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Case Study 1
Missy Bloyd’s Story
10/28/09
Missy
•Client
Name: Missy Bloyd
•Date of
Birth: 10/9
•Age: 10
•Sex:
Female
•Education:
(5th grade) Less than high school
•Occupatio
n: Student
Missy
• Hours of Work: Regular school hours
• Household members: Father (36),
mother (35), sister (5)
• Ethnic Background: Biracial (African
American and Caucasian)
• Religious Affiliation: Catholic
• Referring Physician: D. Null, MD
4
Missy’s Hx
• Sleep disturbance in last several years-
sleeping with mouth open, cessation of
breathing for 10 sec, snoring, restlessness,
enuresis, morning headaches
• Changes in school grades/success
• Change in attention span
• Onset: unspecific, about a year ago
• Tx: none
• Meds: none
• Smoker: no
• Family Hx:gestational diabetes, type 2 DM, in
mother and grandmother
Anthropometrics
Height: 57 in
Weight: 115 lbs
Percentile: 98th
BMI: 24.95
• According to the CDC, overweight in children 2-19 yo. is classified as
being at or above a BMI in the 85th percentile. Obesity in 2-19 yo. is
defined as being at or above a BMI in the 95th percentile.
• For every five point increase in BMI a person enters a higher bracket of
disease risk. The diseases and conditions do not necessarily increase in
number, but in likelihood
• Overweight and obesity can come with several co morbidities and
complications including: diabetes, gall bladder disease, hypertension,
dyslipidaemia (too much fat in the blood), sleep apnea, coronary heart
disease, osteoarthritis (deterioration of cartilage in knees),
hyperuricaemia (too much uric acid in the blood) which may result in
gout (swelling in feet from deposited uric acid), cancer, reproductive,
hormone abnormalities, polycystic ovarian syndrome, impaired
fertility, low back pain, increased anaesthetic risk (loss of sensation or
consciousness), and fetal defects from maternal obesity.
Text
Missy’s Complaint
• “We’ve noticed that Missy appears
to stop breathing for several
seconds several times a night. She
is really cranky when she gets up
for school. Her teacher says Missy
gets very sleepy during
school...She fell asleep in class
yesterday.”
Missy’s Nutritional Hx
• General: very good appetite, wide
vatiety of food
• Food allergies/intolerances: NKA
• Previous Nutrition Therapy? No
• Food Purchase/Preparation: Parent(s)
• Vit/Min Intake: Flintstones vitamin
daily
24 Hour Recall
• AM: 2 breakfast burritos, 8oz whole milk,
4oz apple juice, 6oz coffee with 1/4 c
cream and tsp sugar
•Testing
•Lab Results
16
Testing
•Blood Glucose Test
-Helps to determine whether individuals are
hyperglycemic, hypoglycemic, or if individuals
have diabetes
•Lipid Profile
-Helps to determine whether there is a risk
for heart disease by measuring cholesterol,
triglycerides, HDL, and LDL levels.
Blood Glucose Levels
• Contributing Factors
• -weight, poor insulin circulation, over consumption of
carbohydrates
19
Missy’s Lipid Profile
Results
Cholesterol 190
LDL 110
HDL 50
TG 114
Evaluation of Missy’s
Lipid Profile
• Normal Levels vs. Missy’s
Levels
• Cholesterol-120-199mg/dL 190mg/dL
• Energy Intake
• -includes high fat and high starch foods with
inadequate fruit and vegetable intake
• Energy Breakdown:
• Total calories= 4435 kcals
• Energy dense beverages= 402 kcals
• 9.06% of total calories
• High fat foods= 2697 kcals
• 60.81 % of total calories
Missy’s Assessment
• Energy Intake- High fat and high carbohydrate
content of food with a low energy output.
• Blood Glucose Test- Due to her weight and
high carbohydrate consumption her insulin levels are
not keeping up with her blood glucose levels, which
places her at risk for type II diabetes.
• Lipid Profile- Elevated levels indicate she is at
risk for developing cardiovascular disease as well.
Missy’s Diagnosis and
Treatment Plan
• Missy’s Nutrition Diagnosis ~ PES
29
Missy’s Menu
• Day 1
• Breakfast
• 1% milk (low fat)
• Oatmeal (plain)
• 1% milk (low fat)
• Blueberries (raw)
• Lunch
• Fat free milk (skim)
• Wrap sandwich (meat, vegetables, rice)
Missy’s Menu
• Dinner
• Fat free milk (skim)
• Chicken, veggies & noodles (cream sauce)
• Raw carrots
• Creamy dressing (ranch)
• Wheat roll (part whole wheat)
• Snack
• Banana
• Lowfat cottage cheese
• Cucumber
• Italian dressing (oil and vinegar)
32
Monitoring and
Evaluation
• Next counseling session for Missy should be
scheduled as soon as possible, needs to get
appropriate treatment for sleep apnea and then
start Nutrition counseling immediately.
• Her parents should definitely be included in her
counseling sessions, they are preparing her
meals.
• In follow up visit, assess short term goals that
were originally set, these are first steps to her
long term goals. We would assess any changes
in physical activity and dietary behavior.
Missy’s Lifestyle
and Our Culture
• What put Missy at risk for
becoming overweight?
• Childhood Obesity~ Causes
• Genetics
• Behavioral/environmental
• Global trends/ Personal Habits
Missy’s Weight Loss
Options
• Alli/Orlistat
• Not For Children