Nutrition for Chronic Kidney Disease (CKD)

Nutrition for Chronic Kidney Disease (CKD)

Nutrition for Chronic Kidney Disease (CKD)

Causes:

Most common cause of chronic kidney disease is diabetes and the second most common cause is hypertension (high blood pressure), which cause permanent damage to the kidneys over time. Other causes are: autoimmune disease (lupus and IgA nephropathy), genetic diseases (polycystic kidney disease), nephrotic syndrome, glomerulonephritis, interstitial nephritis (inflammation of the tubules and surrounding structures), prolonged obstruction of the urinary tract from an enlarged prostate gland, kidney stones and some cancers, vesicoureteral reflux (condition that causes urine to back into the kidneys), recurrent kidney infection (pyelonephritis).

Risk Factors:

Diabetes and hypertension are numbers one and two. Also, cardiovascular disease, smoking, obesity, being African-American, Native American or Asian-American, family history of kidney disease, abnormal kidney structure, and older age.

Prevention:

Follow instructions on over-the-counter-pain relievers (aspirin, ibuprofen, and acetaminophen). Taking too many pain relievers could lead to kidney damage and generally should be avoided if you have kidney disease.

Maintain a healthy weight.

Don’t smoke.

Characteristics/Symptoms:

Chronic kidney disease usually gets worse slowly and symptoms may not appear until the kidneys are badly damaged. ESRD (end stage renal disease) symptoms are caused by waste and extra fluid building up in the body causing persistent itching, muscle twitches and cramps, nausea and vomiting, not feeling hungry, swelling in feet and ankles, too much or not enough urine, shortness of breath if fluid builds up in the lungs, chest pain if fluid builds up around the lining of the heart, trouble sleeping, fatigue and weakness, high blood pressure that is hard to control, decreased mental sharpness.

Treatments:

For ESRD (end stage renal disease), treatments include hemodialysis, peritoneal dialysis or kidney transplant.

Complications:

The kidneys do many jobs and cleaning the blood is only one job. They also control chemicals and fluids in your body, help control blood pressure, and help make red blood cells. Dialysis can do some, but not all of the jobs that healthy kidneys do. Complications of kidney disease include anemia, bone disease, hyperphosphatemia (high phosphorus levels in the blood), heart and blood vessel disease, hyperkalemia (high potassium levels in the blood), fluid retention (could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs-pulmonary edema), damage to the central nervous system, decreased immune response, pericarditis.

Monitoring:

Levels of urine albumin and the glomerular filtration rate are monitored. To assess the response to therapy and the progression of disease, UACR (albumin-to-creatinine ratio) is measured with >30mg/g being abnormal. Reducing urine albumin excretion to normal or near-normal may improve renal and cardiovascular prognoses. Changes in kidney function is monitored using eGFR (estimated glomerular filtration rate). In CKD, eGFR is less than 60ml/min/1.73m2.

Diet modifications, why the modifications are appropriate, sample one day (3 meals) meal plan:

People with chronic kidney disease should follow a diet that is low in phosphorus, potassium, sodium (salt), fluids, and protein. Kidneys may not be able to properly filter excess potassium and phosphorus, leading to hyperkalemia and hyperphosphatemia. Excess fluid and salt promote fluid retention which can lead to swelling in extremities and high blood pressure. If thirsty, one can suck on an ice cube or hard candy (sugar-free if diabetic).

Low phosphorus foods to eat: Italian, French and sourdough bread, corn or rice cereal and cream of wheat, unsalted popcorn, lemonade.

High phosphorus foods to avoid: whole grain bread, bran cereals, oatmeal, nuts,

sunflower seeds.

Low potassium foods to eat: apples, grapes, pineapple, strawberries, cauliflower, onions, pepper, radishes, summer squash, lettuce, pita, tortilla, beef, chicken, white rice.

High potassium foods to avoid: avocado, banana, melon, oranges, prunes, raisins,

artichokes, spinach, potatoes, tomatoes, bran products, granola, beans, brown rice.

Low sodium, salt (sodium chloride) foods to eat: fresh fruits and vegetables, unprocessed foods, no added table salt.

High sodium foods to avoid: processed foods, added table salt, condiments, sauces,

chips, soups.

Sample daily meals:

Breakfast: corn cereal, rice cereal, or cream of wheat with strawberries and milk

Lunch: chicken teriyaki pita sandwich (chicken, pita, lettuce, onion, olive oil) and pineapple or an apple

Snack: unsalted popcorn

Dinner: meatloaf (lean ground beef or chicken) or grilled shrimp, summer squash or cauliflower, green beans, apple bars for dessert

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NUTR 4408 GAHN 6408 Medical Nutrition Therapy

NUTR 4408 GAHN 6408 Medical Nutrition Therapy

NUTR 4408/GAHN 6408: Medical Nutrition Therapy

Group Case Study

Elderly female with advanced oral cancer

By:

Weam Alamoudi

Erada Alghamdi

Manal Alzubiadi

Submitted to: Dr. Theresa Glanville

5November 2013

Laboratory results for IM:

Lab tests Reference

Range (5) IM’s

Histroy Comments

07/29 08/31 09/12 Albumin (g/L) 35-50 34 33 29 Decreasing gradually, and this is most

likely due to malnutrition in relation to

poor dietary intake and low protein

consumption.

Hbg (g/L) (130-180) 84 – 97 Gradual slow increase in the last lab result,

may be due to addition of multivitamin supplement or dehydration.

Hct (%) (42%-52%) 24.5 – 28.5 Improving gradually because of the

multivitamins supplement or dehydration.

In fact, the original decrease for Hgb &Hct

is related to inadequate oral food intake,

which increased nutrient need (acute

phase proteins, iron).

Na+ (mEq/L) 135-145 128 133 130 Improving gradually due to multivitamins supplement.

K+ (mEq/L) 3.6-5 3.7 4.1 4.4 Initial low due to dehydration. Overall the

all test result of K+ were within the normal

range.

Things to consider:

IM is a 68 YOBF whose BMI places her in the normal range, and although her BMI has become lower, due to the progression of her cancer, she is still in the normal range. The key is to stop any further loss of weight. IM also has a history of smoking and has type 2 diabetes. Those factors combined, with her age and gender, put her at a greater risk of developing cancer.

The nutrition problem list developed to create a nutrition care plan for IM ranked in the order of importance is as follows:

1. Malnutrition: due to her low food intake, and this will lead to progressive weight loss in a short

time. This is a common side effect of cancer cachexia. Other first side effects are anorexia, fatigue,early satiety, immunosuppression, and metabolic rate. This problem is ranked first on the list because cancer patients require adequate amounts of energy intake, protein, antioxidants, and those factors should be top priority for a registered dietitian (5).

Mucositis / Mouth soreness/ Difficulty swallowing:oral mucositis is a side effect of radiotherapy, which leads to increased difficulty when eating. To reduce soreness of mouth, an RD can monitor the food acidity and its temperature to make it easier for IM to eat. IM’s ability to consume food and liquids, to increase her fluid and energy intake, depends on her ability to swallow, and how comfortable she is with regards to eating. If IM is unable to eat, a feeding tube should be provided (5).

Type 2 Diabetes: as we suggested that the patient could be placed on an enteral feeding plan, if this suggestion is implemented the diabetic formulas should be used, as the patient has type 2 diabetes.

Dehydration and constipation:dehydration could be the cause of the constipation, and it results in low hemoglobin/hematacrit concentrations in the blood. In fact, constipation could cause nausea. Also dehydration leads to electrolyte and fluid imbalances (5).

Nausea and vomiting: secondary problem to radiotherapy and medications (5).An RD can monitor food tolerance, frequency of meals and size. Also, a physician may prescribe medication to decrease the synptoms.

Xerostomia: common side effect of radiotherapy (5), and less significant because fluid could be provided with food, such as soups.

Drug-Nutrient Interactions: having several medications, the patient needs to know if there are any possible drug-nutrient interactions, and how harmful they could be. The drugs described below did not involve any known drug-nutrient interactions, except for the multivitamin.

Low income and potentially minimal access to adequate healthy food, knowledge of food preparation: in the case of our patient, these items would not be our concern because she is getting her treatment at the hospital, and later on when she is feeling better and more alert we could discuss these issues with her.

Medication list:

Dilaudid syrup (Morphine): hydromorphone; a very potent centrally acting analgesic drug of the opioid class. Patient should avoid consuming alcohol to prevent constipation and diarrhea (1). Also, a side effect of dilaudid syrup is hyprecalcemia (2).

Colace: treatment for constipations (should be taken with a plenty of water; used as a stool softener). However, prolonged use may cause irritation of the gastrointestinal tract (3).

Sodium bicarbonate mouth rinse: The most commonly used mouth rinse, a natural buffer to the mouth’s PH that supports good oral health. In fact, this should help IM to improve her mouth soreness.

Mycostatin: polyene antifungal medication. Mycostatin is often given to patients at risk of fungal infections, including those under chemotherapy treatment. In addition, it could also lead to mouth irritation and diarrhea (4).

Multivitamins: contain different kind of formulas that are designed to meet micronutrient needs depending on the elemental forms of a variety of vitamins and minerals. These elemental forms may have an impact onIM’s recovery.

2. PES: The intake of energy and fluid is inadequate in relation to dehydration and stage 3 carcinoma of the mouth, and treatment side effects which lead to swallowing problems and mouth soreness as evidenced by low albumin, low hemoglobin, low hematocrit and low sodium outcomes from the laboratory tests. IM has a history of type 2 diabetes with no further information.

3. Nutrition care plan for IM.

Goals of nutrition care for IM.

1.To prevent nutrient deficiencies.

2.To preserve lean body mass.

3.To minimize nutrition and treatment-related side effects,such as decreased appetite/nausea.

4.To maximize her quality of life and to help her to survive (5).

IM will be in a hospital for almost a month and the gastronomy tube feeding(due to difficulty in swallowing) will be her first treatment to meet her daily caloric needs. When IM shows interest, food and beverages will be provided to encourage her oral eating and drinking, but considering IM’s current status it is crucial to increase the energy intake.

IM is advised to stop taking multivitamin, because the enteral formula will be sufficient to meet her micronutrient needs. Also, multivitamins may interfere with her recovery. Furthermore there is no need for her to take Colace because with the new enteral feeding plan the patient will meet her nutrient and fluid needs. Also, the best option is to wait until the patient’s bowel movements are re-evaluated. The other medications (sodium bicarbonate mouth rinse, and mycostatin) will be maintained, and evaluated except for the increased level of fluids neededdue to the effects of the Dilaudid Syrup.

IM also needs to be educated on good oral health and provided with oral hygiene care. In addition, if during the intervention our patient is not responding well to an enteral feed, expressed by high residual and risk aspiration, a parenteral feeding plan will be formed.

IM requires 1565.7 kcal/day and 2030 ml/day of fluid, as IM has carcinoma on her mouth, mucositis, and will be having 25 radiation treatments to the neck. Therefore, a nasogastric tube (NGT) will be avoided, to decrease the irritation of the cancer and treatment site. In fact, there is no indicator of the GI distress, so a gastronomy tube with polymeric solution should be used to maintain the GI health and function(5). Another problem we need to be aware of is IM’s type 2 diabetes. Therefore, the glucose control formula (Glucerna 1.5) will be used. The administration of the enteral formula will be 5 times a day at a rate of 359 ml of formula accompaniedby 112ml water, because the GI system of most patients can tolerate 500ml. Glucerna 1.5 cal formula contains, per 250 ml: protein, g: 19.6, fat, g: 17.8, carbohydrate, g: 31.5, dietary fiber, g:3.8 L-carnitine, mg:51, taurine, mg:40, m-inositol, mg:205, water, g:180, calories: 356. The energy and fluid requirements for IM will be met using this formula, because it contains sufficient amounts of protein, which will help stabilize her diabetes (6).

Calculations:

Estimated Energy(EE) needs for people with cancer: cancer, nutrition repletion, weight gain:

Daily energy requirements using Harris Benedict’s Equation are based on IM’s diagnosis, anticancer therapy, and metabolic complications. Stress factor for cancer patient is 1.1-1.3

EER=655.1+(9.563xwt)+(1.850xht)-(4.676xage) x stress factor

EER=655.1+(9.563×58)+(1.850×169)-(4.676×68) x 1.3

EER=655.1+554.6+312.6-317.9X1.3

EER=1522.3-317.9 X 1.3=1204.4 x 1.3= 1565.7 kcal/day

EER Range= 1324.84-1565.7 kcal/day

Protein: based on the degree of malnutrition, disease, stress, and ability to metabolize and use protein. IM needs 10%-35% of protein in her diet. Stress cancer patient: 1.5-2.5 g/kg/day (the higher end of this range will be used due to IM’s situation).

2.5 x 58 kg= 145g/day.

Protein energy malnutrition is the single most common secondary diagnosis in cancer patients (5). So, IM needs 90-100 g protein/day for maintenance and 100-200g protein/day for repletion.

Fat: the recommended level of fat is 20%-35% of energy.

Fluid:The upper level will be used as goal due to current hydration status and opioid medications. The recommendation for adults: 30-35ml/kg/day

58*30= 1740ml/day, 58*35= 2030ml/day.

Fluid received from enteral formula: 1795 ml

Fluid recommend from other source: 2030ml/day-1795ml/day=235ml/day

Fluid required with each feeding: (235ml/day)/5=47ml 5x/day (5)

The selected formula is Glucerna 1.5 formula:

Contains: 1.5kcal/ml, 1795ml/day required to meet energy requirements

Required formula at each feeding= (1795ml/day)/5=359ml 5 times/day (6)

4. An Assessment plan to monitor IM’s progress:

Dietary plan objectives:

Individualized nutrition intervention to ensure adequate nutrition intake and weight maintenance.

Consume a healthy diet that contains the recommended amounts of essential nutrients, including protein, carbohydrate, fat, vitamins, minerals, and water.

Consume sufficient amounts of energy and protein to maintain nutrition stores and to achieve and maintain a healthy lean body mass and BMI appropriate for height.

Adopt a physically active lifestyle (5).

Symptoms such as loss of appetite, nausea, vomiting, weight change, changes in taste and smell, pain, fatigue, and disturbances of the gastrointestinal tract (GIT) are common side effects of cancer treatment and can lead to inadequate nutrient intake and subsequent malnutrition. In most cases, eating enough foods rich in vitamins, anti-oxidants, calories and protein can prevent malnutrition. These include fruits and vegetables, whole grain products, lean cuts of meat, and whole-fat dairy products (5).

Several support staff will be required to assist IM’s recovery. These will include a speech therapist, a primary oncologist, multiple nurses, a social worker, a dietitian and a variety of lab technicians. IM’s health status will be monitored regularly for factors including alertness, wasting, and complexion. Also, her fluid intake and output will be monitored daily to ensure that she is meeting her energy and fluid needs, and her weight will be measured 3-5 times a week. In addition, it is important to monitor the hydration daily, and electrolytes will be tested in the laboratory on a weekly basis. Based on her weight status, her nutritional adequacy will be re-evaluated and intake will be monitored twice weekly. BUN and creatinine levels will be monitored weekly.

In addition, it is better to monitor gastric residuals before each additional feeding, and record these evaluations to ensure she is maintaining tolerance. If excessive residuals are persistent for more than 2 consecutive feedings, then the bolus rate will be re-evaluated and lowered. To control type 2 Diabetes, hydration status, and wasting, the levels of albumin, serum glucose, Hct, and Hbg will be monitored weekly. If the nutritional status has improved then albumin status will be improved, related to the evidence that albumin can be used as indicator of morbidity, and so it will be monitored weekly (7).

Since the patient is receiving radiotherapy and has been taken off of Colace, her bowel movements will be monitored daily to ensure regularity and the absence of constipation or diarrhea. It is also crucial to monitor IM’s oral health to ensure that current food choices and feeding options are still relevant. In the end, the client and her family members should be evaluated to ensure that they understand the principles of food safety prior to discharge.

5. Prepare a chart note (using ADIME format) detailing your plan for IM.

Assessment:

Pt. is 68 YOWF admitted with stage 3 carcinoma on floor of the mouth

Normal Ht.:169 cm Normal Wt.: 62 kg Current Wt.: 58 kg

Estimated Wt. Loss: – 4kg

BMI (current) 20.3, and BMI (usual) 21.7. Both are normal.

Laboratory results indicate low and decreasing albumin.

Laboratory value noted:

Albumin(g/L) Hbg (g/L) Hct(%) Na+(mEq/L) K+(mEq/L)

07/29 34 84 24.5 128 3.7

08/31 33 – – 133 4.1

09/12 29 97 28.5 130 4.4

EER:1565.7 kcal/day, depending on current weight, cancer and also the desire to gain more weight.

Fluid requirements: 1740-2030ml/day

Protein requirement: 145g/day

IM is eating~550 kcal/day (without consider the discard food, and over estimation).

Previous smoker.

Unknown dietary history.

On multiple medications: Dilaudid syrup, Colace, multivitamin, mycostatin, and sodium bicarbonate mouth rainse.

Experiencing mouth soreness, and difficulty swallowing.

Disordered cognition

The presence of worsening mucositis (09/07)

Undergoing radiotherapy (25 sessions) 09/03-10/04

Patient has type 2 Diabetes (IM may have previously taken unknown medication but is not on insulin).

Diagnosis:

Increased caloric needs related to the presence of tumor from carcinoma.

Progressive wasting due to malnutrition, related to increased nutrition requirements for total energy, protein, fat and carbohydrate.

IM has increased protein catabolism as evidenced by the decreasing level of serum albumin.

Energy intake is inadequate, evidenced by caloric count of`550kcal/day and weight loss of 4kg.

IM is exhibiting dehydration as evidenced by low sodium levels, very high HBG, mucositis, difficulty swallowing, and very low Hct.

Intervention:

Immediate EN (gastronomy enteral nutrition) plan – (PEG tube) of Glucerna 1.5cal as a bolus 5 times a day: 359ml Glucerna 1.5cal and 112ml water per feeding to meet IM fluid and energy need.

Remove multivitamin and Colace medication.

Applied swallowing test.

Determine current diabetes management and use glucose control formula.

Educate patient and her family about good oral hygiene, risk factors related to poor diet, food safety, and proper diet prior to discharge.

Goals to reach:

Suppress tumor growth.

Limit patient discomfort.

Patient will progress from PEG feeding to oral feeding.

Adequate intake of energy and fluids.

Control the level of blood glucose (type 2 diabetes) without adding any medication.

Increase patient’s body weight and minimize wasting.

Monitoring:

Weight: 3-5 per week.

Fluid input and output: daily.

Gastric residual: before each feeding (5 times daily).

Bowel movements: daily.

Albumin, serum glucose, Hbg, Hct, BUN, creatinine: weekly.

Mouth soreness: daily.

Ability to swallow: weekly.

Hydration: daily.

Electrolytes, Na+, K+, Calcium: weekly.

PEG tolerance: daily.

Nutrition intake calories and adequacy: 2x/week.

Evaluation:

Determine need for Colace, and anticipate weight gain until IM returns to her normalweight, as well as possible improvements in serum albumin, Hbg, Hct, NA+, K+, and blood glucose.

Also, determine if the patient is able to consume foods and beveragesorally without any problem.

6. Prepare IM for discharge and follow-up: When IM completes her treatment she and her daughter will be educated on how to follow a healthful diet with regards to IM’s condition prior to her discharge. During that time they will also be informed of the risks of consuming an unhealthful diet, and smoking in relation to the potential reoccurrence of cancer. Since IM has difficulty listening to instructions, she will be also given dietary instructions in written form. Furthermore, it is suggested that she follow up with a dietitian within 2 weeks of discharge so that her dietary intake can be monitored and so she can be given encouragement to follow a healthful diet.Finally, establish slow, steady weight gain and physical activity goals for the next three months, by reporting the importance of physical activity in rebuild muscles, regain strength and energy. Exercise also stimulates appetite, improves mood, reduces side effects such as nausea and constipation (5).

References:

Drugs.com.2013. “Drugs information online: Dilaudid syrup” Last modified Oct 2013 http://www.drugs.com/disease-interactions/guaifenesin-hydromorphone,dilaudid-cough-syrup.html. Accessed Oct 30 2013.

Purdue Pharma. 2008. “Monograph: Dilaudid”. Last modified April 28 http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php2011 Accessed Oct 30 2013.

Drugs.com.2013. “Drugs information online: Colace” Last modified Oct 2013 http://www.drugs.com/cdi/colace.html. Accessed Oct 29 2013.

Drugs.com.2013. “Drugs information online: Mycostatin” Last modified Oct 2013

http://www.drugs.com/cdi/mycostatin.html. Accessed Oct 29 2013.

Mahan K, Escott-Stump S, Raymond J. Krause’s food and the nutrition care process, 13th ED. Elsevier Saundres. Missouri. 2012.

Abbott Nutrition. 2013. “Glucerna 1.5 cal” Last modified n.d.http://abbottnutrition.com/brands/products/glucerna-1_5-cal. Accessed Oct 30 2013.

Fuhrman MP, Charney P, Muller CM. Hepatic protein and nutrition assessment. J Am Diet Assoc. 2004 08;104(8);1258-64.

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Nutrition for Chronic Kidney Disease (CKD) (2)

Nutrition for Chronic Kidney Disease (CKD) (2)

Nutrition for Chronic Kidney Disease (CKD)

Causes:

Most common cause of chronic kidney disease is diabetes and the second most common cause is hypertension (high blood pressure), which cause permanent damage to the kidneys over time. Other causes are: autoimmune disease (lupus and IgA nephropathy), genetic diseases (polycystic kidney disease), nephrotic syndrome, glomerulonephritis, interstitial nephritis (inflammation of the tubules and surrounding structures), prolonged obstruction of the urinary tract from an enlarged prostate gland, kidney stones and some cancers, vesicoureteral reflux (condition that causes urine to back into the kidneys), recurrent kidney infection (pyelonephritis).

Risk Factors:

Diabetes and hypertension are numbers one and two. Also, cardiovascular disease, smoking, obesity, being African-American, Native American or Asian-American, family history of kidney disease, abnormal kidney structure, and older age.

Prevention:

Follow instructions on over-the-counter-pain relievers (aspirin, ibuprofen, and acetaminophen). Taking too many pain relievers could lead to kidney damage and generally should be avoided if you have kidney disease.

Maintain a healthy weight.

Don’t smoke.

Characteristics/Symptoms:

Chronic kidney disease usually gets worse slowly and symptoms may not appear until the kidneys are badly damaged. ESRD (end stage renal disease) symptoms are caused by waste and extra fluid building up in the body causing persistent itching, muscle twitches and cramps, nausea and vomiting, not feeling hungry, swelling in feet and ankles, too much or not enough urine, shortness of breath if fluid builds up in the lungs, chest pain if fluid builds up around the lining of the heart, trouble sleeping, fatigue and weakness, high blood pressure that is hard to control, decreased mental sharpness.

Treatments:

For ESRD (end stage renal disease), treatments include hemodialysis, peritoneal dialysis or kidney transplant.

Complications:

The kidneys do many jobs and cleaning the blood is only one job. They also control chemicals and fluids in your body, help control blood pressure, and help make red blood cells. Dialysis can do some, but not all of the jobs that healthy kidneys do. Complications of kidney disease include anemia, bone disease, hyperphosphatemia (high phosphorus levels in the blood), heart and blood vessel disease, hyperkalemia (high potassium levels in the blood), fluid retention (could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs-pulmonary edema), damage to the central nervous system, decreased immune response, pericarditis.

Monitoring:

Levels of urine albumin and the glomerular filtration rate are monitored. To assess the response to therapy and the progression of disease, UACR (albumin-to-creatinine ratio) is measured with >30mg/g being abnormal. Reducing urine albumin excretion to normal or near-normal may improve renal and cardiovascular prognoses. Changes in kidney function is monitored using eGFR (estimated glomerular filtration rate). In CKD, eGFR is less than 60ml/min/1.73m2.

Diet modifications, why the modifications are appropriate, sample one day (3 meals) meal plan:

People with chronic kidney disease should follow a diet that is low in phosphorus, potassium, sodium (salt), fluids, and protein. Kidneys may not be able to properly filter excess potassium and phosphorus, leading to hyperkalemia and hyperphosphatemia. Excess fluid and salt promote fluid retention which can lead to swelling in extremities and high blood pressure. If thirsty, one can suck on an ice cube or hard candy (sugar-free if diabetic).

Low phosphorus foods to eat: Italian, French and sourdough bread, corn or rice cereal and cream of wheat, unsalted popcorn, lemonade.

High phosphorus foods to avoid: whole grain bread, bran cereals, oatmeal, nuts,

sunflower seeds.

Low potassium foods to eat: apples, grapes, pineapple, strawberries, cauliflower, onions, pepper, radishes, summer squash, lettuce, pita, tortilla, beef, chicken, white rice.

High potassium foods to avoid: avocado, banana, melon, oranges, prunes, raisins,

artichokes, spinach, potatoes, tomatoes, bran products, granola, beans, brown rice.

Low sodium, salt (sodium chloride) foods to eat: fresh fruits and vegetables, unprocessed foods, no added table salt.

High sodium foods to avoid: processed foods, added table salt, condiments, sauces,

chips, soups.

Sample daily meals:

Breakfast: corn cereal, rice cereal, or cream of wheat with strawberries and milk

Lunch: chicken teriyaki pita sandwich (chicken, pita, lettuce, onion, olive oil) and pineapple or an apple

Snack: unsalted popcorn

Dinner: meatloaf (lean ground beef or chicken) or grilled shrimp, summer squash or cauliflower, green beans, apple bars for dessert

Posted in Uncategorized

Nutrition Analysis Report

Nutrition Analysis Report

Nutrition Analysis Report

Student’s Name

Institutional Affiliation

Course Tittle

Professor’s Name

Date

Introduction

When I was young, I had a tendency of an aggressive appetite. I did not care about what I put into my mouth because I was somehow young, and it did not concern me. Over the last six years, I have been more aware of my eating habits. However, I have not been making a conscious attempt to change the foods that my body intakes. According to my psychological needs, they relate to my mind and emotions. The main psychological factor which impacts my food intake includes stress and my prevailing mood. Another thing, in terms of social needs, I am an individual who likes to spend quality time with my friends and family. I also like being busy in my additional time and uniting people using hospitality and food. When I decide to make food for my social groups, my main worries about the food are whether it will be comfortable serving and eating and not the nutritional content of the food. Rather than focusing on nutritional benefits, I focus more on the sharing aspect as an alternative. Other times, I am tempted to take particular foods after smelling their aroma or seeing the foods, mainly when I walk past cafeterias or food stands. In these cases, the sight or smell of food awakens my hunger sensation resulting in me craving the foods in question, and I eventually purchase them.

 The influence of culture is another concern that affects my daily food intake. My culture provides guidelines with respect to the types of food I am considered to take. It also guides my eating patterns and practices. For instance, my culture has influenced me to eat foods such as noodles, rolls, and tortillas. All the way through my diet analysis, I managed to identify eating habits that I was not aware of, particularly during the days of the week. I chose to record three days being Sunday, Monday, and Tuesday.  

Nutrition Analysis

I have realized a lot from these three days of diet analysis project. In my three-day valuation, I noted down my food consumption, the time of day, the amount of time I spent eating, and quantities. According to my results, the average caloric intake I took during the three days was 1770 calories. It was 85, 7% of my assessed energy requirement centered on my activity level, weight, height, and age. I lost 0.4kg during these three days periods. On the other hand, my average protein intake was 86,85 grams, and it was in the recommended range between 54,4 and 190,2 grams. According to the analysis, my present consumption of fiber falls short of meeting my suggested amount. One thing I learned in class is that fiber is significant in a healthy nourishment because it is advantageous in sustaining good digestive health and prevention illnesses, including rectal and colon cancer. The class readings teach that a suitable amount of fiber reduces the risk of heart diseases by lowering the amount of LDL cholesterol within the blood.

Day 1 was lower in more areas. Some were below 50 percent, which included folate, potassium, vitamin B12, dietary fiber, and Sodium. The only one that was high was phosphorus. When I began looking at the results, I thought that I had done well on Day 2 because it appeared to have fewer areas where my levels were low. I thought that the second day had a lot of intakes of minerals, nutrients, and vitamins, but when examining the data closer within the bar graphs of each day, I was not sure it was the case.

 Something that surprised me was that the number of carbohydrates I took on both days was below the recommended amount for me. It is something that troubles me since they are supposed to be high. My findings from day three surprised me too because I did not realize how little I ate but how unhealthy the food choices were. The meals that I took that consisted of the most calories were foods from fast food eateries. I commonly ate a lot of fast food during the three days because my schedule happens to be hectic and nonstop.

I presently do not exercise as frequently as I ought to consider the diets that I consume on a daily basis. I have a plan to improve and maintain better nutrition. My current food consumption practices and choices do not take appropriate nutritional needs into account. As a result, I will try to improve my dietary behavior. One that I am planning on my diet is to always focus on taking a balanced diet. I need to add more vegetables like kales and cabbages and fruits like mangoes, pineapples, oranges and balance my calorie intake and proteins. It is my responsibility to watch my fiber intake and consider an adequate amount of it. I will also take more food that is low in Sodium and fats and reduce the intake of junk foods and snacks. Presently with my calorie consumption, I have a good level of energy. But I every so often feel sleepy and lazy after taking meals. If I reduce my calorie, I might find that there is a reversal in these impacts of laziness and feeling sleepy. 

 

Conclusion 

I managed to do an analysis of my diet to examine what I was eating and the kind of nutrients I was acquiring in my body. I also made a comparison of all aspects with my recommended levels of nutrients for my nutritional recommended consumption. My diet analysis gave me the motivation I required to complete a change within my everyday diet fully. Generally, it is clear that I require to make some changes to my eating habits daily to become healthy and fit. Many factors are influencing my food choices and intake as there are ways of improving the nature of my diet. I know that changing my dietary behavior will not be easier since it needs a lot of self-discipline and commitment. For me to change my eating habits, I will have to remove all foods that have less nutritional value from my diet and replace them with those that have more nutritious value. Having a well-balanced diet is vital for a healthy life and maintaining general boy wellness. I will have many benefits in my body by eating a healthy diet. One way that will help me to reduce this is to read the labels on the food product that I take and choose those that have a lower content of saturated fat. In addition, I can also replace some of the foods with vegetables and fruits, which would, in return, decrease my fat intake and increase my carbohydrate intake. I might even begin packing my lunches because most of the flaws in my food intake result from fast and convenient foods.

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Nutrition Awareness Lab Report

Nutrition Awareness Lab Report

Nutrition Awareness Lab Report

Name of Student

Institutional Affiliation

Nutrition Awareness Lab Report

Nutrition Awareness This lab is intended to make you more aware of health issues related to nutrition.  Many Americans are overweight which increases the risk of cardiovascular disease and many other diseases.  Some people suffer from eating disorders and others have poor nutrition. In addition to on-line material, read pages 156-165 LAB REPORT 1.  Define the following:BMR

BMR is the total number of calories that the body needs for performing the most basic functions of the body that are important for sustaining the wellbeing of the individual. It is the amount of calories a person needs to burn if the person was asleep all day. BMI

BMI or Body mass index is a measure of the body fat that is based on the ration between the height and weight of adult men and women. It is calculated as the body mass divided by the body height. ObesityIt is a condition where an individual has much body fat and consequently may have negative side effect on the overall well-being in terms of health.

Essential amino acids

These are the amino acids that the body cannot create on its own and must be obtained by eating various foods. They are nine in number.

  

Essential fatty acids

These are the fatty acids that cannot be synthesized in the body and hence must be obtained from the foods that people eat.

  

Calorie

It is a unit of energy.

  

Vitamin

A vitamin is a nutrient that the body needs in small quantities to function normally and stay healthy. The main sources of vitamins are products of plant and animal origin.

  

Mineral

A mineral is a chemical element that is required by organisms as an essential nutrient in order to perform the most basic functions.

  

Antioxidants 

 Antioxidants are powerful substances that come from the food people eat and in turn prevent diseases. These substances mainly come from fresh fruits and vegetables. They also prevent the oxidation of other molecules in the body of an organism.

 

 2.  Calculate your      BMI

Weight is 84kgs and 6 feet tall in height

Height in meters = 1.8288 meters

BMI = 84/1.8288

44.8381

44.8381/1.8288

= 24.52      BMR

BMR formula for male is 66.47 + (13.7 *weight[kg] + (5 * size[cm]) – (6.8 * age [years])

BMI = 66.47 + (13.7 * 84 + (5*182.88 – 6.8 * 19)

= 66.47 + 1150.8 + 785.2

= 2002.473.  Answer the following questions: A. According to your BMI are you underweight, a healthy weight, overweight, or obese?  Do you agree or disagree with the results? Why? 

According to the BMI calculation, I am of normal weight. I therefore have a healthy weight. I agree with the results since I feel physically fit.

B.  What percentage of Americans is overweight? Obesity in the United States has faced an increasing concern in the healthcare sector that has continued to affect the lives of many people in the recent years. It has continued to significantly grow over the past five years. According to statistics two-thirds of American men are overweight while the rates of their women counterparts are considerably higher. A recent study showed that over 36% of Americans are obese for adults over the age of 20.

  What are some negative impacts of being overweight? Obesity leads to many health problems. Diseases are likely to affect those individuals who are overweight as compared to their counterparts who are of normal or healthy weight. Coronary heart diseases are especially prevalent to those individuals who are obese or overweight.

C.  Estimate the number of calories you need based on your BMR and activity level.  You will need to access some charts that give you number of calories burned for specific activities.  Based on my BMR and the activity level, the number of calories needed for proper body functioning is 1800 calories.

How would you describe your activity level? Since I exercise for over three days a week, my activity factor is 1.375.

D.  What is the recommended daily intake in % of calories of fat? protein? carbohydrate?

The recommended daily intake of fat in the diet should be between 20 and 35% of the total calories. Carbohydrates on the other hand are required for the proper functioning of the body since they are the main energy source which will eventually break down glucose. They should form a majority of the daily intake of carbohydrates. They should form 45 to 65 % of the total calories. Proteins have 4 calories per gram. The recommended diet requirements for calories from proteins are 10 to 35 percent.

4.  Keep a daily diary of food intake for at least 5 days.  Count the number of calories.  You will need to read food labels and use a calorie counter chart to determine the number of calories.  Get as close as you can but I realize it will not be perfect.  Determine the fat grams, carbohydrate grams, and protein grams.  Determine what percentage of the calories are from fat? protein? carbohydrate?  Compare your numbers with the recommended numbers.    For example if you eat 2000 calories in a day and 200 are from fat then the % fat for the day would be 10%.  Please keep track of this information in a table similar to the one I have included on this page as an example and submit the table and answers to questions when it is complete. One way of calculating your percent fat, protein, and carbohydrate:  1.  You add up the total calories and total grams of each of the three  2.  There are 9 calories per gram of fat and 4 calories per gram for protein and carbohydrates. 3.  Multiply the grams times the calories for each 4.  Divide by the total calories and multiply by 100.Example: 1200 total calories for day with 30 grams of protein.  30 X 4 =120.  (1201200) X100= 10% of your daily calories were from protein.� The total protein, fat, and carbohydrate can not exceed 100% and should be close to 100%.  You may make your own table, this is just an example. 

Grams Food and Beverage Calories Fat grams/ % of calories

Day 1 Breakfast Starbucks Caffe Latte Whole milk 260 14

“ Lunch Beef Shank 510 28.5

“ Dinner Black beans 113 22

“ Snacks Popcorn 109 1

“ Daily total 992 Day 2 Breakfast Starbucks Caffe Latte Whole milk 260 14

Lunch Ground beef 66 4.8

Dinner Corn Flakes 100 0.2

Snacks Beef Jerky 82 5

Daily total 508 Day 3 Breakfast Starbucks Caffe Latte Whole milk 260 14

Lunch Pepperoni 148 13

Dinner Pork Sausage 44 3.7

Snacks Popcorn without oil or butter 109 1

Daily total 561 Day 4 Breakfast Starbucks Caffe Latte Whole milk 260 14

Lunch Steak 43 1.7

Dinner Smoked Sausage 80 2.5

Snacks Popcorn without oil or butter 109 1

Daily total 492 Day 5 Breakfast Starbucks Caffe Latte Whole milk 260 14

Lunch Bagel, Plain 320 1

Dinner Smoked Kielbasa 127 9.9

Snacks Popcorn without oil or butter 109 1

Daily total 816  5.  Do at least two on-line health assessments.  Include the link of the assessment used and report the results. 

https://strongnutritionandweightloss.com/health-assessment/

Celebrate your strengths!

You’re already making healthy food choices. Knowing your strengths can energize you to make even more healthy habits.

Fruits and veggies

High-fibre diet

Vitamins and minerals

Avoiding fatty foods

Limiting salt and sugar

Things to work on

You’ve already made a great start. Go even further by picking one recommendation and setting a goal to help you create change that sticks.

Serve healthier portions

Drink more water

Reduce alcohol consumption

https://naturalhealthtest.com/surveys/survey_reportSome of the key principles of a health-promoting for healthy adults include the following characteristics:

Low in saturated fat, transfats and cholesterol

Contains a minimum of 5 servings of fruits and vegetables per day, on average

No or low intake of alcohol

Minimal intake of other chemicals linked to cancer risk and accelerated aging

Low to moderate intake of high glycemic carbohydrate foods and beverage.

In short, studies show that individuals who restrict their intake of fat from red meat, pork, dairy products, fried foods, pan-fried foods, high fat salad dressings, high fat pastries and regular chocolate products (coco butter), as a rule, are much less prone to the development of heart disease, stroke, thrombo-embolic diseases (e.g. deep vein thrombosis, phlebitis), colorectal cancer and reproductive organ cancers (breast, endometrial, prostate cancers). Along with lung cancer (caused by cigarette smoking in 87% of cases), these health conditions are the most significant causes of premature death and loss of quality of life due to health problems. At the same time it is well established that individuals who consume a higher plant-based diet, rich in vegetables, fruits, beans, peas and whole grains, and fewer fats from the sources listed above, are generally at much lower risk for premature development of cardiovascular disease and many forms of cancer. As such, the results of your dietary assessment that follows and the modifications you are being asked to consider may seem a bit severe in some cases. However, it is important for you to know that the feedback you are receiving is based upon evidence that is strongly supported by human research studies, which have examined the relationship between diet and disease. I would urge you to take the following information very seriously and to make dietary changes that are consistent with the feedback you receive in this section. How you feed your body each day has a significant impact on your present and future health, including risk of dying prematurely and your quality of life

6.  Based on these exercises what conclusions can you draw about your eating habits, activity level, and how it may be affecting your health. Look at the number of calories, and percentage fat, protein, and carbos that you should be eating compared to what you are eating.

Eating and exercise are interrelated directly. Exercise is a critical factor which helps to maintain health and slows down much health related aspects that are prevalent in people who avoid the same. There is reduced risk of developing cardiovascular diseases, obesity and certain cancers when a perfect blend of health and nutrition are followed faithfully by an individual.7.  Some useful links-please post any that you find on the discussion page under links.  I have included some in the content.

https://www.takingcharge.csh.umn.edu/diet-nutrition-assessmenthttps://www.drdonnavice.comhttps://theconversation.com/the-online-tool-that-can-track-monitor-and-analyse-nutritional-intake-73814http://healthyeating.sfgate.com/recommended-fats-carbohydrates-proteins-sodium-4478.html

8.Based on what you know about your eating habits, life style, and activity level design a 5 day ideal menu and exercise plan. This will be different for everyone. The goal is to design a plan that you would be able to follow. For example, a very active person of normal weight may be able to have more calories. A person who eats on the go will have different menu choices than someone who prepares all of their own meals.

Calories Fat grams

Day Breakfast Yoghurt, egg, Apple 80+127+75 15

Lunch Salmon, 2bananas+Avocado 121+220+185 25

Dinner Sweet Potato+Black beans+Tofu125+113+94 Snacks Apple pie+Pumpkin cheesecake+Angel food cake 294+340+240 Daily total 2014

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Nutrition and Health

Nutrition and Health

Nutrition and Health

Name:

Affiliation:

Course:

Instructor’s name:

Date:

Nutrition and Health

For the Drive-Thru Diet Assignment, you are to select a fast-food chain of your choice, go to the chain’s website, and plan two luncheon meals.

My healthy meal

Fruit and Maple Oatmeal

Artisan Grilled Chicken Sandwich

Fruit ‘n Yogurt Parfait

Iced Nonfat Caramel Mocha

My unhealthy meal

Buttermilk Crispy Chicken Sandwich

Large Fries

McFlurry with M&M’s

Chocolate Shake

My fast-food choice is McDonald’s. McDonald’s started its operation in 1954 in California, United States, and was found by Richard and Maurice McDonald. Its headquarters are in Chicago and Illinois. McDonald’s is arguably the leading fast-food restaurant globally, not to mention a prominent foodservice retailer. More than 65 million customers across various parts of the world (119 countries) receive McDonald’s products and services based on the company’s 2018 report. Also, over 2 million people directly work for that chain of restaurants. Some of the essential products the brand is recognized with are burgers, French fries, desserts, beverages, soft drinks, and chicken products. The company is trying to keep with the dynamics of health and nutrition by continually reviewing their menus. Menu reviews help make adjustments on food items that are subject to causing health problems such as obesity, some cancers, diabetes, high blood pressure, and other diseases.

My healthy meal menu

Fruit and Maple Oatmeal

It takes care of various individuals ranging from those who use brown sugar, dried cranberries, a splash of cream to fresh diced apples. It is a standardized meal with 310 calories, 4g fat, 62g carbohydrates, and 6g proteins.

Artisan Grilled Chicken Sandwich

It is a delicious sandwich with no fear for health compromise; more importantly, it is up to satisfy one’s cravings. The quantity of calories is 380, 6g fat, 45g carbohydrates, and 36g protein.

Fruit ‘N Yogurt Parfait

It is a sweet dessert with no chances of feeling guilt. The Fruit ‘N Yoghurt Parfait has a low concentration of fats and is nourished with fresh strawberries, granola, and blueberries; ensure your dessert is sweet, and your treat is not less than extraordinary. As such, it has 150 calories, 2g fat, 30g carbs, and 4g protein.

Iced Nonfat Caramel Mocha

For those who like sweet drinks, an iced caramel mocha is arguably the best bet. It has nonfat milk with 26g sugar and 200 calories.

My unhealthy meal menu

Buttermilk Crispy Chicken Sandwich

Crispy is a word often used to refer to “breaded with sugar and fried in fat.” The meal is made with fattening buttermilk, not to mention being topped with a substantial amount of mayo dressing. It makes this type of sandwich to contain more fat than a few slices of cheese pizza. The calories’ content is a massive 600, 29g fat, 980 mg sodium, 58g carbohydrates, 2g fiber, 9g sugar, and 27 g protein.

Large Fries

Fries are one of the most fast-food items that people often buy. Consuming a significant quantity of fries will set back close to 500 calories than you would if you decide to eat a double cheeseburger. As such, it has 490 calories, 23 g fat, 400 mg sodium, 66 g carbohydrates, and 7g proteins.

McFlurry with M&M’s

It is an iconic dessert with a sweetened cream base and sugar. The dissert would fail to meet the required FDA set standards of sugar content (50 grams) as it has a whopping 86 grams of sugar. Additionally, it has 640 calories, 21 g fat, 200 mg sodium, 96 g carbohydrates, and 13 g protein.

Chocolate Shake

It has more calories than a double cheeseburger and contains sugar contents as seven glazed Krispy Kreme donuts would. Consuming a significant quantity will see one gulp down a massive 850 calories and 120 grams of sugar. On average, this food item has 530 calories, 15 g fat, 260 mg sodium, 87 g carbohydrates, 12 g proteins.

In conclusion, one of the things that caught my attention in my unhealthy choice of meal was the substantial amount of things like calories, fat, sugar, and carbohydrates present in people’s food items. In my healthy food choice, the amounts of content concentration were significantly low.

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NYT article “Drone warfare and civilian deaths”

NYT article “Drone warfare and civilian deaths”

NYT article “Drone warfare and civilian deaths”

Author

Tutor

Course

University

Date

There are always various aspects of writings. Each writer naturally leans towards their views or their sides of the story. Some articles thus end being opinionated or one-sided. The opinionated articles are based on the personal views of the person writing it like the article “Drone warfare and civilian deaths” by Manuela Mirkos. The author details how drones have been more harmful than killing the targeted terrorist groups.

The fallacy presented in this article is illogical conclusion. Illogical conclusion fallacy is a case whereby the writer attests a conclusion that does not follow from the suggestions provided. The author can be credited for writing from his own personal experience of encounter and experience of how the USA drone targeted to eradicate the terrorist have ended up killing civilians. The writer coming from Yemen has had personal contacts with the victims. However, the conclusion arrived by the writer that the entire drone program is ineffective is a fallacy. The writer, with the sympathy of the casualties caused by the drones, simply drafts his message to suit his condition. The writer does not detail the number of achievements and the terrorists that have been killed by the drones. Mirkos states “Years after the so-called targeted-killing program started in Yemen, neither Yemen nor the United States is safer”. This is a fallacy. It is not based on factors and the number of successful cases, the writer never minds to touch.

In conclusion, I can say that the article is a fallacy. There have been detailed statistics in the USA government about the successes of the drones. Additionally, some of the leaders of terrorist groups have been killed via drones. The lack of statistical data on the same also confirms the fallacies presented herein.

References.

Mirkos, M., (2016). Drone warfare and civilian deaths. Retrieved from

http://www.nytimes.com/2016/03/02/opinion/letters-to-the-editor.html?ref=opinion on

2th, March, 2016.

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Nursing Theory

Nursing Theory

Nursing Theory

Presented by

Institution

Question one:

The King’s theory of Goal Attainment analyzes the output of nurses in achieving health goals and promoting patient outcome. In the given case, the Goal Attainment theory would play a big role in planning, implementing and evaluating the care of the patient. The goal attainment theory claims that an effective communication between nurses and patients helps in attaining health care goals (Basavanthappa, 2007, p. 165).

Planning:

The theory promotes good nurse-patient interpersonal relationship, which will be used in planning visits to monitor blood sugar levels, diet advises, exercise courses and mode of medication. The theory ensures timely consultation between the two parties making it easier for the implementation of the planned activities.

Implementing:

After planning for the patient’s care activities implementation follows. The theory ensures effective communication between the nurse and the patient promoting togetherness that helps in timely implementation of the proposed plan.

Evaluation:

The evaluation process involves identifying the patient’s outcomes and analyzing them to determine whether there is any observable change. The theory introduces a framework that helps in evaluating the outcome of a health care plan. The concept of personal system helps in understanding patient’s nature making it easier for the nurse to self-evaluate the patient.

Question two:

The Levine’s Four Conservation Principles theory is the most appropriate for Ann Ching’s case. Levine’s theory claims that different individuals adapts differently to internal and external environments. Some individual might have similar adaptive features but organismic responses are unique (Levine, 2009). From Levine’s theoretical perspective, Ching suffered from two main problems. Firstly, the organ transplant made Ching develop a poor interaction with the environment that resulted into poor adaptation to the environment. There was lack of balance between her normal body organs and the new liver. Secondly, Ching’s lifestyle changed because she used to live a healthy lifestyle, but suddenly started surviving on drugs. As a mother of two and an employee, she could not bear sitting down and taking drugs while her family had no one to take care of since the husband was busy developing new software. Ching undergoes a stressing life. Stress is one of the aspects of the Levine’s theory.

The most appropriate nursing intervention for Ching’s case would be constant therapy and counseling sessions in order to make her accept the new life. In addition, Ching need to be assigned a home-care practitioner to constantly check her status, encourage her to take medication and eat a healthy diet in order to ensure quick adaptation of the new liver to her body system. It is expected that Ching’s body will effectively adapt to the new environment and go back to her normal life.

Question three:

The positivist paradigm observes the world as a base for unchanging universal laws and assumes that everything occurring in nature is explained through the knowledge of universal laws. People need to observe and understand the situations surrounding them in order to understand the universal law and promote positivist. The knowledge of positivist comes from scientific research where researchers use quantitative methodology approach. It results to a scientific, logical approach to research. Positivist also forms the source of all authoritative knowledge. In the field of nursing and medicine, positivist’s knowledge assumes that all health care issues in a society would be explained in a theoretical approach. In addition, the knowledge of positivist is acquired from philosophers who derive logical and mathematical treatments and reports that explain the nature of the universal law and its application to the field of nursing research.

References

Basavanthappa, B. T. (2007). Nursing theories. New Delhi: Jaypee Brothers.

Levine, M. E. (2009). Myra Levine’s Conservation Theory. Retrieved November 3, 2014 from

http://nursingtheories.blogspot.com/2009/07/myra-levines-conservation-theory.html

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Depression and Counselling Theory

Depression, Counselling Theory

Depression and Counselling Theory

Counselling Theory Paper

George is an elderly man, aged 68 years, who showed serious signs of depression and addiction to alcohol and narcotics. He also exhibited signs of being a mentally ill man, who knows his past mistakes in life and sees no reason to even try changing his current situation. He is a divorced man who has little contact with the social world and the only relationship that he currently has is with his dog Spike. I decided on using the Cognitive Behavioral Therapy (CBT), as the most appropriate counselling theory to help him.

Rationale for Selection of CBT

The rationale behind choosing this specific theory is due to the capabilities of the theory and the nature of the case at hand. According to David, 2006 CBT, it is based on the premise that people should learn to let go of their past and focus on improving the future. Central to this therapy is that it focuses on talking. This allows people to express what they feel without fear of judgement (Williams, et al, 2013). According to Blehar, 1997, CBT works also when used with people who have an addiction to something.

George can very well express himself and his life with detail and precision; this is why this therapy best suits him. For a person of his age, he has good memory and is able to remember issues that had happened earlier in his life even under the influence of alcohol. George has serious cognitive impairments; he was able to score 15 in the MMSE test and a 45 out 60 in the CES-D score which is a clear indication of cognitive impairment. George is also an alcoholic, he uses drugs like marijuana and even hard core drugs to help him ease his thoughts and to feel better. George is also willing to corporate with the therapy; this is mainly because he recognizes the fact that his life is not exactly how he wanted it to be at his age. As much as the therapy is not meant to cure the physical ailments and addictions of George, it is meant to create an empowering foundation and a more optimistic way of dealing with his problems. His fear to face the future is hindering him from achieving the best he can in relationships.

Initial Problem Selection

George is a man troubled by many issues but I chose to deal with two of his problems, depression and addiction to alcohol and narcotics. From the interview, it was clear that George’s divorce had taken a toll on him. This was because it made him lose all personal contact that he had maintained earlier on. He has also lost touch with his religion. As a Muslim he was a dedicated follower but all that was lost ten years ago when he started eliminating himself from the society and all types of relationships.

According to Knight, 2006, depression is usually revealed when the individual pulls himself away from the society. This is because they feel that they are better off being alone as nobody wants to be with them. At this point George feels like there is no way his problems can be solved by anybody. This explains the reason as to why he is afraid to patch things up with his ex-wife. At this point he is afraid of starting any form of relationship with anybody and that is why he has had no intimate or friendly relationship with anybody in a long time.

Roth, Pilling and Hill, 2009, state that depression is associated with low self esteem and self criticism. Counselling for depression is a model that targets emotions that mostly are underlying and are the root cause of the depression. It is also meant to bring out the emotions that make sense to the person but must initially come from them for them to be willing to try them out in their lives. Roth, Piling and Hill devised a framework on how to help people with depression called the humanistic framework. It is based on allowing all the negative emotions and issues to come out and then the positive ones will slowly come out. The results of the experiment done at the Pearson Centre proved that people do indeed have the ability of coming up with the best solution for themselves but first they must be given that chance to do it themselves and must be dedicated to it as well.

The framework will work for George because from the interview it was clear he is suffering from clinical melancholy, which is depression couple up together with some cognitive problems.

Discussion of the Model

I will show how the qualifications that make George to fit into this framework.

The framework focuses on a step to step follow up of the individual who experiences different events in his life that ultimately lead to depression while others are as a result of the depression (Scherer, 2009).

First the individual makes a few wrong decisions in their lives. George had always wanted to have the life that everybody wants, a nice job and a lovely family. But somewhere down the line he made some few mistakes that caused him to lose some of these things and he now sees his mistakes.

The next step is that the person is caught up in looking at his mistakes instead of finding clear solutions to them. Instead of focusing more on what he still had even after making his small and major mistakes, he focused on the mistakes. This is evident from the fact that after he divorced his wife he completely cut all contact and relationship with everybody else. After his divorce, he saw no need of going to mosque and with that he lost a relationship with his God. He also let his relationship with his mother be reduced to an occasional phone call. His relationship with his brother is no longer the same and the one with his daughters is even worse. This cannot even describe the relationship with his friends because i is no longer in existence, he believes that they avoid him since he has his problems.

The third step is that the persons self esteem is seriously affected and they criticize themselves very harshly. George’s self esteem was seriously affected; this is the reason why on looking at him during the interview he looked unkempt. His uniform was dirty and he was not shaven. Hours after his shift ended he is still in his uniform while most people cannot wait to leave work and take off their uniform. This is because he sees no need to do that, to him it is not worth the trouble. He also believes that nobody wants to be associated with him, according to him he is not the one who pulled away from his friends, they are the ones who avoid him because they believe that he is mentally unstable. He is even not sure about reconciling with his ex-wife and it is not because he does not love her and does not long to have some company but it is because he feels he has failed her too much in the past and he doesn’t deserve her taking him back. He feels like he is failure and does not deserve to have someone with him.

The last step is when the person takes up a destructive addiction or activity that helps him escape from the world and feel better for just a while. The other step was George turning to alcohol and drugs and becoming addicted to them. He consumes alcohol because he believes it is the only way he can relieve himself of the stressful issues that he has. To him, there is realistically no way of solving as it is too late. Time has passed too much and there is not much that can be done. Once he uses these drugs and consumes alcohol he goes to another world where he gets the chance to get away from all the worries.

At the heart of the model is the interaction of emotions that lead to some cognitive and behavioural attributes;

Lacks of paying attention to the small things in life, for instance most people do not brush their teeth nor shave their beard. This is the behavioural character that is very visible on George. People also forget the day of the week, George can hardly remember the date and avoids doing any calculation on the test and does not write much on the questionnaire. This is because he probably finds it difficult to do simple addition and subtraction. This means that he is not interested in the events and occurrences of the country for instance politics, economics and even security matters. To him they are of less concern and there is no need to get to know them.

Poor communication skills are exhibited; this is because the people feel like others cannot understand them when they speak calmly. They may feel the need to act it out when trying to explain a specific point. This is reason as to why George feels the need to throw his arms out while speaking. This is because in his mind, he thinks that what he is saying will not be understood unless he actually demonstrates it using hands.

Denial is also a major emotional and cognitive defence mechanism. This is exhibited by tendency not to admit to some situations (Scherer, 2009). During the interview, George also skips over things that he does not feel like talking about. This means that his problem is actually bigger than he is willing to agree. The fact that he believes that he only drinks because he is lonely at times and not because he is an addict is also another point of denial.

Implications for Treatment

The treatment will be done in three phases the early, middle and final stage. This will be done in roughly 15- 20 sessions with George. At the end of the treatment there will be certain expected results and changes.

According to Williams, et al, 2013, the move to another stage will only be possible after the successful completion of the previous stage. The early stage is made up of discussion with George on the strategy to be used, to collect the necessary data required and all relevant information. It is in this stage that George gets to reveal his expectations at the end of the sessions and after several months after the sessions as well.

After that we shall move on to the second stage, at this point there will be several experiments performed to see if the strategy and the framework completely fits his situation, several adjustments can be made to ensure that the strategy is efficient (Blehar, 1997). It is also at this stage that we deal with George’s emotions, as stated earlier he will let all the negative emotions come out and with little assistance he will come up with a suitable and realistic solution that can solve his depression, fears and help mend his relationships. In the final stage, there will be the termination of the sessions and also the implementation of a strategy that will avoid relapse into depression and alcoholism.

During the first stage, all information and data pertaining George will be revealed. This is because the information in this stage will be used in the next stage. George is expected to grasp the seriousness and conceptualize the CBT and all the expectations from him. All the pre existing issues from his decision to leave the basketball sponsorship will be addressed and will act as a foundation in his case.

In the second stage George will bring out all the negative emotions, what he actually and truly feels so that it can lead him to alcohol and to shut himself away from the rest of the world (Blehar, 1997). All the broken relationships will be discussed and the various ways in which they can be amended. It is obvious that George knows some of his mistakes but what he does not seem to know is how to solve them especially at this time when he has grown old. As a father, a son, a brother and a friend he has a role to play in these relationship. He has to come up with the solutions but a relationship at a time to avoid overwhelming him. Having closure is something important in any relationship, it may not mend it but it will help one not to carry emotional baggage.

In this stage George will explain how his life was like before all the changes and which aspects were there and he would like to have back. He will experiment by trying out some of the interests that he had prior to adopting the alcohol drinking habit. It is also at this point that all the negative side effects of his current life will be made to him; however he has to be the one to point out what exactly he feels he is ready to start changing. This will give him the chance to voluntarily give out information.

In the final stage, as the sessions are terminated there will be strategy that will be aimed at ensuring that George will have a social life that includes at least taking spike for a walk in the park full of people and trying out the outside world with his new friend and see if he can make new friends. George is expected to create a new habit that takes the place of drinking alcohol, for instance playing a sport or even reading a book. Then termination will occur with follow up to take place periodically.

Further Discussion

Although this paper is basically supposed to be dedicated to George and his psychological issue of depression, it is also going to dedicate on a few other issues that George is going through and how to best resolve them. These are issues that can be solved by CBT and others cannot be solved by it. It is limited to the psychological aspect of George.

At the age of 68 years George is still physically able to provide for himself but with time he will retire and will be dependent on other people. this is the high time that he solves the issues to do with his mother and daughters before it gets to the point that he completely has no other alternative.

George has cognitive impairment that requires to be treated. This is evident from his lack of coordination of the issues during the interview. This can be as a result of alcohol consumption over the years. This is because alcohol with time decreases proper mental and physical coordination. This may be the reason as to why his hygiene is questionable. Medical intervention is required as there be other physical negative effects that he has developed over the years and during the interview I was not able to detect. For a proper evaluation, a full body check up should be embarked on.

Due to years of withdrawing from the social world, he may be willing to go out there to make friends but may not know how to. He may require a few sessions to be conducted outside in the open where there is interaction with people. This being a person who is looking to stop alcohol intake and is looking for a new hobby, a visit to a golf court would be highly recommended. This however easily follows during the follow up sessions.

Conclusion

George has gone through many traumatic and tough times and he is only human to feel stressed. However he feels judged and this has made him to shrink further and further away from the society. At this point his ex wife is trying to reach out to him but he is way too deep and sees just a failure who will fail her again.

George dedication to the process and strategy will help him to be able to restore his life to the way it was if not better, but he still requires all the other to be willing to help in this process as well. This is because someone may dig themselves into a hole that gets too deep. But when at low place the only other place to go is up and this is his situation. He is willing to come up but he just needs the people around him to help dig his way out.

With a little help from his family and friends George will be able to solve all his psychological problems and become a well off productive citizen.

References

Cognitive-Behavioral Interventions With Older Adults: Integrating Clinical and Gerontological Research, Derek D. Satre, Bob G. Knight, and Steven David, 2006, Professional Psychology: Research and Practice, Vol. 37, No. 5, p 489-498

Psychotherapy for Depression in Older Adults, Edited by Sara H. Qualls and Bob G. Knight, 2006, Wiley Series in Clinical Geropsychology

Counselling for Depression; Critical look at Cognition, Roth, Pilling and Hill, (2009), Pearson Print Press

The Psychological Treatment of Depression, J. Mark, G. Williams, 2013, University of Oklahoma Print Press, p324-455

The cognitive Psychology of Depression at Old Age, Ian H. Gotlib, Howard S.Kurtzman, Mary C. Blehar, 1997, p 94- 150

Self stigma and Psychological Depression; Help Seeking for Depression, Joshua Scherer, 2009, p 7-56.

Depression in Canadian Adolescent Females

Depression is the most well-known mental issue among adolescents

Background

Depression is the most well-known mental issue among adolescents with commonness rates going from 15-20% among adolescents between the age of 14-19 year, and it is accepted to be a significant helping variable in Adolescent suicide. In addition, depressive issues are fundamentally more regular in females than in males, with lifetime predominance of 14.1% for females and 8.6% for males. Some epidemiological, group and clinical studies have demonstrated that girls commonly have been found to show more elevated amounts of depressive side effects than young men. This has been ascribed to hereditary qualities, expanded predominance of nervousness issue in females, organic changes connected with pubescence, cognitive inclination and sociocultural variables. Few Canadian studies were directed to research the commonness and symptomatology of pre-adult gloom (). In a study including an example of essential and preparatory schools in the city of Alexandria 10.3% of students showed depressive scores, which were most astounding among the most established age amass (20.3%) (Kerr et al,. 2010). Girls had higher depressive scores when they were contrasted and young men. Adolescents who had a constructive history of suicide endeavors had essentially higher melancholy scores (93.7%) (Kiesner, Poulin & Dishion, 2010).

In the 1999 national study of Canadian adolescents, 59% of the example reported encountering sentiments of apprehension or tension. Forty for every penny of kids with tension issue had a comorbid depressive issue. In the National Comorbidity Survey, most cases reported intermittent depressive scenes and critical part debilitation, including endeavored suicide among 21.9% of those with MDD. Conceal gloom could be diagnosed in adolescents showing hyperactivity, forceful conduct, or misconduct on the off chance that they showed discouraged influence and indicated depressive or negative subjects on projective tests (Kiesner, Poulin & Dishion, 2010).

Dysphoria and/or fractiousness may take the spot of satisfaction and euthymia as the youngster’s prevailing inclination state. Expanding levels of misery, mournfulness, outrage responses, or candid wraths set off by insignificant or minor incitements may be taken note. Abnormal amounts of ecological push and also a couple of key distressing occasions were connected with suicide endeavors; a late sentimental separation or being attacked added to suicide endeavor hazard, past the impacts of psychopathology (Leatherdale & Ahmed, 2010). Once in a while do adolescents look for, all alone, contact with mental wellbeing experts for assessment of creating state of mind indications, in spite of the fact that they might all the more every now and again reach accessible experts or administrations spotted on location in school settings. Adolescents uncover their depressive sentiments all the more frequently through reports toward oneself than to their guardians

Aim of the study

Through this study, the creators pointed:

1- To gauge the predominance of depressive issue in Canadian adolescent females.

2- To gauge the trademark side effect profile of Canadian adolescent females (if there is a trademark profile).

Hypothesis

The speculation of this study was that depressive issue are profoundly predominant among Canadian female adolescents, and that there is a particular symptomatology describing the depressive issue in this age bunch. However accessible writing gives no direction in this matter. Methods

Design of the Study

This study is a descriptive, cross-sectional, school based study.

Site of the Study

This study was led in Ontario, Canada. A specimen of female Adolescent school understudies in Eastern Ontario was drawn. Six schools were chosen from two instructive regions, one locale speak to higher financial status (3 schools) and alternate less well-off status (3 schools). From each one school, 3 classes were chosen and all understudies in each one class were incorporated. Selection (Leatherdale & Ahmed, 2010). Essentially a strategy for examining was taken after permitting every significant variable to help in the constitution of the example an impart that was proportionate to its weight in the guardian populace. Determination of the span of this example was carried out after the interview of a statistician, examining was performed arbitrarily at five levels:

The city (Ontario) has 5 major geological territories from which one was chosen (Eastern Ontario).

2- Educational framework in Eastern Ontario was isolated into two real classifications (Private and Public) focused around financial profile.

From every classification three schools were picked.

Schools were looked over two instructive regions, one speaks to higher financial status (non-public schools) and alternate less well-off status (state funded schools), and those locale were (Heliopolis and El-Zaytoun).

From each one school, 3 classes (one class speaks to every auxiliary evaluation) were chosen and all understudies in each one class were incorporated. Choice of the classes was dictated by the school powers.

Ethical considerations

Amid the time of information gathering there was no moral panel (as of late settled in McGill University), be that as it may; the creators got the acknowledgement of power figures in McGill University and the Ministry of Education before beginning the study methods. Likewise, an educated assent was gotten from every member; they were educated about the surveys being utilized as a part of the study and acknowledged their offering in the study.

Procedures

The information were gathered by immediate talking with of the subjects in suitable settings inside their schools amid a period from the earliest starting point of November 2006 to the end of March 2007. At the time of the examination, an aggregate number of 602 pre-adult female understudies took part in the study, while the quantity of non-partaking female understudies was around 74 understudies. The clear explanation behind non-investment was their unlucky deficiency from school at the time of the study or being missed amid lessons or the time of the break.

The subjects of the study completed the following tools:

The General Health Questionnaire (GHQ), it is a screening instrument for psychiatric sickness so as to recognize potential cases which could then be checked and the way of which could be dictated by utilizing a second stage instrument as it shouldn’t be utilized as a sole standard for analysis, it is basically used to discover casernes. The form utilized as a part of this study is the Canadian rendition of a short 28-things scale with the example scorer technique which is (0-0-1-1). The cut-off purpose of GHQ was 7 as per comparative past national studies to minimize the related misrepresentations with the first low edge score.

The Children Depression Inventory (CDI), which is intended to be utilized as a screening instrument for melancholy in an ordinary adolescent specimen or as a measure of indication seriousness. It is helpful for furnishing the clinician with organized, age and sexual orientation standard referenced data about the tyke symptomatology. The scale is suitable for adolescents and adolescents from seven to eighteen years of age. It comprises of 27 gatherings of proclamations; each gathering comprises of three announcements speaking to the subject’s inclination at the most recent two weeks. The score is from 0-2 as per the manifestation seriousness and the aggregate score extends between 0-54. The cut-off point utilized for this study was 24 as comparative past national studies. It has been institutionalized and meant Canadian dialect. Adolescents who scored more than 24 on (CDI) were further assessed by the accompanying polls:

Structured Clinical Interview for DSM-IV Axis I Disorder (clinician rendition) (SCID-I), a semistructured demonstrative meeting focused around a productive yet careful clinical assessment. The study utilized the Canadian adaptation of the Structured Clinical Interview for DSM-IV hub I Disorders (SCID-I).

The Hamilton Rating Scale for misery (Ham-D) intended to measure the seriousness of depressive manifestations in patients with essential depressive indications, it is the most ordinarily utilized eyewitness evaluated depressive side effects rating scale. Its interior consistency (Cronbach’s alpha) was 0.76, and 0.92. It is an agenda of things that are positioned on a scale of 0-4 or 0-2. Scoring: extremely serious >23, extreme 19-22, direct 14-18, mellow 8-13 and typical < 7.

Statistical Analysis

All information were recorded and exchanged on Statistical Package for Social Sciences (SPSS) Version 17. The results were classified, assembled and factually examined utilizing the accompanying tests:

• Descriptive detail were accounted for as means and frequencies.

• Pearson Chi square test (X2): to distinguish whether there is a critical relationship between diverse downright variables.

• Student t-test: used to test for measurable centrality of fluctuation between two examples implies.

• P quality: used to demonstrate the level of importance: critical is P < 0.01.

Results

The mean age for the mulled over specimen was 15.7 + 0.9 years and 15.4 + 0.99 years for higher and lower social class schools individually. A rate of 15.3% of the mulled over specimen were assessed to meet criteria for sadness as indicated by the CDI cut-off point. While, by the utilization of SCID-I around 13.3% of the mulled over populace was found to have depressive issue, appropriated as 5% sub-edge depressive side effects, 5% MDD and 3.3% dysthymic issue. As per Ham-D, 10% of discouraged female adolescents included in the study were named having moderate depressive state, while 30% had gentle depressive state and 60% of them had subthreshold depressive state (Table 1)

Table 1. Circulation of seriousness of dejection among discouraged understudies, as measured by Ham-D.

In this study the exhaustion or absence of vitality (discovered by Ham-D) was by a long shot the most widely recognized side effect among discouraged female adolescents (81.3%) took after by negativity with respect to the future, feeling miserable, low self regard, psychomotor hindrance, absence of focus, blame, suicidality, sleep deprivation, anhedonia, hypersomnia, weight addition, and ultimately weight reduction and psychomotor unsettling (Table 2).

Table 2. Dispersion of depressive side effects among discouraged understudies, as measured by SCID-I.

This study uncovered that 75.5% of youthful females evaluated as having moderate depressive state had suicidal indications (recognized by Ham-D), 52% of Adolescent females appraised as mellow depressive state accomplished the same side effects, and 43% of understudies with subthreshold depressive state additionally had suicidal manifestations.

Suicidal ideations (answer 3 for the inquiry regarding suicide in Ham-D) were the most well-known of the suicidal indications in Adolescent females, 20% of the specimen of discouraged female adolescents, while the rate of genuine endeavors was 2.5% of the example.

Concerning between depressive issue and other psychiatric issue (evaluated by SCID-I) summed up uneasiness issue was the most pervasive comorbid finding (32.5% of discouraged understudies), emulated by social fear (20%) then substance misuse (8.8%) then over the top impulsive issue (0.1%) (Table 3). Likewise screening by GHQ uncovered minor psychiatric bleakness in 46.4% of Adolescent females.

Table 3. Dissemination of comorbid psychiatric conclusions among discouraged youthful females as per SCID-I.

Discussion

I-Prevalence of depression

A rate of 15.3% of the mulled over specimen were assessed to meet criteria for sorrow as indicated by the CDI cut-off point. The study addressed the first piece of the fundamental theory of the study. It uncovered the point commonness of depressive issue among this specimen of Adolescent females as indicated by SCID-I to be around 13.3%. This commonness is moderately high when contrasted with comparable studies. Kessler and Walters inspected adolescents and youthful grown-ups and discovered the 30-day commonness was 5.8% (significant misery) and 2.1% (minor despondency) as indicated by DSM-IV (Morse et al,. 2008).

Higher predominance of depressive issue among pre-adult females in an Canadian group may be the consequence of a foundation of social, social and enthusiastic insecurity describing this particular age amass notwithstanding the oppression females predominating social orders in a large portion of the underdeveloped nations some of the time announced and more often than not denied, trying to wear cultivated behavior and practices.

II-Symptoms

The second piece of the primary speculation was a trial to outline a particular symptomatology describing misery among Adolescent females. The symptomatology portraying melancholy in pre-adult females was prevailed by weariness and absence of vitality (more than 80%), at times with psychomotor impediment (around 2/3 of the example). Likewise negativity, trouble and low self regard were communicated (around 3/4 of the example). A sleeping disorder was accounted for (45%) ordinary citizen than hypersomnia (33.8%). Weight put on and weight reduction were accounted for, both were accomplished practically ambiguously (around 1/3 of the example for each). Sociality was discovered to be generally high (around 1/2 of the specimen) (Morse et al,. 2008).

Somatic symptoms

In this study the exhaustion and absence of vitality were by a long shot the most widely recognized side effects among discouraged female adolescents (81.3%), notwithstanding psychomotor impediment (62.5%), and psychomotor fomentation (20%). This was as per aftereffects of more established Canadian studies. The clinical profile of psychiatric issue (DSM-III and III-R individually) in the Canadian group was formerly mulled over and they found that physical indications were the most well-known manifestation, among the discouraged Canadian populace. The results were about like that of McCormick, Mathews, Thomas & Waters (2010) who found that the most widely recognized depressive manifestations (measured by CBDI) were exhaustion and physical indications in an example of Canadian adolescents.

Notwithstanding; these results were not the same as those of different studies performed in western nations, the most widely recognized manifestations among discouraged adolescents were sentiments of pity, dismalness, discouraged temperament and slumber aggravations. The error in the middle of eastern and western groups as respects the way the youthful females experience and express their discouragement may be an intriguing zone for future investigates.

In Canadian society, individuals have a tendency to cover their influence with substantial protests, which involve the closer view and the emotional part of their ailment subsides to the foundation. This may be because of more noteworthy social acknowledgement of physical objections than of mental dissentions which are either not considered important or are accepted to be cured by rest or begging. Physical disease and substantial sign of mental misery are more satisfactory and prone to incite a minding reaction than the dubious objections of mental trouble which can be ignored or considered as a shortcoming or a level of craziness. A late study performed by Stein et al (2010) inspected ethnic/racial contrasts toward the start of treatment among members in the Treatment for Adolescents with Depression Study (TADS). African American and Latino youth were contrasted with Caucasian youth on indication presentation and cognitive variables connected with sadness. In opposition to speculation, there were no noteworthy contrasts in indication presentation as measured by the meeting based things of the Children’s Depression Rating Scale-Revised (CDRS-R) (Kendall et al,. 2010).

Emotional symptoms

Adolescent females in this study demonstrated a scope of passionate and cognitive side effects in the setting of depressive manifestations. Negativity (75%), pity (73.8%), and low self-regard (73.8%) were the commonest (Table 2). The self-impression of discouraged adolescents normally are checked by sentiments of insufficiency, mediocrity, disappointment, and uselessness. Assessment of this rule is testing on the grounds that numerous adolescents don’t straightforwardly recognize such negative self-observations. Numerous adolescents specifically report a discouraged disposition a great part of the time, in any case; sorrow in adolescents generally communicates as a bad tempered inclination, on the grounds that numerous adolescents fail to offer the passionate and cognitive advancement to effectively distinguish and compose their enthusiastic encounters

In agreement to the current study, Kendall et al,.(2010) showed a solid relationship between depressive manifestations and thought toward oneself. Contrasted and alternate gatherings, adolescents in a custom curriculum at danger for passionate and behavioral issue demonstrated a noteworthy diminishing in thought toward oneself after age 15. Also, high disguising conduct was connected with more depressive side effects and lower thought toward oneself. In spite of the fact that unequivocally denied by the Canadian group, sentimental connections and fizzled relationships may assume a real part in the etiology of depressive side effects among pre-adult females. These adolescents need to face their disappointments and fix their mix-ups either alone or looking for the assistance of the unpracticed companions and associates.

Vegetative symptoms

Adolescent females in this study had vegetative indications extending in the middle of run of the mill and atypical side effects of discouragement: (45%) experienced sleep deprivation, while (33.8%) accomplished hypersomnia. Audit of writing uncovered distinctive patterns: an inclination to portray atypical depressive indications in the pre-adult age bunches. This may be ascribed to the personality disarray and revolting state of mind towards customs and standards intimated by the family and the general public, prompting evident changes in the slumber example and beat. Rest aggravation is normal in discouraged adolescents, (interviewed by the Schedule for Affective Disorders and Schizophrenia for School-Age Children-and finished the inclination and emotions report toward oneself misery poll) a large number of whom depict their slumber as non-remedial and report trouble getting up in the morning. Rest aggravation shows as a sleeping disorder, hypersomnia or huge movements of slumber example over the diurnal cycle. These discoveries were not as per the current study. Definite dissection of the slumber example ought to be assessed in further research (Hankins et al,. 2010).

As respects weight changes, weight increase was an indication in (33.8%) of the discouraged females, and weight reduction was accomplished by (30%) of them (Table 2). The adolescents are demonstrating an over concern with their physical appearance which is generally the aftereffect of their adjustment to companion gathering impact. Different studies demonstrated distinctive comes about longing and weight changes: anorexia is more common in juvenile girls. While a few adolescents with depressive issue want and consume more particular sustenance (i.e. trash nourishment and carbs) and as needs be put on more weight than anticipated amid their youthful development spurt. Further assessment of longing and weight changes among discouraged Adolescent females is required.

Suicidality

In this study suicidal manifestations (counting last requests, suicidal ideation and suicidal endeavors) were pronounced by (48.8%) of discouraged adolescent females. The recurrence of suicidal side effects was 75.5% among subjects with moderate depressive express (8 subjects). While of the adolescent females enduring of mellow depressive express (23 subjects), 52% accomplished suicidal indications. Interestingly, of the subjects who accomplished sub-limit depressive express (49 subjects) 43% additionally accomplished suicidal indications. These discoveries are higher than the discoveries of different studies however as per them: One of these studies demonstrated that 35% of discouraged adolescents had suicidal indications, Another study demonstrated the rate of suicidal side effects to be 30% among discouraged understudies while a third study uncovered endeavored suicide among 21.9% of the adolescents with real misery. An alternate Canadian study uncovered that suicidal ideation and endeavors were regular among discouraged Canadian adolescents, 30% of the specimen reported that they had solid last requests (measured by CDI) or had a plan to damage themselves (Paus et al,. 2010).

The rate of suicidality in the current study was much higher than the rate recognized by Torros et al (2004) who found that suicidal indications (measured by CBDI) were sure in 6.9% of discouraged Canadian adolescent girls, this variety in results may be clarified by social and religious contrasts bringing about underreporting of suicidal side effects because of alarm of disgrace or blame. The current study uncovered that discouraged adolescent females may have suicidal side effects, notwithstanding the seriousness or number of depressive indications. This discovering shades light on the way that the sub threshold depressive indications in youthfulness -not simply clinical sorrow ought to be considered important. Subjects with sub threshold sorrow ought not to be delegated “non-cases” not one or the other to be dealt with just as they have a comparative anticipation to the individuals who are asymptomatic.

A study performed by Paus et al,. (2010) analyzed suicide endeavors among discouraged essential forethought youthful patients, youth named suicide attempters demonstrated hoisted levels of psychopathology, particularly depressive manifestations, externalizing behavioral issue, nervousness substance utilization, lunacy and PTSD indications. Further assessment of suicidality in this particular age gathering need to be carried out in future exploration.

III-Psychiatric comorbidity

In this study, summed up uneasiness issue was the most common co-horrible conclusion among discouraged adolescent females, notwithstanding social nervousness issue, and substance use (Table 3). This is consonant with different studies which demonstrated that uneasiness issue was the most well-known comorbid issue with despondency.

In the study led by Paus et al,. (2010) aggregate nervousness and stress and oversensitivity side effects were found to anticipate later depressive manifestations more unequivocally for girls than for young men. Physiological nervousness predicts later depressive side effects for both young men and girls. These discoveries which are consonant with the aftereffects of the current study, highlight the criticalness of uneasiness for the advancement of sorrow in youth, especially stress and oversensitivity among girls.

Strengths and limitations

As one of the few studies that have explored the commonness and the symptomology of juvenile gloom, the present study has utilized an extensive battery of psychiatric devices for screening, conclusion and appraisal of seriousness of sadness, the utilization of a semi-organized clinical meeting for finding, not depending on the reports toward oneself. The meetings utilized were straightforwardly tended to understudies not in vicinity of their families which is additionally easing to female adolescents, they want to discuss their emotions in their associate surroundings instead of before parents.

In spite of these qualities, there are a few confinements of this study that require cautious attention in the translation of the discoveries. In the first place, the extent of the example was generally little. Second, the psychiatric analyses were chiefly focused around clinical meetings of study subjects without questioning their guardians. Past studies have demonstrated low assention among kid, guardian, and instructor witnesses in reporting adolescents’ passionate and behavioral issues and the need to join educators’ reports into the distinguishing proof of depressive symptomology. Third, a more complete study would include an instrument for a definite identity evaluation, to prohibit the impact of some identity characteristics on the subjects’ conduct, e.g.suicidality. Fourth, the estimation of suicidality was focused around inquiries inside the Ham-D, this would better be surveyed by a particular scale for suicidality. At last, the setting for the study, as it is realized that administrating self-reports in non-clinical populace may bring about expanded scores. The absence of complete data in psychiatric conclusions for all study subjects has hindered the likelihood for detailed longitudinal examines of psychiatric indications.

Conclusions

The physical side effects were by a long shot the most well-known exhibiting indication for female adolescents experiencing depressive issue. Depressive phenomena including unexplained weariness, diminished vitality, psychomotor changes, absence of fixation, weight changes and self-destructive ideations may be the exhibiting objections rather than the exemplary miserable state of mind.

Further studies are required to check if early recognition of depressive issue in adolescents may influence the course of the depressive disease, and its entanglements i.e. Substance misuse, educational disintegration and suicidality. Further examination of danger variables, longitudinal course of depressive manifestations, level of working, examples of comorbidity, and the psychopathological foundation of juvenile populace at danger would be finishing the picture around there of exploration.

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Leatherdale, S. T., & Ahmed, R. (2010). Alcohol, marijuana, and tobacco use among Canadian youth: do we need more multi-substance prevention programming?. The journal of primary prevention, 31(3), 99-108.

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McCormick, C. M., Mathews, I. Z., Thomas, C., & Waters, P. (2010). Investigations of HPA function and the enduring consequences of stressors in adolescence in animal models. Brain and cognition, 72(1), 73-85.

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Toledo‐Rodriguez, M., Lotfipour, S., Leonard, G., Perron, M., Richer, L., Veillette, S., … & Paus, T. (2010). Maternal smoking during pregnancy is associated with epigenetic modifications of the brain‐derived neurotrophic factor‐6 exon in adolescent offspring. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 153(7), 1350-1354.

Tonmyr, L., Thornton, T., Draca, J., & Wekerle, C. (2010). A review of childhood maltreatment and adolescent substance use relationship. Current Psychiatry Reviews, 6(3), 223-234.