Nutrition in cardio vascular diseases part 1

NUTRITION in CARDIO- VASCULAR DISEASES PREPARED BY CHARLEMAGNE TAN, RND FACULTY OF NUTRITION AND CULINARY DEPARTMENT OUR LADY OF FATIMA UNIVERSITY

OBJECTIVES SETTING FOR NCP FOR EVERY PROBLEM OR NEED, THERE MUST BE A CORRESPONDING OBJECTIVE. OBJECTIVES must be: Specific and pt-centered Time-bound Realistic Measurable

GUIDE FOR IDENTIFYING HIGH RISK PT Signs of Malnutrition on Admission Underlying Disease Planned ActionsLow Nutritional Intake Increased Nutritional Demands Wt loss 5-10% (last 2-3 months) Serum Albumin, 2 weeks

DIETARY INSTRUCTION / PT COUSELLING - the process of providing individualized professional guidance to assist a person in adjusting his daily food consumption to meet his health needs. The process involves interviewing, counseling and consulting. planned interventions for pt regardless of setting, in-pt or out-pt important aspect of total nutritional care

OBJECTIVES OF DIET COUNSELING To help the pt understand and follow the physicians diet prescription in terms of the kind and amounts of food prepared in specific ways. To advise the pt on lifestyle changes needed to support medical and nutritional management, particularly of chronic ailments. To motivate the pt to make necessary modifications in diet and lifestyle

STEPS IN DIET COUNSELING 1. INTERVIEW Basic parts of an interview are: Opening: introduce self, establish rapport Body: obtain desired info; give info as needed Closing: may include setting date for next session Types of questions asked in an interview: primary or secondary open or closed neutral or leading

STEPS IN DIET COUNSELING Nutrition Interview Guidelines Introduction developing a relationship defining roles determining the pts health need or problem and related personal goals redefining objectives in light of pts goals Pt profile gathering physical data: age, ht, wt [present and past hx], experience with disease or wt problem

STEPS IN DIET COUNSELING The Pts Food Habits Nutrition hx determining present food intake learning about place and time of eating referring to check-list of various food groups and some individuals foods determining who prepares the food and how Physical exercise and rxn: activities associated with the pts food habits Food rxns: pts likes, dislikes, intolerances, allergies

STEPS IN DIET COUNSELING 2. COUNSELING TEACHING PLAN FOR INDIVIDUAL OR GROUP INSTRUCTION Preparation research the subject and make a careful study make out teaching plan, w/c includes: - Aim (rel. to pts needs, procedure, realistic) - Approach (secure attn and interest, stimulation) - Answers (involvement, organization, exploration) - Application (summary of key pts., plan of action) - Assignment (add. Info, feedback hearing) prepare and check out all aids and equipment ahead of time

STEPS IN DIET COUNSELING 2. COUNSELING TEACHING PLAN FOR INDIVIDUAL OR GROUP INSTRUCTION Presentation for group instruction, arrange in advance for the room, chairs, speakers desk, displays, materials and equipment necessary carry out the teaching plan - Timing (begin & end on time, place materials for balance & interest) - Group Involvement (maintain relaxed and permissive atmosphere) Purpose fulfilled?? evaluate class results in light of its objective plan follow-up activity

STEPS IN DIET COUNSELING 2. COUNSELING INDIVIDUAL DIET COUNSELING Choosing the diet Explaining the reasons for the diet Planning a daily food pattern with pt Reviewing the diet and answering questions 3. CONSULTING - involves discussing proposals and plans for the pts nutritional care with the health care team and with the pt himself.

DOCUMENTATION For: monitoring, evaluation and revision of the nutritional care plan and action. Purposes of Medical Records to document the medical care of the pt to facilitate communication among all members of the health care team and assist in the coordination of their activities. to serve as basis for evaluating the hospitals health care delivery and the quality of its care monitoring program for hospital accreditation

DOCUMENTATION Types of Medical Records Source-oriented: the chart is organized according to the category of the personnel writing in the records. [Dr.s notes, nurses notes, AHPs notes] Problem-oriented medical record (POMR): an integrated recording system focusing on the pts probs & profile, plan for care and for pt education, assessment of progress and records. Advantages of POMR: the ability to express each problem in its own observational terms a pt profile that contains descriptions of the pts life situation integration of data recorded by diverse discipline deliberate attn to plans for education of the pt ideas for further applications or adaptations

DOCUMENTATION Types of Information that Need to be Documented Four specific information areas Data base: c/c, present illness, PE and LAB, NUT info. Problem list: any condition the pt presents that requires the health team to obtain more info. Initial care plan Progress notes: S-O-A-P{obtain more info, treat & educate}

DOCUMENTATION Information specifically recorded by dietitians confirmation of diet order summary of diet hx nutritional care therapy nutritional care discharge plan dietetic consultations Other Formats for Progress Notes PIE (prob, intervention, evaluation) PES (prob, etiology, signs and symptoms) What to evaluate The objectives: are they realistic? The interventions: are they appropriate for the problems identified? The implementation: quality of health care, quality of communication among members of the health care team

NUTRITION IN CARDIOVASCULAR DISORDERS The Cardiovascular System Heart Blood vessels Blood Risk Factors for CVD * Non-modifiable * Modifiable 1. Age 1. High BP 2. Genes 2. High LDL 3. Family History 3. Low HDL 4. DM 5. Obesity 6. Inactivity

NUTRITION IN CARDIOVASCULAR DISORDERS Statistics about Mortality 10 Leading Causes of Death in the Philippines (2004) 1. Heart Diseases 2. Vascular System Diseases 3. Malignant Neoplasm 4. Accidents 5. Pneumonia 6. Tuberculosis, all forms 7. Ill-defined and known cause of mortality 8. Chronic lower respiratory diseases 9. Diabetis mellitus 10. Certain condition originating in the perinatal period

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- DEFINITION & CHARACTERISTICS an arterial BP >/= 140/90 mmHg not a disease but a symptom: due to cardiac output & resistance of blood vessel walls to blood flow may occur at any age but most frequently in persons over 40 y.o. smoking & emotional stress may elevate BP

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- Classification of Blood Pressure for Adults CATEGORY SYSTOLIC (mm Hg) DIASTOLIC (mm Hg) Normal High Normal HPN Stage 1 (mild) HPN Stage 2 (moderate) HPN Stage 3 (severe) HPN Stage 4 (very severe) < 130 130 139 140 159 160 179 180 209 >/= 210 < 85 85 89 90 99 100 109 110 119 >/= 120

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- TYPES OF HPNs Primary or Essential HPN: etiology, unknown; more common type; occurring in 85-90% of all HPN cases; can be treated Secondary HPN: due to a clearly defined cause which should be treated. These include: kidney diseases endocrine disturbances tumors coarctation of the aorta toxemia collagen disease

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- RISKS OF HPN -- with increasing BP, there is increasing risk of: formation of atheromas coronary artery disease cardiac failure secondary to increased work of the hearth & relative or absolute coronary insufficiency aneurysm of the aorta acute vascular necrosis hemorrhagic stroke metabolic problems a) glocose intolerance b)hypercholesterolemia c) hyperisulism when HPN coexists with hyperlipedemia, hyperisulism, glucose intolerance & obesity, the condition is known as metabolic syndrome or SYNDROME X

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- DX OF SYNDROME X (clinical assessment) HPN >/= 130/85 mm Hg Low HDL 40in) men >88cm (>35in) women Tryglyceride >/=150mg/dL FBS >/=110mg/dL High LDL >100mg/dL

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- Rx Algorithm for HPN Step 1, non-drug therapy for mild HPN wt reduction, if overwt or obese smoking cessation regular physical exercise moderation of alcohol intake, if drinker dietary modification Step 2, drug or pharmacological therapy for persistent HPN (DONE BY THE PHYSISCIANS) diuretics vasodilators beta blockers

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- Role of Selected Dietary Factors in HPN Na: if ok, extracellular fluid control [edemas] P: helps lower BP in individuals with LSP Mg: reduces intracellular Na, ergo BP Ca: (debatable status) Cd: High conc. of renal Cd is present in HPN pts Omega-3 PUF (in fish oils): promotes synthesis of prostaglandin Alcohol: High intake (>3 drinks/day) = vasoconstriciton Moderate intake >> MEN: (2 drinks/day) (40g absolute alc.) = beneficial WOMEN: (1 drink/day) (20g absolute alc.) = beneficial

NUTRITION IN CARDIOVASCULAR DISORDERS -- HYPERTENSION (HPN) -- Dietary Management DIETARY FACTOR / MODIFICATION RATIONALE 1. Calorie level, depends on weight status or weight goal 2. Na, restricted** 3. Fluids and roughage - Weight loss of 5-6% in over- weight/obese cn lower BP - Excess Na may increase: a) cardiac output; b) peripheral resistance to blood flow - Prevent constipation which hinders absorption of anti-hypertensive drugs **LEVELS OF SODIUM RESTRICTION & INDICATION FOR USE: 500 mg (severe) when there is cardiac involvement, ascites 1000 mg (moderate) when there is CHF, toxemia of pregnancy 2000-3000 mg (mild) maintenance diet in cardiac & renal disease

NUTRITION IN CARDIOVASCULAR DISORDERS THE DASH EATING PLAN (LOWERING CALORIES) To increase fruits Eat a medium apple instead of 4 shortbread cookies. (80 kcal less) Eat c dried apricots instead of a 2-ounce bag of pork rinds.( 200+ kcal less) To increase vegetables Have a hamburger thats 3 ounces of meat instead of 6 ounces. Add c serving of carrots and c serving of spinach. (200+ kcal less) Instead of 5 ounces of chicken, have a stir-fry with 2 ounces of chicken and 1 c of raw veggies. Use a small amount of veg. oil. (50 kcal less)

NUTRITION IN CARDIOVASCULAR DISORDERS THE DASH EATING PLAN (LOWERING CALORIES) To increase lowfat or fat free dairy products Have a cup serving of lowfat frozen yogurt instead of 1 1/2 ounce milk chocolate bar. (110 kcal less) And dont forget these calorie saving tips 1. Use lowfat or fat free condiments. 2. Use half as much veg. oil, soft or liquid margarine, or salad dressing, or choose fat free versions. 3. Eat smaller portions cut back gradually. 4. Chooses lowfat or fat free dairy products to reduce total fat intake. 5. Check the food labels to compare fat content in packaged foods-items marked lowfat or ffat free are not always lower in calories than their regular versions.

NUTRITION IN CARDIOVASCULAR DISORDERS THE DASH EATING PLAN (LOWERING CALORIES) And dont forget these calorie saving tips 6. Limit foods with lots of added sugar, such as pies, flavoured yogurts, candy bars, ice cream, sherbet, regular soft drinks and fruit drinks. 7. Eat fruits canned in their own juice. 8. Add fruit to plain yogurt. 9. Snack on fruit, vegetable sticks, unbuttered popcorn, or bread sticks. 10. Drink water or club soda.

NUTRITION IN CARDIOVASCULAR DISORDERS DASH STUDY EFFECTS OF DIET ON BP Dietary Approaches to Stop Hypertension 459 adults with mild HPN randomized for 8 weeks to: Control diet or High fruit/vegetable diet or DASH combination diet (H Fr./Veg., L sat. fat & chole., H Ca, H K) Sodium intake and body weight remained constant.

NUTRITION IN CARDIOVASCULAR DISORDERS DASH-SODIUM SUMMARY The DASH diet combined with Na reduction was more effective in lowering BP than either dietary intervention alone. DASH Dietary Pattern Per 2000 kcal

NUTRITION IN CARDIOVASCULAR DISORDERS

NUTRITION IN CARDIOVASCULAR DISORDERS -- CORONARY HEART DISEASE (CHD) -- Definitions Atherosclerosis the gradual thickening of the walls of the arteries due to the formation of plaques which consist of cholesterol, triglycerides, phospholipids and Ca. When the coronary artery is involved, it is called CHD or Atherosclerotic heart disease (AHD) or Coronary artery disease (CAD)

NUTRITION IN CARDIOVASCULAR DISORDERS -- CORONARY HEART DISEASE (CHD) -- PATHOLOGIC EVENTS & RISK FACTORS IN CHD PATHOLOGIC EVENTS PHYSIO RISK FACTORS UNCONTROL- LABLE FACTORS DIETARY RISK FACTORS 1. Injury to coronary arteries HPN Lipid oxidation Inflammation AGE SEX HEREDITY - High Na - High alcohol - Low n-3 PUFA - obesity - High SFA - High pro- oxidants (Fe, Cu) -Low anti-oxidants (B-carotene, vit C&E, Se) - Low n-3 PUFA

NUTRITION IN CARDIOVASCULAR DISORDERS -- CORONARY HEART DISEASE (CHD) -- PATHOLOGIC EVENTS & RISK FACTORS IN CHD PATHOLOGIC EVENTS PHYSIO RISK FACTORS UNCONTROL- LABLE FACTORS DIETARY RISK FACTORS 2. Fibrous plaque formation LDL cholesterol Lipoprotein (a) Insulin resistance AGE SEX HEREDITY - High SFA - High cholesterol - High trans PUFA - Low n-6 PUFA - Low cis PUFA - Low dietary fiber - High trans fat FA - Low n-3 PUFA - Low dietary fiber - High central body fat (wais-to- hip ratio)

NUTRITION IN CARDIOVASCULAR DISORDERS -- CORONARY HEART DISEASE (CHD) -- PATHOLOGIC EVENTS & RISK FACTORS IN CHD PATHOLOGIC EVENTS PHYSIO RISK FACTORS UNCONTROL- LABLE FACTORS DIETARY RISK FACTORS 3. Thrombosis and heart attack Platelet aggregation Fibrinogen Arrhythmia AGE SEX HEREDITY - Low n-3 PUFA - low alcohol - Low n-3 PUFA - Low alcohol - Low n-3 PUFA - High SFA

NUTRITION IN CARDIOVASCULAR DISORDERS -- CORONARY HEART DISEASE (CHD) -- GOALS OF DIETARY MANAGEMENT To normalize blood lipid levels: Total cholesterol 50 mg/dL (women) Triglycerides

Nutrition in cardio vascular diseases part 1

Healthcare

pathologic

coronary heart

dash eating

low dietary

health care

counseling

teaching plan

high sfa