Medical Nutrition Therapy - Essay Example

MEDICAL NUTRITION THERAPY MATERNAL-FETAL MEDICINE MODULE QUESTION Discuss the recommended rate and amount of weight gain during the gestational period. It was approved by Institute of Medicine that recommended weight gain should be: For women with BMI 18.5-24.9, normal weight -11.3-15.9kg(25-35 pounds) For women with BMI lower than 18.5, underweight- 12.7-18 kg(28-40 pounds) For women with BMI 25-29.8, overweight 6.8-11.3 kg(15-25 pounds) For women with BMI higher than 30, obese- 5-9 kg (11-20 pounds) The rate of weight gain should be 2-4 pounds during first trimester and than 1 pound per week during two last trimesters. QUESTION 2. What special requirements does the pregnant woman have with respect to calories and protein to attain the identified weight gain? During pregnancy women require between 2.200-2.900 calories per day. During first trimester extra calories are not needed. During second trimester 350 additional calories per day are recommended. During third trimester extra 450 calories per day are required. It is important for pregnant woman to intake 70g of protein per day. QUESTION 3. What is an appropriate nutrition care plan for an obese woman who is pregnant? An underweight woman? It is recommended that overweight woman add less weight during pregnancy (between five to eleven kg). For women who are underweight the recommended weight gain is 12.5 to 18 kg. It is advised that women should maintain physical activity during pregnancy to meet the energy needs from the consumed food. Pregnant women should also drink enough water to support blood volume increases and also to help avoid dehydration. Some supplements with folic acid and iodine are also recommended. Pregnant women should limit discretionary foods and drinks which has amount of saturated fats added salts and sugars. ; QUESTION 4. Develop a nutrition care plan for the patient with hyperemesis. Why does hyperemesis occur? (Hyperemesis – prolonged, persistent vomiting associated with an increase in the maternal free thyroid hormone) The exact cause of hyperemesis is unknown, but some of the contributing factors include: increased estrogen levels, high level of human chorionic gonadotropin and gastrointestinal changes associated with pregnancy. Other factors like stress and anxiety may trigger acute morning sickness. To control this condition, the pregnant women should include more protein and complex carbohydrate such as cheese, milk and nuts in their diet several times in a day. They should avoid food with fatty acid. It is also recommended that they drink plenty of water and get as much rest as possible. QUESTION 5. What is toxemia? In the past toxemia was treated with which dietary restriction? Why is this no longer done? Toxemia is complication that occurs during pregnancy and it is characterized by acute hypertension, albuminuria (increased amount of protein albumin in the urine) and edema. QUESTION 6. Define the following A. AEDF- absent umbilical arterial and diastolic flow, is a feature that characterized fetal vascular stress, can be detected in mid and late pregnancy B. Amenorrhea – absence of menstruation C. Cerclage- is a procedure that help to avoid premature birth, cervix is closed using sutures D. Cystocele – bulging of the bladder into the vagina E. D&C –dilation and curettage , gynecological procedure that usually used for the first trimester abortion, include dilation of the cervix and surgical removal of the internal layer of the uterus F. Ectopic pregnancy – fetal growth in the fallopian tubes G. Endometriosis –displaced growth of the tissue that lines uterus H. Food safety in pregnancy-following of the nutrition care plan for pregnant women to avoid foodborne illness. I. Gravida – amount of times that a woman has been pregnant J. Hellp syndrome- damage of the liver and blood cells that occur during pregnancy K. Incompetent cervix- early dilation of the cervix L. IUGR – Intrauterine Growth Restriction, poor growth of a baby in mother`s uterus M. IVF –In vitro fertilization, fertilization of the egg by the sperm outside the body N. Multiparity – the production of more than one offspring during one pregnancy O. Myoma – benign tumor formed in the uterus P. Oopherectemy – surgical removal of ovaries Q. Parity – the state of having given birth to a child R. PCOS Polycystic Ovarian Syndrome-disorders of woman menstrual cycle, fertility, hormones, insulin production and appearance. S. Pica – craving to eat nonfood substances T. Placenta abruption – wall of the uterus is separated from the placenta U. Placenta Previa – abnormal located placenta that totally covers the cervix V. TAH Total Abdominal Hysterectomy – surgical removal of the uterus W. QUESTION 7. Discuss PCOS and fertility. A. During Polycystic Ovarian Syndrome ovaries are formed that contain follicles with hormones that cause different changes in the woman bode. The disorders in women hormonal production during Polycystic Ovarian Syndrome usually cause women infertility in 75% of cases. The main reason of infertility during PCOS is anovulation, that occurs when ovaries do not release an oocyte and ovulation cannot occur. B. QUESTION 8. Find the most suitable definition for the following medical abbreviations (with a maternity context): A. C/S caesarean section B. CSII continous subcutaneous infusion C. GDM girl meet dress D. IUP intra uterine pregnancy E. NSVD normal spontaneous virginal delivery F. PEC parental evaluation center G. TIUP preterm intrauterine pregancy H. QUESTION 9. What are the nutritional concerns in a multiparity pregnancy? A. The risk of complication during pregnancies is higher in multiparity pregnancy. Study has shown that maternal mortality increases steadily from fifth to tenth pregnancy. Repeated births and breast feeding takes toll of the level of micronutrient in women body. For instance, Study has shown that 72% of multiparous women suffer from iron deficiencies. For women to go through pregnancy without iron deficiency, she should have mobilisable body iron stores of at least 500gm prior to pregnancy. QUESTION 10. What are the dietary reference intakes for folic acid, iron and calcium for pregnant women? How do these compare to the DRI’s for non-pregnant women? What are good sources of these nutrients? A. Pregnant woman have to intake 600-800 micrograms of folic acid per day despite non-pregnant women who daily requirement of folic acid is 400 micrograms per day. B. Foods that contain high amount of folic acid are cabbage, oranges, broccoli,spinach, lentils, asparagus, and sunflower seeds. C. QUESTION 11. What nutritional recommendations/ concerns would you have for a pregnant female who is a strict vegetarian? A. To maintain healthy pregnancy strict vegetarian woman need to follow well-balanced diet. It is necessary to receive an appropriate dose of folic acid, vitamin B12, E, D and calcium, B. QUESTION 12. What are the nutritional requirements for a breastfeeding woman? Name three (3) nutrients a breastfeeding mom should focus on. A. B. It is recommended that breastfeeding women eat nutritious diet so as to keep themselves and the developing fetus healthy. It is crucial that the diet supplies nutrients such as protein, calcium, iron, and vitamins. Fish and chicken meat, dairy products, legumes such as beans and vegetable such as pumpkin, carrots tomatoes will provide the essential nutrients. Breast feeding women should choose food that are low fat, or fat free and have no sugar. This type of food has fewer empty calories. Also while breastfeeding you should increase your fluid intakes. It is recommended that a breastfeeding woman take a glass of water after breast feeding. They should avoid drinking beverages that contain caffeine or alcohol. C. In addition to healthy diet, breastfeeding women may need multivitamin or mineral supplements D. E. F. AND-Evidence Analysis Library G. On the homepage, click on the “Projects” tab and search for Vegetarian Nutrition. H. Click, scroll down and select first: VN: Life-cycle and vegetarian diets (2007-2009) and then VN: Macronutrients in pregnancy (2007). I. Under assessment, explain this question: Are birth outcomes different for mothers who maintain a vegetarian versus an omnivorous diet during pregnancy? J. State the evidence’s grade and its meaning. K. There was no significant difference between the vegetarian and omnivores mothers in term of birth outcomes. L. M. Click on the “Projects” tab and search for Gestational Diabetes. N. Click, scroll down and select GDM: Physical activity (2008) O. Explain this question: In women with GDM, what is the relationship between physical activity during pregnancy and maternal/neonatal outcomes and glycemic control? P. State the evidence’s grade and its meaning. Q. Regular physical activities during pregnancy reduce the risk of gestational diabetes mellitus. It also reduces common discomfort of pregnancies with no negative effect on maternal or neonatal outcome. R. Physical activity for 30 minutes per day and for a minimum of three times per week is needed to assist with improved glycemic control. S. Social support can encourage women with gestational diabetes mellitus to engage in physical activity. T. Gail is a 26 year-old lady with type 1 diabetes who wants to become pregnant and is seeking your advice about how to have a healthy baby and keep her blood sugars under good control. What would you advise her? U. I would recommend her to be involved in regular physical activity during her pregnancy. She should join a gym club and exercise for a minimum of 30 minutes per day and at least three times in a week. Dietary changes will also be recommended as well as monitoring of blood sugar levels. V. W. X. CASE STUDY Y. Z. MC is a 35-year old female with past medical history of hypertension, being regulated with Labetalol. She is pregnant at 30 weeks of gestation and was diagnosed with gestational diabetes a week ago. The physician prescribed Glyburide 2.5mg in am daily and asked her to monitor her blood glucose 4x/day (fasting and 1-hour post-prandial). MC has no other medical conditions and continues taking the antihypertensive agent as per physician. MC’s pre-pregnancy weight is 205 Lbs. (93Kg) and has gained 25 Lbs. during pregnancy. Her height is 5’5”. AA. AB. MC’s blood glucose levels are: AC. Glucose AD. Fasting glucose AE. 1 hr. post-prandial AF. 1 hr. post-prandial AG. 1 hr. post-prandial AH. Time AI. 0700 AJ. 0900 AK. 1300 AL. 1900 AM. Result AN. 98 mg/dL AO. 150 mg/dL AP. 135 mg/dL AQ. 145 mg/dL AR. NSUH within target range levels AS. AT. < 90 mg/dL AU. AV. < 140 mg/dL AW. AX. < 140 mg/dL AY. AZ. < 140 mg/dL BA. 1. Assess M.C.’s calorie and protein needs. BB. Carbohydrate: 50-60% of calories per day BC. Protein:10 to 20% of calories per day BD. Fat: recommended 25 to 35 % per day BE. BF. 2. Create a meal plan for M.C., which includes consistent carbohydrate, for three meals and 3 snacks based on the calorie level assessed above. a. Include your total calorie level selected b. Include the breakdown of the meal plan for carbohydrate, protein and fat c. Indicate how much carbohydrate is provided at each meal. BG. Because mc has type 2 diabetic, he has to distribute his carbohydrate intake through ought the day. He should eat carbohydrates with 50 to 60% of calories per day. His CHO intake per day should total to about 1250 to 1500 kcal/day BH. BI. 3. Discuss the mechanism of action of Glyburide ? BJ. The drug lower the blood glucose acutely by stimulating the insulin release from the pancreases. This effect is dependent upon the functioning bête cell in the pancreatic islets. BK. 4. Discuss the drug-nutrient interaction. BL. BM. Interaction with food has not been established. However individual taking the medication must avoid alcohol because it may cause stress on liver. BN. 5. Identify a nutrition diagnosis and intervention(s). Overweight is related to unhealthy dietary choices, poor eating habits and excessive caloric intake and. BO. 6. Write a nutrition assessment using S.O.A.P. format. BP. BQ. Weight 93KG : height I.674 BMI= 93/1.674=55kg/m2 BR. Energy and protein Recommended intake BS. Carbohydrate: 50-60% of calories per day BT. Protein:10 to 20% of calories per day BU. Fat: recommended 25 to 35 % per day BV. BW. References: BX. http://www.womenshealth.gov BY. http://www.mckinley.illinois.edu/Handouts/pregnancy_lactation.html BZ. http://www.marchofdimes.com CA. http://www.nih.gov CB. http://www.diabetes.org CC. CD. Read More