Post RN BSN Advanced Concepts in Nursing I – Unit V Nutritional–Metabolic Pattern and Calorie Calculation Solved Answers
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| Daily Calorie Requirement and Nutrition Pattern Solved Answers | Post RN BSN ACN-I Use as a revision guide and verify with your course notes. |
Unit V: Nutritional–Metabolic Pattern
Course syllabus · Model exam answers
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-I
ADVANCED CONCEPTS IN NURSING I (ACN-I) – COURSE NO. 701
UNIT V: NUTRITIONAL–METABOLIC PATTERN
Syllabus topics: Concepts of nutrition and metabolism; dietary habits; beliefs and values related to diets; over/under weight; formula for daily calorie requirement according to weight.
Q-1. Define nutrition, nutrients, metabolism, anabolism and catabolism. Explain the concept of the nutritional–metabolic pattern.
Nutrition is the process by which the body takes in and uses food for growth, energy, repair and health. Nutrients are substances in food that the body needs. Metabolism is the sum of all chemical reactions in the body that convert food into energy and body materials.
| Term | Meaning |
|---|---|
| Catabolism | Breakdown of complex substances into simple ones, releasing energy (e.g. glucose to energy) |
| Anabolism | Building of complex substances from simple ones using energy (e.g. protein synthesis, wound healing) |
| Basal metabolic rate (BMR) | Energy needed for vital functions at complete rest |
| Resting energy expenditure (REE) | Energy at rest, slightly more than BMR |
| Nutritional status | Condition of the body resulting from intake and use of nutrients |
In Gordon’s framework, the nutritional–metabolic pattern describes food and fluid consumption relative to metabolic need and indicators of local nutrient supply: skin, hair, nails, mucous membranes, teeth, body temperature, height, weight, and healing (see Part 3).
Q-2. Classify nutrients and describe their functions and sources.
| Nutrient | Main functions | Sources (examples) |
|---|---|---|
| Carbohydrates | Main energy source (4 kcal/g); fibre aids bowel function | Wheat, rice, potatoes, fruit, pulses, sugar |
| Proteins | Growth, repair, enzymes, antibodies (4 kcal/g) | Milk, eggs, meat, fish, pulses (daal), nuts |
| Fats | Concentrated energy (9 kcal/g), fat-soluble vitamins, cell membranes | Oils, ghee, butter, nuts, fish |
| Vitamins | Regulate body processes (fat-soluble A, D, E, K; water-soluble B-complex, C) | Fruit, vegetables, liver, eggs, sunlight (vitamin D) |
| Minerals | Bones (calcium), blood (iron), thyroid (iodine), fluid balance (sodium, potassium) | Milk, green leafy vegetables, liver, iodized salt |
| Water | Transport, temperature, digestion, excretion | Water and other fluids, fruit |
| Fibre | Prevents constipation, helps control cholesterol and glucose | Whole grains, vegetables, fruit, pulses |
Macronutrients (carbohydrate, protein, fat) are needed in large amounts; micronutrients (vitamins and minerals) in small amounts.
Q-3. Describe the factors affecting nutrition and metabolism, and the nutritional needs across the life span.
| Factor | Examples |
|---|---|
| Age and growth | Infants and children need more per kg; elderly need fewer calories but the same protein and micronutrients |
| Sex and body size | Men usually have higher BMR |
| Body composition | Muscle burns more energy than fat |
| Activity | Heavier work needs more energy |
| Health and illness | Fever, burns, surgery, infection raise needs; chronic illness, dysphagia, nausea reduce intake |
| Hormones | Thyroid hormones raise BMR; insulin controls glucose |
| Pregnancy and lactation | Extra energy, protein, iron, folic acid, calcium |
| Climate | Cold increases need |
| Medicines | Appetite changes; nutrient interaction |
| Socio-economic | Poverty, education, food availability, food insecurity |
| Stage | Special points |
|---|---|
| Infancy | Exclusive breastfeeding for the first 6 months; then complementary feeding with continued breastfeeding (WHO) |
| Childhood | Balanced diet; avoid sugary snacks; watch for stunting and wasting |
| Adolescence | Growth spurt; iron and calcium; avoid skipping meals |
| Adulthood | Maintain weight; limit salt, sugar, fat |
| Pregnancy | Iron and folic acid supplements as advised; extra nutrition |
| Old age | Small frequent meals; protein; fluids; vitamin D and calcium; dental problems |
Q-4. Describe dietary habits. How are they assessed and what influences them?
Dietary habits are the regular ways in which a person or group chooses, prepares and eats food: number and timing of meals, snacks, portion size, food preferences, cooking methods and eating environment.
| Influence | Examples |
|---|---|
| Culture and religion | Staple foods (wheat, rice), festival foods, fasting in Ramadan, halal food rules |
| Family and peers | Shared meals, parental example |
| Economy | Income, food prices |
| Knowledge and media | Advertisements, fast food |
| Personal | Taste, allergies, emotions, eating when stressed |
| Health | Dental problems, swallowing, illness |
Assessment
- 24-hour recall: everything eaten and drunk in the last day.
- Food diary for 3 to 7 days.
- Food-frequency questionnaire (how often each food group).
- Questions on appetite, allergies, cooking oil, salt, tea and sweet drinks, meal skipping, who prepares meals.
- Anthropometry (height, weight, BMI, mid-upper arm circumference, waist), physical signs, and laboratory data (e.g. haemoglobin, albumin) as ordered.
Healthy habits to teach
- Three regular meals; breakfast daily.
- More vegetables, fruit, pulses and whole grains; less fried food, salt and sugar.
- Safe, clean food and water; hand washing before eating.
- Adequate fluids; limit tea, soft drinks and energy drinks.
- Eat slowly; avoid overeating.
Q-5. Explain beliefs and values related to diets. How should the nurse respond?
Food beliefs come from culture, religion, family and experience. Some are healthy, some neutral and some harmful (these examples occur in some communities, not all; ask the client).
| Belief or practice (examples) | Nursing response |
|---|---|
| Religious dietary rules: halal food; avoiding pork and alcohol; fasting (Ramadan, other fasts) | Respect; arrange halal diet; discuss safe fasting with the doctor for clients with diabetes, pregnancy or on medicines; help adjust timing of meals and drugs |
| “Hot” and “cold” foods affecting illness, pregnancy or after delivery | Ask what foods the client avoids; keep what is harmless; correct only what is unsafe; ensure adequate protein and micronutrients |
| Restricting food during fever, diarrhoea, or after childbirth | Explain that nutrition and fluids help recovery (ORS in diarrhoea; continue feeding) |
| Men and boys served first; women eat last | Encourage fair distribution, especially for pregnant and lactating women and girls |
| Preference for fattening foods as a sign of health or wealth | Teach healthy body weight |
| Vegetarian, vegan or personal ethical diets | Plan complete nutrition (vitamin B12, iron, protein) |
| Use of herbal tonics or supplements | Ask; check safety and drug interaction |
Approach: assess without judging; include the family member who cooks; offer culturally acceptable alternatives; educate with the client’s own foods; coordinate with a dietitian.
Q-6. Define underweight and overweight. Describe causes, risks and nursing care of the underweight client and the malnourished.
BMI (kg/m2): below 18.5 underweight; 18.5–24.9 normal; 25–29.9 overweight; 30 or above obese (WHO adult cut-offs; lower action points for Asian populations, see Part 4). Malnutrition includes undernutrition (wasting, stunting, underweight, deficiencies) and overnutrition (overweight, obesity), and sometimes both exist in the same community.
| Causes of underweight | Risks / signs |
|---|---|
| Poor food intake, poverty, food insecurity, infection (TB, HIV, chronic diarrhoea), cancer, hyperthyroidism, malabsorption, mental illness (depression, eating disorders), dental problems, alcohol or drug use, ageing | Fatigue, weakness, infections, anaemia, hair loss, dry skin, poor wound healing, amenorrhoea, osteoporosis, growth failure in children, pressure injury, delayed recovery |
Nursing care
- Assess: weight trend, BMI, diet history, appetite, swallowing, teeth, labs, causes, and mental health.
- Treat underlying causes; refer to doctor and dietitian.
- Offer small, frequent, energy- and protein-dense meals and snacks; add milk, ghee or oil, eggs, nuts; supplements as ordered.
- Create a pleasant mealtime; treat nausea and pain; help with eating; oral care.
- Weigh regularly (same scale, same time); keep intake chart.
- Severely malnourished clients need careful, supervised refeeding; do not rush.
- Involve family; address food insecurity through social services.
- Nursing diagnosis: Imbalanced nutrition: less than body requirements.
Overweight and obesity and their management are described in Part 4 (Unit IV). Nursing diagnosis: Overweight; Imbalanced nutrition: more than body requirements.
Q-7. Describe the assessment of nutritional status (ABCD) and the signs of nutritional problems.
| Letter | Assessment | Examples |
|---|---|---|
| A | Anthropometric | Height, weight, BMI, waist, mid-upper arm circumference, skinfold, growth charts for children |
| B | Biochemical / laboratory | Haemoglobin, serum albumin, glucose, cholesterol, electrolytes |
| C | Clinical | Hair, eyes, lips, tongue, gums, teeth, skin, nails, muscles, oedema |
| D | Dietary | 24-hour recall, food diary, frequency |
| Sign | Possible deficiency |
|---|---|
| Pale conjunctiva, spoon-shaped nails, fatigue | Iron (anaemia) |
| Bleeding gums, poor wound healing | Vitamin C |
| Night blindness, dry eyes | Vitamin A |
| Cracked lips and corners of mouth | B-complex vitamins, iron |
| Bone pain, rickets in children, bowed legs | Vitamin D, calcium |
| Goitre | Iodine |
| Oedema, wasting, thin hair | Protein (kwashiorkor / marasmus) |
Q-8. Write the formulas to calculate the daily calorie requirement according to weight. Give solved examples.
Estimating energy needs has three parts: (1) basal needs, (2) activity factor, and (3) adjustment for goal or illness. Rules vary; the following are common textbook methods (estimates only).
Method A: simple weight-based BMR rule
BMR ≈ 0.9 kcal × weight (kg) × 24 hours (women)
Daily need = BMR × activity factor
| Activity level | Factor |
|---|---|
| Sedentary (little or no exercise, desk or bed rest) | 1.2 |
| Lightly active (light exercise 1–3 days per week) | 1.375 |
| Moderately active (3–5 days per week) | 1.55 |
| Very active (hard exercise most days) | 1.725 |
Example 1 (made up): man, 60 kg, light activity. BMR = 1 × 60 × 24 = 1440 kcal. Need = 1440 × 1.375 = 1980 kcal per day.
Example 2: woman, 55 kg, sedentary. BMR = 0.9 × 55 × 24 = 1188 kcal. Need = 1188 × 1.2 = 1425.6, about 1426 kcal per day.
Method B: kcal per kg of (ideal) body weight (used in many clinical diets)
| Activity | Approximate kcal per kg per day |
|---|---|
| Bed rest / very sedentary | About 25 |
| Light activity | About 30 |
| Moderate activity | About 35 |
| Heavy activity | About 40 |
Example 3: ideal weight 58 kg, moderate activity: 58 × 35 = 2030 kcal per day. (For overweight clients, many dietitians use ideal or adjusted weight.)
Method C: Mifflin–St Jeor equation (commonly used by dietitians)
Women: BMR = (10 × weight kg) + (6.25 × height cm) − (5 × age) − 161
Example 4: man, 30 years, 70 kg, 170 cm: BMR = 700 + 1062.5 − 150 + 5 = 1617.5 kcal. With light activity (1.375): 2224 kcal per day.
The Harris–Benedict equation is an older similar formula. Different formulas give different results; use one method consistently and adjust to the client’s response (weight trend).
Q-9. How is the calorie requirement adjusted for weight loss, weight gain and illness? Show the distribution of calories among nutrients.
| Goal | Adjustment (general guide) |
|---|---|
| Weight loss | Reduce about 500 kcal per day from the maintenance need, aiming for about 0.5 kg loss per week (roughly 7700 kcal is about 1 kg of body fat; an estimate). Do not go below safe minimum without supervision |
| Weight gain | Add about 300–500 kcal per day with protein-rich foods and strength activity |
| Fever, infection, burns, surgery, pregnancy (later months), lactation | Increase according to doctor or dietitian |
| Older or very inactive people | May need fewer calories but not fewer nutrients |
Example 5: maintenance need 2200 kcal; goal loss of 0.5 kg per week: 2200 − 500 = 1700 kcal per day.
Distribution of calories (typical balanced diet)
| Nutrient | Share of energy | For a 2000 kcal diet (calculated) |
|---|---|---|
| Carbohydrate | 50–60% (use 55%) | 2000 × 0.55 = 1100 kcal ÷ 4 = 275 g |
| Protein | 10–20% (use 15%) | 2000 × 0.15 = 300 kcal ÷ 4 = 75 g |
| Fat | 20–30% (use 30%) | 2000 × 0.30 = 600 kcal ÷ 9 = about 67 g |
Protein for healthy adults is about 0.8 g per kg body weight per day (more in illness, pregnancy, growth, or as advised). Fluid needs are often about 30–35 mL per kg per day unless restricted (e.g. heart or kidney disease).
Q-10. Prepare a sample one-day balanced diet plan and give nutrition teaching for a client.
| Meal | Example (adapt to local foods and preferences) |
|---|---|
| Breakfast | Whole-wheat chapati or paratha made with little oil, egg or omelette, tea with little sugar, or daliya and milk |
| Mid-morning | Fruit or a handful of nuts |
| Lunch | Chapati or rice (measured portion), pulses or meat/fish/chicken, vegetable curry, salad, yoghurt |
| Evening | Fruit, roasted chana, or light snack instead of fried snacks |
| Dinner | Small portion of chapati or rice, vegetables, pulses or fish; early and light |
| Fluids | Water through the day; limit sweet drinks |
Teaching points: use a hand-size or plate method (half plate vegetables, quarter protein, quarter grains), use less oil and salt, read food labels, avoid skipping meals, include family cook, keep a food diary, and weigh weekly. Adjust for diabetes, kidney disease or other conditions on the doctor’s advice.
Q-11. Describe the nursing process for a client with an imbalanced nutritional pattern. Solve the made-up case.
Case. Mrs S, 45, 82 kg, 1.58 m, sedentary, says “I eat biryani and sweet tea daily; I get tired and cannot walk far.” BP is high-normal and she wants to lose weight.
| Step | Answer |
|---|---|
| Assessment | BMI = 82 ÷ (1.58 × 1.58) = 82 ÷ 2.4964 = 32.8 (obese); diet recall; activity; BP, glucose as ordered; readiness to change |
| Diagnoses | Imbalanced nutrition: more than body requirements; Sedentary lifestyle; Deficient knowledge; Risk for unstable blood glucose / BP |
| Calorie plan (Method A, women; sedentary) | BMR = 0.9 × 82 × 24 = 1771 kcal; maintenance = 1771 × 1.2 = 2125 kcal; for weight loss subtract 500: about 1625 kcal per day (dietitian to confirm) |
| Interventions | Replace sweet tea and sugary drinks; measured rice portion; more vegetables and pulses; less oil; walking 10 minutes after meals, build up; food diary; weekly weight; refer to dietitian and doctor |
| Evaluation | Weight loss of about 0.5 kg per week; improved energy; BP controlled; client states plan correctly |
Q-12. Write the importance of this unit for a Post RN BSN nurse.
- Nutrition affects healing, immunity, growth and chronic illness.
- Calorie calculation lets nurses support diet plans and teach clients.
- Cultural food beliefs must be respected for diet plans to succeed.
- Nutritional assessment is part of every admission assessment.
Conclusion: Good nursing nutrition care combines science (calories and nutrients) with respect for the food habits and beliefs of the client.
Suggested references (see the syllabus page for its own reading list): Gordon, M. Manual of Nursing Diagnosis (Functional Health Patterns; latest edition). Jones & Bartlett / Elsevier.
Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification (current edition). Thieme.
Potter, P. A., & Perry, A. G. Fundamentals of Nursing (latest edition). Elsevier.
Smeltzer, S. C., & Bare, B. G. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (latest edition). Lippincott.
Kozier, B., Erb, G., et al. Fundamentals of Nursing (latest edition). Pearson.
Source syllabus: Post RN BSN Nursing ACN-I Course (course syllabus) (original post dated April 12, 2019).
Series (Advanced Concepts in Nursing I, Course No. 701): Part 1: Unit I – Nursing Process and Diagnoses. Part 2: Unit II – Theoretical Frameworks. Part 3: Unit III – Functional Health Patterns. Part 4: Unit IV – Health Perception and Health Management. Part 5: Unit V – Nutritional-Metabolic Pattern. Part 6: Unit VI – Elimination Pattern. Part 7: Units VII–VIII – Activity-Exercise and Coping-Stress. Part 8: Units IX–X – Sleep-Rest and Sexuality-Reproduction. Part 9: Units XI–XII – Role Relationships and Pain. Part 10: Units XIII–XIV – Self-Perception and Values-Beliefs. Part 11: Clinical Objectives. Part 12: Learning Advanced Nursing Concepts – facts, skills, uses, benefits and hurdles.
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