Download Answer Guide for Medical Nutrition Therapy: A Case Study

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Case Questions for Medical Nutrition Therapy: A Case Study Approach 4th ed.
Title: Case 6 – Heart Failure with Resulting Cardiac Cachexia
Instructions: Answer the questions below. You may print your answers or e-mail them to your instructor.
Questions:
1.
Outline the typical pathophysiology of heart failure. Onset of heart failure usually can be traced to damage from
an MI and atherosclerosis. Is this consistent with Dr. Peterman’s history?
2.
Identify specific signs and symptoms in the patient’s physical examination that are consistent with heart failure.
For any three of these signs and symptoms, write a brief discussion that connects them to physiological changes
that you described in question #1.
3.
Heart failure is often described as R-sided failure or L-sided failure. What is the difference? How are the
clinical manifestations different?
4.
Dr. Peterman’s admitting diagnosis was cardiac cachexia. What is cardiac cachexia? What are the characteristic
symptoms? Explain the role of the underlying heart disease in development of cardiac cachexia.
5.
Dr. Peterman’s wife states that they have monitored their salt intake for several years. What is the role of
sodium restriction in the treatment of heart failure? What level of sodium restriction is recommended for the
outpatient with heart failure?
6.
Should he be placed on a fluid restriction? If so, how would this assist with the treatment of his heart failure?
What specific foods are typically “counted” as a fluid?
7.
Identify any common nutrient deficiencies found in patients with heart failure.
8.
Identify factors that would affect interpretation of Dr. Peterson’s weight and body composition. Look at the I/O
record. What will likely happen to Dr. Peterson’s weight if this trend continues?
9.
Calculate Dr. Peterman’s energy and protein requirements. Explain your rationale for the weight you have used
in your calculation.
10. Dr. Peterman was started on an enteral feeding when he was admitted to the hospital. Outline a nutrition therapy
regimen for him that includes formula choice, total volume, and goal rate.
11. Identify any abnormal biochemical values and assess them using the following table:
Parameter
Normal Value
Pt’s Value
Reason for
Abnormality
Nutrition
Implication
12. The following chart lists drugs/supplements that were prescribed for Dr. Peterman. Give the rationale for the
use of each. In addition, describe any nutrition implications for these medications.
Medication
Rationale for Use
Nutrition Implications
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Medication
Lanoxin
Lasix
Dopamine
Thiamin
Rationale for Use
Nutrition Implications
13. Select two nutrition problems and complete a PES statement for each.
14. Dr. Peterman was not able to tolerate the enteral feeding because of diarrhea. What recommendations could be
made to improve tolerance to the tube feeding?
15. The tube feeding was discontinued because of continued intolerance. Parenteral nutrition was not initiated.
What recommendations could you make to optimize Dr. Peterman’s oral intake?
16. An echocardiogram indicated severe cardiomegaly secondary to end-stage heart failure. Mr. Peterson had a
living will that stated he wanted no extraordinary measures taken to prolong his life. He was able to express his
wishes verbally and requested oral feedings and palliative care only. Mr. Peterman expired after a two-week
hospitalization. What is a living will? What is palliative care?
17. During his final days of life, Dr. Peterman was not receiving parenteral or enteral nutritional support. What is
the role of the registered dietitian during palliative care?
© 2014 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.