Question

Case Study #1: Brittany’s Baby

Brittany is 20 years old, and can’t wait until her 21^st birthday so she can drink legally (even though she plays drinking games regularly with her friends at house parties). She works as a patient care technician at a local hospital and plans to go to nursing school once she saves enough money. She presents in your clinic with nausea/vomiting and fatigue that has been going on for about 5 days. She weighs 155# at 5’4” and doesn’t report any recent change in weight. A rapid pregnancy test reveals that Brittany is pregnant, although she says she hasn’t been sexually active in almost 2 months. Brittany is worried that her parents will be so angry they will kick her out, and she is concerned about supporting herself and her baby. When you ask Brittany about her current diet, she reveals that she usually skips breakfast and often doesn’t eat until she gets off at 7pm, when she’ll grab fast-food on her way home. She says she doesn’t exercise, but is on her feet a lot at work. Additionally, Brittany says sometimes she smokes cigarettes when she’s drinking. Her 24-hour recall includes:

• Breakfast: 2 Nutri-Grain bars, 20 oz. water
• Lunch: 2 Nutri-Grain bars, 1 16-oz. can Monster energy drink
• Dinner: 1 hotdog on a bun with ketchup and mustard, 1 1-oz. bag BBQ potato chips, 24-oz. sweet tea
• Snack: 1 ice cream sandwich

Assessment and Diagnosis:

Describe your patient’s health status and/or condition and their diet. (15 points) What clinical data are used to assess and diagnose or observe this condition? What are the nutritional considerations for this patient and how does their diet impact the progression of their disease or experience? How common is this disease or situation and what are the different approaches to treatment or health promotion? What are the food groups and nutrients of interest for this patient and why? Where can you find these nutrients in food? Are there certain aspects of this patient’s diet that are concerning to you?

Conduct a nutrient analysis of the 24-hour recall that is provided. (15 points) Include calorie calculations and appropriate reports from dietary analysis software and cite specific nutrient amounts.

Assess your patient’s readiness to change. (15 points) At what level of readiness to change is this patient for which specific behaviors? What are some areas of strength for this patient and what are some resources? What are some areas of weakness for this patient?

Intervention:

Describe your strategy for counseling this patient. (15 points) Considering your above assessment, what behaviors would you focus on? What counseling strategies would you implement?

Suggest patient resources. (15 points) Provide a link to a website or handout that you would refer this patient to and include the handout or screenshot. Why did you select it? What specific behaviors are you targeting? What do you hope the outcome will be?

Monitoring and Evaluation

Identify 3-5 SMART goals for this patient. (15 points). Discuss why you would recommend these particular goals and strategies you might suggest for your patient. Describe what the monitoring and follow-up for the patient will be, and how you expect these goals to develop and evolve over time.

Answer 1

The patient is pregnant and she is overweight.

Based on her height and weight her BMI was calculated and it is high indicating overweight.(70/1.62*1.62=26.6)

Based on the social history , symptoms and the result of rapid pregnancy tests suggest that the patient is pregnant. whereas based on her dietary habits and BMI indicates that she is overweight.

Her diet does not meet the needs of daily nutrients for the body. If she continues to follow the same diet , then the patient and her baby's health is at risk.

complications with overweight pregnant women include:

Gestational diabetes

preeclampsia

hypertension

miscarriage or still birth.

Overweight is very common ,according to W.H.O 39% adults of age 18 or older are overweight. This is due to unbalanced diet,stress, hormonal imbalances and lack of exercise. This can be treated by understanding the cause for the problem, providing the diet sheet, advising to do regular exercise and maintaining a healthy lifestyle can reduce the overweight problem to some extent.

Unwanted pregnancies are common among the adolescents, lack of using contraceptive devices like condoms , contraceptive pills leads to unexpected or unwanted pregnancies.

This patient requires a new balanced diet plan that includes fruits and vegetables, protein foods like eggs, meat, milk, beans and pulses. plenty of water to be taken.

All these food items can be taken in six small proportions.

Apart from diet, she can do activities like walking and swimming which is safe in all pregnant women.

Her diet contains no iron or calcium supplementation which is more important during pregnancy, she had been taking monster drinks which contains lots of sugar and caffeine which has ill effects on the body.