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1. Define blood pressure.Blood pressure is the pressure exerted by the circulating volume of blood on the walls of the arteries and veins and on the chambers of the heart. 2. How is blood pressure normally regulated in the body?Blood pressure is normally regulated through the sympathetic nervous system, the renin-angiotensin-aldosterone system, and renal function.3. What causes essential hypertension?Essential hypertension is an elevated systemic arterial pressure for which no cause can be found. There are various factors may cause essential hypertension which include diet, lack of exercise, smoking, stress and obesity. 4. What are the symptoms of hypertension?Hypertension can be symptomless which means that many people that have high blood pressure don’t know it. An individual with very high blood pressure may show symptoms including severe headache, fatigue or confusion, vision problems, chest pain, difficulty breathing, irregular heartbeat, blood in urine, and pounding in chest, neck, or ears. () 5. How is hypertension diagnosed?The diagnostic workup of hypertension includes assessing risk factors and comorbidities, revealing identifiable causes of hypertension, conducting history and physical examinations, obtaining laboratory tests including urinalysis, blood glucose, hematocrit and lipid panel, serum potassium, creatinine, and calcium, and obtaining an electrocardiogram. 6. List the risk factors for developing hypertension.Risk factors for developing hypertension include a family history of hypertension, high sodium intake, low potassium intake, overweight or obesity, lack of physical activity, race; African Americans have higher incidence of hypertension, excessive alcohol intake, smoking, age and stress. 7. What risk factors does Mrs. Anderson currently have?The risk factors that Mrs. Anderson currently has include a family history of hypertension, high sodium intake, her BMI indicates that she is overweight, she is African American which increases her risk, and she has a history of smoking.8. Hypertension is classified in stages based on the risk of developing CVD. Complete the following table of hypertension classificationsBlood Pressure mm HgCategorySystolic BPDiastolic BPNormal<120and<80Prehypertension120-139or80-89Hypertension Stage 1140-159or90-99Hypertension Stage 2>160or>1009. Given these criteria, which category would Mrs. Anderson’s admitting blood pressure reading place her in?Mrs. Anderson’s admitting blood pressure reading would place her in hypertension stage 2 since her reading was 160/10010. How is hypertension treated?Hypertension is treated initially through lifestyle modifications. If those modifications do not solve the problem then drugs are incorporated and the modifications are continued. Different drugs may be suggested for different stages of hypertension with thiazide-type diuretics used for most in Stage 1 Hypertension and a two-drug combination of thiazide-type diuretic and ACEI, ARB, BB, or CCB for most in Stage 2 Hypertension. If goal blood pressure is still not obtained then additional drugs might be added or doses might be optimized. 11. Dr. Thornton indicated in his admitting note that he will “rule out metabolic syndrome.” What is metabolic syndrome?Metabolic syndrome is a group of risk factors that occur together and increase the risk for coranany artery disease, stroke and type 2 diabetes. It occurs when a person has three or more of the following measurements: Abdominal obesityTriglyceride level of 150 milligrams per deciliter of blood or greaterHDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in womenSystolic blood pressure of 130 mmHg or greaterDiastolic blood pressure of 85 mmHg or greater Fasting glucose of 100mg/dL or greaterInsulin resistance or glucose intolerance()12. What factors found in the medical and social history are pertinent for determining Mrs. Anderson’s CHD risk category?The factors found in the medical and social history that are pertinent for determining Mrs. Anderson’s CHD risk category include her mother dying from a heart attack caused by high blood pressure, her cessation of smoking, her weight loss of 10 pounds over the past year as a result of implementing a walking routine, her unwillingness to follow the 4-g Na diet that was recommended to her, her 24-hour recall diet shows that her sodium intake is really high. 13. What progression of her disease might Mrs. Anderson experience?Mrs. Anderson has modified some of her lifestyle habits which may have led to her hypertension and these changes will help her to reduce her risk of CHD. However, her unwillingness to lower her sodium intake will either cause her to remain in a disease state or her disease to progress to CHD. 14. What are the most recent recommendations for nutrition therapy in hypertension? Explain the history of and rationale for the DASH diet.Recent recommendations for nutrition therapy in hypertension include lifestyle modifications and nutrition therapy. Primary strategies include increased physical activity, smoking cessation, weight loss, and reduction of sodium and alcohol intake. The DASH diet was introduced in the late 1990’s and has become the foundation of nutrition therapy for hypertension. The DASH diet focuses on using a variety of foods that decrease sodium intake and increases the intake of potassium, magnesium, calcium, and fiber. The rationale behind the DASH diet is that a diet that is low in saturated fat, cholesterol and total fat, that emphasizes 8-9 servings of fruits and vegetables, and three servings of low-fat dairy foods reduces blood pressure. 15. What is the rationale for sodium restriction in treatment of hypertension? Is this controversial? Why or why not? The rationale for sodium restriction in treatment of hypertension is that large population studies have shown that urinary sodium excretion has a significant and direct relationship with systolic blood pressure. Reduced sodium intake may reduce the incidence of hypertension by as much as 17%. The rationale has been controversial in the past and there are some that still argue that there are “salt sensitive” and “salt resistant” people. 16. What are the Therapeutic Lifestyle Changes? Outline the major components of the nutrition therapy interventions. The Therapeutic Lifestyle Changes are…The major components of the nutrition therapy interventions include DASH diet (Dietary Approaches to Stop Hypertension) which lowers total fat, saturated fat, and sodium intake while increases the intake of potassium, magnesium, calcium and fiber.Weight loss of more than 5 kg has shown to reduce diastolic and systolic BP.Reduced sodium intake has shown to reduce hypertension through population studies like DASH and INTERSALT.As alcohol consumption increases above two drinks per day for men and one drink per day for women the risk of hypertension increases in a dose-dependent relationship. Reducing alcohol consumption may help to avoid hypertension.Increasing consumption of potassium, calcium and magnesium have been positively correlated with reduction of blood pressure and treatment of hypertension.Increase in physical activity, 30 minutes per day, decreases blood pressure by 4-9 mmHg. Cessation of smoking reduces the risk of hypertension and all forms of cardiovascular disease. 17. The most recent recommendations suggest the therapeutic use of stanol esters. What are they, and what is the rationale for their use?Stanol are derivatives of wood pulp and vegetable oil and they inhibit cholesterol absorption from the intestine and they are virtually unabsorbable. Through esterification of stanols allows them to be incorporated into various foods like margarine without changing the taste or texture. Plant stanols inhibit absorption of other plant sterols as well. When compared to unesterified stanols, the fatty acid esters of stanols seem to mix ore easily with the oil phase of the intestinal contents to interfere with cholesterol absorption and decrease plasa cholesterol concentrations. ()18. Calculate Mrs. Anderson’s body mass index (BMI). Weight in Kilograms = x BMI = (Height in Meters) x (Height in Meters)Mrs. Anderson’s BMI = 72.5 = 25.7 (1.68) x (1.68)19. What are the health implications of this number?The health implications are that for her height, Mrs. Anderson is slightly overweight. On the bright side, however, it should not be too hard to get Mrs. Anderson back into a healthy weight range as the normal weight range is 18.5-24.9. (Physical Activity and Health). 20. Calculate Mrs. Anderson’s resting and total energy needs. Identify the formula/calculation method you used and explain your rationale for using it.Mrs. Anderson’s resting energy expenditure was calculated using the Harris-Benedict formula and the results are as follows: REE = 655.096 + 9.563 (72.575) + 1.850 (167.640) – 4.676 (54) = 1,407. I consider Mrs. Anderson to be lightly active so her total energy needs, according to the Harris Benedict formula would be BMR x 1.375; so 1,407 x 1.375 = 1,934 calories to maintain her current weight. I chose to use the Harris Benedict Equation because I had learned about it in a class I took previously and I figure it must hold some merit if I am learning about it twice. 21. How many calories per day would you recommend for Mrs. Anderson?Since it is recommended that Mrs. Harris lose some weight I would recommend that we decrease her calorie intake by 500 calories per day resulting in a decrease of 3500 per week which would result in losing one pound per week. I would recommend that she be placed on a 1,434 calorie diet that is low in fats, saturated fats, and sodium. 22. Determine the appropriate percentages of total kilocalories from carbohydrate, protein, and lipid60% of total kilocalorie intake should be from carbohydrates: 1434 x .60 = 860.420% of total kilocalorie intake should be from fats: 1434 x .20 = 286.820% of total kilocalorie intake should be from protein: 1434 x .20 = 286.823. Using a computer dietary analysis program or food composition table, compare Mrs. Anderson’s “usual” dietary intake to her prescribed diet (DASH/TLC diet). 24 hour recall diet Food ItemPotassium (minimum 4,700mg/120mEq)Sodium (maximum 2,400mg/100mEq)Magnesium (500 mg)Calcium (minimum 1,240mg)Total fat (g)Saturated fat (g)Cholesterol (mg)Fiber (g)Coffee84.23.81%0%0.0290.00350.00.0Oatmeal made with sugar and margarine126.30.171.5127.97195.80.039.223556%0%0%56%11%0%0%11%1.90.03.04.90.340.00.50.840.00.00.050.053.00.00.03.0Orange juice480.87.56%3%0.150.0170.00.572 cups coffee168.37.63%1%0.0580.00690.00.0Glazed doughnut45.9180.92%3%10.32.714.40.67Tomato soup prepared with milk1139.21802.819%39%7.74.421.93.710 saltine crackers46.2321.62%2%3.40.50.00.9Diet cola14.2 56.81%1%0.00.00.00.0Baked chicken3766872%3%22.96.4148.40.0Glazed carrots344.5491.44%4%7.83.310.84.4Baked potato with butter 611.2404.810%1%4.262.64110.82.3Dinner salad with 3 tbsp ranch347.8399.58%6%23.360.04114.92.562 regular beers194.428.811%3%0.00.00.00.02 cups ice cream0.0446.10%35%28.011.449.02.4With this diet, Mrs. Anderson is taking in 5,127 mg of sodium per day! Her fat intake and her saturated fat intake are also too high, while the calories that she obtains from carbohydrates and proteins are too low. If she were to follow a diet that resembled the DASH diet she would be able to lower her sodium intake, lower her total and saturated fat intake, increase her carbohydrate and protein intake, and have better health. 24. What nutrients in Mrs. Anderson’s diet are of major concern to you?The nutrients that are of major concern for me are sodium, of course; she has way too much in her diet, she is lacking in some vitamins like B12, D, and E, and her manganese intake is low. She also needs to get more potassium in her diet. As I discussed above, she needs to decrease her fat consumption and increase her carbohydrate and protein consumption. 25. From the information gathered within the intake domain, list possible nutrition problems using the diagnostic term.Possible nutrition problems that may arise are excessive energy intake, excessive or inappropriate intake of fats, excessive sodium intake, inadequate calcium, fiber, potassium, or magnesium intake, overweight/obesity, food and nutrition-related knowledge deficit, and physical inactivity. (pg. 292)26. Dr. Thornton ordered the following labs: fasting glucose, cholesterol, triglycerides, creatinine, and uric acid. He also ordered an EKG. In the following table, outline the indication for these tests (tests provide information related to a disease or condition).ParameterNormal ValuePatient’s ValueReason for AbnormalityNutrition ImplicationGlucose70-110 mg/dL92Within normal rangeBUN8-18 mg/dL20Insufficient dietary protein Increase protein intakeCreatinine0.6-1.2 mg/dL0.9Within normal rangeTotal cholesterol120-199 mg/dL270Diet high in cholesterol, ageChoose foods lower in fats and cholesterol, eat less full fat dairy products, avoid red meatHDL-cholesterol>55 (women)mg/dL>45 (men) mg/dL30Ex-smoker, high triglyceride levelsChoose more monounsaturated and polyunsaturated fats. Eat more fish and nuts. Moderate alcohol intake.LDL-cholesterol<130 mg/dL314Unhealthy diet, family historyChoose more high-fiber foods, choose foods high in omega-3 fatty acids, choose foods with added plant stanols, cut back on fatty and high cholesterol foods. Apo A101-199 (women) mg/dL94-178 (men) mg/dL75Same as HDL-cholesterolSame as HDL cholesterolApo B60-126 (women) mg/dL63-133 (men) mg/dL140Same as LDL- cholesterolSame as LDL cholesterolTriglycerides35-135 (women)40-160 (men)150Overconsumption of caloriesLower caloric intake. Interpret Mrs. Anderson’s risk of CAD based on her lipid profile.High blood pressure and high blood cholesterol levels are both risk factors for CAD. If Mrs. Anderson does not get her blood pressure and cholesterol in check she has a high risk of developing coronary artery disease. 28. What is the signi?cance of apolipoprotein A and apolipoprotein B in determining a person’s risk of CAD?Alipoproteins A and B are the major protein components of HDL and LDL respectfully. Since HDL and LDL make up cholesterol and cholesterol is a risk factor for CAD, they are pretty significant in determining a person’s risk of CAD. () 29. Indicate the pharmacological differences among the antihypertensive agents listed below.MedicationsMechanism of ActionNutritional ImplicationsDiureticsDecrease bold volume by increasing urinary output; inhibit renal sodium and water reabsorptionMay cause constipation, dry mouth, anorexia, diarrhea; potassium supplements may be necessaryBeta-blockersBlocks β-receptors in heart to decrease heart rate and cardiac outputCalcium may interfere with absorption, so have to figure out the right dose so both can function properly Calcium-channel blockersAffect the movement of calcium, cause blood vessels to relax; therefore, reduce vasoconstrictionAvoid natural licorice, avoid or limit alcohol consumption, limit caffeine ACE inhibitorsVasodilators that reduce BP by decreasing peripheral vascular resistance by interfering with the production of angiotensin II from angiotensin I and inhibiting degradation of bradykininAvoid natural licorice, avoid salt substitutesAngiotensin II receptor blockersInterferes with renin-angiotensin system without inhibiting degradation of bradykininAvoid salt substitutes Alpha-adrenergic blockersBlocks the vascular muscle response to sympathetic stimulation; reduces stroke volumeAvoid natural licoricePg. 29130. What are the most common nutritional implications of taking hydrochlorothiazide?Hydrochlorothiazide inhibits the resorption of sodium, chloride, and potassium.Pg. 29131. Mrs. Anderson’s physician has decided to prescribe an ACE inhibitor and an HMGCoA reductase inhibitor (Zocor). What changes can be expected in her lipid profile as a result of taking these medications?Changes that can be expected include reduction in blood pressure and reduction in LDL-cholesterol and triglycerides. 32. How does an ACE inhibitor work to lower blood pressure?ACE inhibitors decrease the peripheral vascular resistance by blocking or interfering with the production of angiotansin II from angiotensin I and inhibiting degradation of bradykinin. Pg. 29133. How does a HMGCoA reductase inhibitor work to lower serum lipid? An HMGCoA reductase inhibitor works to lower serum lipid by increasing the catabolism of plasma LDL and lowering the plasma concentration of cholesterol. () 34. What other classes of medications can be used to treat hypercholesterolemia?Other classes of medications that can be used to treat hypercholesterolemia include statins, nicotinic acid, or niacin, bile acid sequestrants, cholesterol absorption inhibitors, and fibric acid derivatives. 35. What are the pertinent drug–nutrient interactions and medical side effects for ACE inhibitors and HMGCoA? ................
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