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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.