Question

Shaleen: Pregnancy & Lactation Case Study (10 pts.) Instructions: This case study assignment should be treated as a short paper, including a cover page, a heading, and page numbers. Set up the paper with one-inch margins, double-spacing, with the font set at 12-point Times New Roman. The introduction to the paper should summarize the case you have chosen to discuss. Responses to the case study questions should be written in paragraph form. Each paragraph in the case study should begin with an introductory statement that lets the reader know what topic you will be addressing in the paragraph. For example, if the case study question asks, “What nutrients are deficient in Shaleen’s diet, based on her current diet history?” You might start the discussion in this paragraph by indicating: “Shaleen has X nutritional deficiencies, based on her diet history. Her current diet consists of XXXXX. She is deficient in XXXXX.” The paragraph would continue with the explanation (or rationale) for your response: “According to Rolfe et al. (2012), a 16-year-old requires XXXXX. Because she is pregnant, she also XXXXX and so on. Scenario: Shaleen is a 16-year-old inner-city youth and high school student. She requests a pregnancy test at the Public Health Clinic. The pregnancy test is positive and she informs the clinic that her last menstrual period was 8 weeks ago. Previous History: Shaleen has had two previous pregnancies, one a stillbirth in which she gained 15 pounds and the baby weighed 4 pounds at term. The other ended due to a miscarriage at 9 weeks gestation and occurred 6 months ago. Her first pregnancy was at the age of 13. Social History: Lives at home with her mother and 5 siblings. Her mother provides the only income as a third shift waitress at a local 24-hour restaurant. The family receives $200 per month in food stamps. You speak with Shaleen at the Public Health Clinic after she receives the positive results of her pregnancy test. A brief diet and health history indicates the following information. She is a three-year smoker and is constantly concerned about her weight. Her diet consists mainly of diet cola, pizza, burgers, hot dogs, and convenience pasta dishes like Spaghetti-Os. She does get school lunch for free because of her family income level but rarely eats the fruits and vegetables or drinks the milk. Since Shaleen is the eldest sibling, she prepares meals for her younger siblings and sometimes does not have time herself to eat what has been prepared. Physical Exam: Ht = 5’6” Usual Wt = 108 lbs. Present Wt = 110 lbs. BMI = BP = 118/76 Blood glucose = 100 Shaleen’s pregnancy progresses without any problems until at 30 weeks her physician becomes concerned because her blood pressure has risen to 140/95, her blood glucose is 180, and she has gained 7 lbs. in two weeks. She is showing signs of generalized edema and she has protein and ketones in her urine. Her weight at this time is 118 lbs. Questions:

3) Evaluate her weight gain at 8 weeks and 30 weeks of gestation. What do her current weight gain pattern, blood glucose levels, and BP indicate? How much total weight should Shaleen have tried to gain with this pregnancy? What pattern of weight gain would you recommend for the remainder of the pregnancy?

4) Calculate her approximate caloric and protein needs at 30 weeks.

Answer 1

3) a) Shaleen's usual weight is 108 lbs. At 8 weeks gestation when she is found to be positive for pregnancy, she has her usual weight of 108 lbs.

b) At 30 weeks gestation when she goes to the doctor for checkup her weight is 118 lbs.

c) Her current weight gain indicates of developing pre-eclampsia

d) A weight of 25-35 lbs i.e is permitted in pregnancy for underweight client. For shaleen, she has already attained an increase of 10 lbs but she could have attained 25 lbs increase in weight.

e) Due to indication of pre-eclampsia, with the remainder pregnancy she can gradually gain 5 lbs.

4) Calorie intake should be 2032 calories per day

Protein intake should be 0.66 gm per kg body weight ( 118 lbs= 53 kg) and an additional 31.2 gm in third trimester. so toal protein intake of Shaleen should be 66.18 gms.