User:Trymuks/sandbox

Disease and Nutrition

Part I: The Diet

Part I, Criteria #1: Determination of the Patient’s Diet

The analysis of the patient’s diet reveals that the current diet involves fast foods, high calorie and low nutrients. According to Butt et al (2007), there has been a dramatic increase in the consumption of fast foods in the United States, averaging to around 0.27 meals in a day. In that case, frequent intake of fast foods contributes to excess carbohydrates (CHO), deficient proteins (PRO) and excess fat in the body. To begin with, fast foods are consumed to hasten the natural process of energy gain. As Robinson et al (2013) explains such kinds of food consist higher amounts of carbohydrates hence their preference for consumption. However, the ingestion of the diet comes along with its consequences. Whereas an individual gains almost instant energy upon the intake, the carbohydrates enter the body in excess. Most at times, the surplus carbohydrates fail to be digested into the system, causing an overflow in the body that leads to cases like obesity. While fast foods remain to be the priority among individuals, the resulting effects revolve around excessive intake of carbohydrates that tend to be useless to the body.

In the second instance, frequent ingestion of fast foods leads to the deficiency in the availability of proteins in a number of ways. The fact that they are consumed for faster energy gain opens a loophole for the inclusion of nutrients. In the process of the intake, more undesirable nutrients enter the body while the desirable and most sufficient ones are left aside (Butt et al, 2007). The desirable nutrients whose intake is reduced include calcium, fiber, vitamins and nutrients. On the other hand, the highly consumed undesirable group includes sodium and sugar, which are some of the greatest contributors to obesity. Whereas the significance of proteins is highly evident in the body, fast foods contribute a lower percentage in availing the former. In fact, fast foods contribute to roughly 33% of protein intake to the digestive system (O’Donnell et al, 2008). The figure is way below the average percentage of 50%, which aides in efficient completion of activities like formation of muscles, cartilage and bones. Thus, the inefficient nutrients in the diet offer a reflection for the deficiency of proteins at large.

The final case asserts that fast foods play a major role in the provision of excess fats for intake into the digestive system. The consumption of moderated amounts of fats is highly encouraged. The reason for the same is that, they aide in the production of energy to the body due to the nutrients that are available in them. Notably, they act as the storage systems for the energy that is applied by humans. Most of the fast foods consist of the saturated fats, which are considered to pose various effects to the body. In that case, recommendations are made that unsaturated fats, which normally come from natural materials like corn and olive, should be prioritized. The irony in fast foods is that the opposite of what is expected is happening, in that, a higher amount of wasteful fat than the useful portion is provided. O’Donnell et al (2008) reveal that most fast foods provide less that 30 percent of energy from the consumed fats. In that case, the statistics show that more fats consumed are a waste to the body with a smaller percentage performing the required task.

Table 1below shows the relationship between the consumption of fast foods and intake of nutrients into the body (Butt et al, 2007).

Table 1: The link between fast food consumption and nutrient intake

Part I, Criteria #2: Explanation of the RDA Consistency in the Diet

The Recommended Dietary Allowance (RDA) is an important factor that helps in the management of diets among individuals. RDA varies depending on the nutrients consumed by the person because of the different functionalities posed by each one of them. Hence, consumption of fast foods that consist of low nutrients and higher calories can either meet the RDA requirements or not. Firstly, protein is an important nutrient to the body as it is involved in performing major important tasks. In that case, the recommended dietary allowance for proteins falls on the 0.8 grams per kilogram body weight per day (Beasley et al, 2017). Regarding the diet of the patient, the protein intake within the fast foods consumed settles at less than 30 percent. Comparing the intake and the requirement confirms that the patient does not meet the RDA requirements for proteins.

Secondly, the RDA for vitamin A is 900 micrograms per day, meaning that one of the constituents of fast foods should be at least 25 percent of the vitamin. However, these foods are known to possess very little amounts of vitamin A, with the highest levels being 15 percent (Bahadoran, Mirmiran and Azizi, 2015). As a result, the diet of the patient does not meet the RDA. Thirdly, fast foods contain higher amounts of sodium, which us also important to the body. The current RDA for the nutrient settles at 1500 mg, meaning that the size should be consumed by adult individual in a day. Bahadoran, Mirmiran and Azizi (2015) reveal that fast foods contribute to more than 45 percent of sodium, which fulfills the RDA. Continually, the RDA for carbohydrates is 130 grams per day. With the highest percentage of fast foods constituting of carbohydrates, the diet of the patient meets the requirements of its RDA. Finally, the RDA for added sugar stands at around 25 percent of calories. However, fast foods contain up to around 104 calories in a day’s consumption (Bahadoran, Mirmiran and Azizi, 2015). Thus, the diet meets the RDA for sugar.

Table 2 below shows a comparison of the Recommended Dietary Allowance between Childrenand Adults (Murphy & Barr, 2006).

Table 2: A Comparison between RDA levels in children and adults

Part II: Disease and Nutrition

Part II, Criteria #1: Effects of Diet on Disease Symptoms and Progression

Regular consumption of fast foods contributes in one way or another to the development of weird symptoms and alterations of the disease progression among the patients. It should be noted that, making adjustments of the diet can contribute either negatively or positively to the evolution of the particular infection. In this case, the patient has a sensitive disease, hypertension and type II diabetes, which are very sensitive to cases of dietary. The first effect that is posed by first foods towards the disease is increasing of the severity of type II diabetes. Besides, consumption of the foods over a given period of time leads to the deterioration of patient’s health. The reason for the realization of such criticalities is the resistance of insulin in the body, caused by the nutrients available in the fast foods (Odegaard et al, 2012).

Another effect that fast foods cause in patients with the disease is the increase in weight due to the consumption of foods with unregulated levels of fats. The foods play a role in the adjustment of the Body Mass Index (BMI), hypercholesterolemia and hypertension (Cahill et al, 2014). The idea that is revealed here is that, frequent consumption of fast foods creates an inconsistency in the BMI of the patient, making the weight and the height to create an imbalance. Besides, hypertension, also known as the high blood pressure rises way beyond the normal or rather expected level. Similarly, increased consumption of fast foods boosts the cases of cardio metabolic risk factors, leading to the attainment of low serum high density lipoprotein cholesterol (Cahill et al, 2014). The realization of such results deals a blow to the patient due to the inefficiency of energy production associated with low cholesterol levels.

Importantly, the idea that most of the fast foods undergo frying alters the energy density and the quality of the food. The foods undergo the processes of oxidation, hydrogenation and polymerization, modifying the initial structure and properties. The process leads to the reduction in the levels of unsaturated fatty acids like linolenic and linoleic and increasing the presence of the trans-fatty ones (Cahill et al, 2014). Continually, there are specific foods that have been identified to be contributing to the alteration of the disease symptoms. The three specific foods that are revealed to be among the biggest contributors include doughnuts, burger and fried chicken. The reason for the same is that they contributed to adjustment in the quality of the diet including consumption of sodium, calorie and beverages sweetened with sugar. The direct effects caused by the foods are increase in the body weight, destabilization of the body mass index and other complex effects. To combat the adversity of the infections, recommendations for the application of olive and sunflower oil in preparation of most meals are made (Cahill et al, 2014). The reason for taking such measures is because the aforementioned oils contain unsaturated fats. Hence, diet adoption of foods like vegetables, fatty fish and avocadoes should be made.

Part II, Criteria #2: Interaction of food with Patient Medications

Different medications reveal unique sets of interactions with the foods that are consumed by the patients. Some of the drugs portray a positive result upon interaction while others turn out to be negative, deeming dangerous to the patient. Recommendations can be made on the continuation of the drugs yielding positive results and proper measures to curb those showing resistance. Love-Osborne, Sheeder and Zeitler (2008) reveals that the application of metformin leads to the realization of specific results within the life operations of the patient. The positive reaction that is encountered between the drug and the patient’s food leads to the reduction in the body mass index. In fact, proper observation of the individual lifestyle contributes in the reduction of up to 5 percent of BMI (Love-Osborne, Sheeder & Zeitler, 2008). The results remain positive and effective in the life of the patient because in plays a greater role in the reduction of weight, helping to combat the rising level of obesity.

Importantly, the reaction of metoprolol with the fast foods consumed by the patient produces its unique effect. The antihypertensive drug reacts with the food, leading to the blockage of the interaction of the receptors involved in the process (Jáuregui-Garrido & Jáuregui-Lobera, 2012). The resulting effect is the increase in water and salt excretion and a reduction in the cellular hypertrophy and plasma volume. While most of the fast foods contain saturated fats, which is not healthy to the body, the interaction of the drugs with the foods deems lethal to some degree. The reason for it is the evident increase in the levels of water and salt excretion in the body, a move that can easily cause water shortage. Finally, multivitamins portray a different behavior upon reaction with the fast foods consumed by the patient. In that case, the reaction causes an alteration of the nutrients in the body, reducing some while increasing others (Altoum et al, 2019).Thus, some of the resulting effects include a change in the total cholesterol, vitamins A, C and E, triglycerides and zinc.

Outstandingly, the medication poses some side effects related to the nutrition of the patient. If not critically observed and responded to, they might turn out to be severe and fatal to the affected individual. To begin with, metformin portrays several side effects to the patient, ranging from those associated with the diet to the ones beyond. The first nutrition-related side effect is constipation, which is normally associated with reduced fiber in the body. Another side effect that is related to the diet is heart burn, which might be severe when not attended to in time (Mayo Clinic, n.d.). The interesting fact here is that, metoprolol also causes constipation among patients. Finally, multivitamins are identified to be important in supplementing the body, boosting the activation and completion of various processes. However, one of the critical side effects that are associated with it is the increase in cases of constipation. To help the patient to combat the situation, a recommendation is made for an increase in the consumption of food products that are rich in fiber.

Part III: Patient Education

Part III, Criteria #1: Calculating BMI, BMR, CHO, PRO and Fat Needs

Calculation of the above properties work well in revealing the diet needs of the patient, while predicting the steps that should be taken in the future. In that case, the first calculation involves the body mass index, which helps in identifying whether the height of the patient is consistent with the weight. Most at times, the health of the individual is said to be affected when the BMI rises above the 25.

BMI

The patient weighs 230 lbs and is 6” tall.

Converting the pounds to kilograms: 1 lb= 0.453592

230*0.453592= 104.33 kgs.

Converting the feet to inches: 1 inch= 0.0833333 ft

6*12= 72 inches

230/ 72*72 (5184)= 0.0443*703= 31.2 BMI

With the Body Mass Index of the patient settling at a higher 31.2 mark, it is evident that he is suffering from type 2 diabetes (Nuttall, 2015).

BMR

The Basal Metabolic Rate, commonly known as the BMR plays a major role in the patient’s body. It is important to note that BMR functions in balancing the energy in the body due to the fact that it carries a larger percentage of the energy. The BMR helps in carrying out important body functions when the patient is at the state of rest (Sabounchi, Rahmandad & Ammerman, 2013).

230*10= 2300*0.20 (activity) = 460 + 2300 = 2760 * 0.1 = 276 + 2760 = 3036 calories/day

CHO

The intake of carbohydrates to the body is important when the whole process in undertaken under proper measures. The ingestion is deemed necessary because it reduces or rather lowers the progression of diabetes in the body through the optimization of postprandial glycemia (Deeb et al, 2016). However, the intake should be regulated through the employment of the counting strategies.

3036 * 0.45 = 1366 calories/ 4 calories/gram = 342 grams/day

3036 * 0.65 = 1973 calories/ 4 calories/gram = 493 grams/day

Daily range 1366- 1973 calories/day from CHO, 342- 493 grams/day

PRO

Proteins are one of the most important nutrients within the body of the patient, especially at a time when he is battling type 2 diabetes. The current Recommended Dietary Allowance (RDA) for proteins stands at 0.8 grams/kg whose estimate consumption is around 1.5 to 2 times (Beasley et al, 2017). Also, the ingestion of proteins by a healthy patient stands at around 38.2 grams because it contributes to around 1527 kcal, which can be equated to 4 kcals/g.

230lb. /2.2kg/lb. = 104.55kg. * 0.8 g/kg = 83.64 grams protein daily, healthy person

Or

83.64 grams * 1.5 times as much, requirement= 125 g/day protein* 4 cal/g= 500 calories/day

83.64 grams * 2 times as much, requirement= 167 g/day protein* 4 cal/g= 668 calories/day

Daily range 500- 668 calories/day, or 125- 167 grams/day

FAT

The ingestion of fat to the patient’s body that is already affected by type 2 diabetes and hypertension should be looked into with a lot of care. The intake should be regulated at all costs, considering both saturated and unsaturated types. Since the latter is important in improving the patient’s health, it should be taken in abundance (Cahill et al, 2014). While a recommendation of 20%- 35% of calories is made for healthy individuals, patients with type 2 diabetes 7- 10% fat of total calories.

2839* 0.07= 199 calories/ 9 calories/gram= 22 grams/day

2839* 0.1= 284 calories/ 9 calories/gram= 32 grams/day

Daily range 199- 284 calories/day, or 22-32 grams/day

Part III, Criteria #2: Calculating BMI, BMR, CHO, PRO and Fat Needs

SMART Goal # 1: Patient will prepare a menu for 2 todays, with each of them containing 3 meals per day. The meals will be balance between carbohydrates, protein and fiber but reduced levels of cholesterol. In that case, the patient will consume fish and starch vegetables for the two meals. Goal met patient consumed salmon fish for lunch and starchy spinach for supper. SMART Goal #2: Patient will substitute all the snacks with fruits. Instead of consuming cookies, sandwiches and cakes, he will consume apples, melon and bananas. Goal met patient consumed apples in the morning, bananas in the afternoon and melon in the evening. SMART Goal #3: Patient will participate in energetic and active work and will reduce travel time to one day a week. Instead of being involved in sedentary activity, the patient will activate his body and the excess time used in travelling will be transferred to exercise. Goal met patient jogged in the mornings and evenings and worked for medium distances throughout the day.

Patient is a 60-year old African American whose gender is male and a member of the Catholic Church. The patient who is 6’ (72 inches) and 230 pounds (104.3 kg), BMI OF 31.2 and married with 3 children was diagnosed with hypertension and type II diabetes. The main aim that the patient has in regard to his life is lose 1 pound in every week for the next three months. Besides, the patient is currently taking 500 mg of metformin twice a day, 200 mg metoprolol each day and a multivitamin. Being a registered nurse, caring for patients with diabetes and hypertension is among the key roles. The reason for such steps is because of the sensitivity that is involved and associated with the illnesses. In most cases, higher blood sugars in the body deem dangerous and might harm the patient if not combated in time. As a result, the nurse should ensure that proper assessment is made on the background of the family, ensuring that the latter remains intact and other family members get to know the facts of the situation.

Importantly, the registered nurse will list a range of measures or steps that will be taken to ensure that the patient receives proper attention and does not feel stigmatized. Firstly, personal and family education will be held to cover on the lifestyle and the diet of the patient. The reason for focusing of the two is that they are the major channels through which individuals get the infections. In that case, activity oriented lifestyles will be initiated, where the patient will be interacting with other community members and participating in energy-requiring activities like sports. Activities that involve sitting for long, including playing video games, should be avoided. In the same context, the process will contain more of walking because it helps in burning excessive calories in the body. Regarding the diet, the patient will be educated on the importance of avoiding foods with more cholesterol and sugar and resolving to the ones that contain important nutrients. Recommendations should be made on the adoption of more fruits, vegetables and proteins to the body. Fruits consist of vitamins, which are essential in the body for various purposes like immunity reasons. Besides, vegetables contain starch and fiber, which are efficient for regulating constipation in the patient (Butt et al, 2007). Finally, proteins are majorly important for various significant purposes, including strengthening of bones and muscles.

References

Altoum, A. E., Abbas, M. Y., Osman, A. L., Ahmed, S., & Babker, A. M. (2019). The influence of oral multivitamins supplementation on selected oxidative stress parameters and lipid profiles among Sudanese patients with type-2 diabetes. Open Access Macedonian Journal of Medical Sciences, 7(5), 775-778. doi:10.3889/oamjms.2019.137

Bahadoran, Z., Mirmiran, P., & Azizi, F. (2015). Fast food pattern and cardiometabolic disorders: A review of current studies. Health Promotion Perspectives, 5(4), 231-240. doi:10.15171/hpp.2015.028

Beasley, J. M., Deierlein, A. L., Morland, K. B., Granieri, E. C., & Spark, A. (2016). Is meeting the recommended dietary allowance (RDA) for protein related to body composition among older adults?: Results from the cardiovascular health of seniors and built environment study. The journal of nutrition, health & aging, 20(8), 790-796. doi:10.1007/s12603-015-0707-5

Butt, S., Leon, J. B., David, C. L., Chang, H., Sidhu, S., & Sehgal, A. R. (2007). The prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis. Journal of Renal Nutrition, 17(4), 264-268. doi:10.1053/j.jrn.2007.04.003

Cahill, L. E., Pan, A., Chiuve, S. E., Sun, Q., Willett, W. C., Hu, F. B., & Rimm, E. B. (2014). Fried-food consumption and risk of type 2 diabetes and coronary artery disease: a prospective study in 2 cohorts of US women and men. The American Journal of Clinical Nutrition, 100(2), 667-675. doi:10.3945/ajcn.114.084129

Deeb, A., Al Hajeri, A., Alhmoudi, I., & Nagelkerke, N. (2016). Accurate carbohydrate counting is an important determinant of postprandial glycemia in children and adolescents with type 1 diabetes on insulin pump therapy. Journal of Diabetes Science and Technology, 11(4), 753-758. doi:10.1177/1932296816679850

Jáuregui-Garrido, B., & Jáuregui-Lobera, I. (2012). Interactions between antihypertensive drugs and food. Antihypertensive drugs-food interactions, 27(5), 1866-1875. doi:10.3305/nh.2012.27.6.6127

Love-Osborne, K., Sheeder, J., & Zeitler, P. (2008). Addition of metformin to a lifestyle modification program in adolescents with insulin resistance. The Journal of Pediatrics, 152(6), 817-822. doi:10.1016/j.jpeds.2008.01.018

Mayo Clinic. (n.d.). Metformin (oral route) side effects. Retrieved from https://www.mayoclinic.org/drugs-supplements/metformin-oral-route/side-effects/drg-20067074?p=1

Murphy, S. P., & Barr, S. I. (2006). Recommended Dietary Allowances should be used to set Daily Values for nutrition labeling. The American Journal of Clinical Nutrition, 83(5), 1223S-1227S. doi:10.1093/ajcn/83.5.1223s

Nuttall, F. Q. (2015). Body mass index. Nutrition Today, 50(3), 117-128. doi:10.1097/nt.0000000000000092

Odegaard, A. O., Koh, W. P., Yuan, J., Gross, M. D., & Pereira, M. A. (2012). Western-style       fast food intake and cardiometabolic risk in an eastern country. Circulation, 126(2), 182-      188. doi:10.1161/circulationaha.111.084004

O'Donnell, S., Hoerr, S. L., Mendoza, J. A., & Goh, E. T. (2008). Nutrient quality of fast food kids meals. The American Journal of Clinical Nutrition, 88(5), 1388-1395. doi:10.3945/ajcn.2008.26197

Sabounchi, N. S., Rahmandad, H., & Ammerman, A. (2013). Best-fitting prediction equations for basal metabolic rate: informing obesity interventions in diverse populations. International Journal of Obesity, 37(10), 1364-1370. doi:10.1038/ijo.2012.218

Robinson, E., Harris, E., Thomas, J., Aveyard, P., & Higgs, S. (2013). Reducing high calorie snack food in young adults: a role for social norms and health based messages. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 73. doi:10.1186/1479-5868-10-73