Nutrition

Case Study from pages 273-274:

Amy is a 17-year-old who is at 24 weeks of gestation. She is attending high school and lives with the father of her baby. During her health checkup at the community center clinic, she complained of feeling tired most of the time. A blood sample was drawn and analyzed; her hemoglobin level was 8.5 mg/dl and hematocrit was 30 percent. The normal hemoglobin value is 12 to 16 g/dl and hematocrit 37 to 47 percent. Typically, many physiological and biochemical changes occur during pregnancy, but Amy’s blood values were lower than what is usual. Amy indicated that she is still smoking three packs of cigarettes a day because she is worried about gaining too much weight. She has only visited the community center clinic twice since she found out she was pregnant, and she has stopped taking her prenatal vitamins because one of her friends told her that the vitamins can cause constipation. She continues to wear the clothes she wore before the pregnancy even though the clothes are tight on her. The nurse at the clinic referred Amy to the local WIC program for more assessment. The additional assessment showed that Amy’s weight for height (BMI) was less than 18.5, and she had spoon-shaped fingernails on two fingers. The dietitian assessed Amy’s dietary intake using a 24-hour recall and the Nutritional Risk Score (see TABLE 8-8). Her 24-hour recall showed a lack of some of the essential nutrients such as protein, iron, folate, calories, and some vitamins. Amy’s Nutritional Risk Score was less than 50. Her daily caloric intake was 1,000 kcal per day. She likes to drink espresso, at least 4 cups a day. Amy’s present income is at 185 percent of the U.S. poverty guidelines. The WIC dietitian asked Amy if she wants to breastfeed her baby and if she could attend a workshop on breastfeeding.

Complete #s 2, 4, 16, 25, 29 (2 points each)

2) What are some of the physiological and biochemical changes that occur during a normal pregnancy?

4) Amy’s BMI was assessed at less than 18.5. What is the recommended range of weight gain for a woman of her weight and height? What is the typical weight distribution during pregnancy?

16) List three possible barriers to breastfeeding and the possible solutions to overcome these barriers.

25) What are three of the guidelines for successful breastfeeding?

29)Amy is smoking three packs of cigarettes a day. What are the consequences of cigarette smoking during pregnancy?

(Read the case study on pages 310-311) (9-1):

Sandra is a single mother with three children: Sara is 2 years old, Alice is 6, and James is 13. To support her family, Sandra has a full-time job with an annual income of $18,000 and lives below the poverty line for a family of four. Recently, Sandra expressed to her friend Lisa that she is concerned about Alice and James’s and her own weight gain. She explained that an elderly neighbor, Mary, takes care of the children after school and she likes to bake cookies for the children. Since the children have not made friends in their neighborhood, their main leisure activities are watching television and playing video games. Though time constraints lead Sandra to rely more on take-out and fast-food meals, she recently started attending an aerobics class with a friend and is interested in developing healthier eating habits. Sara is under 5 years old, so Lisa suggested that Sandra enroll her in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and use the opportunity to speak to the WIC nutritionist about her concerns for the other children. Sandra scheduled an appointment with the WIC nutritionist, and nutritional assessments were conducted using such methods as 24-hour recall and anthropometric measurements. The evaluations revealed that Sara receives an inadequate dietary intake of essential nutrients such as calcium (400 mg/day) and iron (5 mg/day). The public health nurse assessments showed that the three children were anemic due to lack of adequate iron intake and the 6- and 13-year-olds were overweight because their BMIs were between the 85th and 95th percentiles on the CDC and National Center for Health Statistics growth chart. Sandra was encouraged to: Enroll her children in the after-school program at the YWCA near their neighborhood that includes different types of physical activities. The program also provides after-school transportation assistance. Enroll in the WIC Farmers’ Market program to obtain more fresh fruits and vegetables. Enroll in the Supplemental Nutrition Assistance Program and National School Lunch Program. Shop for foods once a week using MyPlate as a guide and purchase low-fat foods. Start weekend activities such as swimming instead of watching television or playing video games. Schedule a 3-month follow-up visit to see the WIC nutritionist.

Complete #’s 3, 6, 7, 10, and 12 (worth 2 points each)

3) List and give a description of three of the Healthy People 2010 objectives related to children and adolescents, including the progress toward these three objectives.

6) There are some concerns about Sandra’s children’s food habits. Discuss some of the nutrition-related concerns during childhood and adolescence.

7) What criteria place Sandra’s children and other children at risk for high blood cholesterol? What are the recommended cholesterol levels for children and adolescents ages 2 to 19 years?

10) Sandra’s children are deficient in some important nutrients. Which nutrients are most commonly deficient or low in school-age children?

12) Sandra’s children are in the school system. What are some of the challenges schools face when implementing successful nutrition programs?