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Name: ________________ Period: ____
Date: __________
Nutritious Diet Unit Test
Directions: Read the below case study. Using Calculating a Caloric Based Diet, calculate a meal plan and write a sample menu. The sample menu must exhibit all the characteristics of an aesthetically pleasing meal. Using Nutritional Progress Note worksheet, write a SOAP Progress Note based on the information in the case study. If you determine that there is missing information, make assumptions based on the information provided to complete the assignment.
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|Case Study |
|Desmond Samuels works in the new office park on the outskirts of town. When his office was located downtown, 3 day a week, he would walk five blocks to eat |
|lunch at the high school. At the new office, he uses his car to reach the variety of fast food restaurants located in the area. During most weekends, he |
|plays basketball, go on a hike, or go canoeing with friends. His wife cooks dinner every night. She usually prepares fresh fruits and vegetable once or twice a|
|week. He has noticed a weight gain since the office moved and his 6ft 1in body frame now has a current weight of 205#. At his annual physical two weeks |
|ago, select lab results were cholesterol up to 239; blood pressure = 145/92; fasting glucose level = 111; iron level = 15. His doctor advised him to lose |
|weight, increase his fiber intake and physical activity. He also referred him to the local dietitian to follow-up on his high fasting glucose level. He made|
|the appointment and now he is in your office. |
Calculating a Caloric Based Diet
Step 1: Determine client’s Ideal Body Weight (IBW) [Quick Rule of Thumb Method]
| |Ideal Weight |Per inch | | | |
|Gender |at 60” |over 60” add | |Large-Framed Individuals |Small-Framed Individuals |
| | |under 60” subtract | | | |
| | | | |Increase first sum by 10% for large-framed |Decrease first sum by 10% for small-framed |
| | | | |individuals of either gender. |individuals of either gender. |
|Female |100 pounds |5 | | | |
| | |pounds | | | |
|Male |106 pounds |6 | | | |
| | |pounds | | | |
Ideal Body Weight = ____________ pounds
Step 2: Calculate Caloric Requirement
_________ Basal Calories + ____________ Activity Calories = _______Total Calories
10 calories/pound of IBW 30% of basal for sedentary activity
50% of basal for moderate activity
100% of basal for strenuous activity
Step 3: Distribute Carbohydrate, Protein, and Fat Percentages
For this activity, the percent caloric distribution used will be 55%carbohydrate, 20% protein, and 25% fat. Remember, any percent caloric distribution can be used. Different age groups and genders require different caloric distributions.
Formula:
_____ (total cal.) X ________ (distribution%) = _____calories from CHO ÷ 4 = ___ gm CHO
_____ (total cal.) X ________ (distribution%) = _____calories from PRO ÷ 4 = ___ gm PRO
_____ (total cal.) X ________ (distribution %) = _____calories from FAT ÷ 9 = ___ gm FAT
Step 4: Distribute Meal
Any meal distribution formula can be used if more or less meals/snacks are going to be consumed.
For this activity, the meal distribution formula 3/10, 3/10, 3/10, and 1/10 will be used for three meals and one snack.
_____ (total cal.) ÷ 10 = _______ X 3 = ____ calories per meal
_____ (total cal.) ÷ 10 = _______ X 1 = ____ calories for snack
Step 5: Diet Prescription
_____ calorie diet // _____ gm carbohydrate // _____ gm protein // _____gm fat
Step 6: Develop 1-Day Meal Plan using the Diabetic Exchange List Values. These can be found
in your handout The Exchange List System for Diabetic Meal Planning from the
University of Arkansas Cooperative Extension Service.
Calculation of Diet Plan Chart
| | |Exchange | | | |
|Steps |Exchange |Amounts |CHO |PRO |FAT |
| |Milk | | | | |
|1 |Plan at least 2 cups of dairy per day. | | | | |
| |Vegetables (non-starchy) | | | | |
|2 |Plan at minimum 3 exchanges per day; | | | |xxxxxx |
| |Fruit | | | | |
|3 |Plan at least 3 exchanges per day; | | |xxxxxx |xxxxxx |
| |Total the grams of carbohydrate | | | | |
| | | | | | |
|STOP |______ total grams CHO in diet plan | | | | |
| |Minus (-) | |_______ | | |
|AND |______ subtotal grams CHO |xxxxxx |Subtotal |xxxxxx |xxxxxx |
| |Equal (=) | | | | |
|CHECK |______ remaining grams CHO | | | | |
|TOTALS |Divided (÷) by 15 | | | | |
| |To equal (=) | | | | |
| |______ number of bread and/or | | | | |
| |starchy vegetable exchanges | | | | |
| |Bread // Starchy Vegetables | | | | |
|4 |Plan the number just calculated. | | | | |
| |Total the grams of protein | | | | |
| | | | | | |
| |______ grams PRO in diet plan | | | | |
|STOP |Minus (-) |xxxxxx |xxxxxx |________ |xxxxxx |
| |______ subtotal of grams PRO | | |Subtotal | |
|AND |Equal (=) | | | | |
| |______ remaining grams of PRO | | | | |
|CHECK |Divided (÷) by 7 | | | | |
|TOTALS |To equal (=) | | | | |
| |______ number of meat exchanges | | | | |
| |Meat | | | | |
|5 |Plan number calculated | |xxxxxx | | |
| |Subtotal the grams of fat | | | | |
| | | | | | |
| |______ total grams of FAT | | | | |
|STOP |Minus (-) | | | | |
| |______ subtotal grams FAT |xxxxxx |xxxxxx |xxxxxx | |
|AND |Equals (=) | | | |_______ |
| |______ remaining grams FAT | | | |Subtotal |
|CHECK |Divided (÷) by 5 | | | | |
|TOTALS |To equal | | | | |
| |______ numbers of fat exchanges | | | | |
| |Fat | | | | |
|6 |Plan number just calculated. | |xxxxxx |xxxxxx | |
|TOTAL |Grams: Approximate of caloric level. |xxxxxx |( +5) |( +3) |( +3) |
Step 7: Develop the Meal Plan
Summarize total number of exchanges needed in each exchange group to develop the meal plan.
____________ Starch//Bread Exchanges
____________ Meat Exchanges
____________ Vegetable Exchanges
____________ Fruit Exchanges
____________ Milk Exchanges
____________ Fat Exchanges
Divide the exchange groups into meals and/or snacks. The calories in each meal and/or snack should reflect, as close as possible, the calculated formula distribution in Step 4. The grams of carbohydrate, protein, and fat (Step 5) should be divided into 3/10, 3/10, 3/10, and 1/10
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|Breakfast |
|Percent Distribution = ______ kcal = _____ |
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|CHO = ______ grams PRO = ______ grams FAT = _____ grams |
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|Food Exchange |
|Amount |
|CHO gm |
|PRO gm |
|FAT gm |
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|Starch//Bread Exchanges |
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|Meat Exchanges |
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|Vegetable Exchanges |
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|Fruit Exchanges |
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|Milk Exchanges |
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|Fat Exchanges |
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|Meal Total |
|xxxxxx |
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|Snack |
|(Mid-Morning // Mid-Afternoon // Bedtime) |
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|Percent Distribution = ______ kcal = _____ |
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|CHO = ______ grams PRO = ______ grams FAT = _____ grams |
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|Food Exchange |
|Amount |
|CHO gm |
|PRO gm |
|FAT gm |
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|Starch//Bread Exchanges |
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|Meat Exchanges |
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|Vegetable Exchanges |
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|Fruit Exchanges |
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|Milk Exchanges |
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|Fat Exchanges |
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|Meal Total |
|xxxxxx |
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|Lunch |
|Percent Distribution = ______ kcal = _____ |
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|CHO = ______ grams PRO = ______ grams FAT = _____ grams |
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|Food Exchange |
|Amount |
|CHO gm |
|PRO gm |
|FAT gm |
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|Starch//Bread Exchanges |
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|Meat Exchanges |
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|Vegetable Exchanges |
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|Fruit Exchanges |
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|Milk Exchanges |
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|Fat Exchanges |
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|Meal Total |
|xxxxxx |
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|Dinner |
|Percent Distribution = ______ kcal = _____ |
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|CHO = ______ grams PRO = ______ grams FAT = _____ grams |
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|Food Exchange |
|Amount |
|CHO gm |
|PRO gm |
|FAT gm |
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|Starch//Bread Exchanges |
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|Meat Exchanges |
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|Vegetable Exchanges |
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|Fruit Exchanges |
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|Milk Exchanges |
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|Fat Exchanges |
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|Meal Total |
|xxxxxx |
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Sample Menu Based on _________ Meal Plan
|Breakfast |Lunch |Dinner |
| |________________ |________________ |
|________________ |________________ |________________ |
|________________ |________________ |________________ |
|________________ |________________ |________________ |
|________________ | | |
| |________________ |________________ |
|________________ |________________ |________________ |
|________________ | | |
|Snack |
|________________ |
|________________ |
|________________ |
|________________ |
NUTRITIONAL PROGRESS NOTES
Client Information
|Last Name: |First Name: |M. Initial: |Client #: |
|Date of Birth: |Gender: Male // Female |Phone Number: |Insurance Provider: |
|Referring Physician: |Ethnic Background: |Diagnosis: |
|Date/ |Prob. | |NOTES MUST BE SIGNED WITH NAME AND TITLE |
|Time |No | | |
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