Understanding the Nutrition Therapy 5. What are the current recommendations for nutritional intake during a hospitalization following a myocardial infarction? 6. List the risk factors indicated in his medical record that can be addressed through medical nutrition therapy. 7. A possible intervention is instructing the patient and his wife on the Mediterranean diet for a nutrition plan to follow after discharge. a. What are the basic principles of the Mediterranean diet? b. What does the literature say about the relationship between Mediterranean dietary principles and future heart health?

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
icon
Related questions
Question
Nutrition:
Diet order: no added salt/low saturated fat; low cholesterol
History: Appetite good. He and his wife have been trying to change some things in his diet. Wife
indicates that she has been using "corn oil" instead of butter and has tried not to fry foods as often.
Typical dietary intake:
Breakfast:
Coffee with milk and sugar
Midmorning snack: Egg and cheese on English muffin from work cafeteria; 8 oz. orange juice,
2-3 c coffee with milk and sugar
Lunch:
Dinner:
Snack:
Leftovers from home; if eats in cafeteria: soup, salad, or sandwich.
Had tomato soup and grilled cheese yesterday.
Rice-1 c; black beans-1 c; roast pork with tomato and peppers-
approx. 6 oz; cornbread-2 squares, each 2" wide
Typically has chips or popcorn and 1-2 beers
Food allergies/intolerances/aversions: None
Previous nutrition therapy? No
Food purchase/preparation: Spouse
Vit/min intake: None
Code: FULL
Isolation: None
Allergies: NKA
Pt. Location: RM 704
Code: FULL
Physician: RJ Warren
Isolation: None
Admit Date: 12/1
Garcia, Jose, Male, 01 y.o.
Allergies: NKA
Pt. Location: RM 704
Physician: RJ Warren
Admit Date: 12/1
Extremities: Normal range of motion in all four extremities. No cyanosis or clubbing or
peripheral edema.
Neurological: Conscious, alert, and oriented. Cranial nerves II through XII are intact grossly and
symmetrically. No focal neurologic deficit.
Skin: Skin is warm and dry. Mild diaphoresis. No rashes or ulcerations noted.
Vital Signs: Temp: 98.6°F
Orders:
BP: 140/99
Pulse: 94
Height: 5'9"
Resp rate: 23
Weight: 215 lbs
ED: Oxygen 2 liters per NC to maintain O₂ SAT >95%; nitroglycerin 0.4 mg sublingual;
aspirin 81 mg x 4 (324 mg total), to be chewed
Heparin 70 units/kg bolus IVP (max dose 7500 units)
Clopidogrel 600 mg oral
Admission to CCU:
Early risk stratification: high risk
Activity: bed rest
Cardiac monitor
Vital signs q4h x 24 hours then q8h
Diet: no added salt/low saturated fat; low cholesterol
Call house officer for T>101, SBP >190 mm Hg or SBP <90 mm Hg, HR >120 bpm or
HR <50 bpm, RR >30 or RR <10
Guaiac ALL stools while on heparin, LMWH, Ilb/illa inhibitor
O₂: NC continue 2 L/min
Please call house officer for O₂ SAT <90%
Order for respiratory care O₂ SAT check q8h
EKG and repeat for recurrent chest pain
Troponin T/Troponin I: now and every 6 hrs x 8 times
CK-MB: now and every 6 hrs x 8 times
CBC, lipid profile, PTT, Chemistry (7) panel in AM-fasting
Atenolol 75 mg/d
Nitroglycerin 1/150 (0.4 mg) 1 TAB SL q 5 min x 3 prn chest pain; hold if: SBP <100 mm Hg
PRN: Docusate sodium 100 mg po twice daily; aluminum-magnesium hydroxide 15 mL every 6 h
for indigestion; oxazepam 15-30 mg po every hs prn insomnia; acetaminophen 650 mg po every
4 h for headache; magnesium hydroxide 30 mL po daily for constipation; magnesium sulfate sliding
scale IV qd; call house officer if serum Mg <1.2
Hold order for creatinine >1.9
If serum Mg <1.4, give 5 g MgSO, IV; if serum Mg <1.6, give 4 g MgSO, IV; if serum Mg <1.8,
give 3 g MgSO, IV; if serum Mg <2.0, give 2 g MgSO, IV
Patient Summary: José Garcia is a 61-year-old male admitted through the emer-
gency department with diagnosis of STEMI and transferred directly to Cath lab; s/p
emergency coronary angiography with angioplasty of the infarct-related artery.
History:
Onset of disease: 61-y.o. male who noted the sudden onset of severe precor-
dial pain on the way home from work. The pain is described as pressure-like
pain radiating to the jaw and left arm. The patient has noted an episode of emesis and nausea. He
denies palpitations or syncope. He denies prior history of pain. He admits to smoking cigarettes
(1 pack/day for 40 years). He denies hypertension, diabetes, or high cholesterol. He denies SOB.
Medical history: Not significant before this admission
Surgical history: Surgery; cholecystectomy 10 years ago, appendectomy 30 years ago
Medications at home: None
Allergies: Sulfa drugs
Tobacco use: 40-year history, 1 pack/day
Alcohol use: 1-2 beers per day
Family history: What? CAD. Who? Father-MI age 59.
Demographics:
Marital status: Married, Spouse name: Alicia Garcia, 59 y.o.
Number of children: Daughter and two grandchildren live in the home
Years education: AA degree
Language: English, Spanish
Occupation: IT network specialist
Hours of work: 40/wk
Household members: 5
Ethnicity: Mexican American
Religious affiliation: Catholic
MD Progress Note:
General: Well-developed, overweight male in acute distress from chest pain.
HEENT: Head: normocephalic and atraumatic
Eyes: EOMI, fundoscopic exam WNL. No evidence of atherosclerosis, diabetic retinopathy,
or early hypertensive changes.
Mouth: oral mucosa pink, dentition in good repair
Throat: pharynx pink without exudates
Neck: soft, supple, no palpable masses. No lymphadenopathy.
Cardiac: Isolated posterior MI with ST depression in V2-3. No murmurs, clicks, or rubs.
Pulmonary/Chest: Lungs are clear to auscultation bilaterally.
Abdominal: Abdomen soft, nontender, with normoactive bowel sounds in all four quadrants.
No masses, no organomegaly. No guarding, rebound, or CVA tenderness. RLQ scar and midline
suprapubic scar.
Transcribed Image Text:Nutrition: Diet order: no added salt/low saturated fat; low cholesterol History: Appetite good. He and his wife have been trying to change some things in his diet. Wife indicates that she has been using "corn oil" instead of butter and has tried not to fry foods as often. Typical dietary intake: Breakfast: Coffee with milk and sugar Midmorning snack: Egg and cheese on English muffin from work cafeteria; 8 oz. orange juice, 2-3 c coffee with milk and sugar Lunch: Dinner: Snack: Leftovers from home; if eats in cafeteria: soup, salad, or sandwich. Had tomato soup and grilled cheese yesterday. Rice-1 c; black beans-1 c; roast pork with tomato and peppers- approx. 6 oz; cornbread-2 squares, each 2" wide Typically has chips or popcorn and 1-2 beers Food allergies/intolerances/aversions: None Previous nutrition therapy? No Food purchase/preparation: Spouse Vit/min intake: None Code: FULL Isolation: None Allergies: NKA Pt. Location: RM 704 Code: FULL Physician: RJ Warren Isolation: None Admit Date: 12/1 Garcia, Jose, Male, 01 y.o. Allergies: NKA Pt. Location: RM 704 Physician: RJ Warren Admit Date: 12/1 Extremities: Normal range of motion in all four extremities. No cyanosis or clubbing or peripheral edema. Neurological: Conscious, alert, and oriented. Cranial nerves II through XII are intact grossly and symmetrically. No focal neurologic deficit. Skin: Skin is warm and dry. Mild diaphoresis. No rashes or ulcerations noted. Vital Signs: Temp: 98.6°F Orders: BP: 140/99 Pulse: 94 Height: 5'9" Resp rate: 23 Weight: 215 lbs ED: Oxygen 2 liters per NC to maintain O₂ SAT >95%; nitroglycerin 0.4 mg sublingual; aspirin 81 mg x 4 (324 mg total), to be chewed Heparin 70 units/kg bolus IVP (max dose 7500 units) Clopidogrel 600 mg oral Admission to CCU: Early risk stratification: high risk Activity: bed rest Cardiac monitor Vital signs q4h x 24 hours then q8h Diet: no added salt/low saturated fat; low cholesterol Call house officer for T>101, SBP >190 mm Hg or SBP <90 mm Hg, HR >120 bpm or HR <50 bpm, RR >30 or RR <10 Guaiac ALL stools while on heparin, LMWH, Ilb/illa inhibitor O₂: NC continue 2 L/min Please call house officer for O₂ SAT <90% Order for respiratory care O₂ SAT check q8h EKG and repeat for recurrent chest pain Troponin T/Troponin I: now and every 6 hrs x 8 times CK-MB: now and every 6 hrs x 8 times CBC, lipid profile, PTT, Chemistry (7) panel in AM-fasting Atenolol 75 mg/d Nitroglycerin 1/150 (0.4 mg) 1 TAB SL q 5 min x 3 prn chest pain; hold if: SBP <100 mm Hg PRN: Docusate sodium 100 mg po twice daily; aluminum-magnesium hydroxide 15 mL every 6 h for indigestion; oxazepam 15-30 mg po every hs prn insomnia; acetaminophen 650 mg po every 4 h for headache; magnesium hydroxide 30 mL po daily for constipation; magnesium sulfate sliding scale IV qd; call house officer if serum Mg <1.2 Hold order for creatinine >1.9 If serum Mg <1.4, give 5 g MgSO, IV; if serum Mg <1.6, give 4 g MgSO, IV; if serum Mg <1.8, give 3 g MgSO, IV; if serum Mg <2.0, give 2 g MgSO, IV Patient Summary: José Garcia is a 61-year-old male admitted through the emer- gency department with diagnosis of STEMI and transferred directly to Cath lab; s/p emergency coronary angiography with angioplasty of the infarct-related artery. History: Onset of disease: 61-y.o. male who noted the sudden onset of severe precor- dial pain on the way home from work. The pain is described as pressure-like pain radiating to the jaw and left arm. The patient has noted an episode of emesis and nausea. He denies palpitations or syncope. He denies prior history of pain. He admits to smoking cigarettes (1 pack/day for 40 years). He denies hypertension, diabetes, or high cholesterol. He denies SOB. Medical history: Not significant before this admission Surgical history: Surgery; cholecystectomy 10 years ago, appendectomy 30 years ago Medications at home: None Allergies: Sulfa drugs Tobacco use: 40-year history, 1 pack/day Alcohol use: 1-2 beers per day Family history: What? CAD. Who? Father-MI age 59. Demographics: Marital status: Married, Spouse name: Alicia Garcia, 59 y.o. Number of children: Daughter and two grandchildren live in the home Years education: AA degree Language: English, Spanish Occupation: IT network specialist Hours of work: 40/wk Household members: 5 Ethnicity: Mexican American Religious affiliation: Catholic MD Progress Note: General: Well-developed, overweight male in acute distress from chest pain. HEENT: Head: normocephalic and atraumatic Eyes: EOMI, fundoscopic exam WNL. No evidence of atherosclerosis, diabetic retinopathy, or early hypertensive changes. Mouth: oral mucosa pink, dentition in good repair Throat: pharynx pink without exudates Neck: soft, supple, no palpable masses. No lymphadenopathy. Cardiac: Isolated posterior MI with ST depression in V2-3. No murmurs, clicks, or rubs. Pulmonary/Chest: Lungs are clear to auscultation bilaterally. Abdominal: Abdomen soft, nontender, with normoactive bowel sounds in all four quadrants. No masses, no organomegaly. No guarding, rebound, or CVA tenderness. RLQ scar and midline suprapubic scar.
Understanding the Nutrition Therapy
5. What are the current recommendations for nutritional
intake during a hospitalization following a myocardial
infarction?
6. List the risk factors indicated in his medical record that
can be addressed through medical nutrition therapy.
7. A possible intervention is instructing the patient and
his wife on the Mediterranean diet for a nutrition plan
to follow after discharge.
a. What are the basic principles of the
Mediterranean diet?
b. What does the literature say about the relationship
between Mediterranean dietary principles and
future heart health?
Transcribed Image Text:Understanding the Nutrition Therapy 5. What are the current recommendations for nutritional intake during a hospitalization following a myocardial infarction? 6. List the risk factors indicated in his medical record that can be addressed through medical nutrition therapy. 7. A possible intervention is instructing the patient and his wife on the Mediterranean diet for a nutrition plan to follow after discharge. a. What are the basic principles of the Mediterranean diet? b. What does the literature say about the relationship between Mediterranean dietary principles and future heart health?
Expert Solution
trending now

Trending now

This is a popular solution!

steps

Step by step

Solved in 5 steps

Blurred answer
Similar questions
  • SEE MORE QUESTIONS
Recommended textbooks for you
Phlebotomy Essentials
Phlebotomy Essentials
Nursing
ISBN:
9781451194524
Author:
Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:
JONES+BARTLETT PUBLISHERS, INC.
Gould's Pathophysiology for the Health Profession…
Gould's Pathophysiology for the Health Profession…
Nursing
ISBN:
9780323414425
Author:
Robert J Hubert BS
Publisher:
Saunders
Fundamentals Of Nursing
Fundamentals Of Nursing
Nursing
ISBN:
9781496362179
Author:
Taylor, Carol (carol R.), LYNN, Pamela (pamela Barbara), Bartlett, Jennifer L.
Publisher:
Wolters Kluwer,
Fundamentals of Nursing, 9e
Fundamentals of Nursing, 9e
Nursing
ISBN:
9780323327404
Author:
Patricia A. Potter RN MSN PhD FAAN, Anne Griffin Perry RN EdD FAAN, Patricia Stockert RN BSN MS PhD, Amy Hall RN BSN MS PhD CNE
Publisher:
Elsevier Science
Study Guide for Gould's Pathophysiology for the H…
Study Guide for Gould's Pathophysiology for the H…
Nursing
ISBN:
9780323414142
Author:
Hubert BS, Robert J; VanMeter PhD, Karin C.
Publisher:
Saunders
Issues and Ethics in the Helping Professions (Min…
Issues and Ethics in the Helping Professions (Min…
Nursing
ISBN:
9781337406291
Author:
Gerald Corey, Marianne Schneider Corey, Cindy Corey
Publisher:
Cengage Learning