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Nutrition: Week Seven
Chapter 12: Nutrition for Cardiovascular & Hematologic Disorders
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Nurses must have an awareness of nutritional needs for clients who have cardiovascular and hematologic disorders. It is important to explore dietary needs with the client and recommend modifications related to the disease process. Understanding the role of primary and secondary prevention is essential to successful treatment.
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Cardiovascular diseases are the leading cause of death in the US. Coronary heart disease is the leading cause of death.
Assessment/Data Collection
Coronary heart disease
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Hypercholesterolemia leads to atherosclerosis, a process of damage and cholesterol deposits on the blood vessels of the heart. Atherosclerosis is the cause of many cardiovascular disease complications.
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•High-density lipoprotein (HDL) cholesterol is “good” cholesterol because it removes cholesterol from the body tissue and takes it to the liver. Levels greater than or equal to 60 mg/dL, for males and 70 mg/dL or greater for females provide some protection against heart disease.
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•Low –density lipoprotein (LDL) cholesterol is “bad” because it transports cholesterol out of the liver and into the circulatory system., where it can form plaques on the coronary artery walls. The optimal range for LDL is less than 130 mg/dl.
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•Optimal total cholesterol level is less than 200 mg/dL.
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Risk Factors:
•NON-MODIFIABLE: increasing age, male sex, family history of early CHD.
•MODIFIABLE: high LDL cholesterol, low HDL, consuming a diet high in saturated fat, hypertension, diabetes mellitus, metabolic syndrome, obesity, sedentary lifestyle, nicotine use disorder.
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Metabolic Syndrome:
the presence of three of the five following risk factors.
•Abdominal obesity. Males: greater than or equal to 40-ince waist. Females: greater than or equal to 35-inch waist. For Asian and non-European clients who have lived predominantly outside the US, use population- or country-specific definitions. ‘
•Triglycerides greater than or equal to 150 mg/dL or taking medications to treat high triglyceride levels.
•Low HDL or taking medications to lower HDL-C. males:less than or equal to 40 mg/dL. Females: less than or equal to 50 mg/dL.
•Increased BP or taking antihypertensive meds.
Fasting blood glucose greater than or equal to 100 mg/dL or taking meds to control blood glucose levels
Anemias
Iron deficiency anemia:
RISK FACTORS:
•Blood loss, deficient iron intake, alcohol use, malabsorption syndromes, gastrectomy.
•Metabolic increase caused by pregnancy. Adolescence, infection.
MANIFESTATIONS:
•Fatigue, lethargy
•Pallor of nail beds
•Intolerance to cold
•Headache
tachycaria
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Vitamin B12 deficiency anemia (macrocytic)
RISK FACTORS:
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lack of meat or dairy consumption, small bowel resection, chronic diarrhea, diverticula, tapeworm, excess of intestinal bacteria.
MANIFESTATIONS:
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pallor, jaundice, weakness, fatigue.
GASTROINTESTINAL FINDINGS:
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glossitis, anorexia, indigestion, weight loss.
NEUROLOGIC FINDINGS:
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decreased concentration, paresthesia of hands and feet, decreased proprioception, poor muscle coordination, increased irritability, delirium.
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Folic acid deficiency anemia:
RISK FACTORS:
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poor nutritional intake of foods containing folic acid (green leafy vegetables, citrus fruits, dried bean, nuts), malabsorption syndromes (Crohn’s disease), certain medications (anticonvulsants and oral contraceptives).
MANIFESTATIONS:
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fatigue, pallor, glossitis, irritability, diarrhea
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Findings of folic acid deficiency anemia mimic those for vitamin B12 deficiency except for the neurologic manifestations.
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week seven nutrition
Nutritional Guidelines & Nursing Interventions for Coronary Heart Disease
Preventative nutrition:
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Consuming a diet that is limited in trans fats, saturated fats, and cholesterol can reduce the risk of developing CHD. The Therapeutic Lifestyle Change (TLC) diet is designed to be a user-friendly eating guide to encourage dietary changes.
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Daily cholesterol intake should be less than 200 mg.
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Conservative use of red wine can reduce the risk of developing CHD.
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Increasing fiber and carbohydrate intake, avoiding saturated fat, and decreasing red meat consumption can decrease the risk for developing CHD.
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Increased intake of omega-3 fatty acids found in fish, flaxseed, soy beans, canola, and walnuts reduces the risk of coronary artery disease.
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Homocysteine in an amino acid. Elevated levels can increase the risk of CHD. Deficiencies in folate and vit B6 and B12 increase homocysteine levels.
Therapeutic nutrition:
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Secondary prevention efforts for CHD are focused on lifestyle changes that lower LDL, these include a diet low in cholesterol and saturated fats, a diet high in fiber, exercise and weight management, and cessation of nicotine use.
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Daily cholesterol intake less than 200 mg/day. Saturated fat limited to less than 7% of daily caloric intake.
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Lower cholesterol and saturated fats: trim fats from meats, limit red meat, choose lean meats, remove skin from meats, broil, bake, grill or steam foods. Avoid frying, use low-fat milk, cheese, and yogurt, use spices in place of butter or salt, use liquid oils in place of lard or butter, avoid trans fats, increase consumption of oily fish.
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Encourage the client to consume a high-fiber diet: soluble fiber lowers LDL. Oats, beans, fruits, vegetables, whole grains, barley and flaxseed are good fiber sources.
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Encourage exercise.
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Stop tobacco use.
Nutritional Guidelines & Nursing Interventions for Hypertension
Hypertension
a significant risk factor for developing CHD, myocardial infarction, kidney disease, and stroke.
Hypertension is a sustained elevation in BP greater than or equal to 140/90 mm hG for clients under 60, 150/90 mm Hg for those over 60.
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RISK FACTORS:
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family history, hyperlipidemia, smoking, obesity, physical inactivity, high sodium intake, low potassium intake, African American people have the highest prevalence of hypertension. Risk increases after menopause.
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Therapeutic nutrition
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The dietary Approaches to Stopping Hypertension (DASH) diet is a low-sodium, high-potassium, high-calcium diet that has proven to lower blood pressure and cholesterol: decreased sodium intake gradually to 1,500 mg, include low-fat dairy, include fruits and vegetables rich in potassium (apricots, bananas, tomatoes, potatoes).
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Limit alcohol
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Exercise, lose weight, stop smoking.
Nutritional Guidelines & Nursing Interventions for Heart Failure
Heart failure:
characterized by the inability of the heart to maintain adequate blood flow throughout the circulatory system. It results in excess sodium and fluid retention, and edema.
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RISK FACTORS:
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CHD, arrhythmias, previous MI, valve disorders, hypertension, obesity, diabetes, metabolic syndrome.
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Therapeutic nutrition:
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reduce sodium intake to less than 3,000 mg/day for mild-to-moderate heart failure and less than 2,000 mg/day for severe heart failure. Monitor fluid intake(and possibly restrict 2 L/day). Increase protein intake to 1.12 g/kg. use small, frequent meals that are soft, easy to chew foods.
Nutritional Guidelines & Nursing Interventions for Myocardial Infarction
Myocardial infarction:
occurs when there is an inadequate supply of oxygen to the myocardium. After an MI, it is necessary to reduce the myocardial oxygen demands related to metabolic activity. Risk factors are the same as for CHD.
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Therapeutic nutrition:
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a liquid diet is best for the first 24 hrs after the infarction. Caffeine should be avoided because it stimulates the heart and increases heart rate. Small, frequent meals are indicated. Counsel the client about recommendations for a heart-healthy diet.
Nutritional Guidelines & Nursing Interventions for Anemia
Anemia:
results from either a reduction in the number of RBCs or in hemoglobin. Can result from a decrease in production, an increase in RBC destruction, or a loss of blood.
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SOURCES OF IRON:
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meat, fish, poultry, tofu, dried peas and beans, whole grains, dried fruit, iron-fortified foods. Vitamin C facilitates absorption of iron.
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SOURCES OF B12:
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fish, meat, poultry, eggs, milk. People over 50 are urged to consume their vit B12 from supplements or fortified food. People who follow a vegan diet need B12 supplementation.
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FOLIC ACID SOURCES:
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green leafy vegetables, dried peas and beans, seeds, orange juice, cereals and breads that are fortified.
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