NCM 105 Nutrition 1

FLEXIBLE DOMINICAN EDUCATION MODULE

NUTRITION and DIET THERAPY

MODULE NO. : 3

TOPIC : Enteral and Parenteral Nutrition

WRITTER: HELENE M. LLANERA

MODULE INTRODUCTION AND FOCUS QUESTION(S):

Nutrition is the study of food and how the body makes use of it. It deals not only in the quality and
quantity of food consumed but also with the process of receiving and utilizing it for the growth and
renewal of the body and for the maintenance of the different body functions.

MODULE LESSONS AND GENERAL INSTRUCTION:

COVERAGE:

1. Open the website given. Explore.

2. Take down notes and explore more.
3. Do the activities given.
4. Follow the instructions of each activity given by your
professor.
5. Access the learning materials on line.
6. Modules will be send thru email and or courier.

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 NCM 105 Nutrition 2

Lesson Subtopics LEARNING Estimated time

OUTCOMES

“I SHOULD BE ABLE
TO”…

14th Tube Feeding Discuss Enteral and 2 Hrs

Week Parenteral Nutrition.
Types Indications &
Contraindications for use Explain the special
complications and problems Dietary needs of
clients with medical
Types of Enteral Formulas
problems
Intact
Hydrolyzed
Modular
15th Feeding Administration Demonstrate correct 2 Hrs
Week procedures for
-Continuous Drip
feeding client
-Bolus receiving nutrition

-Combination
-Parenteral Feeding
-Indications and
contraindications for use of
complications and problems.

16th Dietary management of Identify and 4 Hrs

and some common medical describe three or
17th conditions including more nutrition-
Week computations and related health
preparations and their problems that are
rationale common to clients
needing long - term
and short term care
Calculate food
preparations
properly

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 NCM 105 Nutrition 3

Pre Test
Name:_________________________________________
Year and Section: _______________________________
Date Submitted:_________________________________
Score:__________
DIRECTIONS: Encircle the letter that corresponds to the best answer.
1. Therapeutic diets are given to:
a) Regulate the amount of food in metabolic disorders
b) Prevent edema
c) Increase or decrease body weight
d) Assist in all of the above cases
2. Characteristics of successful dieters include all of the following except:
a) Maintaining a daily food journal
b) Counting calories
c) Adhering to a strict eating plan
d) Eliminating all carbohydrates from their diets
3. A client is suspected of having a fat- soluble vitamin deficiency. Which of the following is the
most appropriate nursing intervention statement?.
a) More exposure to sunlight and drinking milk could solve his/her nutritional problem.
b) Eating more pork, fish, eggs, and poultry will increase his/ her vitamin B-complex intake.
c) Increasing his/ her protein intake will increase his/ her negative nitrogen imbalance.
d) Decreasing his/ her triglyceride levels by eating less saturated fats would be a good health
intervention for him/her.
4. A client is pregnant for the third time. With regard to her nutritional status, she should:
a) Limit her weight gain to a maximum of 25 pounds
b) Increase her vitamin A and milk product consumption
c) Increase her Vitamin A and milk product consumption
d) Increase her intake of folic acid

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 NCM 105 Nutrition 4

5. A patient who presents with gastrointestinal disturbances can be given the following foods/
beverages except:
a) Coffee
b) Carbonated beverages
c) Whole-milk dairy
d) Fat- free broth

STUDY
ENTERAL AND PARENTERAL NUTRITION
ENTERAL FEEDING
Enteral Feeding pertains to the delivery of food and nutrients either orally or by the tube directly
into the gastrointestinal track (GIT). It is intended for patients with a functioning GIT but unable
to ingest the required nutrients orally or for patients with impaired digesting capacity or unable
to absorb nutrients.
Types of Enteral Formulation
1. Ready to use Formulation
a) Nutritionally complete formulation can be used alone and provides the total needs in a
specified volume of formula.
b) Modular formulation provides the different forms of individual nutrients to supplement
existing formulas.
c) Combine formulation meets the therapeutic needs.
2. Tube Feedings
This type of feeding may be prepared from regular foods.
3. Standard Tube Feeding
This type of feeding is fiber- free and high in cholesterol, fat, and sugar. It is a milk-based
formulation with sugar and soft cooked eggs.

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DAILY FOOD PLAN

FRUIT 3 EXCHANGES JUICE ONLY
Milk 2 ex whole 2 cups
Evaporated milk 2 ex skim 1/2 cup skim milk powder
Eggs 3 medium Strained, soft cooked
Sugar 10tbsp Sucrose,glucose,lactose or corn syrup
4. Blenderized Tube Feeding
It consists of soft diet allowances which can be blenderized easily.
Food Plan for Blenderized Formula:
Example: 1,800 kcal C-60% P-15% F-20%
C-270 P-70 F-50
Follow the same procedure in the distribution of food items then translate to household
measures.
Compute the total fluid volume.
Volume = Cal Rx______
Cal Density
Example: Cal Rx = 1,800 kcal
Cal Density = 1cal/mL
Volume = 1,800 kcal
1 cal/ mL
= 1,800 mL or 7.5 cups
Total Fluid Rx - sub total = 1,800 - 200 = 1,600 mL
Cups of thick lugaw - 160 mL_____ = 6-7 cup
240 mL/cup
Rice lugaw = 6cups = 1,440 mL; 6 cups thick lugaw = 4 ex rice
Slice bread = 5 ex = 10 slices
Fluid = 200 + 1,440 = 1,640

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Water to be added = Rx - sum total fluid

= 1,800 - 1,640 = 160mL
Food Items Ex C P F Cal
Vegetable B 2 6 2 32
Fruits 3 30 120
Milk 1 12 8 10 170
Rice 9 200 18 900
Meat Med-fat 1 8 6 86
Low-fat 4 32 4 164
Fat 6 30 270
Sugar 3 15 60
TOTAL 273 38 70 1,802

Food group Food Ex Measure Fluid (mL)

Vegetable B Boiled squash 2 1 cup
Fruits Banana 3 3 pcs
Milk Evaporated milk 1 1/2 cup 120
Meat Boiled chicken 4 8 tbsp
breast
Eggs Soft cooked 1 1 pc 50
Oil Corn oil 6 6 tsp 30
Sugar Sugar 3 3 tsp
TOTAL FLUID 200

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Complications
1. Mechanical
a) Nasopharyngeal irritation (ice chips, topical anesthetic, and decongestant)
b) Luminal obstruction (flush; replace tube)
c) Mucosal erosions (reposition tube; ice water lavage; remove tube)
d) Tube displacement (replace tube)
e) Aspiration (discontinue tube feeding)
2. Gastrointestinal
a) Cramping/ Distention (change formula; reduce infusion rate)
b) Vomiting/ Diarrhea (dilute formula; reduce infusion rate; anti-diarrheal agents)
c) Constipation (promote sufficient fluids and fibers; encourage patient activity)
3. Metabolic
a) Hypertonic dehydration (increase free water)
b) Glucose intolerance (reduce infusion rate; give insulin)
c) Cardiac failure (reduce sodium content; fluid restriction
d) Renal failure (decrease phosphate, magnesium, potassium, protein restriction, essential amino
acid solution)
e) Hepatic encephalopathy (decrease amount of protein)
f)
Advantages and Disadvantages of Enteral feeding Routes
Feeding Route Characteristics Advantages Disadvantages
Nasogastric Tube extends from Rapid placement Tube can be easily
nose into the stomach requiring minimal removed by patient; tube
equipment; feedings can be inadvertently
can be immediately inserted into trachea,
following confirmation espicially among patients
of tube placement and with poor gag reflexes.
bowel sounds; formula Anomalies in nose and
can be delivered or neck (deviated septum,
continuous infusion esophageal strictures) may
prevent tube placement

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Feeding Route Characteristics Advantages Disadvantages

Nasoduodenal Nasoduodenal: Tube Risk for aspiration Dislodgment of tube into
or nasojejunal extends from nose may be reduced. the stomach by coughing
through the plylorus Feeding are better or vomiting is common
into the duodenum; tolerated by patients (will increase risk of
Tube may be advanced with poor tolerance to aspiration in patients with
by peristalsis or (gastric retention or altered gastric motility.
videofluoroscopy reflux). Administration usually
limited to continuous
Nasojejunal: Tube Nasojejunal feedings
delivery of formula (small
extends from nose permit enteral feedings
intestine does not tolerate
through plyorus into in patients with partial
bolus feedings or sudden
the jejunum and is gastric outlet
rate changes well. May
usually placed by obstruction or
require use of pump.)
videofluoroscopy doudenal fistula.
Esophagostomy Surgical formation of Procedure can be Route requires surgery
opening into neck performed under local and formation of a stoma,
through which a anesthesia. It does not which must be carefully
feeding tube is placed require opening the maintained. Skin
into esophagus and abdominal wall. surrounding stoma may
down into the stomach Feeding can begin become irritated. Wound
(sometimes used in immediately. may become infected.
patients with head and Excessive granulation of
neck cancer tissue surrounding stoma
may occur. Accidental
dislodgment of tube is
common. Requires
immediate replacement of
tube to prevent closure of
stoma. Gastric contents
may leak around the tube
with gastrotomy. Wound
dehiscence may occur. GI
bleeding and aspiration
may occur. Gastrotomy
feedings usually cannot be
started ubtil up to 72 hours
after surgery. PEG
placement is often
difficult or impossible in
severe obesity.

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Feeding Route Characteristics Advantages Disadvatages

Gastrotomy or Tube is passed through Takes advantage of the
Percutaneous incision in abdominal stomach’s natural
Endoscopic wall into the stomach function of adjusting
Gastrotomy PEG. Tube is osmolarity, mixing,
(PEG) percutaneously placed and serving as a
in the stomach under reservoir; ensures
endoscopic guidance, provided nutrients are
secured by rubber allowed maximal
“bumpers” or inflated opportunity for
balloon catheter absorption; closely
stimulates natural
delivery of nutrients
into the stomach;
eliminates nasal or
esophageal sphincter
closed, may reduced
risk of aspiration; tube
is unobtrusive; PEG
placement can be
performed under local
anesthesia (less
expensive); PEG
feedings can be started
after approximately 24
hours
Jejunostomy or Types include needle Permits feeding in Surgical procedure is
Percutaneous catheter placement, patients with upper GI required. Ambulatory
Endoscopic direct tube placement, tract obstruction, patients may find jejunal
Jejunostomy and creation of jejunal esophageal reflux, feeding restrictive because
(PEJ) stoma that is ulcerative or neoplastic of the need for continuous
catheterized disease of stomach, infusion of formula.
intermittently PEJ: impaired gastric
Weighted feeding tube emptying; reduces risk
passed endoscopically for aspiration; early
through as trostomy postoperative feeding
tube (from PEG possible (jejunum
insertion) into the rapidly resumes its
duodenum; Peristaltic function within 12-24
action advances tube hours)
into the jejunum

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RESEARCH
Activity 1:
Research on the following:
1. What are the indications and contraindication of Tube Feeding?.
2. Types of Enteral Formulas Inctact, Huydrolyzed and Modular
3. Feeding administration methods Continuous drip, Bolus, Combination
References:
https://www.healthline.com/health/enteral-feeding
https://clinicalnutritionespen.com/article/S1751-4991(09)00040-7/fulltext
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Enteral_feeding_and_medicati
on_administration/
ENTERAL AND PARENTERAL NUTRITION
Standard Hospital Diets
A. Liquid Diets
1. Clear Liquid Diet
This is an allowance of tea, coffee or coffee substitute, and fat-free broth. Ginger ale,
fruit juices, gelatin, fruit ices, and water gruels are sometimes also given. Small amounts of
fluid are offered every hour or two to the patient. The diet is used for 24- 48 hours
following acute vomiting,diarrhea, or surgery.
The primary purpose of this diet is to relieve thirst and to help maintain water balance.
Broth provides sodium. Broth and fruit juices contribute potassium. Carbonated beverages,
sugar, and fruit juices, when used, furnish a small amount or carbohydrate.
2. Full Liquid Diet
This is nutritionally adequate diet consisting of liquids and foods that liquefy at body
temperature. It is used for acute infections and fever of short duration and for patients who
are too ill to chew. It may be ordered as the first progressive from the clear fluid diet
following surgery or in the treatment of acute GI upsets.
The diet is offered in 6 feedings or more. Initially, amounts smaller than those
represented by the plan may be given.To increase the calorie intake, one pint of light cream
may be substituted for one pint milk. The protein level of the full fluid diet may be
increased approximately 30 gm by including 3 oz non fat dry milk each day. This may be
added to fresh milk, cream soups, cereal gruels, or custards. Strained meat may be added to

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broth or hot tomato juice. Raw eggs are sometimes a source of Salmonella infection.
Therefore, only pasteurized dried egg powder should be used.

Food Allowance for one day:

6 cups milk
2 eggs
1-2 oz strained meat
1 cup strained citrus juice
1/2 cup tomato juice
1/2 cup vegetable puree
1/2 cup strained cereal
2 servings dessert: soft custard, plain ice cream, sherbet, or plain gelatin
2 tbsp sugar
1 tbsp butter
Protein: 85 gm
Calories: 1950
Sample Menu:
BREAKFAST
Grapefruit Juice
Strained oatmeal with butter, hot milk and sugar
Milk
Coffee with cream and sugar
AM Snack
Orang Juice
Soft Custard
LUNCH
Broth with strained Beef
Tomato Juice
Vanilla ice cream

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Milk
PM Snack
Milk
DINNER
Cream of asparagus soup
Eggnog
Strawberry gelatin with whipped cream
Tea with lemon and sugar
BED TIME
Chocolate malted milk
B. Soft Diets
A nutritionally adequate diet differs from the normal diet in having reduced fiber content,
soft consistency and bland flavor. It is used immediately between the full fluid diet and the
regular diet following surgery, in acute infections and fevers and in GI disturbances.
The normal diet is modified in the following ways:
1. Meat and poultry are minced or ground. Fish usually sufficiently tender without further
treatment.
2. Vegetables are cooked. They may be cooked a little longer than usual to be sure they are
soft and may be diced or chopped.
3. Soft raw fruits may be used.
4. Soft rolls, bread or biscuits are used instead of crisp roll, crust breads, and toast.
5. All desserts on a normal diet may be used including pies with tender crusts, cakes and
puddings.
BREAKFAST Am Snack LUNCH PM Snack DINNER Bed Time
Fried hotdog Fish sinigang Chicken arroz Milk
and egg Pineapple caldo Almondigas
Rice
juice with patola
Rice Calamansi
Banana Rice
Chicken Pie Juice
Milk and
Ripe mango
sugar
Ripe Papaya

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C. Test Meals
1. Fecal Fat Determination Test measures fat globules in the stools to detect fat absorption as in
cases like cystic fibrosis. It consists of 100 g fat ingested daily for 3 days prior to fecal collection.
Food items included are:
2cups whole milk
8 oz. Lean meat
1 egg
10 ex of fat
2. Meat-free Test is used to determine GIT bleeding. A 3- day diet excluded ingestion of meat,
poultry, and fish.
3. Calcium Test is used to determine urinary calcium excretion to diagnose hypercalciuria. The
diet requires 1000 mg calcium intake, 400 mg from food sources, and 600 mg from oral
supplements.
4. Serotonin Test is used to detect calcinoid tumors of the intestinal tract. Food rice in serotonin
are excluded in the diet.
PARENTERAL FEEDING
Parenteral Feeding is designed for individuals who cannot accept or assimilate nutrients
given enterally.
Calculation of Nutritional Needs for Hypermetabolic Patients
1. Energy
Add to basal requirement
60% for stress (treatment regimen, fever infection)
10%-20% for bed rest and light activity
10% for weight gain in malnourished patients or growth in children and adolescents
2. Protein
Increse of 50%-100% to compensate for catabolic effects of stress, certain drugs, fever and
infection

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3. Vitamins and Minerals

Vitamins
E 10 IU
A 3300 IU
D 200 IU
C 5 mg
Folacin 400 ug
Niacin 40 mg
Riboflavin 3-6 mg
Thiamine 3.0 mg
B6 4.0 mg
B12 5.0 mg
Pantothenic 15 mg
Biotin 60 ug

Minerals
Na & Cl 60- 150 mEq
K 70-150 mEq
Ca 0.2-0.3/kg mEq
Mg 0.35-0.45/kg mEq
P 7-10/1,000 mmols/ kcal

4. Fluids
< 20 kg 1500 mL/ m2BSA

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> 20kg 100 ml/kg for first 10 kg and

50 mL for each between 10
and 20
Routes
1. Peripheral Vein Route - This route is intended for patients with mild to moderate
nutritional deficiency.
a) Short- term maintenance and not hypermetabolic - NPO for 2 weeks
b) Supplemental energy and protein to an oral diet
c) Weaning into enteral or parenteral hyperalimentation requiring additional energy and protein
2. Parenteral Hyperalimentation (IVH) - This is a long- term nutritional support of 2 weeks for
patients who cannot be fed through the GIT.

ACTION
Activity 2:
Name:_____________________________________ Date Submitted: ___________________
Year and Section:___________________ Score: _____________
Create a food plan for blenderized formula using the following diet prescription:
1,600 kcal C-60% P-15% F-20%
1. Convert the Rx into grams C,P,F.
2. Distribute into food items
3. Translate into household measures.
4. Compute the total fluid volume.
Food Exchange Carbohydrates Proteins Fats Calories

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Food Group Food Exchange Measure Fluid (mL)

STUDY
THERAPEUTIC DIETS
NUTRITION THERAPY FOR OBESITY AND WEIGHT CONTROL
Obesity, a condition in which the natural energy reserve is increased, is a hazard to health. It is
not surprising that obese people are prone to heart diseases. An obese pregnant woman is more
likely to have complications than a woman of normal weight.
The degree of obesity is often judged by comparing what one weighs with the height- weight
table. If one weighs 10%-19% more than the average for his/ her height and body frame, he/ she
is overweight; if he/ she weighs 20% or more, he/she is therefore, considered obese.
Losing weight simply means balancing food calorie intake with the body’s needs for calories.
One pound of fat is equal to about 3,500 calories. If one has 500 calories less everyday, he/ she
will lose about 1 lb/ week.

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The state of being overweight and obese is a condition in which the body stores of fat are
enlarged. Underweight or under nutrition results when intake does not meet the energy
requirement. Usually, an underweight person weighs 10%-20% below the desirable weight.
Some Reasons for Excessive Calorie Intake
1. Family pattern of rich, hig calorie foods; the mother or any household member being a good
cook.
2. Good appetite; likes to eat; likes many rich foods, may dislike fruits and vegetables.
3. Ignorance of calorie value foods
4. Skips breakfast; is a frequent nibbler; takes coffee break with high calorie snacks.
5. Pattern of living
a.Sedentary occupation; idleness
b. Riding to work or school
c. Little exercise during leisure
d. Often sleeps more as person becomes older
6. Emotional outlet: eats to overcome worries and problems, boredom, loneliness, or grief
7. Many social events serving rich foods; frequent eating at restaurants
8. Lower metabolism with increasing age, but failure to reduce intake
9. Influenced by advertising of many high- calorie foods
Prevention of Obesity
1. There should be a change in the eating patterns of families so that the recommended calorie
intake for members is followed.
2. Children should be encouraged to get more exercise and should be assigned to perform some
chores requiring daily physical activity.
3. Pre- school children should not be bribed or rewarded with food. They should have a variety
of activities so that they take their minds off the excessive pleasure of eating
Low Calorie Diet
Women usually lose weight satisfactorily on diets restricted to 1,000-1,500 calories
whereas men lose weight satisfactorily on diets furnishing 1,200- 1,800 calories. Bed patients,
such as those with heart disease, are often placed on diets restricted to 800-1,000 calories and
sometimes less.
The daily food allowances for the 1,000-1,200 and 1,500- calorie diets are somewhat
higher in protein than normal. This is desirable becauseit provides most people with a feeling of

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satisfaction. Also, it helps correct the greater losses od muscle tissues that occur during reducing.
The extra protein is provided from the meat group, with some restriction on the bread- cereal
group.
Usually, the food allowances are divided into 3 approximately equal meals. Skipping
breakfast is not a good idea.
Meals with a low- calorie diet should be attractive and palatable Herbs and spices may be
used to give variety to vegetable and or meat preparation. Meat, Fish, and poultry should be lean
and prepared by boiling, broiling, roasting and stewing. Fresh fruits or canned unsweetened fruits
are used.
Low-calorie diets should not include alcoholic beverages, sweetened carbonated beverages,
cakes, candles, cookies, cream, fried foods, sweetened fruits, pastries, pies, potato chips, pretzels,
pudding and others.
Sample menu (1,200 calories)
BREAKFAST LUNCH DINNER BEDTIME
Half banana Salad (tomato, tuna Roast Beef 1 apple
fish, diced
Soft cooked egg Boiled Cheese
celery,French
vegetables
1 slice toast dressing, lettuce,
sliced hard- boiled Rice
1 tsp butter egg)
Tea with lemon
Coffee without 1 cup rice
cream and sugar

1 cup skim milk

1 slice Papaya

NUTRITION THERAPY FOR DIABETES MELLITUS

Diabetes mellitus is a metabolic disease that affects the endocrine system of the body and
the use of carbohydrates and fats, specifically, there is not enough insulin available for the
body’s needs. In some patients, the islets of Langerhans of the pancreas are unable to produce
enough insulin. In other patients, the pancreas requires some stimulation to manufacture enough
insulin, and in some the insulin that is produced cannot be used for some reason by the tissues.
Because glucose cannot be used, the blood sugar level rises (hyperglycemia) until finally
some of it is excreted in the urine (glycosuria). To excrete sugar, water is taken from the tissues.
Thus, the patient complains of frequent urination (polyuria) and increased thirst (polydipsia). the

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appetite is often increased (polyphagia) because the patient is not fully consuming the food he/
she normally eats. The patient may also lose weight.
Two types of diabetes are recognized. Juvenile diabetes occurs at any age from birth
through adolescence. It is severe, requires insulin for treatment, and is difficult to manage.
Adult- type diabetes occurs primarily among obese people who become diabetic in middle
age. The disease is usually mild, stable, and well-regulated by diet alone or by diet and oral
compounds.
Characteristics of Diet
The diet is essentially normal, except that the amounts of food and their distribution in
meals are controlled from day to day. Some diet control will be necessary for the rest of the
patient’s life.
1. Energy
Overweight diabetics are initially place on low-calorie diets because weight loss results
in better tolerance to carbohydrate. Individuals of normal weigh are given sufficient calories to
maintain their weight. In bed : 11-12 cal/lb
Sedentary : 13-14 cal/lb
Moderately active : 15-16 cal/lb
2. Protein
About 1 1/2 g per kg body weight (1/2 - 2/3 g per lb) is usually allowed. The higher
level is more typical for patients who show a preference for protein-rich foods.
3. Carbohydrate and fat
4. After subtracting the calories provided by protein, the remainder of the calories for the day is
usually divided about equally between carbohydrate and fats. The number of grams of fat is
ordinarily about the same as the number of grams of protein; the amount of carbohydrates is
roughly twice the number of grams of protein

Meal Plan Carbohydrate (g) Protein (g) Fat (g) Energy (g)
1 125 60 50 1,200
2 150 70 70 1,500
3 180 80 80 1,800
4 220 90 100 1,200
5* 180 80 80 1,800
6* 250 100 130 2,600

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7* 370 140 165 3,500

8 250 115 130 2,600
9 300 120 145 3,000

Food preparation and Service

All food items in the diet are measured according to the amounts in the food exchange
lists. Level measures with standard measuring cups and spoons are used.
Food are prepared using only those allowed on the meal patterns. No extra flour, bread
crumbs, butter, or other food may be used.
Meats may be broiled, baked, roasted, or stewed. If they are fried, some of the fat
allowance may be used.
Frozen or canned fruits packed with sugar must be avoided.
Concentrated sweets and desserts are avoided: sugar, candies, jellies, jams, marmalades,
syrup, honey, molasses, soft drinks, cakes, cookies, pies, pastries, sweet rolls, etc.

Food Exchange Lists

An exchange list is a grouping of foods in which the carbohydrate, protein and fat values
are about equal for the items listed.
1. The following are the steps in planning the measured diet:
Include basic food to ensure adequate levels of minerals and vitamins: 2 cups milk (3 or
more for children)
5 oz meat
2 servings vegetables
2 serving fruit
Breads and cereals
2. List the carbohydrate, protein, and fat values for milk, vegetables and fruit.
3. Subtract the carbohydrate values of these foods from the carbohydrate level prescribed.
divide the difference by 7 to determine the number of meat exchanges.
4. Subtract the total protein values of milk and meat from the total fat described. Divide the
difference by 5 to determine the number of fat exchanges.

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Sample calculation of Diet: C-150 P-70 F-70

Exchange List No.of Ex Carbohydrate (g) Protein (g) Fat (g)
Milk 2 24 16 20
Veg A 1-2
Veg B 1 7 2
Fruit 3 30
61*
Bread 6 90 12
30**
Meat 6 42 30
50***
Fat 4 20
Totals for the day 151 72 70

*150-61 = 89 g CHO to be supplied from bread exchanges

1 bread exchange = 15g CHO
89 divided by 15 = 6 bread exchanges
**70-30 = 40g protein to be supplied from meat exchanges
1 exchange meat = 7 g protein
20 divided by 5 = 4 fat exchanges
Meal Pattern
Breakfast Lunch Dinner Sample Menu
Milk : 1 exchange Milk : 1 exchange Veg Group A Breakfast
Fruit : 1 exchange Veg Group A Veg Group B 1 cup milk
Bread : 2 exchange Fruit : 1 exchange Fruit : 1 exchange 1/4 medium papaya

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Meat : 1 exchange Bread : 2 exchange Bread : 2 exchange’ 1 cup rice

Fat : 2 exchange Meat : 2 exchange Meat : 3 exchange 1 egg (1tsp Butter)
Fat : 1 exchange Fat : 1 exchange

ACTION
Laboratory Activity 3:
Name: ________________________________________ Date Submitted:_______________
Year and Section: _______________________________ Score:_________________

In Preparation for computation of different therapeutic diets, it is imperative that nursing students
first acquire knowledge in calculating diets for normal individuals and planning regular menu
using the Food Exchange List. The Food Exchange List is one of the basic tools in nutrition and
diet therapy. It is used in meal planning and estimating the energy and macro nutrients of normal
and therapeutic diets
1. Objectives
This laboratory session helps the practical nursing students to compute their own calorie
requirements and plan their meals.
At the end of 3 hours, you should be able to:
1. Assess your nutritional status and compute for your calorie requirement, and
2. Plan a one-day menu based from your requirement.
II. Procedures
A. Following the steps in estimating desirable body weight (DBW) discussed in the lecture
portion, calculate your Total Energy Allowance (TEA).
1. Determine your height= ________and actual body weight= __________
Convert lbs to kg weight.
2. Calculate your basal needs =_________X_________kg (DBW)X24=_______kcal
Basal Need Basal Need
Male= 1 kcal per kg DBW/hour Female = 0.9 kcal per kg DBW/hour

3. Estimate physical activities = ______________________kcal

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Physical Needs - approximate percentage increase above basal needs

(use lower factor for woman)
Bed rest 10-20 percent
Sedentary 30 percent
Light activity 50-60 percent
Moderately active 60-70 percent
Severely active 90-110 percent

4. Add values from 2 and 3 to get TEA= ________ kcal = _________= kcal
5. Distribute Total Energy Allowance among Carbohydrate, Protein, fat as follows
Carbohydrates: 50-70
Protein: 10-15%
Fats: 20-30%
Allowances for protein can also be provided based on the Recommended Energy
And Nutrient Intake for Filipinos (RENI) as shown in Appendix A-1.
6. For a normal diet, allot 65% of the total energy allowance for carbohydrates, 15% protein
and 20% fat. Thus, the corresponding energy contributions of the three nutrients in your diet are
as follows:
Carbohydrate= __________ kcal X 0.65 =__________kcal
Protein= _______________ kcal X 0.15= __________kcal
Fats= _________________ kcal X 0.20= __________kcal

7. Calculate the number of grams of CHO, Pro and fats by dividing the calories for each
nutrient by the corresponding physiologic fuel values (4 kcal/g CHO, 4 kcal/ g Pro, 9 kcal/g Fat).
Carbohydrate = ______________ kcal X 4 = __________gms
Protein = ___________________kcal X 4 = __________gms
Fats = ______________________kcal X 9 = __________ gms

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8. For simplicity of the diet prescription (Rx), round off calories to the nearest 50, and
carbohydrates, proteins and fats to the nearest 5 gms. Thus, your diet prescription is:
Diet Rx:____________________________________________________________

ANALYSIS
B. Using the Food Exchange List, design your meal plan taking into consideration your food
habits, food behavior and preferences, etc. Follow the steps in meal planning.
Steps in Meal planning using the food Exchange List
1. Use the table provided for the Food Exchange List
2. Determine the amount of vegetable A and B exchanges the patient can eat (Allow 2-3
exchanges)
3. Determine the amount of fruit exchanges. (A reasonable allowance of 3-4 exchanges can be
given, unless there is drastic restriction of simple carbohydrates.
4. Determine the amount of milk exchange. Type and amount of milk depends upon needs,
food habits and economic considerations.
5. Determine the amount of sugar desired. (Allow 5 to 9 teaspoons of sugar per day unless
contraindicated.)
6. Sub- total the amounts of CHO, Pro and fats and calories provided.
7. Subtract the amount of CHO so far provided by the vegetable, fruit, milk exchanges and the
sugar allowed from the prescribed amount. Divide the result by 23, which is the amount of
carbohydrate in one rice exchange necessary to fill up the prescribed amount.
8. Sub- total the amount of protein; subtract from the total protein prescribed and divide the
result by 8 to get the number of meat exchanges required.
9. Sub- total the amount of fat; subtract from the total fat prescribed and divide the result by 5
to get the number of fat exchanges required.
10. The total number of exchange obtained will be used for planning your menu.
Distribute these exchanges into breakfast, lunch, supper and snacks and provide a one- day
sample menu.

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 NCM 105 Nutrition 25

ACTION
Meal Plan for a Normal Diet
Food No. Of CHO PRO FAT ENERGY Meal Distribution
Exchange Exchanges
g g g kcal B L D Sn
I. Veg A
Veg B
II. Fruits
III. Milk
IV. Rice
V. Meat
VI. Sugar
VII. Fat
Total

SAMPLE MENU
Sample Menu for a Normal Diet
Breakfast Lunch Supper
(indicate HH*measures) (indicate HH*measures) (indicate HH*measures)

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Snacks
(indicate HH*measures)
AM Snack PM Snack Midnight Snack

*HH household measures

C. Submit individual worksheets at the end of laboratory activity.
D. In planning nutritious diets, the students can also use your guide to good nutrition and the
Food Pyramid Guide. These nutrition tools are a daily food guide, which use the recommended
amounts and number of servings of food to provide the variety of nutrients needed by the body.
IV. QUESTIONS FOR DISCUSSION
1. What are the bases for estimating the desirable intake of an individual?
2. What are the pointers to consider in planning a normal diet?. a therapeutic diet?

References:
Basic Nutrition and Diet Therapy Laboratory Manual for Nursing Students
Revised Edition, Maria Lourdes C. Caudal, RND
Basic Nutrition and Diet Therapy TEXTBOOK FOR ALLIED HEALTH
Second Edition, Maria Lourdes Cruz- caudal, RND,MEM

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Rubric for Grading the Activity:

Criteria 1 (75- 80%) 2 (81-85%) 3 (86-90%) 4 (91- 95%)

Organization of words in Answered Answered Answered the Answered the
answering the questions the question the question question question
correctly. correctly by correctly by correctly by correctly by
25% only. 50% only. 75% only. 100% only.

Correct Correct Correct Correct

Computations of the BMI,
computation computation computation computation
DBW, TER.
given by given by given by 75%. given by
25%. 50%. 100%.

Grading System: 60% written output and 40% Project.

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