DB is a 50 YO African American woman. She has been diagnosed with type 2 Diabetes Mellitus and hypertension. DB takes the following medications: Novolin 70/30 insulin breakfast and supper, Lasix and Cymbalta. DB lives with her husband and 3 children, ages 13, 15 and 17. Her height is 5’6”.
Weight: 185 pounds.
Activity level: sedentary
DB reports the following 24-hour food intake:
Wakes up at 6am: Skips breakfast because needs to be at work at 6:45am. Will have coffee with 2 sugars and cream at work.
11am lunch: usually eats out. Yesterday - ate at a popular fast food restaurant. Ate: 2 pieces of fried chicken, 1 biscuit, 1 cup cole slaw, 1 large sweet tea, 1 cup mashed potatoes with gravy, 1 slice of fruit pie.
3pm snack: regular size candy bar from vending machine at work
6pm dinner: 1 large plate of spaghetti with meat sauce. 1 slice of garlic toast with parmesan cheese. 1 large glass of diet soda.
9 pm bedtime snack: 1 bowl of chocolate ice cream
Goes to bed at 10pm.
DB reports that she will walk 1 mile on Saturday and Sunday at a local mall. DB will eat some vegetables, such as corn and potatoes. DB reports that she rarely eats green vegetables. DB’s favorite ways to prepare foods are to grill them or fry them. DB’s family eats at least three meals a week together as a family.
Assess DB’s food intake for calories, fat, saturated fat, carbohydrate, dietary fiber, protein, and sodium. Please indicate how you assessed the diet and include your work.
Analyze the 24-hour recall using example fitday.com or www.choosemyplate.gov. Provide an in text citation for the source of your nutrient analysis.
Show the results of your food intake analysis in a table or cut and past your data table from the web site.
Sample data table to present the results of you intake analysis
[img width="431" height="85" align="center" src="http://content-hsc.kaplan.edu/NS270_1303C/highresmedia/table1.jpg" border="0">
Equation to calculate percentage CHO, PRO, FAT
Identify DB’s intake goals:
Calculate DB’s BMI and identify weight classification.
Calculate DB’s energy needs using Mifflin St. Jeor equation
Mifflin St Jeor Energy Equation
Identify your calorie goal to achieve a healthy weight. Support your answer.
Identify the dietary guidelines you are choosing (Joslin, American Diabetes Association, DASH) to address DB’s diabetes, and hypertension. Provide an in text citation.
Updated Dietary Recommendations
Based on DB’s calorie goal calculate the grams CHO, PRO, FAT, Saturated Fat goals based on a nutrient standard you select.
Equation to calculate grams CHO, PRO, FAT, Saturated fat, dietary fiber
Identify the nutrient goals for dietary fiber, sodium, potassium, calcium, magnesium
Compare DB’s intake to the recommended intake. Present this data in a table and discussion format. Your discussion should include your assessment DB’s intake of Calories, CHO, PRO, FAT, saturated fat, sodium, dietary fiber highlighting any shortage or excess of these nutrients.
[img width="325" height="239" align="center" src="http://content-hsc.kaplan.edu/NS270_1303C/highresmedia/table2.jpg" border="0">
- Based on your analysis of DB’s intake, list and describe the current and potential nutritional deficiencies DB is at risk for developing.
Identify current nutrient deficiency as you find it on the nutrient analysis. You can cut and paste your data table from your nutrient analysis software or create your own data table to show which nutrients are below 100% RDA/AI. Your answer should also include a short written description of DB’s actual nutrient deficiency.
[img width="796" height="460" align="center" src="http://content-hsc.kaplan.edu/NS270_1303C/highresmedia/table3.jpg" border="0">
Identify potential nutrient deficiency. Based on DB’s 24-hour recall, identify what food groups she is consuming and how this compares to the recommended number of food groups based on your calorie recommendations. Identify key nutrients that each missing food group represents as a potential deficiency.
Sample comparison of intake by food group
Dietary exchange calculator: http://diabeteslibrary.org/View.aspx?url=DiabeticExchangeList
Using the DRI tables for vitamins and elements identify additional nutrients DB would potentially be deficient in based on identified missing foods/food groups.
http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Vitamins.ashx DRI: Vitamins
http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.ashx DRI Elements
Write a summary of the potential nutrient deficiency you identify in b and c.
Identify potential pharmacotherapy issues related to DB’s drug prescriptions.
For each medication identify:
Why the medication is prescribed?
Important facts about this medication.
How do you take this medication?
Identify considerations for timing, and missed doses.
Special warnings about this medication.
How do these drugs affect nutrients?
http://www.drugs.com/drug_information.html (food & drug information under “What should I avoid)
Create a 1-day meal plan for DB and explain how the menu meets the some of the guidelines you set in question 1c. You may use the 1 day sample meal plan link below to help the process.
Address these aspects:
Identify calorie and % CHO, PRO, FAT goals
Identify timing for meals and snacks
Identify CHO goals for meals and snacks
Create a sample menu to match your goals
Complete a nutrient analysis on your menu
Day 1 Sample
Describe how you would educate DB on the meal plan you created and your health maintenance recommendations.
During your counseling session, DB confesses to not taking as much of her prescribed medicines so that she can sell it to people at her church that she thinks need it more than she does. She assures you that she charges less than her friends would have to pay for it at the pharmacy. How would you counsel her regarding this new information?