First Name: __Kimberly__ Last Name: __Kavanaugh__

CASE STUDY #2 NUT 116AL

~ Cardiovascular Disease ~
DUE Monday 11/23/15 (DATE CHANGE)

Instructions:
Review the pt.s medical record below. Answer each question and show your calculations for each, if required, on a
separate sheet. Reference all calculation formulas with the text and page number from PR (i.e., PR p. ___). Only
use the PR for all calculations. You may use lecture notes (NUT 116A or 116AL) and the textbook for all other
questions. You must type your answers! If not, questions will not be graded and you will receive 0 points. CS #2 is
worth 50 points.

To familiarize yourself with medical terminology, utilize an online dictionary such as:
http://www.medilexicon.com/medicaldictionary.php

Hxxxxx, Rxxxxx, Male, 59 yo


Allergies: NKA
Code: FULL
Isolation: NONE
Pt. Location: RM 1104
Physician: A. Baum
Admit Date: 9/1
_____________________________________________________________________________________________
Pt. Summary: RH is a 59-year old male admitted through the ED for an emergency coronary angiography with
angioplasty of the infarct-related artery.

Hx:
Onset of disease: 59 yo male who noted the sudden onset of severe precordial pain on the way home from work.
The pain is described as pressure-like pain, radiating to the jaw and left arm. The pt. has noted an episode of
emesis and nausea. He denies palpitations or syncope. He denies prior hx of pain. He admits to smoking cigarettes
(1 pack/day for 40 years). He denies HTN, DM, or high cholesterol. He denies SOB.
Medical hx: not significant before Dx of MI
Surgical hx: cholecystectomy 10 yrs. ago, appendectomy 30 yrs. ago
Medications at home: none
Allergies: sulfa drugs
Tobacco use: 1 ppd for 40 yrs.
Alcohol use: none
Family hx: father with CAD; MI age 58

Demographics:
Marital status: married, 59 yo spouse
Children: grown and away from home
Years education: BS degree
Language: English
Occupation: Project Manager for a refuse company

MD Progress Note:
Review of Systems
Constitutional:
negative
Skin:
negative
Cardiovascular:
no carotid bruits
Respiratory:
negative
Gastrointestinal:
negative
Neurological:
negative
Psychiatric:
negative

Physical Exam
General
mildly overwt male in acute distress from chest pain
appearance:
Heart:
PMI located at 5th ICS, MCL on the left. S1 nl intensity. S2 nl intensity and split. S4
gallop at the apex. No murmurs, clicks, or rubs.
1

First Name: __Kimberly__ Last Name: __Kavanaugh__

HEENT:
Head:
Eyes:

normocephalic
EOMI, fundoscopic exam WNL. No evidence of atherosclerosis, diabetic retinopathy, or
early hypertensive changes.
Ears:
TM nl bilaterally
Nose:
WNL
Throat:
tonsils not infected, uvula midline, gag nl
Genitalia:
WNL
Neurologic:
No focal localizing abnormalities; DTR symmetric bilaterally
Extremities:
No C, C, E
Skin:
diaphoretic and pale
Chest/Lungs:
clear to auscultation and percussion
Peripheral vascular: PPP
Abdomen:
RLQ scar and midline suprapubic scar. BS WNL. No hepatomegaly, splenomegaly,
masses, inguinal lymph nodes, or abdominal bruits

Vital Signs:
Temp: 98.4
Pulse: 92
Resp Rate: 20

BP: 118/78
Ht: 510
Wt: 185 lbs.
BMI: 26.6

Nursing Assessment:

9/1
Abdominal appearance (concave, flat, rounded, obese, distended)
Flat
Palpation of abdomen (soft, rigid, firm, masses, tense)
soft
Bowel function (continent, incontinent, flatulence, no stool)
continent
Bowel sounds (P=present, AB=absent, hypo, hyper)

RUQ
P
LUQ
P
RLQ
P
LLQ
P
Stool color
Light brown
Stool consistency

Tubes/ostomies
NA
Genitourinary

Urinary continence
Catheter in place
Urine source
Catheter
Appearance (clear, cloudy, yellow, amber, fluorescent, hematuria, orange, blue, Clear, yellow
tea)
Integumentary

Skin color
Pale
Skin temperature (DI=diaphoretic, W=warm, dry, DL=cool,
D, M
CLM=clammy, CD+=cold, M=moist, H=hot)
Skin turgor (good, fair, poor, TENT=tenting)
TENT
Skin condition (intact, EC=ecchymosis, A=abrasions, P=petechiae,
Intact
R=rash, W=weeping, S=sloughing, D=dryness, EX=excoriated,
T=tears, SE=subcutaneous emphysema, B=blisters, V=vesicles,
N=necrosis)
Mucous membranes (intact, EC=ecchymosis, A=abrasions,
Intact
P=petechiae, R=rash, W=weeping, S=sloughing, D=dryness,
EX=excoriated, T=tears, SE=subcutaneous emphysema, B=blisters,
V=vesicles, N=necrosis)
Other components of Braden Scale: special bed, sensory pressure,
Activity; 22
moisture, activity, friction/shear (>18=no risk, 15-16=low risk, 13-
14=moderate risk, <12=high risk)

2

First Name: __Kimberly__ Last Name: __Kavanaugh__

Orders:
IV heparin 5000 units bolus followed by 1000 unit/hour continuous infusion with a PTT at 2 x control.
Chewable ASA 160 mg PO and continued every day
Lopressor 50 mg 2x/day
Lidocaine prn
NPO until procedure completed
Type and cross for 6 units of packed cells

Nutrition:
Meal type:
clear liquids, no caffeine
Hx:
appetite good. Has been trying to change some things in his diet. Wife indicates
that she has been using corn oil instead of butter and has tried not to fry foods
as often.
Food allergies/
None
intolerances/
aversions:
Previous nutrition tx:
Yes, last year, community dietitian
Food purchase/
Spouse
preparation:
Vit/min intake:
None

24-hour recall:
Breakfast:
None
Mid-morning
1 large cinnamon raisin bagel with 1 tbsp. fat-free cream cheese, 9 oz. grapefruit juice, 16
Snack:
oz. coffee
Lunch:
1 c canned vegetable beef soup, sandwich with 4 oz. roast beef, lettuce, tomato, dill
pickles, 2 tsp. mayonnaise, 1 small apple, 8 oz. 2% milk
Dinner:
2 lean pork chops (3 oz. each), 1 large baked potato, 2 tsp. margarine, c green beans,
c coleslaw (cabbage with 1 tbsp. salad dressing), 1 slice apple pie
Snack:
8 oz. 2% milk, 1 oz. pretzels
Patient reports that this pattern is fairly typical of his usual weekday intake.

Laboratory Results:

Chemistry
Sodium (mEq/L)
Potassium (mEq/L)
Chloride (mEq/L)
Carbon dioxide (CO2, mEq/L)
BUN (mg/dL)
Creatinine serum (mg/dL)
Glucose (mg/dL)
Phosphate, inorganic (mg/dL)
Magnesium (mg/dL)
Calcium (mg/dL)
Osmolality (mmol/kg/H2O)
Bilirubin, direct (mg/dL)
Protein, total (g/dL)
Albumin (g/dL)
Prealbumin (mg/dL)
Ammonia (NH3, umol/L)
Alkaline phosphatae (U/L)
ALT (U/L)
AST (U/L)
CPK (U/L)
CPK-MB (U/L)

Ref. Range

136-145
3.5-5.5
95-105
23-30
8-18
0.6-1.2
70-110
2.3-4.7
1.8-3
9-11
285-295
<0.3
6-8
3.5-5
16-35
9-33
30-120
4-36
0-35
30-135 F
55-170 M
0

9/1 1957

141
4.2
103
20 !
14
1.1
136 !
3.1
2.0
9.4
292
0.1
6.0
4.2
30
26
75
30
25
75

9/2 0630

142
4.1
102
24
15
1.1
106
3.2
2.3
9.4
290
0.1
5.9 !
4.3
32
22
70
215 !
245 !
500 !

9/3 0645

138
3.9
100
26
16
1.1
104
3.0
2.0
9.4
291
0.2
6.1
4.2
31
25
68
185 !
175 !
335 !

75 !

55 !

First Name: __Kimberly__ Last Name: __Kavanaugh__

Lactate dehydrogenase (U/L)
Troponin I (ng/dL)
Troponin T (ng/dL)
Cholesterol (mg/dL)
HDL-C (mg/dL)
LDL (mg/dL)
LDL/HDL ratio
Apo A (mg/dL)
Apo B (mg/dL)
Triglycerides (mg/dL)
Coagulation (Coag)
PT (sec)
Hematology
3
3
WBC (x 10 /mm )
6
3
RBC (x 10 /mm )
Hemoglobin (Hgb, g/dL)
Hematocrit (Hct, %)
3

MCV (um )
MCH (pg)
MCHC (g/dL)
RBC distribution (%)
3
3
Platelet count (x10 /mm )
Hematology, Manual Diff
Neutrophil (%)
Lymphocyte (%)
Monocyte (%)
Eosinophil (%)
Basophil (%)
Blasts (%)
Segs (%)
Bands (%)
Urinalysis
Color
Appearance
Specific Gravity
pH
Protein (mg/dL)
Glucose (mg/dL)
Ketones
Blood
Urobilinogen (EU/dL)
Leukocyte esterase
Protein check
WBCs (/HPF)
RBCs (/HPF)
Bacteria

208-378
<0.2
<0.03
120-199
>55 F, >45 M
<130
<3.22 F
<3.55 M
101-199 F
94-178 M
60-126 F
63-133 M
35-135 F
40-160 M

12.4-14.4

4.8-11.8
4.2-5.4 F
4.5-6.2 M
12-15 F
14-17 M
37-47 F
40-54 M
80-96
26-32
31.5-36
11.6-16.5
140-440

50-70
15-45
3-10
0-6
0-2
3-10
0-60
0-10

-
-
1.003-1.030
5-7
Neg
Neg
Neg
Neg
<1.1
Neg
Neg
0-5
0-5
0

325
2.4 !
2.1 !
235 !
30 !
160 !
5.3 !

685 !
2.8 !
2.7 !
226 !
32 !
150 !
4.7 !

365


214 !
33 !
141 !
4.3 !

72 !

80 !

98

115

110

105

150

140

130

12.6

11.0
4.7

12.6

9.32
4.75

12.4

8.8
4.68

15

14.8

14.4

45

45

44

91
30
33
13.2
320

55
17
4
0
0
3
45
15 !

Pale yellow
clear
1.020
5.8
Neg
Neg
Trace !
Neg
Neg
Neg
Neg
0
0
0

92
31
32
12.8
295

58
23
4
0
0
3
47
17 !

Pale yellow
clear
1.015
5.0
Neg
Neg
Neg
Neg
Neg
Neg
Neg
0
0
0

90
30
33
13.0
280

62
35
7
0
0
4
52
8

Pale yellow
clear
1.018
6.0
Neg
Neg
Neg
Neg
Neg
Neg
Neg
0
0
0

First Name: __Kimberly__ Last Name: __Kavanaugh__

1.

2.

RH had a myocardial infarction. Explain what happened to his heart during his MI. (1 pt.)
A myocardial infarction is also known as a heart attack. This can occur when the vessels (coronary arteries) surrounding
the heart are blocked so much so that there is a lack of oxygen supply to the heart. In RHs case, his coronary artery
was occluded (atherosclerosis) which ultimately led to lack of blood (and oxygen) supply to his heart. Infarction refers
to dead or damaged tissue of the heart muscle, hence, myocardial infarction (Medical Dictionary).
RHs chest pain resolved after two sublingual NTG at 3-minute intervals and 2 mgm of IV morphine. In the cath lab
he was found to have a totally occluded distal right coronary artery and a 70% occlusion in the left circumflex
coronary artery. The left anterior descending was patent. Angioplasty of the distal right coronary artery resulted in a
patent infarct-related artery with near normal flow. A stent was left in place to stabilize the patient and limit infarct
size. Left ventricular ejection fraction was normal at 42%, and a posterobasilar scar was present with hypokinesis.

Explain and describe what is an angioplasty and what is a stent placement. What is the purpose of these medical
procedures? (2 pts.)
An angioplasty refers to the reconstruction of a blood vessel (Medical Dictionary). The purpose of this procedure is to
reopen the artery to allow for better blood flow to prevent MI. A stent placement can be described as placing a straw
in the vessel to give the vessel walls support. It helps keep the tubular structure open (Medical Dictionary). The
purpose of this is similar to the angioplasty in that it helps keep blood flowing at a normal rate to prevent any further
damage.

3.

4.

5.

What are the current recommendations for the progression of nutritional intake during a hospitalization following a
myocardial infarction? (2 pts.)
The current recommendations for nutritional intake following a MI are: decreasing ones oral intake, clear liquids and
avoiding caffeine, and progression to soft, more frequent meals (CVD lecture slide 41).

Examine the chemistry results for RH. Which labs are consistent with the MI diagnosis and why? Why were the levels
higher on day 2? (4 pts.)
Cholesterol (high)
HDL (low)
LDL (high)
LDL/HDL ratio
APO A
(NTP p. 311)
These are consistent with MI diagnosis because they all contribute to atherosclerosis, which leads to MI.
Atherosclerosis, a plaque build up within the arteries, causes narrowing of the lumen thereby decreasing blood flow to
that part of the heart. This cuts off blood flow, hence oxygen, which then causes tissue death. These levels being high
indicate that RH is at risk for or has already suffered from CVD.
Interpret the results of RHs lipid panel, identifying which of the lipids are elevated based on the NCEP ATP III
Guidelines. List the desired therapeutic goals (TLC goal parameter) based on the NCEP guidelines. (3 pts.)
Parameter
RHs Value in mg/dL
Interpretation based on
Therapeutic goal
NCEP classification
Total Cholesterol
235 mg/dL
Borderline high
<200 mg/dL
LDL Cholesterol
160 mg/dL
High
<100 mg/dL
HDL Cholesterol
30 mg/dL
Major risk factor
>60 mg/dL
Apo A
72 mg/dL
Low
94-178 mg/dL
Triglycerides
150 mg/dL
Borderline high
<150 mg/dL

Overall, what does RHs lipid panel suggest?
RHs lipid panel suggests that he is at high risk of heart disease. He is more likely to develop atherosclerosis with those
HDL and LDL values (NTP p. 310).

6. List & number RHs risk factors for CHD, based on the presentation data from his medical record. (2 pts.)
1) Age (male >45 yo)
2) High total cholesterol (235 mg/dL)
5

First Name: __Kimberly__ Last Name: __Kavanaugh__

3)
4)
5)
6)
7)
8)
9)

7.

8.

9.

Low HDL cholesterol (30 mg/dL)

Cigarette smoking (1 ppd for 40 years)
High glucose levels (136 mg/dL)
MI
Family history-father had CAD
Atherogenic diet
(CVD lecture slide 4)
Cholecystectomy (gallbladder removal)

Using RHs 24-hour recall and the food exchange lists, calculate the total number of servings of each exchange group
and number of calories he consumed as well as the energy distribution of calories for protein, carbohydrate, and fat
using the exchange system. (5 pts.)

Exchange
Kcal
PRO g
CHO g
FAT g
12.25 Starches
1,200
33.75
213.75
21.25
3 Fruits
180
0
45
0
11 Lean meats
565
77
15
22
5 Fats
180
0
0
20
2 Veg
95
4
10
5
2 LF milk
240
16
24
10
Total
2,460
130.75
307.75
78.25
% of total kcals
100%
21.3%
50.0%
28.6%
Compare RHs 24-hour recall with the TLC dietary plan. Briefly discuss the overall adequacy of RHs diet and what
recommendations you can make to align RHs current consumption with the TLC plan. (3 pts.)

TLC Goals:
Your Recommendations:
Total calories:
2,650 kcal/day
Keep food diary to keep track of kcals consumed.
Total fat:
25-35%
73.6-103.0 g/day Limit visible fats (such as mayonnaise)... intake
above is within this range.
Saturated fat:
< 7%
20.6 g/day Skim/low fat milk and dairy products
Monounsaturated
Up to 20%
58.9 g/day
Fat:
Polyunsaturated
Up to 10%
29.4 g/day Include beans/nuts
Fat:
Carbohydrate:
50-60%
331.3-397.5 g/dayintake above is less than this, but this is okay
because of MI condition.
Fiber:
20-30 g/day
20-30 g/day increase beans/legumes
Protein:
About 15% total kcal 99.4 g/day Lean meats/poultryintake above is above this but that is
good because RH is recovering from surgery so he needs more protein.
Cholesterol:
< 2,000 mg/dL
<2,000 mg/day Include whole grain options
Sodium:
< 2,400 mg/day
<2,400 mg/day
Potassium:
4,700 mg/day
4,700 mg/day
Plant
3-4 g/day
3-4 g sterols/day
stanols/sterols
RH was prescribed the following medications on discharge. Provide the generic name and indication of each
medication (specific to RH) and its effects. Also note any dietary recommendations, contraindications/precautions,
and interactions. What effect will these medications have on his nutritional care? Refer to the medication
information in the Food-Medication Interactions text. (5 pts.)

Lopressor 50 mg daily
Generic name:
Metoprolol
Classification:
Antihypertensive, antiangina

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First Name: __Kimberly__ Last Name: __Kavanaugh__

Indication:
To treat angina, HTN, and MI

Diet:
Take with food to increase bioavailability. Decrease intake of Na and possibly decrease kcal.

Possible FoodAvoid natural licorice: 2+ twists can increase cortisol concentration leading to
Medication
pseudohyperaldosteronism, increased sodium reuptake, water retention, K excretion, and
Interactions:
increased BP (MED p. 394)
Potential
Dry mouth, dyspepsia, diarrhea, constipation, N/V; may mask signs of hypoglycemia; may
Nutrition/Oral/GI
decrease insulin release.
Side Effects:




Zestril 10 mg daily
Generic name:
Lisinopril/Catopril/Quinapril
Classification:
Antihypertensive

Indication:
ACE inhibitor-decrease BP; CFT treatment; left ventricular dysfunction; post MI

Diet:
Adequate fluid intake; decrease Na intake and decrease kcal; take caution with potassium and

magnesium supplements.
Possible FoodAvoid natural licorice: 2+ twists can increase cortisol concentration leading to
Medication
pseudohyperaldosteronism, increased sodium reuptake, water retention, K excretion, and
Interactions:
increased BP (MED p. 394)
Potential
Anorexia; dry mouth; N/V; abdominal pain; constipation/diarrhea
Nutrition/Oral/GI
Side Effects:


Zocor 20 mg/day
Generic name:
Simvastatin
Classification:
Antihyperlipidemic

Indication:
Slows atherosclerosis; prevent or decrease risk of cardiovascular events; decrease total and LDL

cholesterols
Diet:
Decrease fat and cholesterol consumption.

Possible FoodAvoid grapefruit: components in grapefruit decrease pre-systemic metabolism of drugs taken 72
Medication
hrs. after consumption (MED p.410)
Interactions:
Potential
Nausea, dyspepsia, abdominal pain, constipation, diarrhea, flatulence
Nutrition/Oral/GI
Side Effects:


Nitrostat 0.4 mg sl prn chest pain
Generic name:
Nitroglycerin
Classification:
Antiangina

Indication:
Relief of acute attack

Diet:
Taken sublingual (under the tongue); diet not specified.

Possible FoodAvoid alcohol.
Medication
Interactions:
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First Name: __Kimberly__ Last Name: __Kavanaugh__

Potential
Nutrition/Oral/GI
Side Effects:

Dry mouth, N/V, abdominal pain

ASA 81 mg daily
Generic name:
Aspirin
Classification:
NSAID

Indication:
To prevent MI; platelet aggregation inhibitor

Diet:
Adequate hydration; foods rich in vitamin C and folate; avoid natural products that affect

coagulation.
Possible FoodGarlic, ginger, gingko, ginseng, horse chestnut; limit caffeine to decrease GI side effects.
Medication
Interactions:
Potential
Anorexia; sudden serious gastric bleeding; N/V; dyspepsia; black tarry stools
Nutrition/Oral/GI
Side Effects:
(All cited from Food Medication Interactions book)

10. Make an overall statement as to the discharge dietary advice you would give RH regarding his medications above.
(1 pt.)
You should take medication as directed. If you have any questions about your medications and how to take them you
should contact your physician. You may also contact your Pharmacist for questions you have about medication and
food interactions.

11. What is metabolic syndrome & does RH meet the criteria? Why or why not? (2 pts.)
Metabolic syndrome is a group of metabolic risk factors associated with increased CVD risk. It is defined by the
presence of any 3 of the following: increased waist circumference, increased TG, decreased HDL, HTN, and impaired
fasting glucose (NTP p. 311). RH does not meet the criteria because he does not have 3 of those characteristics. He has
1 of them, being low HDL cholesterol.

12. You talk with RH and his wife, an elementary school teacher. They are friendly and seem cooperative. They are both
anxious to learn what they can do to prevent another heart attack. List 4 questions you might ask them that will
assist you in assessing their lifestyle. (2 pts.)
1) Tell me more about how many times you exercise per week, and what type, how many minutes?
2) Is your job more sedentary or do you have opportunity to be more mobile?
3) How much sleep do you usually get each night?
4) How often do you guys eat out versus cooking at home?

13. List 4 lifestyle factors you might recommend to support realistic, successful lifestyle changes for RH? (2 pts.)
Increased physical activity
More frequent meals throughout the day
Cut back smoking maybe to pack per day
Increase sleep

14. RH is Muslim and from the SF Bay Area. Describe and explain Islamic dietary laws and any dietary restrictions you
would need to consider when counseling RH. (2 pts.)
The Islamic culture has specific laws when it comes to food consumption. There are Halal and Haram considerations.
Halal means that everything is allowed unless otherwise specified (lawful). Haram means God forbids certain
food/drinks (unlawful). In RHs case, he would not be allowed to eat his pork chops since the flesh of swine is
prohibited (Haram). When counseling RH, one would need to consider the meats he is able to consume and how they
were slaughtered, and also understand what is Halal and what is Haram (Islamic Dietary Law;
http://islam.about.com/od/dietarylaw/a/diet_law.htm).

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First Name: __Kimberly__ Last Name: __Kavanaugh__

15. List and number 4 major teaching points (dietary advice) that you will need to discuss with RH in order for him to
understand and follow the NCEP TLC diet. (2 pts.)
1) Decrease saturated fat intake
2) Incorporate whole grains
3) Low fat/fat free milk and dairy products
4) Incorporate more fruits, vegetables, and protein and less carbohydrate

16. You have seen RH one day post-MI and one day after his cardiac procedure. He has been advanced to a regular
cardiac diet and will be discharged the next morning. He is approved for 12 weeks of Cardiac Rehabilitation,
including 3 visits to an RD. Summarize your observations, assessment and plan of action in an ADIME note. Base your
note on the pertinent information given in the presentation data, 24 hr. recall, and questions above. Write the
ADIME note below and attach a separate sheet with all calculations. Include two PES statements. (12 points)

A:
59 yo male admitted for chest pain and coronary angiography. Family hx of CAD and MI. Pt. notes smoking 1 pack of
cigarettes/day for 40 years. Pt. also notes pain in jaw and left arm.

Anthropometrics:
Wt: 185 lbs./84.1 kg Ht: 70 in/177.8 cm BMI: 26.6 (Overweight) IBW: 166 lbs./75.5 kg IBW %: 111%

Labs:
Lipid profile: total cholesterol (235-borderline high), LDL (160-high), HDL (30-major risk factor), Apo A (72-low), TG
(150-borderline high), glucose (136-high).

Diet order:
Clear liquids, no caffeine

Estimated Energy Requirements:
Kcals: 1,828.5-1,994.7 kcals/d
Protein: 100.9-126.2 g/d
Fluid (1mL/kcal): 1,828-1,994 mL/day

Medications:
IV heparin 1000 unit/hour
Chewable ASA 81 mg daily
Lopressor 50 mg 2x/day
Lidocaine prn (when necessary)
Zestril 10 mg daily
Zocor 20 mg/day
Nitrostat 0.4 mg sl when feeling chest pain
NPO nothing by mouth until procedure completed
No vitamin or mineral intake

Food and nutrition hx:
Previously seen community dietitian for nutrition tx.
Good appetite. Pt. recalls trying to change diet by using corn oil instead of butter and not frying foods as often. No
known food allergies.

24-hour recall:
Breakfast-none

Mid-morning snack:
1 large cinnamon raisin bagel with 1 tbsp. fat-free cream cheese
9 oz. grapefruit juice
16 oz. coffee
9

First Name: __Kimberly__ Last Name: __Kavanaugh__

Lunch:
1 c canned vegetable beef soup
Sandwich with 4 oz. roast beef
Lettuce
Tomato
Dill pickles
2 tsp. mayonnaise
1 small apple
8 oz. 2% milk

Dinner:
2 lean pork chops (3 oz. each)
1 large baked potato
2 tsp. margarine
c green beans
c coleslaw
1 slice apple pie

Snack:
8 oz. 2% milk
1 oz. pretzels
D:
Diagnosis:
1) Excessive fat intake (NI-5.6.2) r/t BMI of 26.6 - overweight AEB pt. reported chest pain and occluded arteries.
2) Physical inactivity (NB-2.1) r/t MI AEB high LDL and low HDL cholesterol.
I:
MNT goal: to prevent further cardiovascular events by educating pt. on TLC diet plan and how to lower his cholesterol
levels.
Recommendations:
1) Keep fat intake on the low end of 25-35% of total kcal per day (limit visible fats such as mayonnaise).
2) Cut back on saturated fat by switching to 1% or fat free milk/dairy products.
3) More frequent meals throughout the day; do not skip breakfast.
4) Increase physical activity when cleared.
Education information given to pt. and his wife to try to change these behaviors in the future. Motivated pt. to lower
cholesterol levels to less than 2000 mg/day to prevent further artery occlusions. Expected compliance is to switch milk
at least 4x/week at each meal.
M/E:
Monitoring/Evaluation:
1) Pt. food records, exercise log when appropriate, follow up on lab values.
2) Follow-up appointment in person 1 week later.

Kimberly Kavanaugh

Kimberly Kavanaugh, Nutrition student, November 23, 2015

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