Pacaña, Christy Rei T.

2BSN-B8

Nutrition and Diet Therapy – Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session # 21

LESSON TITLE: Fat-Controlled, Mineral-Modified Diets for Materials:

Cardiovascular Diseases Pen and notebook

LEARNING OUTCOMES:

At the end of the lesson, you can:

1. Identify the potential consequences of atherosclerosis and
the factors that contribute to its development;
2. Describe how CHD risk is evaluated;
3. Discuss strategies that can reduce risk or prevent future
heart attacks;
4. Describe the different types of stroke, strategies that may
prevent a stroke, and the elements of treatment and Reference:
rehabilitation following a stroke; DeBruyne, L.K., Pinna, K., & Whitney E., (2016).
5. Summarize the potential effects of hypertension, its risk Nutrition and diet therapy: Principles and practice
factors, and current treatment approaches; and, (9th ed.). USA: Cengage Learning.
6. Identify the possible consequences of heart failure and the
current treatment approaches for this condition.

LESSON PREVIEW/REVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: Differentiate Type 1 DM from Type 2 DM.

Type 1 Diabetes Mellitus

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Type 2 Diabetes Mellitus
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MAIN LESSON
You will study and read their book, if available, about this lesson.

A. Atherosclerosis

In atherosclerosis, the artery walls become progressively thickened due to an accumulation of fatty deposits, fibrous
connective tissue, and smooth muscle cells, collectively known as plaque. Atherosclerosis initially arises in response to
minimal but chronic injuries that damage the inner arterial wall. The first lesions tend to develop in regions where the
arteries branch or bend due to the disturbed blood flow in those areas.

The subtle damage caused by disturbed blood flow or other factors elicits an inflammatory response, attracting immune
cells and increasing the permeability of the artery walls. Low-density lipoproteins (LDL) slip under the artery’s thin layer
of endothelial cells, become oxidized by local enzymes, and accumulate. Arterial macrophages engulf this altered LDL
and become foam cells; these fat laden cells are visible as fatty deposits along artery walls, known as fatty streaks.

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Eventually, the plaque thickens and hardens as additional lipids, calcium, and cellular debris accumulate. Atherosclerosis
begins to develop as early as childhood or adolescence and typically progresses over several decades before symptoms
develop.

Consequences of Atherosclerosis. As atherosclerosis worsens, it may eventually narrow the lumen of an artery and
interfere with blood flow. Some types of plaque are highly susceptible to rupture, which promotes blood clotting within the
artery (thrombosis). A blood clot (thrombus) may enlarge in time and ultimately obstruct blood flow. A portion of a clot
can also break free (embolus) and travel through the circulatory system until it lodges in a narrowed artery and shuts off
blood flow to the surrounding tissue (embolism). Most complications of atherosclerosis result from the deficiency of blood
and oxygen within the tissue served by an obstructed artery (ischemia).

Causes of Atherosclerosis
⎯ Shear Stress/Hypertension
⎯ Abnormal Blood Lipids
⎯ Cigarette Smoking
⎯ Diabetes Mellitus
⎯ Age and Gender

Major Nonmodifiable Risk Factors

⎯ Increasing age
⎯ Male gender
⎯ Family history of early heart disease

Major Modifiable Risk Factors: ❚ High LDL

cholesterol ❚ High blood triglyceride (VLDL)
levels ❚ Low HDL cholesterol ❚ Hypertension
(high blood pressure) ❚ Diabetes ❚ Obesity
(especially abdominal obesity) ❚ Physical
inactivity ❚ Cigarette smoking ❚ Alcohol overconsumption (≥3 drinks per day) ❚ An atherogenic diet (high in saturated
fat and trans fats; low in fruits and vegetables)

B. Coronary Heart Disease

Coronary heart disease (CHD), also called coronary artery disease, is the most common type of cardiovascular disease.
As discussed earlier, CHD is most often caused by atherosclerosis, which leads to impaired blood flow through the
coronary arteries; possible outcomes include angina pectoris, heart attack, or even sudden death

The most common symptom of CHD is pain or discomfort in the chest region; the pain may radiate to the left neck and
shoulder, arms, back, or jaw. Other possible symptoms include shortness of breath, unusual weakness or fatigue,
lightheadedness or dizziness, nausea, vomiting, and lower abdominal discomfort.

Blood Cholesterol Levels and CHD Risk. Once a person’s level of risk has been identified, much of the treatment
focuses on lowering LDL cholesterol. Elevated LDL levels are directly related to the development of atherosclerosis, and
clinical studies have confirmed that LDL-lowering treatments can successfully reduce CHD mortality rates. CHD is seldom
seen in populations that maintain desirable LDL levels. As mentioned earlier, HDL helps to protect against
atherosclerosis, and low HDL levels often coexist with other lipid abnormalities; thus, a low HDL level is highly predictive
of CHD risk. In addition, low HDL levels are usually associated with other CHD risk factors, such as obesity, smoking,
inactivity, and insulin resistance. Although having adequate HDL is beneficial, high HDL levels do not necessarily confer
additional benefit

Clinical Measures

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Lifestyle Management to Reduce CVD Risk

Drug Therapies for CHD Prevention. Individuals who cannot improve CHD risk with dietary and lifestyle changes alone
may be prescribed one or more medications. The drugs usually prescribed for lowering LDL levels are the statins (such as
Lipitor and Crestor), which reduce cholesterol synthesis in the liver. Although less effective than the statins, bile acid
sequestrants (such as Colestid or Questran) can reduce LDL levels by interfering with bile acid reabsorption in the small
intestine. For lowering triglyceride levels and increasing HDL, both fibrates (such as Lopid) and nicotinic acid (a form of
niacin) are effective; nicotinic acid can also reduce LDL and lipoprotein(a) levels. Individuals using these medications
should continue their dietary and lifestyle modifications so that they can use the minimum effective doses of the drugs
they require.

C. Stroke

About 87 percent of strokes are ischemic strokes, caused by the obstruction of blood flow to brain tissue. Hemorrhagic
strokes occur in 13 percent of cases and result from bleeding within the brain, which damages brain tissue. Most strokes
are a consequence of atherosclerosis, hypertension, or both. Strokes that occur suddenly and are short-lived (lasting
several minutes to several hours) are called transient ischemic attacks (TIAs). These brief strokes are a warning sign
that a more severe stroke may follow.

Stroke Prevention. Stroke is largely preventable by recognizing its risk factors and making lifestyle choices that reduce
risk. Many of the risk factors are similar to those for heart disease and include hypertension, elevated LDL cholesterol,
diabetes mellitus, cigarette smoking, and a history of cardiovascular disease. Medications that suppress blood clotting
reduce the risk of ischemic stroke, especially in people who have suffered a first stroke or a TIA. The drugs typically
prescribed include antiplatelet drugs (including aspirin) or anticoagulants such as warfarin (Coumadin). Anticoagulant
therapy requires regular follow-up and occasional adjustments in dosage to prevent excessive bleeding.

Stroke Management. The effects of a stroke vary according to the area of the brain that has been injured. Body
movements, senses, and speech are often impaired, and one side of the body may be weakened or paralyzed. Early
diagnosis and treatment are necessary to preserve brain tissue and minimize long-term disability. Ideally, thrombolytic

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(clot-busting) drugs should be used within 4½ hours following an ischemic stroke to restore blood flow and prevent further
brain damage

The focus of nutrition care is to help patients maintain nutrition status and overall health despite the disabilities caused by
the stroke. The initial assessment should determine the nature of the patient’s self-feeding difficulty (if any) and the
adjustments required for appropriate food intake. Some patients may need to learn about dietary treatments that improve
blood lipid levels and blood pressure. Dysphagia (difficulty swallowing) is a frequent complication and is associated with a
poorer prognosis. Difficulty with speech may prevent patients from describing the problems they may be having with
eating. Coordination problems can make it hard for patients to grasp utensils or bring food from table to mouth. In some
cases, tube feedings may be necessary until the patient has regained these skills. Nutrition in Practice 22 describes
additional options for people who have disabilities that impair eating ability as a result of a stroke or other condition

D. Hypertension

Although people cannot feel the physical effects of hypertension, it is a primary risk factor for atherosclerosis and
cardiovascular diseases. In addition to hypertension’s damaging effect on arteries, elevated blood pressure forces the
heart to work harder to eject blood into the arteries; this effort weakens heart muscle and increases the risk of developing
heart arrhythmias, heart failure, and even sudden death. Hypertension is also a primary cause of stroke and kidney
failure, and reducing blood pressure can dramatically reduce the incidence of these diseases

Blood pressure is measured both when heart muscle contracts (systolic blood pressure) and when it relaxes (diastolic
blood pressure). Measurements are expressed as millimeters of mercury (mm Hg).
Systolic Diastolic
Desirable <120 <80
Prehypertension 120–139 80–89
Hypertension ≥140 ≥90

Factors That Contribute to Hypertension

In 90 to 95 percent of hypertension cases, the cause is unknown. In other cases, hypertension is caused by a known
physical or metabolic disorder, such as an abnormality in an organ or hormone involved in blood pressure regulation

A number of risk factors for hypertension have been identified. These include the following:
⎯ Aging. Hypertension risk increases with age. About two-thirds of persons older than 65 years have hypertension.
Moreover, individuals who have normal blood pressure at age 55 still have a 90 percent risk of developing high
blood pressure during their lifetimes
⎯ Genetic factors. Risk of hypertension is similar among family members. It is also more prevalent and severe in
certain ethnic groups; for example, the prevalence in African-American adults is about 41 percent, compared with
a prevalence of about 28 percent in both whites and Mexican Americans.
⎯ Obesity. Numerous clinical studies have confirmed a strong relationship between excess body fat and increased
blood pressure. Obesity raises blood pressure, in part, by stimulating the sympathetic nervous system and
activating hormonal processes that promote sodium reabsorption and blood vessel constriction.
⎯ Salt sensitivity. About 30 to 50 percent of those with hypertension have blood pressure that is sensitive to salt
intake. Salt sensitivity (also called sodium sensitivity) may worsen due to aging, obesity, diabetes, kidney disease,
or hypertension itself.
⎯ Alcohol. Heavy drinking (more than one drink daily for women or two drinks daily for men) increases the
incidence and severity of hypertension. Reducing alcohol consumption reverses this effect.
⎯ Dietary factors. A person’s diet may influence hypertension risk. As explained later, diets that emphasize
vegetables, fruit, and whole grains and include low-fat milk products have been shown to reduce blood pressure.

Treatment of Hypertension. Both lifestyle

modifications and medications are used to treat
hypertension

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Drug Therapies. People with hypertension usually require two or more medications to meet their blood pressure goals.
Using a combination of drugs with different modes of action can reduce the doses of each drug needed and minimize side
effects. The drugs commonly prescribed include diuretics, calcium channel blockers, angiotensin converting enzyme
(ACE) inhibitors, and angiotensin-receptor blockers; some of these drugs are also used to treat various heart conditions.
Drug dosages may need regular adjustment until the blood pressure goal is reached

E. Heart Failure

Heart failure, also called congestive heart failure, is characterized by the heart’s inability to pump adequate blood,
resulting in inadequate blood delivery and a buildup of fluids in the veins and tissues. Heart failure has various causes,
but it is often a consequence of chronic disorders that create extra work for the heart muscle, such as hypertension or
CHD. To accommodate the extra workload, the heart enlarges or pumps faster or harder, but it may eventually weaken
enough to fail completely. Heart failure develops mostly in older adults and the elderly: the majority of cases occur in
individuals 65 years or older.

Consequences of Heart Failure

In heart failure, fluid may accumulate in the liver and abdomen and in the lower extremities, causing chest pain, difficulty
with digestion and absorption, and swelling in the legs, ankles, and feet

Fluid can also build up in the lungs (called pulmonary edema), resulting in extreme shortness of breath and limited
oxygen for activity; in severe cases, it can lead to respiratory failure. With inadequate blood flow, the functions of various
organs, such as the liver and kidneys, may become impaired.

The effects of heart failure depend on the severity of illness: mild cases may be asymptomatic, but severe cases may
cause considerable damage to health. Heart failure often affects a person’s food intake and level of physical activity. In
persons with abdominal bloating and liver enlargement, pain and discomfort may worsen with meals. Limb weakness and
fatigue can limit physical activity. End-stage heart failure is often accompanied by cardiac cachexia, a condition of severe
malnutrition characterized by significant weight loss and tissue wasting.

Cardiac cachexia may develop due to increased levels of pro-inflammatory cytokines (which promote catabolism),
elevated metabolic rate, reduced food intake, and malabsorption. The resultant weakness further lowers the person’s
strength, functional capacity, and activity levels.

Medical Management of Heart Failure

Heart failure is a chronic, progressive illness that may require frequent hospitalizations. Many patients face a combination
of debilitating symptoms, complex treatments, and an uncertain outcome. Important goals of medical therapy are to slow
disease progression and enhance the patient’s quality of life.

The specific treatment for heart failure depends on the nature and severity of the illness. Medications help to manage fluid
retention and improve heart function. Dietary sodium and fluid restrictions can help to prevent fluid accumulation.
Vaccinations for influenza and pneumonia reduce the risk of developing respiratory infections. Treatment of CHD risk
factors, such as hypertension and lipid disorders, can help to slow disease progression. Heart failure patients are also
encouraged to participate in exercise programs to avoid becoming physically disabled and to improve endurance.

Nutrition Therapy for Heart Failure.

The main dietary recommendation for heart failure is a modest sodium restriction of 2000 milligrams or less daily to reduce
the risk of fluid retention. In patients with persistent or recurrent fluid retention, fluid intakes may be restricted to 2 liters
per day or less. Individuals who have difficulty eating due to abdominal or chest pain may tolerate small, frequent meals
better than large meals. Patients with heart failure may be prone to constipation due to diuretic use and reduced physical
activity. Maintaining an adequate fiber intake can help to minimize constipation problems. Because alcohol consumption
may worsen heart function, some patients may need to restrict or avoid alcoholic beverages. Patients on diuretic therapy
or restricted diets may benefit from daily multivitamin-mineral supplementation.66 No known therapies can reverse
cardiac cachexia, and the prognosis is poor. For some patients, liquid supplements, tube feedings, or parenteral nutrition
support can be supportive additions to treatment.

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CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Ischemia in the coronary arteries is a frequent cause of:

a. angina pectoris.
b. hemorrhagic stroke.
c. aneurysm.
d. hypertension
ANSWER: ________a.
RATIO:___________________________________________________________________________________________
Angina pectoris is a condition caused by ischemia in the heart muscle that results in discomfort or dull pain in
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the chest region.
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2. Dietary lipids with the strongest LDL cholesterol–raising effects are:

a. monounsaturated fats.
b. polyunsaturated fats.
c. saturated fats.
d. plant sterols.
ANSWER: ________ c.
RATIO:___________________________________________________________________________________________
Of the dietary lipids, saturated fat has the strongest effect on blood cholesterol levels, and replacing saturated
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fat with monounsaturated and polyunsaturated fats can generally lower LDL levels.
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3. Hemorrhagic stroke:
a. is the most common type of stroke.
b. results from obstructed blood flow within brain tissue.
c. comes on suddenly and usually lasts for up to 30 minutes.
d. results from bleeding within the brain, which damages brain tissue.
ANSWER: ________ d.
RATIO:___________________________________________________________________________________________
Hemorrhagic strokes occur in 13 percent of cases and result from bleeding within the brain, which damages
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brain tissue.
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4. Hypertensive patients can benefit from all of the following dietary and lifestyle modifications except:
a. including fat-free or low-fat milk products in the diet.
b. reducing total fat intake.
c. consuming generous amounts of fruit, vegetables, legumes, and nuts.
d. reducing sodium intake.
ANSWER: ________ b.
RATIO:___________________________________________________________________________________________
The DASH Eating Plan is even more effective when accompanied by a low sodium intake.
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5. Nutrition therapy for a patient with heart failure usually includes:

a. weight loss.
b. reducing total fat intake.
c. sodium restriction.
d. cholesterol restriction.
ANSWER: ________ c.
RATIO:___________________________________________________________________________________________
The main dietary recommendation for heart failure is a modest sodium restriction of 2000 milligrams or less
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daily to reduce the risk of fluid retention.
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RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:________________________________________________________________________________________
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2. ANSWER: ________
RATIO:________________________________________________________________________________________
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3. ANSWER: ________
RATIO:________________________________________________________________________________________
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4. ANSWER: ________
RATIO:________________________________________________________________________________________
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5. ANSWER: ________
RATIO:________________________________________________________________________________________
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning. Let us see
your progress in this chapter!

Three things you learned:

1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
Two things that you’d like to learn more about:
1. __________________________________________________________________________________________
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2. __________________________________________________________________________________________
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One question you still have:

1. __________________________________________________________________________________________
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