andrea myers knh 411. gracie moore 34 female 5’5” 180lbs graduate student graduate...
TRANSCRIPT
POLYCYSTIC OVARY
SYNDROME Andrea Myers
KNH 411
CLIENT Gracie Moore 34 Female 5’5” 180lbs Graduate Student Graduate teaching assistant Married One adopted child, infant
COMPLAINT “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!”
PATIENT HISTORY 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 140lbs.
Since graduating, she has gained an average of 4lbs per year
PCOS symptoms grew worse as she gained weight
PATIENT HISTORY CONT’D 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
DIAGNOSIS 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.
PCOS 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
PCOS
DIAGNOSTIC CRITERIA 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
ETIOLOGY Cause of PCOS is unknown
Several factors seem to be linked to PCOSGeneticsBody’s ability to make insulin
SYMPTOMS Symptoms presented:
Cessation of menstruation Weight gain Sleep apnea Hirsutism Thinning hair Dandruff Acne Skin tags Acanthosis Nigricans High blood pressure High cholesterol
ABNORMAL LAB VALUES Bilirubin: 0.41mg/dL ALT: 42U/L HDL-C: 51mg/dL TG:184 mg/dL LDL:132 mg/dL
DIAGNOSTIC CRITERIA Complete blood count with:
Metabolic panelLipid panelThyroid panel with TSH Testosterone level
2 hour GTT
TREATMENT-MEDICATIONS YAZ 1 tablet PO Glucophage 850mg PO Aldactone 100mg/d PO Vaniqua
Nutrition consult requested
NUTRITION INTERVENTION Gracie’s weight= 180lbs/2.2= 82kg Gracie’s height= 65” x 2.54= 165cm=
1.65m
BMI: 82kg/1.65m^2 = 30 kg/m^2
NUTRITION INTERVENTION TEE: (10 x 140lbs + 6.25 x 65” – 5 x 34)
1.3 = 2,127 kcal/day
Range: 2,100-2,200 kcal/day
NUTRITION INTERVENTION 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 dietadd more lean meats to their diet
24-HOUR RECALL Breakfast: 8oz. 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
PES STATEMENTS 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.
GOALS Reduce weight and BMI to normal range
by reducing daily kilocalorie intake from 2,500kcal to 2,100-2,200kcal/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.
PROGNOSIS With treatment, women with PCOS are
usually able to lead normal lives and can become pregnant.
National Institute of Health
RESOURCES http://www.nlm.nih.gov/medlineplus/ency/
article/000369.htm Nutrition Therapy and Pathophysiology; pg. 501 http://www.nurse-practitioners-and-physician-
assistants.advanceweb.com http://www.womenshealth.gov/publications/our-
publications/fact-sheet/ polycystic-ovary-syndrome.cfm
. http://www.pharmacytimes.com/publications/issue/2004/2004-06/2004-06-7973
http://www.mckinley.illinois.edu/handouts/pcos.htm