Case Study Assignment

Justine Bennett
NFS 2420
December 11, 2012

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My case study is a 55-year-old woman named Mary that had

suffered from a mild myocardial infarction due to hypertension
approximately five years ago, was recently diagnosed with
diverticulosis, and is overweight. She was a smoker from her late teens
to her early 30s then had quit for approximately 25 years but recently
started smoking again. She takes multiple medications for
hypertension including hydrochlorothiazide, Aspirin, Cardizem CD, and
Imdur. She also has a family history of Type ! and Type II diabetes,
esophageal cancer, Alzheimers, and hypertension.
Hypertension is a disease that affects one in four people and it
has become an epidemic in the United States. In this disease the
patient has a systolic blood pressure of 140 mmHg or higher and a
diastolic blood pressure of 90 mmHg or higher and causes strain on
cardiac muscles. The patient experiences systolic hypertension, in
which the systolic blood pressure is typically high. Systolic blood
pressure is the measure of the force applied against the inner walls of
arteries as the heart pumps blood around the body. (1) Marys
hypertension has been caused by both a high sodium intake and
genetics. Typically the goal of nutritional support in patients with
hypertension is to prevent complications such as heart attack or stroke
from occurring, but since the patient has already suffered a mild heart
attack the goal is now to prevent further complications and reduce the
symptoms of the disease.

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The patient also suffers from diverticulosis, which is caused by a

low fiber diet creating pouches in the colon and large intestine that can
lead to diverticulitis. There are no warning symptoms but once
diverticulosis has already set in patients can experience cramping and
bloating or the pouches and become infected or inflamed. This can
lead to a decreased interest in eating due to feeling uncomfortable.
A third issue that the patient faces is being overweight resulting
from a diet high in fat and a lack of physical activity. There has been
evidence to show that being overweight can cause poor vitamin
absorption. The patients diet that has also lead to being overweight
has also caused elevated cholesterol levels, low fiber intake, and high
sodium intake.
The patients BMR is 1,568 calories/day and because she only
exercises 1 to 2 days a week her total calorie requirement to maintain
weight is 2,156 calories/day. When asked if she would be interested in
achieving a healthier weight the patient was very interested and
mentioned she would like to loose approximately 1 pound a week to
stay motivated. Due to these factors the daily recommended caloric
intake to loose 1 pound a week for the patient is 1,656 calories/day.
After analyzing a 3-day-intake of the patient her daily intake
percentages of calories were 39% total fat, 32% carbohydrates, and
25% protein. In order to reduce the amount of fat in the diet and aid in
weight loss and decrease complications from heart disease I would

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recommend the patient consume approximately 50% of calories as

carbohydrates, 25% of calories as protein, and 25% of calories as fat in
order to decrease fat intake and increase complex carbohydrate intake.
This would mean the patient would consume approximately 207 g of
carbohydrates, 103.5 g of protein, and 46 g of fat daily. To achieve
these goals the patient should eat more whole grains to achieve a
sense of fullness during meals, lean meats to reduce fat consumption,
and more fresh fruits and vegetables.
Since the patient already has hypertension and has suffered from
a mild myocardial infarction she needs to limit her sodium intake to
between 1,500 to 2,000 mg per day. Her average intake from the 3-day
average intake was 3,774 mg so In order to achieve this the patient
should avoid processed foods and pre-prepared meals, use seasonings
that are salt-free such as Mrs. Dash and fresh herbs, using frozen or
fresh vegetables instead of canned, and purchasing lower sodium
condiments and food products.
To prevent complications from diverticulosis the patient needs to
increase her fiber intake, which was 22 g from the 3-day average, to 30
g daily. Although 22 g of fiber is close to what the DRI for women over
50, the patient has diverticulosis and a lower fiber intake increases the
risk of experiencing symptoms and complications. Consuming soluble
viscous fiber, such as oats, fruits, vegetables, fruits, bran, legumes,
and barley, help lower blood cholesterol, which helps prevent heart

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disease, and increases satiety, which helps with weight loss and
satisfaction. Insoluble fiber, such as what is contained in wheat bran,
brown rice, fruits, vegetables, and whole grains, are also very
beneficial for weight loss by creating a sensation of fullness.
Smoking releases free radicals, which can cause oxidation of
LDLs increasing the risk of heart disease by causing atherosclerotic
changes. Vitamin C serves as an antioxidant, which can help prevent
and restore free radical damage and t of this the patient should be
consuming approximately 100 mg of vitamin C daily. Foods that are
high in vitamin C include dark leafy greens, citrus fruits, and colored
peppers. Although it can be difficult to fulfill the DRI of vitamin C,
supplementation is an option but they are known to cause constipation
in older adults so consuming it through food sources is preferred.
All other vitamins and minerals should follow the general
recommended intakes for women over 50 but she should pay special
attention to her calcium and potassium intake, because they were the
only vitamins or minerals whose DRI was not fulfilled throughout the 3day-intake. A lack of proper intake of calcium in post-menopausal
women, much like the patient, can lead to osteoporosis. Good sources
of calcium include dairy products, dark green leafy vegetables,
shellfish, and many grains and other products are now fortified with
calcium also.

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The patient is currently taking several medications including

aspirin, hydrochlorothiazide, Cardizem CD, and Imdur. None of the
medications have severe food/drug interactions but none should be
taken with alcohol as they can have an adverse effect on blood
pressure. Cardizem CD is a calcium channel blocker that, when it is
taken with calcium containing products such as a multivitamin, may be
rendered less effective because receptors become saturated with
calcium and are made less effective. Also the patient should not
consume grapefruit juice because it can interact with Cardizem CD by
increasing plasma concentration of the medication.
Before setting a 3-day meal plan the patient was asked 3 longterm goals of what she would like to achieve to improve her health and
they are as follows:

To achieve a healthy weight at a pace that will not discourage

her
To lower her cholesterol level
To better control her blood pressure so she will no longer be
required to take medication

In order to develop a balanced meal plan to achieve the patients

nutritional goals and achieve a healthier lifestyle it is important to use
low-sodium foods by using salt-free spices, fresh foods instead of
prepackaged, purchasing lower sodium options such as low sodium
lunchmeats and soups.

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In the 3 day diet plan designed for the patient there is an

emphasis on whole grains and foods high in fiber so many fresh fruits
and vegetables were used in addition to whole-wheat products in order
to help control the patients diverticulosis, increase satiety for dieting,
and assist in lowering cholesterol levels. To help the patient achieve
weight loss goals the meal plan is set up with smaller meals more
often. The diet plan has a breakfast, lunch, and dinner, along with 2
snacks between the meals. All meals and snacks include a 8-ounce to
ensure the patient received adequate fluid intake.
An exercise plan was also developed for the patient, which
involves moderate exercise for approximately 1 hour and 30 minutes 4
to 5 days a week. Exercise will allow the patient to help loose weight
then maintain the weight loss, strength cardiovascular muscles, and
decrease the risk for other diseases in her family history, Another
important part of the patients lifestyle that needs to be addressed is
smoking. If the patient can quit smoking it would decrease the risk of
diseases that she has a family history of, including esophageal cancer,
and can prevent her hypertension from worsening. But until she is able
to quit smoking her DRI needs to be increased by about 30% to 100
mg.
With a balanced diet and proper nutrient intake the patient will
not only be able to achieve a healthy weight but can also improve
overall health. If the patient stays with the sodium, calorie, and other

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nutrient requirements she may very easily be able to fulfill health
goals.

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Bibliography

1. Bernstein, Melissa, and Ann Schmidt Luggen. Nutrition for the older
adult. Sudbury, Mass.: Jones and Bartlett Publishers, 2010. Print.

2. "ChooseMyPlate.gov." ChooseMyPlate.gov. N.p., n.d. Web. 26 Nov.

2012. <http://www.choosemyplate.gov/>.

3. Weber, Christian, Wolfgang Erl, Kim Weber, and Peter Weber.

"Increased Adhesiveness of Isolated Monocytes to Endothelium Is
Prevented by Vitamin C Intake in Smokers." American Heart
Association 93.8 (1996): 1488-1493. American Heart Association.
Web. 1 Dec. 2012.