social pharmacy d-pharm 1st year by Pragati K. Mahajan
Anemia in medical nutrition therapy.docx
1. Anemia in Pregnancy- medical nutrition therapy
Anemia in Pregnancy- medical nutrition therapyAnemia in Pregnancy- medical nutrition
therapyOrder DescriptionPlease read this case study below and answer all the questions
thoroughly. Use all the knowledge of a nutrition to answer the questions. ALSO,please also
fill out the ADIME chart at the end. This is a case study based in nutrition. Please create a
references citation sheet at the end of the case study. Please answer the questions inside the
document. Use the references I listed IN AIDITION to your own references.read this case
study below and answer all the questions thoroughly. Please also fill out the ADIME chart at
the end. This is a case study based in nutrition. Please create a references citation sheet at
the end of the case study. Please answer the questions inside the document. Here are some
references you can use to answer the questions but use your own references as well:
1. Nelms, Sucher, Lacey, Long Roth: Nutrition Therapy and Pathophysiology. 3rd ed.,
Cengage Learning 2014 ISBN-13:978-1-305-11196-7
http://www.coursesmart.com/IR/1845467/9781305111967?__hdv=6.8 Note: This
textbook will be used in FNES 366 as well.2. Nahikian-Nelms M, Long-Anderson S. Medical
Nutrition Therapy: A Case Study Approach 4th ed. Belmont, CA: Wadsworth; 2013. ISBN:
978-1-133-59315-7 Note: Electronic versions of the individual case studies from the text
can be purchased at www.cengagebrain.com for $3.99 each3. Gylis BA, WeIDing ME:
Medical Terminology Systems (with Termplus 3.0): A Body Systems Approad (with
medicallanguagelab.com), 7th Edition ISBN: 978-0-8036-3575-3 Brown JE, Isaacs J et al:
Nutrition through the Life Cycle. 5th ed. Wadsworth 2014 ISBN-10: 1133600492, ISBN-13:
9781133600497 (recommended, especially when with community focus)4. Nutrition Care
Manual: http://www.nutritioncaremanual.org/member-pricing This is another resource
you should know about. The department is trying to provide access to this resource as
well.5. Mahan LK, Escott-Stump S, Raymond, JL. Krause’ s Food and the Nutrition Care
Process. 13th ed. St. Louis, Missouri: Elsevier/Saunders; 2012. ISBN: 978-1-4377-2233-
86. American Dietetic Association / American Diabetes Association. Choose Your Food:
Exchange Lists for Meal Planning. 2008. (Either Diabetes or Weight Management
booklet). You could purchase from AND website, www.eatright.org. The same resource is
available with less shipping costs elsewhere.
http://www.nhlbi.nih.gov/health/educational/lose_wt/eat/fd_exch.htm#1 also shows
exchange lists, as do many other sites (.edu can be considered reliable for this
purpose).7. Pronsky ZN. Food Medication Interactions. 17th ed. Birchrunville. PA 2012.
(optional; encouraged if on Dietetics Track) ISBN: 0-9710896-4-7. Note: Choose your source
2. – prices vary greatly! Alternatively, consult epocrates, or rxlist.com for information on food-
drug interactions.8. Stedman’ s Medical Dictionary for Health Professionals. 7th ed.
Baltimore, MD: Williams and Wilkins; 2011 (optional; if not purchased use online medical
dictionary i.e. http://www.medterms.com/script/main/hp.asp)9. Wallach: Handbook of
Interpretation of diagnostic tests. Current ed., Lippincott. Or any similar handbook on
(human) diagnostic tests.The following 4 books are resources for more in-depth studying:
? Edelstein S and Sharlin J: Life Cycle Nutrition: An Evidence Based Approach. Jones and
Bartlett 2009. ISBN 13: 978-0-7673-3810-5 (assigned chapters are included in the required
textbook) ? Samour P Q, King K: Pediatric Nutrition, 4th ed., Jones and Bartlett, 2012.
ISBN-13: 978-0-7637-8450-8 (assigned chapters are included in the required textbook)
? Chernoff R. et al.: Geriatric Nutrition: The Health Professional’ s Handbook. Jones and
Bartlett, 3rd ed., 2006. ISBN-13: 978-0-7637-3181-6 (assigned chapters are included in the
required textbook) ? McArdle WD, Katch FI, Katch VL: Sports and Exercise Nutrition,
Wolters Kluwer, 4th ed., 2013. ISBN-13 978-1-4511-1806-3Case study Anemia in
Pregnancy Note: This case study is based on cases in the Nelms books in combination with a
review of current literature to generate an original case study. Cases of iron deficiency
anemia and folate deficiency anemia occur more frequently, thus their treatment challenges
are included here.Patient summary: A.B.C. is a 21 year-old white female, 5 months pregnant,
admitted through the ER after falling and possible syncope to rule out premature labor. Her
CBC warranted a complete hematologic work-up.Pt Summary: 21yo wf, gravida 1, para 0,
presented 23rd week of gestation, after a fall with vaginal spotting and abdominal pain.
Admitted to r/o premature labor secondary to the fall. Patient c/o fatigue.History: ABC is a
21 year-old pregnant woman, gravida 1, para 0, who presented to the ER in her 23rd week
of gestation. She has experienced vaginal spotting and some abdominal pain. She reports
being very tired and sometimes being unusually short of breath. Medical history: not
contributory Surgical history: none medications at home: prenatal vitamins – pt reports not
using the prescription Tobacco use: none alcohol use: about 1 glass of wine per month,
socially family history: Mother: pernicious anemia, colon cancer; Father: HTN, CAD s/p
MIDemographics: Married, lives with husband, 2 years of college, full-time position as office
clerk; ethnicity: Caucasian, no religious affiliationAdmitting Hx/PE CC: “ I was shopping at
the mall when I passed out and fell while looking at some clothes. After I got back home I
noticed a small amount of bleeding when I went to the bathroom. Over the next hour, I had
some abdominal pain. I called my doctor and the office said I should come here to be
checked out.” General appearance: 21-year-old pregnant female, pale, in no acute
distress.Vital Signs: Temp: 98.6, Pulse: 88, RR: 19, BP: 118/72, height: 5’ 5” , weight: 128#,
prepregnancy weight: 118#HEENT: Head: WNL Eyes: Sclera pale, PERRLA, fundi without
lesions ears: clear nose: clear throat: pharynx clear without postnasal drainage genitalia:
normal neurologic: alert and oriented x4 extremities: no edema, DTR 2+ and symmetrical
throughout skin: pale, warm and dry chest/lungs: cta and percussion peripheral vascular:
diminished pulses bilaterally abdomen: bowel sounds x4Nursing Assessment (2 days ago)
Abdominal appearance (concave, flat, rounded, obese, distended) Rounded with
pregnancy Palpation of abdomen (soft, rigid, firm, masses, tense) Soft Bowel sounds
(P=present, AB=absent, hypo, hyper) RUQ P LUQ P RLQ P LLQ P Stool color None
3. Stool consistency Tubes/ostomies N/A Genitourinary Urinary continence Yes Urine
source Clean catch Appearance (clear, cloudy, yellow, amber, fluorescent, hematuria,
orange, blue, tea) Clear, yellow Integumentary Skin color Pale Skin temperature
(DI=diaphoretic, W=warm, dry, CL-cool, CLM=clammy, CD+=cold, M=moist, H=hot) W Skin
turgor (good, fair, poor, TENT=tenting) Good Skin condition (intact, EC-ecchymosis,
A=abrasions, P=petechiae, R=rash, W=weeping, S-sloughing, D=dryness, EX=excoriated,
T=tears, SE=subcutaneous emphysema, B=blisters, V=vesicles, N=necrosis) Intact Mucous
membranes (intact, EC=ecchymosis, A=abrasions, P=petechiae, R=rash, W=weeping, S-
sloughing, D=dryness, EX=excoriated, T=tears, SE=subcutaneous emphysema, B=blisters,
V=vesicles, N=necrosis) Intact Other components of Braden score: special bed, sensory
pressure, moisture, activity, friction/shear (>18=no risk, 15-16=low risk, 13-14=moderate
risk, ? 12=high risk) 21Admissions orders: Laboratory: CBC, RPR, Chem 27, shite count
with differential, folate, B12, homocysteine, anti-parietal cell antibodies, anti-intrinsic factor
antibodies, MMA Repeat CBC, Amylase, Lipase in 12 hrs Repeat Chem 7 every 6hrs
Radiology: abdominal U/S: Pregnancy >1st Vital Signs: every 4 hrs; monitor fetal heart
tones and contractions I&O recorded every 8hrs Diet: NPO Activity: bed rest IVF: LR @
100ml/hrNutrition: Meal type: NPO Fluid requirement 2000-2400m/d History: Patient
states appetite is good right now. She suffered some morning sickness during her first
trimester but is better now. States that she follows a vegan diet and does not take her
prenatal vitamins because they make her stomach hurt. States that she does go the prenatal
care to her OB/GYN Usual dietary intake: Breakfast: 2 slices whole wheat bread, 1 Tbs.
margarine, 1 serving scrambled tofu (200g), 2 wedges cantaloupe Snack: 4pz soy yogurt, 1
Tbs. flax seed, ½ cup rolled oats Lunch: black bean and potato salad, ½ grapefruit Snack:
trail mix (1.5oz) Dinner: 1 cup quinoa with grilled vegetables, 1 cup fruit saladMD progress
note: (1 day ago) Subjective: ABC previous 24 hrs reviewed Vitals: temp 98.5, pulse: 82, RR
20, BP: 120/82 Urine output: 4344ml (67.3ml/kg)Physical exam General: 23 week gestation
– no contractions; no further vaginal spotting HEENT: WNL Neck: WNL Heart: WNL Lungs:
CTA abdomen: WNLDx: Megaloblastic macrocytic anemia, 23 week gestation with normal
ultrasound. Fetal heart sounds WNLPlan: CD IVF. Begin 100µg cyanocobalamin po daily for
1 week, then 50µg/d for 6 weeks. Continue prenatal vitamins daily. Nutrition consult
Discharge to home.Reference range 2 days ago Chemistry Sodium (mEq/L) 136-
145 142 Potassium (mEq/L) 3.5-5.5 3.8 Chloride (mEq/L) 95-105 104 Carbon
dioxide (CO2, mEq/L) 23-30 26 BUN (mg/dL) 8-18 8 Creatinine serum (mg/dL) 0.6-
1.2 0.7 BUN/Crea ratio 10.0-20.0 11.4 Uric acid (mg/dL) 2.8-8.8 F 4.0-9.0 M 3.2
Glucose (mg/dL) 70-110 105 Phosphate, inorganic (mg/dL) 2.3-4.7 3.1 Magnesium
(mg/dL) 1.8-3 2.2 Calcium (mg/dL) 9-11 10.2 Osmolality (mmol/kg/H2O) 285-
295 292 Bilirubin, total (mg/dL) ?1.5 0.4 Bilirubin, direct (mg/dL) <0.3 0.1 Protein,
total (g/dL) 6-8 6.2 Albumin (g/dL) 3.5-5 3.9 Prealbumin (mg/dL) 16-35 33
Ammonia (NH3, µmol/L) 9-33 10 Alkaline phosphatase (U/L) 30-120 45 ALT
(U/L) 4-36 8 AST (U/L) 0-35 2 CPK (U/L) 30-135 F 55-170 M 31 Lactate
dehydrogenase (U/L) 208-378 210 Lipase (U/L) 0-110 5 Amylase (U/L) 25-
125 26 CRP (mg/dL) <1 0.004 Cholesterol (mg/dL) 120-199 145 HDL-C
(md/dL) >55 F, >45 M 62 VLDL (mg/dL) 7-32 13 LDL (mg/dL) <130 70 LDL/HDL
4. ratio <3.22 F <3.55 M 1.12 Triglycerides (mg/dL) 35-135 F 40-160 M 75 FT4
(ng/dL) 0.54-1.18 (2nd trimester) 0.94 T4 (µg/dL) 6.09-12.23 12.00 T3 (ng/dL) 87-
178 178 HbA1C (%) 3.9-5.2 4.9 Coagulation (Coag) PT (sec) 12.4-14.4 13.2 PTT
(sec) 24-34 27 Hematology WBC (x 103/mm3) 4.8-11.8 9.2 RBC (x 106/mm3) 4.2-
5.4 F 4.5-6.2 M 4.2 Hemoglobin (Hgb, g/dL) 12-15 F 14-17 M 10.5 Hematocrit (Hct,
%) 37-47 F 40-54 M 30 Mean cell volume (µm3) 80-96 106 Mean cell Hgb (pg) 26-
32 34 Mean cell Hgb content (g/dL) 31.5-36 38 RBC distribution (%) 11.6-16.5 17.8
Platelet count (x 103/mm3) 140-440 145 Transferrin (mg/dL) 250-380 F 215-365
M 270 Ferritin (mg/mL) 20-120 F 20-300 M 20 Iron (µg/dL) 65-165 F 75-175 M 66
Total iron binding capacity (µg/dL) 240-450 442 Iron saturation (%) 15-50% F 10-
50% M 15 ZPP (µmol/mol) 30-80 32 Vitamin B12 (ng/dL) 24.4-100 11 Folate
(ng/dL) 5-25 14 MMA (mmol/L) 0.08-0.56 0.75 Hcy (µg/dL) 66-160 F 80-
210M 168 Anti-parietal cell antibodies Neg Neg Anti-intrinsic factor
antibodies Neg Neg Hematology, Manual Diff Neutrophil (%) 50-70 55 Lymphocyte
(%) 15-45 20 Monocyte (%) 3-10 5 Eosinophil (%) 0-6 3 Basophil (%) 0-2 0
Blasts (%) 3-10 8 Segs (%) 0-60 58 Bands (%) 0-10 8Case study
questions1. Evaluate the patient’ s admitting history and physical. Are there any signs or
symptoms that support the diagnosis of anemia?2. What laboratory values or other tests
support the diagnosis of megaloblastic macrocytic anemia? List all abnormal values and
explain the likely cause for each abnormal value.3. What hematological values normally
change in pregnancy?4. Define the following types of anemia: megaloblastic anemia,
pernicious anemia, normocytic anemia, microcytic anemia. Include nutrients the deficiency
of which can cause or be caused (distinguish) by these anemias.5. Vitamin B12 and folate
deficiencies are often difficult to distinguish from one another. Describe the
interdependence of these two nutrients and how the deficiency of one may be related to the
deficiency of the other.6. List the most common causes of folate and B12
deficienies.7. Explain why the following tests were included in the medical diagnostic
work-up: a. anti-intrinsic factor antibodiesb. anti-parietal cell
antibodiesc. methylmalonic acidd. homocysteine8. Discuss the specific nutritional
requirements during pregnancy. Be sure to aIDress all macro- and micronutrients that are
altered during pregnancy.9. Assess Mrs. ABC’ s height and weight. Calculate her BMI and
% usual body weight10. Check Mrs. ABC’ s prepregnancy weight. Plot her weight gain on
the maternal weight gain curve (indicate your source). Is her weight gain adequate? How
does her weight gain compare to the current recommendations?11. Determine Mrs. ABCs
energy and protein requirements. Explain the rationale for the method you used to calculate
these requirements.12. Using her 24-hr recall, compare her dietary intake with her
requirements for energy, protein, folate, B12 and iron. Indicate the method you used for
calculation.13. Write a PES statement for each nutrition problem.14. Mrs. ABC says she
does not take her prenatal vitamin. What nutrient does this supplement provide?15. List
factors that you would monitor to assess her pregnancy, nutritional and B12
status.16. Complete the ADIME sheet.PLACE THIS ORDER OR A SIMILAR ORDER WITH US
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