HNSC4240 Medical Nutrition Therapy

Case study 1

PLEASE READ THE INSTRUCTION CAREFULLY. Read the following fictitious medical record from a
patient who has coronary artery disease. Answer the questions below. Noted that some questions will require
that you search for scientific evidence from reliable sources. Please include AT LEAST TWO references in
standard scientific citation format. The assignment must be typed. The assignment is due on March 2 in class.
Late assignment will be subjected to 1 point deduction each day.

Client Name: Carrie Young

DOB: 12/15

Age: 73

Sex: female

Education: Secondary school

Occupation: retired

Household members: husband age 72

History: Mrs. Young is a 73 year-old female with a history of hypertension, hypothyroidism, anxiety/depression,
and ongoing tobacco use who presents with coronary artery disease. Complaints of chest pain and dyspnea.

Family history: What? Coronary heart disease Who? Father- Myocardial infarction age 50

Allergies: Allergic to milk

Vitals: Blood pressure 96/59, pulse 92, temperature 36.9C

Abdomen: bowel sound present, non-distended, non-tender

Height: 1.63 m

Weight: 88 kg
Lab

Values Reference Units

Sodium 139 136-145 mEq/L

Potassium 4.1 3.5-5.5 mEq/L

Glucose 73 70-110 mg/dL

Calcium 9.4 9-11 mg/dL

Albumin 3.2 3.5-5 g/dL

Prealbumin 17 16-35 mg/dL

LDH 325 208-378 U/L

Alk phos 150 30-120 U/L

LDL 130 -- mg/dL

HDL-C 50 -- mg/dL

Nutrition history:

General: Appetite was good. Per Mrs. Young, her husband does the majority of grocery shopping and cooking. She
just eats whatever he prepares. She usually eats three meals each day. Was diagnosed HTN 5 years ago, tried 4-g Na
(no added salt) diet, but the foods were too bland and tasteless, and she soon abandoned the effort. During the
interview, Mrs. Young said that a friend of her, who she referred to as a nutrition expert, told her that cooking with
coconut oil will prevent her from having heart attack again. She was wondering if she should follow it because she is
not used to the taste of coconut and doesnt want to eat it every day unless necessary.

24-hr recall

Breakfast: 3 blueberry pancakes with 3 tbsp maple syrup, 1 c orange juice, 1 hard-boiled egg, 1 c coffee (with 2 tbsp
half and half, 2 tsp table sugar)

Snack: 1 piece of pound cake

Lunch: 1c canned creamy mushroom soup; sandwich with 4 oz roast beef, dill pickles, 2 slices Swiss cheese, 1 c
regular coke

Dinner: 5 oz pork chops, cup cheddar cheese, 1 large baked potato with 2 tbsp butter, 1c steamed sweet peas, 1 c
pasta salad

HS snack: 2 c butter pecan ice cream, 6 chocolate chip cookies

Medications: Lopressor 50 mg every day; lisinopril 10 mg every day; Lipitor 10 mg every day at bedtime.
 Questions:

1. Please calculate her BMI. Classify her BMI.

BMI=kg/m2 BMI= 88kg/1.63m2 = 33.1

Mrs. Youngs BMI is 33.1, placing her in the obese class I category.

2. Use food composition table or any diet analysis software/ online program, estimate Mrs. Youngs protein,
carbohydrate, fiber, sodium, potassium, total fat, saturated fat, monounsaturated fat, polyunsaturated fat,
cholesterol and calories from her 24-hr recall. Please use the table below as a template or provide a printout
of the nutrition analysis report if you completed this part using diet analysis software (you may expand the
columns and rows).

Food items Protei Carbohy Fiber Sodiu Total Saturated Mono Poly (g) Cholesterol Energy
n (g) drate (g) (g) m fat (g) fat (g) (g) (Cal)
(mg) (mg)

Blueberry 8g 32g 2g 502mg 8g 2g 3g 2g 70mg 227 Cal

pancakes

Maple 0g 40g 0g 5mg 0g 0g 0g 0g 0mg 157 Cal

syrup

Orange 2g 29g 1g 5mg 0g 0g 0g 0g 0mg 122 Cal

juice

Hard-boiled 6g 0g 0g 139mg 5g 2g 2g 1g 211mg 77 Cal

egg

Coffee 0g 0g 0g 5mg 0g 0g 0g 0g 0g 2 Cal

Half and 1g 1g 0g 12mg 3g 2g 1g 0g 11mg 39 Cal

half milk

Sugar 0g 8g 0g 0mg 0g 0g 0g 0g 0mg 33 Cal

Pound 6g 49g 0g 300mg 15g 3g 7g 4g 111mg 351 Cal

Cake

Mushroom 4g 17g 0g 1769m 15g 3g 3g 4g 0mg 214 Cal

soup g

2 slices of 4g 26g 1g 354mg 2g 0g 0g 0g 0mg 138 Cal

bread

Roast beef 32g 0g 0g 242mg 10g 4g 4g 0g 87mg 222 Cal

Dill pickles 0g 1g 0g 0mg 0g 0g 0g 0g 0mg 3 Cal

Swiss 15g 3g 0g 242mg 16g 10g 4g 1g 87mg 215 Cal

cheese

Regular 0g 23g 0g 10mg 0g 0g 0g 0g 0mg 91 Cal

coke

Pork chops 20g 0g 0g 33mg 7g 2g 3g 1g 55mg 147 Cal

Cheddar 14g 1g 0g 351mg 19g 12g 5g 1g 59mg 222 Cal

cheese

Baked 4g 49g 3g 11mg 0g 0g 0g 0g 0mg 209 Cal

potato

Butter 0g 0g 0g 155mg 15g 9g 4g 1g 41mg 135 Cal

Sweet peas 8g 23g 9g 115mg 0g 0g 0g 0g 0mg 125 Cal

Pasta salad 7g 40g 3g 924mg 19g 3g 5g 10g 9mg 358 Cal

Ice cream 10g 75g 3g 202mg 29g 18g 9g 1g 90mg 575 Cal

Cookies 3g 38g 1g 178mg 14g 6g 4g 2g 0mg 284 Cal

Total 144g 455g 23g 5,554 187g 101g 54g 37g 831mg 3,946 Cal
mg

3. Compare Mrs. Youngs 24-hr dietary intake (the totals from question 3) with the TLC dietary guidelines
and/or other dietary guidelines. Complete the following table (noted that column 3 needs to have the same
units as column 2 in order to be comparable). Point out two nutrients that are NOT consistent with the
guidelines that are of major concern to you and explain the reasoning.
 Nutrient Recommended amount/ Youngs intake per 24-hr
percentage recall

Protein ~ 15% of total calories 144g

Carbohydrate 50-60% of total calories 455g

Fiber 20-30 grams per day 23g

Sodium < 2400 mg per day 5,554mg

Total fat 25-35% of total calories 187g

Saturated fat < 7% of total calories 101g

Mono-unsaturated fat 20% of total calories 54g

Poly-unsaturated fat 10% of total calories 37g

Cholesterol < 200 mg/day 831mg

Energy Between 1760 and 2200 3,946 Cal

calories per day

Two nutrients not consistent with the guidelines:

Firstly, Mrs. Youngs major concern is her excess energy intake. Given that she is obese, diagnosed with
hypertension and (due to genetics) at risk of Coronary heart disease, weight loss must be implemented upon Mrs.
Young. Excess energy intake may lead Mrs. Young in becoming even more obese. Studies show that obesity is
associated with an increased risk of many chronic diseases such as, cardio vascular disease. A reduced caloric intake
along with increased energy expenditure may assist Mrs. Young in weight loss, which may then regulate her blood
pressure and even reduce her risk of developing a myocardial infraction.

In addition, Mrs. Young must decrease her sodium intake to control her hypertension. According to the TLC
guidelines sodium intake must be limited to 2400 mg per day. This diet is intended for lowering the risk of heart
disease, and involves diet along with healthy changes in lifestyle. Sodium affects blood pressure by influencing the
sympathetic nervous system activity, the sodium pump and sodium-calcium exchange activity (which regulate fluid
balance in the body and may cause vassal constriction) and the production of vasodilator nitrogen monoxide (which
may increase blood pressure). Therefore, by decreasing her sodium intake, Mrs. Young may achieve a healthy
decrease is blood pressure and may eventually begin to regulate her blood pressure.

4. Her husband asks you to show him how to modify recipes to make them heart healthy. Please make at least 3
changes on one of the meals (breakfast, lunch, or dinner) from the 24-hr dietary recall. Use the table below as a
template and only include the items that need to be modified in the table.
 Food items Modification/Alternative(s) Rationale

3 Blueberry pancakes
2 Whole Grain Organic
Blueberry Vans Waffles
Given that Mrs. Young enjoys her blueberry pancakes for
breakfast, I provided her with a healthier alternative that is
lower in calorie and sodium without sacrificing the great
taste! The original pancakes Mrs. Young has been eating
were about 227 calories and 502 mg of sodium. The Vans
blueberry waffles are at 190 calories with a decrease of 192
mg of sodium! Although, the calorie/sodium difference
may not seem too significant, many small tweaks add up to
a greater change, which may slowly lead to a decrease in
hypertension. In addition, the 5g of packed fiber in these
waffles may keep Mrs. Young satisfied through lunch. Mrs.
Young can have her cake and eat it too!

1 egg 3 egg whites An easy swap of 1 egg to 3 egg whites will provide Mrs.
Young with a 29 calorie decrease, 0g of fat and an
additional 5g of protein! Not only will the fewer calories
aid to a decrease in energy and over all weight loss, the
additional protein may keep Mrs. Young satisfied.
Moreover, the 2 additional eggs yield a larger portion size,
this tricks the brain into feeling like you are eating more
yet with less calories!

1 cup of coffee (with 2 tbsp half
and half, 2 tsp table sugar)
1 cup of coffee with 2tbs of
soymilk, 1 packet of truvia
Presented that Mrs. Young clearly enjoys a sweetened cup
of coffee which packs on, I provided her with a healthier
alternative. Soymilk, with as little as 13 calories and 0g of
fat will allow Mrs. Young to enjoy that creamy texture her
cup of coffee desires, opposed to her original take of half
and half milk which packs 39 calories and 3g of a fat. In
addition, the packet of truvia is a 0 calorie sweetener, (an
all-natural sweetener from stevia plant) that will sweeten
Mrs. Youngs coffee without the additional 33 calories and
8g of carb, her 2tsp of sugar provided. A reduction in these
26 calories a day may lead to small changes, which may
help Mrs. Young enjoy her tastes while leading a healthier
lifestyle.

5. What are the mechanisms of action of the medications prescribed to Mrs. Young?

Medications Mechanism of action

Lopressor Hydrochlorothiazide is used alone or in combination with other medications

to treat high blood pressure. Hydrochlorothiazide is used to treat edema
(fluid retention; excess fluid held in body tissues) caused by various medical
 problems, including heart, kidney, and liver disease and to treat edema
caused by using certain medications including estrogen and corticosteroids.
Hydrochlorothiazide is in a class of medications called diuretics. It works by
causing the kidneys to get rid of unneeded water and salt from the body into
the urine.

Metoprolol is used alone or in combination with other medications to treat

high blood pressure. It also is used to prevent angina (chest pain) and to
improve survival after a heart attack. Metoprolol also is used in combination
with other medications to treat heart failure. Metoprolol is in a class of
medications called beta blockers. It works by relaxing blood vessels and
slowing heart rate to improve blood flow and decrease blood pressure.

Lisinopril Lisinopril is used alone or in combination with other medications to treat

high blood pressure. It is used in combination with other medications to treat
heart failure. Lisinopril is also used to improve survival after a heart attack.
Lisinopril is in a class of medications called angiotensin-converting enzyme
(ACE) inhibitors. It works by decreasing certain chemicals that tighten the
blood vessels, so blood flows more smoothly and the heart can pump blood
more efficiently. Lisinopril controls high blood pressure and heart failure but
does not cure them.

Lipitor Also known as, Atorvastatin is used together with diet, weight loss, and
exercise to reduce the risk of heart attack and stroke and to decrease the
chance that heart surgery will be needed in people who have heart disease or
who are at risk of developing heart disease. Atorvastatin is also used to
decrease the amount of fatty substances such as low-density lipoprotein
(LDL) cholesterol and triglycerides in the blood and to increase the amount
of high-density lipoprotein (HDL) cholesterol in the blood. Atorvastatin is in
a class of medications called HMG-CoA reductase inhibitors (statins). It
works by slowing the production of cholesterol in the body to decrease the
amount of cholesterol that may build up on the walls of the arteries and
block blood flow to the heart, brain, and other parts of the body.

6. Identify one peer-reviewed original scientific study about coconut and its effect on cardiovascular health. Briefly
describe the study design, methods and results. Based on the study and other scientific evidence, will you
recommend Mrs. Young to cook with coconut oil? Explain your rationale.
Work Cited

LITERATURE CITED

https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682864.html

https://www.supertracker.usda.gov/