Group 3 CA in HTN & CVD
Almacen
Sanchez
Santos
Tarun
Case Questions
I.
Understanding the Disease and Pathophysiology
1. Define blood pressure.
The force of blood against the artery walls is known as blood pressure. Blood is
transported throughout the body through arteries from the heart. Throughout the day, the
body's blood pressure typically increases and decreases. Two numbers are used to measure
it. Systolic blood pressure, which is the first number, gauges the pressure in your arteries
when your heart beats. Diastolic blood pressure, or the second number, gauges the pressure
in your arteries between heartbeats. The measurement is written as "120 over 80," or "120/80
mmHg," if the systolic and diastolic values are 120 and 80, respectively. Additionally, a
healthy blood pressure reading is less than 120/80 mmHg(Centers for Disease Control and
Prevention, 2021).
2. How is blood pressure normally regulated in the body?
Blood pressure is regulated in the body by changes to the diameters of blood vessels
in response to changes in the cardiac output and stroke volume. Factors such as stress,
nutrition, drugs, exercise, or disease can invoke changes in the diameters of the blood
vessels, altering blood pressure (Libretexts, 2022).
The baroreflex function tries to raise arterial pressure when the organism experiences
acute hypotension so that continuous perfusion is possible. The onset of chronic
hypertension in the body is possible, but it typically results from the combination of several
risk factors rather than having a clear cause. Essential hypertension is the medical name for
this ailment. It represents almost 95% of hypertension patients. Because hypertension can
develop difficulties with the heart, the brain, and the kidneys, it is essential to treat it. Firstline treatments for essential hypertension include thiazide diuretics, ACE inhibitors, calcium
channel blockers, and angiotensin receptor blockers (Shahoud et al., 2022).
3. What causes essential hypertension?
When a person has an abnormally high blood pressure that isn't the outcome of a
medical disease, this is referred to as essential (primary) hypertension. Obesity, a family
history of hypertension, and a poor diet are common causes of this type of high blood
pressure. With medication and a change in lifestyle, the illness can be reversed. Primary
(essential) hypertension is a multifactorial kind of high blood pressure that lacks a single
clearly identifiable cause. It is often referred to as essential or idiopathic hypertension.
Anything above 120/80 mmHg is normally considered to be above-normal. This indicates
that the internal artery pressure is greater than it should be (Cleveland Clinic, 2021). Some
causes of essential hypertension include:
- Being an older adult (age 65 and up).
- Diabetes.
- High-salt diet
- Excessive caffeine and its other forms.
- Family history of high blood pressure.
- Obesity.
- Alcohol use disorder.
- Sedentary lifestyle with limited physical activity.
- Sleep issues, such as insomnia.
4. What are the symptoms of hypertension?
The symptoms of extremely high blood pressure include headaches, impaired vision,
chest pain, and others. The easiest technique to determine whether someone has high blood
pressure is to check their blood pressure. If untreated, hypertension can lead to other
illnesses like renal disease, heart disease, and stroke (WHO, 2023). People with very high
blood pressure (usually 180/120 or higher) can experience symptoms including:
- Usually asymptomatic
- Elevated BP
- Severe headaches
- Chest pain
- Dizziness
- Nausea
- Vomiting
- Blurred Vision / Change in vision
- Confusion
- Buzzing in the ears
- Nose bleeds
- Abnormal Heart Rhythm
- Difficulty Breathing
5. How is hypertension diagnosed?
The WHO (2023) also states that Hypertension is diagnosed if, when it is measured
on two different days, the systolic blood pressure readings on both days is ≥140 mmHg
and/or the diastolic blood pressure readings on both days is ≥90 mmHg, maintaning
consistent high values. For most adults, a normal blood pressure is less than 120/80 mm Hg.
Your blood pressure is considered high when you have consistent systolic readings of 130
mm Hg or higher or diastolic readings of 80 mm Hg or higher (National Heart, Lung, and
Blood Institute, 2022).
6. List the risk factors for developing hypertension.
There are Non-modifiable and Modifiable Risk Factors for HTN.
- Non-modifiable Risk Factors
- Age
- Sex
- Genetics
- Family History of Disease
- Race
- Modifiable Risk Factors
- Dietary Habits and Practices
- Lifestyle Practices (i.e., smoking and alcohol)
- Health and Medical Condition (Obesity BMI>30; DM2, high cholesterol levels)
- Stress and Anxiety
7. What risk factors does Mrs. Anderson currently have?
Mrs. Anderson currently has a family history related to HTN and CVD from her
Mother, and unhealthy lifestyle practices such as her past smoking habits and family
smoking, 1-2 bottles of alcohol consumption, and skipping of dinner but binge eats later on.
8. Hypertension is classified in stages based on the risk of developing CVD. Complete the
following table of hypertension classifications.
Blood Pressure mm Hg
Category
Systolic BP
Diastolic BP
<120
and
<80
Prehypertension
120 to 139
or
80 to 89
Hypertension Stage
140 to 159
or
90 to 99
160 to 179
or
100 to 109
Normal
I
Hypertension Stage
II
9. Given these criteria, which category would Mrs. Anderson’s admitting blood pressure reading
place her in?
Based on the patient’s Blood Pressure upon admission with a reading of 160/100, the
criteria classifies Mrs. Anderson with Hypertension Stage II.
10. How is hypertension treated?
Thiazide is the primary diuretic used to treat high blood pressure. Diuretics are
frequently coupled with other medications for high blood pressure, sometimes in a single
dose. Beta blockers also assist in reducing the speed and force of the heartbeat. The heart
must pump less blood through the blood arteries as a result. For other linked disorders, beta
blockers are normally only administered as a last resort (National Heart, Lung, and Blood
Institute, 2022).
11. Dr. Thornton indicated in his admitting note that he will “rule out metabolic syndrome.” What
is metabolic syndrome?
Metabolic syndrome is a group of five conditions that can lead to heart disease,
diabetes, stroke and other health problems. Metabolic syndrome is diagnosed when
someone has three or more of these risk factors:
- High blood glucose (sugar)
- Low levels of HDL (“good”) cholesterol in the blood
- High levels of triglycerides in the blood
- Large waist circumference or “apple-shaped” body
- High blood pressure
Although each of these is a risk factor for cardiovascular disease, when a person has
three or more and is diagnosed with metabolic syndrome, the chance of developing a serious
cardiovascular condition increases (American Heart Association, 2021).
12. What factors found in the medical and social history are pertinent for determining Mrs.
Anderson’s CHD risk category?
As previously mentioned in item number seven, her social hisotry include a mother
who died of MI related to uncontrolled HTN, and her whole family's smoking habits, as well
as her unhealthy lifestyle practices and tendencies such as binge eating, alcohol drinking,
and non-restraint in intake of salt foods.
13. What progression of her disease might Mrs. Anderson experience?
If Mrs. Anderson current condition of hypertension continue to progress, it may lead to her
developing coronary artery disease (CAD) due to her lipid profile results, excessive fat and energy
intake, and her poorly controlled weight if an intervention is not made.
14. What are the most recent recommendations for nutrition therapy in hypertension? Explain
the history of and rationale for the DASH diet.
Dietary Approaches to Stop Hypertension (DASH) Diet is meant to help treat or prevent
hypertension (high blood pressure). This diet includes potassium, calcium, and magnesium-rich
meals. It also limits sodium, saturated fat, and added sweets in the diet.
15. What is the rationale for sodium restriction in treatment of hypertension? Is this controversial?
Why or why not?
According to the 2018 ACC/AHA and for Mrs. Anderson’s case of hypertension (elevated
blood pressure), she should reduce her sodium intake to an optimal goal of 1500 mg/day. 1500 mg
of sodium is equivalent to 1.5 grams of sodium and initiated for 14 days. It may sound controversial
due to certain factors such as involves calorie tracking, the lack of convenience foods, and not
always budget-friendly.
16. What are the Therapeutic Lifestyle Changes? Outline the major components of the nutrition
therapy interventions.
The National Cholesterol Education Program (NCEP) has created a comprehensive program
called Therapeutic Lifestyle Changes (TLC) to assist people in controlling their cholesterol levels
through lifestyle changes. The program offers suggestions for managing weight, physical activity,
and weight management.
The following are the major components of nutrition therapy interventions in TLC:
●
Saturated fat: < 7% of total calories
●
Cholesterol: < 200 mg/day
●
Total fat: 25-35% of total calories
●
Fiber intake: 20-30 g/day
●
Sodium intake: < 2,300 mg/day
17. The most recent recommendations suggest the therapeutic use of stanol esters. What are
they, and what is the rationale for their use?
Stanol esters are a form of stanol that has been esterified with a fatty acid to boost its
solubility in fat and stability in food products. Stanol esters can aid in lowering blood levels of LDL
("bad") cholesterol. They can lessen the amount of cholesterol that enters the bloodstream when
consumed with a meal because they can prevent dietary cholesterol from being absorbed.
III. Nutrition Assessment
A. Evaluation of Weight/Body Composition
18. Calculate Mrs. Anderson’s body mass index (BMI)?
Height: 5’6” = 168 cm or 1.68 cm
Weight: 160 lbs or 73 kg
BMI: kg/ m²= 73kg/ 1.68m²= 25.8
19. What are the health implications of this number?
According to WHO standards, Mrs. Anderson belongs to the overweight category
B. Calculation of Nutrient Requirements
20. Calculate Mrs. Anderson’s resting and total energy needs. Identify the formula/calculation
method you used and explain your rationale for using it.
Desirable Body Weight
Tanhauser’s method (Broca Index)
Hamwi method
= (168 cm - 100) - [10% (168 cm - 100)]=
100 lbs + (6 x 6) = 136 lbs or 61.8 ~ 62 kg
= 68 cm- 6.8 cm= 61.2 kg
Basal/ Resting Metabolic Rate (Harris-Benedict Equation for females)
BMR (kcal/day)= 655.1 + (9.563 x W) + (1.850 x H)- (4.676 x A)
BMR (kcal/day)= 655.1 + (9.563 x 73 kg) + (1.850 x 165 cm)- (4.676 x 54 years old)
BMR= 1,411. 495 kcal or 1,400 kcal
Mrs. Anderson activity level falls under the light category as she only walks 30 minutes 4-5 per week
and is not employed outside the home. Due to her age and condition, she also misses out on bingo
nights and does not do heavy work.
Total Energy Requirement
Using BMR
TER= BMR x PAL
= 1,400 kcal x 1.45
= 2,030 kcal or 2,000 kcal
Using DBW
61.2 kg x 35= 2,150 or 2,150 kcal
21. How many calories per day would you recommend for Mrs. Anderson?
2,150 kcal per day will be ideal for Mrs. Anderson to meet her energy needs and to improve
her condition.
22. Determine the appropriate percentages of total kilocalories from carbohydrate, protein, and lipid.
CHO: 60 % CHON: 15% FAT: 20%
CHO: 2,150 kcal x 0.65= 1,397.5 kcal/4 kcal/g=349.375 or 350 g
CHON: 2,150 kcal x 0.20= 430 kcal/4 kcal/g= 107.5 or 110 g
FAT: 2,150 kcal x 0.15= 322.5 kcal/9 kcal/g= 35.83 or 36 g
C. Intake Domain
23. Using a computer dietary analysis program or food composition table, compare Mrs. Anderson’s
“usual” dietary intake to her prescribed diet (DASH/TLC diet).
Food item
3c
Potassiu
Sodium
Magnesiu
Calcium
Total Fat
Saturated
Cholester
m
(maximu
m
(MInimum
(g)
Fat (g)
ol (mg)
(minimum
m
mg)
1,240 mg)
4,700 mg/
mg/
120 mEq)
mEq)
372 mg
7.44 mg
29.76
14.88
0g
0g
0 mg
0g
mg
mg
2,400
(500
Fiber (g)
100
Coffee
Oatmeal 144 mg
1.64 mg
60.7 mg
21.3 mg
2.58 mg
0.455 g
0 mg
4.02 g
Margari
0.9 g
0.1 mg
0.15 mg
0.15 mg
4.04 g
0.76 g
0 mg
0g
Sugar
0 mg
0 mg
0 mg
0 mg
0g
0g
0g
0g
2% milk
194 mg
47.6 mg
14.65
153.5
2.32 g
1.36 g
9.75 mg
0g
mg
mg
7.47 mg
4.98 mg
0g
0g
0 mg
0.498 g
ne
Orange
105 mg
4.98 mg
juice
Glazed
45.9 mg 181 mg
7.65 mg
27 mg
10.3 g
2.67 g
14.4 mg
0.675 g
260 mg
9.78 mg
20 mg
2.5 g
1.5 g
5 mg
1g
45.6 mg 282 mg
6.9 mg
5.7 mg
2.59 g
0.49 g
0 mg
0.84 g
28.8 mg 28.8 mg
3.6 mg
10.8 mg
0.108 g
0g
0 mg
0g
131 mg
514 mg
14 mg
4 mg
0.2 g
0.07 g
23 mg
0g
610 mg
376 mg
39 mg
7.8 mg
0.156 g
0.041 g
0 mg
2.34 g
donut
Canned
870 mg
tomato
soup
Saltine
cracker
Diet
cola
Baked
chicken
Baked
potato
w/ salt
Butter
0.95 mg 0.5 mg
0.08 mg
0.7 mg
4.075 g
2.4 g
11.7 mg
0g
Pepper
1.33 mg 0.02 mg
0.171
0.443
0g
0g
0 mg
0g
mg
mg
Glazed
491 mg
315 mg
19.2 mg
60.8 mg
4.29 g
2.22 g
11.2 mg
4.16 g
120 mg
5 mg
7 mg
16 mg
0.1 g
0g
0 mg
1g
28.8 mg 405 mg
2.25 mg
12.6 mg
20.04 g
3.12 g
11.7 mg
0g
98.4 mg 14.28
21.36
14.28
0g
0g
0 mg
0g
carrot
Dinner
salad
Ranchstyle
dressing
2
regular
mg
mg
mg
50 mg
19 mg
72 mg
beer
Ice
164 mg
7.2 g
4.4 g
22 mg
0.8 g
cream
Total 2840.68
3074.53
262.72
446.93
mg
mg
mg
mg
60.5 g
19.49 g 97.1 mg
15.3 g
24. What nutrients in Mrs. Anderson’s diet are of major concern to you?
The nutrients in Mrs Anderson’s diet that are of major concern are intakes of potassium,
sodium, magnesium, and saturated fat. Mrs. Anderson is consuming excessive amounts of sodium
and saturated fat, while she does not consume enough potassium and magnesium.
25. From the information gathered within the intake domain, list possible nutrition problems using
the diagnostic term.
●
Potassium - Inadequate potassium intake
●
Sodium - Excessive sodium intake
●
Magnesium - Inadequate magnesium intake
●
Saturated fat - Inappropriate intake of saturated fat
D. Clinical Domain
26. Dr. Thornton ordered the following labs: fasting glucose, cholesterol, triglycerides, creatinine,
and uric acid. He also ordered an EKG. In the following table, outline the indication for these tests
(tests provide information related to a disease or condition).
Parameter
Glucose
Normal Value
70–110 mg/dL
Patient’s
Reason
Value
abnormality
92
for
Nutrition
Implication
BUN
8–18 mg/dL
20
Kidney malfunction
(abnormal)
Creatinine
0.6–1.2 mg/dL
0.9
Total Cholesterol
120–199 mg/dL
270
H
(abnormal)
Excessive
protein
intake
Possible indication
Excessive
of hyperlipidemia
intake
energy
No direct source of
physical
aside
activity
from
daily
chores
HDL- cholesterol
> 55 (women) mg/dL
30 L
> 45 (men) mg/dL
Poorly
controlled
Excessive
weight
intake
Possible indication
Excessive
of hyperlipidemia
intake
fat
energy
No direct source of
physical
aside
activity
from
daily
chores
LDL- cholesterol
Apo A
< 130 mg/dL
314
Poorly
controlled
No direct source of
(abnormal)
weight
physical
Possible indication
aside
of hyperlipidemia
chores
from
101–199 (women) mg/dL
75 L
Increased risk of
Excessive
94–178 (men) mg/dL
(abnormal)
cardiovascular
intake
diseases
Excessive
Excess cholesterol
intake
activity
daily
fat
energy
levels
Apo B
60–126 (women) mg/dL
140 H
63–133 (men) mg/dL
(abnormal)
Low HDL levels
Excessive
fat
intake or High-Fat
Diet
Triglycerides
35–135 (women)
150 H
Increased risk of
Excessive
40–160 (men)
(abnormal)
cardiovascular
intake
diseases
fat
Excess cholesterol
Excessive
levels
intake
Too
much
energy
fat
around the waist
Genetics
Manifestation
of
Hypertension
27. Interpret Mrs. Anderson’s risk of CAD based on her lipid profile.
Based on her lipid profile, Mrs. Anderson’s total cholesterol, HDL cholesterol, LDL cholesterol,
and triglyceride levels place her at a high risk for developing heart disease. Her total cholesterol level
of 270 mg/dLis much higher than the healthy, normal level. She also has high levels of apo B (140
mg/dL) and LDL cholesterol (210 mg/dL), and low levels of apo A (75 mg/dL) and HDL cholesterol
(30 mg/dL). Her triglyceride levels (150 mg/dL) are higher than the recommended range 0f 35-135
mg/dL. Mrs. Anderson’s lipid profile based on these four lab values place her at a high risk for
developing CAD.
28. What is the significance of apolipoprotein A and apolipoprotein B in determining a
person’s risk of CAD?
Increased levels of Apolipoprotein B and decreased Apolipoprotein A is caused by low HDL
levels as it HDL carries apolipoprotein. In this way, apolipoprotein A can help to lower your risk for
cardiovascular disease.
29. Indicate the pharmacological differences among the antihypertensive agents listed
below.
Medications
Mechanism of Action
Nutritional Implications
Diuretics
Beta-blockers
Promote production of urine,
Electrolyte imbalance,
leading to increased excretion
dehydration, blood sugar
of water and electrolytes
control
Blocks beta receptors in the
Sodium and fluid balance
heart, leading to decrease in
heart rate and blood pressure
Calcium-channel blockers
Blocks the entry of calcium
Fluid retention, sodium
into cells and reduces the
retention, magnesium
amount of calcium available
deficiency
for muscle contraction, leading
to decrease heart rate and
blood pressure
ACE inhibitors
Inhibiting conversion of
Increase level of potassium in
angiotensin I to angiotensin II;
the blood
leading to vasodilation
(widening of blood vessels)
and decrease in blood
pressure
Angiotensin
II
receptor
Interfere with the renin-
Increase potassium level in
angiotensin system
the blood
Reduce stroke volume and
Fluid retention, interfere in
block the sympathetic muscle
sodium excretion, orthostatic
response in vascular muscles.
hypotension
blockers
Alpha-adrenergic blockers
30. What are the most common nutritional implications of taking hydrochlorothiazide?
Nutritional implications of hydrochlorothiazide:
-
Electrolyte imbalance
-
Increased risk of dehydration
-
Jaundice
-
Loss of appetite
The most common nutritional implications of taking hydrochlorothiazide (a diuretic) is the
effect the drug can have on the reabsorption of sodium, chloride, and potassium.
Hydrochlorothiazide can inhibit the reabsorption of these nutrients, which may negatively affect the
electrolyte balance of the individual.
31. Mrs. Anderson’s physician has decided to prescribe an ACE inhibitor and an HMGCoA reductase
inhibitor (Zocor). What changes can be expected in her lipid profile as a result of taking these
medications?
The ACE inhibitor and the HMGCoA reductase inhibitor will have desirable effects on various
contributors and factors of high blood pressure and hypertension. The ACE inhibitor will interfere
with the production of angiotensin II from angiotensin I, by inhibiting activation of the angiotensin
converting enzyme (ACE). If angiotensin II were to be produced, it would increase salt retention,
thus increasing blood pressure. However, if angiotensin II is not produced, there will be less pressure
and less vasoconstriction occurring in the arteries. The HMGCoA reductase inhibitor will lower
cholesterol by slowing down the synthesis of cholesterol. A result from taking these medication, it
can be expected that Mrs. Anderson’s lipid profile will improve, more specifically, levels of LDL
cholesterol and triglycerides will decrease, lowering risk for developing CAD.
32. How does an ACE inhibitor work to lower blood pressure?
ACE inhibitors block the activity of the enzyme ACE, which normally converts angiotensin I
to angiotensin II in the lungs. By inhibiting this process, ACE inhibitors prevent the production of
angiotensin II, which leads to vasodilation (widening) of the blood vessels and a decrease in blood
pressure.
33. How does a HMGCoA reductase inhibitor work to lower serum lipid?
Inhibitors of HMGCoA reductase accelerate the conversion of HMGCoA to mevalonate,
aiding in this rate-limiting cholesterol production process.
34. What other classes of medications can be used to treat hypercholesterolemia?
●
Statins
●
Bile acid sequestrants
●
Fibrates
●
Cholesterol absorption inhibitors (ezetimibe)
●
Nicotinic acid (niacin)
35. What are the pertinent drug–nutrient interactions and medical side effects for ACE inhibitors and
HMGCoA?
ACE inhibitors
●
Increase blood potassium levels
●
Dizziness, cough, and fatigue; angioedema, low blood pressure, and kidney failure
HMGCoA
●
Interfere with the production of coenzyme Q10 (CoQ10)
●
Muscle pain, weakness, and cramps; kidney failure, lover damage, and muscle breakdown
36. From the information gathered within the clinical domain, list possible nutrition problems using
the diagnostic term.
Functional: None
Biochemical: Altered nutrition-related lab values (High cholesterol, LDL, and TCG, Low HDL)
Weight: Overweight/Obesity
IV. Nutrition Diagnosis
38. Select two high-priority nutrition problems and complete PES statements for each.
PES 1: Excessive energy intake related to frequent consumption of energy dense, nutrient poor foods as
evidenced by BMI of 25.8 and analysis of 24 hour recall analysis (3621.50 kcal/day as opposed to
recommendation of 1850 kcal).
PES 2: Limited adherence to nutrition recommendations of a low sodium diet related to lack of desire to
refrain from adding salt to foods as evidenced by patient self-report 24 hour recall analysis (4200 mg).
V. Nutrition Intervention
39. Mrs. Anderson asks you, “A lot of my friends have lost weight on that Dr. Atkins diet. Would it be
best for me to follow that for a while to get this weight off?” What can you tell Mrs. Anderson about
the typical high-protein, low-carbohydrate approach to weight loss?
The Atkins diet, also known as the high-protein, low-carbohydrate approach to weight loss, has
been popular for decades. It involves limiting carbohydrates to force the body to burn fat for energy,
resulting in weight loss. However, there are potential health risks associated with this diet, such as
heart disease, constipation, dehydration, and headaches. Additionally, it may not be sustainable in
the long term, as many people find it difficult to adhere to strict carbohydrate restrictions over time.
It is important to focus on a balanced and sustainable diet that includes nutrient-dense foods and
regular physical activity.
40. When you ask Mrs. Anderson how much weight she would like to lose, she tells you she would
like to weigh 125, which is what she weighed most of her adult life. Is this reasonable? What would
you suggest as a goal for weight loss for Mrs. Anderson?
Using the Hamwi equation, her ideal body weight (IBW) is as follows:
Ideal Body Weight (IBW)
= 100 lbs for 5 ft + 5 lbs per inch over 5 ft
= 100 + 5(6)
= 100 + 30
= 130 lbs
Based on the Hamwi equation, Mrs. Anderson’s ideal body weight for her height is 130 lbs. If
she were to weigh her desirable body weight of 125 lbs, her BMI would be 20.2, placing her in the
normal, healthy category. Therefore, Mrs Anderson’s desire to weigh125 lbs is fairly reasonable.
However, her goal must be achieved in a healthy manner. A weight loss goal for Mrs. Anderson
would lose 25-35 lbs and achieve a weight of 125-135 lbs. By doing so, she would not have only a
normal BMI, but will decrease her risk of developing heart disease and further worsening her stage
2 hypertension.
41. How quickly should Mrs. Anderson lose this weight?
It is recommended that those who are overweight should set their initial weight loss goal over a
6 month period. Mrs. Anderson’s weight loss goal is to lose 25-35 lbs and achieve and maintain a
weight of 125-135 lbs. To lose weight in a healthy manner, she should lose 1-2 lbs per week. If she
were to lose 1-2 pounds per week, she would be able to achieve her weight loss goal in about 5-6
months.
42. For each of the PES statements that you have written, establish an ideal goal (based on the
signs and symptoms) and an appropriate intervention (based on the etiology).
PES 1: Excessive energy intake related to frequent consumption of energy dense, nutrient-poor foods as
evidenced by BMI of 25.8 and analysis of 24-hour recall analysis (3621.50 kcal/day as opposed to
recommendation of 1850 kcal).
Goal: Reduce daily caloric intake to 1850 kcal
Intervention: Counsel patient on healthier options for snack foods
PES 2: Limited adherence to nutrition recommendations of a low sodium diet related to lack of desire to
refrain from adding salt to foods as evidenced by patient self-report 24-hour recall analysis (4200 mg).
Goal: Reduce daily sodium intake to 2,400 mg
Intervention: Recommend alternative methods of adding flavor to foods and
meals, such as spices or salt substitutes. Recommend lower sodium food options. Low sodium cooking
education.
43. Identify the major sources of saturated fat and cholesterol in Mrs. Anderson’s diet. What
suggestions would you make for substitutions and/or other changes that would help Mrs. Anderson
reach her medical nutrition therapy goals?
The major sources of saturated fat and cholesterol in mrs. Anderson’s diet came from fat
sources such as butter/margarine and sweets (e.g. ice cream). Some suggestions for Mrs. Anderson
would be replacing high-fat dairy products with low- or non-fat versions (e.g. skim milk or low-fat
yogurt), increasing consumption of fruits and vegetables, and use healthy fats such as avocado,
olive oil, and nuts instead of butter and other high-saturated fat oils.
44. Assuming that the foods in her 24-hour recall are typical of her eating pattern, outline
necessary modifications you could use as a teaching tool.
Foods
Modification/Alternative(s)
Rationale
Coffee (3 c/day)
Limit to 1 c/day
Caffeine should be consumed
in moderation
Oatmeal
(w/margarine
& Fruits as substitute for sugar
sugar) or
Provides additional nutrients
and natural sugar
Frosted Mini-Wheats
2% low-fat milk
Can be replaced with skim milk Contains less cholesterol
Orange juice
n/a
Glazed donut
Apple cider vinegar and dairy Allergen friendly
free milk
Canned tomato soup
Select low-sodium version
Will help lower blood pressure
Saltine crackers
Low-sodium or unsalted
Will help lower blood pressure
Diet cola
Fruit juice
Provides additional nutrients
12 oz bottle regular beer
Light beer
Decrease calorie content
Baked chicken
n/a
Baked potato (w 1 tbsp butter,
Butter can be replaced with Provides less saturated fat
salt, & pepper)
margarine
Carrots
n/a
Salad w/ranch-style dressing
Low-fat
Provides less saturated fat
Ice cream
Sherbet
Provides less fat
45. What would you want to reevaluate in 3 to 4 weeks at a follow-up appointment?
In 3 to 4 weeks at a follow-up appointment after counseling with Mrs. Anderson, prescribing the
TLCS/DASH diet, and recommending diet modifications, the following levels should be reevaluated:
blood pressure, total serum cholesterol, HDL and LDL cholesterol, apo A, apo B, and triglycerides.
Hopefully, her blood pressure decreased, as did levels of total serum cholesterol, LDL cholesterol,
apo B, and triglycerides. Additionally, it would be desirable for her HDL cholesterol and apo A levels
to increase as well. Another 24-hour recall to assess the restriction of sodium intake and calorie
reduction would be useful as well. Monitoring Mrs. Anderson’s weight loss would also be a good idea
to do in 3 to 4 weeks at a follow-up appointment, as weight is important.
46. Evaluate Mrs. Anderson’s labs at 6 months and then at 9 months. Have the biochemical goals
been met with the current regimen?
Mrs. Anderson’s lab values at 3 and 6 months are both significant improvements compared to
her initial lab values. Her total serum cholesterol level was 270 mg/dL and decreased to 210 mg/dL
at 6 months. This is very close to the normal healthy range of 120-199 mg/dL. Her HDL cholesterol
level at admittance was 30 mg/dL and increased to 38 mg/dL at 6 months. This 6-month lab value
does not meet the normal value of more than 55 mg/dL, but is an improvement and can eventually
increase and meet this value if she follows the current regimen. Her LDL cholesterol admittance was
210 mg/dL and has decreased to 147 mg/dL at 6 months. This has not met the normal value of less
than 130 mg/dL but is approaching this value.
References:
High Blood Pressure Symptoms, Causes, and Problems | cdc.gov. (2021, May 18).
Centers for Disease Control and Prevention.
https://www.cdc.gov/bloodpressure/about.htm
Shahoud, J. S. (2022, August 29). Physiology, Arterial Pressure Regulation.
StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK538509/
What to Know About Essential Hypertension (Primary Hypertension). (n.d.).
Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22024-primaryhypertension-formerly-known-as-essential-hypertension#
World Health Organization: WHO & World Health Organization: WHO. (2023).
Hypertension. www.who.int. https://www.who.int/news-room/factsheets/detail/hypertension
Diagnosis | NHLBI, NIH. (2022, March 24). NHLBI, NIH.
https://www.nhlbi.nih.gov/health/high-blood-pressure/diagnosis#
Know Your Risk for High Blood Pressure | cdc.gov. (2023, March 17). Centers for
Disease Control and Prevention.
https://www.cdc.gov/bloodpressure/risk_factors.htm
Cholesterol Medications. (2022, October 10). www.heart.org.
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