Mrs. Cookie Sanders is a 54-year-old homemaker. For the pastyear, she has treated her newly diagnosed hypertension withlifestyle changes including diet, smoking cessation, and exercise.She is in to see her physician for further evaluation and treatmentfor essential hypertension. Blood drawn 2 weeks prior to thisappointment shows an abnormal lipid profile.
Patient Summary:
54-year-old female here for evaluation and treatment foressential hypertension and hyperlipidemia
Dx: Stage 2 HTN, heart disease, early COPD Medical
Assessment and Plan: 54-year-old female with Stage 2 HTN herefor initiation of pharmacologic therapy with and reinforcement oflifestyle modifications.
History:
Onset of disease: Mrs. Sanders is a 54-yo female who is notemployed outside the home. She was diagnosed 1 year ago with Stage2 (essential) HTN. Treatment thus far has been focused onnonpharmacological measures. She began a walking program resultingin a 10-pound weight loss she has been able to maintain during thepast year. She walks 30 minutes 4–5 times per week, though shesometimes misses on bingo nights. She was given a nutritioninformation 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 c/o of any symptomsrelated 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 touncontrolled HTN
Demographics:
Marital status: Married; Spouse name: Steve Sanders, 60 yo
Number of children: Children are grown and do not live athome.
Years education: High school
Language: English
Occupation: No employment outside of home
Hours of work: Varies
Household members: 2
Ethnicity: African-American
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.” Shedoes the majority of grocery shopping and cooking, although Mr.Sanders cooks breakfast on the weekends. She usually eats threemeals each day, but on bingo nights, she usually skips dinner andjust snacks while playing bingo. When she does this, she is reallyhungry when she gets home in the late evening, so she often eats abowl of ice cream before going to bed. The Sanders usually eat outon Friday and Saturday evenings at pizza restaurants or steakhouses(Mrs. Sanders usually has 2 regular beers with these meals). Shementions that last year when her HTN was diagnosed, a nurse at theMD’s office gave her a sheet of paper with a list of foods to avoidfor a lower-salt diet. She and her husband tried to comply with thediet guidelines, but they found foods bland and tasteless, and theysoon abandoned the effort.
24-hour recall:
AM: 1 c coffee (black)
Oatmeal (1 instant packet with 1 tspmargarine and 2 tsp sugar)
½ c low-fat (2%) milk
1 c orange juice
Snack: 2 ccoffee (black)
1 glazed donut
Lunch: 1 canCampbell’s® tomato bisque soup prepared with milk
10 saltines
1 can diet cola
PM: 6 oz baked chicken (white meat, no skin; seasoned with salt,pepper, garlic)
1 large baked potato with 1 tbspbutter, salt, and pepper
1 c glazed carrots (1 tsp sugar, 1 tspbutter)
Dinner salad with ranch-style dressing(3 tbsp)—lettuce, spinach, croutons, sliced cucumber
2 regular beers
HS snack: 2 c butter pecan icecream
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
ANSWER ALL THE FOLLOWING QUESTIONS.
Diagnosis:
- Select two nutrition problems and complete the PES statementfor each. Note the associated codes, and make sure that your E isset up so that your interventions can target it. (2 points)
PES #1:
PES #2:
Intervention:
- When you ask Mrs. Sanders how much weight she would like tolose, she tells you she would like to weigh 125 lbs., which is whatshe weighed most of her adult life. Is this reasonable? What wouldyou suggest as a goal for weight loss for Mrs. Sanders?
- How quickly should Mrs. Sanders lose this weight?
- For each of the PES statements that you have written, establishan ideal goal (based on the signs and symptoms) and an appropriateintervention (based on the etiology).
- Identify the major sources of sodium, saturated fat, andcholesterol in Mrs. Sanders’s diet. What suggestions would you makefor substitutions and/or other changes that would help Mrs. Sandersreach her medical nutrition therapy goals?
- What would you want to reevaluate in three to four weeks at afollow-up appointment?
