Download Hypertension case study

Nicole Karetov, 1
Case Study #4
7. Mrs. Sanders has the following risk factors: history of smoking 2 packs per day, drinking
occasionally, an elevated BMI, excessive intake of sodium from the diet, age, hyperlipidemia, and a
family history of HTN.
13. DASH stands for Dietary Approach to Stop Hypertension. It is a result of a key study in the 1990's,
which displayed that following the DASH diet reduced blood pressure. The diet is based on 2000 kcal
per today and emphasizes 8-9 servings of fruits and vegetables, 4-5 servings of nuts, seeds or beans (for
magnesium), 7-8 servings of grains, 2-3 servings of low-fat dairy, 6 ounces or less of lean protein, and
2-3 servings of fats and oils per day. The DASH diet allows 5 servings of sweets per week. This diet
encompasses one that is low in saturated fat, cholesterol and totally fat, as well as being rich in
magnesium, potassium, calcium, protein and fiber.
15. Lifestyle modifications that reduce blood pressure include following the DASH diet, weight loss,
reduction of sodium in the diet, decreased alcohol intake, increased intake of potassium, calcium and
magnesium, increase in physical activity, and smoking cessation. Studies show that a weight decrease
of >5 kg lowered systolic and diastolic BP, and <10% weight loss will have a sustained effect on BP.
The risk of hypertension increases as alcohol consumption increases. It is recommended that men drink
no more than 2 drinks per day and women drink no more than one drink per day. In addition, physical
activity of 30 min/day can decrease BP by 4-9 mm HG.
16. Mrs. Sanders has a BMI of 25.8 meaning she is considered overweight. She is more at risk to
developing diabetes mellitus, cardiovascular disease and hypertension.
17. REE = 655.1 + 9.6(72.73) + 1.9 (167.64) - 4.7 (54) = 1418 kcal
TEE = 1418 kcal x 1.3-1.4 = 1843 - 1985 kcal
18. Totals from 24 hour recall:
 Calories = 3092 kcal
 Total fat = 125.8 g
 Saturated fat = 44.9 g
 Sodium = 4864 mg
Mrs. Sanders is consuming excess kilocalories, total fat, saturated fat, and sodium.
19. Mrs. Sander’s nutrition problems:
- Excessive fat intake (total fat and saturated fat)
- Excessive mineral intake (sodium)
21. Based on her lipid profile, Mrs. Sanders has the following risks for CAD: high total cholesterol
(210 mg/dL), high LDL cholesterol (147mg/dL), low HDL cholesterol (38mg/dL), high LDL/HDL
ratio (3.9) and high triglycerides (150mg/dL). She displays dyslipidemia, a condition in which LDL
levels are elevated and HDL levels are decreased. High triglyceride levels are also a risk for CAD, but
Mrs. Sanders' triglycerides are now within a normal range.
Nicole Karetov, 2
32. PES Statements:
#1. Excessive fat intake related to high consumption of saturated fats as evidenced by high serum LDL
(147mg/dL) and low serum HDL (38mg/dL) levels.
#2. Excessive mineral intake related to high consumption of sodium as evidenced by blood pressure of
160/100 and stage 2 hypertension diagnosis.
33. Mrs. Sander’s desired weight is 125lbs, which lower her BMI to 20.4. Although this is considered a
healthy BMI, her percent weight loss would be 21.8%.
% Weight Change [(160-125)/(160)] x 100 = 21.8%
Unless she spent over a year losing the weight, this would be considered a dramatic weight loss in a
short period of time. A more realistic weight loss would be to set her goal BMI in the 24 to 24.9 range,
which would bring her to a healthy weight. For example, if she lost 10 lbs her BMI would be 24.4, and
it would only be a 6% weight loss. This would occur in roughly two months and would not be
considered unsafe or dramatic.
34. Mrs. Sanders should lose this weight at a pace of 1-2 pound per week which is considered to be
healthy and safe weight loss. If she is successful at doing so, weight loss goal of 10 lbs should occur
over 10-12 weeks. This will help prevent any dramatic changes in her weight and will promote
maintenance of the weight loss.
35. Goals for PES Statements
#1. A goal for Mrs. Sander’s first PES statement is to reduce her LDL levels to less than 130mg/dL and
increase her HDL levels to greater than 55mg/dL. An appropriate intervention would be comprehensive
nutrition education on the different types of fats (unsaturated, saturated, trans) and their effects on LDL
and HDL cholesterol levels. In addition, provide education on healthier oils to replace butter, as well as
information on increasing soluble fiber intake.
#2. A goal for Mrs. Sander’s second PES statement is to reduce her sodium intake to less than 2300mg
per day, with the intent of lowering her blood pressure to under 120/80. Her current sodium intake
(based on her diet analysis) is over 4,800mg per day. An appropriate intervention would be nutrition
education regarding the DASH diet. If Mrs. Sander’s followed the DASH diet, her sodium intake
would decrease, which would help lower her blood pressure. In addition, her saturated fat intake would
decrease, which would help lower her LDL cholesterol. Another option would be to suggest low
sodium products, such as low sodium soups and saltines.
36. The major sources of sodium in Mrs. Sanders diet comes from primarily from her soup, crackers,
and ranch dressing. To decrease her sodium intake, I would suggest to her to choose low-sodium soup
options and choose salt-free or low-sodium crackers. Instead of ranch, she could use some type of
vinaigrette which would also decrease the amount of total and saturated fat from her salads. She could
also be cautious of the salt she adds to foods when she cooks and remember to use less. The major
sources of saturated fat comes from the ice cream, butter and donut. She could replace the ice cream
Nicole Karetov, 3
with a lower fat option, or choose a frozen yogurt. Instead of using butter she could use olive oil or
another monounsaturated fat. She could replace the donut with a different pastry that would be lower in
fat. The cholesterol in her diet comes from the butter, chicken, milk, and ice cream. I would suggest she
eat less ice cream (she ate 2 cups this day) and I would suggest that she continue cooking chicken
without the skin to decrease fat and cholesterol.