NS335 NURTITION FOR SPECIAL POPULATION

Unit 3 Assignment: A Patient With Cardiovascular Disease and Diet Planning

This unit’s assignment involves a patient who has been admitted to the hospital after experiencing acute symptoms associated with cardiovascular disease. Nutrition and associated diet recommendations will be explored in detail. A heart-healthy sample diet will also be developed.

Unit Outcomes addressed in this assignment:

Discuss diet therapy for treatment of CVD.

Develop dietetic and nutritional protocols for clients with chronic progressive degenerative diseases.

Course Outcome addressed in this assignment:

NS335-1: Design a therapeutic menu for a progressive degenerative disease.

• Assignment Information:
• Imagine that you are working in a hospital setting as a nutrition educator under the supervision of a registered dietitian (RD). You are assigned a referral for a new patient who has been admitted into the cardiac care unit. Your task is to summarize Mr. E’s nutritional and clinical status and to design a realistic meal plan for Mr. E.

Mr. E is a 62-year-old male who works as a lawyer. Access to his electronic medical record shows his most recent clinical data from about 6 months ago when he was evaluated by his family physician:

Weight: 220 pounds

Height: 5’10”

Blood pressure: 140/95

Total cholesterol: 230 mg/dl

Past medical diagnoses: GERD & occasional constipation

Medications: No prescribed medications. Over-the-counter usage of antacid tablets & occasional need of OTC laxatives or enemas.

Social/other: He has no hobbies or outside activities except occasional golf with his friends. His workdays are often long and stressful.

Prior MD advice: During his last checkup, the doctor advised him to start exercising daily and lose 25 lb.

• Upon further reading within the referring physician’s medical note and records, you see that Mrs. E has reported that her husband often chews antacid tablets “like candy.” He also has bouts of constipation that sometimes require laxatives or enemas when he becomes “desperate.”
• From this current hospital admission record, you were able to gather that Mr. E collapsed during a meeting at work after a sudden onset of severe chest pain that radiated into his left arm. He was brought to the emergency room pale, frightened, and short of breath. He was cold and sweaty, and he vomited shortly after arriving in the emergency room. His nail beds and lips were cyanotic, and his blood pressure was 100/70.
• Mr. E was placed on strict bed rest, and a clear liquid diet was ordered after day one; then he progressed to a full liquid diet for 2 days. The attending cardiologist has a standard protocol to progress patients like Mr. E to a low-saturated-fat, 1,200 kcal soft diet on the fourth day. You, as the nutrition educator, visited Mr. E and reported that his appetite was improving and responding well to the treatment. A regular texture diet was then recommended after you reported your findings to the supervising RD. The MD ordered a 1,600 kcal, low-saturated-fat, low-cholesterol diet by the end of the week, and this diet order was written on the discharge paperwork.
• The discharge diet specifications were:
• 1,600 total calories
• Total fat: 20% of total calories
• Saturated fat: no more than 7% of total calories
• cholesterol <300 mg

Just before discharge, you and the RD met with Mr. E and his wife several times to discuss his home care and dietary regimen. You noticed the MD did not address the previous GERD and occasional constipation reports. The RD asked you to contact the attending physician’s office to get verbal approval for appropriate diet therapy discharge orders that address his heart health, GERD, and constipation. Mr. E showed good general recovery and was willing to try the newly modified food plan, but he admitted his wife would need to be the main source of support and meal preparation.

Instructions:

Respond to the following questions:

What is meant by the term “myocardial infarction?” What are the clinical signs and symptoms of an MI? How does it apply to this patient’s scenario?

Identify and discuss several of Mr. E’s predisposing risk factors associated with cardiovascular disease.

• What is the rationale associated with diet progression and modifications (from clear to full liquids and then to solids along with the changes in texture, amount of fats, and total caloric level)?
• Explain the link between diet recommendations and symptom management. Why should the nutrition educator address his other medical issues (GERD/constipation) when planning the patient’s discharge diet? The cardiologist ordered a 1,600 calorie/low-fat diet.

What other advice would you give Mr. & Mrs. E regarding meal planning, preparation, and shopping for recommended foods on the diet? Be sure to include all aspects of his dietary needs related to heart health, GERD, and constipation.

• Appendix: Write a sample menu for Mr. E to follow when he arrives home. Include realistic food descriptions and accurate serving sizes. To display how the foods meet the guidelines prescribed, including the menu’s totals for:
• calories

total fat

cholesterol

saturated fat

fiber

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