Case study hypertension presentation show

Medical Nutrition Therapy Hypertension Case Study

2. Group Members
•MeeraMaraj
•OmariJoseph
•NailahAntoine
•Mikhail Lutchmedial
•Kern Rocke

3. Patient Profile and
Medical Records Data
Age= 50 years
Sex= Male
Ethnicity= African American
Occupation= High School Football Coach
Height= 6 feet 3 inches
Weight= 220 lbs
BP= 160/100
Medical Hx= Stage 2 (essential) Hypertension
P.A.= Walks 30 mins, 4-5 times per week
Previously a 2-pack a day smoker
Previous Dietary Tx= 4-gm Na Diet
Pharmacological Tx= 25 g hydrochlorothiazide qd

4. Patient Profile and
Medical Records Data
Chief Complaint:
Difficulty in adhering to a reduction of salt in the diet.
Food tastes bland and tasteless.

5. Pathophysiology
of Hypertension

6. Pathophysiology of
Hypertension
•Hypertension is the chronic elevation of blood
pressure that, in the long-term, causes end-organ
damage and results in increased morbidity and
mortality.
•Occurs due to the abnormal functioning of the
arterial pressure related to the central nervous
system, renin-angiotensin-aldosterone system,
endothelial dysfunction, genes and even due to
certain environmental factors.

7. Pathophysiology of
Hypertension
•Factors which contribute to the development of
hypertension are:
Aging
Genetics
Obesity
Smoking
Salt Sensitivity
High Frequent Alcohol Consumption
High Fat Diet
Low FiberDiet
•Normal blood Pressure is calculated as: 120/80 in
healthy adults.

8. Pathophysiology of
Hypertension
•Resting Blood Pressure ≥ 140/90 on two separate
occasions in an individual is characterized as either
Stage I or Stage II Hypertension.
•Resting Blood Pressure ≥ 130/80 in diabetic patients
increases their risk for the development of heart
disease.

9. Nutritional
Assessment

10. Anthropometrics
•Weight= 220 lbs/ 2.2 lbs
= 100 kg
•Height= 6’3”= 75 inches
= 75 x 2.54
= 190.5 cm= 1.905 m
•B.M.I = 100 kg/ (1.905)
2
m
=27.56 (overweight)

11. Anthropometrics
•Height = 6 feet 3 inches
=5 feet + (12 inches for the additional foot + 3
inches)
=5 feet + 15 inches
•IBW = 106 lbs+ (6lbs * 15 inches)
=106 lbs+ 90 lbs
=196 lbs
•%IBW = (220 lbs/ 196 lbs) * 100
= 112.24% (overweight)

12. Anthropometrics
•BMR = 66 + (13.7 x 100kg) + (5 x 190.5cm) –(6.8 x 50)
x 1.48
= 66 + 1370 + 952.5 –340 x 1.48
= 2048.5 x 1.48
= 3031.8 kcals/ day
•EER = 864 –(9.72 x 50) + PA x (14.2 x 100) + (503 x 1.905)
=864 –486 + (PA x 1420 + 958.2)
=378 + (PA x 2378.2)
=378 + (1.27 x 2378.2)
=378 + 3020.3
=3398.3 kcals/ day

13. Biochemical
Biochemical
parameter
Patient value –mg/dlNormal value –mg/dl
Total cholesterol 300 140-199
LDL cholesterol 135 <130
HDL cholesterol 35 37-70
Triglycerides 250 35-160

14. Biochemical
•Altered Lipid Values as a result of:
1)High Saturated Fat and Trans-Fat Intake
2)High Sugar Intake
3)High Alcohol Intake
4)Overweight

15. Clinical
Healthy, male who looks his age
Temp= 98.6
0
F BP= 160/100 mmHg
HR= 80 bpm RR= 15 bpm
Regular rate and rhythm, normal heart sounds (No
clicks, murmurs, or gallops)
No edemapresent on the skin and on hands and feet

16. Clinical
•Diagnosis of Stage 2 (Essential) Hypertension 1 year
ago
•Medical History shows that the subject’s mother
died from a Myocardial Infarction Related to
Uncontrolled Hypertension
•Hypertension of subject may have been caused
due to genetic history of hypertension

17. Dietary-History
24-hr Recall
Usual dietary intake:
AM: 1 c coffee (black)
Hot (oatmeal with 1 tspmargarine and 2 tspsugar) or cold (Frosted
Mini-Wheats) cereal.
½ c 2% milk
1 c orange juice
Snack 2 c coffee (black)
1 glazed donut
Lunch: 1 can Campbell’s tomato bisque soup
10 saltines
1 can diet cola
After work: 2 (usually) gin and tonics (3 ozgin with 5 oztonic)
PM: 6 ozbaked chicken (white meat no skin) (seasoned with salt pepper,
garlic)
1 large baked potato with 1 T butter, salt and pepper
1 c glazed carrots (1 tspsugar, 1 tspbutter)
Dinner salad with ranch –style dressing (3 tsp)-lettuce, spinch,
croutons, sliced cucumber
HS snack: 2 c butter pecan ice cream

18. Dietary-Analysis
Parameter Patient Intake
Calories (kcals) 4100
Protein (% Calories) 12
Carbohydrate (% Calories) 45
Dietary Fiber (g) 30
Total Fat (% Calories) 34
Saturated Fat (% Calories) 13
Monounsaturated Fat (% Calories) 13
Polyunsaturated Fat (% Calories) 6
Cholesterol (mg) 411
Calcium (mg) 1546
Potassium (mg) 6309
Sodium (mg) 5849
Vitamin B6 (mg) 3.6
Vitamin B12 (mg) 4.7
Vitamin C (mg) 4118
Vitamin D (µg) 8
Vitamin E (mg) 13
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19. Recognition of
Diet/ Drug
Interaction

20. Recognition of Diet/ Drug
Interaction
•High intakes of salt in the diet increases the excretion
of Potassium while taking hydrochlorothaizdecan
lead to development of hypokalemia
•High intakes of Caffeine while taking
hydrochlorothaizdecan lead to a strong diuretic
effect on the body thereby leading to dehydration
•Untreated dehydration can lead to heart injury,
cerebral edema, kidney failure, hypovolemic shock
and even death.

21. Nutritional
Needs
Calculations

22. Nutritional Needs
Calculations
CHO requirements = 45% -65% based on a 2000 calorie
intake
If 45% -65% of carbohydrates are recommended based on
a 2000 calorie intake
X % -Y of carbohydrates are recommended based on a
3031.8 calorie intake
X% -Y% = (45% -65%) * 3031.8 / 2000
= (136,431% -197,067) / 2000
= 68.2g –98.5g

23. Nutritional Needs
Calculations
•PRO requirements = 10% -35% based on a 2000 calorie
intake
If 10% -35% of proteins are recommended based on a 2000
calorie intake
X % -Y of proteins are recommended based on a 3031.8
calorie intake
X% -Y% = (10% -35%) * 3031.8 / 2000
= (30,318% -106,113) / 2000
= 15.2 g –53.1g

24. Nutritional Needs
Calculations
FAT requirements = 40% -65% based on a 2000 calorie
intake
If 40% -65% of proteins are recommended based on a 2000
calorie intake
X % -Y of proteins are recommended based on a 3031.8
calorie intake
X% -Y% = (40% -65%) * 3031.8 / 2000
= (121,272% -197,067) / 2000
= 60.6 g –98.5 g

25. Nutrition
Diagnosis

26. Nutrition Diagnosis
•Overweightasrelatedtohighcarbohydrateandfat
dietasevidencedbyBMIof27.56and%IBWof
112.24%.
•Alterednutritionrelatedlaboratoryvaluesrelatedto
highfatdietasevidencedbytotalblood
cholesterolof300mg/dL,bloodtriglyceridesof
250mg/dL,LDLof135mg/dLandHDLof35mg/dL.
•Alteredmetabolicstatus(hyper)relatedtohighsalt
andfatintake,familyhistoryofhypertensionas
evidencedbybloodpressureof160/100mmHg
anddeathofpatient’smotherfromMIrelatedto
uncontrolledhypertension.

27. Nutrition Diagnosis
•Inadequate mineral intake (Potassium and
Calcium) related to low dietary intake as
evidenced by dietary intake of 81.1% Potassium
and 84.2% Calcium.
•Low adherence to nutrition recommendations
related to patient’s low adherence to a 4mg sodium
diet as evidence by chief complaint of foods being
bland and tasteless.

28. Nutrition Care
Plan

29. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Overweight To achieve a weight
loss of 20-22 lbs in 10
months.
To provide a 2925
kcal/day low sodium
and Low fat,
reduced diet.
24 hr recall, food
frequency
questionnaire,
monthly weight
check-up.
Altered nutrition
related laboratory
values
The patient will
achieve lower
laboratory values to
reach normal range.
Cholesterol = 140-199
mg/dL
LDL-C = < 130 mg/dL
HDL-C = >40 mg/dL
TG = 35-160 mg/dL
To provide a diet
low in lipids
(saturated fat and
cholesterol) and to
increase daily
physical activity
levels.
To educate pt. on
choosing foods low
in saturated fat,
cholesterol and
triglycerides.
To monitor pt.
laboratory values.

30. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Altered metabolic status
(hyper)
Patient should achieve a
normotensive BP of
≤ 120mmHg
80
To increase activity
(aerobic) to 60 minutes, 5
times/week.
To provide a low sodium
diet (< 2300 mg/day) –
based on the DASH Diet.
To decrease the
consumption of fast
foods on weekends from
Fridays and Saturdays
once/week to Fridays
and Saturdays once
every 3 weeks.
To increase consumption
of low sodium home
cooked meals.
Monthly blood pressure
measurements, food
frequency questionnaire
and24-hr recall.

31. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Inadequate mineral
intake (Potassium (K)
and Calcium(Ca))
To increase consumption
of foods rich in K and Ca.
To provide a diet rich in
K and Causing foods
such as low-fat dairy
products (Ca), mango
(K), tomatoes (K),
tomatoes (K), leafy green
vegetables (Caand K),
fish (K).
Food frequency
questionnaire, monthly
biochemical tests.
Low adherence to
nutrition related
recommendations
To increase adherence to a
low sodium diet.
To provide nutrition
education and
counselling on the
importance of adherence
to a low sodium diet to
patient and patient’s
wife.
Food frequency
questionnaire, 24-hr
recall.

32. Menu
Breakfast:
2 servings of whole wheat cereal
2 servings of a medium sized banana (sliced)
2 servings of 1% or low fat milk
1 serving of garlic tea
Snacks: (AM)
1 large mango
1 20oz bottle water

33. Menu
Lunch:
2 servings of mackerel (steamed / lemon)
3 servings of whole wheat pasta
1 serving of cooked pigeon peas
2 servings of vegetables –1 toss salad (1c lettuce, carrots)
1 serving of olive oil
3 servings of vegetable / fruit juice –beet root (1.5 serv) &
pineapple juice (1.5 serv)
Snack: (PM)
1 20oz bottle water
1 medium orange
3 servings of Trail Mix

34. Menu
DINNER:
4 servings of whole wheat bread (Home-made, low
sodium)
1 serving tomatoes
1 serving lettuce
1 serving salmon
1 cup of water (8oz)

35. Nutrient Content of Menu
Parameter Patient Intake
Calories (kcals) 2756
Protein (% Calories) 20
Carbohydrate (% Calories) 69
Dietary Fiber (g) 63
Total Fat (% Calories) 16
Saturated Fat (% Calories) 3
Monounsaturated Fat (% Calories) 7
Polyunsaturated Fat (% Calories) 5
Cholesterol (mg) 153
Calcium (mg) 1340
Potassium (mg) 6595
Sodium (mg) 1816
Vitamin B6 (mg) 3.8
Vitamin B12 (mg) 7.9
Vitamin C (mg) 434
Vitamin D (µg) 25
Vitamin E (mg) 15

36. Questions

37. References
Life Extension. 2012. “Risk Factors for High Blood Pressure.” Accessed November 10
th
, 2012.
http://www.lef.org/protocols/heart_circulatory/high_blood_pressure_04.htm.
Mahan, L. Kathleen, and Escott-Stump, Sylvia. 2008. Krause’s Food and Nutrition and Diet
Therapy. 12th edition. Philadelphia: W.B. Saunders Co.
United States Department of Agriculture. (N.d.) “SuperTracker” Accessed 3
rd
November, 2012.
https://www.supertracker.usda.gov/default.aspx.
Vanlterson, Erik. 2010. “Proper Nutrition for Hypertension Patients.” Livestrong.com. November
2
nd
. Accessed November 12
th
, 2012. http://www.livestrong.com/article/295001-proper-
nutrition-for-hypertension-patients/.
Weber, Craig. 2009. “Diabetics and High Blood Pressure.” About.com. July 23. Accessed
November 10
th
, 2012.
http://highbloodpressure.about.com/od/highbloodpressure101/a/diabetes-hbp.htm.

38. Thank You