DNP 801 Topic 5 DQ1

DNP 801 Topic 5 DQ1

Objectives:

1.   Analyze the mechanisms by which nutrition can influence health.

2.    Integrate human nutrition with epidemiologic concepts.

 

Topic 5 DQ 1

Assessment Description

Health issues in a clinical setting can be influenced by nutrition. Identify a health issue that has been positively influenced by nutrition in your clinic. How does nutrition improve health? How can the doctoral-prepared nurse apply this information in practice? Explain. Support your rationale with a minimum of two scholarly sources.

Topic 5 DQ 2

Assessment Description

Choose one disorder of malnutrition that is found in your clinical setting or community. What are the genetic and environmental influences on this disorder, including prevalence rates, testing, treatment, and prognosis? How can the doctoral-prepared nurse apply this information into practice? Explain. Support your rationale with a minimum of two scholarly sources.

Case Study: Part 3

Assessment Description

You will be creating a case study in stages over four course topics. This assignment will add to your previous work in Topic 3. Use an example from your own personal practice, experience, or own personal/family (however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment). Examples might include a patient with Duchesne’s muscular dystrophy, Huntington’s disease, Down’s syndrome, sickle-cell anemia, BRCA 1 or BRCA 2 mutations, or another genetic disorder that you or the organization you practice in may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment requires that at least two additional scholarly research sources related to this topic and at least one in-text citation for each source be included.
• You are required to submit this assignment to Lopeswrite. A link to the Lopeswrite technical support articles is located in Class Resources if you need assistance.

Directions:

For this assignment (Part 3 of the Case Study), write a paper (1,000-1,250 words) incorporating genetics
information learned from assigned readings in Topics 1-5. Include the following:

1.    Examine how genetics can influence policy issues.

2.    Discuss any nutritional influences for the cause of this disease.

3.    Discuss the process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness.

4.    Discuss the prevalence rates, testing, treatment, and prognosis as they relate to human nutrition.

 

Sample 1 Topic 5 DQ1

The health issue mostly seen in adults and children is chronic kidney disease (CKD) impacted by protein-calorie malnutrition (PCM). Although they have different pathogenesis, protein-calorie (energy) malnutrition is caused by a deficiency of energy, protein, and micronutrients. Signs and symptoms of PCM include being underweight compared to the expected healthy weight or muscle wasting seen in certain disease conditions such as HIV/AIDS. Protein calorie malnutrition (PCM) is also common in older people as seen in aggressive weight loss programs or patients with CKD (Mathur, et al., 2022).

During recent research by Mathur, et al., 2022 in a large community cohort with CKD, studies have characterized the relationship between severe protein-calorie malnutrition and the appearance of metabolic syndrome (MS) in adulthood. With each rise in serum bicarbonate levels, the hazard ratios adjusted for age, sex, race, GFR rate, serum albumin, hemoglobin, diabetes, and cardiovascular comorbidities were noted as an outcome of protein-calorie malnutrition (Mathur, et al., 2022).

Experimental animal and human studies conducted by Mathur, et al., 2022 show that chronic kidney disease (CKD) is very high among geriatric patients with a risk of adverse effects such as metabolic acidosis associated with protein catabolism and bone loss. Research studies by Mathur, et al., 2022 sought to quantify the independent association of metabolic acidosis with adverse muscle, bone, and functional outcomes in patients with non-dialysis-dependent patients with stage 3–5 CKD who had low estimated glomerular filtration (GFR) and serum bicarbonate values. The presence and severity of metabolic acidosis were significant and independent risk factors for failure to thrive, protein-calorie malnutrition, and falls with a possible fracture (Mathur, et al., 2022).

The second type of protein-calorie malnutrition is edematous malnutrition known as Kwashiorkor and
Marasmus. They are two clinical syndromes observed in severe acute malnutrition in young children primarily found in developing countries. Marasmus comprises of depletion of antioxidants, vitamins, and minerals. While Kwashiorkor is a severe and uncontrolled oxidative stress associated with the depletion of gut anaerobes and proliferation of aerotolerant gut pathogens (Pham, et al., 2021).

How does nutrition improve health?

Nutrition improves health positively because, urgent correction of plasma glutathione depletion, alongside supply of specific essential amino acids, particularly methionine and cysteine, early suppression of gut Proteobacteria including K. pneumoniae, and the use of probiotics to restore the human gut anaerobic and mature microbiota open new avenues to develop more targeted and effective treatments modalities. We can use this knowledge to healthily educate our patients and their family that increasing the intake of protein-containing foods, using milk-based formulas, antioxidants, vitamins, minerals, and daily multivitamins are the
treatment of choice for replacement therapy (Mathur, et al., 2022).

How can the doctoral-prepared nurse apply this information in practice?

The doctoral-prepared nurse applies this information in practice by using Anthropometry methods to monitor blood pressure, weekly weight, and laboratory test levels such as plasma levels of glucose, triglyceride, and HDL. It was determined that the prevalence of non-communicable diseases such as protein-calorie malnutrition
shows a direct and significant association between the burden of metabolic syndrome on body mass index, waist/height index, Dyslipidemia, CKD, and blood pressure. Identification of the specific pathogenic organisms and treatment with antibiotics could also save many children with kwashiorkor and marasmus
(Pham, et al., 2021).

References

Mathur, V., Reaven, N. L., Funk, S. E., Whitlock, R., Ferguson, T. W., Collister, D., & Tangri, N. (2022). Association of metabolic acidosis with fractures, falls, protein-calorie malnutrition and failure to thrive in patients with chronic kidney disease. Clinical Kidney Journal. V15 (7), p1379-1386, 8p. Retrieved from DOI: 10.1093/ckj/sfac065

Pham, T. P., Alou, M. T., Golden, M. H., Million, M., & Raoult, D. (2021). Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment. Microbial
pathogenesis. V150, pp. 104702. DOI: 10.1016/j.micpath.2020.104702

Sample 2 Topic 5 DQ1

Nutrition has significantly impacted hypertension in patients at our healthcare facility. Patients diagnosed with hypertension in the clinic are referred to the clinical nutritionist who educates them about the DASH diet, which effectively lowers hypertension. The DASH diet encourages a high consumption of fruits, vegetables, and whole grains and moderate amounts of low-fat dairy products, lean meat, nuts, seeds, dry beans, fats, and oils. Patients are advised to have low consumption of red meat, salt, cholesterol and saturated fat, sweets, and sweetened drinks (Koehler & Drenowatz, 2019). The DASH diet has significantly reduced the number of patients with pre-hypertension who advance to stages 1 and 2 hypertension. Furthermore, it has helped maintain patients’ blood pressure below 140/90 and promoted weight loss, lowering the incidence of hypertension complications and comorbidities.

Nutrition plays a major role in health and development. Good nutrition is associated with strong immunity and a low risk of malnutrition and non-communicable diseases (NCDs) (Shahid & Bishop, 2019). Malnutrition occurs in two forms, undernutrition (due to inadequate intake of nutrients) and overweight (excessive caloric intake). Individuals who observe healthy nutritional practices have a low risk of developing NCDs like hypertension, diabetes, heart disease, and some cancers.

The DNP-nurse can utilize this information in practice by educating patients and their families about healthy dietary practices to promote good nutrition. The nurse can assess patients with malnutrition and offer nutritional counseling on the nutrients they should increase or reduce in their diet to attain healthy nutrition (Koehler & Drenowatz, 2019). Besides, the nurse can apply the information in managing patients with lifestyle diseases by educating them on dietary habits they need to adopt to promote weight loss and achieve optimal blood
pressure and blood glucose levels.

References

Koehler, K., & Drenowatz, C. (2019). Integrated Role of Nutrition and Physical Activity for Lifelong Health. Nutrients, 11(7), 1437. https://doi.org/10.3390/nu11071437

Shahid, S. M., & Bishop, K. S. (2019). Comprehensive Approaches to Improving Nutrition: Future
Prospects. Nutrients, 11(8), 1760. https://doi.org/10.3390/nu11081760

Sample 1 Topic 5 DQ2

Nutritional management has always been an important part of the multidisciplinary approach to cystic fibrosis (CF) care. In the past poor growth and malnutrition were common features of CF. The disorder was first likened to the changes seen in the pancreas to a coeliac type syndrome and concluded that the ‘fibrocystic disease
of the pancreas’ was likely to be caused by vitamin A deficiency. Life expectancy was thought to be about six months. The main factor is fat malabsorption and poor growth results in infants and children being fed very
unpalatable low-fat diets.

In the past 2 decades, there have been many more advances in both the respiratory and nutritional management of CF, which have had a significant impact on improving the nutritional status of patients. One advancement has been the introduction of national newborn screening programs with the ability to start treatment early, thereby preventing an early decline in nutritional status and conserving respiratory function. Nutritional management guidelines’ goal is to ensure that infants and children grow normally, achieving the 50th percentile for weight
for length (WFL) by the age of two years and that adults have a BMI target in the middle of the normal range. It is also essential that patients achieve a normal body composition, ensuring optimal muscle and bone strength and optimal fat-soluble vitamin and essential fatty acid status. Improved life expectancy has resulted in additional nutritional challenges, including managing CF-related diabetes and liver disease, renal complications, optimizing bone health, and optimizing nutrition during pregnancy and before and following
transplantation (Wolfe & Collins, 2017).

Close monitoring of nutritional status is critical to the overall health of a patient with CF. As part of routine CF care, measurement of weight and height should be evaluated and analyzed at each visit. Early recognition of nutritional risk is imperative and evaluation with a multidisciplinary team should be performed to assess for
caloric intake, caloric malabsorption, and other causes of poor weight gain and growth (Sullivan & Mascarenhas, 2017).

The DNP nurse should focus on intervention to optimize the nutritional status that will lead to improved health outcomes, including survival. Therefore, Close monitoring of nutrition and growth is essential in caring for pediatric and adult patients with Cystic Fibrosis (CF). The Cystic Fibrosis Foundation (CFF) recommends that
nutritional status be monitored as part of routine CF care and that both children and adults with CF achieve a nutritional status comparable to healthy children and adults, as optimal nutritional status is associated with better clinical outcomes (Sullivan & Mascarenhas, 2017).

References

Sullivan, J. S., & Mascarenhas, M. R. (2017). Nutrition: Prevention and management of nutritional failure in Cystic Fibrosis. Journal of Cystic Fibrosis, 16, S87–S93. https://doi.org/10.1016/j.jcf.2017.07.010

Wolfe, S., & Collins, C. (2017). The Changing face of Nutrition in Cystic Fibrosis. Journal of Cystic Fibrosis.
https://www.cysticfibrosisjournal.com/article/S1569-1993(17)30763-4/fulltext

‌Sample 2 Topic 5 DQ2

One disorder of malnutrition that is found in this scholar clinical setting is Iron deficiency anemia. According to Emiroglu, Görpelioglu & Aypak (2019, p 677), “malnutrition may lead to iron, vitamin B12 and folic acid deficiency, resulting in anemia.” Iron deficiency anemia is the most common of all the deficiency stated. Iron deficiency anemia is a multifactorial disease with complex inheritance and can be influenced by genetic and environmental factors (Petry et al., 2016).  This was supported by Oksnes et al. (2022, p 2) who cited that “mutations in various iron metabolism genes can cause both iron deficiency.” In addition, Jallow et al. (2020) mentioned that in a genome-wide association study examining genetic predictors of pertinent hematological traits and iron status there was notable alterations in variants in haemochromatosis gene and the transferrin genes thus supporting its genetic influence and associations.

Iron deficiency anemia as mentioned by Honda et al. (2017) is an extremely frequent disorder in the elderly populations and denoted by a deficiency or reduction of hemoglobin in circulating blood.  Chaparro. & Suchdev (2019) mentioned it as a condition whereby circulating red blood cells and their oxygen binding volume
are not enough to meet physiologic needs. The deficiency result varies according to gender and the iron limits for males are different from females based on guidelines.

The prevalence of anemia varies per population. In developed countries, anemia is one of the most common
conditions in the elderly, with an incidence of over 10 % of elderly in selected populations and overall, nearly 25% of the world population (Wouters et al., 2019). In general anemia affects one third of the world’s population (Chaparro. & Suchdev, 2019). Also, the World Health Organization mentioned the prevalence of anemia in the elderly based on population studies as 12 % in community residents, 40 % hospitalized, and 47% in nursing home residents (Stauder & Thein, 2014).  In the aged population residing in American, Honda et al. (2017) cited that approximately 2.9% and 60.1% of elderly Americans are diagnosed with anemia. The general causes of anemia in the elderly include micronutrient deficiencies such as iron, cyanocobalamin and
folate.  Renal insufficiency, air pollutants and anemia of chronic inflammation contributes to this type of anemia. In addition, a third of anemia in this population cannot be explained and or defined by a single
factor (Honda et al., 2017). The main risk factors for iron-deficiency anemia include a poor intake of iron from diet or poor absorption of iron from diets rich in Iron. 

Testing for anemia may be done through blood studies to confirm diagnosed through hematocrit, Red Blood
Cell count, mean corpuscular volume, blood reticulocyte count, blood film analysis, or Hemoglobin electrophoresis (Chaparro. & Suchdev, 2019). Genetic testing is also encouraged from a precision medicine perspective to develop individualized treatment algorithms (Stauder & Thein, 2014). Clinical signs and comprehensive health assessment and physical examination all help to confirm diagnosis. Anemia in the elderly may be treated and improve through dietary/ nutritional screening, adjustments, referrals and consultations and counseling and education. In addition, the identification of sources of anemia and treating the underlying cause is also beneficial. Supplements and fortification are suggested in the elderly. Transfusions in the elderly to treat anemia is usually a last resort and decision is influenced comorbidities, patient’s preferences, specific situation
and clinical expertise and judgment (Le Calvé et al., 2017).

Anemia in the elderly population represents trials and numerous issues for the individual, the community and
health care providers. All healthcare providers should be aware and sensitized to the impact anemia has on the elderly as it relates to various adverse health outcomes, such as increased mortality, potentially severe health consequences, altered functionality status, impairment and disorders of discernment. As DNP prepared nurses, an understanding of the association between anemia and quality of life is important. Hence, education and awareness through collaboration and revisiting, updating and implementing policies and procedures to ensure that anemia is identified, diagnosed and treated in the elderly to promote and maintain health and quality of life

                                                     
 References

Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Annals of the New York Academy of Sciences, 1450(1), 15–1. https://doi.org/10.1111/nyas.14092

Emiroglu, C., Görpelioglu, S., & Aypak, C. (2019). The relationship between nutritional status, anemia and other vitamin deficiencies in the elderly receiving home Care. Journal of Nutrition, Health & Aging, 23(7),
677–682. https://doi-org.lopes.idm.oclc.org/10.1007/s12603-019-1215-9

Honda, T., Pun, V. C., Manjourides, J., & Suh, H. (2017). Anemia prevalence and hemoglobin levels
are associated with long-term exposure to air pollution in an older population. Environment International, 101,
125–132. https://doi-org.lopes.idm.oclc.org/10.1016/j.envint.2017.01.017

Jallow, M. W., Cerami, C., Clark, T. G., Prentice, A. M., & Campino, S. (2020). Differences in the
frequency of genetic variants associated with iron imbalance among global populations. PloS One, 15(7),
e0235141. https://doi.org/10.1371/journal.pone.0235141

Le Calvé, S., Somme, D., Prud’homm, J., & Corvol, A. (2017). Blood transfusion in elderly patients with chronic anemia: a qualitative analysis of the general practitioners’ attitudes. BMC Family Practice,
18(1), 76. https://doi.org/10.1186/s12875-017-0647-8

Oksnes, M. R., Graham, S. E., Wu, K. H., Hansen, A. F., Gagliano Taliun, S. A., Zhou, W., Thorstensen,
K., Fritsche, L. G., Gill, D., Mason, A., Cucca, F., Schlessinger, D., Abecasis, G. R., Burgess, S., Åsvold, B. O., Nielsen, J. B., Hveem, K., Willer, C. J., & Brumpton, B. M. (2022). Genome-wide meta-analysis of iron status biomarkers and the effect of iron on all-cause mortality in HUNT. Communications Biology, 5(1), 591. https://doi.org/10.1038/s42003-022-03529-

Petry, N., Olofin, I., Hurrell, R. F., Boy, E., Wirth, J. P., Moursi, M., Donahue Angel, M., & Rohner, F. (2016). The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys. Nutrients, 8(11),
693. https://doi.org/10.3390/nu8110693

Stauder, R., & Thein, S. L. (2014). Anemia in the elderly: clinical implications and new therapeutic
concepts. Haematologica, 99(7), 1127–1130. https://doi.org/10.3324/haematol.2014.109967

Wouters, H., van der Klauw, M. M., de Witte, T., Stauder, R., Swinkels, D. W., Wolffenbuttel, B., & Huls, G. (2019). Association of anemia with health-related quality of life and survival: a large population-based cohort study. Haematologica, 104(3), 468–476. https://doi.org/10.3324/haematol.2018.195552

 

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