Discussion 3

nutrition discussion question and need the explanation and answer to help me learn.

Complete the attached discussion
Requirements: 1
Intervention Quiz
Students must
Submit one typed SMART goal for each PES statement. Goals should be specific, measurable, attainable/achievable, relevant/realistic and timely/time-bound. (7 points)
Choose appropriate interventions for a PES statement below. (3 points)
Answer questions regarding what additional information is needed to determine if an intervention is effective and to whom the patient should be referred. (5 points). (fully analyze case study)
Your total write up should be about three pages
Dietetic Practice Case Study ASSESSMENT BMI = Weight (kg) / (Height (m))^2 a) Weight: 148 lbs. = 67.13 kg (1 lb. = 0.453592 kg) b) Height: 5’8″ = 1.7272 m (1 ft = 0.3048 m, 1 in = 0.0254 m) BMI = 67.13 / (1.7272)^2 c) BMI 22.5 kg/m^2 %IBW (Percent Ideal Body Weight): %IBW = (Actual Weight / Ideal Weight) x 100 d) Ideal Weight for 5’8″ female: Approximately 145 lbs. %IBW = (148 / 145) x 100 = 102.1% %UBW (Percent Usual Body Weight): %UBW = (Current Weight / Usual Weight) x 100 e) Usual Weight: 152 lbs. %UBW = (148 / 152) x 100 = 97.4% % Weight Loss: % Weight Loss = ((Usual Weight – Current Weight) / Usual Weight) x 100 % Weight Loss = (152 – 148) / 152 x 100 = 2.6%
2. Calculate and evaluate the patient’s MCV, MCH, and MCHC. Thoroughly evaluate these and the other abnormal lab values. Investigate potential causes and discuss the causes that are applicable to this patient. (Limit the discussion of abnormal values to those which apply to this patient.) MCV = Hct * 10/RBC. MCV = (Hct x 10) / RBC = (30 x 10) / 4.2 = 71.4 fL (typically 80-100 fl) A. Evaluation: Low MCV indicates microcytic anemia. MCH = Hgb * 10/RBC. MCH = (Hgb x 10) / RBC = (10 x 10) / 4.2 = 23.8 pg. (typically 27-33 pg.) A. Evaluation: Normal MCHC. MCHC = Hgb * 100/Hct. MCHC = (Hgb x 100) / Hct = (10 x 100) / 30 = 33.3 g/dL (typically 32-36 g/dL) A. Evaluation: Normal MCHC. Ca (Calcium) 8.8 mg/dL: Below the reference range, indicating hypocalcemia. Hgb (Hemoglobin) 10.0 g/dL: Below the reference range, indicating anemia. Hct (Hematocrit) 30%: Below the reference range, indicating anemia. WBC 76000/mm3: High above the reference range, indicating possible infection or other serious condition. 3. Discuss the issues that are contributing to patient’s problems. Possible Issues with this Patient: 1. Anemia: If her vegan diet isn’t well-balanced, it’s probably because of her heavy menstrual cycles. It’s important to keep an eye on iron, vitamin B12, and folate. 2. Hypocalcemia: Since she doesn’t eat dairy, her vegan diet may be to blame for this. 3. Elevated WBC: This is a concerning result that needs to be looked at right away. 4. Fatigue: This may be brought on by anemia, an unhealthful diet, or other underlying issues. 4. Evaluate patient’s intake. Estimate calorie and protein intake based upon her food recall. Consider her intake of vitamins and minerals. Discuss the adequacy of micronutrient and macronutrient intake. Because of her dietary limitations, Ms. Espinoza’s vegan diet has to be unusually high in iron, calcium, and vitamin B12. Meals enriched with calcium and B12, or supplements, could be beneficial for her. Iron and calcium are two important elements that may be found in foods like legumes, nuts, and greens.
5. Determine patient’s kcal, protein, and fluid requirements. Equation: %estimated needs met=current kcal intake/estimated kcal needs x 100 = % 1. Caloric Intake: Based on her computed TDEE of 1751.76 kcal, she needs to consume 1500–1700 (1600) kcal per day in order to stay at her current weight. Approximately 112.5% of the calories she needs are consumed. This is almost what she needs, but considering her symptoms and lifestyle, it might not be sufficient to combat her drowsiness and inactivity. One possible explanation for her apparent weakness and low academic achievement is a prolonged calorie deficit. EXCEEDING 2. Protein: It is estimated that she will consume around 65 grams of protein per day, or around 122.4% (102.4%)of her calculated requirements 50-60 g (53.7 grams). This might sound enough, but there are significant differences in the quality of the protein sources in a vegan diet. Plant-based proteins might not be as readily available as animal-based proteins due to the absence of one or more essential amino acids. Given her symptoms and the potential for nutritional deficiencies, a comprehensive evaluation of her protein intake is necessary. EXCEEDING 3. Fluid Intake: She needs about two liters of water every day to stay hydrated. 2354 mL/kg – 2690 mL/kg. Her fluid intake was not mentioned, but it is crucial to make sure she receives what she needs if she is using diuretics like tea, which can lead to dehydration and exacerbate her symptoms. Other concerns: iron, calcium, and B12 – Her vegan diet and heavy menstrual periods further support the diagnosis of iron-deficiency anemia, which is indicated by low hemoglobin and hematocrit levels – Needs heme iron from animal products since the iron in plants isn’t as easily absorbed – Hemoglobin and hematocrit levels indicate iron-deficiency anemia – Low blood calcium levels with aversion to dairy products – Insufficient calcium levels can have negative effects on nerve transmission, muscle function, and bone health – Lack of B12 from absence of animal products – B12 is necessary for both normal nerve function and the synthesis of red blood cells. 6. Compare her current intake to her estimated needs (from question 5). What percent of her kcal and protein needs is she currently meeting? Protein: daily protein consumption is predicted to be between around 65 grams, or around 122.4% of her calculated requirements (53.7 grams). This may seem sufficient; however, the quality of the protein sources in a vegan diet varies widely. Kcal: Approximately 112.5% of the calories she needs are consumed by her. This is almost what she needs, but considering her symptoms and lifestyle, it might not be sufficient to combat her fatigue symptoms. 7. Is patient’s dietary intake of kcals, protein, and vitamins and minerals adequate? Why or why not? Explain in detail. Ms. Espinoza’s diet is problematic from what we know thus far, especially in light of her symptoms and laboratory findings. Ms. Espinoza is approaching her required intake of calories and protein; yet, because of her symptoms, potential vitamin deficiencies, and way of living, she could not be receiving enough. Her diet appears to be lacking in important nutrients, which might seriously jeopardize her health and perhaps be the cause of her reported symptoms. It is recommended that you consume a better diet, maybe with the use of vitamins or fortified meals.
DIAGNOSIS 8. List three pertinent nutrition diagnoses that apply to patient. Inadequate Iron Intake: Her low hemoglobin and hematocrit numbers, together with her extreme tiredness and pale complexion, strongly suggest that she has iron deficiency anemia. Her diagnosis is strengthened by the fact that she is a vegan and has heavy periods. Inadequate Calcium Intake: Since dairy, a primary dietary source of calcium, is not included in her vegan diet, her serum calcium levels are below the guideline range. The health of your bones and muscles might suffer as a result of this. Inadequate Energy Intake: Her energy levels may be low since her calorie intake is predicted to be somewhat lower than her predicted demands. Her symptoms and way of life make this a cause for alarm. 9. Prioritize the nutrition diagnoses from question 8. Write two PES statements for the most pertinent diagnoses. Which of the two diagnoses is more important and why? 1. PES Statement for Inadequate Iron Intake: A. Problem: Iron-Deficiency Anemia B. Etiology: Inadequate dietary iron intake exacerbated by heavy menstrual cycles C. Signs/Symptoms: Fatigue, low hemoglobin and hematocrit levels, pallor. D. PES: Iron-Deficiency Anemia related to inadequate dietary iron intake as evidenced by fatigue, low hemoglobin and hematocrit levels, and pallor. 2. PES Statement for Inadequate Calcium Intake: A. Problem: Hypocalcemia B. Etiology: Inadequate dietary calcium intake due to vegan diet C. Signs/Symptoms: Low serum calcium levels D. PES: Hypocalcemia related to inadequate dietary calcium intake as evidenced by low serum calcium levels. Which of the Two Diagnoses is More Important and Why? There is a higher degree of urgency surrounding the diagnosis of Iron Deficiency Anemia due to inadequate iron intake in this situation. The immediate and severe repercussions of iron deficiency anemia, such as excessive exhaustion, weakness, and cognitive deficits, are negatively impacting Ms. Espinoza’s academic performance and quality of life. An untreated case of anemia increases the risk of complications, including heart disease. Ms. Espinoza’s iron deficiency should be treated immediately since she is showing signs of anemia, and her test findings reveal low hemoglobin and hematocrit levels.

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