Mini Case Study #1: Brittany’s Baby
Brittany is 20 years old, and can’t wait until her 21st 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.
1) Is Brittany’s pregnancy at high-risk? If so, what factors make that so?
2) Discuss Brittany’s pre-pregnancy weight and how much weight gain will be healthy for her. What amount of calories, protein, carbohydrates, and fat should she be consuming?
3) Is Brittany’s drinking problematic for her baby? How could Brittany’s drinking affect the fetus’s development and what are some potential long-term consequences?
4) Brittany says she heard that it’s so important to take prenatal supplements before getting pregnant. What can you tell her how developed her baby is at 2 months and what the role of nutrition (specifically folate) is in this stage of her baby’s development?
5) What recommendations can you make to Brittany regarding her nutrition? What specific vitamin and mineral supplements does she need?
Mini Case Study #2: Betsy’s Bones
Betsy is a 68-year-old retired teacher who lives alone. She used to love gardening, but since moving to a condo, doesn’t get much time outside, and spends most of her days reading or talking on the phone. She presents to her doctor complaining of right leg pain and muscle weakness. Her laboratory results showed deficient vitamin D and reduced bone density, and a diet recall included:
· Breakfast: two hard-boiled eggs, 1 whole grapefruit with 1 tsp sugar, 12 oz. black coffee
· Lunch: cucumber sandwich (made with 2 1 medium cucumber, 2 slices white bread, and 1 T mayonnaise), 1 oz. potato chips, 16 oz. unsweetened iced tea
· Dinner: pasta (1 c.) with red sauce (1/2 c.), small white roll, 1 glass red wine, fun-size milky way
Betsy is 5’4” and weighs 126# (57kg). She says she loves to cook, but since it’s just her, she usually just prepares something quick and easy. Every Sunday she goes to church and to the grocery store, but otherwise, she doesn’t leave the house much.
1) Estimate how much protein Betsy is getting. How much does she need? Is her intake adequate? What recommendations do you have regarding Betsy’s protein intake?
2) What about Betsy’ fluid intake? Is she getting enough water? What are potential consequences of not taking in enough fluid?
3) Her doctor recommended a vitamin D supplement. What other ways can Betsy improve her vitamin D status? List some foods that are good sources of vitamin D.
4) Betsy’s mom had osteoporosis and she’s concerned about developing it too. What steps can Betsy take to maintain her bone health? Are there specific nutrients other than vitamin D and calcium that are important to bone health?
5) Why is vitamin D deficiency more common in the elderly?