Andrea Myers KNH 411 Gracie Moore 34 Female

Andrea Myers KNH 411

� Gracie Moore � 34 � Female � 5’ 5” � 180 lbs � Graduate Student � 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 night!”

� 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 140 lbs. � Since graduating, she has gained an average of 4 lbs per year � PCOS symptoms grew worse as she gained weight

� 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 intervention � Has had nutrition education 6 years prior to current admission

� Diagnosed with Polycystic Ovary Syndrome (PCOS) six years ago � PCOS 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 ovaries � 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 morphology) � exclusion of other androgen excess or related disorders

� Cause of PCOS is unknown � Several factors seem to be linked to PCOS �Genetics �Body’s ability to make insulin

� Symptoms �Cessation presented: of menstruation �Weight gain �Sleep apnea �Hirsutism �Thinning hair �Dandruff �Acne �Skin tags �Acanthosis Nigricans �High blood pressure �High cholesterol

� Bilirubin: 0. 41 mg/d. L � ALT: 42 U/L � HDL-C: 51 mg/d. L � TG: 184 mg/d. L � LDL: 132 mg/d. L

� Complete blood count with: �Metabolic panel �Lipid panel �Thyroid panel with TSH �Testosterone level � 2 hour GTT

� YAZ 1 tablet PO � Glucophage 850 mg PO � Aldactone 100 mg/d PO � Vaniqua � Nutrition consult requested

� Gracie’s weight= 180 lbs/2. 2= 82 kg � Gracie’s height= 65” x 2. 54= 165 cm= 1. 65 m BMI: 82 kg/1. 65 m^2 = 30 kg/m^2

� TEE: (10 x 140 lbs + 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: 8 oz. 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 years.

� Reduce weight and BMI to normal range by reducing daily kilocalorie intake from 2, 500 kcal to 2, 100 -2, 200 kcal/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 walks.

� With treatment, women with PCOS are usually able to lead normal lives and can become pregnant. National Institute of Health

� http: //www. nlm. nih. gov/medlineplus/ency/arti cle/000369. htm � Nutrition Therapy and Pathophysiology; pg. 501 � http: //www. nurse-practitioners-and-physicianassistants. advanceweb. com � http: //www. womenshealth. gov/publications/ou r-publications/fact-sheet/ polycystic-ovarysyndrome. cfm �. http: //www. pharmacytimes. com/publications/i ssue/2004 -06/2004 -06 -7973 � http: //www. mckinley. illinois. edu/handouts/pco s. htm