Case Study in Nutrition

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/statin


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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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Case Study in Nutrition