Denielle Saitta

NCP
Cardiovascular
I.

II.

Introduction: Patient Profile

Patient S is an 89 year-old male undergoing Coronary artery
bypass graft surgery (CABG) surgery. His current nutrition-related
problems include coronary artery disease, hypertension, congestive
heart failure, anemia, acute renal failure, hypocholesteremia, and type
2 diabetes.
Disease Process

Coronary heart disease (CHD) is a disease in which plaque builds

up inside the coronary arteries. The arteries supply blood to your heart
muscle. When there is a buildup of plaque in the arteries, this condition is
called atherosclerosis. Hardened plaque constricts the coronary arteries and
lessens the movement of blood to the heart. If the plaque ruptures, a blood
clot can form on its surface.
Certain factors damage the inner layers of the coronary arteries such as
smoking, overweight or obese, age, high levels of LDL cholesterol and low
levels of HDL cholesterol, high blood pressure, high levels of sugar in the
blood due to insulin resistance or diabetes, and blood vessel inflammation.
Coronary artery bypass grafting (CABG) is a type of surgery that is performed
to help increase blood flow to the heart. During a CABG, a healthy artery
from the body is connected to the blocked coronary artery. The grafted artery
bypasses the blocked portion the coronary artery. This generates a new path
for blood to flow to the heart.
CABG is not a cure for CHD and will require a treatment plan that includes
lifestyle changes to help a patient stay healthy and reduce the chance of
CHD worsening. Lifestyle changes may include making changes to your diet,
quitting smoking, doing physical activity regularly, and lowering and
managing stress.
Following a CABG procedure a patient will be recommended to follow a heart
healthy diet to prevent further progression of CHD. A heart healthy diet
includes reduced intake of saturated fatty acids and trans fats, reduce
cholesterol intake, increase omega-3 fatty acids, increase consumption of
fresh fruits and vegetables and plenty of whole grains, low-fat or nonfat dairy
products, limit consumption of sodium and alcohol.
III.

Patient history: Coronary artery disease, hypertension, congestive

heart failure, abnormal cardiac enzyme level, anemia, aortic valve

IV.

V.

sclerosis, chest pain, hypocholesteremia, non-stemi, acute renal

failure, DM2, CABG, polymyalgia rheumatic.
Course of hospital treatment N/A

Nutrition Care
a. Nutrition Assessment
Weight
o 145 lb = 65.91 kg
Height
o 66 in = 167.64 cm
BMI
o ((145)/((66)(66)) x 703 = 23.4 kg/m2
Ideal Body Weight
o 106 + 6(6) = 142 lb
o 145/142 = 102%
Labs
o BUN: 29
o HGB 10.1
o HCT: 29.4
o NA: 141
o K: 3.3
o PHOSPHORUS: 3.3
o GLUCOSE: 35
Medications
o Lipitor
o Reglan
o Dextrose
o Lopressor
o Bobutamine HCL
o Zofran
o Cefazolin Sodium
o Protonix
o Epinephrinem Insulin
o Ultram
Aspart
o Metoprolol
o Insulin Detemir

Nutrition Needs
o Kcal: 1613-1936 kcal (25 30 kcal/kg)
o Protein: 52-65g protein (0.8-1.0 gm/kg IBW) , if AKI
resolved increase 1.2-1.5
o Fluid: 1613-1936 mL
Other: Patient M is S/P CABG X 4, on O2, sleeping a lot, per
discussion with family member patient was eating okay prior to
admission and has not lost weight. Patient is allergic to eggs and
is vegetarian. Complaints of N/V when started on clear liquids
per nursing report.

b. Diagnosis (PES) Statement

Inadequate oral intake related to N/V post-surgery as evidenced
by minimal PO intake.
c. Intervention Plan & Implementation
Resume diabetic, clear liquid A/T once cleared per surgery
Advance further A/T to GI soft + vegetarian preference
Resource Diabetasheild on clear tray as PO status allows
Vegan NCS PO A/T + snacks (peanut butter crackers BID)
Trial Juven BID if patient agreeable healthy shot daily for
additional protein to promote surgical healing
Weights daily
Multivitamin/ mineral
Bowel regimen PRN
d. Monitoring/Evaluation
Maintain lean body mass
Promote maintenance of skin healing and surgical healings
Watch for swallowing and aspiration
PO advancement
Intake greater than 75%
Supplement acceptance
e. Documentation
Completed
References:
http://www.nhlbi.nih.gov/health/health-topics/topics/cabg
http://www.nhlbi.nih.gov/health/health-topics/topics/cad/