QUIRINO STATE UNIVERSITY
College of Health Sciences
Bachelor of Science in Nutrition and Dietetics
…fostering wellness
Student to tear this Worksheet page/s for submission
WORKSHEET 4
Name of Student: Date:
Course, Year/ Section: Score:
Laboratory Exercise 4: Medical Nutrition Therapy for Cancer
Objective:
At the end of the exercise, students would be able to:
1. relate diagnostic procedures, medication and other forms of treatment for patients with Cancer,
2. formulate a nutritional care plan to address the needs of individuals with Cancer, and
3. modify diets and prepare meals of patients with Cancer considering family traditions and individual
preferences.
Materials:
Worksheet, laptop, pen/ pencil, calculator
Instructions:
1. Analyze and assess the case below.
2. Write your nutritional care plan following ADIME format for him/her.
3. Show computations for DBW using Tannhauser’s, TER using Krause and distribute TER using
Percentage Distribution.
4. Properly write your Diet Rx and the consequent computations to come up a one-day sample menu.
5. Write all your answers on the answer sheet provided.
6. Presentation of sample cooked menu including oral questioning will be done synchronously during lab
hours. The instructor will provide the link for the meeting.
7. Rubrics for requirements and laboratory performance will be used for evaluation.
Ted is a 68-year-old white man who has been diagnosed with prostate cancer. He has been sent to
your nutrition clinic by his oncologist and expects to undergo surgery in the next few months. His BMI is
35, and he works at home as a computer programmer. His hobbies include reading and making model
airplanes. Your diet history reveals a usual daily intake of 12 to 14 oz of meat or poultry, 2 to 3 c of whole
milk, fruits on rare occasion, corn and potatoes with the dinner meal, and a lunch that includes a luncheon
meat and cheese sandwich on white bread. Currently he is taking Proscar and saw palmetto, as
prescribed by his physician.
RESULTS/ DISCUSSIONS (present/ discuss the outputs/ results of the activity): Attach separate sheet if
necessary
This portion to be filled
only by the instructor
NUTRITIONAL CARE Rating
1 Needs 3 5
Improvement Good Excellent
Patient’s Summary
NCP STEPS AND DOMAINS
1 Needs 3 5
ASSESSMENT Improvement Good Excellent
Food/Nutrition
Related History
Anthropometric
Measurements
Biochemical Data,
Medical Tests, and
Procedures
Nutrition Focused
Medical Findings
Client History
QUIRINO STATE College of Health
BSND NUTRITION THERAPY II Developed by:
NOBELYN V. AGAPITO, RND
UNIVERSITY
03.09.2022
Sciences
Page 13
QUIRINO STATE UNIVERSITY
College of Health Sciences
Bachelor of Science in Nutrition and Dietetics
…fostering wellness
1 Needs 3 5
DIAGNOSIS Improvement Good Excellent
Intake
Clinical
Behavioral-
environmental
PES Statement 1
1 Needs 3 5
INTERVENTION Improvement Good Excellent
Food and or nutrient
delivery
Nutrition Education
Nutrition Counselling
Coordination of
Nutrition Care
1 Needs 3 5
MONITORING AND EVALUATION Improvement Good Excellent
Food/Nutrition
Related History
Outcomes
Anthropometric
Measurements
Outcomes
Biochemical Data,
Medical Tests, and
Procedures
Outcomes
Nutrition Focused
Medical Findings
outcomes
Total
This portion to be filled only by the instructor
DIETARY CALCULATIONS 1 Needs 3 5
Improvement Good Excellent REMARKS
B. TER = DBW X PA
A. DBW =59Kg (Based on PDRI) TER= 59 X 30
TER= 1770 or 1750Kcal
C. CPF DISTRIBUTION
CHO =1750 X . 65= 1137.5/4=284.37 D. DIET PRESCRITION (Diet Rx)
or 285g Diet Rx: 1750Kcal;285g CHO;65g
PRO =1750 X . 15= 265.5/4=65.62 or PRO;40g FAT
65g
CHO = 1750 X . 20= 350/9=38.89 or
40g
TRANSLATION OF NUTRIENTS INTO EXCHANGES This portion to be filled only by the instructor
1 Needs 3 5
FOOD EXCHANGES CHO PRO FAT ENERGY Improvement Good Excellent REMARKS
QUIRINO STATE College of Health
BSND NUTRITION THERAPY II Developed by:
NOBELYN V. AGAPITO, RND
UNIVERSITY
03.09.2022
Sciences
Page 14
QUIRINO STATE UNIVERSITY
College of Health Sciences
Bachelor of Science in Nutrition and Dietetics
…fostering wellness
ITEMS
Vegetable 8 24 8 - 128
A
Fruit 4 40 - - 160
Whole Milk
Low Fat 1 12 8 5 128
Milk
Very Low 1 12 8 - 80
Fat Milk
Sugar 3 15 - - 60
Partial Sum 103
285-
103=182/23=7.91o
r 8 exchanges for
CHO
Rice A – 2 46 - - 184
low PRO
Rice B – 6 138 12 - 600
medium
PRO
Rice C –
high PRO
Partial Sum 36
65-
36=29/8=3.625o
r 4 Exchanges
for PRO
Low Fat 3 - 24 3 123
Meat
Medium Fat 1 - 8 6 86
Meat
High Fat
Meat
Partial sum 14
40-
14=26/5=5.2or
5 Exchanges
for FAT
Fat 5 - - 25 225
TOTAL 287g 68g 39g 1771Kcal
DISTRIBUTION OF EXCHANGES INTO MEALS This portion to be filled only by the instructor
No. of AM PM Midnight 1 Needs 3 5
FOOD ITEMS Exchanges
Breakfast
Snack
Lunch
Snack
Supper
Snack Improvement Good Excellent REMARKS
Vegetable A
Fruit
Whole Milk
Low Fat Milk
Very Low Fat Milk
Sugar
Rice A – low
PRO
Rice B – medium
PRO
Rice C – high
PRO
Low Fat Meat
Medium Fat Meat
High Fat Meat
Fat
SAMPLE MENU This portion to be filled only by the instructor
Food HH Measures/
Meal Pattern Menu
Group
Ex. Approx. Wt.
1 Needs
Improvement
3
Good
5
Excellent REMARKS
Breakfast
Appetizer/
Soup
Main Dish
Side Dish
QUIRINO STATE College of Health
BSND NUTRITION THERAPY II Developed by:
NOBELYN V. AGAPITO, RND
UNIVERSITY
03.09.2022
Sciences
Page 15
QUIRINO STATE UNIVERSITY
College of Health Sciences
Bachelor of Science in Nutrition and Dietetics
…fostering wellness
Dessert/
Fruit
Rice/
Alternatives
Beverage
Lunch
Appetizer/
Soup
Main Dish
Side Dish
Dessert/
Fruit
Rice/
Alternatives
Beverage
Supper
Appetizer/
Soup
Main Dish
Side Dish
Dessert/
Fruit
Rice/
Alternatives
Beverage
AM Snack
PM Snack
Midnight
Snack
DIET RATIONALE This portion to be filled only by the instructor
1 Needs 3 5
Improvement Good Excellent REMARKS
QUIRINO STATE College of Health
BSND NUTRITION THERAPY II Developed by:
NOBELYN V. AGAPITO, RND
UNIVERSITY
03.09.2022
Sciences
Page 16
QUIRINO STATE UNIVERSITY
College of Health Sciences
Bachelor of Science in Nutrition and Dietetics
…fostering wellness
FOODS ALLOWED AND AVOIDED This portion to be filled only by the instructor
FOOD ITEM 1 Needs 3 5
ALLOWED AVOIDED Improvement Good Excellent REMARKS
CATEGORIES
REQUIREMENT RUBRICS
1 3 5
CONTENT
a. completeness
b. accuracy
ORGANIZATION
EVIDENCE OF
PREPARATION
CREATIVITY/
NEATNESS
TOTAL SCORE
QUIRINO STATE College of Health
BSND NUTRITION THERAPY II Developed by:
NOBELYN V. AGAPITO, RND
UNIVERSITY
03.09.2022
Sciences
Page 17
