- PDF Free Download

Size: px

Start display at page:

Download ""

Tabitha McKenzie
6 years ago
Views:

1 KNH 413 Case Study #3 Drug- Nutrient Interaction Brittany Wrasman 1. What is depression? A. Depression is a serious illness that interferes with daily life. Depending on its severity, signs and symptoms of depression can include persistent sadness; feelings of hopelessness; irritability; loss of interest in activities or hobbies once pleasurable; difficulty concentrating; insomnia or excessive sleeping; overeating or loss of appetite; thoughts of suicide or suicide attempts; and/or aches or pains, headaches, cramps, or digestive problems that do no ease with treatment Dr. Byrd has decided to treat Ms. Geitl with Zoloft, a selective serotonin reuptake inhibitor. Are there any pertinent nutritional considerations when using this medication? A. Side effects of SSRIs such as Zoloft include nausea. Taking Zoloft with food or at bedtime may help reduce the risk of nausea. The consumption of alcoholic beverages should also be avoided while taking Zoloft. Dangerous reactions can occur when Zoloft is combined with other antidepressants, certain pain or headache medications, or herbal remedies. In particular, when taken with St. John s wort, dangerously 1

2 high levels of serotonin may be produced resulting in serotonin syndrome. conditions/depression/in- depth/ssris/art How do serotonin reuptake inhibitors (SSRIs) work? A. SSRIs ease depression by blocking the reuptake of the neurotransmitter serotonin in the brain. SSRIs alter the balance of serotonin to help brain cells send and receive chemical messages, resulting in a boost in mood. conditions/depression/in- depth/ssris/art During the diet history, you ask Ms. Geitl if she uses any OTC vitamins, minerals, or herbal supplements. She tells you her mother suggested she try Hypericum perforatum (St. John s wort) because in Germany it is prescribed to treat depression. Ms. Geitl did as her mother suggested, as it is available without prescription in the United States. What is St. John s wort? A. St. John s wort is an herb in which its flowers and leaves are used to make medicine. Due to some strong scientific evidence supporting its effectiveness in the treatment of mild to moderate depression, it is most commonly used for depression and depression related conditions How is St. John s wort used in the United States? 2

3 A. St. John s wort has not been approved by the Food and Drug Administration in the United States as an over- the- counter or prescription medicine for depression. Therefore, it is used as an herbal supplement. and- depression.htm 6. How does St. John s wort work as an antidepressant? A. Hyperforin and hypericin are two compounds contained within St. John s wort that are thought to have pharmacological activity. Its antidepressant properties are considered to be a result of the herb s selective inhibition of serotonin, dopamine, and norepinephrine reuptake in the central nervous system. pro- stjohnswort.pdf 7. Does St. John s wort have any side effects? A. Minor and less common side effects of St. John s wort include upset stomach, sensitivity to sunlight, and worsen feelings of anxiety in some people. If taken with certain antidepressants, St. John s wort can cause dangerously elevated levels of serotonin, leading to a condition called serotonin syndrome. This can cause symptoms such as tremors, diarrhea, dangerous confusion, muscle stiffness, drops in body temperature, or death. St. John s wort can also weaken the effects of other prescription medications such as: antidepressants, birth control pills, cyclosporine, 3

4 digoxin, some IV drugs, some cancer medications, and blooding thinning medications. and- depression.htm#risks 8. How is St. John s wort regulated in the United States? A. Herbs, such as St. John s wort, are not regulated in the United States. In Europe, the contents and potency of such herbal products is guaranteed, although their regulatory process is not as strict as the United States Food and Drug Administration. depression/article/502- st- johns- wort- faq 9. How is St. John s wort used in Europe? A. St. John s wort is widely prescribed for depression in Europe and has been used for centuries for mental health conditions. and- depression.htm 10. Why do you think people are interested in alternative medicine and herbal treatment? A. People have this notion that anything labeled as natural is always safe and good for them. However, this is not always the case and herbal medicines don t go through the testing that drugs do Because Ms. Geitl is ambulatory, you are able to measure her height and weight. She is 5 11 tall and weighs 160 pounds. You also determine that she is of 4

5 medium frame. Because Ms. Geitl is from Germany, she is used to reporting her weight in kilograms and her height in centimeters. Convert her height and weight to metric numbers. A. Height= cm; Weight= kg 5 11 = 71 inches x 2.54cm= cm 160 pounds/ 2.2 kg= kg 12. Is Ms. Geitl s recent weight loss anything to be worried about? A. Ms. Geitl s weight loss has been 3% of her usual body weight over the course of the past 3 months, which is not of worry. %UBW= 160#/165# x 100= 97% (Nelms, Sucher, Lacey, & Roth, 2011, pg. 48) 13. Because Ms. Geitl is alert and cooperative, you ask her to complete a Patient- Generated Subjective Global Assessment (PG- SGA) of Nutritional Status. How would you score her? (See Appendix I) Sections Box 1 1 Score Current weight: kg Current height: cm One month ago I weighed about: ~73.64 kg Six months ago I weighted about: 75 kg During the past two weeks my weight has: decreased Box 2 1 Food intake is less than usual- normal food but less than normal amount. Box 3 1 Symptoms: no appetite, just did not feel like eating. Box 4 3 5

6 Activities and Function: not feeling up to most things, but in bed or chair less than half the day. Weight loss 0 section (Table 1) Disease section 0 (Table 2) Metabolic section 0 (Table 3) Physical section 0 (Table 4) Total 6 SGA Rations Select one: A= Well Nourished B= Moderately (or suspected of being C= severely malnourished malnourished) 14. Using Appendix I, how would you triage nutritional intervention? A. Based on the above information, I would triage nutritional intervention at a 2-3. This means the patient and family is in need of education by dietitian, nurse, or other clinician with pharmacologic intervention as indicated by survey and laboratory values as appropriate. 15. What methods are available to estimate Ms. Geitl s energy needs? A. Methods available to estimate Ms. Geitl s energy needs include the Harris- Benedict Equation and Mifflin- St. Jeor Equation. (Nelms, Sucher, Lacey, & Roth, 2011, pg. 60) 16. Calculated Ms. Geitl s basal energy needs using one of the methods you listed in Question 15. 6

7 A. Basal Energy Needs= 1,600 kcal Mifflin- St. Jeor Equation (females)= 10 W H 5 Age (72.73) (180.34) 5(20) 161= 1,593 kcal W= kg H= cm Age= 20 (Nelms, Sucher, Lacey, & Roth, 2011, pg. 60) 17. What is Ms. Geitl s estimated energy expenditure? A. Energy Expenditure= 1,900 kcal 1,600 kcal x 1.2 (activity factor)= 1,912 kcal 55% CHO= 1,900 kcal x.55= 1,045 kcal/ 4 kcal/g= 261 g 30% Fat= 1,900 kcal x.30= 570 kcal/ 9 kcal/g= 63 g 15% Pro= 1,900 kcal x.15= 285 kcal/ 4 kcal/g= 71 g 18. Evaluate her diet history and her 24- hour recall. Is she meeting her energy needs? A. After evaluating Ms. Geilt s energy intake based on her diet history and 24- hour recall, it can be concluded that she is not meeting her energy needs. With her usual intake, Ms. Geilt is only consuming ~480 kcal/day, 13 g coming from fat, 75 g from carbohydrates, and 22 g coming from protein. Based on her 24- hour recall, she only consumed ~565 kcal, 9 g of fat, 78 g of carbohydrates, and 41 g of protein. These numbers are significantly below her estimated energy needs of 1,900 kcal/day with 7

8 recommendations of 261 g coming from carbohydrates, 63 g coming from fat, and 71 g coming from protein sources. Usual Dietary Calories Fat (g) Carbohydrates Protein (g) Intake (g) Breakfast: 2 c.- black coffee Lunch: Diet Cola PM Snack: ½ c. LF Frozen Yogurt (chocolate or strawberry) Dinner: ½ 3 Square Stouffer s lasagna 1 c. Steamed Broccoli 1 Breadstick Diet Cola HS Snack: 1 c. Air- popped popcorn sprayed with butter- flavored Pam and Salted Diet Cola Totals: 478 kcal 13 g 75 g 22 g 24- Hr Recall Calories Fat (g) Carbohydrates Protein (g) (g) Breakfast: 1 c.- black coffee slice Whole Wheat Toast Lunch: 2 c. Chicken Noodle Soup 2 Saltine Crackers ½ c. Strawberry Gelatin Diet Cola Dinner: 2 Peach halves

9 1 c. Cottage Cheese 1 c.- black coffee Totals: 565 kcal 9 g 78 g 41 g What would you advise? A. Since Ms. Geilt is significantly falling short of meeting her estimated energy needs and does not have much of an appetite, I would advise her to consume frequent, small meals. I would make suggestions to her on some convenient meal options since she states not having time for lunch. I would also suggest that she try preparing some of her favorite traditional foods from Germany. This would allow her to particularly enjoy some foods from home while sharing part of her cultural background with her roommates. 20. List each factor from your nutritional assessment and then determine an expected outcome from each. Assessment Factor Expected Outcome Inadequate energy intake Increase patient s caloric to around 1,900 kcal/day by encouraging small, frequent meals throughout the day. Also make suggestions for easy to prepare foods for her busier days. Inadequate protein intake Encourage the patient to meet her recommended protein intake of 71 g/day through the consumption of lean meats, beans, nuts, and reduced fat dairy products. Inadequate carbohydrate intake Provide patient with nutrient dense carbohydrate sources such as fruits, 9

10 Inadequate fat intake vegetables, and whole grains for her to meet her recommended amount of 261 g/day. The patient will be encouraged to meet her 63 g/day fat recommendations by consuming healthy fats. Sources may include LF dairy products, lean meats, and plant- based fats. 21. What is your immediate concern regarding this patient s use of St. John s wort? A. My immediate concern regarding this patient s use of St. John s wort is the development of serotonin syndrome. Taking this supplement in combination with the prescription antidepressant, Zoloft, in which she is prescribed, can lead to dangerously high levels of serotonin. I would recommend that the patient cease the use of the herbal supplement St. John s wort and follow the prescription regiment in which her physician prescribed. conditions/depression/in- depth/ssris/art ?pg=2 22. Review the initial nutrition note written for this patient. Is this progress note appropriate? Is it complete? Any errors? Any omissions? A. This progress note is appropriate and can help other members of the patient s health care team determine and carry out necessary treatment. In this particular progress note, the RD divided the patient s information into subjective, objective, assessment, and plan sections, but lacked thorough detail in each. Under the subjective section of the SOAP note, 10

11 the RD failed to mention the patient s occupation, her country of origin, and her current moodiness and lack of motivation. The RD also included the patient s current nutritional intake in the subjective section, when a more appropriate section for this information would have been under objective data. The patient s ethnicity and BMI should also be included in this section but is not in this progressive note. In this progressive note, the patient s nutrient needs were calculated to be higher than what I would recommend based on my calculations and should be reevaluated by this RD. In this progress note s assessment, the patient s problems are mentioned but no details on the etiology or signs/symptoms are discussed. The RD does mention some action plans, however she does not make any referral suggestions, discuss specific nutrition plans, set goals, or offer a way to evaluate the patient s progress. (Nelms, Sucher, Lacey, & Roth, 2011, pg ) 11

12 References Cracchiolo C. (n.d.). St. John's wort FAQ- Depression: Major depression & unipolar varieties. Retrieved from depression/article/502- st- johns- wort- faq Digitale E., Hathaway C., Zidenberg- Cherr S., & Heneman K. (2007). Some facts about St. John's wort. Retrieved from pro- stjohnswort.pdf FitDay (2014). My fitness log. Retrieved from Mayo Clinic (2013). Selective serotonin reuptake inhibitors (SSRIs). Retrieved from conditions/depression/in- depth/ssris/art Nelms, M. N., Sucher, K., Lacey, K., & Roth, S. L. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA: Brooks/Cole Cengage Learning. NIH (2014). Herbal medicine: MedlinePlus. Retrieved from NIH (2013). St. John's wort and depression. Retrieved from and- depression.htm NIH (2012). St. John's wort: MedlinePlus supplements. Retrieved from NIMH (n.d.). Depression. Retrieved from 12

Diet Instruction: Full Liquid Diet

Diet Instruction: Full Liquid Diet Liz DeJulius KNH 413 Description of patient and diagnosis Susan, a 21 year old woman, who was diagnosed with Irritable Bowel Syndrome (IBS) and Crohn s disease. After