ 1 ½

IV. Milk 2 1 1

V. Rice 11 3 1½ 3 1½ 2

V. meat

LF 2 1 1

MF 2 1 1

HF

VI. Sugar 4 1 1 1 1

VII. Fat 2½ ½ 1 1

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FOOD SAMPLE NO. OF Wt. IN APPROXIMATE
GROUP FOOD EXCHANGES GRAMS SERVING SIZE
BREAKFAST

Veg B Mashed Squash 1 45 g ½ cup cooked

Fruit Mango Puree ½ 60 g ½ cup
ripe
Milk Fresh cow’s 1 250 g 1 cup
milk
Rice Lugaw (Medium 1 435 g 3 cups
Consistency)
Sweet potato 2 160g ½ of 11 cm long x
4 – ½ cm diameter
Med Fat Meat Egg 1 60 g 1 pc
Fat Oil ½ 5g 1 tsp
Sugar Honey 1 5g 1 tsp
AM SNACK

Rice Cassava Cake 1½ 45 g ½ of 15 x 3 x 2 cm

Sugar Taho with syrup 1 40 g ¼ cup
and sago
LUNCH

Veg. A Malungay 1 45 g ½ cup cooked

Leaves
Veg. B Tomato 1 45 g ½ cup cooked
Fruit Banana 1 40 g 1 (9 x 3 cm)
Rice Porridge (Med. 1 435 g 3 cups
Consistency)
Sweet Potato 2 160g ½ of 11 cm long x
4 – ½ cm diameter
Meat LF Chicken Tinola 1 30 g 1 slice match box
size (5x3 – ½ x 1)
MF Tofu 1 100 g ½ cup
Fat Oil 1 5g 1 tsp
Sugar Honey 1 5g 1 tsp
PM SNACK

Milk Fresh cow’s 1 250 g 1 cup

milk
Rice Sweet potato 1½ 80 g ½ cup
Sugar Sugar 1 5g 1 tsp
DINNER

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Fruit Watermelon ½ 140 g 1 cup
Rice Lugaw (Thin ½ 352.5 g 2 ¼ cups
Consistency)
Gabi 1½ 150g 2 (6 cm long x 4 cm
diameter)
Meat (LF) Pork Liver 1 35 g ¾ cup
Fat Oil 1 5g 1 tsp

Appendix C
Maintenance Diet
DBW (Tannhauser’s)
c. = (5 ft x 12 in.) + 4 b. =167.56 – 100 c. =67.56 – 10%
= 64 x 2.54 = 67.56 = 67.56 – 6.756
= 162.56 = 60.804 or 61 kg

TER = 61 (DBW) x 40 (Light Pa)

= 2,440 kcal or 2450 kcal

NO. OF
FOOD CHO CHON FAT ENERGY
EXCHANGES
Veg. A 2 3 1 16
Veg. B 1 3 1 16
Fruit 3 30 80
Milk (Whole) 2 24 16 20 340
Rice 14 322 28 1400
V. meat
LF 3 24 3 114
MF 2 16 12 172
HF 1 8 10 122
Sugar 4 20 80
Fat 2½ 12.5 112.5

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TOTAL 402g 94g 57.5g 2452.5

# B AM L PM D MN
2 ½ 1 ½
I. Veg. A
1 ½ ½
II. Veg. B
3 2 1
III. Fruit
2 1 1
IV. Milk
14 4 4 2 4
V. Rice

V. meat
3 2 1
LF
2 1 1
MF
1 1
HF
2½ 1 1/2 1
VI. Sugar
4 1 1 1 1
VII. Fat

FOOD SAMPLE NO. OF Wt. IN APPROXIMATE

GROUP FOOD EXCHANGES GRAMS SERVING SIZE
BREAKFAST

Veg A ½ Onion and garlic 22.5g. ½ cup sautéed

Veg B ½ Carrot strips 22.5g. ½ cup cooked
Milk 1 Whole milk 250g. 1 cup
Rice 4 Rice Gruel (thick) 320g. ½ cup
Medium Fat 1 Chicken Egg 60g. 1 piece
Meat
Fat 1 Olive oil 5g. 1 teaspoon
Sugar 1 Sugar 5g. 1 teaspoon
AM SNACK
10:00 am
Fruit 2 Mango (ripe) 120g. 1 slice (12 x 7 cm)

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Sugar 1 Condensed Milk 10g. 2 teaspoons
LUNCH

Veg A 1 Onion and garlic 45g. ½ cup sautéed

Rice 4 Rice Gruel (thick) 320g. ½ cup packed
Low Fat Meat 2 Beef lean meat 60g. 1 slice, matchbox size
Medium Fat 1 Beef flank 30g. 1 slice, matchbox size
Meat
Fat ½ Olive oil 2.5g. 1 teaspoon
PM SNACK

Milk 1 Milk evaporated 125g. ½ cup

Rice 2 Glutinous rice 160g. ½ cup, packed
Sugar 1 Sugar 5g. 1 teaspoon
DINNER

Veg A ½ Onion and garlic 22.5g. ½ cup sautéed

Veg B ½ Carrot strips 22.5g. ½ cup cooked
Fruit 1 Pineapple 75g. ½ cup
Rice 4 Rice Gruel (thick) 320g. ½ cup, packed
Low Fat Meat 1 Beef lean meat 60g. 1 slice, matchbox size
Medium Fat 1 Beef flank 30g. 1 slice, matchbox size
Meat
Fat 1 Olive oil 5g. 1 teaspoon
Sugar 1 Condensed milk 10g. 2 teaspoons

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Appendix D

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Appendix E

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Appendix F

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