Weebly



Lisa SilvaggioKNH 411October 15, 2013Case Study #1 Pediatric Weight ManagementCase StudyUnderstanding the Disease and PathophysiologyCurrent research indicates that the case of childhood obesity is multifactorial. Briefly outline the roles of genetics, environment, and nutritional intake in development of obesity in children.Certain genetic factors may lead to childhood obesity by influencing the metabolism. Obesity of the parents also influences obesity in children (“Childhood Obesity”). The environment can also influence obesity in children, such as the parents’ influence on food choices. In addition, children spend a good amount of time at school, so physical activity and food choices are influenced. Finally, if the energy intake is higher than the expenditure, then weight gain will occur. Describe health consequences of overweight and obesity for children.The health consequences of overweight and obesity in children are heart disease, type 2 diabetes, and being overweight or obese as an adult (256).Jamey has been diagnosed with obstructive sleep apnea. Define sleep apneaSleep apnea is a disorder characterized by having one or more pauses in breathing pauses that could last anywhere from a few seconds to minutes. This can disrupt your sleep because when breathing stops or becomes shallow, the body moves out of a deep sleep and into a light sleep (“Sleep Apnea”) Explain the relationship between sleep apnea and obesity.Sleep apnea can cause obesity from lack of sleep leading to lack of energy to do physical activity. Also, obesity can worsen or cause sleep apnea by they increase pharyngeal collapsibility (“Sleep Apnea”)Understanding the Nutrition Therapy5. What are the goals for weight loss in the pediatric population?To be under the 85th percentile and to maintain a baseline weight initially, but slowly add changes in eating and exercise, decrease fat consumption, eat fewer sweets and eat more fruits and veggies. Under what circumstances might weight loss in overweight children not be appropriate?Weight loss would be inappropriate if the child is very young, such as a toddler or an infant and it is important for them to get the most nutrients for growth and development.What would you recommend as the current focus for nutritional treatment of Jamey’s obesity?I would really focus on cutting down on her intake of calorically dense beverages. They take up a significant chunk, almost 1000 kcal, and I would suggest as a goal to cut it down to at least half of that. Nutrition AssessmentEvaluate Jamey’s weight using the CDC growth charts provided (p.8) : What is Jamey’s BMI percentile? How is her weight status classified? Use the growth chart to determine Jamey’s optimal weight for height and age.For Jamey’s stature-for-age chart she is about in the 85th percentile, in her weight-for-age chart she is about in the 97th percentile. Since her BMI is 24.9 kg/m^2, that puts her around the 97th percentile which would be in the obese range, but since she is tall for her age, she is expected to weigh more (CDC). According to the growth charts her optimal weight for height and age is about 75 lbs and 55”.Identify two methods for determining Jamey’s energy requirements other than indirect calorimetry, and then use them to calculate Jamey’s energy requirements.EER equation for females 9-18:=135.3-30.8 x 10 y.o. + 1.16 PA x (10 x 52.2 kg + 934 x 1.5 m) + 25=135.3-308+1.16 x (522+1401)+25=2083 kcal/ dayMifflin-St. Jeor=10 x 52.2 kg + 6.25 x 145 cm - 5 x 10 y.o. -161= 1217 kcal x 1.6 PAL=1947 kcal/dayAccording to these two equations, Jamey should be getting about 1900-2100 kcal/day for her current height and weight.Dietary factors associated with increased risk of overweight are increased dietary fat intake and increased calorie-dense beverages. Identify foods from Jamey’s diet recall that fit these criteria.Foods that fit the criteria for increased fat from Jamey’s diet are the breakfast burritos, sandwiches (bologna, cheese and mayo), the bag of corn chips, twinkies, peanut butter, fried chicken, mashed potatoes and fried okra. The foods from her diet that fit the increased calorie-dense beverages are whole milk, apple juice, sweet tea and coca-cola.Calculate the percent of kcal from each macronutrient and the percent of kcal provided by fluids for Jamey’s 24-hour recallUsing , I calculated that Jamey is consuming about 4200 kcal from her 24-hour recall. 41% of her calories are from fat (1700 kcal), 43% are from carbohydrates (1800 kcal) and 17% from protein (700 kcal). Approximately 22% or 930 kcal are from fluids.Increased fruit and vegetable intake is associated with decreased risk of overweight. What foods in Jamey’s diet fall into these categories?The foods that could fall into the fruits and vegetable categories from her diet include apple juice, and the okra.Use the ChooseMyPlate online tool/ to generate a customized daily food plan. Using this eating pattern, plan a 1-day menu for Jamey.*Could not insert the menu but it added up to 2051 kcal.Now enter and assess the 1-day menu you planned for Jamey using MyPlate). Does your menu meet macro- and micronutrient recommendations for Jamey? NutrientsTargetAverage EatenTotal Calories2200 Calories2051 CaloriesProtein (g)***46 g102 gProtein (% Calories)***10 - 35% Calories20% CaloriesCarbohydrate (g)***130 g278 gCarbohydrate (% Calories)***45 - 65% Calories54% CaloriesDietary Fiber25 g30 gTotal Fat20 - 35% Calories28% CaloriesSaturated Fat< 10% Calories9% CaloriesMineralsTargetAverage EatenCalcium1000 mg1485 mgPotassium4700 mg3932 mgSodium**< 2300 mg3527 mgCopper900 ?g1374 ?gIron18 mg19 mgVitaminsTargetAverage EatenVitamin A700 ?g RAE1623 ?g RAEVitamin B61.3 mg2.6 mgVitamin B122.4 ?g7.1 ?gVitamin C75 mg103 mgVitamin D15 ?g11 ?gThis diet meets the macro and micro nutrient recommendations for Jamey.Why did Dr. Lambert order a lipid profile and blood glucose tests? What lipid and glucose levels are considered altered (i.e., outside of normal limits) for the pediatric population? Evaluate Jamey’s lab results.Dr. Lambert ordered the lab values to further assess if her health was at risk because sometimes BMI alone can be misleading and may be something a child grows out of. Her glucose (112 mg/dL) is elevated, and her HDL was low (34 mg/dL) and this raised her LDL/HDL ratio 3.23). This means that she may be at risk for diabetes.What behaviors associated with increased risk of overweight would you look for when assessing Jamey’s and her family’s diet? What aspects of Jamey’s lifestyle place her at increased risk for overweight?I would ask what type of community her family lives in, like if they have a park nearby or if it is safe to walk in their neighborhood to get more physical activity. I would also ask how often her family goes out to eat or how often they cook at home to help assess what their skill level is with food and to advise on healthier choices when eating out. The aspects of Jamey’s lifestyle that place her at an increased risk are her small amount of physical activity, eating an increased amount of calories and having a parent with type 2 diabetes. You talk with Jamey and her parents, who are friendly and cooperative. Jamey’s mother asks if it would help for them to not let Jamey snack between meals and to reward her with dessert when she exercises. What would you tell them?I would recommend that Jamey could still have snacks to help control her hunger, but to pick healthier options, like popcorn or cheese and crackers. Although I would not recommend that Jamey be rewarded with dessert, as it will motivate her to excercise for the wrong reasons and almost cancel out any work she has done.Identify one specific physical activity recommendation for Jamey.I would recommend Jamey to start with walking as her physical activity, something manageable like 30 minutes sometime after dinner, then each week add ten minutes. In the future, she should be encouraged to try different sports when she is able to participate and to find a hobby that she enjoys but is also healthy.Nutrition DiagnosisSelect two nutrition problems and complete the PES statement for each.Excessive energy intake (NI-1.5) related to frequent consumption of calorically dense foods as evidenced by diet recall and weight gain.Physical inactivity (NB-2.1) related to discontinued physical education and self reports of playing vido games/reading as evidenced by family and patient’s report.Nutrition InterventionFor each PES statement written, establish an ideal goal (based on signs and symptoms) and an appropriate intervention (based on etiology).I would encourage her to reduce her amount of calories a day to under 2000, since it was estimated that is what she needs to maintan her weight, I would want to reduce that by 250 calories to promote a small weight loss of about a 0.5 pounds a week. To increase physical activity I would encourage walking as previously stated and eventually finding a sport that she will enjoy.Mr. and Mrs. Whitmer ask about using over-the-counter diet aids, specifically Alli (orlistat). What would you tell them?I would tell Jamey’s parents that orlistat has not been tested in adolescents below 12, and can be moderately effective for a short term but application is limited by GI distress (EAL). Overall I would not recommend it because if she learns healthy eating habits, those can last a lifetime, as opposed to taking a short-term supplement.Mr. and Mrs. Whitmer ask about gastric bypass surgery for Jamey. Using the EAL, what are the recommendations regarding gastric bypass surgery for the pediatric population?The EAL recommends that dietitians collaborate with their health care team for severely obese adolescents who did not have success with weight loss in other ways. If adolescents do meet the additional criteria, surgery may be effective, but one of the criteria is having attained a majority of skeletal maturity (over 13 years old for girls). Since Jamey is only 10 and does not have a BMI of over 40, another criteria for bypass surgery, I would not recommend she undergo surgery, especially without having tried a weight loss plan or having a serious obesity-related medical complication.Nutrition Monitoring and EvaluationWhat is the optimal length of weight management therapy for Jamey?Should her parents be included? Why or why not?Jamey’s parents should be included in the weight loss plan, because they are in charge of buying and preparing food and can report whether she is following her plan/goals. Since Jamey is still dependent on her parents for most of her meals, it is important to include them in this process.What would you assess during this follow-up counseling session?During the follow-up I would assess any weight changes, ask if they keep a food log of what she eats and if she is handling any physical activity. I would ask if they ran into any problems and help work through them. Finally, I would make myself available to them with my phne number/email if they have any questions or concerns before they have their next follow-up. Works CitedNahikian-Nelms, Marcia. Nutrition Therapy and Pathophysiology. 2nd ed. Belmont, CA: Wadsworth, Cengage Learning, 2011. N. pag. Print ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download