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 Kadims family.

His blood pressure is 210/110. His blood

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

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 Kadims 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

3. How significant is his problem?

A strong link exists between elevated serum lipid levels
and the development of coronary heart disease.
Lipoproteins circulate in the blood and are made up of
cholesterol, triglycerides, and phospholipids. A high
dietary intake of saturated fats is most critical factor for
the development of elevated serum lipids. The average
American diet often contains more than 40% of its calories
in fat.
Hypertension increases the risk of coronary heart disease
in several ways. First, it increases the workload of the
heart, 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, hypertension causes endothelial damage
to the blood vessels, which stimulates the development of
atherosclerosis.
Sedentary people, by contrast, have risk of cardiovascular
disease.

Shortness of breath because cardiovascular

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

4. What are the potential consequences if

Kadim ignore his doctor advice?
If Kadim ignore his doctor advice, he will
develop cardiovascular disease and stoke

Diagnosis

5. Write a diagnostic statement about Kadims lack of knowledge

regarding his cardiac condition and his new diet.
Deficient
knowledge
regarding
pathophysiology
of
condition/outcomes, treatment, 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. 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. Physical exercise or activity increases
the heart rate and hence the supply of oxygen in the body. With a
regular vigorous exercise, the heart muscle becomes more powerful
and efficient. Aerobic exercise shows the atherosclerotic process,
reducing the risk of cardiovascular disease.

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

8. 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. 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. A diet high
in saturated fat causes cholesterol to build up in your
arteries (blood vessels). Cholesterol is a soft, waxy
substance that can cause

clogged or blocked arteries. This puts you at risk for heart

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

Beat hypertension with bananas

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

Prevention of heart attack

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

Animal products, which contain high levels of

cholesterol and higher levels of saturated fats, should be
eliminated from your diet. Decreasing cholesterol content
of the diet will help prevent blood vessel damage. Try a
vegetarian diet.
Rest is very essential to the body especially to the heart
which works 24 hours a day, seven days a week. Physical
rest prevents your heart from getting overloaded. You need
7-8 hours of sleep during the night.
Temperance should be practiced. Avoid drinks which
contain alcohol or caffeine. Beer, wine, coffee, tea, and
cola drinks, among other alcoholic or caffeinated drinks,
unduly stimulate the sympathetic nervous system and this
can cause hypertension. Avoid cigarette smoking. Reports
say that the risk of a smokers first myocardial infarction
is 2.5 times higher than that of a non-smoker. Besides
nicotine, cigarette smoke contains poisons which cause
heart disease and strokes.

Behaviour must be in conformity to a lifestyle of healthful living. Make it your

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

9. What cardiac topic does Kadim need to learn to understand his new diet?
Diet can also affect cardiovascular function. A healthy diet with adequate calories,
protein, and other nutrients is important to maintain good immune function and
increase resistance to disease. Along with certain vitamins and minerals, dietary
protein is important to prevent anemia. High salt intake can affect blood pressure
and contribute to hypertension in two ways. First, it may increase the release of a
hormone called natriuretic hormone which indirectly contributes to hypertension.
Additionally, sodium stimulates vasopressor mechanisms, which cause
vasoconstriction. There is also evidence that other factors such as low potassium,
calcium, and magnesium intake may contribute to vasoconstriction and the
development of hypertension. One study showed that a high consumption of dairy
products and dietary products and dietary calcium reduced blood pressure levels.
10. What two food categories can Kadim use that have almost no restriction in his
new diet?
Fruits and vegetables. One easy way to lower your cholesterol is to add more
fresh fruits and vegetables to your diet. Fruits and vegetables contain natural fiber,
which has been shown in numerous studies to have a remarkable cholesterollowering effect. Fresh fruits and vegetables are generally low in sodium. 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.

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

Evaluation

12. If diet and exercise are successful, 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. 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), he can eat
whatever he wants and thus her have a family history of heart attacks in
young male. 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.

14. If the diet is insufficient to lower his cholesterol in 6 months, 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 they often work the best. They can reduce the risk for
heart attack, stroke, and early death in people who are at high risk for a heart
attack or stroke.
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.
Coronary angioplasty or heart bypass is a procedure used to restore flow through
narrowed or block arteries that supply blood to the heart muscle. At times a tube is
inserted into the open vessel to keep it from reblocking.

Further Thinking

Too much cholesterol in the blood, or high blood cholesterol, can

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

END
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