New Era University

9 Central Ave, New Era, Quezon City, 1107 Metro Manila

College of Nursing

NCM 105L-18-Nutrition and Diet Therapy Lab

Case Scenario Groups 3 and 4

Members:
Majan, Danah Corrine Q.
Manuel, Deejay
Moralejo, Mary Corrine F.
Niric, Jesreel Nicole M.
Nuevo, Arabella T.
Palmones, John Cyrus P.
Peregrino, Eran Gelo E.
Refugia, Erica Vens S.
Reyes, Christopher Angelo B.
Rotairo, Kristine Caye M.
Santos, Charlaine Clarisse Q.
Sidugen, Jhon Michael
Songcayawon, Kurtny Love T.
Unay, Jenniel G.
Urbina, Gwyneth Abbygaile R.
Velasquez, Alexandra Jeanne S.
Zantua, Zhierie Gwyneth C.

Leader:
Toñacao, Chanel Hazel P.

Mid-Year Summer Classes, A.Y. 2021-2022

 Case Scenario for Group 3&4:

❖ Mrs. Catalina Garda is a 35-year-old woman weighing 68 kgs and with a height
of 5 foot and 5 inches and had just given birth to her third baby. She wishes to
know how to properly take care of her own health and her baby as well while
planning to provide an exclusive breastfeeding.

Subjective cues Objective cues

Wishes to know how properly take care of Height: 65 inches or 165.1 cm

her health and baby Weight: 68 kg

Questions:

1. What factors may possibly hinder Mrs. Garda to continue breastfeeding her
baby?
● Lack of breastfeeding counseling after delivery - Lack in education
and counseling can affect the proper technique of exclusive breastfeeding
as well as the confidence of the breastfeeding mom.
● Area of residence - Mothers from rural area were more likely to
exclusively breastfeed compared to mothers from urban area (more
vulnerable to health-related issues)
● Husband’s support on breastfeeding - Postpartum mothers need extra
support from their spouses to start and continue breastfeeding.
● Bed-sharing practice - Mothers who bed-share with their baby tend to
breastfeed longer and maintain exclusive breastfeeding longer than those
who do not co-sleep.
 ● Pressure - Some women who lack breastfeed counseling were more
likely to have a negative experience and pressure of breastfeeding and it
can result in postpartum depression.
● Lactation Problems - Milk doesn't come in within 5 days of the baby's
birth, Shooting or burning pain during or after breastfeeding, or pain in the
nipples. Stress and anxiety may also decrease production and milk
ejection reflex.
● Poor nutrition of the mother - Breastfeeding burns 200-500 extra
calories. Having less than 1, 500 calories per day is considered abnormal.
● Hormonal fluctuations - Catalyze additional hormonal imbalance during
the postpartum period, estrogen levels decline after you deliver your
placenta.

2. Why exclusive breastfeeding highly recommended by the World Health

Organization?

Breastfeeding has a significant role in the growth, health and for the development
of babies. Breast milk is the ideal nourishment for a newborn because it has the proper
amount of sugar, fats, water, and proteins. It also includes essential antibodies that
provide the ideal combination of nutrients to aid the proper growth and development of
newborns. According to the World Health Organization, the mother should nurse her
infant during the first hour after delivery and up to 2 years or for as long as it is desired
for her and for her baby. In the first 6 months it is recommended that the baby should
not be fed anything except for breast milk and should continue the breastfeeding only at
the breast. After the first 6 months, gradually introduce supplementary meals since the
infant's requirement for energy and other nutrients exceeds at this age, and
complementary foods are required to satisfy those needs. Furthermore, they highly
recommend exclusive breastfeeding since it has so many health benefits for the
breastfed child in terms of protection against infectious disease such as diarrhea or
respiratory infections and also has long term benefits after breastfeeding has stopped
protecting the baby against the development of childhood overweight, obesity, sids and
leukemia. Mothers also benefit from breastfeeding since this protects them against
breast cancer, ovarian cancer and diabetes. Exclusive breastfeeding is definitely the
healthiest choice a mother can make for her newborn child.

3. Are there any medical complications associated with breastfeeding? Explain your
answer.

Although numerous drugs enter into breast milk, the majority of them have no
known negative effects on milk production or baby health. It's critical to look after
yourself so you can provide your kid the finest care possible. This involves getting
adequate sleep and eating well so you have the energy to care for your kid and stay
healthy. Some women believe that they should not breastfeed while they are unwell.
However, most common infections including colds, flu, and diarrhea cannot be
transmitted through breast milk. In fact, if you're unwell, antibodies will be present in
your breast milk. These antibodies will aid in the prevention of your infant contracting
the same illness.

These are the common breastfeeding problems:

● Sore or cracked nipples - your infant is not correctly positioned and connected
at the breast, which causes sore nipples.
● Breastfeeding and thrush - when your nipples get cracked or injured, thrush
infections can occur. This implies the thrush-causing candida fungus can enter
your nipple or breast.
● Breast engorgement - engorgement can occur during the early stages of
breastfeeding, when both you and your baby are still getting acclimated to it. Your
milk production may take a few days to adjust to your baby's demands.
● Blocked milk duct - If breast engorgement persists, a blocked milk duct may
develop. A tiny, sensitive bump in your breast may be felt.
● Mastitis - When a clogged milk duct is not cleared, this occurs. It causes hot,
aching breasts and might make you feel quite ill with flu-like symptoms.
 ● Breast abscess - Mastitis, if left untreated or not responding to therapy, can
evolve to a breast abscess, which may require surgery to empty.

4. Compare and contrast the nutrient contents of a cow's milk from that of a human
milk.

Nutrients Cow’s Milk Human Milk Similarities

Protein value - 7.9 g Value - 2.5 g

● Some nutrients
Higher protein Protein is present are found in both
content than breast in small amounts milks and help to
milk, but can cause but is enough for provide nutrients
excessive protein the newborn. to the body.
in the newborn
Carbohydrates value - 11.0 g Value - 17.0 g
● Both milk are low
Carbohydrates in Higher amount of in iron
smaller portions carbohydrates

Fats value - 7.9 g Value - 17.0 g ● They have

similar
It is low in fat in Higher amounts of monosaccharide
comparison to fat, particularly (lactose) that is
human breast milk. omega-3 fatty different from
acids any other kind of
Vitamin C Value - 0 g Value - 12.3 g milk

Has now vitamin c

Sodium (mg) value - 98 g value - 42 g

Found in higher Found in smaller

amounts amounts
Iron (mg) value - 0.07 g value - 0.07 g

Calcium (mg) value - 276 g 79 g

Found in higher Found in smaller

amounts amounts
Water The body adjusts
Cow's milk the amount of
contains a fixed water in breast
amount of water. If milk according to
the milk is diluted, the baby's
it may also have a demands, the
larger water environment, and
content. the mother's diet.

Advantages Disadvantages

Cow’s Milk ● Cow's milk contains lots ● Cow's milk does not
of calcium, which is contain enough of
essential for bone certain nutrients that
development and babies under a year old
strengthening. need

● Reduces the risk of high ● No antibodies produced

blood pressure by 50%
 ● Difficult to digest for
● Rich in protein baby

● Reduces the chances of ● Cow's milk also does

developing osteoporosis, not contain the
colon cancer, and type 2 healthiest types of fat
diabetes. for growing babies

● has low amount of

vitamin C which is not a
great source for it

Human Milk ● Antibodies are produced ● When a child reaches a

that helps the baby’s
immune system grow and
protects the child against
any diseases
● Produces the needed
amount of nutrients,
vitamins, and minerals for
the newborn
certain age, he or she is
frequently switched to
cow's milk because
there are nutrients that
are not in the human
milk

● Easy to digest

● It is also high in
immunoglobulin, which
helps protect the GI
system from infection.
 5. Formulate two (2) highly prioritized nursing diagnoses for this client.

Mrs. Garda’s two highly prioritized nursing diagnoses are as follows:

-Readiness for Enhanced Breastfeeding related to the mother's adequate

proficiency and satisfaction with the breastfeeding process.

-Readiness for Enhanced Parenting related to the desire to improve the parent
role

6. Establish at least 2 goals with 3 objectives each per goal in reference to the
identified diagnosis

GOALS OBJECTIVES

Readiness for Enhance Breastfeeding
At the end of 30 minutes assessment
the mother place the baby in the positions.
proper feeding posture.
1.1 After one hour, the mother
understands how to appropriately place
the infant for nursing in at least 2 out of 3
1.2 Within an 2-4 hrs of breastfeeding the
mother is less likely to suffer from back
discomfort or any other complications.

1.3 After 4 hours, the mother can

breastfeed without the aid of the nurse for
optimal positioning.
Readiness for Enhance Parenting 1.1 Within 3-6 days information points,
the client indicates a desire to improve his
After interventions, parents gain
or her role as a parent at least 3 out of 4
knowledge on how to be excellent
parents.
1.2 After 12 hours, parents can
provide for their children's bodily and
emotional requirements, about which
the client will recall 3 to 5 details.

1.2 In 6 hours, the Client understands

what she should and should not do to
improve her baby's life.

7. Calculate the DBW of Mrs. Garda including her diet based on appropriate
formula for computation of REI per day.

Ador Dionisio’s Method Tannhauser’s Method

Female, 35 yrs. old, 5’5” tall Female, 35 yrs. old, 5’5” tall

Height = 5 feet = 100 lbs Height = 5’5” inches = 165.1 cm

5 inches x 2 = 10 lbs 165.1 cm - 100 = 65.1 cm
= 110 lbs 10 % of 65.1 cm = 6.51 cm
165.1 cm - 6.51 = DBW (kg)
Age (35 years) 2 = 14 lbs DBW (kg) = 159 lbs or
5 72.3 kg
DBW = 110 lbs + 14 lbs = 124 lbs

REI = 1,870 kcal + 500

(lactating) = 2,370
kcal
8. Prepare a menu plan.

I. Calculating Diets & Meal Planning

A. Procedures

1. Following the steps in estimating desirable body weight (DBW), calculate your total energy allowance
(TEA).

2. Determine your height = 165.1 and actual body weight = 68 kgs

3. Calculate your basal needs = 0.9 x 72.1 kg (DBW) x 24 = 1,557.36 kcal

Male = 1 kcal/kg of DBW/hour

Female = 0.9 kcal/kg of DBW/hour

4. Estimate physical activities = 1,557.36 x 0.10 = 155.74 or 156 kcal

Physical needs = approximate percentage increase above basal needs

(use lower factor for women)

Bed rest 10-20%

Sedentary 30%
Light activity 50-60%

Moderately active 60-70%

Severely active 90-110%

5. Add values from 3 and 4 to get TEA = 1,557.36 kcal + 156 kcal = 1,713.36 kcal + 500 = 2,213.4 kcal
6. Distribute the total energy allowance among carbohydrates, proteins and fats as follows:

7. For a normal diet, allow 65% of the total energy allowance for carbohydrates, 15% proteins and 20%
fats. Thus the corresponding energy contributors of the three nutrients are as follows:
Carbohydrates = 2,213.36 kcal x 0.65 = 1,439 kcal

Proteins = 2,213.36 kcal x 0.15 = 332 kcal

Fats = 2,213.36 kcal x 0.20= 443 kcal

Total = 2,214 kcal TEA = 2,213

8. Calculate the number of grams of carbohydrates, proteins and fats by dividing the calories for each
nutrient by corresponding physiologic fuel values (CHO and CHON = 4 kcal/g and Fat = 9 kcal/ g).

Carbohydrates =1439 kcal/ 4 = 359.8 or 360 g

Proteins = 332 kcal/4 = 83 g

Fats = 443 kcal/9 = 49.2 or 50 g

9. For simplicity and practicality of the diet prescription (Rx), round off calories to the nearest 50, and
carbohydrates, proteins and fats to the nearest 5 g. Thus, your diet prescription is:

Diet Rx : 2,213 kcal/day

360 g Carbohydrates

83 g Proteins

50 g Fats
 B. Meal Plan for Normal Diet (2,213 Kcal, 360 g CHO, 83 g CHON, 50 g Fats)

Food No. of CHO CHON Fat Energy Meal Distributions

Exchanges Exchanges
kcal
g g g B L D Snacks

1. Vegetables 1 cup of pinakbet 11 2.7 5.5 44+10.8+4 1 cup of 1 cup of

9.5=104.3 tofu pinakbet
1 cup of tofu 2.9 25 13
11.6+100+
4.8 1.2 0.2 117=228.6

2. Fruits 2 medium pcs of 54 2.6 0.8 216+10.4+ 1 cup 1 slice of

banana 7.2=233.6 pieces of Watermelo
25 1.4 0.6 2 medium Mango n
1 cup pieces of 100+5.6+5 pcs of
Mango 22 1.7 0.4 .4=111 banana

1 slice of 36 4.1 8.8 88+6.8+3.

Watermelon 6=98.4

1 cup of mashed 144+16.4+

potatoes 79.2=239. 1 cup of
6 mashed
potatoes
3. Milk 1 cup of milk 12 8.1 4.8 48+32.4+4 1 cup of milk
3.2=123.6

4. Rice 3 pcs of pandesal 55 10 6.7 220+40+6 1 cup of 1 cup of 1 cup of

0.3=320.3 Rice Rice Rice
3 cups of Rice 135 12.9 1.3 3 pcs of
540+51.6+ pandesal
11.7=603.
3

5. Meat 1 cup of chicken 4.4 15 7.6 17.6+60+6 1 cup of

tinola 8.4=146 chicken
tinola

6. Sugar N/A N/A N/A N/A N/A

7. Fat N/A N/A N/A N/A N/A

TOTAL 362 85 50 2208.7

 C. Sample Menu for a Normal Diet

Breakfast Lunch Dinner

(Indicate House Hold Measures) (Indicate House Hold Measures) (Indicate House Hold Measures)

1 cup of tofu 1 cup of Rice 1 cup of Rice

2 medium pcs of banana 1 cup of chicken tinola 1 cup of pinakbet

1 cup of Rice 1 cup piece of Mango 1 slice of Watermelon

1 cup of milk

Snacks

(Indicate House Hold Measures)

AM Snack PM Snack Midnight Snack

3 pcs of pandesal 1 cup of mashed potatoes

 9. Develop a teaching plan for Mrs. Garda using the prescribed format.

Topic: Health teaching plan for for Healthy Breastfeeding

Date of Implementation: June 22, 2022

Venue: At the client's house

Total Duration: 1h- 2hour

Participant/Learner: Mrs. Catalina Garda, a 35-year-old woman who had just given birth to her third child.

Purpose:

● To provide an optimal source of information to the mother on how to take good care of her own body and her baby.
● To provide counselling and support for lactating mother

GOAL/s: After 1-2 hour of health teaching, the client will be able to gain sufficient knowledge and skills about effective
breastfeeding as well as maintaining a good health for her own and her baby.

Specific Objectives Contents Time Methodology Resources Success Indicators

Frame
1. To increase the 10-15 Coordinate Multimedia During the exclusive
awareness of the mins with the equipments: breastfeeding stage,
● Dietary Guidelines
lactating mother client's family (Laptop, Charts, the client will
about the ● Things to avoid to for the posters) understand and
importance of maintain healthy body conduct of appreciate the
proper nutrition to breastfeeding importance of proper
her own health and orientation nutrition for her own
Hand-outs / leaflets for
her baby. health and that of her
the client.
Encourage baby..
family to be
2. To discuss the ● Definition of 10-15 The client’s
involved from
correlation of health breastfeeding mins knowledge on
the
and breastfeeding breastfeeding will
● Impact of health to breastfeeding
as well as its 5,000 estimated expand as evidenced
breastfeeding process
importance to the budget for successful by;

baby. ● Benefits of exclusive implementation of the

Invite at least ● The client is able
breastfeeding for six objectives
2 nurses to to identify the
months
get involved impact of health
● Importance of in health to breastfeeding.
Dolls to demonstrate
breastfeeding during teaching plan
proper breastfeeding ● The client is able
pregnancy and
to enumerate
 afterbirth Interactive positioning and some of the
learning attachment (if needed) benefits of
● Risk of not
discussion breastfeeding.
breastfeeding
● The client is able
to understand
the importance of
breastfeeding.

3. To identify the List of the factors that may 10-15

factors that may positively or negatively mins
positively and affect the health of the
negatively affect the mother and her baby;
mother and her
● Calorie intake
baby's health
● Food intake
● Fluid intake
● Lifestyle

4. To educate the ● Breast-self 20 Live The mother can now

 mother how to examination mins demonstratio perform a self-breast
establish a routine n and examination and
of checking her ● Information about interactive routinely checks her
breasts and nipples how to identify, discussion breasts and nipples
regularly. prevent, and treat for signs of
conditions that can discomfort.
occur during
breastfeeding that
can help the mother
avoid problems and
resolve discomfort
faster.

5. To teach correct ● Demonstration of: 30 The lactating mother

positioning and mins can now correctly
attachment for Correct demonstrate her
breastfeeding breastfeeding baby's positioning
positioning and attachment when
providing breastfeed..
Good attachment
10. Include visual aids of food exchange list related to lactation.

https://www.canva.com/design/DAFEN46l4fo/5rWJtNo948XzT8pulxG__w/edit?utm_con
tent=DAFEN46l4fo&utm_campaign=designshare&utm_medium=link2&utm_source=sha
rebutton
11. Upload your group output and summarized peer evaluation at the given link on your
NEUVLE.

12. Present your group output to the designated clinical instructor.

References:

A comparison between human milk and cow's milk. Viva! The Vegan Charity. (2022,
January 17). Retrieved June 22, 2022, from
https://viva.org.uk/health/a-comparison-between-human-milk-and-cows-milk/#:~:text=Th
is%20is%20because%20of%20differences,vitamins%20and%20minerals%20vary%20w
idely.

Dewey, K. G. (2001, November 1). Maternal and Fetal Stress Are Associated with
Impaired Lactogenesis in Humans. OUP Academic.
https://academic.oup.com/jn/article/131/11/3012S/4686704

MN, D. J. A. R. N., & Daisy Jane Antipuesto RN MN Currently a Nursing Local Board
Examination Reviewer. Subjects handled are Pediatric. (2012, September 21).
Difference between a cow's milk and human breast milk. Nursing Crib. Retrieved June
22, 2022, from
https://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/difference-between
-a-cows-milk-and-human-breast-milk/

NHS. (n.d.). NHS choices. Retrieved June 22, 2022, from

https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-prob
lems/common-problems/

Nikita. (2015, August 10). Difference between mother's milk and cow's milk. Difference
between Mother's Milk and Cow's Milk | Mother's Milk vs Cow's Milk. Retrieved June 22,
2022, from
http://www.differencebetween.info/difference-between-mothers-milk-and-cows-milk
Tan, K. L. (2011, February 2). Factors associated with exclusive breastfeeding among
infants under six months of age in peninsular malaysia - International Breastfeeding
Journal. BioMed Central.
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-
6-2#:%7E:text=Variables%20that%20were%20significantly%20associated,sharing%20p
ractice%20(Table%203).

World Health Organization. (2011, January 15). Exclusive breastfeeding for six months
best for babies everywhere. Retrieved from
https://www.who.int/news/item/15-01-2011-exclusive-breastfeeding-for-six-months-best-f
or-babies-everywhere

World Health Organization. (2019, December 20). Complementary Feeding. Retrieved

from https://www.who.int/health-topics/complementary-feeding#tab=tab_1

Vera, M. B. (2022, May 11). Nursing Diagnosis Guide and List: All You Need to Know to
Master Diagnosing. Nurseslabs. Retrieved June 21, 2022, from
https://nurseslabs.com/nursing-diagnosis/#h-risk-nursing-diagnosis