Case study hypertension presentation show

transcript

Group Members • Meera Maraj

• Omari Joseph

• Nailah Antoine

• Mikhail Lutchmedial

• Kern Rocke

Patient Profile and Medical Records Data

Age= 50 years

Sex= Male

Ethnicity= African American

Occupation= High School Football Coach

Height= 6 feet 3 inches

Weight= 220 lbs

BP= 160/100

Medical Hx= Stage 2 (essential) Hypertension

P.A.= Walks 30 mins, 4-5 times per week

Previously a 2- pack a day smoker

Previous Dietary Tx= 4-gm Na Diet

Pharmacological Tx = 25 g hydrochlorothiazide qd

Patient Profile and Medical Records Data

Chief Complaint:

Difficulty in adhering to a reduction of salt in the diet.

Food tastes bland and tasteless.

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.

• 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.

• 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.

Nutritional Assessment

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)

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)

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

Biochemical

parameter

Patient value – mg/dl Normal value – mg/dl

Total cholesterol 300 140-199

LDL cholesterol 135 <130

HDL cholesterol 35 37-70

Triglycerides 250 35-160

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

ClinicalHealthy, male who looks his age

Temp= 98.6 0F BP= 160/100 mmHg

HR= 80 bpm RR= 15 bpm

Regular rate and rhythm, normal heart sounds (No

clicks, murmurs, or gallops)

No edema present on the skin and on hands and feet

Clinical

• Diagnosis of Stage 2 (Essential) Hypertension 1 year

• 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

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% milk1 c orange juice

Snack 2 c coffee (black)1 glazed donut

Lunch: 1 can Campbell’s tomato bisque soup10 saltines1 can diet cola

After 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 pepper1 c glazed carrots (1 tsp sugar, 1 tsp butter)Dinner salad with ranch – style dressing (3 tsp)- lettuce, spinch, croutons, sliced cucumber

HS snack: 2 c butter pecan ice cream

Dietary- AnalysisParameter 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) 13

Polyunsaturated 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

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.

Nutritional Needs

Calculations

Nutritional Needs Calculations

CHO requirements = 45% - 65% based on a 2000 calorie intake

If 45% - 65% of carbohydrates are recommended based on a 2000 calorie intake

X % - Y of carbohydrates are recommended based on a 3031.8 calorie intake

X% - Y% = (45% - 65%) * 3031.8 / 2000

= (136,431% - 197,067) / 2000

= 68.2g – 98.5g

• PRO requirements = 10% - 35% based on a 2000 calorie intake

If 10% - 35% of proteins are recommended based on a 2000 calorie intake

X % - Y of proteins are recommended based on a 3031.8 calorie intake

X% - Y% = (10% - 35%) * 3031.8 / 2000

= (30,318% - 106,113) / 2000

= 15.2 g – 53.1g

FAT requirements = 40% - 65% based on a 2000 calorie intake

If 40% - 65% of proteins are recommended based on a 2000 calorie intake

X % - Y of proteins are recommended based on a 3031.8 calorie intake

X% - Y% = (40% - 65%) * 3031.8 / 2000

= (121,272% - 197,067) / 2000

= 60.6 g – 98.5 g

Nutrition Diagnosis

• Overweight as related to high carbohydrate and fatdiet as evidenced by BMI of 27.56 and % IBW of112.24 %.

• Altered nutrition related laboratory values related tohigh fat diet as evidenced by total bloodcholesterol of 300mg/dL, blood triglycerides of250mg/dL, LDL of 135mg/dL and HDL of 35mg/dL.

• Altered metabolic status (hyper) related to high saltand fat intake, family history of hypertension asevidenced by blood pressure of 160/100 mmHgand death of patient’s mother from MI related touncontrolled hypertension.

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.

Nutrition Care Plan

Nutrition Care PlanProblem Goal Strategies Monitoring and

Evaluation

Overweight To achieve a weight

loss of 20-22 lbs in 10

months.

To provide a 2925

kcal/day low sodium

and Low fat,

reduced diet.

24 hr recall, food

frequency

questionnaire,

monthly weight

check-up.

Altered nutrition

related laboratory

values

The patient will

achieve lower

laboratory values to

reach normal range.

Cholesterol = 140-199

LDL-C = < 130 mg/dL

HDL-C = >40 mg/dL

TG = 35-160 mg/dL

To provide a diet

low in lipids

(saturated fat and

cholesterol) and to

increase daily

physical activity

levels.

To educate pt. on

choosing foods low

in saturated fat,

cholesterol and

triglycerides.

To monitor pt.

laboratory values.

Evaluation

Altered metabolic status

(hyper)

Patient should achieve a

normotensive BP of

≤ 120 mmHg

To increase activity

(aerobic) to 60 minutes, 5

times/week.

To provide a low sodium

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.

Monthly blood pressure

measurements, food

frequency questionnaire

and 24-hr recall.

Evaluation

Inadequate mineral

intake (Potassium (K)

and Calcium(Ca))

To increase consumption

of foods rich in K and Ca.

To provide a diet rich in

K and Ca using foods

such as low-fat dairy

products (Ca), mango

(K), tomatoes (K),

tomatoes (K), leafy green

vegetables (Ca and K),

fish (K).

Food frequency

questionnaire, monthly

biochemical tests.

Low adherence to

nutrition related

recommendations

To increase adherence to a

low sodium diet.

To provide nutrition

education and

counselling on the

importance of adherence

to a low sodium diet to

patient and patient’s

Food frequency

questionnaire, 24-hr

recall.

MenuBreakfast:

2 servings of whole wheat cereal

2 servings of a medium sized banana (sliced)

2 servings of 1% or low fat milk

1 serving of garlic tea

Snacks: (AM)

1 large mango

1 20oz bottle water

MenuLunch:

2 servings of mackerel (steamed / lemon)

3 servings of whole wheat pasta

1 serving of cooked pigeon peas

2 servings of vegetables – 1 toss salad (1c lettuce, carrots)

1 serving of olive oil

3 servings of vegetable / fruit juice – beet root (1.5 serv) & pineapple juice (1.5 serv)

Snack: (PM)

1 20oz bottle water

1 medium orange

3 servings of Trail Mix

DINNER:

4 servings of whole wheat bread (Home-made, low

sodium)

1 serving tomatoes

1 serving lettuce

1 serving salmon

1 cup of water (8oz)

Nutrient Content of MenuParameter 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

Questions

References

Life Extension. 2012. “Risk Factors for High Blood Pressure.” Accessed November 10th, 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.

Thank You

Case study hypertension presentation show

Health & Medicine