The purpose of this assignment is to synthesize and apply the knowledge you gained in class into a well-written research paper. For this assignment, you will conduct research and write a paper containing three parts:
- Part I: Analyze diet
- Part II: Evaluate how the patient’s diet affects:
The person’s health (anatomy)
The progression of the illness (pathophysiology)
Common medications associated with the disease
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- Part III: Create patient SMART goals and an evidence-based plan of care (patient education)
Begin by viewing the patient profiles and assignment details in the the Worksheets, Forms, and Templates area at left. Choose one patient profile and use it to complete Parts I–III of the assignment.
In addition to the assignment specifics, your paper should:
- Be 4–5 pages, not including the title and reference pages.
- Source(s) should be integrated into the paragraphs. Use in-text citations pointing to evidence in the literature and supporting your ideas.
- Incorporate a minimum of two peer-reviewed sources into your paper.
- Use current APA format to style your paper and to cite your sources. Follow the list structure of the sample paper for the section on calculations. You can download a sample paper in the Worksheets, Forms, and Templates area at left.
- Include a title page and a reference page listing the sources you used. Be sure to plan enough time for proofreading and editing.
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Final Research Paper: Disease & Nutrition
Signature Assignment Details
Part I The Diet
Include the following in Part I:
• Criterion 1: Determine if the person’s diet is deficient or in excess of CHO, PRO, and fat
and explain why.
• Criterion 2: Explain in detail how the person’s diet meets or does not meet the RDA for
five or more micronutrients.
Part II Disease and Nutrition
Include the following in Part II:
• Criterion 1: Explain how the person’s diet would affect the patient’s disease symptoms
and progression. Provide a minimum of three examples of how specific foods affect the
disease pathophysiology. Provide examples of foods the person should avoid, and those
he/she should consume.
• Criterion 2: Explain how food interacts with the medications this patient takes. What are
the nutrient-related side effects of the medication? What are the nutrient restrictions and
recommendations for the medications?
o Example: Iron supplements cause constipation, so people are
advised to increase fiber foods; however, if a person is taking fiber
with iron, the fiber will reduce the absorption of the iron thus
decreasing the effectiveness of the iron.
Part III Patient Education
Include the following in part III:
• Criterion 1: Calculate the following for the patient: BMI, BMR, CHO, PRO, and fat
needs and any other relevant calculations that will help you develop a nutritional plan for
your patient.
• Criterion 2: Develop an evidence-based nutritional education plan with three SMART
goals for your patient. Provide specific nursing strategies and examples for the patient,
and consider all aspects of the patient’s lifestyle.
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Rev 02/14/17
Getting Started Tips
Some common diets in the United States:
• Paleo diet
• DASH
• Diabetic
• Hemodialysis
• Vegetarian
• Atkins
A few recommended peer-reviewed journals:
• Journal of American Medical Association
• Lancet
• Journal of American Dietetic Association
* You may not use WebMD or any Wiki sources. Check with your instructor or librarian to
confirm that your sources are credible and scholarly. Your librarians are here to help you with
your research questions!
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Running head: NUTRITION FINAL RESEARCH PAPER
HCG Diet and Cystic Fibrosis
West Coast University
Or
ange County
Your Name Here
NURS 225: Nutrition in Health and Disease
201
7
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NUTRITION FINAL RESEARCH PAPER
Topic # 1: HCG Diet
Part I, Criteria # 1: Identification of Nutrients
According to the Dudek (2016), the RDAs represent the average daily-recommended
intake to meet the nutrient requirements of 97% to 98% of healthy individuals by life stage and
gender. When estimating the nutritional needs of people with health disorders, health
professionals use the RDA’s as a starting point and adjust them according to the individual’s
need (Dudek, 2013). Even though HCG is a hormone injection program, there are extremely
strict and limited food choice to their diet plan such as: 500 calories limit per day, no cosmetic
products that contain fat in them, 2 small apples are not an expectable exchange for 1 apple.
Table 1 below lists some foods that patients are allowed to choose from for daily intake
(Simeons, 2016).
Table 1 The Original HCG Diet Protocol by Dr. Simeons
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NUTRITION FINAL RESEARCH PAPER
Due to such strict rules and limitation on food selection, patients would end up with deficiency in
two important macronutrients such as carbohydrate and fat. As we can see, if we plug in some
foods from Table 1 above into MyFitnessPal website we would end up with 509 calories, which
is very close to what the HCG program requires (Lose weight with MyFitnessPal. Retrieved
from http://www.myfitnesspal.com/). However, if we look at the amount of carbohydrate
remaining, it is obvious that patients only consume 50% of their daily-recommended calories.
Carbohydrate is a macronutrient that is important in providing energy for the daily living.
Clearly, patients using HCG program are very limited on fat consumption. According to
example below, if we follow The Original HCG Diet Protocol by Dr. Simeons, we would end up
with only 5 grams from fat when the daily-recommended intake is 40 grams. Fats come in
multiple different forms. While some are bad and should be limited, some are essential for the
body; therefore, limiting the amount of fat consumption to almost completely nothing is not a
good diet plan. On the other side, this program provides a very sufficient amount of protein to
the patients. As we can see from Table 2 below, patient fulfilled the amount of daily-
recommended requirement, 60 grams, with the additional 4 grams. This might be also the key
element to the program that claims that by injecting HCG, patients will not feel hungry. It might
be because the high amount of protein patients consume that make them feel less hungry.
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NUTRITION FINAL RESEARCH PAPER
Table 2 Patient Food Diary from MyFitnessPal Showing Daily Intake Goals versus RDAs.
Part I, Criteria # 2: RDA Approval Analysis
As mentioned previously, Recommended Dietary Allowances (RDAs) is the average
daily dietary intake level sufficient to meet the nutrient requirement of 97% to 98% of healthy
individuals in a particular life stage and gender group (Dudek, 2013). Even though the amount of
intake varies on the individual, HCG program still provides patient with very little in
micronutrients such as calcium, potassium, iron, fiber, sodium, vitamin A, and vitamin C.
However, out of these nutrients, there are five nutrients that the diet is very deficient in: sodium,
potassium, calcium, vitamin A, and iron. These 5 nutrients are not even at 50% of the daily-
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NUTRITION FINAL RESEARCH PAPER
recommended intake. Sodium plays an important role in fluid and electrolyte balance. Even
though deficiency is rare, patient can experience nausea, dizziness, and/or muscle cramps
(Dudek, 2013). Potassium is also important in fluid and electrolyte. It also has nerve impulse
transmission function and skeletal and cardiac muscle activity. Deficiency will lead to muscle
weakness, anorexia, confusion, and irregular heartbeats (Dudek, 2013). Calcium involves in bone
and teeth formation, blood clotting, nerve transmission, contraction and relaxation of muscles,
and blood pressure regulation. Deficiency in this mineral can lead to impaired growth in children
and osteoporosis in adults (Dudek, 2013). Vitamin A is very important in formation of visual
purple, normal growth and development of bones and teeth, healthy skin and hair, and also
important in immune function. Deficiency can result in ceases of bone growth, dry skin, decrease
saliva production, and impair immune system (Dudek, 2013). Last but not least, iron is very
important in transporting oxygen. Iron in foods exists in two forms: heme iron, found in meat,
fish, and poultry, and nonheme iron, found in plants such as grains, vegetables, legumes, and
nuts. The majority of iron in the diet is nonheme iron (Dudek, 2013).
Part 2, Criteria 1# Nutrition and Pathophysiology
Cystic fibrosis is a genetic disorder where the individual inherits one defective gene
(mutation of the transmembrane conductance regulator gene [CFTR] located on chromosome 7)
from each parent and is “characterized by abnormally thick mucus secretions from the epithelial
surfaces that results in progressive lung disease, pancreatic insufficiency and dysfunction of the
gastrointestinal and genitourinary systems”. Due to the CFTR’s inability to function properly
leads to obstruction of the ducts and glands of affected organs such as the lungs and pancreas,
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NUTRITION FINAL RESEARCH PAPER
digestive tract, liver, skin and reproductive organs (Nahikian-Nelms, Sucher, & Lacey, 2016, pp.
650).
Patients with cystic fibrosis, enzymes are suppressed and unable to reach the small
intestines related to pancreatic insufficiency secondary to obstructed ducts. These patients will
show symptoms such as abdominal distention; frequent bowel movements that are oily, bulky,
and foul smelling; and even with normal appetite will present with poor growth pattern,
decreased muscle mass and decreased subcutaneous tissue. These patients, both children and
adults, are also at risk for electrolyte imbalance and dehydration due to excessive sweating in hot
weather and fever related to the increased levels of chloride and sodium in their sweat. Other
complications that occur because of the disease process include varices and cirrhosis of the liver
with portal hypertension; cystic fibrosis related diabetes (10% to 15% of adults of adults) with
subsequent clinical complications is acquired. Also, patients with cystic fibrosis have a higher
risk of infection (mainly Staphylococcus aureus and Pseudomonas aeruginosa) due to defective
or impaired cilia action, which can lead to the inability to clear mucus from the lungs due to the
defective regulation of the respiratory tract. The major cause of death (more than 95% of
patients) with cystic fibrosis patients is pulmonary insufficiency, which in turn leads to
pulmonary failure (Nahikian-Nelms, Sucher, & Lacey, 2016, pp. 650).
To prevent nutritional deficiencies, maintain nutritional status, and maximize growth of
patients with cystic Fibrosis, early detection is of the utmost importance. Some of these
diagnostic tests to help with early detection include DNA analysis of the CFTR gene to confirm
mutation, pancreatic function tests, pulmonary function tests, and a sweat chloride test (usually
done during the newborn screening). “Common nutrition diagnostic labels for cystic fibrosis
include inadequate energy intake, inadequate oral intake, increased energy needs, malnutrition,
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NUTRITION FINAL RESEARCH PAPER
less than optimal intake of fats, inappropriate intake of types of carbohydrates, inconsistent
carbohydrate intake, inadequate vitamin and mineral intake, altered GI function, altered
nutrition-related laboratory values, underweight, unintended weight loss, self-monitoring deficit,
limited adherence to nutrition-related recommendations, and poor nutrition quality of life”
(Nahikian-Nelms, Sucher, & Lacey, 2016, pp. 653). Most studies show that cystic fibrosis
patients have vitamin and mineral deficiencies including Vitamin A, Vitamin D, Vitamin E, and
Iron and Zinc (mostly children and adolescence). Although Vitamin A deficiency is common, it
also can be misleading because during an infection or an acute illness a patient’s the serum
plasma Vitamin A levels may be decreased. Due to the increased prevalence of bone fractures
and osteoporosis, Vitamin D needs to be monitored carefully to ensure they are receiving the
right amount because studies have also shown that CF patients still have low levels of Vitamin D
concentrations despite intake of supplements (Nahikian-Nelms, Sucher, & Lacey, 2016, pp. 651-
652).
Part 2, Criteria # 2: Medical and Nutrient Related Interventions and Dietary Needs
Timely interventions and accurately assessing their nutritional status is very important
because many cystic fibrosis patients may present with multiple nutritional diagnoses at any
given time related to the complexity of their disease. Every treatment plan for CF patients will
vary from patient to patient but, also usually include the “following components; airway
clearance techniques; oral, inhaled and nebulized medications; nutrition therapies; and a fitness
plan” (Cystic fibrosis Foundation, n.d.); and nutritional-related medication management with
Pancreatic Enzyme Therapy.
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NUTRITION FINAL RESEARCH PAPER
“Because a significant number of individuals with CF have pancreatic insufficiency,
malabsorption of dietary fat, protein, fat-soluble vitamins, and other nutrients often occurs…
Individuals with CF are prescribed pancreatic enzyme supplements. These enzymes are
specifically formulated with an enteric coating that allows for better absorption into the
duodenum. The target dose is 1500 to 2500 unit’s lipase/kg… [and the] FDA has issued a rule
requiring manufacturers of pancreatic enzyme supplements to obtain approval for their products
[because of the inconsistencies in the formulation].” With this new FDA ruling in place,
Pancreatic enzyme supplements, like any new drug, must go through the same standards of
testing before being distributed to the public (Nahikian-Nelms, Sucher, & Lacey, 2016, p. 652).
Cystic fibrosis patients, especially with pancreatic insufficiencies, need adequate intake
of calories to help with development and growth and these needs will vary based on each
individual and their nutritional status. These patients usually need 1 ½ to 2 times that amount
calories than someone without cystic fibrosis and “if an individual has significant growth
deficits, lung disease, or malabsorption, energy requirements may be significantly increased
(110%–200% of the RDA for age)”. Usually caloric intake is never restricted or minimized due
to the majority of CF patients have difficulty gaining or maintaining their weight (Nahikian-
Nelms, Sucher, & Lacey, 2016, p. 652). Cystic fibrosis patients have trouble absorbing fats
related to pancreatic insufficiency and in turn they have trouble absorbing fat-soluble vitamins
such as Vitamin A, Vitamin D, Vitamin E and Vitamin K, which are critical for normal growth.
Besides taking these fat-soluble vitamins as supplements they need to ensure they consume
appropriate amount of water-soluble vitamins, such as; Vitamin C and the B-complex vitamins
(to include biotin and pantothenic acid, and folic acid) (Cystic fibrosis Foundation, n.d.).
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NUTRITION FINAL RESEARCH PAPER
One treatment recommended for cystic fibrosis patients include Airway clearance, which
allows the mucus that is thick and viscous to loosen up and dislodge from their lungs allowing
for better oxygenation, improve lung function and helps decrease the risk of lung infections.
Some techniques include: coughing or huffing; chest physiotherapy (including percussion with
cupped hands or equipment can be prescribed and ordered through various manufacturers).
Along with these Airway clearance techniques, usually cystic fibrosis patients are on long term
bronchodilators (usually nebulized) that can result in abdominal pain and anorexia,
corticosteroids, antibiotics like ciprofloxacin may have delayed absorption when taken with dairy
products, mucus thinners, and “CFTR (cystic fibrosis transmembrane conductance regulator)
modulator therapies. [They] are designed to correct the function of the defective protein made by
the CF gene and there are currently [only] two FDA-approved CFTR modulators: ivacaftor
(Kalydeco®) and lumacaftor/ivacaftor (Orkambi®)” (Cystic fibrosis Foundation, n.d.).
Part 3, Criteria # 1 Nutrient Calculations
Our patient is a 22-year-old female who is 5’5″ (65 inches) and 112 pounds (50.9 kg).
BMI
Using this calculation, the patient’s BMI is 18.6 and according to the Quick Bite
Interpreting BMI Chart, the patient’s BMI barely meets the Healthy Weight, which ranged from
18.5 to 24.9 (Dudek 2014, p. 7). “The 2002 Nutrition Consensus Report states that there is no
perfect method to estimate the calorie needs of a person with CF” (Nahikian-Nelms, et al., 2016,
p.652).
112/ 65 X 65 (4225) = 0.0265 X 703 = 18.6 BMI
BMR
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NUTRITION FINAL RESEARCH PAPER
Since the patient’s BMI falls under the Healthy Weight category to estimate her caloric
needs we will use the equation for a healthy adult, which is (weight in kg) x (30 kcal/kg). Using
this calculation, we estimate that her calorie intake needs would be roughly be 1527 kcal. The
BMI plus activity and food intake is the calculation documented below.
112 X 10 = 1120 X 0.20 (activity) = 224 + 1120 = 1344 X 0.1(food) = 134 + 1344 =
1478 calories/day
CHO
For carbohydrate intake, should be individualized and “should be monitored to achieve
glycemic control. Although carbohydrate is not restricted, patients should be taught to distribute
carbohydrate calories throughout the day and to avoid concentrated carbohydrate loads”
(Nahikian-Nelms, et al., 2016, p.653).
1478 X 0.45 = 665 calories then/by 4calories/gram = 166 grams/day
1478 X 0.65 = 960 calories then/by 4 calories/gram = 240 grams/day,
Daily range 665-960 calories/day from CHO, 166 – 240 grams/day,
PRO
Protein intake, recommended intake is roughly 1.5 to 2.0 times the Daily Recommended
Intake (DRI) for that age (Nahikian-Nelms, et al., 2016, p.653). “The Recommended Dietary
Allowance (RDA) for protein for healthy adults is 0.8 g/kg” and “the Acceptable Macronutrient
Distribution Range (AMDR) for protein for adults is 10% to 35% of total calories” (Dudek 2014,
p. 54). With a caloric intake of 1527 kcal, minimum protein intake of 10% and protein equaling 4
kcals/gram, for a healthy patient would need a minimum intake of roughly 38.2 grams. Since a
cystic fibrosis patient needs 1.5 to 2.0 times the normal intake of protein, at a minimum a cystic
fibrosis patient would need 57.3 grams to 76.4 grams of protein per day.
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NUTRITION FINAL RESEARCH PAPER
112 lb. / 2.2 kg/lb. = 50.9 kg. X 0.8 gm/kg = 40.7 grams protein daily, healthy person
Or
40.7 grams X 1.5 times as much, requirement = 61grams/day protein X 4 calories/gram =
244
calories/day
40.7 grams X 2 times as much, requirement = 81.4 grams/day X 4 calories/gram = 326
calories/day
Daily range 244 – 326 calories/day, or 61 – 81 grams/day
FAT
For patients with cystic fibrosis , there is no restriction on fat intake because it is essential
for weight maintenance. Unlike the 25% to35% recommended fat intake for the normal
population, cystic fibrosis patients require a greater fat intake of 35% to 40 % of total kcal
(Nahikian-Nelms, et al., 2016, p.653). With a caloric intake of 1527 kcal, maximum fat intake of
40% and fats equaling 9 kcals/grams, the patient would need a minimum intake of roughly 67.9
grams of fat per day.
2839 X 0.35 = 568 calories then/by 9 calories/gram = 63 grams/day
2839 X 0.40 = 994 calories then/by 9 calories/gram = 110 grams/day
Daily range 568 – 994 calories/day, or 63 – 110 grams/day
Part 3, Criterion #2 SMART Goals and Patient Care Plan
SMART Goal # 1: Patient will make a menu for two days, 3 meals/day with a heme rich protein
food in two meals, menus will be discussed at the end of the shift. Patient was able to plan six
meals with four containing heme rich proteins. Goal met SMART Goal # 2: Patient will consume
75% of 2 meals during this 12—hour shift. Goal met patient consumed 100% of breakfast and
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NUTRITION FINAL RESEARCH PAPER
75% of lunch. SMART Goal # 3: Patient will consume a serving of probiotic rich food, (yogurt)
daily by end of shift. Goal met, patient consumed a Greek yogurt for lunch.
Patient is a 22-year-old female who’s 5’5” (65 inches) and 112 pounds (50.9 kg), BMI of 18.6
who was diagnosed with cystic fibrosis at two years old. She came to the ER complaining that she has
trouble breathing. Her blood pressure is 130/86, heart rate 92 beats per minute, temperature of 98.8
degrees Fahrenheit, and oxygen saturation at 88% in room air. Patient denies any history of smoking or
illicit drug use and occasionally has an alcoholic drink. Patient states that she is still taking
Ciprofloxacin after having pneumonia about two weeks ago.
As an RN caring for a person with cystic fibrosis, there are many roles and duties that one
must be responsible for. An RN must ask the patient if they have any type of food allergies.
There are no particular foods that an adult with cystic fibrosis should really avoid, but you must
take precautions before giving food that a patient may be allergic to. The RN must assess the
patient for low protein by obtaining the serum prealbumin and globulin levels. Patient teaching
would include the importance of maintaining a high protein, fat diet with a daily consumption of
probiotics (Jafir, 2014). Listen to the patient and what she likes to eat, thus avoiding any
ethnocentricism. Give the patient different options of high protein meals to choose from in order
to effectively gain the nutrients needed. Advise the patient to consider what foods she prefers
that are easy to chew that are also high in protein, and fat.
The plan for maintaining nutritional balance throughout the shift was implemented by first
collaborating with the nutritionist to aid in planning a food menu that tailored the patient’s needs,
making sure to accommodate the patient’s appetite. After the menu was provided, the patient decided on
eat hot cereal, with scrambled eggs, and whole wheat toast for breakfast, lunch included Greek yogurt,
butter lettuce salad and fruit, and for dinner roasted chicken, mashed potatoes with gravy, and edamame.
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NUTRITION FINAL RESEARCH PAPER
Patient was asked what kind of high protein foods she would like to eat at home and replied with
chicken, salmon, and steak. Patent airway was ensured before feeding by checking gag reflex and her
ability to swallow. Suction was also readily available by her bedside. I monitored the patient’s protein
by obtaining labs and assessing her total protein, albumin, prealbumin and globulin levels.
Due to thick and sticky mucus build up in the lungs, it is very important that the RN
check the patient’s airways because it can suddenly get clogged. The nurse must auscultate
breath sounds and recognize wheezing, crackles, or rhonchi. Assess the patient’s air way and
ensure a patent passage. Teach the patient how to perform effective coughing and deep breathing
techniques daily in order to help the secretion of sputum. Other duties include physiotherapy to
aid in secretion of the mucus. The patient should be in a comfortable position with the head
elevated in a semi-fowler position. Thick, sticky mucus also makes it easier for bacteria to
colonize into the lungs so the RN must assess the patient for any lung infections. This may also
result in the patient preferring softer foods, for ease of eating and swallowing. The nurse must
check labs such as blood tests for WBC and platelet count, ABGs, sputum culture, as well a chest
x-ray. The thick mucus can also block tubes or ducts in the pancreas (George & Hazle, 2016).
The thick mucus can lead to malnutrition due to digestive enzymes not being able to reach the
small intestine.
Educate the patient in the importance of physical exercise and how it helps with
improving GI motility and respiratory muscles (George & Hazle, 2016).
During patient teaching, she showed willingness to learn as she stated that she learns better if I
demonstrated techniques. Patient showed understanding as she demonstrated effective coughing and
deep breathing techniques, preparation of meal plans and protein sources. She stated that she will
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NUTRITION FINAL RESEARCH PAPER
practice these techniques daily to excrete her sputum. She also understood to take her antibiotics
throughout the entire time it is prescribed (Miller & Stoeckel, 2016).
References
Cystic fibrosis Foundation. (n.d.). Treatments and therapies [website]. Retrieved
https://www.cff.org/Living-with-CF/Treatments-and-Therapies/
Dudek, S. G. (2014). Nutrition essentials for nursing practice (7th ed.). Philadelphia, PA:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
George, C., & Hazle, L. (2016). Cystic fibrosis: Nurses act as a healthcare provider, advocate
and educator for CF patients. Advance Healthcare Network for Nurses. Retrieved from
http://nursing.advanceweb.com/Continuing-Education/CE-Articles/Cystic-Fibrosis.aspx
Miller, M. A., & Stoeckel, P. R. (2016). Client education: Theory and practice (2nd ed.).
Burlington, MA: Jones & Bartlett Learning.
MyFitnessPal (n.d.). Lose weight with MyFitnessPal. Retrieved from
http://www.myfitnesspal.com/
Nahikian-Nelms, M., Sucher, K., & Lacey, K. (2016). Nutrition therapy and pathophysiology
(3rd ed.). Boston, MA: Cengage Learning.
Simeons, W. (2016). The original HCG diet protocol & menu by Dr. A. T. W. Simeons: An
overview. Retrieved from https://hcgdietinfo.com/Diet-HCG
HCG Diet and Cystic Fibrosis
Topic # 1: HCG Diet
Part I, Criteria # 1: Identification of Nutrients
Part I, Criteria # 2: RDA Approval Analysis
Part 2, Criteria 1# Nutrition and Pathophysiology
Part 2, Criteria # 2: Medical and Nutrient Related Interventions and Dietary Needs
Part 3, Criteria # 1 Nutrient Calculations
BMR
CHO
1478 X 0.45 = 665 calories then/by 4calories/gram = 166 grams/day
PRO
Or
FAT
2839 X 0.35 = 568 calories then/by 9 calories/gram = 63 grams/day
Part 3, Criterion #2 SMART Goals and Patient Care Plan
References
