Case Study 4
Case Study 4
Case Study 4
10. Dr. Thornton indicated in his note that he will “rule out metabolic syndrome.”
What is metabolic syndrome?
Metabolic syndrome is a combination of metabolic risk factors, including
abdominal obesity, insulin resistance, dyslipidemia, hypertension, and
prothrombotic state, a state in which the formation of blood clots is facilitated.
You must have 3 of 5 risk factors to have metabolic syndrome.
11. What factors found in the medical and social history are pertinent for determining
Mrs. Sanders’s CHD risk category?
Her family history, her history with smoking 2 packs of cigarettes a day before
cessation, the amount of alcohol she consumes and her diet.
2. Using the EAL, describe the association between sodium intake and blood
pressure.
Sodium intake directly affects blood pressure.The EAL recommends to counsel
patients on reducing sodium intake for blood pressure in adults with hypertension.
The recommendation is to lower dietary sodium intake to roughly 1200 mg-1500
mg per day to reduce systolic and diastolic blood pressure up to 12mm Hg and
6mm Hg.
4. From the information gathered within the intake domain, list possible nutrition
problems using the diagnostic terms.
Excessive energy intake, excessive fast food consumption, excessive sodium
intake, inadequate potassium, magnesium intake, less than optimal intake of
unsaturated fats, inadequate fiber intake.
5. Dr. Thornton order the following labs: fasting glucose, cholesterol, triglycerides,
creatinine, and uric acid. He also ordered an EKG. In the following table, outline
the indication for these tests (tests provide information related to a disease or
condition).
10. Mrs. Sanders’s physician has decided to prescribe an ACE inhibitor and an HMG-
CoA reductase inhibitor (Zocor). What changes can be expected in her lipid
profile as a result of taking these medications?
Both ACE and HMG-CoA inhibitors are expected to be helpful in improving Mrs.
Sander’s lipid profile. Zocor is an example of simvastatins. Simvastatins are
lipophilic compounds that easily across the cell membrane of extrahepatic tissues
inhibiting HMG-CoA reductase. This inhibition leads to reduced production of
total cholesterol and as a result lower plasma LDL-cholesterol (Shuhaili,
Samsudin, & Stanslans, 2017).
Similarly, ACE inhibitors are shown to reduce total cholesterol and increase
plasma HDL-cholesterol (Short Communicatio, The Journal of Science Society).
15. From the information gathered within the clinical domain, list possible nutrition
problems using the diagnostic terms.
BUN measures the amount of nitrogen in the blood that comes from urea. Urea is
made in the liver and is created when is protein is broken down. A high BUN can
indicate that the kidneys are not functioning properly because they are not doing
their job to remove the urea from the blood. This can also result from heart
failure, dehydration or a high protein diet. However, because the creatinine levels
are within normal range, which can also tell how well the kidneys are working,
this raise in level might be from dehydration. Dehydration can lead to rapid heart
rate, lethargy, confusion, low blood pressure, and dizziness. If it is severe, it can
lead to coma and seizures (American College of Cardiology).
Mrs. Sanders’s triglyceride level is high. High triglyceride levels indicated when
there is an elevated amount of fat in the blood. Nutrition problems related to high
triglycerides include prediabetes or type II diabetes, and metabolic syndrome.
High triglycerides can also be a side effect of taking hydrochlorothiazide, which
is a diuretic. From Mrs. Sanders’s chart, she might have metabolic syndrome from
her results of high blood pressure, high triglycerides, high blood sugar, and
abnormal cholesterol levels (Triglycerides: Why Do They Matter?). All of these
are very serious and can lead to heart disease, stroke, and even death.
V. Nutrition Intervention
1. When you ask Mrs. Sanders how much weight she would like to lose, she tells
you she would like to weigh 125, which is what she weighed most of her adult
life. Is this reasonable? What would you suggest as a goal for weight loss for Mrs.
Sanders?
This is an ambitious goal, at 54 years old it would be a challenge to lose 35
pounds. As the body ages, it becomes harder to lose weight, and it’s unrealistic to
want to achieve the weight she was in her prime years of age. According to the
data, losing 10 kg of body weight will lower blood pressure. I would not set an
ideal weight for her to achieve but I would suggest attempting to lose ½-1 pound
per week to try to reduce her blood pressure. I would also recommend exercise to
decrease body fat and increase lean muscle, but this may cause her weight to go
up in some instances after muscle has been gained. That is why a specific number
would not be recommended, but attempting gradual weight loss and exercise
would be the best recommendation.
3. For each of the PES statements that you have written, establish an ideal goal
(based on the signs and symptoms) and an appropriate intervention (based on the
etiology).
PES #1: An ideal goal would be to reduce sodium intake and as a result lower her
blood pressure. Unfortunately, she tried the DASH diet but didn’t stick with it due
to the bland tastes. An appropriate intervention would be to give her some
resources about adding flavor to meals without adding excess salt. An example of
this would be to add fresh herbs to her meals. Another intervention to help her
reduce her sodium would be to limit eating fried foods and red meat to once a
week, due to her history she may be able to achieve this goal because she cooks
often and only eats fried foods and red meats outside of the home. If she complies
with the dietary changes and goals implemented by her care team, an attainable
goal of lowering blood pressure to 140/100 could take place after a month on this
program.
PES #2: An ideal goal to increase levels of fiber, potassium, and magnesium
would be to implement high fiber and high water content foods to her diet.
Referring her to a handout that outlines foods high in fiber will help her to
understand what foods to buy at the grocery store and add into her meals she
cooks at home. Some examples of high fiber, potassium, and magnesium foods
include whole grains, spinach, bananas, and even dark chocolate. By suggesting a
different sweet after bingo night such as homemade dark chocolate covered
frozen bananas, this was an attainable goal because she could still satisfy her
sweet tooth but also increase her magnesium, potassium, and fiber intake.
Implementing an intervention that recommends substitutions or health additions
to her meals and snacks is a realistic goal for her to attain. If this intervention is
followed, in a month her care team should see a significant rise in these nutrient
levels.
4. Identify the major sources of sodium, saturated fat, and cholesterol in Mrs.
Sanders’s diet. What suggestions would you make for substitutions and/or other
changes that would help Mrs. Sanders reach her medical nutrition therapy goals?
Major sources of sodium include canned soups, saltine crackers, pizza, red meat,
and adding additional salt to her meals in the cooking process. Saturated fat and
cholesterol sources include pizza, steak, ice cream, donuts.
To reduce sodium levels, it is recommended to buy low sodium soups and low
sodium crackers, preferably whole grain crackers. Red meat should be an
occasional food, at the most once a week. Red meat should be substituted with
leaner meats like poultry or fish. Pizza should be a special treat consumed rarely
if craving pizza attempt to make it from home so ingredients can be monitored.
Lastly limiting additional salt as seasoning to food cooked at home, attempt to add
natural flavors like whole herbs and natural flavors. Reducing intake of sweets
like donuts and ice cream would be highly recommended, treats of that nature
should be substituted with healthier options. Ice cream should be low fat or made
with nut or soy milks. Donuts should be substituted with other less saturated
sweets. A strong recommendation for substituting sweets could be eating fruits
with whip cream or dark chocolate drizzle.
References
American College of Cardiology. Blood Urea Nitrogen Test Overview. (2013). Retrieved from
https://www.cardiosmart.org/healthwise/aa36/271/aa36271
Ogedegbe, Henry. Apolipoprotein A-I/B Ratios May Be Useful in Coronary Heart Disease Risk
Assessment. (2002). Fort Myers, FL. Retrieved from https://doi.org/10.1309/0TQV-
C4F0-0W7D-JC5U
Shuhaili, M., F., Samsudin, I., N., Stanslas, J., Hasan, S., Thambiah, S., C. (2017). Effects of
Different Types of Statins on Lipid Profile: A Perspective on Asians.
Endocrinology Metabolism, 15(2): e43319. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556327/