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9.
a. Justify choice of growth chart: I choose to plot JCs growth using the CDC
growth charts: Stature-for-age, Weight-for-age and BMI-for-age for boys 2 to 20
years of age. The CDC growth charts are used for children ages two years and
older in the U.S., whereas, the WHO growth standards are to monitor growth for
infants and children ages 0 to 2 years of age in the U.S.
b. Evaluate patients growth: JCs BMI-for-age places him at the 91st
percentile for boys ages 16 years. This means JC is overweight. According to
the CDC BMI-for-age growth chart, overweight is any 85th to less than the
95th percentile. A healthy weight for JC would be between the 5th percentile and
up to the 85th percentile.
10. Estimated Requirements
a. Energy Needs: Kcals/kg: 29.4 kcals/kg
b. Protein Needs: Grams Protein/kg: 0.85 grams protein/kg
c. Maintenance fluid needs mL/day: 2,971.5 3396 ml
d. Justify how you determined these numbers
i.
Mifflin St. Jeor (MSJ) based on Actual Body Weight (ABW):
Men: REE= [9.99 X wt (kg)] + [6.25 X ht (cm)] [4.92 X age] + 5
Men: REE = [9.99 X 84.9 kg] + [6.25 X 180 cm] [4.92 X 16] + 5
REE= 848.2 kg + 1125 cm 78.7 + 5 = 1754.2 kcals
REE= 1899.5 (round to nearest Kcal) = 1,900 kcals
TDE= REE X AF X IF
ii.
iii.
Function
Novolog (insulin
aspart)
Lantus (insulin
glargine)
Lisinopril
ACE inhibitor
Levothyroxine
Lamictal
Possible-Nutrition Related
Side Effect
Hypoglycemia (excessive
hunger, nausea), hyperglycemia
(increased thirst, weight loss),
hypokalemia (dry mouth,
increased thirst)
Hypoglycemia, hyperglycemia,
hypokalemia
Abdominal pain, diarrhea,
nausea, vomiting, sore throat,
loss of appetite
Difficulty with swallowing,
nausea, swelling of lips, throat,
or tongue, diarrhea,
Bloody stools, painful mouth
sores, sore throat, trouble
breathing, loss of appetite, or
weight loss, dry mouth
Hemoglobin A1c
14-day average blood
Target
1/21/15
<5.7%
<7%
13.8%
150
sugars
(7.8 mmol/L)
BloodPressure
Lessthan120/80mmHg
125/75mmHg
14-day average blood sugars: High blood sugar levels over long periods
of time can lead to serious complications such as heart disease, blindness,
kidney failure, and amputation. Very high blood sugar levels can lead to
diabetic ketoacidosis (DKA), or a diabetic coma. JCs high blood
glucose levels are a result of his poor diabetes management, including
skipping his insulin dosages, skipping meals and then eating large
quantities later in the day, and consuming food with higher glucose
content without injecting extra insulin.
Assessment:
1. Nutrition risk level: Overweight/ uncontrolled type 1 diabetes/ binge eating disorder
a. Justify choice of risk level: Pt BMI-for-age is in the 91st %ile. Pt has
uncontrolled type 1 diabetes given his difficulty with consistent blood sugar
checks, missed insulin injections and skipped meals over the past year. Pt
reported excessive food intake and grazing late at night, usually on large
amounts of sugary or carbohydrate-rich foods. These irregular patterns of eating
have greatly contributed to JCs blood sugars levels, elevated blood pressure, and
weight status.
Weight
January29,2014
February14,2014
April16,2014
May20,2014
July23,2014
November22,2014
November26,2014
January21,2015
86.8kg
85.5kg
88.3kg
87.0kg
83.9kg
84.0kg
86.3kg
84.9kg
Rateofweight
change
1.3kg
+2.8kg
1.3kg
3.1kg
+0.1
+2.3kg
1.3kg
b. Appropriateness of growth: JCs weight has fluctuated over the past year
between 83.9 kg and 88.3 kg. These changes in weight are likely due to his
irregular eating patterns and history of excessive food intake. For JCs age he is
overweight.
c. Justify your assessment: JC is overweight because his BMI-for-age (26.2
kg/m2) on the CDC growth chart places him at the 91st percentile for boys ages
16 years of age. JC admits to frequent binges late at night and poor dietary
compliance to a carbohydrate restricted diet. This can lead to weight gain and
cause high blood sugar levels.
5. Diet prior to admission
a. Adequacy of macro and micronutrients: Pt has poor glycemic control, likely
not reaching macro and micronutrient needs. JC often skips meals, leading to
excessive hunger later in the day. JC usually would overconsumemicronutrient
poorprocessedfoods(i.e.:pasta,sugar,andsoda), with minimal intake of fruits
and vegetables. It is likely JC was lacking in both macro and micronutrients
secondary to his poor dietary choices.
b. Adequacy of fluid: n/a- pt did not report about his fluid intake
c. Appropriateness of supplements: n/a- pt does not take any supplements
d. Contribution of supplements to overall intake: n/a
e. Justify your assessment: Pt has a history excessive food intake, grazing late at
night, skipping meals and lack of carbohydrate control. A poor diet is generally
associated with both macro and micro deficiencies. In addition, people with
eating disorders and diabetes often use unhealthy strategies to control their
weight, which sometimes leads to weight gain.
6. Diet order
American Diabetes Asociation. Medical Management of Type 1 Diabetes. Alexandria, VA, American
Diabetes Association, 2008. Web. 22 Jan. 2015.
Appel, Lawrence J., Michael W. Brands, Njeri Karanja, Patricia J. Elmer, Frank M. Sacs. Dietary
Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart
Association.
Barlow, S. E. "Expert Committee Recommendations Regarding the Prevention, Assessment, and
Treatment of Child and Adolescent Overweight and Obesity: Summary
Report." Pediatrics 120.Supplement (2007): S164-192. 22 Jan. 2015.
"Bipolar Disorder | Anxiety and Depression Association of America, ADAA." ADAA, n.d. Web. 28 Jan.
2015.
BMI Percentile Calculator for Child and Teen Metric Version. CDC, n.d. Web. 30 Jan. 2015.
<http://nccd.cdc.gov/dnpabmi/Calculator.aspx?CalculatorType=Metric>.
Board, A.D.A.M. Editorial. Graves Disease. U.S. National Library of Medicine, 10 May 2014. Web. 26
Jan. 2015.
Clinical Nutrition Pocket Guide- MedStar Square Medical Center/ MedStar Harbor Hospital
Diabetes - type 1 | University of Maryland Medical
Center http://umm.edu/health/medical/reports/articles/diabetes-type-1#ixzz3PyIU7HcE
Glucometer. Google Images Labeled for Re-use:
http://pixabay.com/static/uploads/photo/2014/11/11/22/19/nurse-527615_640.jpg
KDIGO. Chapter 1: Definition and classification of CKD. Kidney Int Suppl 2013; 3:19.
http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf 26 Jan.
2015.
Lowry, Adam W., Kushal Y. Bhakta, and Pratip K. Nag. Texas Children's Hospital Handbook of
Pediatrics and Neonatology. New York: McGraw-Hill, 2011. Print.
Mahan, L. Kathleen., Sylvia Escott-Stump, and Janice L. Raymond. Krause's Food & the Nutrition
Care Process. St. Louis (Miss.): Saunders, 2012. Print.
Michigan Diabetes Research and Training Center. Diabetes Research, n.d. Web. 28 Jan. 2015.
<http://www.med.umich.edu/borc/cores/ChemCore/hemoa1c.htm>.
"Standards of Medical Care in Diabetes--2012." Diabetes Care35.Supplement_1 (2011): S11-63. Web.
22 Jan. 2015.
Type 1 diabetes. Google Images Labeled for Re-use:
http://upload.wikimedia.org/wikipedia/commons/8/8c/Pancreas_insulin_beta_cells.png
Wu, Patricia, MD, FACE, FRCP. "Thyroid Disease and Diabetes." Thyroid Disease and Diabetes 18.I
(2000): n. pag. Thyroid Disease and Diabetes. Web. 28 Jan. 2015.
Organization &
Structure
Scholarly Journal
Article
No scholarly journal
article used as
reference.
Scholarly journal
article used as
reference but is not
relevant to topic.
Scholarly journal
article used as
reference and is
relevant to topic.
Development of
Ideas & Use
Supportive
Evidence
Fails to develop
information beyond
the minimum
requested. Completely
lacks relevant and
accurate supporting
information/
examples/ discussion.
Minimal supporting
information/
examples/ discussion
and/or are irrelevant
or inaccurate.
Scholarly journal
article used as
reference but is only
minimally relevant to
topic.
Provides relevant
information/
examples/ discussion
that adequately
explains or develops
understanding of the
assignment, but more
is needed or some is
inaccurate.
Growth Chart
Assessment Form
No assessment form
used for the
assignment.
Assessment form is
used, but information
presented is largely
inaccurate or lacks
sufficient elaboration
to be used in a clinical
setting.
Information presented
is largely accurate and
could be used in a
clinical setting with
minimal
modifications.
Provides accurate,
relevant,
purposeful
information/
examples/
discussion that
develop and/or
expand on the
assignment
effectively.
Growth chart used
for the assignment
is appropriate for
case study and
plotting is
accurate.
Information
presented is
accurate and could
be used in a
clinical setting
without
modifications.
Comments
Date: ___________________