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patient

with
Congestive
Heart
Failure
Megan Smith
UMD Dietetic Intern
May 6, 2015

E
l
C
o
r
a
z
o
n

Congestive Heart
Failure
Most common
signs and
symptoms
Fatigue
Edema
Shortness of
breath
Chest
congestion
Md Health

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

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

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

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

Medical
Considerations
Diagnosis: Acute left systolic heart failure

with aortic insufficiency. Broadly referred to


as CHF.

Signs/Symptoms: Fatigue, loss of appetite, SOB


PMH: hypertension
Echocardiogram: Ejection Fraction was 20-25%

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.

Nutrition Assessment
Anthropometric Measurements
Height=168 cm Weight=194 lbs (88.2 kg)
BMI=31
UBW=210 lbs;16 pound wt loss, 7% weight
change in past month

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

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

Nutrition Assessment
Biochemical
BNP levels normal upon admission
BUN slightly elevated: 26 mg/dL on 12/11
XX Labs

were not nutritionally significant


throughout his stay in the hospital

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).

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

Intervention
Date

Diet

Average Intake

Nutrition
Supplements and
Intake

December 8th

Patient placed on a
cardiac diet upon
admission
Cardiac Diet

25-50%

25-50%

December 10th

NPO at midnight for


impending surgery

Ensure Chocolate TID


ordered, Patient
consumed one Ensure
before surgery
-

December 11th

NPO

December 12th

CLD/FLD

50-75%

Ensure Clear TID


ordered, 1 consumed

December 13th

Cardiac diet

50-75%

Ensure Clear TID


ordered, 1 consumed

December 14th

Cardiac diet

25-50%

Ensure Clear TID


ordered, 2 consumed

December 15th

Cardiac diet

25-50%

Ensure Chocolate TID


ordered, 2 consumed

December 16th

Cardiac diet

40%

December 17th

Cardiac diet, patient


discharged today

Ensure Chocolate TID, 3


consumed
Magic Cup x 1/day,
consumed
-

December 9th

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

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

Nutrition Implications
Severity of MDs CHF was reflected in the
medical and nutritional therapy.
Many CHF patients will require a fluid-modified
diet (ND-1.2.8)

XX was not experiencing edema or


hypernatremia
Dietary Approaches to Stop Hypertension
(DASH)
Implemented to help client make better
choices after surgery
2000 mg sodium/day

Nutrition Implications
Self-monitoring (C-2.3)
Reading nutrition labels
Choosing salt-free additives

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%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.com
Electrocardiogram American Accreditation HealthCare
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
Healthy heart vs. Congested Heart MD Health http://www.md-health.com/Congestive-Heart-Failure.html
Heart El Corazon. http://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. 13th 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.
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.htm

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