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Cardiovascular Disease Assignment

This case study describes 62-year-old Alan who is concerned about his risk for cardiovascular disease. Alan smokes 1.5 packs of cigarettes per day, has a sedentary job and lifestyle, and is overweight. His diet is high in saturated fat, refined carbohydrates, and alcohol. Laboratory results show Alan has high blood pressure, high total cholesterol, and an unfavorable LDL/HDL ratio. The nutrition care plan focuses on reducing Alan's calorie and sodium intake, limiting saturated fat and alcohol, increasing physical activity, and improving diet quality through increased fruits and vegetables.

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79 views

Cardiovascular Disease Assignment

This case study describes 62-year-old Alan who is concerned about his risk for cardiovascular disease. Alan smokes 1.5 packs of cigarettes per day, has a sedentary job and lifestyle, and is overweight. His diet is high in saturated fat, refined carbohydrates, and alcohol. Laboratory results show Alan has high blood pressure, high total cholesterol, and an unfavorable LDL/HDL ratio. The nutrition care plan focuses on reducing Alan's calorie and sodium intake, limiting saturated fat and alcohol, increasing physical activity, and improving diet quality through increased fruits and vegetables.

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© © All Rights Reserved
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Sarah Cordova

CUNY School of Public Health


NUTR734 Clinical Nutrition I
Case Study II DUE 12/8/2015
Cardiovascular Disease Assignment
Alan is a 62 year old man who has recently retired from his career as an
accountant. He just read an article in a popular magazine about heart attacks,
and he is concerned that he might be at high risk. He is convinced that he
should change his diet and lifestyle to reduce his risk, but he isnt sure what
changes should be made. Alan has smoked 1 packs of cigarettes a day for
35 years, and was unable to get much exercise because his desk job kept him
so busy and because of his long commute each day. He is 6 feet tall and
weighs 235 pounds. Meat, potatoes, bread and butter are the staples of his
diet. Alan usually skips breakfast. He frequently eats lunch out with former
clients or friends. A typical lunch consists of a cocktail and about 3 pieces of
sourdough bread with 3 pats of butter beforehand, then a sausage or pork
cutlet sandwich, and coffee and pie for dessert. Dinner at home in the evening
often includes beef steak, a large baked potato with butter and sour cream,
several slices of sourdough bread and butter and wine. Dessert usually
consists of ice cream with chocolate sauce and coffee. Alan does not like
salads and most vegetables. He states Thats chick food Im a man!
Because of his concern about his risk for cardiovascular disease, Alan recently
had a check up with his physician. At that time he found out that his blood
pressure was 145/98 and his total cholesterol was 300 mg/dl. When the
physician saw how high his serum cholesterol was, he scheduled him for a
complete lipid profile. The results of that profile showed that his LDLcholesterol was 185 mg/dl and his HDL cholesterol was 35.
Write an SOAP note (including three PES statements) documenting your
nutrition care for Alan based on the above information, calculations,
recommendations and goals.
S: 62 yo obese male concerned about risk for heart attack; has intentions to
change diet and lifestyle to reduce risk. Patient smokes 1.5 packs of cigarettes
per day for past 35 years and has sedentary lifestyle; does not usually eat
breakfast. Diet high in saturated fat, refined carbohydrate, starch, and alcohol.
Diet lacking in fruits, vegetables, whole grains.
O:

PMH: Cigarette smoker (1.5 packs/day x 35 years)


PSH: N/A
Meds: N/A
Diet Rx: N/A
Labs:
BP: 145/98
Cholesterol: 300 mg/dl
LDL cholesterol: 185 mg/dl
HDL cholesterol: 35
LDL/HDL ratio: ~ 5:1
Skin/Physical: N/A
Ht: 60
BMI: 32.4 kg/m2
CBW: 235 lbs/106.8 kg
IBW: 178 lbs +/- 10%
%IBW: 132%
ABW: 192.25 lbs/87.7 kg
Estimated Requirement (based on ABW of 87.7 kg)
2,193 2,631 kcal/day (based on 25-30 kcal/kg ABW for weight loss)
70 88 g Protein/day (0.8-1.0 g Protein/kg ABW for weight loss)
2,631 3,070 ml fluid/day (30-35 ml/kg ABW for maintenance)
A:
-Pt at high risk for MI due to BMI, stage 1 HTN, hyperlipidemia, tobacco use,
alcohol use, poor diet, and physical inactivity.
-Pt has class I obesity and is 132% of IBW. To promote weight loss and improve
comorbidities of obesity such as HTN and hyperlipidemia, pt likely to benefit
from energy intake of 2,193 2,631 kcal/day based on ABW.
-Pts stage 1 HTN likely also result of high dietary sodium intake, as well as PMH
of smoking. Pt likely to benefit from low-sodium diet and smoking cessation.
-Elevated total cholesterol and LDL/HDL ratio likely result of high saturated fat
in diet. Pt likely to benefit from diet low in saturated fat (limit to 5-6% of
kcal/day)
-Possible that pt is consuming excess alcohol. Patient would likely improve
weight status, BP, lipid profile if alcohol were limited to <15 drinks/wk.
-Pt should begin regular physical activity to promote weight loss and improve
comorbidities of obesity. 150 min of moderate physical activity/wk is advised.
-Pts current diet lacking in fruits, vegetables, and whole grains. Diet rx should
include adequate servings of fruits and vegetables, and refined grains replaced
by whole grains.
-Pt omits breakfast and consumes all daily calories in 2 large meals. Diet rx
should include regular breakfast and small snacks in order to prevent excess
energy intake at lunch and dinner.

PES statements
1.Excess positive energy balance related high fat, refined carbohydrate diet,
and physical inactivity as evidenced by BMI in class I obesity range.
2.Excess sodium intake related to regular consumption of processed foods as
evidenced by stage 1 hypertensive BP of 145/98.
3. Excess lipid intake related to high fat diet and alcohol consumption as
evidenced by elevated cholesterol of 300 mg/dl and LDL/HDL ratio of ~5:1.
P:
-Start pt on diet rx of 2,193 2,631 kcal/day, low-sodium, (1500mg/day) lowsaturated fat (5-6% total kcal/day), alcohol consumption of <15 drinks/wk,
daily breakfast/healthy snacks
-Provide pt and pts family with education and counseling on diet transition;
emphasize adequacy of fruits, vegetables, whole grains
-Start pt on physical activity regimen; provide counseling aim for 30 minutes
of moderate exercise, 5 times/wk
-Assess patients level of motivation towards smoking cessation; provide
counseling
-Monitor weight status, BP, blood lipids over next 6 months
-Monitor diet and physical activity compliance on weekly basis for next 6
months

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