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KELSI SWETLAND

MENU PLAN PROJECT


LIFE-CYCLE NUTRITION FSCN 3612
UNIVERSITY OF MINNESOTA
FALL 2014

TARGET AUDIENCE DEFINITION AND INTRODUCTION

Target Population
The target population will be a group of females staying at Hennepin County
Medical Center in the OB GYN unit, age 20-30 years old. These females will have
recently given birth and are staying in the hospital following the birth to ensure the
mother and child are in good health.
Demographics
This group includes 20-30-year-old females of any ethnicity within Minnesota.
Hennepin County Medical Center is known for serving the low-income population of
Minneapolis. It is possible that many of the women in the OB-GYN unit at HCMC will
also be low-income, which has the potential to affect the food choices that they
make during their hospital stay.
Environment
Hennepin County Medical Center is located in downtown Minneapolis, MN, at 701
Park Avenue. HCMC is known for its safety-net attributes, providing care for lowincome, uninsured and/or vulnerable populations. In 2013 the HCMC Birth Center
was home to 2,289 births.
Hospital Rooms: Patients stay in private rooms with a full bathroom, bed, sink
for bathing newborn and other minimal furniture. The rooms do not have a

microwave or other equipment to make or store food. The OB-GYN unit has a
kitchen with microwave, refrigerator (with freezer), coffee maker, and juice
machine, available to use by staff only, but for the purpose of meeting patients
needs.
Meal Service: HCMCs Food and Nutrition Services automatically provide meal
service to all patients with active diet orders. Patients are encouraged to order their
meals through a Nutrition Services Aid for breakfast, lunch and dinner, when
possible (some meals may be missed due to doctor visits, etc.). Patients are able to
choose what food is served to them within their specific diet order, which is usually
Regular, unless the patient is not feeling well (liquid diet) or diabetic (consistentcarbohydrate diet). Between-meal snacks can also be ordered for patients by
nursing staff or registered dietitians. Patients are also allowed to bring in any food
that they desire, either from home or from restaurants, stores, etc.
Physical Limitations/Demands
Following childbirth, there are many changes that the body goes through. On
average, women are 12-13 lbs. lighter than their full-term weight, after giving birth 1.
Physically, women will experience soreness and tenderness while their bodies begin
healing and recovering. Hormone levels adapt to meet the needs of breastfeeding.
Postpartum exercise is not advised until about six weeks after giving birth, and
physical demands require the mother to rest when possible. Additionally, sexual
intercourse is not recommended for the first six weeks after childbirth. The physical
limitations and demands after giving birth, such as requiring ample amounts of rest
and limiting physical activity, affect the nutritional and caloric needs of the female
body.2
Economic/Sociocultural Factors

Hennepin County Medical Center serves populations that may be uninsured,


vulnerable and/or underserved, these factors affect access to physical and
educational resources, although this may not be the case with all patients. Multiple
sociocultural factors affect the health of new mothers, including, but not limited to,
average age of mother, educational opportunities for new mothers, resources and
costs of raising a child, individual religious beliefs, traditions, and cultural practices.
Specific Nutritional Needs
After giving birth many women are in need of a greater supply of calcium,
magnesium, zinc, vitamin B6, and folate. The recommended daily intake of calcium
in lactating women of this age range is 1000 mg/day, and studies have shown boneloss in breastfeeding women with low-calcium diets. A woman within these
parameters should also be consuming 310 mg/day of magnesium to maintain
biochemical reactions within the body. Additionally, a daily intake of 4 mg/day of
zinc, more than double the zinc requirement for a woman who was not pregnant, is
recommended due to nutrient loss via breastfeeding. Women should be receiving
double the pre-pregnancy daily intake of vitamin B6, at 2.0 mg/day, and folate
should be ingested at 500 mcg/day. Lastly, iron is another essential nutrient to
supplement in order to prevent loss of iron stores and sinking to anemic levels. In
order to restore iron status to pre-pregnancy levels, women should aim to consume
15 mg /day.3 Fluid consumption is vital in order to satisfy increased thirst, and
prevent constipation or other digestive issues, especially in breast feeding mothers.
Caffeine and alcohol intake are not recommended but are deemed to be safe in
small amounts. Breastfeeding mothers are also advised to limit fish intake, as it
may contain harmful pollutants. Another dietary aspect to consider for pregnant and
postpartum women, is pregnancy cravings, as they can be experienced during

pregnancy and can lead to abnormal or specifically limited food choices. For
example, it is very common for pregnant women to crave sour foods. 4 This could
potentially have an effect on nutrient needs and body levels.
Ideal Body Weight, BMI and Caloric Needs
An additional 500 calories/day are suggested for most breastfeeding women,
however, it may be necessary for women that exercise, are underweight, or that are
breastfeeding more than one child, to increase by up to 700 calories daily. Caloric
intake for any postpartum woman should not fall below 1,800 calories/day. Most of
the weight gained during pregnancy will naturally decrease during the first year
after being pregnant, placing women back into their standard BMIs. However,
women who were overweight or extremely overweight before pregnancy, and that
desire weight loss can do so safely by setting a maximum of 4.5 lbs./month. 5

MENU PLAN

DAY ONE
Breakfast:
Creamy oatmeal ( cup oatmeal,
cup
milk) Almond
topping ( cup)
1 Large Hardboiled egg
8 oz. 1% Milk
AM Snack:
Hummus dip(2oz)

Pita chips (12)


Carrot sticks ( c)
8 oz. water
Lunch:
Minestrone soup (1 cup - black
beans, carrots, onion, tomatoes and
beef stock) Chicken Caesar salad (6
oz. chicken, 3 cups romaine lettuce,
cup shredded parmesan cheese,

2 Tbsp. Caesar dressing, 2 Cups


total)
Pears ( cup sliced)
1 2 oz. whole-wheat breadstick
1 tsp. salt
1 tsp. pepper
PM Snack:
Sweet and salty trail mix ( cup
almonds, 2 Tbsp. chocolate chips,
1/8 cup raisins, cup
cashews)
Dinner:
Chicken (6 oz. grilled breast)
Scalloped Potatoes ( cup potatoes, milk, cheddar cheese)
Green beans ( cup, cut and
steamed) Pumpkin pie (1 slice pumpkin puree, graham cracker
crust)
8 oz. Cranberry juice
1 tsp. salt
1 tsp. pepper
HS Snack:
1 Large Apple + 2 Tbsp. Carmel
Apple Dip

DAY TWO
Breakfast:
Bowl of granola cereal (2 cups
granola 1 cup
1% milk)
1 small banana (4 oz.)
8 oz. Orange juice
AM Snack:
Celery (1 cup cut stalks)
Peanut butter ( cup)
8 oz. Unsweetened Iced tea

Lunch:
Taco salad ( cup beef, 2 cups
iceberg lettuce, cup black olives,
cup cheese, 2
Tbsp. sour cream, 2 Tbsp. chopped
onion,
cup chopped tomato)
1 Large Granny smith apple
PM Snack:
Popcorn (4 cups with butter and
salt)
1 small Clementine
Dinner:
Ranch snack wrap (6 oz.
chicken, 1 10 whole-wheat
wrap, cup lettuce, cup
cheddar cheese) 1 cup Sweet
Potato Fries
8 oz. 1% milk
1 tsp. salt
1 tsp. pepper
HS Snack:
1 Large Pear (sliced) sauted in 1
Tbsp.
butter + 1 tsp. cinnamon
DAY THREE
Breakfast:
Sunny breakfast sandwich (1
multigrain English muffin, 2 tbsp.
cream cheese, 1 large fried egg,
1oz breakfast sausage)
100% vegetable V8 juice, served
over ice
(11.5oz can)
1 medium banana, chopped
AM Snack:
Blueberry muffin (1 medium)
Lunch:

Baked spaghetti (3 oz. whole-wheat


spaghetti noodles, cup marinara
sauce, cup mozzarella cheese,
cup spinach, 2 tbsp. parsley)
1 cup Roasted Italian vegetable
blend (zucchini, lima beans,
carrots, cauliflower, green beans)
cup Berry Medley ( cup
blueberries, cup strawberries,
cup raspberries)
1 tsp. salt
1 tsp. pepper
PM Snack:
Sweet and salty popcorn (2 cup
popcorn, 3
tsp sugar, 2 tsp salt)
Dinner:
Oven roasted pork loin (6 oz.)
Mashed sweet potatoes (1 Tbsp.
butter, 2 tsp cinnamon, 2 tsp salt,
1 cup boiled sweet potato)
Steamed vegetable medley,
C (carrots, corn, peas, green
beans) 8 oz. 1% milk
2 small chocolate chunk cookies
1 tsp. salt
1 tsp. pepper
HS Snack: cup Cheez-its
1 beef jerky stick

DAY FOUR
Breakfast:
1 cup Scrambled eggs with cheese
(2 eggs,
cup cheddar shredded cheese)
1 medium brae burn apple
8 oz. Orange juice
1 tsp. salt
1 tsp. pepper

AM Snack:
1 cup Broccoli with
cup ranch
dressing
8 oz. water
Lunch:
1 chili cheese hot dog (1 bun, 1
hot dog, cup chili sauce, cup
cheddar shredded cheese) 1
small clementine
Mini carrots with ranch dressing (15
mini carrots, cup ranch dressing)
8 oz. Orange juice
PM Snack:
Ben and Jerrys Half Baked ice
cream ( cup)
Dinner:
1 cup Tater-tot Casserole (tater
tots, green beans, cream of
mushroom soup, shredded
cheddar cheese, baked) cup
Mashed potatoes (potatoes, 1%
milk,
butter)
1 cup Cheesy Brussel sprouts
(Brussel sprouts, cheddar shredded
cheese, baked)
1 tsp. salt
1 tsp. pepper
HS Snack:
1 cup Celery with cup ranch
dressing
8 oz. Orange juice

DAY FIVE
Breakfast:
2 slices French Toast (bread, egg,
cinnamon) cup scrambled eggs
(2 eggs, 2 Tbsp. fat free milk) 2
slices bacon (pork, baked)
4 oz. orange juice
1 small (4 oz.) banana
8 oz. Greek yogurt made with 2%
milk
8 oz. tea (caffeine-free)
1 tsp. salt
1 Tbsp. butter
1 tsp. pepper
4 T pancake syrup

chicken gravy cup mixed


vegetables (steamed carrots,
broccoli, lentils, cauliflower)
8 oz. 1% milk
1 tsp. salt
1 tsp. pepper
1 Tbsp. butter
cup chocolate pudding (instant
pudding
mix, milk)

AM Snack:
1 slice whole-wheat toast with 2
Tbsp.
creamy peanut butter

DAY SIX
Breakfast:
Yogurt parfait (3/4 cup 2% Greek
yogurt - vanilla, cup
strawberries, 1/4 cup cinnamon
toasted granola) Multigrain toast,
buttered (2 slices, 2 Tbsp. butter)
8 oz. Apple Juice

Lunch:
4 oz. beef pot roast with 2 oz. beef
gravy cup roasted red potatoes
(made with olive oil, basil, salt,
pepper, baked)
cup cooked carrots (steamed)
8 oz. 1% milk
2 oz. serving pineapple upsidedown cake (pineapple, sugar, flour,
butter, brown sugar, eggs, baked)
1 tsp. salt
1 tsp. pepper
1 T butter
cup red grapes
PM Snack:
cup whole roasted almonds
1 medium peach (whole)
Dinner:
6 oz. Baked chicken (breast)
cup mashed potatoes (potatoes,
1% milk, butter) with 2 oz.

HS Snack:
1 Large Banana
1 Slice Whole-Wheat Bread
1 Tbsp. Creamy Peanut Butter

AM Snack
Cinnamon pita chips (12)
Fresh mango salsa (1/8 cup)
Lunch
Side salad (1/2 cup lettuce, 2 Tbsp.
diced tomatoes, 2 Tbsp. shredded
carrots, 1 Tbsp. French dressing)
Crunchy coconut chicken wrap (1
flour tortilla, 1/8 c lettuce, 2 diced
tomatoes, 4 oz. coconut chicken,
1/8 cup shredded cheddar cheese,
1 tsp mayonnaise) Tropical fruit
salad (1/2 cup each; mangos,
pineapple, guava)
1 tsp. salt
1 tsp. pepper
PM Snack

Pretzel dippers (13 pretzels, 2 Tbsp.


creamy peanut butter)
Dinner
Baja tacos (3 corn tortillas, 6 oz.
fried Mahi-mahi, cup cabbage
slaw, 3 tsp cilantro cream sauce)
Black beans (1/2 cup)
DAY SEVEN
Breakfast:
Breakfast taco (1 large
scrambled egg, cup
shredded cheddar cheese, 1
Tbsp. sour cream)
Strawberry yogurt ( cup,
2% Greek style)
1 tsp. salt + pepper
8 oz. Orange Juice
AM Snack:
Toasted, Salted Almonds (1/2 cup)
8 oz. 1% Milk
Lunch:
Black Bean Burrito (10 in. flour
tortilla, 1 Tbsp. chopped
onion, chopped green
pepper, cup black beans,
cup sour cream, cup
canned salsa)
Spanish Rice (1 cup white rice,
1 Tbsp. olive oil, 1 Tbsp. minced
onions + garlic)
Refried Beans (3/4 cup, canned)
Orange Juice (8 oz.)

Brown rice (1/3 cup)


Fresh Guacamole ( cup - avocado,
onion,
tomato,
cilantro) 1 tsp.
salt
1 tsp. pepper

Dinner:
Cheeseburger ( lb. ground beef, 1
slice cheddar cheese, slice of
onion, slice of tomato, slice of
lettuce, 1 Tbsp. each ketchup +
mustard)
Sweet Potato Fries (2 sweet
potatoes, baked, salt)
Small Dinner Salad (1 stalk
romaine lettuce, 5 cherry
tomatoes, cup chopped onion,
cup ranch dressing)
1 tsp. salt
1 tsp. pepper
8 oz. 1% Milk
HS Snack:
10 Whole Wheat Saltine
Crackers

PM Snack:
Strawberry Jell-O (1 cup
prepared)
8 oz. Skim Milk

TARGET AUDIENCE INTERVIEW AND MEAL OBSERVATION

Date: 11/2/14 and 10/29/14


Location: Hennepin County Medical Center OB GYN Unit
Time: 7:30 am for breakfast, 11:30 for lunch, 4:30 for dinner
Observer: Kelsi Swetland
Patients may receive snacks from nutrition services if ordered by the RD (not
common in this unit, but possibly for diabetic mothers), or they may also bring any food
in from home or other restaurants. The rooms are not supplied with refrigerators or
microwaves, however there is one microwave and refrigerator in the nutrition galley for
the entire unit to use (only staff members have access, but may bring food in to
prepare/store for patients).
I observed breakfast, lunch and dinner on October 26 th and November 2nd, however,
I am also an employee with Food and Nutrition Services at HCMC and have worked with
this unit many times over the last two years. I have added commentary as necessary
from knowledge gained throughout this time period in the observation form.
Meal Consumption Questions

These questions should be addressed during the observation to obtain as much


information as possible to disseminate to your group as well as discuss your menu and
the success in the Summary section of the paper.
1. Who is present at the meal (e.g. family, friends, alone, etc.)?
a. Husbands/babys father, mother, other children, other family, sometimes
nurses, varies from room to room
2. Duration of meal
a. Is the time allowed enough time to eat all components of the meal? (This
should be actual time that is allowed when the food is available not
including waiting time for food.)
i.
Usually patients are given 1 hour to eat, and then the tray will
be collected. If the patient wishes to keep their tray because
they are not done eating, they are allowed to do so. Sometimes
the patients are not done eating because they have other
appointments they need to go to or they have been sleeping or
taking care of their baby.

b. Is the person allowed to dismiss themselves from the table early?


i.
Yes, patients only have to eat as much as they want.

3. How is the food served? What type of dishes (reusable, disposable)? Are
plate/bowl/eating and serving utensils standard types and sizes?
a. Food is served on dishes designed to keep food hot while traveling from
kitchen to patients rooms, and then organized on a tray. Some items, such
as milk, are in disposable containers. Cups for other beverages, such as
juice, are 4 ounces, silverware and plates are standard size, bowls for hot
cereal are 4 or 6 ounces. Coffee and tea are served in 6 oz. cups.
b. Food is arranged on a tray that is set on a bedside table so that the patient
can reach and eat their food from their bed.
4. Who served the food?

a. Nutrition associates pass food trays to patients in their rooms. Patients


feed themselves or may have a nurse or family member assist.
5. How the food was served (pre-portioned, self-serve, etc.)?
a. Food is pre-portioned in the kitchen; every patient is served approximately
the same amount of each dish. Some dishes may come in different sizes
(i.e. small or large oatmeal), which the patient may choose.
6. Who determines portions (pre-portioned, self-serve, serving cups, etc.)?
a. Portion sizes are determined by the foodservice management team and
directors, taking into account total calories and nutrition values. Patients
may choose how much they are served, to an extent. For example,
ordering two or three milks instead of one, or zero milks, or two servings of
the entre, etc.
7. Menu what foods are served?
a. Patients are allowed to order whatever they would like to eat, if they do not
choose (due to being unavailable to order from nutrition associate,
sleeping, or being admitted after a mealtime, etc.) they are sent a
standard house tray. Entre options have two featured items for lunch
and dinner that change day to day.
b. Breakfast: House Meal = two small (4 diameter) pancakes and (2
diameter) turkey sausage patty or 3x3 vegetable egg bake for the entree,
4 oz. orange juice, 8 oz. 1% milk, salt, pepper, margarine, 2 oz. pancake
syrup (for pancakes), and a small (4 oz.) banana.
c. Lunch: House Meal = a hamburger with lettuce, tomato and cup potato
wedges or a large (full plate- 8 diameter) chef salad (lettuce, ham, turkey,
tomato, egg, shredded carrots) for the entree, 8 oz. 1% milk, cup apple
crisp, salt, pepper, ketchup, mustard, margarine, or salad dressing, cup
fruit cup, cup cooked carrots with hamburgers
d. Dinner: House Meal = 4 oz. Roast turkey slice with 1 oz. gravy, cup sage
dressing, 1 oz. cranberry sauce and cup green beans or 6 oz. beef and

bean chili with a small corn muffin for the entre, 8 oz. 1% milk, salt,
pepper, margarine, cup fruit cup, a dessert is not sent up with the house
meal but most patients order a small chocolate chip cookie, cup pudding
or cup Jell-O
8. How are items served, cooked or raw, baked or fried (add as much detail as
possible)?
a. Items are served to food safety guidelines, cooked. Eggs are fried in the
morning, pancakes are pre-made and microwaved in the morning, sausage
and bacon are baked, fruit are assembled into small cups each morning. ii.
Hamburgers are fried, potato wedges are baked, carrots are boiled, chef
salads are prepared in the morning and kept in cooler, apple crisp is baked
3 days prior and portioned the previous day and kept in cooler, fruit cups
are portioned every morning, fruit is bought precut and received every
other day.
b. Turkey is sliced and baked the previous day, warmed up in steamer for
dinner, dressing is baked the day of, green beans are steamed, chili is
cooked, corn muffins are baked two days prior to use, cookies are baked
daily and used as needed, pudding is portioned from can daily, Jell-O is
made in kitchen and portioned on designated days and used accordingly
(Wednesdays and Fridays)

9. Comment on the most, least popular items? Were their items not taken or tossed
excessively?
a. Breakfast: Items that were commonly ordered included bacon, pancakes,
banana bread, blueberry muffin, yogurt, orange or apple juice, fruit cup,
grapes, strawberries, pineapple, coffee, tea. Items that were given and
often rejected or un-eaten included 1% milk, scrambled eggs and oatmeal.
b. Lunch: hamburgers with potato wedges are a commonly ordered item and
most patients eat them, sometimes they request a cheeseburger instead,
chef salads are commonly ordered and eaten in this unit, other common

items that are ordered include chicken noodle soup, chocolate milk, apple
and orange juice, apple crisp, and some type of fruit cup. Items that are
often rejected include macaroni and cheese, most patients order what they
would like and will eat what they ordered.
c. Dinner: half of the patients that received the turkey dinner do not want to
eat it, the dressing is commonly rejected, these items have a tendency to
not look appealing by the time they make it to the patient, therefore they
are rejected. Patients who order the chili and corn muffin often do not feel
full and request more food, patients will order a cheese- or hamburger
again instead, other common items ordered on this night include spaghetti,
grilled cheese and tomato soup and cheese quesadilla with black beans and
rice. Many patients will request the apple crisp again, but it is only offered
for lunch.
10.Are there any distractions present during the meal?
a. During a stay in the hospital there are countless distractions occurring
throughout the entire day. Patients are continuously having other hospital
personnel enter their rooms and request their attention, personnel from
the lab, nurses, birth certificate officials, midwives, environmental services
and nutrition services all come in and can distract patient from
eating/meal-time. Breakfast may come earlier than the patient wants to be
awake and will sleep through breakfast meal-time. The same situation may
occur with dinner time, dinner might be served much earlier than the
patient would prefer or is accustomed to, which may leave them feeling
hungry later in the evening when food and nutrition services is not
available.
11.Other information of interest concerning the meal:
a. Patients are usually either REALLY hungry and order the maximum amount
(as much as can fit on the tray) or they dont feel like eating at all. Patients
in this unit are usually given a regular diet order (without restrictions),

but some are given diabetic when necessary, or a clear liquid diet if the
patient is not feeling well or have a C-section. Nutrition services also
provides the entire unit with boxed lunches (consisting of a turkey
sandwich (turkey, cheese, lettuce, tomato on wheat bread), apple, 2
cookies, bag of potato chips and mayo/mustard, prepared daily) that the
nurses may provide the patients with if they are hungry overnight, when
nutrition services are not available. Otherwise, any other food items that
are desired by the patient must be provided by their own means, the
patients are allowed to order in or bring in any food items that they wish.

MEAL PLAN NUTRIENT ANALYSIS (DAY 1 AND 3)

NDSR 2014 Averaged Recommended Dietary Allowances/Adequate


Intake Report
Project Abbreviation: 32
(Complete Project)Comment:
Life Stage Group: Lactation, Age 19-30 y
Nutrient
Vitamin A

Amount Reported
2590mcg RAE

RDA
1300
mcg RAE

%RDA
199
%

AI

Vitami
nC
Vitamin D

146.250mg

Vitamin E

22.791mg

Vitamin K
Thiamin

387.597mcg
2.616mg

1.4 mg

Riboflavin

2.870mg

1.6 mg

Niacin
Vitamin B6
Folate
Vitamin B12
Pantothenic Acid
Choline
Calcium
Copper
Iron

7.084mcg

61.774mg NE
2.953mg
766mcg DFE
3.735mcg
7.450mg
577.868mg
1379mg
2138mcg
20.145mg

Magnesium

469mg

Manganese
Phosphorus

4.990mg
1922mg

Selenium

120 mg
15 mcg
19 mg

122
%
47
%
120
%
90 mcg

17 mg
NE
2.0 mg
500 mcg
DFE
2.8 mcg

187
%
179
%
363
%
148
%
153
%
133 %
7 mg
550 mg

1000 mg
1300
mcg
9 mg
310 mg

138
%
164
%
224
%
151
%
2.6 mg

700 mg

176.055mcg

70 mcg

Zinc

14.137mg

12 mg

Potassium
Sodium
Total Fiber
Total Water

4g
5g
33.385g
3.317l

275
%
252
%
118
%
5.1 g
1.5 g
29 g
3.8 l

RDA/AI values based on the Dietary Reference Intakes provided by the National
Academy of Sciences, Institute of Medicine, Food and Nutrition Board (19972011).

Main Folder
Page 1 of 2

Printed: 11/24/2014 15:45

NDSR 2014 Averaged Recommended Dietary Allowances/A


Intake Report
Project Abbreviation:
Comment:

32

adequate

(Complete Project)

Life Stage Group: Lactation, Age 19-30 y


Additional Recommendations
Nutrient
Energy
Fat
Carbohydrate
Protein
Alcohol
Cholesterol
Saturated Fatty Acids
Trans-Fatty Acids

Amount Reported
2637 kcal
101.9
87 g
315.0
16 g
127.416 g
0.000 g
m
g
32.10
6g
2.38
1g

% of Energy

Recommended Intake
2

34.028 %

20-35%

46.529 %

45-65% 2

19.405 %
0.000 %

10-35% 2
1
< 300 mg

471

10.7 %
36
0.813798 %

<
10%

2
Linoleic Acid
23.497 g
8.021 %
5-10%
Alpha-Linolenic
2.182 g
0.745 %
0.6Acid
1.2%
Added Sugars
45.319 g
6.876 %
< 25% 2
Note: DSAM nutrients are not included in these total ls. Nutrient totals may not
equal the sum of their parts. (Refer to the NDSR User Manual.)

Dietary Guidelines for Americans, 2010.

Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids.

National Academy of Sciences, Institute of Medicine, Food and Nutrition Board


(2002/2005)

MEAL PLAN COST ANALYSIS (DAY 4)

Food
Item

Brand

Large
Grade A
Eggs

Hickmans

Cheddar
Shredded
Cheese

Name

Purchase
Size
18 count

Great Value 8 cups


Shredded
Mild
Cheddar

Purchase
Price
$4.41

$8.88

1 apple
Brae burn
Apple

Orange
Juice
Broccoli

Ranch
Dressing

Hotdog
bun

Hotdog

Target
Store Brand

Serving
Size

Cost per
Serving

2 eggs

$0.40

1 cup

$1.24

lb.

$0.50

$1.49/lb.

59 fl. Oz.

$2.88

16 fl. Oz.

$0.78

56 oz.

$5.98

8 oz.

$0.85

36 oz.

$3.18

6 fl. Oz.

$0.54

16 ct.

$4.08

1 bun

$0.26

10 ct.

$2.50

1 package

$0.25

Minute
Made
Birds Eye
Broccoli
Florets

Great
Value

Rainbow

Oscar
Mayer

15 oz.

$1.98

2 oz.

$0.26

Cuties

5 lbs.

$2.44

1 (0.28 lb.)

$0.68

Bolthouse
Farms

32 oz.

$2.89

9 carrots
(3 oz.)

$0.27

16 oz.

$3.00

cup

$0.75

Chili
Sauce

Hormel

Clementin
e
Mini
Carrots
HalfBaked
Ice
Cream

Ben and
Jerrys

Tater-tots

Ore-Ida

28 oz.

$3.59

package
(7 oz.)

$0.13

Green
Beans

Del-Monte

1.75 cup

$1.67

0.05 cup

$0.05

Great
Value

10.5 oz.

$1.25

0.5 oz.

$0.06

Potatoes

Russet

11 - 13
potatoes

$3.99

1 potato

$0.33

1%
Milk

Kemps

1 gallon

$3.50

cup

$0.05

Crystal
Farms

4 sticks
cup each

$4.28

Brussels
Sprouts

EatSmart

2 lbs. (8
cups)

$4.53

1 cup

$0.57

Celery

Dole

1 lb. (4 cups) $1.98

1 cup

$0.50

Cream of
Mushroom
Soup

Butter

TOTAL FOR ONE DAY_$8.59__

$0.03
2 tbsp.

GOAL = $6.91 TOTAL PERCENTAGE OF GOAL = 1.2%

DISCUSSION AND SUMMARY

Overall, my menu plan was well-suited for the target population. The menus
met the DRIs for all nutrients, except for Vitamin D. Unfortunately, this hospital is
located in Minnesota where vitamin D exposure may not be an option during all
times of the year. One way to change this would be to add more foods that are rich
in vitamin D to the menu plan such as fish, fortified cereals, and/or mushrooms. After
childbirth, many women do not get enough calcium, magnesium, zinc, vitamin B6,
and folate. For this reason, I focused on foods rich in these nutrients when making
the menu. These nutrients are vital to recovery and for supporting an infant through
breastfeeding. I chose a variety of foods when making the menu in order to ensure
that the DRIs for essential nutrients were being met. Breastfeeding women should
consume 1000mg/day of calcium to prevent bone loss while breastfeeding, while a
DRI of 310mg/day is essential for maintenance of the bodys biochemical reactions.
Increased zinc consumption is necessary as well, and the DRI for breastfeeding
women is almost double that of non-breastfeeding women because zinc is lost
through breast-milk. Iron is especially essential for postpartum women because of
the blood lost during birth, and 15mg/day is the recommendation to bring the body
back to pre-pregnancy levels. After achieving pre-pregnancy levels, a breastfeeding
woman should consume about 9mg/day of iron to prevent anemia. The nutrient
analysis for the food items on the menu for day one and three showed that 20mg of
iron was supplied, more than the amount needed to recover from birth. Omega-3
fatty acids are also essential for the recovery of the mother, as well as for brain
development of the infant consuming breast-milk. The recommended amount for
lactating women ages 19-30 is 0.6%-1.2% of your daily calories. The menu was in
this range, at 2.182 g of omega-3s, however, the amount consumed could
potentially be increased because they are so vital for postpartum women. Omega-3s
can be found in several food sources including green vegetables, fish, walnuts,
soybean oil, canola oil and eggs. Unfortunately, in a clinical setting more expensive
foods such as walnuts and omega-3 rich fish may not be available.

HCMC serves a very diverse patient population, that may not be familiar with
some of the foods served or offered to them while staying in the hospital, and many
patients may prefer to eat based on their own personal, cultural, or religious
practices. Because this hospital serves such a variety of ethnic groups it was
difficult to plan a menu that would encompass all individuals, while simultaneously
providing the nutrition they need for this life-stage. The population I menu planned
for is also on the younger side of motherhood. Additionally, the target audience was
on the lower end of the age-spectrum, and it is reasonable to consider that many
mothers may have been experiencing their first childbirth, and therefore would be
less experienced with proper nutrition during pregnancy and postpartum or
lactation. Not only is it important that this population consumes their recommended
daily values of nutrients, but it is also important that they know to consume extra
calories when breast feeding. The menu plan provided three snacks on most days to
ensure that the mother had enough energy to recover as well as breastfeed if she
chooses to. Breastfeeding is optimal for the health of the baby, and is the best
financial option for providing nourishment, making breastfeeding an attractive
choice for families or individuals in low-income households.
As illustrated by the table on page 17-18, the menu created for the fourth day
did not stay within the spending budget of $6.91, going over by almost $2.00 at
$8.59. This would lead to budget problems with individuals or families, especially
when taken into consideration that the fourth day menu had the smallest amount of
food variety within the full menu. That being said, all of the prices were taken from
either Target or Wal-Mart, where the food was not packaged in bulk. Also, when the
menu was written, it was assumed that there would be a little extra money to spend
on things such as brand name items, such as Ben and Jerrys ice cream. After
calculating the cost analysis, it would be advisable to edit the menu so that off-brand
or less costly items could replace the more expensive name-brand items. I believe

that the majority of the menu would be feasible, as long as foods are bought in bulk
when possible, brand-names are avoided, and individuals stay within portion sizes.
Based on the observation conducted with this project, the patients did not
have reservations or restrictions with their diet preferences. The items that were
selected by patients created a wide array of options with many foods from each of
the food groups. The menu that I have written would provide enough
nutrition/calories to satisfy hunger and cravings by patients, however, it may be
altered or have some items that would be omitted in the hospital/clinical setting,
due to availability and cost. For example, items such as Mahi-mahi and Chili-Cheese
Dogs may not be served in a clinical setting because the food items served must be
applicable to patients with varying health complications, as well as being financially
appropriate to buy on a large scale. Along with this, the snacks that I have written
into the menu would not likely be provided by the health-care center, and would
require the patient to provide them for themselves. Based on the observation, many
of the patients had other food items stocked in their rooms; either brought in by
visitors or by the patient themselves. Many patients also had snacks or specific
items stored in their rooms; these could include a favorite item of the patient, not
provided by the health-care center, or items that are specific to the patients
cultural or religious beliefs. Many of the patients chose fresh fruit items and limited
items that were in packages or highly processed food items. The menu I have
written includes many of the types of foods that were selected by patients. Foods
like this displayed in my menu include fresh fruit and vegetables for snacks, as well
as balanced entrees that would be easy to make at home, but also in the healthcare center food service department (minus the Mahi-Mahi and snack items). Many
of the items written in my menu are similar to what the patients in my observation
setting would see on the menu at Hennepin County Medical Center.

In conclusion, I believe that my menu plan would work well as a basic plan for
a postpartum female, and would meet the nutritional needs of postpartum women
ages 20-30 years old. The food selection is specific to meeting the increased iron,
zinc, folate and calcium needs of women after pregnancy. The menu plan also
features a variety of foods, optimal for women after giving birth because cravings
may or changes in taste may occur, and it is an important part to providing the
variety of nutrients that are required for women that are breastfeeding. The menu
also uses many of the same ingredients throughout the week so as to stay within a
budget that would be appropriate for the selected target audience. While the
population I observed was under the care and supervision of a health-care facility,
therefore having limited control over what foods they consumed, the menu would
still be applicable after the patient returned home. Some of the items on the menu
could be substituted for less-costly items, making it more appropriate to low-income
families. It was observed that the population I chose preferred a variety of fresh
foods and fewer processed and packaged items, for this reason, I chose to comprise
my menu of meals featuring this type of food. This menu could be used as a guide
for any woman in the days after giving birth by meeting their specific nutritional,
food variety, financial and food preparation needs.

RESOURCES

1. Association of Reproductive Health Professionals. Postpartum Counseling. Diet,


Nutrition, and Exercise: Quick Reference Guide for Clinicians. Association of
Reproductive Health Professionals. http://www.arhp.org/publications-andresources/quick-reference-guide-forclinicians/postpartum-counseling/diet. Published
(n.d.). Revised July 2013. Accessed September 29, 2014.

2. Office on Womens Health, U.S. Department of Health and Human Services.


Pregnancy > Recovering from birth. WomensHealth.gov.
www.womenshealth.gov/pregnancy/childbirthbeyond/recovering-from-birth.html.
Published January 2008. Revised September 27, 2010. Accessed September 29,
2014.

3. U.S. Department of Health and Human Services. Fact Sheet for Health Professionals.
Health Professional Fact Sheet. National Institutes of Health - Office of Dietary
Supplements website. http://ods.od.nih.gov/factsheets/Magnesium-

HealthProfessional/#h2. Published January 2010. Revised November 4, 2013.


Accessed September 29, 2014.

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6. Kathleen L. Deegan, Katherine M. Jones, Clara Zuleta, Manuel Ramirez-Zea, Dorte L.


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