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Myocardial Infarction
Myocardial Infarction
Myocardial Infarction
Myocardial Infarction
Molly Chaffin Denielle Saitta Claire Holladay Lauren Mitchell Karly Childress
A heart attack occurs when blood flow to the heart muscle is decreased or blocked completely, keeping the heart from getting enough oxygen, which can damage or destroy part of the heart muscle.
Heart attacks are most often caused by the buildup of plaque in the arteries that lead to the heart. Plaque is the accumulation of calcium and fatty acids such as cholesterol and triglyceride.
Other
Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea and vomiting Light-headedness or sudden dizziness
What is angioplasty?
Angioplasty is a nonsurgical procedure to open narrowed or blocked coronary arteries that supply blood to the heart. A coronary artery stent is a small, metal mesh tube with a balloon that expands inside a coronary artery which is placed during or after an angioplasty. The stent helps prevent blockages in the artery in the future.
History
61 y.o. male Occupation: Lutheran Minister Marital Status: Married, with grown children Tobacco use: 1 ppd for 40 years Alcohol use: 1 glass of wine per day
Patient
Medical History
Brought to emergency room by his wife after having severe chest pain returning home from work. He described having pressure-like pain radiating to his jaw and left arm and had an episode of emesis and nausea
History cont
Family
History
Surgical treatment Diagnosed as myocardial infarction Angioplasty of distal right coronary artery Stent placement to stabilize patient
Height:
Weight: BMI:
5 feet 10 inches
185 pounds
Unplanned
Nerves
and Cognition
Vital
Signs
Glucose (mg/dL)
ALT (U/L) AST (U/L) CPK (U/L) CPK-MB (U/L) Lactate Dehydrogenase (U/L)
136 H
30 25 75 0 325
106
215 H 245 H 500 H 75 H 685 H
104
185 H 175 H 335 H 55 H 365
70-110
4-36 0-35 55-170 (M) 0 208-378
HDL-C (mg/dL) 30 L LDL-C (mg/dL) LDL/HDL ratio Apo A (mg/dL) Apo B (mg/dL) PT (sec) 160 H 5.3 H 72 L 115 12.6
Interactions
Lisinopril Blood Pressure Nitro-Bid Chest Pain Vasodilator Avoid alcohol NTG Chest Pain Vasodilator Avoid alcohol Aspirin Blood thinner COX inhibitor Vitamin K affects thickness of blood, Calcium decreases absorption
Beta blocker ACE inhibitor Calcium interferes with absorption, avoid licorice Avoid high potassium
Nitroglycerin and morphine until pain recession IV Heparin: 5000 bolus units; 1,000 unit/hr continuous infusion Chewable aspirin: 160 mg continued daily Lopressor: 50mg twice daily Lidocaine: as needed
Pre-surgery: NPO Post-surgery: High protein (1g/kg body weight) Low saturated fat (5-6%) Moderate cholesterol
New guidelines supported by AHA suggest no specific limit for dietary cholesterol
hour recall:
None 1 large cinnamon raisin bagel 1 tbsp fat-free cream cheese 8 oz orange juice coffee 1 cup canned vegetable beef soup Sandwich (4oz roast beef, lettuce, tomato, dill pickles, 2 tsp mayonnaise) 1 small apple 8 oz 2% milk 2 lean pork chops (3 oz each) 1 large baked potato (2 tbsp margarine) cup green beans cup coleslaw 1 slice apple pie 1 oz pretzels 8 oz 2% milk
Lunch
Dinner
Snack
Mid-Morning Snack
Carbohydrate (g) 60g Protein (g) (0-12)g Fat (g) (0-4)g Calories 320
Food List Large Cinnamon Raisin Bagel (4 carb exchanges) 1 tbsp fat free cream cheese (1 free exchange) 8 oz orange juice (2 fruit carb exchange) coffee TOTAL
30g
120
90g
0-12g
0-4g
=440
Lunch
Carbohydrate (g) 15g Protein (g) (0-3)g Fat (g) (0-1)g Calories 80
30g
30g
28-34g
(0-6)g 28g
10-15g
(0-1)g (0-4)g
434
160 184
10g
90
60
8 oz 2% milk
TOTAL
12g
72g
8g
36-45g
5g
15-21g
120
=694
Dinner
Carbohydrate (g) Protein (g) 42g Fat (g) (0-18)g Calories 600
Food List
2 lean pork chops (6 meat exchanges) Large baked potato (4 starch exchange) cup green beans (2 low carb exchanges) cup coleslaw (1 carb + 1.5 fat exchanges)
60g
(0-12)g
(0-4)g
320
10g
4g
50
15g
(0-3)g
7.5g
147.5
45g
(0-9)g
(5-6)g
285
TOTAL
130g
46-70g
12.5-35.5g
=1,402.5
Snacks
Food List
Carbohydrate (g)
Protein (g)
Fat (g)
Calories
18.75 g
(0-3.75)g
(0-1.25)g
100
12g
8g
5g
120
30.75g
8-11.75g
5-6.25g
=220
Appetite good Recent diet changes Corn oil instead of butter Less fried foods
none
Activity
Total
Energy Requirements
Normal activity factor: 1.4 (low activity) 1,652 kcal/day x 1.4 = 2,313 kcal/day Hospitalized factor: 1.2 (surgery) 1,652 kcal/day x 1.2 = 1,982 kcal/day
needs
protein needs (67-84 g/day) 84 kg x 0.8-1.0= 67.2-84 g protein/day Post-op protein needs (84-126 g/day) 84 kg x 1.0-1.5= 84-126 g protein/day
Nutrition Diagnoses
PES
#1:
Altered nutrition-related laboratory values related to high saturated fat diet as evidenced by total cholesterol >200mg/dL, HDL <45mg/dL, and LDL >130mg/dL
PES
#2:
Physical inactivity related to sedentary lifestyle as evidenced by only walking 15 minutes each day
Nutrition Intervention
PES #1: Altered nutrition-related laboratory values related to high saturated fat diet as evidenced by total cholesterol >200 mg/dL, HDL <45 mg/dL, and LDL >130 mg/dL
Nutrition Rx: Modify diet to consume less than 5-6% of daily calories from saturated fats; this translates to between 99.1-118.92 calories from saturated fat or 16 grams of saturated fat per day for Mr. Klosterman Nutrition Intervention: This can be done by decreasing dietary consumption of saturated fats by choosing a lower fat milk option. Provide nutrition education to promote healthy cooking and appropriate portion sizes. Also, continue to replace butter with oil when cooking and reduce fried foods. Participate in the DASH diet to reduce sodium intake and have a better heart healthy diet and help reduce BMI.
Nutrition Intervention
PES #2 Physical inactivity related to sedentary lifestyle as evidenced by only walking 15 minutes each day
Nutrition Rx: Increase physical activity to 150 minutes per week of moderate intensity physical activity.
Nutrition intervention: From Nutrition Care Manual, increase walking to 30 minute per day, five or more times per week. Discuss other options for physical activity to decrease sedentary time. Gradually increase daily activity time to walking the dog for 30 minutes twice daily two times per week. Also, meet with a personal trainer to set and achieve specific goals.
Evaluate the effectiveness of the nutrition interventions in meeting the nutrition goals
Monitor the patients Cholesterol (>200mg/dL), HDL (<45 mg/dL) and LDL (>130 mg/dL) levels for changes through laboratory values Monitor Anthropometrics by checking weight, BMI, and waist circumference Have patient keep track of a food diary so dietary intake can be monitored Monitor his daily physical activity to see an increase from only walking 15 minutes per day Monitor the patients progress in his cardiac rehab program Monitor the patients progress in cessation of smoking
ADIME Notes
Age 61
Gender Male
Race/Ethnicity White
Living/housing situation- living with wife Smokes 1 PPD Dx: Myocardial Infarction s/p angioplasty
Meal type: clear liquids, no caffeine History: Appetite good. Has been trying to change diet. Wife indicates that she has been using corn oil instead of butter and has tried not to fry foods as often. 24-hour recall: Breakfast- none Midmorning snack- 1 large cinnamom rasiin bagel with 1 tbsp. fat-free cream cheese, 8 oz orange juice, 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 Food allergies/intolerances/aversions: none Previous nutrition therapy? Yes, last year with community dietation Food purchase/ preparation: spouse Vitamin/mineral intake: none
Height and Weight: 510 and 185 pounds: BMI: 26.6 kg/m2
Cholesterol214mg/dL HDL 30mg/dL LDL 141mg/dL VLDL 40mg/dL HDL/LDL ratio 4.8 ApoA 98mg/dL
Vital signs Blood Pressure 118/78 mm Hg Temperature 98.4 F Pulse 92 bpm Respiratory rate 20 bpm
Total Energy estimated needs: 2300 calories Total Protein estimated needs: 67.2 84 g protein/day Total Fat estimated needs: 25-35%
Diagnosis:
PES #1: Altered nutrition-related laboratory values related to high saturated fat diet as evidenced by total cholesterol >200mg/dL, HDL <45mg/dL, and LDL >130mg/dL PES #2: Physical inactivity related to sedentary lifestyle as evidenced by only walking 15 minutes each day
Nutrition Rx: Modify diet to consume less than 5-6% of daily calories from saturated fats; this translates to less than 162 calories or 18 grams of fat for Mr. Klosterman. Nutrition intervention: This can be done by decreasing dietary consumption of saturated fats by choosing a lower fat milk option. Provide nutrition education to promote healthy cooking and appropriate portion sizes. Also, continue to replace butter with oil when cooking and reduce fried foods. Participate in the DASH diet to reduce sodium intake and have a better heart healthy diet and help reduce BMI.
PES #2:
Nutrition Rx: Increase physical activity to 150 minutes per week of moderate intensity physical activity (1).
Nutrition intervention: Increase walking to 30 minute per day, five or more times per week. Discuss other options for physical activity to decrease sedentary time. Gradually increase daily activity time to add up to 300 minutes per week until healthy weight is reached.
References
Nahikian-Nelms, Marcia, and Sara Long. Roth. Medical Nutrition Therapy: A Case Study Approach. Belmont, CA: Wadsworth/Thomson Learning, 4th ed., copyright 2014. Print.
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