Medical Nutrition Therapy In

Patients with Congestive Heart

Failure

Rory Costigan
Dietetic Intern
University of Maryland, College Park

Table of Contents
I.
II.
III.
IV.
V.
VI.
VII.

Executive Summary3
Case Report.....4
Hospital Course of Patient...6
Case Discussion...9
Appendices12
Glossary.....15
References.15

Executive Summary

Congestive heart failure is a condition in which the heart cannot pump enough blood to
supply the bodys tissue with sufficient oxygen and nutrients; back up of blood in vessels and
the lungs cause a buildup of fluid in the tissues. With congestive heart failure, blood moves
through the heart and body at a slower rate, and pressure in the heart increases. As a result
the chambers of the heart may respond by stretching to hold more blood to pump through
the body or becoming stiff and thickened. This helps to keep the blood moving, but the
heart muscle walls may eventually weaken and become unable to pump efficiently. As a
result the kidneys may respond by causing the body to retain fluid and salt. When fluids
build up in the arms, legs, ankles, feet, lungs or organs, the body becomes fluid-overloaded.
(4) Research suggests heart failure often occurs more frequently in elderly patients who have
multiple comorbid conditions such as angina, coronary artery disease, hypertension, renal
disease, diabetes, and chronic lung disease. (4) Symptoms of congestive heart failure include
shortness of breath, increased heart rate, lightheadedness, fatigue, edema, wheezing or
coughing and swelling in the extremities such as legs, ankles and feet (2).
Patients with congestive heart failure exacerbations frequently have symptoms that affect
their food intake, including fatigue during food preparation, generalized breathing difficulties
and gastrointestinal symptoms like nausea and early satiety. Research supports that specific
diet plans aid in the management of congestive heart failure (7). A sodium and fluid
restriction diet is commonly prescribed for individuals admitted with congestive heart failure
to control swelling caused from fluid build-up (edema) and control hypertension (in salt
sensitive individuals). Research has suggested that supplementation of specific vitamins and
minerals might improve heart function (8). Diuretics are often administered to patients with
congestive heart failure to relieve symptoms of fluid build-up, breathing difficulty and
swelling of the legs ankles and feet.
Treating congestive heart failure from a nutrition perspective is a crucial component in the
management of heart function. The ultimate goal of the dietitian is to initiate a diet plan that
will help decrease fluid retention and fluid overload. Dietitians must educate and inform the
patient about the effect sodium plays in fluid retention. Because congestive heart failure is a
chronic disease the dietitian is also responsible for educating the patient on diet management
post hospitalization to manage heart failure.

Case Report

GENRAL INFORMATION
JF is a 90-year-old African America man admitted to the DC VA Medical Center on
December 2nd 2014. Patient complained of worsening edema of the extremities, Shortness of
Breath (SOB) and wheezing. The patient was diagnosed with fluid overload associated with
Congestive Heart Failure (CHF). JF was transferred to a nearby rehabilitation facility on
December 11th, 2014.

SOCIAL HISTORY
JF lived at the Armed Services Retirement Home in Washington DC in an independent
apartment. Patients daughter, his primary durable power of attorney, was present for facility:
family meetings and frequently visited JF during hospitalization. The family was trying to
transition JF into an assisted living home due to decreased ability to live independently. The
patients family medical history was unknown as JF was adopted. The patient denied use of
tobacco, drugs or alcohol. The patient currently has Medicare part A, B, D, which is
supplemented by Kaiser insurance.

MEDICAL/SURGICAL DATA

Past Medical History

Past medical history included Congestive Heart Failure (CHF), Coronary Artery Disease (CAD)
status post coronary artery bypass grafting (s/p CABG), Cerebral Vascular Accident,
Hypertension (HTN), Hyperlipidemia (HLD), Diabetes Mellitus Type 2 (DM2), Parkinsons disease,
Zenkers diverticulum, mild cognitive impairment, benign prostate hyperplasia, and gout.
Patient did not have any known food allergies.
Past Surgical History
The patient did undergo a coronary artery bypass grafting surgery in 2005 at Holy Cross
Hospital.
Admitting Physical Examination
Upon admission, the patient complained of SOB and wheezing. Peripheral edema was
present.
Laboratory Results
Refer to Appendix A for laboratory results during this hospitalization.
Medications
Refer to Appendix B for complete lists of home and in-patient medications.
Diagnostic Tests with Results
Date
Diagnostic Test
Dec 3
Dec 3
Dec 4

Results
Echocardiogram Normal LV cavity normal wall thickness and severely reduced
global function, past EF= 20% (11/17/2014).
Cystoscopy
Removal of blood clots to allow urine to flow freely from the
bladder through the urethra.
Chest x-ray

Chest x-ray with shallow inspiration. Blunting of the left

costophrenic angle is seen suggesting left pleural effusion. The
right costophrenic angle is sharp and no pleural effusion is
noted on right side. The left hemi-diaphragm was not clearly
identified and possible left lower lobe airspace disease could
not be excluded. The heart silhouette was enlarged. There was
no evidence of pulmonary edema.

Dec 7

Pacemaker
evaluation

Intermittent episodes of atrial fibrillation. Cardiology team

discussed with patient atrial fibrillation management in
addition to heart failure advice.

NUTRITIONAL HISTORY FROM INITIAL ENCOUNTER

Diet History
The patient reported decreased appetite for approximately two weeks prior to admission
(pta) with reported recent weight gain of 20 pounds in the last 2 months. (Nutrition staff had
seen GS in November 2014 for a diagnosis of SOB.) Per chart, the diet was tolerated. Intake
varied; initially it was poor (less than 5% of trays), but by discharge it had increased to 75%
of trays.
Weight History
Hospital weights see table below
IBW- 155lbs (70.5kg) per Vista assessment
UBW- 134lbs (60.9kg) per November 2014 weight
Using Vista to calculate ideal body weight (IBW) for men, JF's ideal body weight is 155
pounds. Per JF, his usual body weight (UBW) is 134 pounds. The patient has experienced
significant weight loss since November 2014 of 21 pounds (13%) over 7 weeks. While bed
scale measurement errors are frequently an issue, JFs 18-pound weight loss over 3 days
(12/4/2014-12/7/2014) is possible because patient came into the hospital in severe fluid
overload, received IV Lasix, breathing had significantly improved, and within 3 days visible
edema was disappearing.

Date

Weight (in pounds)

Source of Weight % UBW

% IBW

Dec 2

154

Measured

115%

99%

Dec 4

155

Measured

115%

100%

Dec 5

141.2

Measured

105%

91%

Dec 7

137.7

Measured

102%

88%

Dec 8

136.7

Measured

102%

88%

Dec 9

134.2

Bed Weight

100%

87%

Dec 10

134.9

Bed Weight

100%

87%

Physical Activity Level

No information regarding the patients physical activity level pta was available. During the
course of hospitalization, patient was not ambulatory and used a wheelchair for mobility.

Estimated Nutrient Needs

Source
Kcal Requirements

Protein
Requirements

Fluid Requirements

Facility Standards

25-30 kcal/kg
1761-2115 kcal

0.8-1 g/kg
56-72 g

25-30 ml/kg
1761-2115 ml

Evidence Analysis
Library (EAL)

n/a

n/a

n/a

Use of Vitamins/Minerals, Oral Liquid Supplements, and/or Alternative Supplements

Patient denied use of Vitamins and Minerals, oral liquid minerals and/or alternative
supplements.
Cultural Attitudes That Influence Dietary Intake
Patient did not express any cultural or religious food preferences or restrictions during
hospitalization.
Past Nutritional Therapy
Date
Diet
Modifications

Average Nutrition Supplement(s) Average

Intake
Intake

Nov 14

2G NA+

60-75%

Nov 17

2G NA+

85%

Nov 18

NPO
for
testing

*Based on need for modified consistency diets during previous hospitalizations.

Hospital Course of Patient

Medical treatment
Day 1 (12/2/2014)- Patient admitted to the CCU with CHF and significant volume
overload. Patient complained of dyspnea, peripheral edema, wheezing and shortness of
breath. Foley catheter was inserted due to inability to urinate. Pt had a history of prior
admissions for CHF exacerbation requiring Lasix for diuresis. Patient was reported to have
dry weight of 128lbs in June 2014. Diet: 2G NA
Day 2 (12/3/2014)- Patient complained of pain associated with Foley placement; Foley was
removed and replaced with a condom catheter with continued complaints of pain. Condom
catheter drainage included blood, minimal urine, and some bloody urine clots. Patient
currently DNI. Diet: 2G NA
Day 3 (12/4/2014)- JF was transferred from 4BE to 4E (general medical floor) due to
improved status. Patient denied chest pain, reported eating well, and c/o of abdominal gas, 2

Simethicone tabs were given for gas pains. Urology performed a bedside cystoscopy due to
increasing number of blood clots collecting in condom catheter to assure normal urine flow
and excretion. Diet: 2G NA
Day 4 (12/5/2014) The patient c/o of mild nausea, emesis x1 and abdominal pain. Denied
Chest Pain (CP)/SOB. Abdominal pain associated with ingestion of small amounts of food,
which patient believes is due to blockage in stomach may be related to constipation as JF
had no BM since hospitalization. Cardiac consult service recommended continued diuresis.
Diet: 2G NA
Day 5 (12/6/2014)- The patients fluid overload symptoms (breathing, edema, etc.) were
improving and he remained on 20mg of IV Lasix daily. Patient continued to c/o of
constipation; he had no bowel movement in 4 days, despite receiving Senna. Patient reported
decreased appetite. Diet: 2G NA
Day 6 (12/7/2014)- Nursing reported new facial edema; puffy eyelids and puffy cheeks, yet
systemic edema was decreasing. Patient reported poor appetite with intake of less than 5%
of dinner tray. Patient denied n/v; patient had not had a BM for 5 days. Diet: 2G NA
Day 7 (12/8/2014)- Patients symptoms had improved with IV diuresis, although mild pitted
edema in lower legs continued. Patient endorsed appetite had returned and was present.
Patient had not had a BM in 6 days. PICC inserted in right arm for infusion of IV
medications. New hematura was noted. Diet 2G NA + DIA 2000
Day 8 (12/9/2014) Patient denied SOB/n/v; patient reported first BM in 6 days. Patient
reported appetite was present. Noon fingerstick reported BG 245, covered with 2 units of
insulin. Peripheral edema was slowly improving. Diet 2G NA + DIA 2000
Day 9 (12/10/2014) Patient reported fair appetite. Patient had recurrent hematuria, foley
was draining well. Noon finger stick was BG 179, covered with 1 unit of insulin. Discharge
plans were made to the Soldiers Home/ Armed Services Retirement Home- Washington
DC. Diet 2G NA +DIA 2000
Day 10 (12/11/2014)- Urine was returning to normal color. Patient reported no N/V/C/D
or SOB. Medical team stated patient was medically stable and ready for discharge. Patient
was discharged to sub acute facility to undergo physical therapy to improve his ability to
ambulate. Patient planned for a follow up for urine output on 12/15/2014. Diet 2G NA+
DIA 2000

Nutritional Treatment
Nutrition Assessment
Age: 90 years old
Gender: Male
Weight: 134# UBW, 154# admission
weight
% UBW Weight gain: 26 pounds PTA (20%)
Height: 510 or 70

Labs (admission):
Na: 136
K: 4.7
Cl: 106
Cr: 1.2
Glucose: 135 (H)

BUN: 28 (H)
Ca: 9.4
PMH: CAD s/p CABG in 2005, CHF with EF Mg: 2.2
20% (ECHO in 11/7/2014), HTN, HLD, DMII,
WBC 6.0
Gout, BPH, Zenkers Diverticulum, Parkinsons
BMI: 22.3 (Normal, healthy weight)

Disease. Recently hospitalized 11/5/2014 for

CHF exacerbation; diuresed with IV Lasix

Symptoms: Worsening edema of the

extremities. Wheezing and SOB

Medications prior to admission:

Simvastatin 20 mg, Ergocalciferol (Vit D2)
200
Current Diet: Regular texture 2G NA+

Diet History: Poor appetite and poor intake

pta for the past 1-2 weeks ~50%. Before
poor appetite patient consumed 2 meals per
day, when appetite decreases patient
consumed 1 meal per day.
Nutrition Diagnosis
NC 2.1- Predicted suboptimal nutrient intake related to patients medical condition and
mentation as evidence by diet history recall.

Nutrition Intervention
Nutrition Prescription
2G NA + DIA 2000
Energy Requirements: 1761-2115 kcal/day
(25-30 kcal/kg)
Protein Requirements: 56-71 gm/day (0.81g/kg)
Fluid Requirements: 1761-2115 ml/day (2530ml/kg)

Intervention with goals

RC 1.4- Coordination of Care: Collaboration
with other providers: Recommend Speech
consult for appropriate diet texture. Goal:
Implement within 24 hours
RC 1.4 -Coordination of Care: Collaboration
with other providers: Recommend MVI.
Goal: MD consider supplement
E1.1- Purpose of Dietary Education:
Educate patient on the low sodium diet.
Goal: Complete education within 24 hours.
E1.1- Purpose of Dietary Education: Review
diet education at discharge. Goal: complete
education review at discharge.

Nutrition Monitoring and Evaluation

Indicators
Total energy intake (FH-1.1.1.1)

Criteria
Patient consumes >75% of meals < 2 days

Food and nutrition knowledge (FH-3.1)

Patient is able to describe the importance of

low sodium diet for CHF maintenance.

Adherence (FH-4.1)

Nursing aides verbally repot resident is

eating appropriate foods at meal rounds.

Weight (AD-1.1.2)

Weight change over 4 weeks of weekly

weights is <5%

PRESENT NUTRITIONAL THERAPY

Date

Diet

Modifications

Average
Intake

Dec 2

2G NA

75%

Dec 4

2G NA

50%

Nutrition
Supplements
-

Average
Intake
0%

Case Discussion

MEDICAL CONSIDERATIONS

In Congestive Heart Failure (CHF) the heart fails to pump incoming blood from the vena
cave through the heart to the lungs and then eventually to the rest of the body, which results
in fluid accumulation in the other organs primarily the lungs and the peripheral extremities.
A 2006 Respiratory Care journal article suggested heart failure often occurs in elderly
patients who have multiple comorbid conditions including angina, hypertension, diabetes,
and chronic lung disease. (4) In the usual form of heart failure, the hearts pumping power is
weaker, causing blood to move through the body slower. As a result the heart cannot pump
enough oxygen and nutrients to meet the bodies needs. In order for the heart to hold and
pump more blood through the body, the chambers of the heart decrease muscle contractility
by stretching or becoming stiff and thickened. This will cause the heart muscle walls to
eventually become weakened and unable to pump blood efficiently. As a result the kidneys
may respond by causing the body to retain fluid and salt. When fluid builds up in the arms,
legs, ankles, feet, lungs and organs the body becomes fluid overloaded.
According to a Journal of the American College of Cardiology article, congestive heart
failure is a common problem in the U.S., with significant prevalence and mortality, which
worsens with increasing age. (5) The lifetime risk of developing congestive heart failure is
one in five in the U.S. Risk factors including ischemic heart disease, hypertension, smoking,
obesity, and diabetes have been identified and can be used to predict the incidence of
congestive heart failure as well as its severity (6).
A history and physical examination, chest x-ray, and a series of diagnostic tests are needed to
assess the presence, acuity and severity of a patients congestive heart failure. The history will
provide information regarding an underlying cause such as myocardial infraction,
hypertension, or noncompliance with diet or medication. History of current symptoms
including fatigue, weakness, dyspnea, and cardiac-induced wheezing can provide information

regarding the severity of congestive heart failure (4). A chest x-ray provides a static picture of
the structures in you chest (lungs, heart, blood vessels); it can show if your heart is enlarged
or if you have fluid in your lungs. An electrocardiogram (EKG) is a test that measures the
electrical activity of the heart including heart rate speed, rhythm, timing of electrical signals;
it indirectly allows determination if the heart walls are thicker, which makes pumping harder
or if you have signs of prior heart damage. B-type natriuretic peptide, is a hormone that is
released into the blood when the heart starts to fail; the higher the level, generally the worse
the CHF. Echocardiography (or Echo) uses sound waves bouncing off the heart to create a
moving picture; it allows the viewer to see the size of the heart, the heart chambers and
valves which allow determination of poor blood flow, poor heart contraction, general heart
muscle damage and ejection fraction (EF). MRI (magnetic resonance imaging) is used to
provide moving images of the structure of the heart and its ability to pump blood to the
body and provides information about the inflammation; injury and blood flow to the heart.
Cardiac catheterization utilizes dye to measure dye movement through the heart chambers
and also the flow through the coronary arteries to identify blockages (coronary angiography).
(4)
Nutritional Therapy
JF had a discharge reported weight of 134.9lbs in December 2014, and a dry weight of
128lbs in June 2014. JFs recorded weight upon admission was 154lbs and JF reported a 20pound weight gain over the last two months. Based on the facilities standards for
determining energy and protein needs the following was calculated: 1761-2115 kcals, 56-71
gm protein, and 1761-2115 mL fluids.
The patient initially was put on a 2G NA diet upon admission. The patients PO intake for
the first 24 hours was poor most likely related to pain from the Foley catheter placement.
After the pain resolved the patients appetite increased to normal. The next day the patient
reported abdominal pains from gas that resolved with Simethicone therapy. On the 4th day of
hospitalization the patient complained of mild nausea with abdominal pain, which the
patient believed due to stomach blockage. JF reported no Bowel Movement (BM) for 5
days. After the patient had a BM his abdominal pain diminished and his appetite again
increased.
During JFs hospitalization he never consumed 100% of his estimated requirements, but his
intake had been increasing. The patient was discharged to a sub-acute facility for physical
therapy to improve his ambulation. Patient is planned for a follow-up visit on 12/15/2014.
Implications of Findings to the Practice of Dietetics
Malnutrition, muscle wasting and cachexia may be present in patients with severe congestive
heart failure due to a combination of fatigue on exertion (e.g. food preparation), breathing
difficulties (from impact of fluid overload), and gastrointestinal symptoms like nausea and
early satiety. Initially when patients are admitted with congestive heart failure a low sodium
diet is prescribed to reduce peripheral swelling from fluid build up (edema) and to assist in
blood pressure control (7). In patients with very severe CHF, a fluid restriction may be
necessary to reduce the need for excessive diuretic drugs and limit further fluid retention.
Some research suggests that folate supplementation (0.8-5.0mg daily) and Vitamin B12
supplementation (200mcg to 500 mcg daily) given with other micronutrient supplements,

10

may result in decreased homocysteine levels, improvements in left ventricular volume,

ejection fraction and quality of life scores (8). Limited evidence is available to determine
protein needs for congestive heart failure patients. Studies report that patients with
congestive heart failure have significantly higher protein needs than those without heart
failure as measured by a negative nitrogen balance. One study indicates at least daily intake
of 1.37 grams of protein per kilogram for clinically depleted patients with heart failure and
daily intake of 1.12 g of protein per kilogram for nourished patients can preserve actual body
composition or limit the effects of hypercatabolism (9).
Depending on the symptoms and amount of fluid retention caused by congestive heart
failure, diuretics may be used to stimulate the removal of salt and water from the body.
Diuretics can help relieve heart failure symptoms including difficulty breathing and swelling
in the legs and ankles. Diuretics are often used with ACE inhibitors to increase excretion of
extra fluid and sodium. With this patient specifically, intravenous Lasix was used daily to
increase kidney fluid excretion to decrease excess fluid/fluid overload. With treatment, the
patients peripheral edema decreased and new facial puffiness also decreased. This patient
was also kept on a sodium-restricted diet throughout the hospital stay but did not have any
restrictions to fluid intake.
Dietitians play a crucial role in working with the patient to educate patients on a heart
healthy diet plans to assist in the management of CHF. In this case the patient stated he
had a poor appetite for about 3 days prior to admission due to SOB and wheezing. Prior to
this acute episode, the patients daughter reported a fair appetite that included consumption
of 1 small meal and 2 medium size meals per day. Patient received Novolog, a type of insulin
shot, to manage blood sugar levels. Since the patient did not following a low sodium diet pta,
it was important to educate the patient a low sodium diet as well as how sodium intake could
effect fluid build up. Due to this patients increased age (90 years old) and his comorbidities
a less restrictive diet as well as diuretic treatment was necessary for congestive heart failure
management.
In younger individuals who are able to make dietary changes, the DASH (Dietary
Approaches to Stop Hypertension), which encourages a variety of fruits and vegetables,
whole grains, fat-free or low-fat dairy products and proteins such as lean meats, eggs,
seafood, nuts, seeds, beans, and peas is encouraged. The DASH diet is low in sodium, solid
fats including saturated fats and trans fatty acids.
The use of alternative medication or herbal medications by the public is increasing, but there
is little published research available as to its impact and/or any morbidity it may cause.

Appendices
APPENDIX A: LABORATORY RESULTS
Lab

Reference
Range

12/2

12/3

12/4

12/5

12/6

12/7

12/8

12/9

Na

135-147
mmol/L

136

135

138

137

135

136

134

12/10

12/11

135

132

11

3.5-5.3
mmol/L

4.7

4.3

4.2

3.6

3.9

4.0

3.6

3.9

3.8

Cl

100-109
mmol/L

106

106

106

103

103

102

101

101

97

CO2

21-31
mmol/L

22

21

26

27

27

29

28

28

24

Creatini
ne

0.7-1.5 mg/dl

1.2

1.3

1.4

0.9

0.9

0.8

0.8

0.8

0.8

Glucos
e

10-121 mg/dl

135

198

157

156

162

158

179

165

BUN

6-23 mg/dl

28

29

31

16

17

19

18

16

16

Bili
Total

0.2-1.2 mg/dl

1.7

1.7

1.7

Ca

8.9-10.5
mg/dl

9.4

9.2

8.6*

8.5*

8.6*

8.4*

8.3*

Phos

2.5-4.5
mg/dl

3.0

2.9

2.6

2.2

2.1

2.1

2.0

2.1

Mg

1.5-2.5 mg/dl

2.2

2.0

2.0

1.8

2.0

1.9

2.1

1.9

AST

8-40 IU/L

28

24

25

ALT

6-33 IU/L

27

30

17

WBC

3.2-9.5 k/uL

6.0

6.5

5.7

10.1

10.7

7.2

6.0

7.0

7.2

195

* No albumin given for calcium correction factor

APPENDIX B: MEDICATIONS

Home Medications
Medication

Dosage

Frequency

Function

Nutritional Implications

Simvastatin

30 mg

Daily
(bedtime)

Reduces levels of lowdensity lipoprotein and

triglycerides in the blood,
while increasing levels of
high-density lipoprotein

Dry mouth, fruit-like

breath odor, increased
hunger, increased thirst,
nausea, stomachaches,
vomiting

Ergocalciferol
(Vit D)

50,000
unit
cap

Weekly

A form of Vitamin D that

promotes the absorption
and use of calcium and
phosphate

Increased thirst, nausea,

constipation, anorexia,
weight loss

Daily

Platelet aggregation inhibitor

that slows or stops platelets
from sticking to blood vessel
walls or injured tissues

Vomiting, nausea,
stomach pain, abdominal
swelling

Clopidogrel
Bisulfate

75 mg

12

Albuterol
(oral inhalation)

90 mcg

4 times a
day

Bronchodilator that relaxes

muscles in the airways and
increases air slow to lungs

Difficulty swallowing,
nausea, vomiting, gagging

Colchicine

0.6 mg

Daily

Beta-tubulin interactor,
affects certain proteins,
which relieves gout
symptoms

Nausea, vomiting,
stomach pain, heartburn

Calcium/Vitamin
D

200
Unit
Tab

2 times a
day

Calcium and Vitamin D is

used to prevent or treat
calcium deficiency

Stomach pain, vomiting,

loss of appetite

Alendronate

10mg

Daily
(morning
before
meals)

Alendronate is a
bisphosphonate which
works to slow bone loss

Abdominal or stomach
pain, difficulty
swallowing, irritation or
pain of the esophagus,
diarrhea

Allopurinol

100mg

Daily

Reduces the production of

uric acid

Abdominal or stomach
pain, ammonia-like breath
odor, constipation,
diarrhea, dry mouth

Insulin Aspart
(Novolog)

1-4
units
PRN

Daily

Hormone that lowers the

levels of glucose in the
blood

Dry mouth, increased

hunger, increased thirst,
loss of appetite

Aspirin

81mg

Daily

A salicylate that works to

reduce substances in the
body that causes pain, fever
and inflammation

Vomiting, severe stomach

cramps, nausea

In-Patient Medications
Medication

Function

Nutritional Implications

Albuterol (oral
inhalation)
(Lipitor)

Bronchodilator that relaxes muscles in

the airways and increases air slow to
lungs

Difficulty swallowing, nausea,

vomiting, gagging

Alendronate

Alendronate is a bisphosphonate which

works to slow bone loss

Abdominal or stomach pain,

difficulty swallowing, irritation or
pain of the esophagus, diarrhea

Allopurinol

Reduces the production of uric acid

Abdominal or stomach pain,

ammonia-like breath odor,
constipation, diarrhea, dry mouth

Carbidopa
(Levodopa)

Levodopa is converted to dopamine in

the brain to treat muscle symptoms of
Parkinsons disease

Severe nausea, vomiting or

diarrhea

Dextrose in IV
fluid

Provides fluids containing various

amounts of sugars when fluids are
needed

Hyperglycemia

13

Docusate
(Senna)

Relieving occasional constipation and

preventing dry, hard stools by helping
fat and water into the stool mass to
soften the stool

Bitter taste, bloating, cramping,

diarrhea, gas

Furosemide
(Lasix)

Loop diuretic that prevents fluid

retention and the absorption of too
much salt, allowing the salt to instead
be passed in the urine.

Sore throat, constipation, diarrhea,

increased hunger, increased thirst,
loss of appetite, nausea and
vomiting

Glucagon

Peptide hormone, produced by alpha

cells of the pancreas that raises the
concentration of glucose in the blood
stream

Diarrhea, loss of appetite, nausea

and vomiting

Insulin Aspart
(Novolog)

Hormone that lowers the levels of

glucose in the blood

Dry mouth, increased hunger,

increased thirst, loss of appetite

Losartan

Angiotensin II which keeps blood

vessels from narrowing, lowering blood
pressure and improves blood flow

Stomach pain, increased hunger,

nausea, vomiting

Metoprolol
succinate

Beta-blocker that affects the blood flow

through arteries and veins

Rapid weight gain

Ondansetron

Blocks the actions of chemicals in the

body that can trigger nausea and
vomiting

Dry mouth, increased thirst, loss

of appetite

Simvastatin

Reduces levels of low-density

lipoprotein and triglycerides in the
blood, while increasing levels of highdensity lipoprotein

Dry mouth, fruit-like breath odor,

increased hunger, increased thirst,
nausea, stomachaches, vomiting

Spironolactone

For potassium-sparing diuretic that

prevents the absorption of too much
salt while preventing potassium levels
from getting too low.

Abdominal or stomach cramping,

constipation, diarrhea, increased
thirst, loss of appetite, sore throat

Terazosin

Relaxes veins and arteries for blood to

pass through to treat hypertension.

Nausea and vomiting

Glossary

Ascites- the accumulation of fluid in the peritoneal cavity, causing abdominal swelling
Costophrenic angle- Chest x-ray done to confirm the presence of pleural fluid
Emesis- the action or process of vomiting
DIA 2000- Diabetic menu plan consisting of 2000 calories.

14

Hematura- the presence of blood in urine

Hyperplasia- the enlargement of an organ or tissue caused by an increase in the reproduction
rate of its cells, often as an initial stage in the development of cancer
Inspiration- the drawing in of breath; inhalation
Natriuretic peptide- a peptide which induces natriuresis
- natriuresis- excretion of sodium in the urine
Ventricular volume- the volume of blood in a ventricle at the end of contraction

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