NTFS 7334 Applied Medical Nutrition Therapy

Hypertension and Cardiovascular Case Study

Due Thursday, May 24th by Noon
Worth 125 Points
Name: Callie Ford
Please type your answer below each question in bold and email to Dr. Riggs.
Save as a Word document as follows: Last Name_First Name_Case Study 1

I. Understanding Hypertension and Pathophysiology of Hypertension

1. Based on the case study information, what risk factors does Mrs. Moore currently have?
Worth 5 points

Risk factors for the patient:

o Ethnicity and gender- African Americans females have the highest
prevalence rate at 45.7%
o Age- the patient’s age (57 years old) puts her at an increased risk for
hypertension
o Smoking- the patient was a 2-pack-a-day smoker, although she did quit “cold
turkey” when she was diagnosed with HTN last year.
o Alcohol intake- 2-4 beers per week.
o Diet- the patient’s diet consisted of many high sodium, saturated fats and
trans fats.
o High sodium foods: soup, crackers, ranch dressing, added salt, and
popcorn.
o High SF foods: butter, doughnut, ice cream
o Trans fats: doughnut, margarine, saltines, popcorn
o Obesity- She has a BMI of 25.8, which is classified as overweight,
contributing to hypertension.
o Family History- the patient’s mother died of MI related to uncontrolled
HTN.

2. Dr. Evans indicated in his note that he will “rule out metabolic syndrome.” What is
metabolic syndrome and what factors are used to diagnose it? Worth 5 points

o Metabolic syndrome is a constellation of metabolic risk factors and its

diagnosis can be determined on five different metabolic risk factors. To be
diagnosed with metabolic syndrome, the patient must have three of five risk
factors.
o The five risk factors are:
o Abdominal obesity
 Waist circumference- men > 40 in, women > 35 in
o Triglyceride levels

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  At or above 150 mg/dL
o HDL- Cholesterol
 Men: <40 mg/dL
 Women: < 50 mg/dL
o Blood Pressure
 At or above 130/85 mmHg
o Insulin resistance
 Fasting blood glucose at or above 100 mg/dL

3. What factors found in the medical and social history are pertinent for determining Mrs.
Moore's coronary heart disease (CHD) risk category? Worth 5 points

o There are many contributing factors that are relevant from the patient’s medical
and social history. The patient is a 57-year-old, African American female, with a
BMI of 25.8, diagnosed with Stage 2 hypertension. This puts her at a greater risk
category. She was a 2-pack-a-day smoker, but recently quit one year ago after
her diagnosis. Smoking is a significant risk factor that can lead to CHD and
other cardiovascular diseases. According to her family history, her mother died
of MI related to uncontrolled hypertension. Family history is an unalterable
factor, which is why it is important for the patient to control her HTN. Along
with family history; age, sex, obesity, and smoking play an important factor in
her medical history.
o In relation to her social history, the patient is a retired nurse, who lives at home
with her husband and volunteers at her church several times per month. The
patient and her husband usually eat out Friday and Saturday evenings at a pizza
restaurant or steakhouse.

4. Identify nutrients and food items that should be limited in the diet as well as increased in
the diet when addressing hypertension. Worth 10 points

o Nutrients and food items that should be limited in the patient’s diet include:
o Limiting foods with high sodium content
o Limiting foods high in saturated fat
o Limiting foods high in trans-fat
o Limiting alcohol
o Overall, it will be beneficial for the patient to limit her intake of soups, crackers,
doughnuts, added salts, added butters, hi-fat dressings, hi-fat restaurant foods
like pizza and steak, and alcohol consumption.
o Nutrients and food items that should be increased in the patient’s diet include:
o Potassium
o Magnesium
o Calcium

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 oFiber
oIncrease fruits (important source of potassium, magnesium and fiber)
oIncrease veggies (rich sources of potassium, magnesium and fiber)
oIncrease low-fat or fat-free dairy products (major sources of protein and
calcium)
o Overall, it will be beneficial for the patient to increase her intake of fruits,
veggies, lean protein, and low-fat/fat-free food choices.

5. From the information gathered within the intake domain, list possible nutrition problems
using appropriate diagnostic terms for hypertension. Worth 10 points

o Excessive energy intake

o Excessive or inappropriate intake of fats
o Excessive sodium intake
o Inadequate calcium, magnesium, potassium and fiber
o Overweight/obesity
o Food and nutrition related knowledge deficit
o Undesirable food choices

II. Understanding Nutrition Therapy for Hypertension

1. Briefly describe the DASH eating plan and discuss the major nutrients that are
components of this type of nutrition therapy. Worth 5 points

o Dietary Approach to Stop Hypertension- DASH:

o Focused on a variety of foods that reduce sodium and increase potassium,
magnesium, calcium and fiber.
o Servings-
o Grains: 7-8 servings/day
o Vegetables: 4-5 servings/day
o Fruits: 4-5 servings/day
o LF/FF Dairy: 2-3 servings/day
o Meat/Poultry/Fish: 2 or less
o Nuts/Seeds/Dry beans: 4-5 per week
o Fats and Oils: 2-3 servings/day
o Non-fat Sweets: 5 per week
o To promote weight loss DASH has an emphasis on: increasing fruits, veggies and
low-fat/fat-free dairy products.

2. Lifestyle modifications reduce blood, enhance the efficacy of antihypertensive

medications, and decrease cardiovascular risk. List lifestyle modifications that have been
shown to lower blood pressure. Worth 5 points

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 o Weight reduction- standard component for treatment of hypertension.
o The patient has lost 10 pounds and has maintained over the past year.
o Sodium reduction- limiting amount of highly processed foods, and added
salts.
o The patient was given guidelines to reduce sodium, but has poor
adherence to this diet.
o Alcohol- limit to no more than one drink/day for women.
o The patient typically has 2-4 beers/week
o Potassium, Calcium, Magnesium- increasing these 3 micronutrients lowers
BP more than reducing sodium intake alone.
o The patient has little to no intake of these micronutrients
o Physical Activity- 30 mins per day decreases BP
o The patient walks 30 mins 4-5 times per week
o Smoking Cessation- most important change to make
o The patient has quit smoking “cold turkey” after diagnosis of
hypertension

III. Nutrition Assessment

1. What are the health implications of Mrs. Moore’s body mass index (BMI)? 3 points

o Height: 5’6 (1.7 m)

o Weight: 160 lbs. (72.7 kg)
o BMI: 25.8- overweight

2. Using the Mifflin St. Jeor equation, calculate Mrs. Moore’s energy requirements. 5
points

o 10 (72.7 kg) + 6.25 (167.6 cm) – 5 (57) – 161

o 727 + 1,047.5 – 285 – 161
 1,328.5 kcal

3. Calculate Mrs. Moore’s protein requirements. Worth 5 points

o 0.8 x 72.7 = 58 g pro/kg

to
o 1.0g x 72.7kg = 72.7 g pro/kg

o Range: 58g – 72.7g pro

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 4. Identify the major sources of sodium and saturated fats in Mrs. Moore’s diet. Compare
her diet to the components of the DASH diet. Worth 10 points
o Major sources of sodium:
(from 24-hour recall)
o Soup
o Saltines
o Ranch dressing
o Popcorn
o Added salt to food preparation
o Foods when she goes to pizza restaurants or steakhouses
o Major sources of saturated fat:
o Glazed doughnut
o Added margarine in oatmeal
o Added butter in baked potato
o Milk (if regular fat milk)
o Ice cream
Comparing the patient’s diet to the components of DASH:
DASH Recommendations Patient’s Intake
Grains & grain products 7-8 servings Oatmeal, popcorn, crackers,
croutons
Vegetables 4-5 servings Carrots, baked potato,
lettuce, spinach, cucumber,
tomato soup

Fruit 4-5 servings 1 cup of orange juice

Low-fat/ Fat-free 2-3 servings 0

Meats, poultry, fish 2 or less 6 oz. baked chicken

Nuts, seeds and dry beans 4-5 per week 0

Fats and oils 2-3 Ranch dressing, butter,

margarine on baked potato,
butter in popcorn, doughnut,
milk in tomato soup
Sweets 5 per week Doughnut, glaze (from
carrots), diet cola

5. From the information gathered within the intake domain, list possible nutrition problems
using the diagnostic terms. Worth 5 points

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 o Excessive energy intake
o Excessive or inappropriate intake of fats
o Inadequate intake of fat types
o Excessive sodium intake
o Inadequate calcium, magnesium, potassium and fiber
o Inadequate vitamin intake
o Overweight/obesity
o Physical inactivity
o Food and nutrition related knowledge deficit

6. Dr. Evans ordered laboratory tests listed in table below. Complete the table with Mrs.
Moore’s values from 6/25 and the potential cause of any abnormalities. Worth 10 points
Parameter Normal Value Pt’s Value Reason for Abnormality

Glucose 70-99 mg/dL 101 High

Due to high intake of sugary and carbohydrate foods.

BUN 6-20 mg/dL 20 WNL

Creatinine 0.6-1.1 mg/dL 0.9 WNL

Total cholesterol < 200 mg/dL 270 High

Due to high intake of saturated fats, trans fats and high

sodium foods.

HDL-cholesterol > 59 mg/dL 30 Low

Due to smoking, poor diet, overweight and genetic factors.

LDL-cholesterol < 130 mg/dL 210 High

Due to poor diet, overweight, and genetic factors.

Apo A 80-175 mg/dL 75 Low

Associated with low levels of HDL (excess cholesterol in the

body) and related to heart disease.

Apo B 45-120 mg/dL 140 High

Due to a high fat diet and related to heart disease.

Triglycerides 35-135 mg/dL 150 High

Related to heart disease, obesity, high fat intake, high blood

glucose, and abnormal cholesterol levels.

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IV. Nutrition Diagnosis
1. Select two of the three nutrition problems (intake, clinical, or behavior domain)
and write at least two PES statements for each of the two problems you chose. Worth 12
points

Intake:
1. Excessive mineral intake related to unsupported beliefs/attitudes about food and
nutrition related topics as evidence by lack of adherence to low sodium diet

2. Excessive energy intake related to food-and nutrition-related knowledge deficit as

evidence by a caloric intake of 1,328 kcals and an overconsumption of foods high in
sodium and fat content.

Behavioral:
1. Limited adherence to nutrition-related recommendations related to unwilling or
disinterested in applying/learning information as evidence by lack of compliance or
inconsistent compliance with plan.

2. Food and nutrition-related knowledge deficit related to unwilling or disinterested

in learning/applying information as evidence by verbalizes unwillingness or
disinterest in learning information (rejection of low sodium diet parameters).

2. How did Mrs. Moore's labs change between 6/25 and 3/15 (9-month span)? What factors
in her history may have made an impact on these? Worth 10 Points
Parameter 6/25 3/15

Glucose 101 96
Bun 20 19
Creatinine 0.9 1.1
Total Cholesterol 270 210
HDL-Cholesterol 30 38
LDL-Cholesterol 210 147
Apo A 75 110
Apo B 140 115
Triglycerides 150 125

o There was a positive decrease in glucose, BUN, total cholesterol, Apo B and
triglycerides. The parameters that had a positive increase were HDL levels and
Apo A. In the 9-month span, these parameters may have declined/improved

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 because she quit smoking, walks 30 mins a day 4-5 times/week, has maintained
her 10-pound weight loss, and has some nutrition education.
V. Nutrition Intervention
1. When you talk with Mrs. Moore on 3/15, you ask her 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 her?
How quickly should she lose this weight? 5 points

o The patient is capable of obtaining her goal of losing 35 pounds, however she
must be willing to make lifestyle changes.
o I would first recommend more nutrition education on things like- how to use
Mrs. DASH seasonings on foods when cooking to make them less bland, how
to read food labels, how to decrease saturated fat and sodium intake, and
how to make better decisions at a restaurant.
o Along with the patient, it would be beneficial if her husband can be
educated on the importance of DASH because he could be her support
and the two of them could do this together.
o After the patient is aware of the lifestyle changes she must make, she will
start losing weight gradually because of the learning adherence to the
modifications.
o I would suggest the patient loses between 1 to 2 pounds per week.
o Losing 1-2 pounds per week (gradually) will be beneficial for her
lifestyle.
 Taking anthropometrics measurements weekly or monthly,
whichever desired.
o Because the patient is overweight, the pounds will come off faster if
she adheres to her diet.

2. For each of the PES statements that you have written, establish an ideal goal (based on
signs and symptoms) and an appropriate nutrition intervention (based on etiology). 10
points

Intake:
1. Excessive mineral intake related to unsupported beliefs/attitudes about food and
nutrition related topics as evidence by lack of adherence to low sodium diet
o GOAL: Adhere to a lower sodium intake of 2300 mg/day.
o INTERVENTION: Additional nutritional education to change unsupported
beliefs on DASH, emphasizing low fat and low sodium.

2. Excessive energy intake related to food-and nutrition-related knowledge deficit as

evidence by consumption of a 1,328 kcals, high in sodium and fats.
o GOAL: Increasing nutrient dense foods and lowering intake from non-
nutrient dense foods, measured by food recall.

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 o INTERVENTION: Education on how to prepare/cook foods using herbs and
spices rather than added salt, choosing more nutrient dense foods and
learning to make smarter choices at restaurants.

Behavioral:
1. Limited adherence to nutrition-related recommendations related to unwilling or
disinterested in applying/learning information as evidence by lack of compliance or
inconsistent compliance with plan.
o GOAL: More compliant with nutrition plan and education of lowering
sodium and fat intake- measured weekly.
o INTERVENTION: Nutrition counseling on finding interest in learning how
to lower sodium and fat, which leads to lowering lab parameters out of
normal limits.
2. Food and nutrition-related knowledge deficit related to unwilling or disinterested
in learning/applying information as evidence by verbalizes unwillingness or
disinterest in learning information (rejection of low sodium diet parameters).
o GOAL: Making small changes at a time for better adherence to DASH diet.
o INTERVENTION: Nutrition education for the client and husband on how to
prepare/cook foods using herbs and spices rather than added salt, choosing
more nutrient dense foods and learning to make smarter choices at
restaurants. Having social support from her husband could improve her
interest in learning and applying information.

3. Your appointment with Mrs. Moore in 3/15 is completed. What would you want to
reevaluate at her next follow-up appointment? Worth 5 points
o Food intake- food recall
o Diet adherence
o Anthropometrics, if possible
o Motivation level
o Evaluate lab values