Download Rochelle Doney NUTR 425 CS #5 Congestive Heart Failure with

Rochelle Doney
NUTR 425 CS #5
Congestive Heart Failure with Resulting Cardiac Cachexia
1. Heart failure, often called congestive heart failure (CHF), occurs when the heart is unable to
provide sufficient pump action to distribute blood flow to meet the needs of the body. There
is excessive secretion of vasopressin and angiotensin II. Increased blood volume, increased
resistant to blood flow, decreased contractility, and decreased filling. The onset of heart
failure can usually be traced to damage from MI and atherosclerosis and this is consistent
with Dr. Peterman’s history due to him having previous anterior MI, long-standing history
of CAD, HTN, and mitral valve insufficiency.
2. BP 90/70 mm Hg, diffuse PMI in AAL in LLD; Grade II holosystolic murmur at the apex of
radiating to the left sternal border, skin is grey and moist, ascites, liver tender to A&P, hard
to know the difference between his real weight and any fluid retention.
3. In right-sided heart failure, the right ventricle loses its pumping function, and blood may
back up into other areas of the body, producing congestion. Causes of right-sided heart
failure include left-sided heart failure and lung diseases such as chronic bronchitis and
emphysema. The left side of the heart receives blood rich in oxygen from the lungs and
pumps it to the remainder of the body. As the ability to pump blood forward from the left
side of the heart is decreased, the remainder of the body does not receive enough oxygen
causing fatigue and leading to failure.
4. Cardiac cachexia is unintentional severe weight loss caused by heart disease. Even with a
very good appetite and high calorie intake, some people with heart failure lose muscle mass.
Patients with cardiac cachexia suffer from generalized loss of lean tissue, fat tissue, as well
as bone tissue. Patients are weaker and tire easier. This is due to both reduced skeletal
muscle mass and impaired skeletal muscle quality.
5. The consumption of too much sodium causes the body to retain water in an effort to
maintain fluid balance. When water is retained, blood pressure increases and causes the
heart to work harder. If an excess amount of salt is consumed regularly, it leads to chronic
high blood pressure. Over time, high blood pressure weakens the heart and the arteries and
can lead to congestive heart failure. The normal sodium recommendation for those without
congestive heart failure is no more than 2,300 mg of sodium per day. For those with
congestive heart failure, the recommendation drops down to no more than 2,000 mg per
day. It is important to note that 2,000 mg per day is considered an upper limit. It is
beneficial to keep salt intake as low as possible.
6. Yes, he should be placed on a fluid restricted diet. Sodium and fluid retention both should be
used as a way of controlling the symptoms of CHF. Things like soups and broths and juices
in fruits all will increase fluid intake.
7. B-vitamins, Thiamin, magnesium, potassium, calcium.
8. Fluid retention and fluid loss. His weight loss can be explained by his loss of fluid and having
little fluid intake. Dr. Peterman had 12% decrease in his weight.
9. 22 kcal/kg = 1430 x1.2 x1.4 = 2402 = 2400 kcal/day
Protein requirement: Critical illness 1.5 – 2 = 97 – 130 g pro/d.
I used Dr. Peterman’s current body weight of 145 lbs to calculate his energy and protein
needs, because it is obvious that his weight alteration of 20lbs was due to fluid retention.
10. 1 mL/kcal = 2400 mL/day. To treat fluid retention due to CHF, he will be limited to 15002000 mL/day.
11. 50 mL/hr of NuBasic 2.0 consistently for 24hrs/day. Add 650 ml of free water.
12. Inadequate food/beverage intake, Inadequate protein-energy intake, Difficulty swallowing
13.
Parameter
Albumin
Normal
Value
(g/dl)
3.5 – 5
Total Protein
6–8
Sodium
136 –
145
Potassium
3.5 –
5.5
Magnesium
Calcium
Patient’s Reason for
value
Abnormality
(g/dl)
2.6
Malabsorption
of protein
5.5
Malabsorption
of protein
133
Loop diuretics
ACEIs or Beta
Blockers
1.8 – 3
3.8 w/in
normal
range
but low
end
1.8
9 - 11
8.9
Loop Diuretics
Loop diuretics
Nutrition Implication
Gut edema
Gut edema
Fluid retention, water enters
brain cells, nausea, lethargy,
confusion, and possible
seizures.
Muscle weakness, shallow
breathing, heart rhythm
changes
Increase sodium and decrease
potassium
Altered nerve transmission and
electrical activity of cell –
muscle spasms. Tetany, and
cardiac dysrhythmias
14.
Medication
Lanoxin
Lasix
Dopamin
Thiamin
Rationale for use
Antiarrhythmic
medication
Antihypertensive
Increase heart
rate and blood
pressure.
To help prevent
edema
Nutrition Implications
Anorexia, decreased wt. Ca & Vit D induced
hypercalcemia may increase drug effects
Anorexia, increased thirst, increase in Na excretion –
hyponatermia
Decreased blood pressure, vomiting, irregular
heartbeat, diarrhea
Increase requirements with increase CHO intake
15. Altered gastrointestinal function; Impaired nutrient utilization
16. 1) Inadequate food/beverage intake RT decreased ability to consume sufficient food AEB
weight loss = 12 % decrease in weight. 2) Impaired nutrient utilization RT medications that
affect nutrient interactions AEB Albumin, potassium, and magnesium all being below the
normal levels.
17. Decrease the amount of formula fed per day to ensure the patient can tolerate the feeding.
Adjust medication to have less food-medication interactions and increase absorption.
18. Try having the patient eat foods that he feels like eating. The texture of the foods,
consistency of the foods, and amount of fluid in foods could be changed to make it easier to
swallow.
19. A living will is a legal document that a person uses to make known his or her wishes
regarding life prolonging medical treatments. Palliative care is a specialized medical care
for people with serious illnesses. It focuses on providing patients with relief from the
symptoms, pain, and stress of a serious illness.
20. The dietitian helps determine what foods the patient is able to tolerate or have. In the case
of weight loss, the dietitian makes a plan to add calories and protein to the patient's diet.
Swallowing or chewing problems are addressed with changes of texture/consistency and
meal content to better meet the patient's needs.