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Case Study: Hypertension and Cardiovascular Disease

Patient Summary: 54- year old female (Mrs. Sanders) here for evaluation and treatment for
essential hypertension and hyperlipidemia
What risk factors for developing hypertension does Mrs. Sanders have? List 6 risk
factors.
Family history
Ethnicity- African American people are at higher risk of HTN. The risk for black women
45.7%.
High sodium diet
Higher consumption of alcohol than recommended
Smoking history
Overweight: BMI 25.8
Briefly describe the DASH diet eating plan
The DASH diet is an eating plan developed to reduce a persons blood pressure. Based on a 2000
calorie per day diet, it is high in plant based foods, is low in sodium, fat and added sugars. The
DASH diet is high in potassium, calcium, magnesium and fiber.
List lifestyle modifications that have been shown to lower blood pressure:
Weight reduction
Following DASH diet plan
Physical activity
Moderation of alcohol consumption
Low-sodium intake
What are the health implications of Mrs. Sanders body mass index (BMI)?
Ms. Sanders BMI indicates she is overweight. While the risks are higher in the obese category,
she still is in danger of developing a resistance to insulin and metabolic syndrome.
Calculate Mrs. Sanders resting (REE) and total (TEE) energy needs. (Harris-Benedict
formula)
REE= 1410 kcal, TEE= 1833 kcal
What nutrients in Mrs. Sanders diet are of major concern to you?

Added sugars from ice cream, donut, and ranch dressing, as well as sugar added to oatmeal and
glazed carrots; sodium from soup, saltines, ranch dressing, diet cola, and salt used as a
seasoning; increased fat intake from butter, margarine, ice cream, and the glazed donut, which is
typically deep fried. (total cal, fat, sat fat)
From information gathered within the intake domain, list possible nutrition problems
using the diagnostic terms:
Excessive energy intake
Excessive fat intake
Increased sodium intake
Inadequate mineral intake-potassium
Inadequate fiber intake
Inadequate fluid (water) consumption
Interpret Mrs. Sanders risk of CAD based on her profile
High risk at initial visit based on low Apo A level (75mg/dL), high cholesterol (270 mg/dL), low
HDL (30 mg/dL), high LDL (210 mg/dL), and high triglycerides (150 mg/dL). Decreasing risk
after 9 months as her Apo A level has increased to 110 mg/dL, which is considered within
normal range. Her cholesterol, LDL, and triglyceride levels have decreased but are still above
normal range. HDL level has increased, but are still below normal range.
Select nutrition problems and complete the PES statement for each
1. Excessive energy intake related to consumption of higher fat milk and high fat snack
foods as evidenced by a laboratory total cholesterol of 270 mg/dl ( HDL 30 mg/dl LDL
210 mg/dl) and patients 24 hour diet recall.
2. Inadequate fluid (water) intake related to increased diuretic consumption and suboptimal
water consumption as evidenced by borderline high serum osmolality (295
mmol/kg/H20) and lack of water consumption in 24-hour diet recall.
3. Excessive energy intake related to frequent consumption of calorie dense (ex: ice cream,
donuts) food as evidenced by typical daily intake of 2900 cal
When you ask Mrs. Sanders how much weight she would like to lose, she tells you she
would like to weigh 125lbs, which is what she weighed most of her adult life. Is this
reasonable? What would you suggest as a goal for weight loss for Mrs. Sanders?

If Ms. Sanders weighed 125 pounds she would be within the normal range of the BMI. However,
it would be more advisable for her to set smaller goals. Losing 10 percent of body weight
improves health outcomes. For Ms. Sanders her goal weight would then be 144 pounds and still
within the normal range.

How quickly should Mrs. Sanders lose this weight?


Mrs. Sanders current weight is 160 pounds while her suggested goal weight is 144 pounds. To
reach this goal, she would need to lose 16 pounds. This weight should be lost gradually, at a rate
of about 1-2 pounds per week.
For each PES statement that you have written, establish an ideal goal (based on the signs
and symptoms) and an appropriate intervention (based on the etiology).
In regards to Ms. Sanders excess energy intake the ideal goal would be to limit her saturated fat
intake by choosing non-fat or one percent fat milk and to replace her high fat snacks and
processed foods for healthier options.
In regard to Ms. Sanders inadequate fluid (water) intake, it would be ideal for her to incorporate
water into her daily fluid intake and reduce her caffeine consumption. An ideal goal for her to
achieve this would be to replace her diet cola with water, and try to refrain from coffee
consumption in the morning.
Identify the major sources of sodium, saturated fat, and cholesterol in Mrs. Sanders diet.
What suggestions would you make for substitutions and/or other changes that would help
Mrs. Sanders reach her medical nutrition therapy goals?
sodium: canned tomato soup can be replaced with homemade tomato soup without salt added or
a low-sodium (<120mg per serving) canned soup, saltine crackers can be replaced with a
different type of cracker or toast, or saltines with unsalted tops, added salt as seasoning can be
eliminated when cooking, and ranch dressing can be replaced with olive oil and vinegar or fresh
citrus juice.
saturated fat: ice cream can be replaced with a fresh fruit sorbet with little to no added sugar.
cholesterol: ice cream can be replaced with a vegan ice cream that does not contain eggs or with
a fruit sorbet, butter can be replaced with olive oil for the carrots and

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