II.
Case Situation
III. Discuss of the condition
a. Discuss of Case
This is the case of patient W.G., a 34-year old woman who is currently on her second
5 pregnancy at 24 weeks AOG. She is identified as Obese type II since she has a weight of
220 lbs or 100 kg, height of 5 ft and 5 inches or 1.68m and a BMI of 35.5. During her
prenatal check-up, her BP shows 130/80 mmHg which is still considered normal.
However, she is at high risk for Pre-eclampsia since she is nearing to a BP of 140/90
mmHg which is abnormal in pregnancy. In addition to, her weight would also be a great
10 factor in increasing her risk for Pre-eclampsia since BP rises as body weight increases.
On the other hand, the patient has a family history of type 2 Diabetes Milletus. Hence,
she is also at risk for developing a type 2 Diabetes Mellitus since her excessive weight
predisposed her to diabetes. Thus, this will result for her baby to become Large for
Gestational Age again. Furthermore, she also has a knowledge deficit on proper nutrition
15 for a pregnant mother knowing that she is already G2P1 because of her notion that one
must double the food to be eaten during pregnancy.
b. Pathophysiology
A. DIABETES
Type 2 diabetes or diabetes mellitus characterized by high levels of sugar in the blood.
20 During digestion, food is broken down into basic components. Carbohydrates are broken down into
simple sugars, primarily glucose. Glucose is a critically important source of energy for the body's
cells.
To provide energy to the cells, glucose needs to leave the blood and get inside the cells.
Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone produced by
25 the pancreas. Type 2 diabetes occurs when your body's cells resist the normal effect of insulin, which
is to drive glucose in the blood into the inside of the cells. This condition is called insulin resistance.
As a result, glucose starts to build up in the blood. In people with insulin resistance, the
pancreas "sees" the blood glucose level rising. The pancreas responds by making extra insulin to
maintain a normal blood sugar. Over time, the body's insulin resistance gets worse. In response the
30 pancreas makes more and more insulin. If the pancreas get exhausted, it cannot keep up with the
demand for more and more insulin. It protrude. As a result, blood glucose levels start to rise.
Medical nutrition therapy for people with diabetes should be individualized, with
consideration given to the individual’s usual food and eating habits, metabolic profile, treatment
goals, and desired outcomes. Monitoring of metabolic parameters, including glucose, HbA 1c, lipids,
blood pressure, body weight, and renal function, when appropriate, as well as quality of life, is
essential to assess the need for changes in therapy and to ensure successful outcomes. Ongoing
nutrition self-management education and care needs to be available for individuals with diabetes.
B. PREECLAMPSIA
5 Preeclampsia is a condition that pregnant women develop. It's marked by high blood pressure in
women who haven't had high blood pressure before. Preeclamptic women will have a high level of
protein in their urine and often also have swelling in the feet, legs, and hands. This condition usually
appears late in pregnancy, though it can happen earlier and may even develop just after delivery.
Diffuse or multifocal vasospasm can result in maternal ischemia, eventually damaging multiple
10 organs, particularly the brain, kidneys, and liver. Factors that may contribute to vasospasm include
decreased prostacyclin or an endothelium-derived vasodilator, increased endothelin or an
endothelium-derived vasoconstrictor, and increased soluble Flt-1 or a circulating receptor for
vascular endothelial growth factor.
15 According to R. James et al. (n.d), administering calcium or (n-3) fatty acids in unselected
women from midgestation is not effective therapy for reducing the risk of preeclampsia. It also seems
unlikely that zinc or magnesium supplements with the same strategy are useful. Antioxidant therapy
with vitamins C and E is quite effective to a preeclampsia patient. It is unclear based on the study
performed whether the administered vitamins were pharmacological treatment or replacement of
20 inadequate nutritional intake.
This question of whether administration of a micronutrient and diet manipulation replace
inadequate nutrients or are therapy has not been adequately addressed. The results of the calcium
trials, apparently effective when there is low calcium intake but not when there is adequate calcium,
suggest replacement rather than supplementation. With this in mind, an important strategy should be
25 selective nutrient administration to deficient populations before a potential therapy is discarded.
5
10
15
20
25
A. Body Mass Index (BMI)
220 lbs
5’8’’
5ft inches(1m/39.37 inches) = 1.65m X 1.65 m = 2.72m
5 BMI = 100 kg / 2.72m = 36.76/37 -------- Obese Class II
B. Desirable Body Weight (DBW)
65 X 2.54 cm = 65.1 - 100 = 65.1 kg
65.1 kg
10 -6.51 kg
58.59 kg ------ 59 kg
C. Total Energy Requirement (TER)
59 kg X 35 = 2065 = 2050
15 CHO= 2050 X 68% = 1394 /4 = 348.5 = 350
CHON= 2050 X15%= 307.5=300/4= 76.8 = 75
FAT= 2050 X 15% = 307.5 /9 = 34.1 = 35
20
25
Food Food CHO CHON FATS ENERGY
Groups Exchange
s
Vegetable A 2 3 1 0 16
Vegatbale B 1 3 1 0 16
Fruits 3 30 0 0 120
Skimmed 1 12 8 0 80
Milk
Sugar 6 30 0 0 120
TOTAL:
78
5 350 - 78 = 272 / 23 = 12
Rice 12 276 24 0 1200
TOTAL:
34
75 - 34 = 41 / 8 = 5
Low Fat Meat 5 0 40 5 205
TOTAL: 5
35 - 5 = 30 / 5 = 6
Fats 6 0 0 30 270
TOTAL: TOTAL: TOTAL: TOTAL:
354 2027
74 35
10
FOOD EXCHANGES PER GROUP
1. Vegetable A - Ampalaya, Sayote, Kangkong
5 B - Carrots
2. Fruits - Apple, Banana, Grapes, Tomato
3. Milk - Yogurt
4. Sugar - Taho, Tamarind Candy, Honey, Nata de coco, Banana chips
5. Rice - Whole wheat bread, Sweet potato, Potato, Corn flakes, Cookies, Lugaw, Purple yam,
10 Taro, Boiled corn, Casava, Sago, Chestnut
6. Low Fat Meat - Chicken breast, Lean beef, Cat fish/Dalag, Chicken leg, Pigeon pea seeds
8. Fat - Olive oil, Avocado, Cream cheese, Sesame oil, Canola oil, Peanut butter
MEAL PLANNING
15
I. Breakfast 7:30am to 8:00am
1 and 1/2 cup (1/2 cup cooked rice plus 2 cups water) lugaw + 1/4 breast (6 cm long)
1 boiled banana saba (10x4cm)
II. Snack 10:00am to 10:30 am
20 1/2 of 8 cm diameter apple
10 (2 cm diameter each) or 4 (3 cm diameter each) grapes
1/2 cup of yogurt
III. Lunch 12:00nn to 12:30pm
Fried lean beef with a pinch of iodized salt (oil used - sesame oil)
25 Boiled ampalaya leaves with sliced tomato + onion and garlic
Banana chips (1 6 x 3-1/2 cm )
IV. Snack 3:00 to 3:30pm
2 (2x1 cm) whole wheat bread with cream cheese or peanut butter
1/4 cup Taho with sago with honey syrup
1/2 of 11 cm long x 4 to 1/2 cm diameter of sweet potato
V. Dinner 6:30pm to 7:00pm
1 small leg (13-1/2 cm long x 3cm dm)
kangkong tops with alamang (boiled)
5 2 to 1/2 of 7 cm long x 4 cm diameter each of mashed potato
VI. Midnight snack 9:00pm to 10:00pm
Cookies (Quaker oats)
2 (6cm long x 4cm diameter) or 1 cup of boiled taro/gabi
11 pieces large or 20 pieces small of chestnut
10
REFERENCES:
Nutrition Principles and Recommendations in Diabetes. (2015, January 1). Retrieved from
https://care.diabetesjournals.org/content/27/suppl_1/s36.
Roberts, M. et al., (2013, May 1). Nutrient Involvement in Preeclampsia. Retrieved from
15 https://academic.oup.com/jn/article/133/5/1684S/4558569.
Dulay, A. T., By, Dulay, A. T., & Last full review/revision June 2019 by Antonette T. Dulay.
(2019). Preeclampsia and Eclampsia - Gynecology and Obstetrics. Retrieved from
https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-
pregnancy/preeclampsia-and-eclampsia.
20 Johnson, T. C. (2019, July 17). Preeclampsia & Eclampsia: Risk Factors, Signs & Symptoms,
and Treatment. Retrieved from https://www.webmd.com/baby/preeclampsia-eclampsia#1.
Burton, G. J., Redman, C. W., Roberts, J. M., & Moffett, A. (2019, July 15). Pre-eclampsia:
pathophysiology and clinical implications. Retrieved from
https://www.bmj.com/content/366/bmj.l2381.
25
