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Nutrition and Diet

Therapy Case
Study

Kadim is a 29 year old African
American stock exchange manager for a
large corporation. He has been feeling
tightening in his chest for 3 days and
now has shortness of breath and pain
radiating down his left arm. Kadim
thinks he is having heart attack. He was
taken to the emergency and is admitted
in the cardiac intensive care unit. He is
placed on a cardiac monitor and is given
nasal oxygen. The admitting nurse finds
out that there is a history of heart attacks
in young males in Kadim’s family.

the dietician places him on a low-cholesterol. elevated triglycerides. and lowsodium diet. low-fat. hoping they would be in his favor. he did eat well and exercised regularly before he started with his firm.His blood pressure is 210/110. The doctor suggests that Kadim participate in a candidate for heart attack but decides to play the odds. As his team of physicians and nurses get Kadim stabilized. After all. and markedly elevated LDL. . His blood work shows cholesterol of 320.

Assessment ASSESSMENT Assessment .

1. What subjective data do you have about Kadim and his health? •Kadim is feeling tightening in his chest for 3 days •Now has shortness of breath •Pain radiating down his left arm •Kadim thinks he is having heart attack •History of heart attacks in young males in Kadim’s family .

2. What objective data do you have? •His blood pressure is 210/110 •His blood work shows cholesterol of 320 •Elevated triglycerides •Markedly elevated LDL .

it increases the workload of the heart. First. increasing oxygen demand and coronary blood flow. The increased workload also causes hypertrophy of the ventricles. Over time this can contribute to heart failure. Secondly. •Sedentary people. triglycerides. which stimulates the development of atherosclerosis. have risk of cardiovascular disease. A high dietary intake of saturated fats is most critical factor for the development of elevated serum lipids. by contrast. and phospholipids. Lipoproteins circulate in the blood and are made up of cholesterol. How significant is his problem? •A strong link exists between elevated serum lipid levels and the development of coronary heart disease.3. •Hypertension increases the risk of coronary heart disease in several ways. . The average American diet often contains more than 40% of its calories in fat. hypertension causes endothelial damage to the blood vessels.

a condition known as pulmonary edema. This may cause fluid to escape into the alveoli and interfere with gas exchange. Shortness of breath is one sign of heart failure.•Shortness of breath because cardiovascular system compensates respiratory system. In the left-sided heart failure. •Pain radiating down his left arm and tightening of chest are signs of myocardial infraction •Coronary heart disease is hereditary . the vessels of the pulmonary system become congested or engorged with blood.

he will develop cardiovascular disease and stoke . What are the potential consequences if Kadim ignore his doctor advice? •If Kadim ignore his doctor advice.4.

Diagnosis .

. Physical exercise or activity increases the heart rate and hence the supply of oxygen in the body. Write a diagnostic statement about Kadim’s lack of knowledge regarding his cardiac condition and his new diet. reducing the risk of cardiovascular disease. treatment.5. What education is needed to help achieve lower cholesterol? .Physical activity is associated with a reduction in the risk of death due to cardiovascular disease. the heart muscle becomes more powerful and efficient. Aerobic exercise shows the atherosclerotic process. •Deficient knowledge regarding pathophysiology of condition/outcomes. and self-care needs related to lack of information regarding his cardiac condition and his diet as evidenced by statements of concern and development of preventable complications 6. With a regular vigorous exercise.

7.What are several reasonable goals for Kadim? •Blood pressure of 120/90 •Lowers cholesterol •Lowers triglycerides •Lowers LDL •Relief in shortness of breathing as evidence by regular and effortless Breathing .

Implementation .

A diet high in saturated fat causes cholesterol to build up in your arteries (blood vessels). waxy substance that can cause .8. Since Kadim manifested signs and symptoms of developing cardiovascular disorder. A diet low in saturated fat and cholesterol can help lower blood cholesterol levels and help prevent cardiovascular diseases. Cholesterol is a soft. What dietary issues does Kadim need to learn to comply with his new diet? Low fat diet and low-cholesterol diet is prescribed for patients with cardiovascular disorders such as atherosclerosis and congestive heart failure.

and other major health problems. stroke. •Low sodium diet is prescribed for patients with hypertension that client manifested and congestive heart failure that may develop. The hardening of the arteries is due to the buildup of fatty deposits called plaque. lack of exercise and eating fatty foods can increase the risk of developing coronary artery disease. Too much sodium makes client’s body retain water and makes his heart work harder. . This can worsen the symptoms of congestive heart failure. which lead to heart failure. This puts an extra strain on your heart and can increase blood pressure. Sodium can make your blood vessels and body tissues swell and fill with fluid.clogged or blocked arteries. and mineral deposits. which include shortness of breath and swelling. Sedentary lifestyle. This puts you at risk for heart attack.

Scotland.D. stroke and even cancer.2) . p 2) Tomatoes for the heart The tomato slice in your sandwich could help prevent heart attack. The yellow. making it the perfect way to beat high blood pressure. according to Asim Dutta-Roy. p. jelly-like material surrounding the seeds helps make the blood less “sticky”. (Health & Home 2010. Heart and stroke patients should benefit from eating two to four raw tomatoes a day.Beat hypertension with bananas The unique tropical fruit is extremely high in potassium yet low in salt. the US Food and Drug Administration have just allowed the banana industry to make official claims for the fruit’s ability to reduce the risk of blood pressure and stroke. principal scientist at the Rowett Research Institute in Aberdeen. Ph. inhibiting the formation of dangerous blood clots that trigger heart attacks and strokes. So much so. (Health & Home 2008..

Prevention of heart attack We call it “HEARTBEAT”. and helps improve the circulatory process by increasing the capacity of the heart to pump blood. additives. exercise. Exercise helps lower blood pressure and cholesterol. Brisk waliking is a good form of exercise. thus making the individual less susceptible to heart attack. behaviour. rest. and cholesterol checkup. animal fats. temperance. . This should be done especially if you’re male and not younger than 40. or if you’re female who is in your post menopausal age and with a positive family history of heart disease. Get a regular 45-minute exercise at least three to four times a week. Here they are: Habitually have a regular BP (blood pressure). environment. ECG. acronym for habit. and trust in God.

Rest is very essential to the body especially to the heart which works 24 hours a day. You need 7-8 hours of sleep during the night. unduly stimulate the sympathetic nervous system and this can cause hypertension. Avoid cigarette smoking. among other alcoholic or caffeinated drinks. Temperance should be practiced. seven days a week. Reports say that the risk of a smoker’s first myocardial infarction is 2. should be eliminated from your diet. and cola drinks. Decreasing cholesterol content of the diet will help prevent blood vessel damage. cigarette smoke contains poisons which cause heart disease and strokes. Besides nicotine. wine.Animal products. Beer. Try a vegetarian diet. coffee. tea. which contain high levels of cholesterol and higher levels of saturated fats.5 times higher than that of a non-smoker. Avoid drinks which contain alcohol or caffeine. . Physical rest prevents your heart from getting overloaded.

He is the greatest Physician. How marvelous to know that with God’s new kingdom. too much of them. need to be avoided. there will be no sorrows. Sugar clogs. Additives. sickness. Our world is full of insecurity. A merry heart does well like a medicine (Proverbs 17:22). Environment is important as well. Trust in God.Behaviour must be in conformity to a lifestyle of healthful living. thus causing increased blood pressure which will eventually lead to heart problem. 16-17) . Not more than one teaspoon of salt a day is recommended. Cast all your cares upon Jesus. p. Don’t get into a stressful situation at home. Stop worrying. stress and uncertainty. Have a positive outlook in life. Use salt and sugar sparingly. or death. “I can do all things through Christ which strengthened me” (Philippians 4:13). Too much salt accumulates water in the heart. (Health & Home 1999. unhealthy relationship with spouse and problems at work. The only assurance is to trust in God’s divine power after obeying His will. Make it your commitment. the system and so only one tablespoon is recommended daily. the greatest Cardiologist who can heal and restore the impaired function of the most damaged heart. with no added salt in the diet.

sodium stimulates vasopressor mechanisms. What cardiac topic does Kadim need to learn to understand his new diet? •Diet can also affect cardiovascular function. calcium. which cause vasoconstriction. Fruits and vegetables contain natural fiber. and other nutrients is important to maintain good immune function and increase resistance to disease. 10. One easy way to lower your cholesterol is to add more fresh fruits and vegetables to your diet. First. it may increase the release of a hormone called natriuretic hormone which indirectly contributes to hypertension. What two food categories can Kadim use that have almost no restriction in his new diet? •Fruits and vegetables. High salt intake can affect blood pressure and contribute to hypertension in two ways. Additionally.9. One study showed that a high consumption of dairy products and dietary products and dietary calcium reduced blood pressure levels. and magnesium intake may contribute to vasoconstriction and the development of hypertension. A healthy diet with adequate calories. There is also evidence that other factors such as low potassium. Fruits and vegetables lower blood pressure so it is possible to treat your high blood pressure naturally without any medication by eating fruit and vegetables. Along with certain vitamins and minerals. protein. Fresh fruits and vegetables are generally low in sodium. . which has been shown in numerous studies to have a remarkable cholesterollowering effect. dietary protein is important to prevent anemia.

Over-the-counter pain medications may also help. avoid self medication and cut down salts.11. •Gallbladder disease . . and soups. elevation. What other risk factors does Kadim have. Avoid pain medications that can affect the liver. After the fast. Lower cholesterols and fats. Nothing but water should be taken during this period. artificial kidney can be used or dialysis. •Fat malabsorption – lower cholesterols and fats. Adopt a liquid diet consisting of foods such as broth. and compression. and stop drinking alcohol •Renal failure – incase of recovery function is incomplete. the patient should fast for two or three days until the acute condition is cleared. gelatin. eat adequate calories and proteins. movement of edematous part can reduce swelling •Cirrhosis – Avoid medications that are harmful to liver. massage. the patient should take fruit and vegetable juices for a few days. and what does he need to do about them? •Edema – reduce salt intake. take daily multivitamin. These simple foods may allow the inflammation process to get better.In cases of acute gall-bladder inflammation. cut down salt. •Steatorrhea and Pancreatitis – Stop alcohol consumption.

Evaluation .

12. If diet and exercise are successful. . What will the dietician be able to assess in an interview with Kadim? •The dietician will be able to assess that a lifestyle change can be done to Kadim specifically on his diet due to his high status in life (African American stock exchange manager for a large corporation). what changes will be measurable in 3 to 6 months? •If client shows -Blood pressure of 120/90 -Lowers cholesterol -Lowers triglycerides -Lowers LDL -Relief in shortness of breathing as evidence by regular and effortless Breathing 13. One more thing to be considering that Kadim will on a Low Sodium and Low Fat or Low Cholesterol did to avoid any further complications. he can eat whatever he wants and thus her have a family history of heart attacks in young male.

•Prescribe ezetimibe with simvastatin (Vytorin) to Lower how much cholesterol your body makes and the amount of cholesterol your body absorbs •Prescribe atorvastatin with amlodipine (Caduet) Lower how much cholesterol your body makes and lower blood pressure •Prescribe niacin with lovastatin (Advicor) Raise good (HDL) cholesterol and lower bad (LDL) cholesterol •Worst case scenario a coronary angioplasty or heart bypass will be done to remove the cholesterol or clot on the narrow arteries and thus to make the blood flow freely. stroke. •Coronary angioplasty or heart bypass is a procedure used to restore flow through narrowed or block arteries that supply blood to the heart muscle. . what is the doctor likely to do? •To give medication such us statins which is the medicines used the most often to treat high cholesterol. and early death in people who are at high risk for a heart attack or stroke.14. and they often work the best. If the diet is insufficient to lower his cholesterol in 6 months. At times a tube is inserted into the open vessel to keep it from reblocking. They can reduce the risk for heart attack.

Further Thinking .

The release of cholesterol and fat may cause your blood to clot. Large plaque areas can lead to chest pain called angina. This is called coronary heart disease. plaque can cause narrowing of the arteries.Too much cholesterol in the blood. •Plaque and resulting health problems can also occur in arteries . This blockage can cause angina or a  heart attack. This buildup of cholesterol is called plaque. or high blood cholesterol. can be serious. so many people are unaware that their cholesterol level is too high. Over time. Angina happens when the heart does not receive enough oxygen-rich blood. releasing cholesterol and fat into the bloodstream. When the arteries narrow. called coronary arteries. •Special arteries. •Cholesterol can build up in the walls of your arteries. High blood cholesterol on its own does not cause symptoms. Narrowing of your coronary arteries due to plaque can stop or slow down the flow of blood to your heart. the amount of oxygen-rich blood is decreased. •Some plaques have a thin covering and can burst. Angina is a common symptom of CHD. bring blood to the heart. A clot can block the flow of blood. People with high blood cholesterol have a greater chance of getting heart disease. or hardening of the arteries. This is called atherosclerosis.

END THANK YOU!  .