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Group Members• Meera Maraj• Omari Joseph• Nailah Antoine• Mikhail Lutchmedial• Kern Rocke
Patient Profile and    Medical Records DataAge= 50 yearsSex= MaleEthnicity= African AmericanOccupation= High School Footba...
Patient Profile and     Medical Records Data                   Chief Complaint:Difficulty in adhering to a reduction of sa...
Pathophysiologyof Hypertension
Pathophysiology of          Hypertension• Hypertension is the chronic elevation of blood  pressure that, in the long-term,...
Pathophysiology of            Hypertension• Factors which contribute to the development of  hypertension are:      Aging ...
Pathophysiology of          Hypertension• Resting Blood Pressure ≥ 140/90 on two separate  occasions in an individual is c...
NutritionalAssessment
Anthropometrics• Weight= 220 lbs / 2.2 lbs         = 100 kg• Height= 6’3”= 75 inches          = 75 x 2.54          = 190.5...
Anthropometrics• Height = 6 feet 3 inches     =5 feet + (12 inches for the additional foot + 3                            ...
Anthropometrics• BMR = 66 + (13.7 x 100kg) + (5 x 190.5cm) – (6.8 x 50)            x 1.48      = 66 + 1370 + 952.5 – 340 x...
Biochemical  Biochemical       Patient value – mg/dl   Normal value – mg/dl   parameterTotal cholesterol           300    ...
Biochemical• Altered Lipid Values as a result of:   1) High Saturated Fat and Trans-Fat Intake   2) High Sugar Intake   3)...
ClinicalHealthy, male who looks his ageTemp= 98.6 0F                BP= 160/100 mmHgHR= 80 bpm                   RR= 15 bp...
Clinical• Diagnosis of Stage 2 (Essential) Hypertension 1 year  ago• Medical History shows that the subject’s mother  died...
Dietary- History24-hr RecallUsual dietary intake:AM:                   1 c coffee (black)                      Hot (oatmea...
Dietary- Analysis           Parameter               Patient Intake        Calories (kcals)                4100 !      Prot...
Recognition of Diet/ Drug Interaction
Recognition of Diet/ Drug      Interaction• High intakes of salt in the diet increases the excretion  of Potassium while t...
Nutritional  NeedsCalculations
Nutritional Needs          CalculationsCHO requirements = 45% - 65% based on a 2000 calorieintakeIf 45% - 65% of carbohydr...
Nutritional Needs           Calculations• PRO requirements = 10% - 35% based on a 2000 calorie  intakeIf 10% - 35% of prot...
Nutritional Needs          CalculationsFAT requirements = 40% - 65% based on a 2000 calorieintakeIf 40% - 65% of proteins ...
NutritionDiagnosis
Nutrition Diagnosis• Overweight as related to high carbohydrate and fat  diet as evidenced by BMI of 27.56 and % IBW of  1...
Nutrition Diagnosis• Inadequate mineral intake (Potassium and  Calcium) related to low dietary intake as  evidenced by die...
Nutrition Care    Plan
Nutrition Care PlanProblem              Goal                      Strategies          Monitoring and                      ...
Nutrition Care PlanProblem                  Goal                       Strategies                 Monitoring and          ...
Nutrition Care PlanProblem                 Goal                         Strategies                  Monitoring and        ...
MenuBreakfast:2 servings of whole wheat cereal2 servings of a medium sized banana (sliced)2 servings of 1% or low fat milk...
MenuLunch:2 servings of mackerel (steamed / lemon)3 servings of whole wheat pasta1 serving of cooked pigeon peas2 servings...
MenuDINNER:4 servings of whole wheat bread (Home-made, lowsodium)1 serving tomatoes1 serving lettuce1 serving salmon1 cup ...
Nutrient Content of Menu  Parameter                          Patient Intake  Calories (kcals)                   2756  Prot...
Questions
ReferencesLife Extension. 2012. “Risk Factors for High Blood Pressure.” Accessed November 10 th, 2012.            http://w...
Thank You
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Case study hypertension presentation show

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Medical Nutrition Therapy Hypertension Case Study

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Case study hypertension presentation show

  1. 1. Group Members• Meera Maraj• Omari Joseph• Nailah Antoine• Mikhail Lutchmedial• Kern Rocke
  2. 2. Patient Profile and Medical Records DataAge= 50 yearsSex= MaleEthnicity= African AmericanOccupation= High School Football CoachHeight= 6 feet 3 inchesWeight= 220 lbsBP= 160/100Medical Hx= Stage 2 (essential) HypertensionP.A.= Walks 30 mins, 4-5 times per weekPreviously a 2- pack a day smokerPrevious Dietary Tx= 4-gm Na DietPharmacological Tx = 25 g hydrochlorothiazide qd
  3. 3. Patient Profile and Medical Records Data Chief Complaint:Difficulty in adhering to a reduction of salt in the diet. Food tastes bland and tasteless.
  4. 4. Pathophysiologyof Hypertension
  5. 5. Pathophysiology of Hypertension• Hypertension is the chronic elevation of blood pressure that, in the long-term, causes end-organ damage and results in increased morbidity and mortality.• Occurs due to the abnormal functioning of the arterial pressure related to the central nervous system, renin-angiotensin-aldosterone system, endothelial dysfunction, genes and even due to certain environmental factors.
  6. 6. Pathophysiology of Hypertension• Factors which contribute to the development of hypertension are:  Aging  Genetics  Obesity  Smoking  Salt Sensitivity  High Frequent Alcohol Consumption  High Fat Diet  Low Fiber Diet• Normal blood Pressure is calculated as: 120/80 in healthy adults.
  7. 7. Pathophysiology of Hypertension• Resting Blood Pressure ≥ 140/90 on two separate occasions in an individual is characterized as either Stage I or Stage II Hypertension.• Resting Blood Pressure ≥ 130/80 in diabetic patients increases their risk for the development of heart disease.
  8. 8. NutritionalAssessment
  9. 9. Anthropometrics• Weight= 220 lbs / 2.2 lbs = 100 kg• Height= 6’3”= 75 inches = 75 x 2.54 = 190.5 cm = 1.905 m• B.M.I = 100 kg/ (1.905)2 m =27.56 (overweight)
  10. 10. Anthropometrics• Height = 6 feet 3 inches =5 feet + (12 inches for the additional foot + 3 inches) =5 feet + 15 inches• IBW = 106 lbs + (6lbs * 15 inches) =106 lbs + 90 lbs =196 lbs• %IBW = (220 lbs/ 196 lbs) * 100 = 112.24% (overweight)
  11. 11. Anthropometrics• BMR = 66 + (13.7 x 100kg) + (5 x 190.5cm) – (6.8 x 50) x 1.48 = 66 + 1370 + 952.5 – 340 x 1.48 = 2048.5 x 1.48 = 3031.8 kcals/ day• EER = 864 – (9.72 x 50) + PA x (14.2 x 100) + (503 x 1.905) =864 – 486 + (PA x 1420 + 958.2) =378 + (PA x 2378.2) =378 + (1.27 x 2378.2) =378 + 3020.3 =3398.3 kcals/ day
  12. 12. Biochemical Biochemical Patient value – mg/dl Normal value – mg/dl parameterTotal cholesterol 300 140-199LDL cholesterol 135 <130HDL cholesterol 35 37-70 Triglycerides 250 35-160
  13. 13. Biochemical• Altered Lipid Values as a result of: 1) High Saturated Fat and Trans-Fat Intake 2) High Sugar Intake 3) High Alcohol Intake 4) Overweight
  14. 14. ClinicalHealthy, male who looks his ageTemp= 98.6 0F BP= 160/100 mmHgHR= 80 bpm RR= 15 bpmRegular rate and rhythm, normal heart sounds (Noclicks, murmurs, or gallops)No edema present on the skin and on hands and feet
  15. 15. Clinical• Diagnosis of Stage 2 (Essential) Hypertension 1 year ago• Medical History shows that the subject’s mother died from a Myocardial Infarction Related to Uncontrolled Hypertension• Hypertension of subject may have been caused due to genetic history of hypertension
  16. 16. Dietary- History24-hr RecallUsual dietary intake:AM: 1 c coffee (black) Hot (oatmeal with 1 tsp margarine and 2 tsp sugar) or cold (Frosted Mini- Wheats) cereal. ½ c 2% milk 1 c orange juiceSnack 2 c coffee (black) 1 glazed donutLunch: 1 can Campbell’s tomato bisque soup 10 saltines 1 can diet colaAfter work: 2 (usually) gin and tonics (3 oz gin with 5 oz tonic)PM: 6 oz baked chicken (white meat no skin) (seasoned with salt pepper, garlic) 1 large baked potato with 1 T butter, salt and pepper 1 c glazed carrots (1 tsp sugar, 1 tsp butter) Dinner salad with ranch – style dressing (3 tsp)- lettuce, spinch, croutons, sliced cucumberHS snack: 2 c butter pecan ice cream
  17. 17. Dietary- Analysis Parameter Patient Intake Calories (kcals) 4100 ! Protein (% Calories) 12 ! Carbohydrate (% Calories) 45 Dietary Fiber (g) 30 Total Fat (% Calories) 34 Saturated Fat (% Calories) 13 !Monounsaturated Fat (% Calories) 13Polyunsaturated Fat (% Calories) 6 Cholesterol (mg) 411 ! Calcium (mg) 1546 Potassium (mg) 6309 Sodium (mg) 5849 ! Vitamin B6 (mg) 3.6 Vitamin B12 (mg) 4.7 Vitamin C (mg) 4118 Vitamin D (µg) 8 ! Vitamin E (mg) 13 !
  18. 18. Recognition of Diet/ Drug Interaction
  19. 19. Recognition of Diet/ Drug Interaction• High intakes of salt in the diet increases the excretion of Potassium while taking hydrochlorothaizde can lead to development of hypokalemia• High intakes of Caffeine while taking hydrochlorothaizde can lead to a strong diuretic effect on the body thereby leading to dehydration• Untreated dehydration can lead to heart injury, cerebral edema, kidney failure, hypovolemic shock and even death.
  20. 20. Nutritional NeedsCalculations
  21. 21. Nutritional Needs CalculationsCHO requirements = 45% - 65% based on a 2000 calorieintakeIf 45% - 65% of carbohydrates are recommended based ona 2000 calorie intakeX % - Y of carbohydrates are recommended based on a3031.8 calorie intake X% - Y% = (45% - 65%) * 3031.8 / 2000 = (136,431% - 197,067) / 2000 = 68.2g – 98.5g
  22. 22. Nutritional Needs Calculations• PRO requirements = 10% - 35% based on a 2000 calorie intakeIf 10% - 35% of proteins are recommended based on a 2000calorie intakeX % - Y of proteins are recommended based on a 3031.8calorie intake X% - Y% = (10% - 35%) * 3031.8 / 2000 = (30,318% - 106,113) / 2000 = 15.2 g – 53.1g
  23. 23. Nutritional Needs CalculationsFAT requirements = 40% - 65% based on a 2000 calorieintakeIf 40% - 65% of proteins are recommended based on a 2000calorie intakeX % - Y of proteins are recommended based on a 3031.8calorie intake X% - Y% = (40% - 65%) * 3031.8 / 2000 = (121,272% - 197,067) / 2000 = 60.6 g – 98.5 g
  24. 24. NutritionDiagnosis
  25. 25. Nutrition Diagnosis• Overweight as related to high carbohydrate and fat diet as evidenced by BMI of 27.56 and % IBW of 112.24 %.• Altered nutrition related laboratory values related to high fat diet as evidenced by total blood cholesterol of 300mg/dL, blood triglycerides of 250mg/dL, LDL of 135mg/dL and HDL of 35mg/dL.• Altered metabolic status (hyper) related to high salt and fat intake, family history of hypertension as evidenced by blood pressure of 160/100 mmHg and death of patient’s mother from MI related to uncontrolled hypertension.
  26. 26. Nutrition Diagnosis• Inadequate mineral intake (Potassium and Calcium) related to low dietary intake as evidenced by dietary intake of 81.1% Potassium and 84.2% Calcium.• Low adherence to nutrition recommendations related to patient’s low adherence to a 4mg sodium diet as evidence by chief complaint of foods being bland and tasteless.
  27. 27. Nutrition Care Plan
  28. 28. Nutrition Care PlanProblem Goal Strategies Monitoring and EvaluationOverweight To achieve a weight To provide a 2925 24 hr recall, food loss of 20-22 lbs in 10 kcal/day low sodium frequency months. and Low fat, questionnaire, reduced diet. monthly weight check-up.Altered nutrition The patient will To provide a diet To monitor pt.related laboratory achieve lower low in lipids laboratory values.values laboratory values to (saturated fat and reach normal range. cholesterol) and to Cholesterol = 140-199 increase daily mg/dL physical activity LDL-C = < 130 mg/dL levels. HDL-C = >40 mg/dL To educate pt. on TG = 35-160 mg/dL choosing foods low in saturated fat, cholesterol and triglycerides.
  29. 29. Nutrition Care PlanProblem Goal Strategies Monitoring and EvaluationAltered metabolic status Patient should achieve a To increase activity Monthly blood pressure(hyper) normotensive BP of (aerobic) to 60 minutes, 5 measurements, food ≤ 120 mmHg times/week. frequency questionnaire 80 To provide a low sodium and 24-hr recall. diet (< 2300 mg/day) – based on the DASH Diet. To decrease the consumption of fast foods on weekends from Fridays and Saturdays once/week to Fridays and Saturdays once every 3 weeks. To increase consumption of low sodium home cooked meals.
  30. 30. Nutrition Care PlanProblem Goal Strategies Monitoring and EvaluationInadequate mineral To increase consumption To provide a diet rich in Food frequencyintake (Potassium (K) of foods rich in K and Ca. K and Ca using foods questionnaire, monthlyand Calcium(Ca)) such as low-fat dairy biochemical tests. products (Ca), mango (K), tomatoes (K), tomatoes (K), leafy green vegetables (Ca and K), fish (K).Low adherence to To increase adherence to a To provide nutrition Food frequencynutrition related low sodium diet. education and questionnaire, 24-hrrecommendations counselling on the recall. importance of adherence to a low sodium diet to patient and patient’s wife.
  31. 31. MenuBreakfast:2 servings of whole wheat cereal2 servings of a medium sized banana (sliced)2 servings of 1% or low fat milk1 serving of garlic teaSnacks: (AM)1 large mango1 20oz bottle water
  32. 32. MenuLunch:2 servings of mackerel (steamed / lemon)3 servings of whole wheat pasta1 serving of cooked pigeon peas2 servings of vegetables – 1 toss salad (1c lettuce, carrots)1 serving of olive oil3 servings of vegetable / fruit juice – beet root (1.5 serv) &pineapple juice (1.5 serv)Snack: (PM)1 20oz bottle water1 medium orange3 servings of Trail Mix
  33. 33. MenuDINNER:4 servings of whole wheat bread (Home-made, lowsodium)1 serving tomatoes1 serving lettuce1 serving salmon1 cup of water (8oz)
  34. 34. Nutrient Content of Menu Parameter Patient Intake Calories (kcals) 2756 Protein (% Calories) 20 Carbohydrate (% Calories) 69 Dietary Fiber (g) 63 Total Fat (% Calories) 16 Saturated Fat (% Calories) 3 Monounsaturated Fat (% Calories) 7 Polyunsaturated Fat (% Calories) 5 Cholesterol (mg) 153 Calcium (mg) 1340 Potassium (mg) 6595 Sodium (mg) 1816 Vitamin B6 (mg) 3.8 Vitamin B12 (mg) 7.9 Vitamin C (mg) 434 Vitamin D (µg) 25 Vitamin E (mg) 15
  35. 35. Questions
  36. 36. ReferencesLife Extension. 2012. “Risk Factors for High Blood Pressure.” Accessed November 10 th, 2012. http://www.lef.org/protocols/heart_circulatory/high_blood_pressure_04.htm.Mahan, L. Kathleen, and Escott- Stump, Sylvia. 2008. Krause’s Food and Nutrition and Diet Therapy. 12th edition. Philadelphia: W.B. Saunders Co.United States Department of Agriculture. (N.d.) “SuperTracker” Accessed 3rd November, 2012. https://www.supertracker.usda.gov/default.aspx.Vanlterson, Erik. 2010. “Proper Nutrition for Hypertension Patients.” Livestrong.com. November 2nd. Accessed November 12th, 2012. http://www.livestrong.com/article/295001-proper- nutrition-for-hypertension-patients/.Weber, Craig. 2009. “Diabetics and High Blood Pressure.” About.com. July 23. Accessed November 10th, 2012. http://highbloodpressure.about.com/od/highbloodpressure101/a/diabetes-hbp.htm.
  37. 37. Thank You

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