How should Marisa be further evaluated? What additional lab tests would you recommend and why?

Marisa, a 27-year-old female who practices a vegan diet and reports increased symptoms of restless leg syndrome, fatigue, and painful abdominal bloating and heavy menses for the past year. A physical examination reveals inflammation and tenderness around her knee and ankle joints. Her diet history shows low intake of omega 3 fatty acis, iron, zinc and frequent use of processed foods. MEDICATIONS: None; HT: 5’5’’; WT: 215 lb LABORATORY VALUES: Client Normal Range WBC 8.3 3.8 – 10.5 K/uL RBC 4.86 3.8 – 5.20 M/uL HGB 10.8 L 12.0 – 16.0 g/dL HCT 32.7 L 34.5 -45.0 % MCV 74.1 L 80.0 – 100.0 fl MCH 24.3 L 27.0 – 34.0 pg MCHC 30.4 L 32.0 – 36.0 gm/dL IRON 28 L 40 – 160 ug/dL UIBC 429 H 110 – 370 ug/dL TIBC 508 H 220 – 430 ug/dL % Saturation, Iron 12 L 14-50 % Transferrin 435 H 200 – 400 mg/dL Ferritin 12 L 15-150 ng/mL C-Reactive Protein 0.96 H 0.00 – 0.40 mg/dL Vitamin D 14.6 L 30.0 – 100.0 ng/mL

1) How should Marisa be further evaluated? What additional lab tests would you recommend and why? (4)

2) What tool can you use to specifically assess Marisa’s omega 3 fatty acid intake and why is this important to collect? (2)

3) Calculate Marisa’s BMI, energy and protein needs- show your work (3)

4) What foods should be part of her treatment plan? Be specific. Why? (4)

5) What anemias are influenced by food intake/nutrition? Explain what type of anemia you suspect for Marisa and probable cause (use textbook reference here) (6)

6) What lab tests or questions would you include in your follow-up with her? (3)

7) How can Marisa reduce inflammation in her body? (3) Please use references from Chapter 3 and list page numbers with your response

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