GROUP 5 - Nutrition Care Plan (Geriatric)

Republic of the Philippines
PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila
College of Nursing
Nutrition and Diet Therapy Laboratory:
Nutrition Care Plan for a Geriatric

Submitted by:
Group Leader – Mendoza, Kobe C.
Group Members:
Agbayani, Carl Jason R.
Domasin, Angel S.
Ereno, Alexandra Mari B.
Lantin, Ellysa Nicole M.
Medina, Katherine Anne M.
Melitante, Faith Louise B.
Pacheco, Christina Maegan A.
Paguirigan, Fritz G.
Ramos, Matthew Angelo J.
Trinidad, Romina R.
BSN 2-2; GROUP 5
Submitted to:
Prof. Albina Garcia
Prof. Maricel Chua
December 9, 2021
Intramuros, Manila
College of Nursing
I. INTRODUCTION
The 21st century is an era of aging population. With the increasing number of the elderly
population, many nations worldwide are gradually entering a more serious aging society. Aging is
defined as the unavoidable, permanent reduction in organ function that happens over time even if
there is no occurrence of injury, sickness, environmental dangers, or bad lifestyle habits and
choices. In an article written by Rajesh Parihar (2019), he mentioned that aging has always been
recognized as a natural process that is actually involved with outgoing maturity, growth, and
development. At first, alterations in organ function have little effect on baseline performance. The
earliest signs are a decrease in each organ's ability to sustain or preserve the body's homeostasis
under any distress. The most susceptible organs which can be highly affected during aging are the
cardiovascular system, central nervous system, and renal system.
Geriatric clients and their hierarchy of needs go through a sudden shift as they age further
into life. A study conducted by Majercsik (2005), most clients of this age oppose the general
hypothesis of maslow’s motivation theory, which in turn, may catalyze a necessary shift in the
approach of geriatric care, emphasizing more on the self-actualization and esteem aspects of the
clients other than their veracious need for physiologic care. People who turn 65 years old and
above every year contribute to an increase to the number of their own population in every country
- this population transition would have a significant impact on the healthcare delivery system
leaving nurses with a responsibility to allocate resources and satisfy the needs of this certain age
group population. These individuals are distinct people since they have existed the farthest and
have witnessed and responded to complicated societal shifts and this is where the significant role
of nurses in geriatric care happens. Nutrition is a key health factor to those over the age of 65.
Malnourishment in the older people is frequently misdiagnosed. A thorough nutritional evaluation
is required for the effective identification of malnutrition in geriatric population, as well as the
formulation of extensive treatment regimens. Though findings show that the best way to utilize
Maslow’s theory is to adjust it in order to fit each individual’s need, it has also been proven that
areas which received the least amount of attention were esteem, safety, and self-actualization needs
- particular aspects that most health care practitioners forget the most (Doerr, 2015).
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College of Nursing
II. INFORMATION ABOUT THE CLIENT
The client’s name is Wilhelmina R. Trinidad, a female and is 62 years old. She is a Filipino
and a Roman Catholic. She finished primary education and is currently a housewife. She has been
married to her husband, Rodolfo A. Trinidad, who is 63 years old. They had five children, one
male and four females. At present, the client is living with her husband and their youngest
daughter, who is 21 years old in their house that is made of both concrete and other light materials.
The person responsible for choosing what food to buy and the preparation of food, is the client
herself. While her husband and their daughter are the persons responsible for purchasing the food.
The family’s food is stored in their refrigerator and a gas stove is used in preparing or cooking the
food.
The client is 1.562 meters high and weighs 165.34 pounds or 75 kilograms. In the past, the
client usually weighed about 187.393 pounds or 85 kilograms. However, in January 2021, the
client verbalized that she was diagnosed with hypertension, elevated levels of cholesterol, and
diabetes, which affected her appetite for the past few months, leading to her weight loss of about
11 pounds or 5 kilograms. In line with these findings, the client’s BMI or Body Mass Index is 30.7
which is interpreted as Obese under Class I. The client has approximately 50 millimeters of triceps
skinfold thickness.
Upon interviewing, the client stated that she eats three meals a day with snacks once a day.
She does not consume any alcohol and does not smoke. Due to her medical condition, she has six
maintenance medicines, which she takes everyday according to schedule. She also stated that her
medications for hypertension are always constant in dosage and frequency. However, the dosage
and frequency of intake of her medications for diabetes and cholesterol varies according to her
laboratory results. If her blood sugar and cholesterol are low, the dosages are reduced. But if the
results are too high, the dosages and frequency are increased. For exercise, the client specifically
does not follow any exercise routine, but she stated that she does household chores such as cooking
and cleaning every day for about 30 minutes to 1 hour.
As mentioned, the client has experienced weight loss due to her lack of appetite for the past
several months, but she also said that about two months ago, her appetite came back, and she has
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been eating well since. She said, “Noong una talaga mahina ako kumain, siguro paga-adjust pa
sa gamot. Pero nitong bandang September, parang bumalik na ulit siya dahil pinipilit ko nga din
yung sarili ko kumain.” The client also said that she hasn’t experienced indigestion for a while
now. She also doesn’t have any food that causes nausea and vomiting. However, she admitted that
whenever she eats even a tiny bit of chocolate, she experiences diarrhea. Her bowel elimination is
also normal as she defecates every day during the morning in which her bowels are well-formed
without blood and abnormal discoloration. During the interview the client is also calm and well-
participative.
During the whole duration of the interview, observation and visual inspection are done
which revealed that the physical appearance of the client from head to neck is normal except from
her teeth and her neck. The client has about 10 teeth left that are fully functioning and does not
have cavities in them but has light yellow discoloration and spots. She mentioned that she has fully
functioning dentures, however she only uses it whenever she leaves home as she is not quite
comfortable using it. As for her neck, the client has numerous warts of various sizes with the
smallest being 1 millimeter and the largest being 3 millimeters. But other than these, head to neck
appearance is normal as her hair is shiny and lustrous with her scalp that is smooth and healthy
without any microorganisms or dusts in it. Her face together with her skin is smooth, moist and
has uniformity of color. The client’s eyes are also bright clear with no visible spots in the sclera
and the conjunctiva are also moist and pinkish. There is also no visible swelling, redness and
discharges from the ears. The lips are smooth and pink, and the tongue is deep red with a slightly
rough surface. There are also no lumps, nodules, and enlargement palpated on the neck as the
student nurse performed palpation on the client.
As per the nails, the client has brittle and ridged nails with pale nail beds. The client
verbalized that she thinks, the discoloration of her nails was due to the detergent that she uses on
their laundry, “Masyado kasi atang matapang yung gamit ko na sabon, kaya naging ganyan na
ang kulay niyan.”
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As for the client’s musculoskeletal system, the client has firm and well-developed muscles
that exhibit good mobility and actions. She also has good posture and normal gait and there are no
observed malformations of the skeleton system.
For the internal systems such as the gastrointestinal system, the student nurse asked the
client to drink half-cup of water, to assess if she has difficulty swallowing in which the client
verbalizes denied and emphasized that she did not experience any discomfort. As for the abdominal
examination, the student nurse asked the client to lie down so that the abdomen will be exposed
for inspection, auscultation, palpation, percussion. Upon inspection, there are no visible abnormal
findings such as discoloration, lesions, scars, masses, and distention. The client also has a flat
abdomen. There are also no abnormal bowel sounds during auscultation. During palpation, the
liver is not tender and has normal size. Most regions of the abdomen also produced tympanic
sounds which are normal upon percussion, except on the upper region of the abdomen which
produced dull sounds as organs such as liver and spleen are there.
For the cardiovascular system, the student nurse got the client's vital signs which revealed
that the client’s blood pressure upon the assessment was 119/76 with a pulse rate of 102 beats per
minute and a respiratory rate of 17 breaths per minute.
III. 24 HOUR RECALL AND FOOD FREQUENCY QUESTIONNAIRE

A 24-hour dietary recall (24HR) is a systematic interview designed to collect precise
information about all foods and beverages (as well as any dietary supplements) taken by the client
in the previous 24 hours. The purpose of this open-ended response style is to encourage the client
to offer a thorough and detailed account of all foods and beverages ingested. The portion quantity
of each food and beverage is recorded in addition to additional detailed descriptors such as time of
day and source of food.
In terms of the client's dietary history, it is clear that she eats healthily because she prefers
fruits and vegetables. Fruits like apple, banana, papaya, lemon, ponkan, dalandan, pineapple which
are rich in potassium, fiber, vitamin C, A, K, phosphorus, zinc, calcium and various antioxidants.
The client stated that she sometimes paired the vegetables with meat whenever she’s cooking,
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dishes like chop suey, pakbet, ginataang kalabasa and sauté vegetables. The client also eats
processed foods like hotdog, longganisa, and skinless. She also often eats eggs that are either boiled
or fried. The client also drinks coffee and partners it with plain biscuits like fita and skyflakes, or
whole grain breads for her merienda in the afternoon. In addition, the client also likes to drink
green tea. Pork, chocolate, leche flan, halaya, juice, cake, ice cream, and marine foods are among
the foods she can eat. Moreover, the client also mentioned that she wants to consume these items,
but owing to her illness, she refrains from doing so and has been successful since then. Soft
beverages, junk foods, instant noodles, beef, and canned products are among the foods that the
client dislikes. She also doesn't have any food allergies.
The client stated that she wakes up at 6:00 am and prepares her morning meal at 6:30 am
which is 1 cup of coffee, 2 pcs of hotdogs and 1 cup of rice in their kitchen. In addition, the client
mentioned that she prefers 3 in 1 coffee or sometimes instant coffee and then she mixed it with
creamer. Coffee is very rich in antioxidants that may improve health and reduce the risk of several
diseases of the client. Meanwhile, the client said that the hotdogs were bought by her husband in
the grocery store. The hotdogs are also high in Vitamin B12, with just one hot dog delivering 30%
of the daily value. Vitamin B12 is necessary for regular metabolism, and adult mental clarity. In
addition, long-grain white rice is a rich source of energy, carbohydrates, calcium, iron, thiamin,
pantothenic acid, folate, and vitamin E.
For lunch, the client makes food at 11:30 am and the dish for that time is sinampalukan na
manok. In addition, the client stated that she is the one who generally makes their meals, she
claimed that she usually boils meat, particularly chicken meat. She normally sautéed the vegetables
first before simmering and boiling them. The client said that she ate 1 bowl of viand, 1 cup of rice
and 2pcs of banana at that time. The sinampalukan na manok has a lot of health advantages.
Tamarind, which is high in polyphenols and flavonoids, has been found to lower LDL cholesterol
while increasing HDL cholesterol, reducing the risk of atherosclerosis. The dried pulp also has
antihypertensive properties, lowering diastolic blood pressure.
The client cooks longganisa at 6:00 pm for their dinner. She stated that what she consumes
that night is 1 piece of longganisa and 1 cup of rice. The longganisa is heavy in fat and
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carbohydrate, making it unsuitable for dieters. It also contains large amounts of sodium,
cholesterol, and sugar, all of which are harmful to your health. The only positive aspect of this
sausage is the protein content, which is only 7 grams per serving. Given that longganisa is primarily
composed of meat, it is undoubtedly high in protein, helping the client to feel satisfied without
consuming additional carbohydrates. The client stated that she normally consumes snacks at 3:00
in the afternoon and she normally eats 2 packs of skyflakes in their living room. Skyflakes contain
Omega-3 from flaxseed that has anti-inflammatory benefits that reduces the risk of arthritis, lupus,
asthma, and certain types of cancer. Lastly, the client does not take any vitamin or mineral
supplements.
To determine the amount of nutrients of each food eaten by the client in the 24-hour recall,
it is based on the serving size and food item. Table 1 shows the nutrient content of each food.
Meal Food Item Serving Calorie (Kcal) CHO (G) Fats (G) Proteins (G)
Size
Breakfast: Hotdog 2 pieces 151 x 2 = 302 4.2 x 2 = 8.4 8 x 2 = 16 4x2=8
Rice 1 cup 206 45 1 3
Coffee 1 cup 35 18 2 0
Lunch: Sinampalukan 1 bowl 168 17 2 20

na Manok
Rice 1 cup 206 45 1 3
Banana 2 pieces 105 x 2 = 210 27 x 2 = 54 0.4x2 = 0.8 1.3 x 2=2.6
Snack: Skyflakes 2 packs 120 x 2 = 240 16 x 2 = 32 5 x 2 = 10 2 x 2=4
Dinner: Longganisa 1 piece 180 14 10 10
Rice 1 cup 206 45 1 3
Banana 1 piece 105 27 0.4 1.3
TOTAL 1858 kcal 305.4 g 44.2 g 54.9 g
Table 1. Nutrient Content of each Food based on the 24-hour Recall

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For more accurate and precise consumption of food, its amount, and frequency, a food
frequency questionnaire (FFQ) was administered to the client. The FFQ used was proposed by the
Fred Hutchinson Cancer Research Center and can be accessed through the following link:
https://www.fredhutch.org/en/research/divisions/public-health-sciences-
division/research/nutrition-assessment.html.
The questionnaire is composed of approximately 125-line items of foods and beverages,
its frequency of consumption and portion of size over a defined period of time. Additional
questions on food type and preparation are also asked in the questionnaire. The FFQ can be self-
administered, however the student nurse resorted to administering the questionnaire to the client
to overcome difficulties.
Upon interviewing, it was revealed that the client consumed 37 different kinds of food and
beverages in the past month out of 125 items in the questionnaire. The FFQ revealed that the client
frequently consumes 1 pack of non-fat crackers such as sky flakes, 1 pack of regular crackers such
as fita, 2 slices of whole grain bread, 2 eggs, 1 hotdog, ½ clove of onion, ⅛ cup of garlic, 3 cups
of rice a day, 1 banana, 2 slices of tomato, and 1 cup of either coffee with creamer or tea. In
addition to these, she also consumes at least two different kinds of vegetable meals a week and
different kinds of fruits that are either orange, grapes, watermelon, or apple at least once a week.
Chicken meat is also consumed approximately twice each week while pork is consumed for about
thrice a month. The most used condiment of the client is catsup in which she consumes twice a
week. Table 2 reflects the most frequent food the client consumed in the past month.
Food Frequency Amount
Bread and Snacks
Whole grain breads and rolls Once per day 2 slices
Sugar in coffee 4 times per week 1 tbsp.
Nonfat (Skyflakes) crackers 6 times per week 6 crackers
Regular crackers Once per day 6 crackers

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Meat, fish, and eggs
Eggs Once per day 2 eggs
Hotdog Once per day 1 hotdog
Meat Once a month 2 ounces
Ground meat Thrice a month 1.5 ounce
Fried chicken Thrice a month 1 large piece
Broiled chicken 3 times a week 1 large piece
Fried fish Once per week 3 ounces
Pasta, Mixed Dishes, Soups
Spaghetti Once a month 1 cup
Mac and Cheese Once a month 1 cup
Tofu Thrice a month 3 ounces
Vegetables
Tomatoes 4 times a week 2 slices
Carrots Twice a week ½ cup
Red peppers Thrice a month 1/8 cup
Cabbage Twice a month ¼ cup
Green beans Twice per month ¼ cup
Sweet potatoes Twice per month 1 piece medium
Garlic Once a day ½ clove
Onion Once a day 1/8 cup
Rice Thrice a day 1 cup

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French fries Once a month ¾ cup
Boiled potato Twice a month 1 medium-sized
Sauces and Condiments
Gravy Once a month 1/8 cup
Catsup Twice a month 1 tbsp
Fruits
Mayonnaise Once a week 1 tbsp
Apple Twice a week ½ cup
Banana 6 times a week 1 medium-sized
Orange Once a week 1 piece
Watermelon Once a month 1 slice
Grapes Once a week ½ cup
Coffee 4 times a week 1 cup
Unsweetened tea 4 times a week 1 cup
Creamer 4 times a week 1 tbsp
100% apple juice Once a month 1 cup
Table 2. Food Frequency Questionnaire

ANALYSIS
To determine whether the nutrients, kinds, kcal, and amounts of food were adequate, it is
important to determine various values first such as Basic Metabolic Rate (BMR) as it is needed for
calculation of total energy requirement; Total Energy Requirement (TER) as it is needed to
calculate the adequacy of carbohydrate, fats, and protein taken by an individual.
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The Basal Metabolic Rate (BMR) of the client using Harris Benedict’s Formula by supplying
the height (156 cm), weight (75 kg), age (62), and sex (female) of the client, shows that:
BMR (for females) = 655 + (9.6 x wt (kg)) + (1.8 x ht (cm)) – (4.7 x age (yr))
BMR = 655 + (9.6 x 75kg) + (1.8 x 156cm) – (4.7 x 62 yrs old)
BMR = 1364.4 kcal per day
The Total Energy Requirement (TER) of the client using the formula proposed by
FAO/WHO/UNU in 1985, shows that:
TER = BMR x Type of Activity
TER = 1364.4 kcal x 1.3 (very light activities)
TER = 1773.72 kcal per day ≈ 1800 kcal per day
To determine the required Carbohydrate (60%):
CHO Required = TER x 60%
= 1800 kcal per day x 0.60
= 1080 / 4
CHO Required = 270 g
To determine the required Fats (30%):
FAT Required = TER x 30%
= 540 / 9
FAT Required = 60 g
To determine the required Protein (10%):
CHON Required = TER x 10%
= 180 / 4
CHON Required = 45 g
Table 2.1. Computations for Required Calories, Proteins, and Fats

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Upon calculation, the results showed that the BMR of the client is 1364.4 kcal per day
base on the Harris-Benedict’s formula. This BMR led to a TER of 1773.72 kcal per day or
equivalent to 1800 kcal per day. Referencing to this calculated TER, the client has a required
intake of 270 grams of carbohydrate, 60 g of fats, and 45 grams of protein. Comparing the data
in Table 2.1 and Table 1, the results showed that there is an excessive intake of carbohydrates,
calories, and proteins while there is an insufficient consumption of fats.
Calorie Carbohydrate Fat Proteins

Dietary Intake based 1858 kcal 305.4 g 44.2 g 54.9 g
on 24-hour recall
Computed Dietary 1800 kcal 270 g 60 g 45 g
Requirement
DIFFERENCE: 58 kcal 35.4 g 15.8 g 9.9 g
Table 2.2. Difference of Dietary Intake and Computed Dietary Requirement
The dietary intake base on the 24-hour recall is 58 kcal higher than the computed dietary
requirement for the condition of the client. The carbohydrate intake base on the 24-hour recall is
also 35.4 g higher than the computed CHO requirement. As per the proteins, there is a 9.9 g
difference. While for the fat, the computed dietary requirement is higher of about 15.8 g than the
consumption of the client.
As per relating the values to the RDA for each major nutrients, since the client has
hypertension and diabetes, RDA differs from normal. For carbohydrates, it is said that people
living with type 1 or type 2 diabetes should aim to get 45% of their daily calories from
carbohydrates (Tinsley, 2020). As for protein intake, the RDA for diabetic elderly is about 10% to
35% of daily calories as long as the kidneys are healthy (Lehman, 2021) while for fat intake, it is
recommended for elderlies to get only 20-35% of their daily calories from fat (Serenity Care, n.d.).
Referencing to the 24-hour recall:
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Calories Carbohydrate % Protein % Fat %
1858 kcal 𝐶𝐻𝑂 𝑔 𝑥4 𝐶𝐻𝑂𝑁 𝑔 𝑥4 𝐹𝑎𝑡 𝑔 𝑥9
= 𝑇𝑜𝑡𝑎𝑙 𝑘𝑐𝑎𝑙 x 100 = x 100 = 𝑇𝑜𝑡𝑎𝑙 𝑘𝑐𝑎𝑙 x 100
𝑇𝑜𝑡𝑎𝑙 𝑘𝑐𝑎𝑙
305.4 𝑔 𝑥4 54.9 𝑔 𝑥4 44.2 𝑔 𝑥9
= x 100 = 1858 𝑘𝑐𝑎𝑙 x 100 = 1858 𝑘𝑐𝑎𝑙 x 100
1858 𝑘𝑐𝑎𝑙
= 65.75% = 11.82 % = 21.41 %

Interpretation: More than RDA Within RDA Within RDA
Table 2.3. RDA for each Major Nutrient

Following the formula in computing the percentage for each nutrient base on its kcal, all
of the nutrients reached the RDA with protein and fat intake falling within the RDA range.
However, carbohydrate intake is way above the RDA for diabetic elderlies.
IV. BRIEF ANATOMY AND PHYSIOLOGY

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough
insulin or when the body cannot effectively use the insulin it produces (WHO, n.d.). Diabetes is
the most common disorder of the endocrine system. The Philippine Statistics Authority data
showed that deaths due to diabetes mellitus ranked fourth in 2020 at 37,365, after heart diseases
(99, 680), cancer (62,289), and cerebrovascular diseases (59,736). More than 32 percent of those
with type 2 diabetes have cardiovascular complications, while more than 87 percent are either
overweight or obese.
Insulin is the hormone responsible for regulating blood sugar. A large portion of the food
you eat is separated into sugar which is also called glucose and released into your bloodstream. At
the point when your glucose goes up, it flags your pancreas to release insulin. Insulin behaves like
a key to allow the blood to sugar into your body's cells for use as energy.
What happens is that after a meal, the small intestine absorbs glucose from digested food,
resulting in the rise of blood glucose which will then stimulate the beta cells in the pancreas to
produce insulin. Insulin triggers the liver, fat and muscle tissue cells to absorb glucose where it is
stored. When the glucose is absorbed, the blood glucose levels decrease and once blood glucose
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levels drop below a threshold, there is no longer a sufficient stimulus for insulin release and the
beta cells stop releasing insulin.
TYPES OF DIABETES
● TYPE 1 DIABETES (previously known as insulin-dependent, juvenile or childhood-
onset) is characterized by deficient insulin production and required daily administration of
insulin. It is also the result of the autoimmune reaction that the body attacks itself by
mistake, which leads to the stoppage of your body from making insulin. Symptoms include
excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss,
vision changes, and fatigue. The said symptoms may occur suddenly and it is usually
diagnosed in children, teens, and young adults. Being insulin-dependent, you will need to
take insulin every day to survive.
Type 1 Diabetes occurs when the pancreatic beta cells are destroyed by an immune-
mediated process. Pancreatic beta cells sense plasma glucose levels and response by
releasing insulin. Thus, clients with type 1 diabetes have a complete lack of insulin. People
who lose their pancreas are affected by this and have type 1 diabetes.
● TYPE 2 DIABETES which was previously called non-insulin-dependent, or adult-onset

is a result of the use of insulin by the body ineffectively (the body doesn’t use the insulin
well and can’t keep the blood sugar at normal levels). According to the World Health
Organization, more than 95% of people with diabetes have type 2 diabetes. This type of
diabetes is also the result of excess body weight and physical inactivity. Symptoms may be
similar to those of type 1 diabetes but are often less marked those results in diagnosis of
disease several years after onset and after complications have risen already. It is usually
diagnosed in adults and can be prevented or delayed with healthy lifestyle changes such as
losing weight and having a healthy lifestyle.
Type 2 diabetes occurs when tissues do not respond effectively to normal levels of
insulin despite the pancreas still making insulin which is a condition called insulin
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resistance. Over numerous years the pancreas will diminish the degrees of insulin it
secretes, yet that isn't the principal issue when the illness starts. Many individuals with type
2 diabetes don't realize they have it, despite the fact that it is a significant condition.
HYPERTENSION
Hypertension is a frequent, chronic, age-related disorder that often yields to cardiovascular
and renal complications. The pathophysiology of its onset depends on the primary and secondary
incapability of one’s kidney to release sodium under normal blood pressure (Staessen, Wang,
Bianchi, & Birkenhager, 2003). Several other factors that may affect the presence of the said
disease are endocrine factors, large arteries, the microcirculation of blood, as well as the central
nervous system. According to Staessen, et al., (2003), commonly, hypertension arises as a complex
quantitative trait which may be due to different combinations of genetic and environmental factors,
which is why antihypertensive maintenance drugs are prescribed as treatment to most geriatric and
adults in their later adult ages, for it diminishes the complications of hypertension.
Among the several factors that may contribute to the onset of hypertension, the most
common as mentioned are salt intake, obesity and insulin resistance, the RAS (renin-angiotensin
system), and the sympathetic nervous system (Beevers, Lip, & O’Brien, 2001). According to
Ohishi (2019), elevated blood pressure is closely related to increased fluid volume and peripheral
vascular resistance which is experienced by clients with diabetes mellitus, which is caused by
vascular remodeling and increased fluid volume associated with insulin resistance-induced
hyperinsulinemia and hyperglycemia. Both of these mechanisms elevate systemic blood pressure.
The contraction of smooth muscle cells, according to Beevers, et al., (2001), has been predicted to
have a correlation with the rise in intracellular calcium concentration, explaining the vasodilatory
effect of calcium channel blockers. This justifies why most hypertensive clients have normal
cardiac output by raised peripheral resistance, which is determined not by the enlargement of either
capillaries or arteries, but by the enlargement of the small arterioles, containing smooth muscle
cells. Moreover, it has been also believed that during very early onset of hypertension, the
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peripheral resistance of blood vessels is not raised, and the rise in blood pressure is caused by a
raised cardiac output related to sympathetic overstimulation.
Meanwhile clients display hyperinsulinemia with insulin opposition because of disabled
glucose resistance and early-stage diabetes. Due to insulin sensitivity or opposition, glucose levels
in the blood rises, causing the red blood cells to stick together, causing a blockage or a
hypercoagulability state of the blood constituents. These yields increased vascular resistance for
the maintenance of the delivery of blood throughout the systems, as well as endothelial dysfunction
or damage to the epithelial walls of the blood vessel, causing bleeding (Beevers, et al., 2001).
Hypertension occurs due to increased body fluid volume. Subsequent to arriving at mid stage
diabetes the vascular remodeling has advanced, and fringe vascular opposition likewise adds to
hypertension. Additionally, vascular remodeling firmly impacts diabetic complications. In
particular, afferent arteriolar remodeling during diabetic nephropathy prompts expanded
glomerular strain. Accordingly, treatment with a renin-angiotensin framework inhibitor that
advances renal harm relapse is basic to bringing down the fundamental pulse and enlarging efferent
arterioles to diminish glomerular pressure.
V. LABORATORY TESTS
The laboratory results which are showcased below are the most recent diagnostic findings
acquired by the client last July 7, 2021. The normal values are also shown together with its
corresponding interpretations and remarks.
Complete Blood Count (CBC)
Client’s Lab Normal Range Remarks

Result Values for
Geriatrics
(Upper Limit -
Lower Limit)
Hemoglobin 127 120 g/L - 155 g/L ● The hemoglobin content

of the client’s blood is
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within the normal range
values.
Hematocrit 0.38 0.36 - 0.46 ● The hematocrit content of

the client’s blood is
values.
● The lab result is near the
base of the lower limit. A
low hematocrit in the
blood can indicate anemia
or insufficient supply of
RBC, large numbers of
WBC due to disease or
infections, deficiency in
vitamins and minerals, or
recent/long-term blood
loss (Mayo Clinic, 2021).
Platelets 248 150 - 450 x 10^9/L ● The platelets content of

values.
Neutrophils 0.58 0.50 - 0.70 ● The neutrophils content

values.
● A single blood test cannot
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determine if the client has
neutropenia because the
neutrophil levels are
highly flexible which can
change day-by-day
(Mayo Clinic, 2020).
Multiple blood testing is
needed to confirm
neutropenia.
Lymphocytes 0.36 0.20 - 0.40 ● The lymphocytes content

values.
● Lymphocyte counts that
are below the normal
range might potentially
be transient. They might
arise as a result of a cold
or another illness, or they
can be induced by
strenuous physical
activity, acute stress, or
even malnutrition (Silva,
2020).
Monocytes 0.04 0.00 - 0.07 ● The monocytes content of

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values.
Eosinophils 0.02 0.00 - 0.04 ● The eosinophils content

values.
Table 3. Complete Blood Count

The normal values indicated for each category of the complete blood count (CBC) test was
almost similar from the study of Eun Hee Nah et al. (2018) wherein the study formulated a
reference parameter for the different components involved in complete blood count examinations.
The study also established reference intervals for CBC aligned to different age groups such as
pediatrics, adults, and geriatrics - corresponding interpretations and remarks to the garnered values
are based on various articles and resources; these interpretations or remarks do not intend, in any
way, diagnose any particular disease. Looking at the client’s results, all of the values for each
component of the CBC falls within the normal ranges.
Urinalysis

Result for Geriatrics
Color Yellow Yellow ● Client’s urine color

(light/pale to signifies normal
dark/deep findings.
amber)
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Transparency Clear Clear or ● The appearance of

translucent the client’s urine
shows no signs of
abnormalities.
pH 6.0 4.5-8 ● Urine pH of the client

is within the normal
range.
Specific Gravity 1.010 USG = 1002- ● Client’s Urine

1.035 (usually Specific Gravity
1.016 to 1.022) (USG) shows normal
data.
O = 50-1200
mOsm/kg
(usually 275-900
mOsm/kg)
Protein Negative Negative ● There is no

detectable amount of
protein in the urine of
the client. It appears
to be a normal
finding.
Sugar Negative Negative ● Negative result

shows normal blood
glucose level.
WBC 2-4 0-5 WBC/hpf ● The WBC in the

urine sample of the
client is within the
normal range.
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RBC 0–2 0 – 2 RBC/hpf ● The RBC found in the
client’s urine sample
is within normal
values.
Epithelial Cells Few Squamous ● The number of

epithelial cells: 0 epithelial cells in the
– 2 per hpf urine sample is
Renal epithelial normal. Large
cells: 0 – 1 per numbers may indicate
hpf poor or contaminated
samples, or renal
tubular injury.
Mucus Threads Few Not present to ● There are a few

Small Amount mucus threads found
in the urine sample of
the client. A small
amount of mucus in
the urine is normal.
Bacteria Occasional Negative* ● Presence of bacteria is

not always predictive
of an infection and
must be analyzed in
conjunction with
other factors.
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Phosphates / Rare Not present ● There is a rare

Amorphous Urates presence of
phosphates or
amorphous urates in
the client’s urine. It is
still normal, and not
indicative of any
infection.
Table 4. Urinalysis
Based on the data gathered, the result of the urinalysis test of the client with regard to color,
transparency, pH level, urine specific gravity, protein, sugar, and WBC implies normal findings.
According to the study of Milani et al. (2021) the client’s lab results with the said categories, all
of them fall under the normal range or findings. Furthermore, the epithelial cells, mucus threads,
bacteria, amorphous urates, and RBC found in the urine of the client show no signs of
abnormalities.
Creatinine Clearance
Result for Geriatrics
Creatinine Clearance 0.96 0.6 – 1.3 mg/dL ● The creatinine levels

of the client based on
the results are within
the normal range.
Table 5. Creatinine Clearance

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Other Laboratory Test Results
Other Lab Client’s Lab Normal Remarks

Tests Result Range Value
for Geriatrics
Fasting Blood 75.5 mg/dL 70-115 mg/. ● The fasting blood sugar in the client
Sugar (FBS) dL is 75.5 and is within normal range
values.
Triglycerides 206.3 mg/dL 35-165 mg/dL ● The triglyceride amount of 206.3

mg/dL in the client’s blood is above
the normal range values.
● The classification of the triglyceride
lab result of the client belongs to the
category of “high” triglyceride
levels. This means that the client has
hypertriglyceridemia and is
associated with increased risk of
cardiovascular disease, obesity,
insulin resistance, diabetes,
hypertension, and hyperuricemia
(Yuan, G. et.al., 2007)
HDL 28.5 mg/dL 30-85 mg/dL ● The high-density lipoprotein value

of 28.5mg/dL in the client’s blood is
below the normal range values.
● High levels of high-density
lipoprotein are desired to an
individual since it removes low-
density lipoprotein (bad cholesterol)
from the walls of the arteries,
decreasing the risk of clogging of
arteries that can cause
cardiovascular complications. Since
the client has low levels of HDL, the
client is at higher risk for heart
diseases (Hoffman, 2020).
LDL 113.64 mg/dL 50-160 mg/dL ● The low-density lipoprotein (LDL)

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amount of 113.64 mg/dL in the
client’s blood is within normal
range values.
VLDL 41.26 mg/dL 5-40 mg/dL ● The very-low density lipoprotein

(VLDL) value of 41/26 mg/dL on
the client’s blood is above normal
range values.
● Unlike LDL, VLDL is a type of LDL
that carries triglycerides to the
body’s cells and tissues which
makes it essential to the human
body. However, high levels of
VLDL similar to the client, it
contributes to the buildup of plaque
in the blood that increases the risk of
the client of atherosclerosis that can
lead to cardiovascular complications
(Arquilla, 2021).
SGPT/ALT 36.8 IU/L 0-45 IU/dL ● The alanine aminotransferase

enzyme amount of 36.18 IU/L in the
blood is within normal range
values.
● This enzyme is prominent at the liver
cells, and normal level of alanine
aminotransferase enzyme in the
blood indicates normal liver function
since it releases normal enzyme
levels in the blood (Robinson, 2021).
HbA1C 6.3 % 4.0 % - 6.0 % ● The HBA1C content on the client’s

(Fluorescence blood is above normal range values.
Immunoassay ● The quantity of blood sugar
Method) (glucose) bound to hemoglobin is
measured by a hemoglobin A1c or
HbA1c testing. This test is utilized to
detect and check diabetes or
prediabetes occurring in adults. The
typical range for hemoglobin A1c
levels in adults without diabetes is
around 4% and 5.6 %. If hemoglobin
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A1c level is between 5.7 and 6.4
percent, the client possesses
prediabetes and an increased risk of
developing diabetes. Diabetes is
diagnosed at a level of 6.5 percent or
above (WebMD, 2020).
Table 6. Other Laboratory Results
The table above is the other significant laboratory test results of the client. The normal
values written in the table are based on the reference value provided by the clinical laboratory who
catered the laboratory tests of the client. According to the results, the fasting blood sugar (FBS),
low-density lipoprotein (LDL), and serum glutamic pyruvic transaminase/alanine
aminotransferase test levels of the client were within normal levels. Meanwhile, the triglycerides
& very-low density lipoprotein are above normal levels while the high-density lipoprotein (HDL)
are below normal levels, both of which increases the risk of the client from atherosclerosis and
eventually lead to cardiovascular complications such as coronary artery disease, myocardial
infarction, and etc.
Upon reviewing the overall laboratory results of the client, the HBA1C content of the
client’s blood is the most concerning component of the whole blood chemistry. Having these said,
the HBA1C test result of the client reveals an elevated level of 6.3% as compared to the normal
range of 4.0%-6.0% - the result only indicates that the client is still at the borderline of being
diabetic. The student nurses further looked up unto the past blood chemistry concerning the
HBA1C:
HbA1C Results
Date Result Normal Range
July 27, 2021 6.3% 4.0% - 6.0%

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April 27, 2021 7.2%
February 24, 2021 8.1%
Table 7. HbA1C Results of the client for the past laboratory tests.
The table above showcases the HbA1C results of the client for the past months of
monitoring. It reveals that the client still hasn't reached the normal range of HBA1C despite all of
the medications prescribed by the physician.
VI. DRUG STUDIES
Drug Name Dosage, Route, Classification & Contraindications Drug-Food Interactions

& Form General Use
Metformin ● 500 mg PO ● Biguanide; ● Includes renal ● Should be taken with

(Normax) bid (after antihyperglycemic impairment with meals to limit
breakfast agent elevated serum gastrointestinal side
and after ● Lowers blood creatinine levels effects.
dinner) glucose or abnormal
● Form: concentrations in creatinine
Extended- type II diabetes clearance
release tablet without causing ● Congestive
hypoglycemia heart failure
● Advanced age
Glimepiride ● 2 mg PO ● Sulfonylurea drug ● Contraindicated ● No specific foods were

once a day used to treat type II in clients with mentioned that would
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College of Nursing
(after lunch) diabetes mellitus diabetic be excluded from the
● Form: Tablet ketoacidosis, client who is receiving
with or without this medication.
coma.
Clopidogrel ● 75 mg PO ● Antiplatelet; ● Contraindicated ● Grapefruit products

once a day thienopyridine in clients with may decrease its effects.
(after lunch) derivative hypersensitivity ● Herbals with
● Form: Film- ● Used to reduce the to clopidogrel anticoagulant/antiplatel
coated tablet risk of myocardial and active et properties (e.g. garlic,
infarction and bleeding (e.g. ginger, ginkgo biloba)
stroke. peptic ulcer, may increase the risk of
intracranial bleeding.
hemorrhage).
Irbesartan ● 300 mg PO ● Antihypertensive; ● Contraindicated ● No drug-food

(Virbez) once a day angiotensin II in clients with interactions known.
(after receptor antagonist hypersensitivity ● Herbals with
breakfast), ● Used as treatment to irbesartan and hypertensive properties
especially of hypertension concomitant use (e.g. licorice, yohimbe)
when blood alone or in of aliskiren in and hypotensive
pressure is combination with clients with properties (e.g. garlic,
too high. other diabetes. ginger, ginkgo biloba)
● Form: Film- antihypertensives. may alter the drug’s
coated tablet effect.
Amlodipine ● 10 mg PO ● Antihypertensive, ● Contraindicated ● Grapefruit products

Intramuros, Manila
College of Nursing
once a day antianginal; to clients with may increase
(after dinner) calcium channel hypersensitivity concentration and
● Form: Tablet blocker to amlodipine hypotensive effects.
● Used in the and decreased ● Garlic is also known to
management of liver and kidney increase
hypertension and function. antihypertensive effect.
coronary artery ● Alcohol with
disease amlodipine can further
lower blood pressure
and may increase
certain side effects of
the drug.
Fenofibrate ● 200 mg PO ● Antihyperlipidemi ● Contraindicated ● All foods increase

once a day c; fibric acid to clients with absorption.
(after dinner) derivative hypersensitivity ● Grapefruit juice
● Form: ● Added to diet to to fenofibrate, increases the
Capsule reduce LDL-C, has active concentration of the
total cholesterol, hepatic diseases, drug in the bloodstream.
triglycerides, apo- preexisting ● Alcohol with
lipoprotein, and to gallbladder fenofibrate can result in
increase HDL-C in diseases, and liver damage.
clients with severe
primary renal/hepatic
hypercholesterole dysfunction
mia, and mixed (including
dyslipidemia. primary biliary
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cirrhosis and
unexplained
hepatic function
abnormality)
Table 8. Drug study of each client’s medications

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VII. NUTRITION CARE PLAN
ASSESSMENT DIAGNOSIS OBJECTIVES INTERVENTION RATIONALE MONITORING AND
EVALUATION
Subjective: Excessive CHO Short-term Objective Short-term Short-term Intervention
 CHO-rich diet based intake related to  The client will be Intervention  Being mindful of  After 24 hours,
on food preferences and food and able to identify and  The client will one’s meal is the most the client can
frequency consumption. nutrition-related determine the CHO receive health teaching primary way of watching independently
knowledge value of certain foods for at least 20 minutes to over their nutrition. determine the CHO
Objective: deficit based on its displayed 1 hour about food According to the Centers value of certain foods
 HbA1C > 6% (6.3%) concerning nutritional facts. portions according for Disease Control and based on its nutrition
appropriate to her health condition Prevention (2019), people facts by verbalizing it
 BMI of 30.7 which is amount of CHO and learn about who live with diabetic to the attending nurse.
indicative of being obese intake as carbohydrate counts condition should consume
under Class I. evidenced by found in foods about 45% of their total
HbA1C > 6%, that she consumes. calories per day from
 CHO intake (305.4 g) obese Class I carbohydrates. For the
is higher than computed BMI (30.7), and meal planning of a diabetic
CHO requirement (270 g) high CHO intake person, the CDC also stated
based on total energy of 305.4 that 1 carb serving roughly
requirement (TER). g (65.75%). equates to 15 grams of
carb. For females, it is
 CHO intake of 305.4 recommended to consume
g which is 65.75% from total 3 - 4 carb serving, which
calorie intake of 1858 kcal translates to about 30 to 60
which is 20.75% higher than grams (Fletcher, 2020).
RDA CHO intake for
geriatric clients with  The client will be  Client will obtain  The link between  After 24 hours,
diabetes. able to understand information through body weight and metabolic the client can explain
the risk of being nutrition education for disease must be defined in autonomously to the
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obese in correlation about 30 minutes to 1 order to have a better attending nurse the
to the current health hour regarding to the understanding of the interconnection and
status. effects of excessive body underlying threat of above the
weight (BMI) to pathophysiological normal range Body
diabetes. mechanisms that contribute Mass Index to the
to metabolic disease underlying condition.
caused by excessive fat
(Beys et al., 2007). Obesity
is the leading risk factor for
type 2 diabetes. The
Centers for Disease
Control and Prevention
report that women with a
body mass index (BMI) of
30 kg/m2 have a 28 times
greater risk of developing
diabetes than do women of
normal weight. The risk of
diabetes is 93 times greater
if the BMI is 35 kg/m2
(Barnes, 2011).
Long-term
Long-term Objectives: Intervention Long-term Intervention
 The client will  The client will  Modification of  After two
exhibit normal HbA1C engage in resistance lifestyle is necessary weeks, the client has
levels for her next training, such as using for clients with diabetes already established a
scheduled laboratory resistance bands, including older adults. good exercise routine
testing. weights (dumbbells, full Development of a safe fit for maintaining her
water bottles, or soup exercise program based on health. Specifically,
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 The client will cans), or body weight the client’s current she had engaged in
continue to lose weight resistance (doing planks physical capacity is resistance
to acquire the target or lunges), with initial 8- effective in glycemic training through the use
weight of 61kg (2%) to 12 repetitions per control, improvement of of resistance bands,
improve her blood sugar exercise for at least 2 independence, self-esteem, with a total of 8
levels and decrease the days per week, and and overall quality of life. repetitions per exercise
risk of hyperglycemia aerobic exercises, such (Ferriolli, Pessanha, & for at least 2 day per
and associated as dancing, or walking, Marchesi, 2014). It was week; as well as
complications. for at least 30 minutes also known that exercising aerobic exercises such
per day (5-10 minutes helps people with type 2 as walking and dancing
per exercise session), at diabetes improve their for at least 15 minutes
least 3 days per week to average blood glucose per day
help in improving (sugar) levels (HbA1c).
HbA1c levels and to (Hook, n.d.).  The medical
promote weight loss of technologist reported
14 kilograms in a span of  Combination of the client's HbA1c
6 months aerobic exercises and improvement through
resistance activities is the the HbA1c test, a
best choice in the month after the
promotion of weight loss. intervention.
(Ferriolli, Pessanha, &
Marchesi, 2014). Aerobic
exercises (AE) include
walking, cycling,
swimming, dancing, and
more, are known to be a
remedy for weight loss as it
allows weight loss by
moving for long periods
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without tiring out.
(Hariram, 2019).
Resistance training (RT)
such as using resistance
bands, dumbbells or
household items for
accessibility and
availability, and body
weight resistance exercises
(e.g. planks, lunges, wall or
modified knee push-ups)
are known to be effective
for long-term weight
control since RT increases
muscle size therefore
increasing resting
metabolic rate (required
calories to function at rest)
and increasing or
sustaining fat loss over
time. (Clark, Langar-
Evans, & Erskine, 2020).
In addition, it was also
known that when AE and
RT are undertaken in one
session, performing RT
first results in less
hypoglycemia than when
AE is performed first.
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College of Nursing
(Colber, Sigal, et al.,
2016).
 The client will  Client will utilize  The DASH diet is a  Assessing after
have a balanced diet the DASH (Dietary clinically acceptable eating 3 months of practicing
which caters to both Approaches to Stop plan for clients who have DASH diet therapy,
hypertension and Hypertension) diet for hypertension and diabetes. the client has been
diabetes. at least 3-7 days, instead It promotes blood pressure religious and consistent
of her current TLC-like control and improves with the meal plan.
diet (i.e. increased insulin resistance,  The re-
intake of CHO-rich hyperlipidemia, and administration of the
foods and cutting off overweight/obesity FFQ form showcased a
fatty foods). (Campbell, 2017). It lowered CHO intake of
includes foods that are rich the client.
in potassium, calcium, and
magnesium, which are
known to help control
blood pressure levels. It
also limits foods that are
high in sodium, saturated
fat, and added sugars. The
DASH diet is rich in
vegetables, fruits, and
whole grains, fish, poultry,
beans, nuts, as well as fat-
free and low-fat dairy
products (National Heart,
Lung, and Blood Institute,
Intramuros, Manila
College of Nursing
2021). The DASH diet
would suit the client better
due to her current condition
of hypertension and
fluctuating blood sugar
levels.
 The client will  Client will learn  Self-monitoring of  After 1 month

learn and be well-rounded about blood sugar the client’s blood sugar of performing the test,
about sugar monitoring at home, as levels even at home is one the client has
monitoring and well as its parameters, of the most effective ways demonstrated mastery
understand its through client health to manage blood sugar and efficiency while
parameters. teaching to determine levels. It allows conducting her own
and manage factors that the client to determine sugar level-monitoring.
affect the fluctuations in
what foods, activities, She also verbalized the
their blood sugar level.medications, or other appropriate
The client will have free
environmental factors management when her
home blood sugar (e.g. stress) affect their sugar level fluctuates.
monitoring equipment blood sugar levels.  As per assessing
from the Diabetes Case (American Diabetes during her re-visit to
Manager. Association, 2019). Since the hospital (1 month
the client’s levels are after), 2 hours after her
frequently fluctuating, it is meal, the client’s sugar
Parameters: important to pinpoint what level has reported to be
 Fasting: less than causes these fluctuations so 170 mg/dL, which is
100 mg/dL it can be avoided. In this within the normal or
way, the healthcare team
Intramuros, Manila
College of Nursing
 Before Meals: 70- will be able to formulate preferable range for her
130 mg/dL the best care plan fitted for condition.
 After Meals (1- the client’s needs (CDC,
2 hrs): less than 180 2021). Frequent
mg/dL monitoring of blood sugar
 Before Exercise: levels also evaluates the
if taking insulin, at least effectiveness of
100 mg/dL medications taken and
 Bedtime: 100-400 alerts the client if their
mg/dL blood sugar level is too
high or low. According to
the CDC, high blood sugar
levels should not be left for
too long as it could damage
nerves and/or blood vessels
over time. Considering that
the client currently has
hypertension, it could
increase their risk of
developing cardiovascular
conditions (e.g. heart
attack and stroke).
 Client will learn  Client will be  It is important for a  Five (5) months
how to manage her own educated about low- diabetic client to learn diets after the client’s health
diet in relation to her CHO diet and its and techniques they could education regarding
condition. benefits in the control of use to manage the factors low-CHO diet,
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College of Nursing
HbA1c levels, related to their condition, the client has reported
management of weight such as their weight and normal ranges of
and the reduction of use their HbA1c levels. Low- HbA1c levels after
of diabetes medication CHO diets or low-carb conducting the test
and will practice the diets is a type of diet that during her visit in the
diet for 3 weeks to 6 generally limits the hospital, has lost 5 kg
months to achieve its consumption of in her weight, and her
results. carbohydrate-rich foods physician has reduced
(e.g., rice, grains, legumes, her medication dosage.
breads, pasta, and starchy
vegetables). Following the
diet with CHO levels that
do not induce ketosis,
resulted in a reduction of
use of diabetes medication
(Kirkpatrick, Bolick, Kris-
Etherton,
Sikand, Aspry, Soffer,
Willard & Maki, 2019). It
also results in a greater
reduction of HbA1C levels
and weight compared to a
low-fat diet but may vary in
results beyond 1 year
(Abbasi, 2018).
Table 9. The nutrition care process for Mrs. Trinidad.
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ANNEX
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FOOD FREQUENCY QUESTIONNAIRE
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GROUP 5 - Nutrition Care Plan (Geriatric)

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Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

Nutrition and Diet Therapy Laboratory:

Nutrition Care Plan for a Geriatric

BSN 2-2; GROUP 5

III. 24 HOUR RECALL AND FOOD FREQUENCY QUESTIONNAIRE

Breakfast: Hotdog 2 pieces 151 x 2 = 302 4.2 x 2 = 8.4 8 x 2 = 16 4x2=8

Rice 1 cup 206 45 1 3

Lunch: Sinampalukan 1 bowl 168 17 2 20

Rice 1 cup 206 45 1 3

Banana 2 pieces 105 x 2 = 210 27 x 2 = 54 0.4x2 = 0.8 1.3 x 2=2.6

Snack: Skyflakes 2 packs 120 x 2 = 240 16 x 2 = 32 5 x 2 = 10 2 x 2=4

Dinner: Longganisa 1 piece 180 14 10 10

Rice 1 cup 206 45 1 3

Banana 1 piece 105 27 0.4 1.3

TOTAL 1858 kcal 305.4 g 44.2 g 54.9 g

Table 1. Nutrient Content of each Food based on the 24-hour Recall

Food Frequency Amount

Bread and Snacks

Whole grain breads and rolls Once per day 2 slices

Sugar in coffee 4 times per week 1 tbsp.

Nonfat (Skyflakes) crackers 6 times per week 6 crackers

Regular crackers Once per day 6 crackers

Eggs Once per day 2 eggs

Hotdog Once per day 1 hotdog

Meat Once a month 2 ounces

Ground meat Thrice a month 1.5 ounce

Fried chicken Thrice a month 1 large piece

Broiled chicken 3 times a week 1 large piece

Fried fish Once per week 3 ounces

Pasta, Mixed Dishes, Soups

Spaghetti Once a month 1 cup

Mac and Cheese Once a month 1 cup

Tofu Thrice a month 3 ounces

Tomatoes 4 times a week 2 slices

Carrots Twice a week ½ cup

Red peppers Thrice a month 1/8 cup

Cabbage Twice a month ¼ cup

Green beans Twice per month ¼ cup

Sweet potatoes Twice per month 1 piece medium

Garlic Once a day ½ clove

Onion Once a day 1/8 cup

Rice Thrice a day 1 cup

Boiled potato Twice a month 1 medium-sized

Sauces and Condiments

Gravy Once a month 1/8 cup

Catsup Twice a month 1 tbsp

Mayonnaise Once a week 1 tbsp

Apple Twice a week ½ cup

Banana 6 times a week 1 medium-sized

Orange Once a week 1 piece

Watermelon Once a month 1 slice

Grapes Once a week ½ cup

Coffee 4 times a week 1 cup

Unsweetened tea 4 times a week 1 cup

Creamer 4 times a week 1 tbsp

100% apple juice Once a month 1 cup

Table 2. Food Frequency Questionnaire

Table 2.1. Computations for Required Calories, Proteins, and Fats