Dietary Management of Atherosclerosis
Nutrition Care Plan
Dietary Management of Atherosclerosis
415 Nutrition Care Plan
Mr. F is a 54 y/o who is a CPA. Ht: 6’0” Wt: 235# He has been spending long hours at work, eating out frequently and not getting more than 5 hours of sleep per night. He also smokes 3 ppd. He has smoked for 30 yrs. Upon arrival at home one night he went to lift his garage door and noted an excruciating pain radiating up his left arm and shoulder. He also concurrently broke into a cold sweat and was SOB. He immediately went inside and sat down on the couch. His wife was asleep at the time and he did not bother to wake her. He did discuss it with his wife the following day, assuming it was a muscle sprain. On his drive to work he experienced much the same s/o but this time a more intense episode, therefore, drove straight to the ER of the closest hospital. Upon explaining his s/o to the triage nurse he was whisked into a room and hooked up to an EKG which noted ST segment depression. He was currently having a MI. Streptokinase was administered immediately. He would have to undergo an angioplasty for further assessment.
2 points each
What is his % IBW based on the Hamwi equation?
What is his BMI?
Why was streptokinase administered?
Define the following (1 point each):
EKG:
Telemetry:
Cardiologist:
Balloon dilation:
Cardiac Cath:
Treadmill Stress Test:
COQ-10:
PCO’s:
PUFA—omega 6
PUFA—-omega 3
What oil(s) is Omega 9 found in?
What does CABG stand for?
2 points each…………………….
His family history for heart disease is non-existent. With this in mind, what lab test should you recommend be ordered on him?
____________________________________________________________________
If the lab test above comes back elevated what (3) vitamins may be of benefit to this patient to help decrease this level? Give dose recommendations too.
1)
2)
3)
His lipid results come back as follows:
TG 158; T chol 245; LDL 148; HDL 40
Other labs: CK 582; LDH 324; hs-CRP extremely high
(1 point each)
What is his goal for LDL?
What is his goal for HDL?
Based on current lipid profile values what is pts. CHD risk ?
Why was his CK elevated?
Why was his LDH elevated?
What does the high hs-CRP predict?
Using the Harris Benedict equation calculate calorie needs and give range (2 points).
What goals would you set for wt redxn (2 points)?
How many calories would you recommend he take in qd to meet wt redxn goals (2 points)?
List the principles of a heart healthy diet for (2 points each):
Fat (total and
SFA
)
Na
Cholesterol
Fiber
What effect on total cholesterol and LDL do the following oils have? Answer by choosing either increase or decrease
SFA
PUFA
MUFA
The dietitian went to visit Mr F to discuss his diet with him. His typical food intake was as follows: scrambled eggs, hash browns, 1 slice toast with margarine, juice, and coffee with sugar. At work his only snack is coffee with one sugar. For lunch, he eats a sandwich. This is usually a dressed hamburger with French fries and coffee with sugar. Sometimes a piece of cake and pie. At home, he has meat every evening (chicken, beef, pork or sometimes fish), potatoes, and usually boiled vegetable (carrots, green beans, cabbage, etc.). A salad is seldom is ever eaten. Sometimes dessert i.e.: pudding, ice cream or jello (something soft and sweet). Before bedtime cheese, crackers, ice cream or a sandwich of any meat leftover from dinner. He usually has a regular soft drink with his snack. (10_points).
Please list the foods that are high in cholesterol, SFA and Na in Mr. F’s diet
Place an “x” is the box if the food is a high source. Don’t list amounts specifically
|
Food |
Cholesterol | SFA | Na |
|
Eg: Bacon |
X |
||
Write a PES statement based on the information you have gathered
1 point each……………….
Mr. F is sent home on baby ASA i/d, nitroglycerin take prn and he would also like to take 400 iu vitamin E/day.
As the RD. What should you tell him re: the vitamin E?
If he wanted to take vitamin E, garlic and ASA what may be a potential problem?
What exercise recommendation are you going to encourage for this patient once d/ced from the hospital (this is once he has received an exercise clearance and approval by the MD)
Plan a day’s menu for Mr. F that will include all the appropriate diet recommendations (20pts).
EXTRA CREDIT – 1 point each
Who orders the food for a hospital?
Who in the hospital would enter the patients diet order? Who has the ability to change the diet order?
Who in the kitchen would make certain the patients diet order is recorded and that they are placed on this diet?
Who would go up to the patient floor to get food preferences from a patient?
Who would screen the patient and assess their nutrition risk status?
Who would give the recommendation to do a calorie count or to start an enteral tube feeding?
Food delivery in a Hospital or Nursing home
You should have an idea how things work getting food from the hospital or nursing home kitchen to the patient’s room. So, here is a brief review.
Who orders the food at the hospital?
The person in the hospital or nursing home ordering the hospital food is either the foodservice director or their assistant and food orders are based on current and projected census.
Who orders the diet?
Either the MD or the nurse order the patient diet. Once the diet is ordered the clerk on the floor, nurse or nurse’s aide would make certain the diet is received by the diet office. In Illinois: If the RDN has clinical privileges the RDN can order diet orders and supplements in the hospital setting. However, in long term care an MD is the only person who can do this.
Who in the kitchen would make certain the patients diet order is recorded and that they are placed on a diet?
The diet clerk verifies the patients and then makes a note of it so they are sent the correct menu.
Who would go up to the patient floor to get food preferences from a patient?
Usually the dietetic technician would do this but it could also be the RDN.
Who would screen the patient and assess their nutrition risk status?
The nurse who admits the patient will ask them some standard screening questions (each question gives you a certain score) and that score is entered into the system. Moderate and high-risk patients would be flagged (based on their screening score) so the RDN know they need to see that patient.
Who would give the recommendation to do a calorie count or to start an enteral tube feeding?
This would be the role of a dietetic technician or RDN. Sometime an RN or MD would order a nutrition consult to assess intake of the patient and this would lead to the diet tech or RDN starting a calorie count. Once the calorie count is kept the RDN adds up calories and protein intake and determines the best plan of action. If the patient cannot meet their calorie or protein needs with food and supplements, then the RDN will assess patient for a tube feeding.