Clinical Case Study: Acute Onset Heart Failure. Amy Lofley Case study #2. Objectives. Overview of Acute Heart Failure Physiology Pathophysiology Treatment Multidisciplinary team. Case Study Medical Hx Nutrition Assessment Nutrition Intervention Prognosis Conclusion.
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Case study #2
The heart pumps blood throughout the body to deliver oxygen and nutrients and bring back carbon dioxide and waste.
A normal heart is able to pump this blood effectively throughout the body.
Class I – No undue symptoms associated with ordinary activity and no limitation of physical activity
Class II – Slight limitation of physical activity; patient comfortable at rest
Class III – Marked limitation of physical activity; patient comfortable at rest
Class IV – inability to carry out physical activity without discomfort; symptoms of cardiac insufficiency or chest pain at rest
Coronary Heart Disease
Left ventricular hypertrophy
Referral to a RD for MNT when an individual has HF. An initial visit lasting 45 minutes and up to three planned follow up visits lasting 30 minutes to improve diet and quality of life.
Protein needs for patients are based on their nutrition status. Patients that are clinically stable but protein depleted should have at least 1.37 g/kg and patients with a normal nutrition status should have 1.12 g/kg actual body to preserve body composition and limit hypercatabolism.
Energy needs are best determined with indirect calorimetry but if not possible usual predictive equations should be used adjusting with increased needs for a catabolic state.
Fluid should be limited to between 1.4 and 1.9 L per day, depending on symptoms of edema, fatigue, and shortness of breath.
Sodium intake should be limited to less than 2000 mg per day from AND and 1500 mg from the AHA.
Patients with HF should consume the DRI for folate, B6, and B12.
A multi-vitamin/mineral should be recommended that contains B12, B6 and folate.
Thiamine status should be monitored closely because of diuretic use. Encouraging the patient to consume the DRI of thiamine is important until further research is conducted.
Magnesium should be consumed at the DRI because of the increased risk for HF patients to have an irregular heart beat.
According to patient, he follows a no added salt diet at home.
Increased nutrient needs (protein/kcals) RT increased demands for wound healing AEB skin breakdown, delayed wound healing, decreased intake x 2 days.
Food and nutrition related knowledge deficit RT lack of prior diet education AEB lacks understanding of prescribed diet
Mahan LK, Escott-Stump S. Medical nutrition therapy for heart failure and transplant. Krause. 2008: 884-897.
Jessup M, Abraham WT, Case DE, et al. 2009 focused update: ACCF/AHA guidelins for the diagnosis and management of heart failure in adults. Journal of the American College of Cardiology.2009; 53(15):1343-82.
Academy of Nutrition and Dietetics. Evidence Analysis Library. Available at: http://andevidencelibrary.com/topic.cfm?cat=2800