MNT in a Patient with Congestive Heart Failure Megan Smith UMD Dietetic Intern May 6, 2015 El...
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- Slide 1
- MNT in a Patient with Congestive Heart Failure Megan Smith UMD
Dietetic Intern May 6, 2015 El CorazonEl Corazon
- Slide 2
- Congestive Heart Failure Most common signs and symptoms Fatigue
Edema Shortness of breath Chest congestion Md Health
- Slide 3
- Congestive Heart Failure Systolic Heart failure: Occurs when
the heart cannot pump, or eject, blood efficiently out of the
heart. Diastolic Heart Failure: Occurs when the heart cannot
properly fill with blood. Pixshark
- Slide 4
- Congestive Heart Failure Etiology most commonly includes:
Coronary Artery Disease Myocardial Infarction Uncontrolled
Hypertension Arrythmias, valve problems, drugs,and alcohol can also
contribute Leading Predictors Coronary artery disease Poorly
controlled blood pressure Elevated B natriuretic peptides
- Slide 5
- Congestive Heart Failure Electrocardiogram Test that checks for
problems with the electrical activity of the heart. Ejection
Fraction A test that determines how well your heart pumps with each
beat. American Accreditation HealthCare Commission Emory
Health
- Slide 6
- Meet the Patient XX is a 59 year-old Caucasian male Married
with two daughters Lives at home with wife Employed as a physician
by a local Baltimore Hospital
- Slide 7
- Medical Considerations Diagnosis: Acute left systolic heart
failure with aortic insufficiency. Broadly referred to as CHF. PMH:
hypertension Echocardiogram: Ejection Fraction was 20-25%
Signs/Symptoms: Fatigue, loss of appetite, SOB
- Slide 8
- Nutrition Assessment Food/Nutrient Related History Decreased
appetite one month PTA Eating approx. 50% of meals PTA MD expressed
basic understanding of nutrition and wanted to maximize caloric
intake prior to surgery. MD is a physician so he understood his
disease state MD is on feet all day; in training for a
marathon.
- Slide 9
- Nutrition Assessment Height=168 cm Weight=194 lbs (88.2 kg)
BMI=31 UBW=210 lbs;16 pound wt loss, 7% weight change in past month
Anthropometric Measurements
- Slide 10
- Nutrition Assessment Client History PMH: hypertension,
dyslipidemia, hypercholesteremia No surgical history (hx) Employed
as a physician as Chief of Orthopedics Denies family psychiatric
hx, alcohol, and drug use
- Slide 11
- Nutrition Assessment Nutrition Focused Physical Findings No
edema present on admission Vital signs stable on admission Signs
& Symptoms on admission: 3 weeks SOB, orthopnea, upper back
discomfort, fatigued, lower energy levels during normal work
activities, loss of appetite, weight loss
- Slide 12
- Nutrition Assessment Biochemical BNP levels normal upon
admission BUN slightly elevated: 26 mg/dL on 12/11 XX L abs were
not nutritionally significant throughout his stay in the
hospital
- Slide 13
- Diagnosis NI-1.2: Inadequate oral intake related to decreased
desire to consume sufficient energy 2/2 to CHF symptoms of
shortness of breath and fatigue as evidenced by patient report of
poor po intake (50% of meals) over last month. NC-3.2: Unintended
weight loss related to decreased appetite 2/2 inadequate oral
intake caused by CHF symptoms as evidenced by 15 pound weight loss
in past month (7% weight change).
- Slide 14
- Intervention Nutrition Prescription Energy Needs: 1870-2066
kcal (Mifflin St. Jeor) Protein Needs: 65-78 grams (1-1.2 gram/kg)
Fluids: 1760-2200 mL
- Slide 15
- Intervention DateDietAverage IntakeNutrition Supplements and
Intake December 8 th Patient placed on a cardiac diet upon
admission 25-50%- December 9thCardiac Diet25-50%Ensure Chocolate
TID ordered, Patient consumed one Ensure before surgery December
10thNPO at midnight for impending surgery -- December 11thNPO--
December 12thCLD/FLD50-75%Ensure Clear TID ordered, 1 consumed
December 13thCardiac diet50-75%Ensure Clear TID ordered, 1 consumed
December 14thCardiac diet25-50%Ensure Clear TID ordered, 2 consumed
December 15 th Cardiac diet25-50%Ensure Chocolate TID ordered, 2
consumed December 16thCardiac diet40%Ensure Chocolate TID, 3
consumed Magic Cup x 1/day, consumed December 17thCardiac diet,
patient discharged today --
- Slide 16
- Intervention RC 1.3 Coordination with other providers:
Recommend low sodium, cardiac Diet. Goal: Implement once medically
feasible after surgery. ND-3.1 Medical food supplements: Initiate
Ensure Chocolate TID once medically feasible. RC 1.3 Coordination
with other providers: Recommend Ensure Chocolate TID. Goal:
Implement once advanced to Clear Liquid Diet after surgery. RC 1.3
Collaboration with other providers: Patient will maintain current
weight throughout hospital stay. E-1.1 Purpose of Nutrition
Education: Prior to discharge educate patient and patient family on
importance of adhering to low sodium, cardiac diet after surgery
and discharge. E-1.4 Nutrition relationship to health/disease:
Prior to discharge help patient recognize and understand importance
of adherence to low sodium cardiac diet in relation to his CHF
- Slide 17
- Monitor/Evaluate FH 1.1.1.1 Energy Intake FH-1.2.1
Fluid/beverage intake FH 1.6.2 Sodium Intake FH 4.1.1 Food and
Nutrition Knowledge/Skill FH 4.1.2 Diagnosis specific food and
nutrition knowledge
- Slide 18
- Nutrition Implications Severity of MDs CHF was reflected in the
medical and nutritional therapy. Dietary Approaches to Stop
Hypertension (DASH) Implemented to help client make better choices
after surgery 2000 mg sodium/day Many CHF patients will require a
fluid-modified diet (ND-1.2.8) XX was not experiencing edema or
hypernatremia
- Slide 19
- Nutrition Implications Self-monitoring (C-2.3) Reading
nutrition labels Choosing salt-free additives
- Slide 20
- References Academy of Nutrition and Dietetics. International
Dietetics and Nutrition Terminology (IDNT) Reference Manual.
Chicago, IL: American Dietetic Association; 2013; Academy of
Nutrition and Dietetics. Nutrition Care Manual.
http://www.nutritioncaremanual.org. Accessed several times from
December 2014-February 2015.
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5803&lv2=8585&ncm_toc_id=8585&ncm_heading=Nutrition%20Carehttp://www.nutritioncaremanual.org
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5803&lv2=8585&ncm_toc_id=8585&ncm_heading=Nutrition%20Care
Cotugna N, Wolpert S. Sodium Recommendations for Special
Populations and the Resulting Implications. Journal of Community
Health. 2011; 36: 874-882. Ejection Fraction picture Emory Health
http://www.emoryhealthsciblog.comhttp://www.emoryhealthsciblog.com
Electrocardiogram American Accreditation HealthCare
commission-http://www.medicalwordmeanings.com/what-is-electrocardiogram-the-meaning-and-diagram/commission-http://www.medicalwordmeanings.com/what-is-electrocardiogram-the-meaning-and-diagram/
Evidence Analysis Library. Academy of Nutrition and Dietetics
Website. https://www.andeal.org. Accessed several times from
December-February 2015.
https://www.andeal.org/topic.cfm?menu=5289&cat=2815
https://www.andeal.org/topic.cfm?menu=5289&cat=2815 Healthy
heart vs. Congested Heart MD Health
http://www.md-health.com/Congestive-Heart-Failure.htmlhttp://www.md-health.com/Congestive-Heart-Failure.html
Heart El Corazon.
http://www.efn.uncor.edu/departamentos/divbioeco/anatocom/Biologia/Los%20Sistemas/Circulatorio/Corazon.htmhttp://www.efn.uncor.edu/departamentos/divbioeco/anatocom/Biologia/Los%20Sistemas/Circulatorio/Corazon.htm
Lavid CJ, Ventura HO. Analyzing the Weight of Evidence on the
Obesity Paradox and Heart FailureIs there a Limit to the Madness?
Congestive Heart Failure. 2013; 19:158-159. Lennie TA, Moser DK,
Biddle MJ, Walsh D. Nutrition Intervention to Decrease Symptoms in
Patients with Advanced Heart Failure. Res Nurs Health. 2013; 36(2):
120-145. Mahan LK. & S. Escott-Stump. 2012. 13 th edition of
Krauses Food, Nutrition & Diet Therapy. W.B. Saunders Co.: New
York. Medical Reference Guide-Complementary and Alternative
Medicine Guide. University of Maryland Medical Center. January
2012. http://umm.edu/health/medical/altmed/condition/heart-failure
Accessed April 2015.
http://umm.edu/health/medical/altmed/condition/heart-failure Riegel
B, Moser DK, Anker SD, Appel LJ. State of Science. Promoting
Self-Care in Persons with Heart Failure-A Scientific Statement From
the American Heart Association. Systolic/Diastolic HF picture
http://pixshark.com/congestive-heart-failure-prevention.htmhttp://pixshark.com/congestive-heart-failure-prevention.htm