Case Presentation in Nutrition and Diet TheraphyPresentation Transcript
Nutrition and Diet Therapy Case Study
Kadimis a 29 year old African American stock exchange manager for a large corporation. He has been feeling tightening in his chest for 3 days and now has shortness of breath and pain radiating down his left arm. Kadim thinks he is having heart attack. He was taken to the emergency and is admitted in the cardiac intensive care unit. He is placed on a cardiac monitor and is given nasal oxygen. The admitting nurse finds out that there is a history of heart attacks in young males in Kadim’s family.
His blood pressure is 210/110. His blood work shows cholesterol of 320, elevated triglycerides, and markedly elevated LDL. As his team of physicians and nurses get Kadim stabilized, the dietician places him on a low-cholesterol, low-fat, and low-sodium diet. The doctor suggests that Kadim participate in a candidate for heart attack but decides to play the odds, hoping they would be in his favor. After all, he did eat well and exercised regularly before he started with his firm.
Assessment ASSESSMENT Assessment
1.What subjective data do you have about Kadim and his health?
Kadim is feeling tightening in his chest for 3 days
Now has shortness of breath
Pain radiating down his left arm
Kadim thinks he is having heart attack
History of heart attacks in young males in Kadim’s family
2. What objective data do you have?
His blood pressure is 210/110
His blood work shows cholesterol of 320
Markedly elevated LDL
3. How significant is his problem?
A strong link exists between elevated serum lipid levels and the development of coronary heart disease. Lipoproteins circulate in the blood and are made up of cholesterol, triglycerides, and phospholipids. A high dietary intake of saturated fats is most critical factor for the development of elevated serum lipids. The average American diet often contains more than 40% of its calories in fat.
Hypertension increases the risk of coronary heart disease in several ways. First, it increases the workload of the heart, increasing oxygen demand and coronary blood flow. The increased workload also causes hypertrophy of the ventricles. Over time this can contribute to heart failure. Secondly, hypertension causes endothelial damage to the blood vessels, which stimulates the development of atherosclerosis.
Sedentary people, by contrast, have risk of cardiovascular disease.
Shortness of breath because cardiovascular system compensates respiratory system. In the left-sided heart failure, the vessels of the pulmonary system become congested or engorged with blood. This may cause fluid to escape into the alveoli and interfere with gas exchange, a condition known as pulmonary edema. Shortness of breath is one sign of heart failure.
Pain radiating down his left arm and tightening of chest are signs of myocardial infraction
Coronary heart disease is hereditary
4. What are the potential consequences if Kadim ignore his doctor advice?
If Kadim ignore his doctor advice, he will develop cardiovascular disease and stoke
5. Write a diagnostic statement about Kadim’s lack of knowledge regarding his cardiac condition and his new diet.
Deficient knowledge regarding pathophysiology of condition/outcomes, treatment, and self-care needs related to lack of information regarding his cardiac condition and his diet as evidenced by statements of concern and development of preventable complications
6. What education is needed to help achieve lower cholesterol? - Physical activity is associated with a reduction in the risk of death due to cardiovascular disease. Physical exercise or activity increases the heart rate and hence the supply of oxygen in the body. With a regular vigorous exercise, the heart muscle becomes more powerful and efficient. Aerobic exercise shows the atherosclerotic process, reducing the risk of cardiovascular disease.
7.What are several reasonable goals for Kadim?
Blood pressure of 120/90
Relief in shortness of breathing as evidence by regular and effortless Breathing
8. What dietary issues does Kadim need to learn to comply with his new diet? Low fat diet and low-cholesterol diet is prescribed for patients with cardiovascular disorders such as atherosclerosis and congestive heart failure. Since Kadim manifested signs and symptoms of developing cardiovascular disorder. A diet low in saturated fat and cholesterol can help lower blood cholesterol levels and help prevent cardiovascular diseases. A diet high in saturated fat causes cholesterol to build up in your arteries (blood vessels). Cholesterol is a soft, waxy substance that can cause
clogged or blocked arteries. This puts you at risk for heart attack, stroke, and other major health problems. The hardening of the arteries is due to the buildup of fatty deposits called plaque, and mineral deposits. Sedentary lifestyle, lack of exercise and eating fatty foods can increase the risk of developing coronary artery disease, which lead to heart failure.
Low sodium diet is prescribed for patients with hypertension that client manifested and congestive heart failure that may develop. Sodium can make your blood vessels and body tissues swell and fill with fluid. This puts an extra strain on your heart and can increase blood pressure. Too much sodium makes client’s body retain water and makes his heart work harder. This can worsen the symptoms of congestive heart failure, which include shortness of breath and swelling.
Beat hypertension with bananas The unique tropical fruit is extremely high in potassium yet low in salt, making it the perfect way to beat high blood pressure. So much so, the US Food and Drug Administration have just allowed the banana industry to make official claims for the fruit’s ability to reduce the risk of blood pressure and stroke. (Health & Home 2008, p 2) Tomatoes for the heart The tomato slice in your sandwich could help prevent heart attack, stroke and even cancer. The yellow, jelly-like material surrounding the seeds helps make the blood less “sticky”, inhibiting the formation of dangerous blood clots that trigger heart attacks and strokes. Heart and stroke patients should benefit from eating two to four raw tomatoes a day, according to AsimDutta-Roy, Ph.D., principal scientist at the Rowett Research Institute in Aberdeen, Scotland. (Health & Home 2010, p.2)
Prevention of heart attack We call it “HEARTBEAT”, acronym for habit, exercise, animal fats, rest, temperance, behaviour, environment, additives, and trust in God. Here they are: Habitually have a regular BP (blood pressure), ECG, and cholesterol checkup. This should be done especially if you’re male and not younger than 40, or if you’re female who is in your post menopausal age and with a positive family history of heart disease. Exercise helps lower blood pressure and cholesterol, and helps improve the circulatory process by increasing the capacity of the heart to pump blood, thus making the individual less susceptible to heart attack. Get a regular 45-minute exercise at least three to four times a week. Brisk waliking is a good form of exercise.
Animal products, which contain high levels of cholesterol and higher levels of saturated fats, should be eliminated from your diet. Decreasing cholesterol content of the diet will help prevent blood vessel damage. Try a vegetarian diet. Rest is very essential to the body especially to the heart which works 24 hours a day, seven days a week. Physical rest prevents your heart from getting overloaded. You need 7-8 hours of sleep during the night. Temperance should be practiced. Avoid drinks which contain alcohol or caffeine. Beer, wine, coffee, tea, and cola drinks, among other alcoholic or caffeinated drinks, unduly stimulate the sympathetic nervous system and this can cause hypertension. Avoid cigarette smoking. Reports say that the risk of a smoker’s first myocardial infarction is 2.5 times higher than that of a non-smoker. Besides nicotine, cigarette smoke contains poisons which cause heart disease and strokes.
Behaviourmust be in conformity to a lifestyle of healthful living. Make it your commitment. Environment is important as well. Don’t get into a stressful situation at home, unhealthy relationship with spouse and problems at work. Have a positive outlook in life. A merry heart does well like a medicine (Proverbs 17:22). Additives, too much of them, need to be avoided. Use salt and sugar sparingly. Too much salt accumulates water in the heart, thus causing increased blood pressure which will eventually lead to heart problem. Not more than one teaspoon of salt a day is recommended, with no added salt in the diet. Sugar clogs, the system and so only one tablespoon is recommended daily. Trust in God. Our world is full of insecurity, stress and uncertainty. The only assurance is to trust in God’s divine power after obeying His will. “I can do all things through Christ which strengthened me” (Philippians 4:13). How marvelous to know that with God’s new kingdom, there will be no sorrows, sickness, or death. Stop worrying. Cast all your cares upon Jesus. He is the greatest Physician, the greatest Cardiologist who can heal and restore the impaired function of the most damaged heart. (Health & Home 1999, p. 16-17)
9. What cardiac topic does Kadim need to learn to understand his new diet?
Diet can also affect cardiovascular function. A healthy diet with adequate calories, protein, and other nutrients is important to maintain good immune function and increase resistance to disease. Along with certain vitamins and minerals, dietary protein is important to prevent anemia. High salt intake can affect blood pressure and contribute to hypertension in two ways. First, it may increase the release of a hormone called natriuretic hormone which indirectly contributes to hypertension. Additionally, sodium stimulates vasopressor mechanisms, which cause vasoconstriction. There is also evidence that other factors such as low potassium, calcium, and magnesium intake may contribute to vasoconstriction and the development of hypertension. One study showed that a high consumption of dairy products and dietary products and dietary calcium reduced blood pressure levels.
10. What two food categories can Kadim use that have almost no restriction in his new diet?
Fruits and vegetables. One easy way to lower your cholesterol is to add more fresh fruits and vegetables to your diet. Fruits and vegetables contain natural fiber, which has been shown in numerous studies to have a remarkable cholesterol-lowering effect. Fresh fruits and vegetables are generally low in sodium. Fruits and vegetables lower blood pressure so it is possible to treat your high blood pressure naturally without any medication by eating fruit and vegetables.
11. What other risk factors does Kadim have, and what does he need to do about them?
Edema – reduce salt intake, and compression, massage, elevation, movement of edematous part can reduce swelling
Cirrhosis – Avoid medications that are harmful to liver, cut down salt, eat adequate calories and proteins, take daily multivitamin, and stop drinking alcohol
Renal failure – incase of recovery function is incomplete, artificial kidney can be used or dialysis, avoid self medication and cut down salts.
Steatorrhea and Pancreatitis – Stop alcohol consumption. Adopt a liquid diet consisting of foods such as broth, gelatin, and soups. These simple foods may allow the inflammation process to get better. Over-the-counter pain medications may also help. Avoid pain medications that can affect the liver. Lower cholesterols and fats.
Fat malabsorption – lower cholesterols and fats.
Gallbladder disease - In cases of acute gall-bladder inflammation, the patient should fast for two or three days until the acute condition is cleared. Nothing but water should be taken during this period. After the fast, the patient should take fruit and vegetable juices for a few days.
12. If diet and exercise are successful, what changes will be measurable in 3 to 6 months?
If client shows
Blood pressure of 120/90
Relief in shortness of breathing as evidence by regular and effortless Breathing
13. What will the dietician be able to assess in an interview with Kadim?
The dietician will be able to assess that a lifestyle change can be done to Kadim specifically on his diet due to his high status in life (African American stock exchange manager for a large corporation), he can eat whatever he wants and thus her have a family history of heart attacks in young male. One more thing to be considering that Kadim will on a Low Sodium and Low Fat or Low Cholesterol did to avoid any further complications.
14. If the diet is insufficient to lower his cholesterol in 6 months, what is the doctor likely to do?
To give medication such us statins which is the medicines used the most often to treat high cholesterol, and they often work the best. They can reduce the risk for heart attack, stroke, and early death in people who are at high risk for a heart attack or stroke.
Prescribe ezetimibe with simvastatin (Vytorin) to Lower how much cholesterol your body makes and the amount of cholesterol your body absorbs
Prescribe atorvastatin with amlodipine (Caduet) Lower how much cholesterol your body makes and lower blood pressure
Prescribe niacin with lovastatin (Advicor) Raise good (HDL) cholesterol and lower bad (LDL) cholesterol
Worst case scenario a coronary angioplasty or heart bypass will be done to remove the cholesterol or clot on the narrow arteries and thus to make the blood flow freely.
Coronary angioplasty or heart bypass is a procedure used to restore flow through narrowed or block arteries that supply blood to the heart muscle. At times a tube is inserted into the open vessel to keep it from reblocking.
15. What are possible consequences for non-compliance for Kadim?
Too much cholesterol in the blood, or high blood cholesterol, can be serious. People with high blood cholesterol have a greater chance of getting heart disease. High blood cholesterol on its own does not cause symptoms, so many people are unaware that their cholesterol level is too high.
Cholesterol can build up in the walls of your arteries. This buildup of cholesterol is called plaque. Over time, plaque can cause narrowing of the arteries. This is called atherosclerosis, or hardening of the arteries.
Special arteries, called coronary arteries, bring blood to the heart. Narrowing of your coronary arteries due to plaque can stop or slow down the flow of blood to your heart. When the arteries narrow, the amount of oxygen-rich blood is decreased. This is called coronary heart disease. Large plaque areas can lead to chest pain called angina. Angina happens when the heart does not receive enough oxygen-rich blood. Angina is a common symptom of CHD.
Some plaques have a thin covering and can burst, releasing cholesterol and fat into the bloodstream. The release of cholesterol and fat may cause your blood to clot. A clot can block the flow of blood. This blockage can cause angina or a heart attack.
Plaque and resulting health problems can also occur in arteries elsewhere in the body.