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Polycystic Ovary Syndrome

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.

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Polycystic Ovary Syndrome

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  1. Polycystic Ovary Syndrome Andrea Myers KNH 411

  2. Client • Gracie Moore • 34 • Female • 5’5” • 180lbs • Graduate Student • Graduate teaching assistant • Married • One adopted child, infant

  3. 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!”

  4. 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

  5. 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

  6. 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.

  7. 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

  8. PCOS

  9. 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

  10. Etiology • Cause of PCOS is unknown • Several factors seem to be linked to PCOS • Genetics • Body’s ability to make insulin

  11. symptoms • Symptoms presented: • Cessation of menstruation • Weight gain • Sleep apnea • Hirsutism • Thinning hair • Dandruff • Acne • Skin tags • AcanthosisNigricans • High blood pressure • High cholesterol

  12. Abnormal Lab Values • Bilirubin: 0.41mg/dL • ALT: 42U/L • HDL-C: 51mg/dL • TG:184 mg/dL • LDL:132 mg/dL

  13. Diagnostic Criteria • Complete blood count with: • Metabolic panel • Lipid panel • Thyroid panel with TSH • Testosterone level • 2 hour GTT

  14. Treatment-Medications • YAZ 1 tablet PO • Glucophage 850mg PO • Aldactone 100mg/d PO • Vaniqua • Nutrition consult requested

  15. 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

  16. 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

  17. 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 diet • add more lean meats to their diet

  18. 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

  19. 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.

  20. 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.

  21. Prognosis • With treatment, women with PCOS are usually able to lead normal lives and can become pregnant. • National Institute of Health

  22. 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

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