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7/23/2019 Case Study in Nutrition
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Nutrition and Diet
Therapy CaseStudy
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Kadim is a 29 year old AfricanAmerican stock exchange manager for alarge corporation. He has been feelingtightening in his chest for 3 days andnow has shortness of breath and pain
radiating down his left arm. Kadimthinks he is having heart attack. He wastaken to the emergency and is admittedin the cardiac intensive care unit. He is
placed on a cardiac monitor and is givennasal oxygen. The admitting nurse findsout that there is a history of heart attacksin young males in Kadims family.
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His blood pressure is 210/110. His blood
work shows cholesterol of 320, elevatedtriglycerides, and markedly elevated LDL.As his team of physicians and nurses getKadim stabilized, the dietician places him
on a low-cholesterol, low-fat, and low-sodium diet. The doctor suggests thatKadim participate in a candidate for heartattack but decides to play the odds,hoping they would be in his favor. Afterall, he did eat well and exercised regularly
before he started with his firm.
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Assessment
Assessment
ASSESSMENT
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1. What subjective data do you haveabout Kadim and his health?Kadim is eelin! ti!htenin! in his chest
or " daysNo# has shortness o breath$ain radiatin! do#n his let armKadim thin%s he is havin! heart attac%
&istory o heart attac%s in youn! malesin Kadim's amily
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2. What objective data do you have?His blood pressure is 210/110His blood work shows cholesterol of 320
Elevated triglyceridesMarkedly elevated LDL
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3. How significant is his problem?A strong link exists between elevated serum lipid levelsand the development of coronary heart disease.
Lipoproteins circulate in the blood and are made up ofcholesterol, triglycerides, and phospholipids. A highdietary intake of saturated fats is most critical factor forthe development of elevated serum lipids. The averageAmerican diet often contains more than 40% of its calories
in fat.Hypertension increases the risk of coronary heart diseasein several ways. First, it increases the workload of theheart, increasing oxygen demand and coronary bloodflow. The increased workload also causes hypertrophy ofthe ventricles. Over time this can contribute to heartfailure. Secondly, hypertension causes endothelial damageto the blood vessels, which stimulates the development ofatherosclerosis.Sedentary people, by contrast, have risk of cardiovasculardisease.
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Shortness of breath because cardiovascularsystem compensates respiratory system. Inthe left-sided heart failure, the vessels of thepulmonary system become congested orengorged with blood. This may cause fluid to
escape into the alveoli and interfere with gasexchange, a condition known as pulmonaryedema. Shortness of breath is one sign ofheart failure.
Pain radiating down his left arm andtightening of chest are signs of myocardialinfractionCoronary heart disease is hereditary
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(. What are the potential conse)uences iKadim i!nore his doctor advice?* Kadim i!nore his doctor advice+ he #ill
develop cardiovascular disease and sto%e
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Dia!nosis
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,. Write a dia!nostic statement about Kadim's lac% o %no#led!e
re!ardin! his cardiac condition and his ne# diet.Deicient %no#led!e re!ardin! pathophysiolo!y o
condition-outcomes+ treatment+ and selcare needs related to lac% oinormation re!ardin! his cardiac condition and his diet as evidenced
by statements o concern and development o preventable
complications
/. What education is needed to help achieve lo#er cholesterol?
$hysical activity is associated #ith a reduction in the ris% o death
due to cardiovascular disease. $hysical e0ercise or activity increases
the heart rate and hence the supply o o0y!en in the body. With a
re!ular vi!orous e0ercise+ the heart muscle becomes more po#erul
and eicient. Aerobic e0ercise sho#s the atherosclerotic process+
reducin! the ris% o cardiovascular disease.
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.What are several reasonable !oals or
Kadim?2lood pressure o 134-546o#ers cholesterol6o#ers tri!lycerides
6o#ers 6D67elie in shortness o breathin! as
evidence by re!ular and eortless2reathin!
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*mplementation
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8. What dietary issues does Kadim need to learn to
comply #ith his ne# diet?
6o# at diet and lo#cholesterol diet is prescribed or
patients #ith cardiovascular disorders such as
atherosclerosis and con!estive heart ailure. SinceKadim maniested si!ns and symptoms o developin!
cardiovascular disorder. A diet lo# in saturated at and
cholesterol can help lo#er blood cholesterol levels
and help prevent cardiovascular diseases. A diet hi!hin saturated at causes cholesterol to build up in your
arteries 9blood vessels:. Cholesterol is a sot+ #a0y
substance that can cause
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clogged or blocked arteries. This puts you at risk for heart
attack, stroke, and other major health problems. The hardeningof the arteries is due to the buildup of fatty deposits calledplaque, and mineral deposits. Sedentary lifestyle, lack ofexercise and eating fatty foods can increase the risk ofdeveloping coronary artery disease, which lead to heart failure.Low sodium diet is prescribed for patients with hypertensionthat client manifested and congestive heart failure that maydevelop. Sodium can make your blood vessels and body tissuesswell and fill with fluid. This puts an extra strain on your heartand can increase blood pressure. Too much sodium makesclients 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.
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Beat hypertension with bananasThe unique tropical fruit is extremely high in potassium yetlow in salt, making it the perfect way to beat high blood
pressure. So much so, the US Food and rug !dministrationha"e #ust allowed the banana industry to make o$cial claimsfor the fruit%s ability to reduce the risk of blood pressure andstroke. &'ealth ( 'ome )**+, p )
Tomatoes for the heartThe tomato slice in your sandwich could help pre"ent heartattack, stroke and e"en cancer. The yellow, #elly-like materialsurrounding the seeds helps make the blood less sticky/,inhibiting the formation of dangerous blood clots that triggerheart attacks and strokes.
'eart and stroke patients should bene0t from eating two tofour raw tomatoes a day, according to !sim utta-1oy, 2h..,principal scientist at the 1owett 1esearch 3nstitute in!berdeen, Scotland. &'ealth ( 'ome )*4*, p.)
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$revention o heart attac%
We call it ;&et a re!ular (,minute e0ercise at least three to
our times a #ee%. 2ris% #ali%in! is a !ood orm o e0ercise.
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Animal products, #hich contain hi!h levels o
cholesterol and hi!her levels o saturated ats+ should be
eliminated rom your diet. Decreasin! cholesterol content
o the diet #ill help prevent blood vessel dama!e. Try ave!etarian diet.
Rest is very essential to the body especially to the heart
#hich #or%s 3( hours a day+ seven days a #ee%. $hysical
rest prevents your heart rom !ettin! overloaded. @ou need
8 hours o sleep durin! the ni!ht.Temperance should be practiced. Avoid drin%s #hich
contain alcohol or caeine. 2eer+ #ine+ coee+ tea+ and
cola drin%s+ amon! other alcoholic or caeinated drin%s+
unduly stimulate the sympathetic nervous system and thiscan cause hypertension. Avoid ci!arette smo%in!. 7eports
say that the ris% o a smo%er's irst myocardial inarction
is 3., times hi!her than that o a nonsmo%er. 2esides
nicotine+ ci!arette smo%e contains poisons #hich cause
heart disease and stro%es.
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Behaviour must be in conormity to a liestyle o healthul livin!. a%e it your
commitment.
Environment is important as #ell. Don't !et into a stressul situation at home+
unhealthy relationship #ith spouse and problems at #or%. &ave a positiveoutloo% in lie. A merry heart does #ell li%e a medicine 9$roverbs 133:.
Additives, too much o them+ need to be avoided. Bse salt and su!ar sparin!ly.
Too much salt accumulates #ater in the heart+ thus causin! increased blood
pressure #hich #ill eventually lead to heart problem. Not more than one
teaspoon o salt a day is recommended+ #ith no added salt in the diet. Su!ar
clo!s+ the system and so only one tablespoon is recommended daily.
Trust in God. ur #orld is ull o insecurity+ stress and uncertainty. The only
assurance is to trust in >od's divine po#er ater obeyin! &is #ill. ;* can do all
thin!s throu!h Christ #hich stren!thened me= 9$hilippians (1":. &o#marvelous to %no# that #ith >od's ne# %in!dom+ there #ill be no sorro#s+
sic%ness+ or death. Stop #orryin!. Cast all your cares upon esus. &e is the
!reatest $hysician+ the !reatest Cardiolo!ist #ho can heal and restore the
impaired unction o the most dama!ed heart. 9&ealth E &ome 1555+ p. 1/1:
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5. What cardiac topic does Kadim need to learn to understand his ne# diet?Diet can also aect cardiovascular unction. A healthy diet #ith ade)uate calories+
protein+ and other nutrients is important to maintain !ood immune unction and
increase resistance to disease. Alon! #ith certain vitamins and minerals+ dietary
protein is important to prevent anemia. &i!h salt inta%e can aect blood pressure
and contribute to hypertension in t#o #ays. First+ it may increase the release o a
hormone called natriuretic hormone #hich indirectly contributes to hypertension.
Additionally+ sodium stimulates vasopressor mechanisms+ #hich cause
vasoconstriction. There is also evidence that other actors such as lo# potassium+
calcium+ and ma!nesium inta%e may contribute to vasoconstriction and thedevelopment o hypertension. ne study sho#ed that a hi!h consumption o dairy
products and dietary products and dietary calcium reduced blood pressure levels.
14. What t#o ood cate!ories can Kadim use that have almost no restriction in his
ne# diet?Fruits and ve!etables. ne easy #ay to lo#er your cholesterol is to add more
resh ruits and ve!etables to your diet. Fruits and ve!etables contain natural iber+
#hich has been sho#n in numerous studies to have a remar%able cholesterol
lo#erin! eect. Fresh ruits and ve!etables are !enerally lo# in sodium. Fruits and
ve!etables lo#er blood pressure so it is possible to treat your hi!h blood pressurenaturally #ithout any medication by eatin! ruit and ve!etables.
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11. What other ris% actors does Kadim have+ and #hat does he need to do
about them?allbladder disease *n cases o acute !allbladder inlammation+ the patient
should ast or t#o or three days until the acute condition is cleared. Nothin!
but #ater should be ta%en durin! this period. Ater the ast+ the patient should
ta%e ruit and ve!etable juices or a e# days.
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13. * diet and e0ercise are successul+ #hat chan!es #ill be measurable in
" to / months?* client sho#s
-2lood pressure o 134-54-6o#ers cholesterol-6o#ers tri!lycerides-6o#ers 6D6-7elie in shortness o breathin! as evidence by re!ular and eortless
2reathin!
1". What #ill the dietician be able to assess in an intervie# #ith Kadim?The dietician #ill be able to assess that a liestyle chan!e can be done to
Kadim speciically on his diet due to his hi!h status in lie 9Arican
American stoc% e0chan!e mana!er or a lar!e corporation:+ he can eat
#hatever he #ants and thus her have a amily history o heart attac%s in
youn! male. ne more thin! to be considerin! that Kadim #ill on a 6o#
Sodium and 6o# Fat or 6o# Cholesterol did to avoid any urther
complications.
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1(. * the diet is insuicient to lo#er his cholesterol in / months+ #hat is the
doctor li%ely to do?To !ive medication such us statins#hich is the medicines used the most oten to
treat hi!h cholesterol+ and they oten #or% the best. They can reduce the ris% or
heart attac%+ stro%e+ and early death in people #ho are at hi!h ris% or a heart
attac% or stro%e.$rescribe eHetimibe #ith simvastatin 9Iytorin: to 6o#er ho# much cholesterol
your body ma%es and the amount o cholesterol your body absorbs
$rescribe atorvastatin #ith amlodipine 9Caduet: 6o#er ho# much cholesterolyour body ma%es and lo#er blood pressure$rescribe niacin #ith lovastatin 9Advicor: 7aise !ood 9&D6: cholesterol and
lo#er bad 96D6: cholesterolWorst case scenario a coronary an!ioplasty or heart bypass #ill be done to
remove the cholesterol or clot on the narro# arteries and thus to ma%e the bloodlo# reely.Coronary an!ioplasty or heart bypass is a procedure used to restore lo# throu!h
narro#ed or bloc% arteries that supply blood to the heart muscle. At times a tube is
inserted into the open vessel to %eep it rom rebloc%in!.
http://www.webmd.com/hw-popup/statinhttp://www.webmd.com/hw-popup/high-cholesterolhttp://www.webmd.com/hw-popup/heart-attackhttp://www.webmd.com/hw-popup/stroke-7439http://www.webmd.com/cholesterol-management/cholesterol-absorption-inhibitors-for-high-cholesterolhttp://www.webmd.com/cholesterol-management/statins-for-high-cholesterolhttp://www.webmd.com/cholesterol-management/nicotinic-acid-for-high-cholesterolhttp://www.webmd.com/cholesterol-management/nicotinic-acid-for-high-cholesterolhttp://www.webmd.com/cholesterol-management/statins-for-high-cholesterolhttp://www.webmd.com/cholesterol-management/cholesterol-absorption-inhibitors-for-high-cholesterolhttp://www.webmd.com/hw-popup/stroke-7439http://www.webmd.com/hw-popup/heart-attackhttp://www.webmd.com/hw-popup/high-cholesterolhttp://www.webmd.com/hw-popup/statin7/23/2019 Case Study in Nutrition
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Further Thinking
be serious 2eople with high blood cholesterol ha"e a greater
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be serious. 2eople with high blood cholesterol ha"e a greaterchance of getting heart disease. 'igh blood cholesterol on its owndoes not cause symptoms, so many people are unaware that theircholesterol le"el is too high.9holesterol can build up in the walls of your arteries. This buildupof cholesterol is called plaque. :"er time, plaque can causenarrowing of the arteries. This is called atherosclerosis, orhardening of the arteries.Special arteries, called coronary arteries, bring blood to theheart. ;arrowing of your coronary arteries due to plaque can stop
or slow down the
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