Question

Jackie, a 44-year-old female, has had HIV for 12 years. Her physician has recently diagnosed her with AIDS due to a decline in her CD4+ T cells over the past five years, an elevated viral load, and recurrent bacterial pneumonia. She has ongoing lipodystrophy; she lost approximately 30 pounds in the past year and has had diarrhea for the past six weeks. Her roommate reports that Jackie’s appetite has been minimal lately and he attributes this to a thrush infection that has been resistant to medical treatment. Her current weight is 112 pounds.

1. Calculate Jackie’s estimated kcalorie and protein needs using the following factors: 30 to 35 kcalories/kilogram, 1.0 to 1.6 grams protein/kilogram (show your work).

2. What suggestions do you have for the chewing and swallowing problems Jackie is having related to thrush?

3. What advice do you have for Jackie and her roommate regarding food safety?

4. What can Jackie do to manage the metabolic complications associated with lipodystrophy?

5. What dietary modifications might help Jackie manage her ongoing diarrhea?

Answer 1

ANSWERS:-

1) Jackie's estimated calorie and protein needs-

* one pound = 0.454kilogram

*112pound= 112×0.454 =50.84kg

* Calorie requirements = 30-35 calories per kg

=50.8×30 =1524calories

= 50.8× 35 =1778 calories

* Calories required for Jackie = 1524 -1778 calories per day.

*protein requirements = 50.8×1= 50.8g

= 50.8×1.6= 81.28g

* protein requirements for Jackie = 50.8 -81.28gram per day.

2) Suggestions for chewing and swallowing problems related to thrush -

* Maintain good oral hygiene

* Improve nutritional status.

* Keep the oral cavity moist always.

* Increase fluid intake.

* Soft and bland diet.

*Treatment with flucanazole, clotrimazole or nystatin.

3) Advice for Jackie and her roommate regarding food safety -

* Maintain good foid hygiene.

* Eat cooked food, avoid raw fruits and vegetables.

* Hand hygiene before eating.

*Avoid spicy, greasy foods.

4) Managing metabolic complications associated with lipodystrophy -

* Lipodystrophy occur in hiv patient due to antiretroviral treatment.

* metabolic complications ralated to lipodystrophy include, insulin resistance leading to hyperglycemia (increased blood sugar or diabetes mellitus ) and its complications, hypertriglyceridemia and hepatic cirrhosis.

* Well balanced diet with macronutrients carbohydrates 50-60%, protein 10-20% and fat 20-30%.

* Avoid over feeding and energy restricted diet to control hyperglycemia and hypercholestremia.

* Encourage to do exercise or improve physical activities.

* Low fat diet with mono- unsaturated fatty acids and omega -3 fatty acids.

*Treatment with Insulin or oral hypoglycemic agents for hyperglycemia.

5) Dietary modifications to manage diarrhea -

* Avoid foods that cause irritation and cause diarrhea like spicy foods, milk,

* Drink plenty of liquids

* Reduce fat content in diet

* Eat only well cooked vegetables and fruits. Avoid raw food.

* Maintain good personal hygiene

* Do not eat outside food.

* Eat diet high in soluble fibre like oatmeal, which slows diarrhea by absorbing water.

* Avoid foods high in insoluble fiber such as corn, popcorn, dried and raw fruits, vegetables, nuts, seeds etc.