Date post: | 29-Jan-2018 |
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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
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.
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.
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.
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
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
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
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
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Recognition of Diet/ Drug Interaction
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
Nutritional Needs Calculations
• 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
Nutritional Needs Calculations
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
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
mg/dL
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.
Nutrition Care PlanProblem Goal Strategies Monitoring and
Evaluation
Altered metabolic status
(hyper)
Patient should achieve a
normotensive BP of
≤ 120 mmHg
80
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.
Nutrition Care PlanProblem Goal Strategies Monitoring and
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
wife.
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
Menu
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