NCM 105: BASIC NUTRITION AND DIET THERAPY

Chapter 1
LEARNING ACTIVITY 1: CASE STUDY
Erick is a 73-year-old man who weighs 168 pounds and is 5 ft 10 in tall. He has had progressive difficulty
swallowing related to supranuclear palsy. He has no other medical history other than hypertension, which is
controlled by medication. He denies that the disease interferes with his ability to eat, even though he coughs
frequently while eating and has lost 20 pounds over the last 6 months. He is currently hospitalized with
pneumonia, and a swallowing evaluation concluded that he should have nothing by mouth (NPO). He has
agreed to an NG tube because he believes the “problem” will be short term and he will be able to resume a
normal oral diet after he is discharged from the hospital.

1. How many calories and how much protein does Erick need? Is his weight loss classified as “significant”?
➢ Given his age and activities, as well as his weight and health status, his needed calories and protein is
determined to be 1900-2280 (76 kg x 25 cal/kg; 76 kg x 30 cal/kg) calories per day and 60.8 (76kg x 0.8
g/kg) g protein per day. His weight loss is considered “significant” since it is more than 5% of his usual
body weight. Since he weighs 168 pounds and has lost 20 pounds over the last 6 months, his total weight
loss percentage is over 10%.

2. What type of formula would be most appropriate for him? How much formula would he need to meet his
calorie requirements? How much formula would he need to meet his vitamin and mineral requirements?
➢ Since Erick has neither digestive or absorption problems, nor does he have any disease-specific
requirements, standard formulas would be most appropriate for him. They're made to mimic a regular
diet, and contains complex molecules of protein, carbohydrate, and fat. Nutrient density, as measured by
the amount of formula required to achieve 100% of RDIs for vitamins and minerals, differs among
formulas. In general, the amount of formula required to meet RDIs ranges from 1000 to 1500 mL/day.
Erick would thus require the necessary amount of formula to achieve his dietician's objective of 1900-
2280 calories per day and around 60.8 grams of protein per day in order to maintain muscle mass.

3. What type of delivery would you recommend? What would the goal rate be?
➢ Considering Erick’s condition, I would recommend that his formula be administered via intermittent
tube feeding since it is generally used for noncritical patients. Intermittent feedings have the advantage
of simulating a more regular eating pattern and allowing Erick to move around freely between feedings.
They are given in equal quantities of 250-400 mL infused over 30-60 minutes every 4-6 hours. The
number of feedings given per day, on the other hand, is determined by the total volume of feeding
required. Since Erick’s required calorie intake is maximum of 2280 calories per day, the goal would then
be to administer 400 mL of formula 5 to 6 times a day to meet his caloric needs.

4. If the doctor convinces him to agree to having a PEG tube placed, what formula and feeding schedule would
you recommend for use at home? What does his family need to be taught about tube feedings?
 ➢ I would educate Erick, as well as his family, about PEG or percutaneous endoscopic gastrostomy tube.
PEG is a tube that enters through the skin and into the stomach to deliver tube feeding, fluids, and drugs
when oral intake is inadequate. Only liquids may be provided with PEGs, hence they'd have to help
Erick with a full liquid diet. A full liquid diet comprises primarily of clear liquid with modest amounts of
milk and fiber added. I think Bolus feedings, which are used for feedings into the stomach, are well
tolerated, and allow for greater patient independence, would be appropriate for his condition. I'd also
show Erick and his family how to properly administer bolus feedings, which involves pouring formula
into a syringe, attaching it to the PEG feeding tube, and delivering it swiftly every 3-4 hours in 5-15
minutes.

Chapter 2
LEARNING ACTIVITY 1: CASE STUDY
Ivan was diagnosed with COPD 7 years ago and has had recurrent bronchitis over the past 40 years. He is
68 years old, 5 ft 9 in tall, and weighs 134 pounds. About 3 years ago, he had a normal adult weight of 150 to
155 pounds. He has lost 7 pounds in the last month due to lack of appetite and early satiety. He complains of a
dry mouth and that “food has lost its taste.” He is currently on multiple medications, including a bronchodilator,
an inhaler, and an antibiotic. He uses oxygen as needed. During his recent hospitalization for pneumonia, the
dietitian told him he should be eating at least 2000 calories, but he doesn’t have the energy to prepare or eat that
much food. His usual intake appears in the box on the left.

1. Evaluate Ivan’s current BMI and normal adult weight. Calculate his percent
weight loss over the past month. Is it significant?
➢ Based on Ivan’s weight and height, his BMI is determined to be 19.03
which is classified as normal weight since normal weight ranges from 18.5-
24.9 BMI. His percentage weight loss over the past month is calculated to be 4.9% which is not
considered to be “significant” as it does not go over 5%.
2. What factors contribute to Samuel’s poor appetite and intake? What specific strategies would you
recommend he implement to improve his intake?
➢ Factors like stress, stress response, early satiety, and chronic inflammation, which increases metabolism
and impairs appetite, contribute to Ivan’s poor appetite and intake. To improve his intake, I suggest that
he ask advise from dietary professionals and take nutrition therapy. This will help him improve his
metabolic response to stress, prevent and repair cell damage, and support normal immune system
functioning. Eating small frequent meals can also help improve his intake because it will help his
stomach adjust to the food he takes instead of immediately forcing him to eat a full meal which might
cause shock and trauma to his organs. Eating most nutritionally dense foods and drinking high-protein
and high calorie nutrition formulas between meals can help too.
3. Is 2000 calories an appropriate amount of daily calories for him? How much protein should he consume in a
day?
➢ 2000 calories per day might be a bit too much for Ivan considering his age, weight, and health status.
The appropriate daily calorie intake for him would be between 1525-1830 calories per day. He should
consume about 73.2 (61 kg x 1.2 g/kg [protein needs for COPD patients]) grams of protein per day.
➧ Devise a sample menu for him that takes into account the calories and protein he needs and his symptoms of
anorexia, early satiety, dry mouth, and fatigue.
Breakfast Hot wheat toast with cream cheese, pancakes with butter, orange juice, milk with
skim milk powder, coffee with whipped cream.
Snack Yogurt topped with fruits, fresh fruits, smoothies made with yogurt.
Lunch Meat, potatoes, and vegetables with gravy, water with protein powder, chicken salad
with mayonnaise.
Snack Apples and crackers with peanut butter, fruits and tea with honey.
Dinner Potato salad with mayonnaise, chicken curry, milk, carrot cake with whipped cream.
Sandwich with melted cheese, hot chocolate with marshmallows.
Snack

Chapter 3
LEARNING ACTIVITY 1: CASE STUDY
Diane is a 72-year-old woman with a “Type A” personality who was diagnosed with a peptic ulcer more
than 40 years ago. At that time, her doctor told her to follow a bland diet and eat three meals per day with three
snacks per day of whole milk to “quiet” her stomach. She meticulously complied with the diet to the point of
becoming obsessive about eating anything that may not be “allowed.” She lost 15 pounds by following the
bland diet because her intake was so restricted. She recently began experiencing ulcer symptoms and has put
herself back on the bland diet, convinced it is necessary in order to recover from her ulcer. Yesterday, she ate the
following:
Breakfast: 1 poached egg 2 slices dry white toast 1 cup whole milk
Morning Snack: 1 cup whole milk
Lunch: 3⁄4 cup cottage cheese with 1⁄2 cup canned peaches
Afternoon snack: 1 cup whole milk
Dinner: 3 oz boiled chicken 1⁄2 cup boiled plain potatoes 1⁄2 cup boiled green beans 1⁄2 cup gelatin
Evening snack: 1 cup whole milk

1. Diane’s 1600-calorie MyPlate plan calls for 1.5 cups of fruit, 2 cups of vegetables, 5 grains, 5 oz of meat/
beans, 3 cups of milk, and 5 teaspoons of oils. How does her intake compare? What food groups is she
undereating? Overeating? What are the potential nutritional consequences of her current diet?
➢ Comparing her intake to her MyPlate plan, I can see that Diane is not eating the amount of food she is
supposed to consume in a day. She is undereating in the fruits, vegetables, and grains food group. On the
other hand, she is overeating in the protein and dairy food group. As a result, she might not be able meet
her daily required calorie intake and she might not receive adequate amount of nutrients that her body
needs.
2. What other information would be helpful for you to know in dealing with Diane?
➢ Information such as the use of any medication, drinking, smoking, or substance use, any specific
complaint like nausea and vomiting, psychological assessment for any depression, any other medical
conditions, time of meals, and lifestyle habits would be helpful in dealing with Diane's case.
3. Diane clearly wants to be on a bland diet; what would you tell her about diet recommendations for PUD?
What recommendations would you make to improve her symptoms and meet her nutritional requirements while
respecting her need to follow a “diet”?
➢ She should consume a well-balanced, healthy diet. It doesn't help if she eats more frequently or
consumes more milk and dairy products. These alterations may result in increased stomach acid
secretion. Despite the fact that dietary restrictions are frequently used to treat ulcers, there is no evidence
that they promote PUD or hasten ulcer healing. A high-fiber diet, particularly soluble fiber, such as dry
peas and beans, lentils, oats, and certain fruits and vegetables, can help her avoid duodenal ulcers.
Avoiding foods that induce gastric acid release, such as dairy products, caffeine, alcohol, and chocolate,
as well as not eating two hours before bedtime and avoiding particular individual intolerances, may be
beneficial.

Chapter 4
LEARNING ACTIVITY 1: CASE STUDY
Margie is a 33-year-old woman who was recently diagnosed with IBS. She alternates between episodes of
diarrhea and constipation and complains of distention and abdominal pain. Her doctor suggested she eat more
fiber and take Metamucil. She dislikes whole wheat bread. She is reluctant to take a fiber supplement; she
knows fiber helps people with constipation, and because she also has diarrhea, she believes it will only make
her problem worse. She is thinking about adding yogurt to her usual diet to see if that helps. She drinks an
“irritable bowel syndrome–friendly tea” that is supposed to help, but she hasn’t noticed any improvement. Her
usual intake is as follows:

1. What does Margie need to know about fiber and bowel function? What
would you say to her about eating more fiber? About taking a fiber
supplement? About yogurt? And about “irritable bowel syndrome–
friendly tea”?
➢ Margie needs to understand that just because fiber helps with
constipation, it doesn’t mean that it will make her diarrhea
worse. Fiber is a carbohydrate that the body is unable to digest. It
cannot be broken down into sugar molecules and hence travels
undigested through the body. In relation to bowel movements,
dietary fiber softens and increases the weight and size of your stool. It also absorbs water in the stool,
making them easier to pass. I will recommend she have a high-fiber diet complemented with fiber
supplements since it will help with her constipation and diarrhea. Eating probiotics, such as yogurt, can
help with IBS symptoms by increasing helpful bacteria in the large intestine, reducing bacterial
overgrowth in the small intestine, and creating a healthy balance of pro- and anti-inflammatory
substances. As for the “irritable bowel syndrome–friendly tea,” they also help relieve digestive issues
since they soothe the intestines, relieve abdominal pain, and reduce bloating. However, they might not
be effective for Margie since she didn’t see any improvement in her condition.

2. What else do you need to know about Margie to help relieve her symptoms?
➢ Information such as her individual intolerances or food sensitivities, use of any medication, emotional
troubles, family history, prior adverse life experiences, and any other medical conditions would be
helpful in relieving Margie’s symptoms since it will be easier to find out the root of her condition.

3. What other diet interventions could she implement to try to improve her symptoms?
➢ There are many interventions that can be done to help improve and relieve Margie's symptoms. Eating
small meals, avoiding coffee, eating less fat, learning relaxation exercises, keeping a food diary, and
following an elimination diet to uncover probable food intolerances or allergies are some other anecdotal
nutritional recommendations.

4. What elimination diet items is she consuming? What alternatives to those foods would you suggest?
➢ The elimination diet items she consumes include cookies, milk, cheese and crackers, apples, coffee, ice
cream, and fruit juice like orange juice. Instead of apples, she can eat fruits like bananas, berries,
grapefruits, and oranges which are low in fructose. Instead of fruit juices, milk, and coffee, she should
drink tea and other variations of milk that are non-dairy like oat milks. Instead of ice creams, cookies
and cheese, she should eat more yogurts and hard cheese.