Last 4 digits of PSU ID# 9546

Nutrition 453, Spring 2016 Hypertension Homework

15 points
Mr. Sparrows wife Carla has been recently diagnosed with hypertension. Her systolic/diastolic
blood pressure readings ranged from 145/90 to 159/99 mm Hg. Her physician has sent her to
you, the dietitian, for dietary advice to help control her hypertension. Carla is 5 ft 9 inches tall
and weighs 205 pounds. She has gained 10 pounds over the past five years, but her weight has
been stable for over one year. Carla is a 40 yr old law enforcement officer and has been married
to Mr. Sparrow for 15 years. At the beginning of her career in the police force, at the age of 22,
she worked out regularly and played basketball with Mr. Sparrows sister Tanya. Due to her
recent promotion to night shift supervisor, she has to work extended hours at least 4 times per
week. Her job-related stress has increased since this promotion. Carla is able to prepare meals at
home only 1-2 days per week. Her husband does not cook at home and as a result, she consumes
convenience foods for most of her meals. Her extended work hours prevent her from exercising
regularly or playing basketball. As a result of this she has gained weight. On occasion she will
have cereal with 2% milk for breakfast at home, otherwise she will stop at the coffee shop and
order an egg and sausage sandwich for breakfast. Her lunches consist of cream-based soups,
meat/cheese sandwiches with a pickle, regular soda, and packaged chips or cookies from the
workplace cafeteria. Her dinner is usually a frozen entre or some kind of take-out or home
delivery item such as pizza, or Chinese food. During her night-shifts she drinks at least two 8 oz
cups of coffee with 2% milk and sugar, at least one regular 12 oz soda and snacks on chips,
pretzels, and popcorn from the vending machine. You ask her about her food preferences and
learn that she enjoys fruits, vegetables, and nuts when she can get them and that she really wants
to get herself back on track.
Assess the patient:
1. A. (0.5 pt) How would you classify Carlas blood pressure?
Carlas systolic/diastolic blood pressure readings range from 145/90 to 159/99 mm Hg
Systolic 145-159 mm Hg/ Diastolic 90-99 mm Hg are categorized as High Blood Pressure
Hypertension Stage 1

B. (1 pt) List at least 5 lifestyle modifications that are recommended to reduce blood
pressure, as provided in the hypertension lecture notes. Next to each recommendation,
provide some specific suggestions that you think Carla could incorporate into her life
given what you know about her. Be specific, being sure to mention specific food sources
and citing the scientific sources of the information you provide whenever you can. (See
lecture notes to guide your thinking; remember, the dietitian can only deal with
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dietary/behavioral interventions; he/she cannot prescribe medications. The hypertension

notes, as well as slide 34 of the weight control lecture notes will be particularly helpful.)

Lifestyle recommendation
from notes

What Carla can do specifically

DASH diet

Follow dietary pattern that emphasizes intake of vegetables,

fruits, and whole grains. Choose low-fat dairy products, poultry,
fish, legumes, nontropical vegetable oils and nuts; and limits
intake of sweets, sugar-sweetened beverages and red meats.

Lower sodium intake

Avoid added table salt, canned soup, salted snack food, high
sodium convenience foods found in vending machine

Consume no more than 2400

mg/day
Further reduction to 1500
mg/day is desirable
Combine DASH diet with
lower sodium intake

By choosing healthy options that are included in both the

DASH diet and low in sodium, patient will reduce blood
pressure.

Physical Activity to lower

blood pressure

Engage in aerobic physical activity 3-4 sessions a week lasting

40 minutes per session involving moderate to vigorous intensity
physical activity

Lower body weight because

BP increases with BMI

>5% loss in body weight can reduce blood pressure

Expect 5-20 mm Hg reduction with 10 kg body weight loss

2. A. (0.4 pt) What is Carlas BMI?

Conversions:
205 lb x 0.45 kg/lb = 92.25 kg
5 9 = 69 inches x 0.025 m/in = 1.725 m
BMI Formula:

BMI = weight (kg) / height (meters)2

BMI Calculation:
BMI = 92.25 kg / (1.725m)2
= 31

B. (0.4 pt) How would you classify her BMI?

BMI of 31 is classified as Obesity Class I: increased risk of CVD and mortality of all
causes. Weight loss is advised.
C. (0.4 pt) What is her TDE?
TDE = REE x AF x IF
Determining REE
Women: Women: [9.99 X wt (kg)] + [6.25 X ht (cm)] - [4.92 X age] -161
= [9.99 x 92.25kg] + [6.25 x 172.5 cm] [4.92 x 40 y/o] 161
= 1641.9
= 1642 kcal
REE = 1642 kcal
AF = Given that patient is a law enforcement officer on rotating shifts and therefore does not
get much exercise, she fits activity factor of 1.3
IF = N/A Patient has no injuries specified
TDE = REE x AF x IF
= 1642 x 1.3 x 1
= 2134.6
= 2150 kcal
D. (0.8 pt) How much energy do you recommend and why? (Do you recommend that
she increase, decrease, or maintain her intake at her current TDE? If you
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recommend an increase or decrease, indicate how much you want her to increase or
decrease her energy intake.) Be sure to show all of your calculations.
I recommend a decrease of 500 kcal in order to lose 1 lb per week initially. I advise my
client to lose weight because a weight reduction of 5% has been studied to lower blood
pressure. For client to lose 5% of her weight (~10 pounds) she will have to continue this
diet plan for 10 weeks and then continue to manage her weight.
Note: If client wants quicker weight loss results, she can further reduce caloric intake by
an extra 500 kcal (totaling 1000 kcal deficit per day) to lose 2 lbs per week = 10 lbs in 5
weeks.
Diagnosis:
3. (2 pt) Write two PES statements. Note the associated codes, and make sure that your E is
set up so that your interventions can target it.
Excessive Energy Intake (NI -1.3) related to obesity as evidenced by BMI of 31.
Excessive sodium intake (NI 5.10.2) related to frequent consumption of high sodium
choices as evidenced by relying on convenience food for most meal choices.

Intervention:
4. (2 pt) Write 2 intervention statements. Use the Is it a WRAP? guideline for what Carla will
do.
Intervention #1:
Dietitian: I will prescribe my client to follow a weight loss plan of 1650 kcal per day in order
to lose 10 lbs in 10 weeks following a DASH dietary pattern. (NP-1.1) This 5% reduction in
weight will aid Carla in lowering her blood pressure.
Carla: Client will track choices with a food diary or electronic app to help keep track of total
caloric intake. Client will choose choices that follow DASH diet: whole grains, vegetables, fruit,
low-fat or nonfat dairy foods, lean meats, poultry, fish, nuts, legumes, and seeds.
Intervention #2:
Dietitian: I will educate my client to modify her diet by choosing low sodium choices to
lower her sodium intake to 1500 mg/day. (E-1.5) Choosing low sodium choices with aid Carla in
lowering her blood pressure. I will advise my client to experiment in the
Carla: Client will pay attention to nutrition labels. Client will use an electronic app to track
her daily sodium intake making sure she does not exceed recommendation of 1500 mg/day.

5. After discussing various options with Carla at her next visit, she expresses her willingness to
try the DASH diet.
A. (2 pt) How can she change her diet in order to meet the recommendations for a
DASH diet? Provide at least 4 examples of specific changes that Carla could make.
Choose whole grains. Aim for 6 servings per day. Instead of buying egg and sausage
sandwich at coffee shop, prepare breakfast before work with whole grain bread such as a
toasted egg sandwich or peanut butter toast.
Choose fruits and vegetables. Aim for 3-4 servings of each per day. Pack healthy snacks
for work to avoid vending machine options such as an apple, banana, carrots, etc.
Choose low-fat or non-fat dairy products. Aim for 2-3 servings per day. Choose low-fat
milk instead of 2%.
Snack on nuts and seeds. Aim for 3 servings per week. Choose unsalted varieties.
Examples are a handful of unsalted almonds, cashews, or pistachios.
B. (0.5 pt) In addition to directly helping her blood pressure, name at least one other
aspect of her profile for which the DASH diet would be beneficial?
DASH diet will aid client in achieving a healthy weight
C. (5 pt) Based on your energy calculations in question 2 and the DASH Eating Plan at
Various Calorie Levels in Appendix 10 of the 2010 Dietary Guidelines (on ANGEL in
the HT HW folder or go to
http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/
PolicyDoc/Appendices.pdf ), modify Carlas diet in the following manner: Select the
DASH eating pattern in Appendix 10 of the 2010 Dietary Guidelines for Americans that
comes closest to your recommended energy level. Then modify it as needed in order to
meet her energy needs and to make it something to which she is likely to comply. To
answer this question, create a chart like the one below in which each food group is listed
and briefly explain how/why you modified Carlas diet and/or the DASH plan to promote
health, but also to enhance compliance. You will need to insert rows to include all of the
food groups included in the Appendix 10 Table.
How much energy do you want Carla to have?
1650 kcal

Food Group

How many servings do Provide at least 2

you want Carla to have examples of lowin her new diet?
sodium foods that are
in this food group.

Using the dietary

information provided
above, make specific
suggestions to help
Carla adapt her current
dietary pattern to more
closely align with
DASH.

Grains

Continue to snack on
popcorn, but she
should choose the
unsalted airpopped
variety for a healthy
source of whole
grains.

1 slice 100% whole

wheat bread
C unsweetened
oatmeal

Carla should choose

whole grain bread for
her breakfast
sandwiches.
Vegetables

3-4

C bell peppers
C carrots

Fruits

1 medium banana
1 medium apple

Fat-free or low-fat
2-3
milk and milk products

1 C fat-free or low-fat
yogurt
1 C fat-free or low-fat
milk

Lean meats, poultry,

and fish

3-4 or less

1 egg

Pack vegetables for a

snack rather than
vending machine
options.
Pack fruits for a snack
rather than vending
machine options.
Choose fat-free or
low-fat dairy products
instead of 2%.

Choose lean meats.

Avoid overly
processed meats such
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1 oz. skinless chicken

as sausage as
frequently consumed
for breakfast. Choose
healthier breakfast
meat options such as
turkey bacon.

Nuts, seeds, and

legumes

3 per week

2 tbsp. unsalted peanut Snack on nuts rather

butter
than vending machine
options.
C unsalted nuts

Fats and oils

1 tbsp. sodium free

salad dressing

Choose low-sodium
choices provided.

1 tsp. vegetable oils:

canola, olive, peanut,
or sesame
Sweets and added
sugars

3 or less per week

Maximum sodium
limit

2300 mg /day

1 tbsp. jelly
1 tbsp. sugar

Limit sweets and

sugars when following
DASH diet. Use sliced
lemon or lime to
enhance water rather
than drinking soda.

Avoid adding
Follow the provided
salt/Replace salt with tips to lower sodium
herbs, spices, and salt- intake.
free seasoning blends.
Chop and cook
Choose low-sodium
vegetables such as
garlic, onions, peppers, soup options rather
than a creamy soup.
etc. to add flavor to
dishes