Nutrition case study due in 16 hours

CASE STUDY 2

Introduction: Sarah Henley is a 31-year-old female gravida 3 para 2 who presented to the emergency room in her 23rd week gestation. She fell on the ice this morning and has now experienced some vaginal spotting and abdominal pain. She is now admitted to rule out premature labor secondary to her fall.

History: Mrs. Henley has had two previous pregnancies delivered at 38 and 37 weeks respectively. Patient states that she is much more tired with this pregnancy but has related it to having two small children. She describes being short of breath, which she states also occurred commonly with previous pregnancies, but may be earlier this pregnancy.

Current medications: none except prenatal vitamins. States she doesn’t take everyday because they make her nauseaous.

Laboratory Values: Hgb. 9.1 g/dl; Ferritin 10 (g/dL [consistent with microcytic, hypochromic iron deficiency anemia]

Lifestyle: Alcohol – denies; Smoker – yes ½ pack per day; husband smokes also.

Ht. 5’5” Wt. 145 lbs. Pre-pregnancy – 135# Gained 15-18 lbs. with previous two pregnancies (3 years and 18 months ago).

Nutrition History: Patient states appetite is good. She suffered a lot of morning sickness during the first trimester but is better now.

Usual dietary intake: AM: coffee, cold cereal, occasionally toast

Lunch: sandwich or soup

Dinner: casserole such as hamburger helper, hot dogs, soup. About twice a week she cooks a full meal with meat and vegetables. Husband works nights so she doesn’t always cook every night.

24 hour recall: 2 c. Frosted Flakes; ½ c. whole milk, black coffee

Lunch: hot dog on bun, ½ c. macaroni and cheese

Dinner: 3 oz. Salisbury steak, 1 c. green beans, 1 roll, 1 c. black coffee.

1. In reading the patient’s medical record, you note that she is in her 24th week gestation. You also learn she is “gravida 3 para 2.” What does this mean?

2. Mrs. Henley’s physician indicated the need for additional lab work when her admitting CBC revealed low hemoglobin. Why is this a concern? Are normal changes in hemoglobin associated with pregnancy? If so, what? Do any other hematological values normally change in pregnancy? Explain.

3. Check Mrs. Henley’s prepregnancy weight. How much weight has she gained? Plot her weight gain on the maternal weight gain curve. Is her gain adequate? How does her weight gain compare to current recommendations? Was the weight gained during her previous pregnancies within normal limits?

4. What factors in her pregnancy histories indicate any additional risk factors for the development of iron deficiency anemia? Were her other pregnancies normal?

5. Could anything else in her medical, nutritional, or lifestyle history affect her pregnancy outcome? Explain.

6. Assess this patient’s average daily iron intake. Actually enter food into a diet analysis program and PRINT and attach it to this case! How does this compare to the RDI for iron during pregnancy? Are there any other nutrients you should be concerned about? Use printout referenced above and address the inadequacies.

7. What are good dietary sources of iron? Is the absorption of iron affected by any other conditions? Explain.

8. 8. Mrs. Henley states she loves eating fish that her family catches. Are there any specific recommendations you would make to her regarding fish intake during pregnancy?

9. You note in Mrs. Henley’s history that she has received nutrition counseling from the WIC program. What is WIC? Would you refer her back to that program? If so, how would you make this referral?