Question: Mrs. Cookie Sanders Is A 54-year-old Homemaker. For The Past Year, She Has Treated Her Newly Diagnosed Hypertension With Lifestyle Changes Including Diet, Smoking Cessation, And Exercise. She Is In To See Her Physician For Further Evaluation And Treatment For Essential Hypertension. Blood Drawn 2 Weeks Prior To This Appointment Shows An Abnormal Lipid …

Mrs. Cookie Sanders is a 54-year-old homemaker. For the past year, she has treated her newly diagnosed hypertension with lifestyle changes including diet, smoking cessation, and exercise. She is in to see her physician for further evaluation and treatment for essential hypertension. Blood drawn 2 weeks prior to this appointment shows an abnormal lipid profile. Patient Summary: 54-year-old female here for evaluation and treatment for essential hypertension and hyperlipidemia Dx: Stage 2 HTN, heart disease, early COPD Medical Assessment and Plan: 54-year-old female with Stage 2 HTN here for initiation of pharmacologic therapy with and reinforcement of lifestyle modifications. History: Onset of disease: Mrs. Sanders is a 54-yo female who is not employed outside the home. She was diagnosed 1 year ago with Stage 2 (essential) HTN. Treatment thus far has been focused on nonpharmacological measures. She began a walking program resulting in a 10-pound weight loss she has been able to maintain during the past year. She walks 30 minutes 4-5 times per week, though she sometimes misses on bingo nights. She was given a nutrition information pamphlet in the MD office outlining a lower-Na diet. Mrs. Sanders was a 2-pack-a-day smoker but quit (“cold turkey”) when her HTN was diagnosed last year. No clo of any symptoms related to HTN. Pt denies chest pain, SOB, syncope, palpitations, or myocardial infarction. Medical history: Not significant before Dx of HTN Surgical history: None Medications at home: None Tobacco use: No—quit 1 year ago Alcohol use: 2-4 beers/wk Family history: What? HTN. Who? Mother died of MI related to uncontrolled HTN Demographics: Marital status: Married; Spouse name: Steve Sanders, 60 yo Number of children: Children are grown and do not live at home. Years education: High school Language: English Occupation: No employment outside of home Hours of work: Varies Household members: 2 Ethnicity: African-American 1 Vital Signs: Temp: 98.6; Pulse: 80 ; Resp rate: 15 BP: 160/100 Height: 5’6″ Weight: 160 lbs Nutrition: General: Mrs. Sanders describes her appetite as “very good.” She does the majority of grocery shopping and cooking, although Mr. Sanders cooks breakfast on the weekends. She usually eats three meals each day, but on bingo nights, she usually skips dinner and just snacks while playing bingo. When she does this, she is really hungry when she gets home in the late evening, so she often eats a bowl of ice cream before going to bed. The Sanders usually eat out on Friday and Saturday evenings at pizza restaurants or steakhouses (Mrs. Sanders usually has 2 regular beers with these meals). She mentions that last year when her HTN was diagnosed, a nurse at the MD’s office gave her a sheet of paper with a list of foods to avoid for a lower-salt diet. She and her husband tried to comply with the diet guidelines, but they found foods bland and tasteless, and they soon abandoned the effort. 24-hour recall: AM: 1 c coffee (black) Oatmeal (1 instant packet with 1 tsp margarine and 2 tsp sugar) 12 c low-fat (2%) milk 1 c orange juice Snack: 2 c coffee (black) 1 glazed donut Lunch: 1 can Campbell’s® tomato bisque soup prepared with milk 10 saltines PM: 1 can diet cola 6 oz baked chicken (white meat, no skin; seasoned with salt, pepper, garlic) 1 large baked potato with 1 tbsp butter, salt, and pepper 1 c glazed carrots (1 tsp sugar, 1 tsp butter) Dinner salad with ranch-style dressing (3 tbsp) lettuce, spinach, croutons, sliced cucumber 2 regular beers 2 c butter pecan ice cream HS snack: Food allergies/intolerances/aversions: None Previous nutrition therapy? Yes. If yes, when: 1 year ago. Where? MD’s office Food purchase/preparation: Self and husband Vit/min intake: Multivitamin/ mineral daily 2 Assess the patient: 1. How is hypertension diagnosed? 2. List the risk factors for developing hypertension. 3. What risk factors does Mrs. Sanders currently have? 4. How would you classify Mrs. Sander’s blood pressure? 5. Lifestyle modifications reduce blood pressure, enhance the efficacy of antihypertensive medications, and decrease cardiovascular risk. List lifestyle modifications that have been shown to lower blood pressure. Nutrition Assessment 6. What is Mrs. Sanders BMI (show your calculations)? 7. How would you classify her BMI? What are the health implications of her BMI? 8. Calculate Mrs. Sanders’s TDE (show your calculations). 9. What would you recommend that her daily energy intake be and why? (Do you recommend that she increase, decrease, or maintain her intake at her current TDE?) If you 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. (1 point) 10. What nutrients in Mrs. Sanders’s diet are of major concern to you? 11. Mrs. Sanders’s physician has decided to prescribe an ACE inhibitor. How does an ACE inhibitor lower blood pressure? 12. Are there any contraindications for which Mrs. Sanders should be concerned? 13. Indicate the pharmacological differences among the antihypertensive agents listed below. Medications Mechanism of action Nutritional Side Effects and Contraindications Diuretics Beta-blockers Calcium-channel blockers ACE inhibitors Angiotensin Il receptor blockers Alpha-adrenergic blocker