File - Clinical Manual

Andrea Myers
KNH 411
 Gracie
 34
 Female
 5’5”
 180lbs
 Graduate
 Graduate teaching assistant
 Married
 One adopted child, infant
 “I
just keep gaining weight, no matter what I
do! The more weight I gain, the more hair
shows up on my body. And I just found out I
have sleep apnea and I have to use a CPAP at
 Stopped
menstruating in college
 Placed on oral contraceptives
 Controlled her weight during her
undergraduate education through regular
physical activity and eating a healthy diet.
Maintained weight of 140lbs.
 Since graduating, she has gained an average
of 4lbs per year
 PCOS symptoms grew worse as she gained
 Has
had two miscarriages
 Adopted infant girl one year ago
 Stress of school, job and family have
exacerbated her symptoms further and
caused her to seek further medical
 Has
had nutrition education 6 years prior to
current admission
 Diagnosed
with Polycystic Ovary Syndrome
(PCOS) six years ago
is a health problem that can affect a
woman’s menstrual cycle, fertility,
hormones, insulin production, heart, blood
vessels and physical appearance.
 Only
affects women
 Elevated level of androgens (male hormones)
 Irregular or no menstrual cycle
 May cause many small cysts to develop in the
 The
most common hormonal reproductive
problem in women of childbearing age
 There
is not a well-defined diagnostic
criteria for PCOS
 Criteria according to the Androgen Excess
Society (2006):
hyperandrogenism (clinical or biochemical)
ovarian dysfunction (oligomenorrhea or
anovulation and/or polycystic ovarian
exclusion of other androgen excess or related
 Cause
of PCOS is unknown
 Several
factors seem to be linked to PCOS
Body’s ability to make insulin
 Symptoms
Cessation of menstruation
Weight gain
Sleep apnea
Thinning hair
Skin tags
Acanthosis Nigricans
High blood pressure
High cholesterol
 Bilirubin:
 ALT: 42U/L
 HDL-C: 51mg/dL
 TG:184 mg/dL
 LDL:132 mg/dL
 Complete
blood count with:
Metabolic panel
Lipid panel
Thyroid panel with TSH
Testosterone level
hour GTT
1 tablet PO
 Glucophage 850mg PO
 Aldactone 100mg/d PO
 Vaniqua
 Nutrition
consult requested
 Gracie’s
weight= 180lbs/2.2= 82kg
 Gracie’s height= 65” x 2.54= 165cm= 1.65m
BMI: 82kg/1.65m^2 = 30 kg/m^2
 TEE:
(10 x 140lbs + 6.25 x 65” – 5 x 34) 1.3 =
2,127 kcal/day
Range: 2,100-2,200 kcal/day
 Those
with PCOS are encouraged to follow a
healthy, balanced diet in moderation. One
with PCOS should take care to:
Limit processed foods and foods containing
processed sugars
Add more whole grains to their diet
Add more fruits and vegetables to their diet
add more lean meats to their diet
 Breakfast:
8oz. calcium-fortified orange
juice, 6 oz. black coffee
 Snack: 1 cup mixed nuts (salted), 10 oz.
unsweetened iced tea
 Lunch: Cheeseburger and small fries from
fast food restaurant, 18 oz. Diet Coke
 Dinner: 1 ½ cup ham and beans, 2 corn
muffins, 12 oz. Diet Coke
 Snack: Skinny Cow ice cream sandwich
 Excessive
energy intake related to frequent
consumption of high-fat, high kilocalorie
foods as evidenced by 24-hour dietary recall
and obese BMI of 30 kh/m^2.
 Physical
inactivity related to busy lifestyle
and lack of access to facility as evidenced by
undesired weight gain of 40 lbs over ten
 Reduce
weight and BMI to normal range by
reducing daily kilocalorie intake from
2,500kcal to 2,100-2,200kcal/day and eating
balanced meals containing 50% CHO, 20%
protein and 30% fat
 Increase
physical activity slowly, starting
with 30 minutes 4 times/week and working
up to recommended 1 hour/day. Encourage
family physical activities, such as daily
 With
treatment, women with PCOS are
usually able to lead normal lives and can
become pregnant.
National Institute of Health
 Nutrition Therapy and Pathophysiology; pg. 501
r-publications/fact-sheet/ polycystic-ovarysyndrome.cfm