Download Define blood pressure - Kerry B Barbera, RDN, LDN

Name Kerry Barbera
NHM 365
HTN Case Study
This is an individual assignment and is not to be completed as a group. Please type your answers into this document and
submit the completed assignment by the due date via the Assignments link on the Course Tools menu.
Please answer each question thoroughly.
I. Understanding the Disease and Pathophysiology
Define blood pressure.
The force exerted by the circulating blood upon the walls of the blood vessels. It is a function of cardiac output multiplied by the
peripheral resistance, the resistance in the blood vessels to the flow of blood. Blood pressure will be high when the diameter of the
blood vessel is decreased and low when the diameter of the blood vessel is increased. It is measured in millimeters of mercury
(mmHg).
2.What does the measurement of systolic blood pressure represent (physiologically)? What does diastolic blood pressure
represent?
The systolic pressure is the blood pressure during the contraction phase of the cardiac cycle. It is the pressure against the arterial walls
when the heart contracts and pushes the blood against the wall of the arteries as it leaves the heart. The diastolic pressure is the
pressure against the artery wall with the relaxation of the cardiac cycle. The pressure exerted against the wall of the artery when the
heart relaxes.
3.What are the 3 major regulators of blood pressure?
a)The two branches of the autonomic nervous system the sympathetic nervous system and the parasympathetic nervous system work
together and are responsible for short-term control. In response to a drop in blood pressure the sympathetic nervous system stimulates
the release of norepinephrine from the adrenal gland, which increases heart rate. It is also acts as a vasoconstrictor, which increases
peripheral resistance on the blood vessels, which increases blood pressure. The parasympathetic nervous system in a response to an
increase in blood pressure stimulates the release of acetylcholine, which decreases the heart rate through stimulation of the vagus
nerve. The release of acetylcholine also acts to dilate the blood vessels, which decreases peripheral resistance and lowers blood
pressure.
b)The kidneys are responsible for long-term control of blood pressure. The kidneys are responsible for regulating extracellular fluid
and sodium volume. When there is a decrease in blood pressure, serum, sodium or plasma volume this stimulates the kidneys to
release renin. Renin converts angiotensin into angiotensin I, where in the lungs it is converted to angiotensin II. Angiotensin II
stimulates the release of aldosterone, which is a vasoconstrictor the decreases peripheral resistance on the blood vessels that in turn,
increases blood pressure. It also acts on the kidneys to reabsorb sodium and chloride resulting in water retention. This will increase
blood volume and in turn, increase blood pressure.
c) The Pituitary gland responds to a decrease in blood pressure caused by a decrease in fluid volume and releases vasopressin, a
antidiuretic hormone. Vasopressin causes vasoconstriction of the blood vessels increasing blood pressure. It also acts on the kidneys to
retain water, which increases fluid volume and raises blood pressure.
4.What causes essential hypertension?
Etiology is unknown, however it does involve the interaction between poor lifestyle choices and gene expression. Poor lifestyle
choices could include smoking, poor diet, inactivity, obesity and stress.
5.When symptoms present themselves, what are the symptoms of hypertension?
Hypertension is considered a silent killer and is considered a symptomless condition, according to the American Heart Association.
Symptoms that have been associated with extreme elevation of blood pressure may include headaches, facial flushing, dizziness, and
blurred vision. People with long standing uncontrolled hypertension may develop subconjunctival hemorrhages on their retina due to
damage of the eye.
6.List the risk factors for developing hypertension.
Risk factors for hypertension include heritability, hyperinsulinemia, smoking, physical inactivity, stress, obesity, high cholesterol,
excessive alcohol intake and poor diet, especially one high in sodium. There is a higher risk for non-Hispanic black adults.
7.What risk factors does Mrs. Anderson have?
Mrs. Anderson is African American. She has high total cholesterol, high LDL levels and low HDL levels. She consumes a poor diet.
She reports walking for 30 minutes 4-5 times a week; this is less than the recommendation of 30-60 minutes of physical activity 5-6
days a week. When she drinks alcohol, she exceeds the recommended limit of 1 drink per day for women.
8.Hypertension is classified in stages. Complete the following table of hypertension classifications.
Blood Pressure (mmHg)
Category
Systolic BP
Diastolic BP
Normal
<120
<80
and
Prehypertension
120-139
80-89
and/or
Hypertension, Stage 1 140-159
90-99
and/or
Hypertension, Stage 2 ≥ 160
≥ 100
and/or
_
9.Given these criteria, which category would Mrs. Anderson’s admitting blood pressure place her in?
Her blood pressure was 160/100 placing her in the category of Stage 2 Hypertension, however, on her physical exam it states she was
diagnosed with Stage 1 Hypertension.
10.How is hypertension treated?
It is a comprehensive approach which uses a combination of lifestyle changes, nutrition therapy, and medications. Lifestyle changes
may include, quitting smoking, maintaining a healthy weight by balancing energy intake and physical activity, and managing stress.
Nutrition therapy may include following the DASH diet, restricting sodium and alcohol intake and increasing dietary sources of
magnesium, calcium and potassium. Medications typically used to manage hypertension include diuretics, beta-blockers, calcium
blockers, ACE inhibitors, and melatonin.
11.Dr. Thornton indicated in his admitting note that he will “rule out metabolic syndrome”. What is metabolic syndrome?
Metabolic Syndrome is a group of risk factors that often occur together. Individuals diagnosed with metabolic syndrome will have 3 or
more of the following risk factors: waist circumference greater than 40 inches in men and 35 inches in women, high blood pressure,
elevated fasting glucose, elevated triglyceride levels, low HDL levels. Metabolic syndrome increases one’s risk for coronary heart
disease, type 2 diabetes, heart attack, stroke, atherosclerosis and cancer.
12.What factors found in the medical and social history are pertinent for determining Mrs. Anderson’s CHD risk?
Medical and social history factors that are pertinent for determining Mrs. Anderson’s CHD risk include her elevated total cholesterol,
LDL’s, triglycerides, decreased HDL’s, BMI, HTN category 2, Family history-her mother died from a MI related to HTN, poor diet
and decreased physical activity.
13.What progression of her disease might Mrs. Anderson experience?
Her physician is checking for metabolic syndrome and with her fasting glucose being within normal limits, I have to believe she is
progressing towards heart disease, especially with her family history. Hypertensive heart disease is heart conditions brought about
from hypertension. Hypertensive heart disease can eventually progress to congestive heart failure.
II. Understanding the Nutrition Therapy
14.What are the most recent recommendations for nutrition therapy in hypertension? Explain the history and rationale of the
DASH diet.
The most current recommendations for nutrition therapy in hypertension are decreasing alcohol intake, saturated fat intake, and
sodium intake while increasing physical activity, fiber, calcium, potassium and magnesium.
Decrease alcohol to the recommended intake of 1 drink a day for women and 2 drinks a day for men.
Balancing energy intake and increasing physical activity will help maintain a healthy weight. Weight loss positively impacts blood
pressure; each kg of weight lost can result in a reduction of 1 mmHg in both systolic and diastolic blood pressure.
Increasing calcium, potassium and fiber intakes, while decreasing sodium with the DASH diet, will have a positive impact on
decreasing blood pressure.
Dietary Approach to Stop Hypertension, also known as the DASH diet, was developed to evaluate three different levels of sodium
intakes. DASH research found an eating plan containing 2,300 mg of sodium per day lowered blood pressure and a 1,500mg of
sodium per day eating plan lowered blood pressure even more. Such data provided the basis for current dietary guidelines to limit
sodium for those with higher than normal blood pressure intake to 1,500mg and those with normal blood pressure to limit sodium to
2,300mg.
The DASH diet is low in saturated fat, total fat and cholesterol. It encourages increased intakes of fresh fruit, vegetables, whole grains,
fish, poultry, low fat or fat free dairy, and fewer intakes of sweets and red meat. The Dash eating plan focuses on decreasing sodium
while increasing intakes of foods high in potassium, calcium and magnesium, which can help, lower blood pressure. The DASH eating
plan is a well-balanced and healthy eating plan for any adult to follow. It can help protect one from many diseases, not just
hypertension.
15. What is the rationale for sodium restriction in treatment of hypertension?
The DASH sodium trials, mentioned above, demonstrated that individuals benefited greatest with the reduction of sodium to 1,500mg
than 2,300mg. Such data provided the basis for our current dietary guidelines to limit sodium for those with higher than normal blood
pressure intake to 1,500mg and those with normal blood pressure to limit sodium to 2,300mg.
Is this controversial? Why or why not? The controversy surrounds that some individuals have a greater reduction in blood pressure
in response to the reduction of sodium than others. Salt-sensitivity varies among individuals. Individuals who have salt-resistant
hypertension are usually obese, black, middle-aged and have chronic kidney disease and hypertension. There is well-documented
research that has found a positive correlation between the reductions in sodium and blood pressure. I do not believe it is controversial
because the benefits outweigh the few individuals whose blood pressure does not respond to a reduction in sodium.
16.The most recent recommendations suggest the therapeutic use of stanol esters. What are they, and what is the rationale for
their use?
Stanol esters are a group of naturally occurring compounds found in plant cell membranes. They are structurally similar to our bodies
cholesterol which, when consumed, compete with the cholesterol for absorption in the digestive system. As a result, blood cholesterol
levels drop. The FDA has approved health claim on phytosterols (sterols and stanols) which states, “Foods containing at least 0.65
gram preserving of vegetable oil plant sterol esters, eaten twice a day with meals for a daily intake of at least 1.3 grams, as part of a
diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” They have been incorporated into margarines, like
Benecol. According to our book, the recommended intake for plant stanols is 2-3 grams per day, which may lower cholesterol up to
20%.
III. Nutrition Assessment To receive credit, show your work on all calculations.
A. Evaluation of Weight/Body Composition
17.Calculate Mrs. Anderson’s BMI. (Note – use the metric formula and do not round until you get your final answer. Round your
final answer to 1 decimal place.)
BMI=weight in kg/height in meters2 (160lb/ 2.2)= 72.72727 kg / (66in/39.37)= (1.6764 m)2 = 25.8785 BMI=25.9 kg/m2
18.What BMI category does this place her in? What are the health implications of this number?
Mrs. Anderson’s BMI places her in the Overweight category. She has similar health implications as someone in the obesity category
but not to the same severity. Health implications at her number would include cardiovascular disease, type 2 diabetes and hypertension.
B. Calculation of Nutrient Requirements
19.Calculate Mrs. Anderson’s resting energy needs using the Harris Benedict equation.
BEE = 655.1 + (9.563 x kg) + (1.850 x cm) - (4.676 x age) kg from #17=72.73kg cm = 66in x 2.54= 167.64cm
BEE = 655.1 + (9.563 x 72.73kg) + (1.850 x167.64) – (4.676 x 54) = 655.1 + 695.517 + 310.134 – 252.504 = 1,408.247
BEE = 1408.2 kcal
20.Calculate her total energy needs using an activity factor appropriate for a sedentary individual.
I Used the Estimated Energy Requirement (EER) found in Krause. EER is the average dietary energy intake that is predicted to
maintain energy balance in healthy, normal weight individuals. I used the formula for overweight and obese women 19 years or older.
TEE = 448 – 7.95 x age + PA x (11.4 x kg + 619 x m) where PA = 1 if sedentary kg= 72.72 m=1.67 and age=54
TEE = 448 – (7.95 x 54y/o) + 1 x (11.4 x 72.73kg) + (619 x 1.67m)= 448-(429.3) + 1 (828.122) + ( 1,033.73)= 448-(429.3) + 1
x( 828.122+1,033.73) =1881.552 1905.4
TEE = 1881.6 kcal
21.What percentage of her total energy should be from fat? Carbohydrate? Protein? Using these percentages, calculate how
many calories she will be getting from each of these macronutrient categories. Based upon EER of 1882 kcals calculated in #20
Macronutrient
Carbohydrates
Protein
Fat
C. Intake Domain
Percentage Range
45-65% of energy intake
10-35% of energy intake
20-35% of energy intake
Calories
847-1,223 kcals
188-659 kcals
376-659 kcals
22.After assessing Mrs. Anderson’s 24-hour recall, identify 3 food choices that could be changed to potentially improve her
cardiovascular health. Give possible healthier substitutions for these foods.
Food Choice
2 cups butter pecan ice cream
Glazed donut
Campbell’s Tomato Bisque Soup made with
milk
Alternative
½ cup Edy’s Slow Churned No Sugar Added
Butter Pecan Ice Cream
Whole wheat toast with Benecol
Campbell’s Tomato Soup on the Go
1. ½ cup of Edy’s Slow Churned Butter Pecan provides a significant decrease in kcals, fat, saturated fat, cholesterol, sodium and sugar
intake. All of these factors will improve her cardiovascular health. Decrease kcals from 640-120 kcals. Decrease total fat from 36 g-4g
and saturated fat from 16 g-1.5g. Sodium drops from 400mg-75mg, Sugar 52g-12g. All factors Mrs. Anderson needs because of her
CVD risk and history of hypertension.
2. Whole grain with the Benecol with her oatmeal increases both her soluble and insoluble fiber intake, which helps to keep the
bowels healthy and decrease cholesterol. This will also help keep her full longer than empty sugar calories of the donut and help her to
not over eat at lunchtime.
3. Campbell’s Creamy Tomato on the Go, is an individual 1 serving, which will help Mrs. Anderson from over eating, it has
significant reduction in sodium from 1760mg (over daily recommendation of 1,500mg of the DASH diet) to 650 mg, still high, but a
significant reduction.
I tried to provide small realistic changes that Mrs. Anderson would be more likely to follow and maintain. All of the changes above
will significantly improve her cardiovascular health.
D. Clinical Domain
23.In the following table, indicate the normal lab range, the patient’s lab values, whether they are high or low, the suspected
reason that the lab is abnormal, and what the nutritional implication may be. (For example, if a patient were to have
hypernatremia, the possible reason for the abnormality could be dehydration and/or renal dysfunction. In that case an
example of a nutritional implication might be to suggest rehydration with a hypotonic solution.)
Parameter
Normal Value
Patient’s Value
Reason for
Abnormality
Glucose
70-110 Mg/Dl
92, 90, 96
With In Normal
Nutrition
Implication
Values
Dehydration,
impaired renal
function, excessive
protein intake or
catabolism
With in normal
values
Family history, poor
diet, overweight,
inactivity, smoking,
high cholesterol diet.
Bun
8-18 Mg/Dl
20H, 15, 22H
Creatinine
0.6-1.2 Mg/Dl
0.9, 1.1, 1.1
Total Cholesterol
120-199 Mg/Dl
270H, 230H, 210H
Hdl-Cholesterol
>55 Mg/Dl
30L, 35L, 38L
Family history, poor
diet, overweight,
inactivity, smoking,
metabolic syndrome.
Ldl-Cholesterol
<130 Mg/Dl
150H, 169H, 147H
Family history,
hypothyroidism,
inactivity, alcohol
consumption.
Apo A
101-199 Mg/Dl
75L, 100L, 110
Apo B
60-126 Mg/Dl
140H, 120, 123
CAD, low levels risk
factor of atherogenic
vascular disease,
smoking, high
carbohydrate diet,
low HDL levels
CAD, high levels
risk for atherogenic
vascular disease,
diets high in sat fat,
high LDL levels
Triglycerides
35-135
150H, 130, 125
Family history, poor
diet, overweight,
Increase fluid intake,
keep protein intake
to a recommended
47-160 g/day.
Improve overall diet,
DASH eating plan,
keeping cholesterol
intake to 300 mg
/day, increase
physical activity.
Improve overall diet,
DASH eating plan,
keeping cholesterol
intake to 300 mg
/day, increase
physical activity.
Improve overall diet,
DASH eating plan,
keeping cholesterol
intake to 300 mg
/day, increase
physical activity.
Improve overall diet,
DASH eating plan,
keeping cholesterol
intake to 300 mg
/day, increase
physical activity
Improve overall diet,
DASH eating plan,
keeping cholesterol
intake to 300 mg
/day, increase
physical activity.
Improve overall diet,
DASH eating plan,
inactivity, smoking
high cholesterol,
high cholesterol diet.
keeping cholesterol
intake to 300 mg
/day, increase
physical activity.
24. Interpret Mrs. Anderson’s risk of CAD based on her lipid profile.
Mrs. Anderson’s lipid profile places her at risk for CAD. She has elevated triglycerides, elevated LDL’s and low HDL’s this
combination is what increases her risk for CAD. She also has several of the risk factors associated with CAD, family history, poor diet,
hypertension and physical inactivity. Her Apo A has been low 2/3 times and her Apo B high 1/3 times; these tests are indicators for
atherosclerosis.
25. What is the significance of apolipoprotein A and apolipoprotein B in determining a person’s risk of CAD?
These tests are better indicators for one’s risk of CAD than LDLs, HDLs, low levels of Apo A and high levels of Apo B have been
associated with atherosclerosis. Low levels of Apo A and HDL suggest insufficient clearing of cholesterol from the circulation.
26.Indicate the pharmacological differences among the antihypertensive agents listed below:
Medications
Mechanism of Action
Nutritional
Implications/interactions
Diuretics
Loop diuretic, primarily inhibits the
absorption of sodium and chloride
not only in the proximal and distal
tubules but also in the loop of Henle.
Take on empty stomach unless GI
distress occurs and limit alcohol.
Important to stay hydrated and
maintain a diet high in potassium
and magnesium intake, a supplement
maybe necessary. Use caution with
calcium supplements. Avoid natural
licorice as it may counteract the
effect of the drug.
Beta-blockers
Targets the beta receptor to inhibit
epinephrine and norepinephrine
release and a decrease in renin
release, which will decrease heart
rate and BP.
Take with food to increase
bioavailability, maintain DASH diet.
Monitor glucose and lipid
metabolism, hypoglycemia.
Calcium-channel blockers
Decrease BP by blocking the
calcium channels of the cell
membrane. Acts on the vascular
smooth muscles, which reduces
force of contraction of the heart and
causes vasodilation. Slows down
heart rate.
Take on empty stomach. do not take
with grapefruit/related citrus; avoid
ginger, ginko, ginseng; avoid
alcohol; sore throat, nausea,
dyspepsia, constipation, diarrhea,
flushing, peripheral edema,
dizziness, HA, fatigue, muscle
cramps, tachycardia.
ACE inhibitors
ACE inhibitor; decreases plasma
angiotensin II, which leads to
decreased vasopressor activity and
decreased aldosterone secretion.
Check each agent for specific
recommendations regarding
ingestion with food
Angiotensin II receptor blockers
It blocks vasoconstrictor and
aldosterone-secreting effects of
angiotensin II by selectively
blocking the binding of angiotensin
II in many tissues.
Alpha-adrenergic blockers
Alpha-adrenergic blockers
cause vasodilation by blocking the
binding of norepinephrine to the
smooth muscle receptors.
Caution with high potassium diets or
potassium supplements. Avoid salt
substitutes. Ensure adequate
hydration. Avoid natural licorice;
avoid grapefruit and related citrus
with losartan.
Avoid alcohol and alcohol products.
Drug increases sensitivity to alcohol,
which may increase sedation.
27.What are the most common nutritional implications of taking hydrochlorothiazide?
Hydrochlorothiazide is a strong diuretic, which can cause dehydration. It increases urinary excretion of sodium, potassium and
magnesium. Increases renal absorption of calcium. Important to stay hydrated, maintain a diet high in potassium and magnesium
intake, a supplement maybe necessary. Use caution with calcium supplements. Avoid natural licorice as it may counteract the effect of
the drug.
28.Mrs. Anderson’s physician has decided to prescribe an ACE inhibitor and an HMGCoA reductase inhibitor (Zocor). What
changes can be expected in her lipid profile as a result of taking these medications? Zocor, the HMG Co-A reductase inhibitor
lowers LDL cholesterol levels and raise HDL cholesterol levels. The ACE inhibitor lowers blood pressure by decreasing plasma
angiotensin II, a vasoconstrictor. Mrs. Anderson’s should see a drop in her blood pressure accompanied by a decrease in her LDL
levels and increase in her HDL levels.
29.What are the pertinent drug-nutrient interactions and medical side effects for nicotinic acid and HMGCoA reductase
inhibitors?
Nicotinic acid may increase glucose and uric acid levels. Maintain a diabetic diet and low purine diet maybe necessary. Monitoring
glucose levels while taking this drug, especially diabetics. Most common side effect is skin flushing usually on the face and neck
which and can be accompanied by itching. Dizziness, nausea diarrhea and headaches are also common side effects.
HMGCoA reductase inhibitors may cause a significant decrease in Q10. Maintain a low-fat low cholesterol diet for optimal drug effect.
Avoid grapefruit and related citrus. Common side effects include abdominal pain, headache, and nausea.
IV. Nutrition Diagnosis and Intervention
30.When you ask Mrs. Anderson how much weight she would like to lose, she tells you she would like to weigh 125#, which is
what she weighed for much of her adult life. Is this reasonable? What would you suggest as a weight loss goal for Mrs.
Anderson?
I do not think this is a realistic goal for Mrs. Anderson. A more realistic goal would be to loose 10% body weight, loosing just 10%
body weight has been linked to many health benefits and can help Mrs. Anderson decrease her blood pressure and cholesterol levels.
An initial weight loss goal of 15 pounds would place Mrs. Anderson in healthy BMI range of 23.45. Once she reaches this goal we
could set a new weight loss goal if warranted.
a. How quickly should she lose this weight?
Safe and effective weight loss is 0.5-1.0 pounds per week. This should be a very attainable goal for Mrs. Anderson if she makes the
necessary changes to her diet and physical activity levels. Decreasing her Kcal intake of 500 kcal per day, Mrs. Anderson should meet
this goal safely in approximately 4-6 months.
31.Select 2 high-priority nutrition problems and write PES statements for each. (Note- be sure to review the NCP module then
look at the ADA Problem Statements file or, if you have one, your ADA IDNT Reference Manual prior to writing your PES
statements.)
Excessive Sodium Intake (5.10.2.10736) r/t frequent poor food choices, intake of high sodium processed foods AEB level 2
hypertension, and excessive sodium intake during 24-hour recall.
Excessive energy intake (NI-1.3) r/t frequent poor food choices, inactivity, intake of high caloric processed foods and decreased
physical activity AEB BMI of 25.9kg/m2 , self report of inactivity, and excessive intake of kcal during 24 hour recall.
32.For each of the PES statements you have written, establish an ideal goal (goals should be specific and measurable, and
related to improving the nutrition diagnosis) an appropriate nutrition-related intervention (based on the etiology), your
method for monitoring, and how you will evaluate the success of your intervention.
For example:
PES Statement
(This is the “nutrition
diagnosis” that you
wrote in #16)
Inadequate energy
intake (NI-1.4) related
to dementia and poor
appetite as evidenced
by diet history and
recent unintentional
weight loss 6% of UBW
in 2 months.
Goal
(What would you
like to achieve?)
Intervention
(How will you achieve
your goal?)
Short-term: Improve
caloric intake to
meet estimated
energy needs of
1800 kcals/day.
Provide meal assistance
to help patient consume
meals on tray.
Monitoring
(What will you be monitoring
to see if your goal is
achieved? How often will you
monitor this?)
Short-term:
Monitor trays daily to
determine if oral intake
improves and if supplement is
being consumed. Institute 3day calorie counts.
Evaluation
(What criteria will you use to determine your
intervention successful?)
Short-term: Patient drinks beverages and
calorie counts indicate pt is meeting or
exceeding energy needs.
Long-term: Patient demonstrates weight gain
of 1-2 lbs/week until goal BMI is reached.
Long-term: Increase
energy intake to 500
kcal>EER to allow
for weight gain of 12 lbs/week until BMI
of 19.0 is reached.
Try oral supplements to
determine patient
preference and evaluate
acceptance. If patient
enjoys supplement,
provide Ensure Plus bid
with breakfast and
dinner to provide an
additional 711 kcal/day.
PES Statement
Goal
Intervention
Monitoring
Evaluation
Excessive energy
Short-term:
Educate patient on
Short-term:
Short term:
Long-term: Weigh patient
twice weekly.
intake (NI-1.3) r/t
frequent poor food
choices, inactivity,
intake of high caloric
processed foods and
decreased physical
activity AEB BMI of
25.9kg/m2 , self report
of inactivity, and
excessive intake of
kcal during 24 hour
recall.
Reduce energy
intake to meet
estimated energy
needs of 1882 kcals.
Increase physical
activity to 30
minutes daily, 5-6
times per week
Long-term:
Reduce energy
intake < EER to
provide a weight
loss of 1-2 pounds
per week.
healthier food choices.
Provide sample menu
plan. Slowly replace
poor food choices with
healthier fruits, nuts and
vegetables. Begin with
one change per week
agreed upon by client.
Track food intake and
exercise daily via a
food/activity log.
Long term:
Weigh patient weekly
Food/activity log indicates patient meeting
energy and activity requirements
Long term: patient weight loss of 1-2 pounds
per week.
BMI in healthy weight category.
Educate patient on
importance of physical
activity in improving her
over health.
Increase physical
activity to 45
minutes daily, 5-6
times per week
PES Statement
Goal
Intervention
Monitoring
Evaluation
Excessive Sodium
Intake (5.10.2.10736)
r/t frequent poor food
choices, intake of high
sodium processed foods
AEB level 2
hypertension, excessive
sodium intake during
24-hour recall
Adapt the DASH
diet.
Reduce sodium to
2300mg.
Educate patient on
DASH diet guidelines.
Provide sample menu
plan.
Short-term:
Monitor sodium intake and
exercise daily via
food/activity log.
Short-term:
Food/activity log indicates patient meeting
sodium and activity requirements
Increase physical
activity to 30
minutes daily, 5-6
times per week.
Educate patient on salt
substitute options and
ways to add increased
flavor to lower sodium
meals with spices and
fresh herbs.
Long-term:
Check patients blood pressure
weekly
Long-term:
Reduce sodium
levels <2300mg,
ideally 1500 mg.
Increase physical
activity to 45
Educate patient on
importance of physical
activity in improving her
over health.
Long-term:
Patient’s blood pressure preferably 140/90 or
below
Patient independent in monitoring her blood
pressure
minutes daily, 5-6
times per week
Educate patient on
taking her own blood
pressure, if the patient
does not have her own
machine, educate patient
on where she can have
her blood pressure
checked locally.