Question

In: Anatomy and Physiology

Susan is a 67-year-old white female who works part-time at the library and volunteers at least...

Susan is a 67-year-old white female who works part-time at the library and volunteers at least 10 hours per week. She and her husband live in a two-story home; her children and grandchildren visit every 6 months. She and her husband travel at least twice per year. She participates in water aerobics and yoga 4 days per week for 1 hour each. She will eat lunch at casual dining restaurants at least four times per week. She consumes three meals per day but is not eating as much due to recovering from a wrist fracture from a fall that happened 2 months ago. For breakfast, she will have ¾ cup of high-fiber cereal with ½ cup skim milk. For lunch, a heavy salad (chicken, cheese, romaine lettuce, vegetables) with light dressing, 1 slice of bread or a roll, and 4 ounces of wine. At dinner, she will have a big bowl of thickened soup/stew with bread or 2–3 ounces of fatty fish or meat, 1 cup of salad with light dressing, vegetables, and 4 ounces of wine. She tries to avoid milk-based foods due to the gas and bloating it causes and also tries to eat low-fat/low-salt to avoid gaining weight and increasing her blood pressure. She has no issues with chewing/swallowing or bowels aside from when eating milk-based foods. From her fall, the doctors performed a bone mineral density exam, in which her T-scores are as follows: for the hip: 1.7 (normal is > –1.0); for a vertebra: –2.6 (normal is > –2.5). Susan’s serum vitamin D level is 23 nmol/L. Her doctor has placed her on an over-the-counter 500-mg calcium with vitamin D supplement. She has prehypertension (average blood pressure of 128/92) and refuses to take any hypertension medications. She has lost 5 pounds over the past 2 months.

Height: 5’6”, weight: 122 pounds, weight history: 127 pounds (2 months ago)

Questions

  1. What do her lab values lead you to believe about her bone status?
  2. What is her BMI? What is her BMI classification?
  3. Is her weight loss a concern to you? Why or why not?
  4. What additional questions would you ask Susan regarding her nutritional intake?
  5. What are Susan’s calorie, macronutrient, and micronutrient needs?
  6. What are your diet recommendations for Susan?
  7. What are your nutritional goals for Susan?

Solutions

Expert Solution

answer

1. T score is comparision of a peson's  bone density with that of a healthy 30 years old of same sex.

this score help to find out osteoporosis . a value above 1 is normal . here the women's T score are above 1 . which indicates that her bone had adequate density. her vit D also within normal limits (normal is 20 to 50 ng/ mm)

2 . BMI is body mass index . it is a measure of persons leanness based on their heifht and weight, and is intended to quantify tissue mass.

formula for BMI = weight in kg / height in meter square

here weight = 122 pounds

= 122 * 0.45 kg

= 55 kg

height is 5 feet 6 inch

1 feet = 30.4 cm . 1 inch =2.5 cm

5 feet = 5 * 30.4 6 inch = 6 * 2.5

= 152 cm =15 cm

5 feet 6 inch = 152 + 15 cm

= 167 cm

= 1.67 meter

apply formula, BMI = 55/ 1.67 *1,67

= 19.78

according to WHO , normal BMI = 18.5 to 25

so her BMI is within normal limits

3. a significant weight loss is , loosing 10 or more pounds body weight over a period of 6 to 12 months . this is unexplained body weight loss , and it occur in chronic illness , cancer...

here the person lost 5 pounds of weight over 2 months . this may be the non functioning wrist which cause little food intake .this is little concern about her health.

4 . additional question regarding nutritional intake , can ask regarding use of fish , meat , protien rich food items like beans , dry fruits , soya foods ..

amound of green leafy vegetable intake per day

how much non veg items like red meat are consuming daily or weekly

any problem with egg intake

regarding intake of vitamin supplements .

any use of fruits like banana , apple , orange ....

5 . according to age wise need of calorie requirment, she need 1600 calorie per day for normal functioning.

the macronutrients she needed to take are more protien rich foods , less fats and carbohydrates , include more diatary fibres , water intake appropriately .

micronutruents like vitamins supplements she can take, she need more calcium , vitamin c , zinc .. for healing of wounds and to improove immunity. need more antioxidants for protect cell injury.

6. dietary recommendation for this patient

eat food frequently , not in 3 meals per day, instead she can take the food items in a regular interval like breakast with more protien and energy yielding foods items , around 11 am , try to eat fruits or eggs , then around 1 to 2 pm eat rice with curry include more green leafy vegetables , fish , beans ..

in the eavening also can take one fruit like banana , around 8 pm , she can take foods made from wheat prioducts , and avoid more fat items , salted items ,pickles , canned foods . avoid frequent eating from restuarants .

7. the nutritional goal should be prevent the person develop more obesity , instead mainatin her body fitness by include more proitein ,vitramine , dietary fibres rich food items. avoid salt intake , do regular excercise , include more sea fish items to prevent osteoporosis , sun exposure every day atleast 15 minutes to help production of vitamin d in body, they are required for normal maintainance of bone structure and functions .


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