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Annelise ChmelikMarch 18, 2014KNH 413Depression: Drug-Nutrient InteractionWhat is depression?Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think, and behave ad can lead to a variety of emotional and physical problems.. Byrd has decided to treat Ms. Geitl with Zoloft, a selective serotonin reuptake inhibitor. Are there any pertinent nutritional considerations when using this medication?SSRI can cause nausea and dry mouth, which can affect hunger and daily food intake. There can be some dangerous reactions with some herbal remedies. If combined with St. John’s wort, dangerously high levels of serotonin may occur in the body causing serotonin syndrome. do serotonin reuptake inhibitors work?SSRIs ease depression by affecting the chemical messengers (neurotransmitters) used for communication between the cells of the brain. Changing the balance of serotonin allows the brain cells to send and receive messages, boosting mood. the diet history, you ask Ms. Geitl if she uses any OTC vitamins, minerals, or herbal supplements. She tells you her mother suggested she try Hypericum perforatum (St. John’s wort) because in Germany it is prescribed to treat depression. Ms. Geitl did as her mother suggested, as it is available without prescription in the United States. What is St. John’s wort?St. John’s wort is a plant with yellow flowers. It is used medicinally to treat depression, anxiety, and sleep disorders. is St. John’s wort used in the United States?The flowering tops of St. John’s wort is used to prepare teas, tablets, and capsules for medicinal use. In the US there is a public interest in using St. John’s wort for the treatment of depression. However, it is not prescribed medication. The FDA does not approve it for the treatment of depression. does St. John’s wort work as an antidepressant?The compounds of St . John’s wort as an antidepressant is not fully understood. Some studies indicate that St. John’s wort works on serotonin and dopamine. Other studies have shown that St. John’s wort might prevent nerve cells in the brain from reabsorbing the chemical messenger serotonin. Other cases suggest that it works by reducing the levels of protein involved in the body’s immune system functioning. St. John’s wort have any side effects?Side effects of St. John’s wort include: dry mouth, dizziness, diarrhea, nausea, increased sensitivity to light, fatigue, anxiety, headache, and confusion. is St. John’s wort regulated in the United States?St. John’s wort is not regulated in the US. Rather, it is classified as a dietary supplement.().How is St. John’s wort used in Europe?St. John’s wort is only available by prescription in parts of Europe. It is advertised to treat depression, anxiety, and sleep disorders. In Germany, St. John’s wort is prescribed more often than Prozac. In Europe, it is also used to treat inflammation, bedwetting, stomach issues, hemorrhoids, hypothyroidism, insomnia, migraines, kidney disorders, and malaria. dicine/HerbsVitaminsandMinerals/st-johns-wortWhy do you think people are interested in alternative medicine and herbal treatments?I believe people are interested in alternative medicine and herbal remedies because people want to find a more natural way to cure sickness and disease. Because Ms. Geitl is ambulatory, you are able to measure her height and weight. She is 5’11” tall and weighs 160 pounds. You also determine that she is of medium frame. Because Geitl is from Germany, she is used to reporting her weight in kilograms and her height in centimeters. Convert her height and weight to metric numbers.Height: 71 inches X 2.54 cm = 180.34 cm 1.8034 metersWeight: 160 lbs / 2.2 lbs/kg = 72.73 kgIs Ms. Geitl’s recent weight loss anything to be worried about?Ms. Geitl’s recent weight loss of 5 pounds is not a major concern at the present moment. The weight loss is related to her poor appetite, due to her depression. So it is crucial to monitor her weight to ensure that she is not losing a significant amount of weight, in which deficiencies and malnutrition could eventually occur. Because Ms. Geitl is alert and cooperative, you ask her to complete a PG-SGA of Nutritional Status. How would you score her?SectionsScoreBox 1Weight: has decreased Box 2Food Intake: less than normalBox 3Symptoms: loss of appetite, does not feel like eatingBox 4Activities and Function: not feeling up to most activities Weight Loss Section2Disease Sections0Metabolic Section1Physical Section0Total3Using Appendix I, how would you triage nutritional intervention?Based on Ms. Geitl’s PG-SGA point score, her triage point score is 2-3. This indicates that Ms. Geitl is in need of patient and family education by a dietitian, nurse, or other medical professional. Particularly, this professional should provide pharmacologic intervention as indicated by the symptom survey and lab values. However, if her weight loss continues, Ms. Geitl’s triage score may be 4-8. This higher score warrants intervention by a dietitian along with a nurse or physician.What methods are available to estimate Ms. Geitl’s energy needs?Mifflin-St. Jeor formulaHarris-Benedict formulaCalculate Ms. Geitl’s basal energy needs using one of the methods you listed in Question 15.10 x wt + 6.25 x ht – 5 x age – 16110 x 72.73 + 6.25 x 180.34 – 5 x 20 – 1611,593.43 kcal 1,500 – 1,600What is Ms. Geitl’s estimated energy expenditure?Estimated Energy Expenditure354 – 6.91 x age + PA x (9.36 x wt + 726 x height)354 – 6.91 x 20 +1.12 x (9.36 x 72.73 + 726 x 1.8034)= 2,287.5 kcalProtein Needs:2,287.5 x 20% = 457.5/4 = 114.375 gramsFat Needs2,287.5 x 15% = 343.125/9 = 38.125Carbohydrate Needs2,287.5 x 60% = 1,372.5/4 = 343.125Evaluate her diet history and her 24-hour recall. Is she meeting her energy needs?Ms. Geitl is not meeting her energy requirement needs. Looking at her diet history, she is consuming significantly less calories that she should be to meet her basic needs. Her 24-hour recall also shows that she is consuming much less than she should be. Based on her diet history and 24 hour recall, Ms. Geitl needs to increase her calorie, fat, protein, and carbohydrate intake.What would you advise?I would advise that Ms. Geitl increase her calorie consumption. I would encourage her to consume foods that she enjoys, particularly a German cuisine. I would also tell her that by increasing her total calories for the day she might feel as if she has more energy.List each factor from your nutritional assessment and then determine an expected outcome from each.Calories: increase caloric consumption by increasing food consumption. Increasing calories would stop the weight loss she is experiencing.Protein: increase protein consumption by consuming a wide variety of sources of protein, such as meat, beans, or tofuCarbohydrate: Increase carbohydrate consumption by following the daily-recommended number of grains. By increasing her servings of grains, she will also increase her caloric consumption.Fat: increase her fat intake so she can replenish the weight that she has lost. She should focus on monounsaturated and polyunsaturated fat sources.What is your immediate concern regarding this patient’s use of St. John’s wort?My immediate concern with the patient’s use of St. John’s wort is that depending on her specific type and severity of depression, she should not be relying on a herbal supplement as treatment. Severe depression is characterized as not being able to function on a day to day basis, or having thoughts of harming oneself. Ms. Geitl fits this definition. Therefore, I suggest that she discontinue the use of St. John’s wort and take her prescribed medication only.Review the initial nutrition note written for this patient. Is this progress note appropriate? Is it complete? Any errors? Any omissions?While the SOAP note is appropriate, there are aspects that should have been included, which were not. The RD should have included that a 24 hour recall and diet history were taken in the subjective portion of the note. The RD does not include any information regarding the patient’s religious or ethnic background and the patient’s alcohol consumption. The RD should have included the patient’s weight and height in metric units in the objective portion of the note. Also, the RD did not include other empirical information such as blood pressure, temperature, pulse, respiration rate, medical diagnosis, and current medical care. The Assessment portion of the note is lacking the nutrition problems. The Plan portion of the SOAP note should outline the interventions that will be implemented to combat the nutrition problems. Nutrition Therapy and Pathophysiology, 2nd ed, pg 108. ................
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