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NUTRITION SKILLS LABORATORY

CULMINATING ACTIVITY SEPT. 25,27, OCT. 2, 2019

GROUP PROFILE
BSN 2____ Members: Assigned Task
Group :
1.
2.

CLIENT PROFILE

NAME AGE SEX HEIGHT CIVIL STATUS

WEIGHT
OCCUPATION NATURE OF DAILY ACTIVITIES

MONTHLY INCOME OTHER INTEREST AND HOBBIES


DISEASE PROFILE

DIAGNOSIS NATURE OF DISEASE/CONDITION

CAUSES

SYMPTOMS PREVALENCE

DIETARY CHANGES

NURSING RESPONSIBILITIES FOR NUTRITION EDUCATION


MEAL FOR CLIENT WITH __________________

MENU FOR LUNCH HOUSEHOLD MEASURE TOTAL MENU COSTING

DIET KILOCALORIES REQUIREMENTS in 24HRS


PRESCRIPTION KCalories =
CHO gms =
CHON gms =
FATS gms =

FOOD NUMBER OF CHO CHON F Estimated


EXCHANGES EXCHANGES Caloric Count
Veg A
Veg B
Fruits
Milk
Sugar
Rice
Meat
LF
MF
Total
SAMPLE MENU

BREAKFAST LUNCH DINNER

AM SNACKS PM SNACKS MIDNIGHT SNACKS

SUBMITTED TO:

_____________________

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