Medical Nutrition Therapy

In Patients with
Congestive Heart Failure

Rory Costigan
Dietetic Intern
University of Maryland, College Park

Table of Contents
I.

Executive Summary3

II.
III.
IV.
V.
VI.
VII.
VIII.

Case Report.....4
Hospital Course of Patient...6
Case Discussion...9
Appendices12
Glossary.....15
References.15

Executive Summary
Congestive heart failure is described as a condition in which the heart
cannot pump enough blood to supply the bodys tissue with sufficient
oxygen and nutrients; back up of blood in vessels and the lungs cause
a buildup of fluid congestion in the tissues. With congestive heart
failure, blood moves through the heart and body at a slower rate, and
pressure in the heart increases. As a result the chambers of the heart
may respond by stretching to hold more blood to pump through the
body or becoming stiff and thickened. This helps to keep the blood
moving, but the heart muscle walls may eventually weaken and
become unable to pump efficiently. As a result the kidneys may
respond by causing the body to retain fluid and salt. When fluids build
up in the arms, legs, ankles, feet, lungs or organs, the body becomes
congested. (4) Research suggests heart failure often occurs in elderly
patients who have multiple comorbid conditions such as angina,
coronary artery disease, hypertension, renal disease, diabetes, and
chronic lung disease. (4) Symptoms of congestive heart failure include
shortness of breath, increased heart rate, lightheadedness, fatigue,
edema, wheezing or coughing and swelling in the extremities such as
legs, ankles and feet (2).
Patients suffering from congestive heart failure can also have
symptoms that can affect their food intake, for example fatigue during
food preparation, breathing difficulties and gastrointestinal symptoms
like nausea and ascites. Research supports that specific diet plans aid
the management of congestive heart failure (7). A sodium and fluid
restriction diet is commonly prescribed for individuals admitted with
congestive heart failure to control swelling caused from fluid build-up
(edema) and control hypertension (in salt sensitive individuals).
Research has suggested that supplementation of specific vitamins and
minerals might improve heart function (8). Diuretics are often
administered to patients with congestive heart failure to relieve
symptoms of fluid build-up, breathing difficulty and swelling of the
legs ankles and feet.
Treating congestive heart failure from a nutrition perspective is a
crucial component in the management of heart function. The ultimate
goal of the dietitian is to initiate a diet plan that will help decrease
fluid retention and fluid overload. Dietitians must educate and inform
the patient about the effect sodium plays in fluid retention. Because
congestive heart failure is a chronic disease the dietitian is also
responsible for educating the patient on diet management post
hospitalization to manage heart failure.

Case Report
GENRAL INFORMATION
XX is a 90-year-old African America man admitted to the DC VA
Medical Center on December 2nd 2014. Patient complained of
worsening edema of the extremities, SOB and wheezing. The patient
was diagnosed with fluid overload associated with CHF. XX was
transferred to a nearby rehabilitation facility on December 11th, 2014.
SOCIAL HISTORY
XX lived at the Armed Services Retirement Home in Washington DC in
an independent apartment. Patients daughter, his primary durable
power of attorney, was present for facility: family meetings and
frequently visited XX during hospitalization. The family was trying to
transition XX into an assisted living home due to decreased ability to
live independently. The patients family medical history was unknown
as XX was adopted. The patient denied use of tobacco, drugs or
alcohol. The patient currently has Medicare part A, B, D, which is
supplemented by Kaiser insurance.
MEDICAL/SURGICAL DATA
Past Medical History
Past medical history included Congestive Heart Failure (CHF), Coronary
Artery Disease (CAD) status post coronary artery bypass grafting (s/p
CABG), Cerebral Vascular Accident, Hypertension (HTN), Hyperlipidemia
(HLD), Diabetes Mellitus Type 2 (DM2), Parkinsons disease, Zenkers
diverticulum, mild cognitive impairment, benign prostate hyperplasia,
and gout. Patient did not have any known food allergies.
Past Surgical History
The patient did undergo a coronary artery bypass grafting surgery in
2005 at Holy Cross Hospital.
Admitting Physical Examination
Upon admission, the patient complained of shortness of breath and
wheezing. Peripheral edema was present.
Laboratory Results
Refer to Appendix A for laboratory results during this hospitalization.
Medications

Refer to Appendix B for complete lists of home and in-patient

medications.
Diagnostic Tests with Results
Date
Diagnostic
Results
Test
Dec 3

Echocardiog
ram

Normal LV cavity normal wall thickness and

severely reduced global function, past EF= 20%
(11/17/2014).

Dec 3

Cystoscopy

Removal of blood clots to allow urine to flow

freely from the bladder through the urethra.

Dec 4

Chest x-ray

Chest x-ray with shallow inspiration. Blunting of

the left costophrenic angle is seen suggesting left
pleural effusion. The right costophrenic angle is
sharp and no pleural effusion is noted on right
side. The left hemi-diaphragm was not clearly
identified and possible left lower lobe airspace
disease could not be excluded. The heart
silhouette was enlarged. There was no evidence
of pulmonary edema.

Dec 7

Pacemaker
evaluation

Intermittent episodes of atrial fibrillation.

Cardiology team discussed with patient atrial
fibrillation management in addition to heart
failure advice.

NUTRITIONAL HISTORY FROM INITIAL ENCOUNTER

Diet History
The patient reported decreased appetite for approximately two weeks
prior to admission (pta) with reported recent weight gain of 20
pounds in the last 2 months. (Nutrition staff had seen GS in November
2014 for a diagnosis of shortness of breath.) Per chart, the diet was
tolerated. Intake varied with initial intake in first two days of less than
5% of trays to an increased intake of 75% of trays by end of
hospitalization.
Weight History
Hospital weights see table below
IBW- 155lbs (70.5kg) per Vista assessment
UBW- 134lbs (60.9kg) per November 2014 weight
Using Vista to calculate ideal body weight (IBW) for men, XX's ideal
body weight is 155 pounds. Per XX, his usual body weight (UBW) is
134 pounds. The patient has experienced significant weight loss since
November 2014 of 21 pounds (13%) over 7 weeks. Due to history of
6

bed scale measurement errors all significant weight changes are

questioned. However, 18 pound weight loss over 3 days (12/4/201412/7/2014) is possible because patient came into the hospital in fluid
overload and was getting IV Lasix and edema was disappearing.
Date

Weight (in
pounds)

Source of
Weight

% UBW

% IBW

Dec 2

154

Measured

115%

99%

Dec 4

155

Measured

115%

100%

Dec 5

141.2

Measured

105%

91%

Dec 7

137.7

Measured

102%

88%

Dec 8

136.7

Measured

102%

88%

Dec 9

134.2

Bed Weight

100%

87%

Dec 10

134.9

Bed Weight

100%

87%

Physical Activity Level

No information regarding the patients physical activity level pta was
available. During the course of hospitalization, patient was not
ambulatory and used a wheelchair for mobility.
Estimated Nutrient Needs
Source
Kcal
Requirements

Protein
Requirements

Fluid
Requirements

Facility
Standards

25-30 kcal/kg
1761-2115
kcal

0.8-1 g/kg
56-72 g

25-30 ml/kg
1761-2115 ml

Evidence
Analysis Library
(EAL)

n/a

n/a

n/a

Use of Vitamins/Minerals, Oral Liquid Supplements, and/or

Alternative Supplements
Patient denied use of Vitamins and Minerals, oral liquid minerals
and/or alternative supplements.
Cultural Attitudes That Influence Dietary Intake
Patient did not express any cultural or religious food preferences or
restrictions during hospitalization.
Past Nutritional Therapy

Date

Diet

Modifications

Avera
ge
Intak
e

Nutrition
Supplement(s)

Avera
ge
Intak
e

Nov 14

2G
NA+

6075%

Nov 17

2G
NA+

85%

Nov 18

NPO
for
testing

*Based on need for modified consistency diets during previous

hospitalizations.

Hospital Course of Patient

Medical treatment
Day 1 (12/2/2014)- Patient admitted to the CCU with CHF and
significant volume overload. Patient complained of dyspnea,
peripheral edema, wheezing and shortness of breath. Foley catheter
was inserted. Pt has a history of prior admissions for CHF
exacerbation requiring Lasix for diuresis. Patient was known to have
dry weight of 128lbs in June 2014. Diet: 2G NA
Day 2 (12/3/2014)- Patient complained of pain associated with Foley
placement; Foley was removed and replaced with a condom catheter
with continued complaints of pain. Condom catheter drainage
included blood, minimal urine, and some bloody urine clots. Patient
currently DNI. Diet: 2G NA
Day 3 (12/4/2014)- XX was transferred from 4BE to 4E (general
medical floor) due to improved status. Patient denied chest pain,
reported eating well, and c/o of abdominal gas, 2 Simethicone tabs
were given for gas pains. Urology performed a bedside cystoscopy
due to increasing number of blood clots collecting in condom catheter
to assure normal urine flow and excretion. Diet: 2G
Day 4 (12/5/2014) The patient c/o of mild nausea, emesis x1 and
abdominal pain. Denied CP/SOB. Abdominal pain associated with
ingestion of small amounts of food, which patient believes is due to
blockage in stomach related to constipation. XX had no BM since
hospitalization. Cardiac consult service recommended continued
diuresis. Diet: 2G NA

Day 5 (12/6/2014)- The patients fluid overload symptoms (breathing,

edema, etc) were decreasing and he remained on 20mg of IV Lasix
daily. Patient continued to c/o of constipation; no bowel movement in 4
days, despite receiving Senna. Patient reported decreased appetite.
Diet: 2G NA
Day 6 (12/7/2014)- Nursing reported new facial edema; puffy eyelids
and puffy cheeks, yet systemic edema was decreasing. Patient
reported poor appetite with intake of less than 5% of dinner tray.
Patient denied n/v; patient had not had a BM for 5 days. Diet: 2G NA
Day 7 (12/8/2014)- Patients symptoms had improved with IV diuresis,
although mild pitted edema in lower legs continued. Patient endorsed
appetite had returned and was present. Patient had not had a BM in 6
days. PICC inserted in right arm for infusion of IV medications. New
hematura was noted. Diet 2G NA + DIA 2000
Day 8 (12/9/2014) Patient denied SOB/n/v; patient reported first BM
in 6 days. Patient reported appetite was present. Noon fingerstick
reported BG 245, covered with 2 units of insulin. Peripheral edema
was slowly improving. Diet 2G NA + DIA 2000
Day 9 (12/10/2014) Patient reported fair appetite. Patient had
recurrent hematuria, foley was draining well. Noon finger stick
reported BG 179, covered with 1 unit of insulin. Discharge plans were
made to the Soldiers Home/ Armed Services Retirement HomeWashington DC. Diet 2G NA +DIA 2000
Day 10 (12/11/2014)- Urine was returning to normal color. Patient
reported no N/V/C/D or SOB. Medical team stated patient was
medically stable and ready for discharge. Patient was discharged to
sub acute facility to undergo physical therapy to improve his ability to
ambulate. Patient planned for a follow up for urine output on
12/15/2014. Diet 2G NA+ DIA 2000
Nutritional Treatment
Nutrition Assessment
Age: 90 years old
Gender: Male
Weight: 134# UBW, 154#
admission weight
% UBW Weight gain: 26 pounds PTA
(20%)
Height: 510 or 70 - is this the

Labs (admission):
Na: 136
K: 4.7
Cl: 106
Cr: 1.2
Glucose: 135 (H)
BUN: 28 (H)

correct ht
BMI: 22.3 (Normal, healthy weight)
PMH: CAD s/p CABG in 2005, CHF

with EF 20% (ECHO in 11/7/2014),

HTN, HLD, DMII, Gout, BPH, Zenkers
Diverticulum, Parkinsons Disease.
Recently hospitalized 11/5/2014 for
CHF exacerbation; diuresed with IV
Lasix

Symptoms: Worsening edema of

the extremities. Wheezing and SOB

Ca: 9.4
Mg: 2.2
WBC 6.0
Medications prior to admission:
Simvastatin 20 mg, Ergocalciferol
(Vit D2) 200
Current Diet: Regular texture 2G
NA+

Diet History: Poor appetite and

poor intake pta for the past 1-2
weeks ~50%. Before poor appetite
patient consumed 2 meals per day,
when appetite decreases patient
consumed 1 meal per day.
Nutrition Diagnosis
NC 2.1- Predicted suboptimal nutrient intake related to patients medical
condition and mentation as evidence by diet history recall.

Nutrition Intervention
Nutrition Prescription
2G NA + DIA 2000
Energy Requirements: 1761-2115 kcal/day (25-30
kcal/kg)
Protein Requirements: 56-71 gm/day (0.8-1g/kg)
Fluid Requirements: 1761-2115 ml/day (25-30ml/kg)

Intervention with goals

RC 1.4- Coordination of Care:
Collaboration with other providers:
Recommend Speech consult for
appropriate diet texture. Goal:
Implement within 24 hours
RC 1.4 -Coordination of Care:
Collaboration with other providers:
Recommend MVI. Goal: MD
consider supplement
E1.1- Purpose of Dietary Education:
Educate patient on the low sodium
diet. Goal: Complete education
within 24 hours.
E1.1- Purpose of Dietary Education:
Review diet education at discharge.
Goal: complete education review at

10

discharge.

Nutrition Monitoring and Evaluation

Indicators
Total energy intake (FH-1.1.1.1)

Criteria
Patient consumes >75% of meals <
2 days

Food and nutrition knowledge (FH3.1)

Patient is able to describe the

importance of low sodium diet for
CHF maintenance.

Adherence (FH-4.1)
Nursing aides verbally repot
resident is eating appropriate foods
at meal rounds.

Weight (AD-1.1.2)

Weight change over 4 weeks of

weekly weights is <5%

PRESENT NUTRITIONAL THERAPY

Date

Diet

Modifications

Averag Nutrition
e
Supplements
Intake

Dec 2 2G NA

75%

Dec 4 2G NA

50%

Avera
ge
Intake
0%

Case Discussion
MEDICAL CONSIDERATIONS

In Congestive Heart Failure the heart fails to pump blood adequately

to the rest of the body, which results in fluid accumulation in the other
organs primarily the lungs and the peripheral extremities. A 2006
Respiratory Care journal article suggested heart failure often
occurred in elderly patients who have multiple comorbid conditions
including angina, hypertension, diabetes, and chronic lung disease.
(4) In the usual form of heart failure, the hearts pumping power is
weaker, causing blood to move through the body slower. As a result
the heart cannot pump enough oxygen and nutrients to meet the
bodies needs. In order for the heart to hold and pump more blood
11

through the body, the chambers of the heart decrease muscle

contractility by stretching or becoming stiff and thickened. This will
cause the heart muscle walls to eventually become weakened and
unable to pump blood efficiently. As a result the kidneys may respond
by causing the body to retain fluid and salt. When fluid builds up in
the arms, legs, ankles, feet, lungs and organs the body becomes
congested.
According to a Journal of the American College of Cardiology article,
congestive heart failure is a common problem in the U.S., with
significant prevalence and mortality, which worsens with increasing
age. (5) The lifetime risk of developing congestive heart failure is one
in five in the U.S. Risk factors including ischemic heart disease,
hypertension, smoking, obesity, and diabetes have been identified and
can be used to predict the incidence of congestive heart failure as
well as its severity (6).
A history and physical examination, chest x-ray, and a series of
diagnostic tests are needed to assess the presence, acuity and
severity of a patients congestive heart failure. The history will
provide information regarding an underlying cause such as
myocardial infraction, hypertension, or noncompliance with diet or
medication. History of current symptoms including fatigue, weakness,
dyspnea, and cardiac-induced wheezing can provide information
regarding the severity of congestive heart failure (4). A chest x-ray
provides a static picture of the structures in you chest (lungs, heart,
blood vessels); it can show if your heart is enlarged or if you have
fluid in your lungs. An electrocardiogram (EKG) is a test that
measures the electrical activity of the heart including heart rate
speed, rhythm, timing of electrical signals; it indirectly allows
determination if the heart walls are thicker, which makes pumping
harder or if you have signs of prior heart damage. B-type natriuretic
peptide, is a hormone that is released into the blood when the heart
starts to fail; the higher the level, generally the worse the CHF.
Echocardiography (or Echo) uses sound waves bouncing off the heart
to create a moving picture; it allows the viewer to see the size of the
heart, the heart chambers and valves which allow determination of
poor blood flow, poor heart contraction or general heart muscle
damage. MRI (magnetic resonance imaging) is used to provide
moving images of the structure of the heart and its ability to pump
blood to the body and provides information about the inflammation;
injury and blood flow to the heart. Cardiac catheterization utilizes dye
to measure dye movement through the heart chambers and also the
flow through the coronary arteries to identify blockages (coronary
angiography). (4)

12

Nutritional Therapy
XX had a discharge reported weight of 134.9lbs in December 2014,
and a dry weight of 128lbs in June 2014. XXs recorded weight upon
admission was 154lbs and XX reported a 20-pound weight gain over
the last two months. Based on the facilities standards for determining
energy and protein needs the following was calculated: 1761-2115
kcals, 56-71 gm protein, and 1761-2115 mL fluids.
The patient initially was put on a 2G NA diet upon admission. The
patients PO intake for the first 24 hours was poor most likely related
to pain from the Foley catheter placement. After the pain resolved the
patients appetite increased to normal. The next day the patient
reported abdominal pains from gas that resolved with Simethicone
therapy. On the 4th day of hospitalization the patient complained of
mild nausea with abdominal pain, which the patient believed due to
stomach blockage. GF reported no Bowel Movement (BM) for 5 days.
After the patient had a BM his abdominal pain diminished and his
appetite again increased.
During GFs hospitalization he never consumed 100% of his estimated
requirements, but his intake had been increasing. The patient was
discharged to a sub-acute facility for physical therapy to improve his
ambulation. Patient is planned for a follow-up visit on 12/15/2014.
Implications of Findings to the Practice of Dietetics
Malnutrition, muscle wasting and cachexia may be present in patients
with severe congestive heart failure due to a combination of fatigue
on exertion (e.g. food preparation), breathing difficulties (from impact
of fluid overload), and gastrointestinal symptoms like nausea and
ascites. Initially when patients are admitted with congestive heart
failure a low sodium diet is prescribed to reduce peripheral swelling
from fluid build up (edema) and to assist in blood pressure control (7).
In patients with very severe CHF, a fluid restriction may be necessary
to reduce the need for excessive diuretic drugs and limit further fluid
retention. Some research suggests that folate supplementation (0.85.0mg daily) and Vitamin B12 supplementation (200mcg to 500 mcg
daily) given with other micronutrient supplements, may result in
decreased homocysteine levels, improvements in left ventricular
volume, ejection fraction and quality of life scores (8). Limited
evidence is available to determine protein needs for congestive heart
failure patients. Studies report that patients with congestive heart
failure have significantly higher protein needs than those without
heart failure as measured by a negative nitrogen balance. One study
indicates at least daily intake of 1.37 grams of protein per kilogram
for clinically depleted patients with heart failure and daily intake of

13

1.12 g of protein per kilogram for nourished patients can preserve

actual body composition or limit the effects of hypercatabolism (9).
Depending on the symptoms and amount of fluid retention caused by
congestive heart failure, diuretics may be used to stimulate the
removal of salt and water from the body. Diuretics can help relieve
heart failure symptoms including difficulty breathing and swelling in
the legs and ankles. Diuretics are often used with ACE inhibitors to
increase excretion of extra fluid and sodium. With this patient
specifically, intravenous Lasix was used daily to decrease fluid
overload. The patient also showed to have decreased pitting edema in
the extremities as well as decreased puffyness in they face and neck.
This patient was also kept on a sodium-restricted diet throughout the
hospital stay but did not have any restrictions to fluid intake.
Dietitians play a crucial role in working with the patient to educate
the patient on a heart healthy diet plan to manage congestive heart
failure. In this case the patient stated he had a poor appetite for about
3 days prior to admission due to SOB and wheezing. Prior to the 3
days of poor PO intake patient and daughter reported a fair appetite
that included consumption of 1 small meal and 2 medium size meals
per day. Patient was also on diabetic medication, Novolog, to manage
blood sugar levels. Patient did not follow a low sodium diet prior to
admission. It is important to educate the patient on the importance of
a low sodium diet and the effects of sodium intake on fluid build up. In
this case, the patient was educated on a low sodium diet and foods
that limited sodium. In individuals who are able to make dietary
changes, the DASH (Dietary Approaches to Stop Hypertension), which
encourages a variety of fruits and vegetables, whole grains, fat-free or
low-fat dairy products and proteins such as lean meats, eggs, seafood,
nuts, seeds, beans, and peas is encouraged. The DASH diet is low in
sodium or salty foods, solid fats including saturated fats and trans
fatty acids.
Given the extensive research on congestive heart failure patients have
achieved positive results by following a decreased sodium and fluid
diet along with use of diuretic medications. The use of alternative
medication or herbal medications by the public is increasing, but
there is little published research available as to its impact and/or any
morbidity it may cause. Due to this patients increased age and
comorbidities a less restrictive diet as well as diuretic treatment is
necessary for congestive heart failure management.

14

Appendices
APPENDIX A: LABORATORY RESULTS
Lab

Reference
Range

12/2

12/3

12/
4

12/
5

12/
6

12/7

12/8

12/9

12/1
0

12/1
1

Na

135-147
mmol/L

136

135

138

137

135

136

134

135

132

3.5-5.3
mmol/L

4.7

4.3

4.2

3.6

3.9

4.0

3.6

3.9

3.8

Cl

100-109
mmol/L

106

106

106

103

103

102

101

101

97

CO2

21-31
mmol/L

22

21

26

27

27

29

28

28

24

Creat
inine

0.7-1.5
mg/dl

1.2

1.3

1.4

0.9

0.9

0.8

0.8

0.8

0.8

Gluco
se

10-121
mg/dl

135

198

157

156

162

158

179

165

195

BUN

6-23
mg/dl

28

29

31

16

17

19

18

16

16

Bili
Total

0.2-1.2
mg/dl

1.7

1.7

1.7

Ca

8.9-10.5
mg/dl

9.4

9.2

8.6*

8.5*

8.6*

8.4*

8.3*

Phos

2.5-4.5
mg/dl

3.0

2.9

2.6

2.2

2.1

2.1

2.0

2.1

Mg

1.5-2.5
mg/dl

2.2

2.0

2.0

1.8

2.0

1.9

2.1

1.9

AST

8-40 IU/L

28

24

25

ALT

6-33 IU/L

27

30

17

WBC

3.2-9.5
k/uL

6.0

6.5

5.7

10.
1

10.7

7.2

6.0

7.0

7.2

* No albumin given for calcium correction factor

APPENDIX B: MEDICATIONS

Home Medications
Medication

Dosag
e

Frequen
cy

Function

Simvastatin

30
mg

Daily
Reduces levels of
(bedtim low-density
e)
lipoprotein and
triglycerides in the

Nutritional
Implications

Dry mouth, fruitlike breath odor,

increased hunger,
increased thirst,
15

Ergocalciferol
(Vit D)

50,00 Weekly
0 unit
cap

blood, while
increasing levels of
high-density
lipoprotein

nausea,
stomachaches,
vomiting

A form of Vitamin D
that promotes the
absorption and use
of calcium and
phosphate

Increased thirst,
nausea,
constipation,
anorexia, weight
loss

Clopidogrel
Bisulfate

75
mg

Daily

Platelet aggregation
inhibitor that slows
or stops platelets
from sticking to
blood vessel walls or
injured tissues

Vomiting, nausea,
stomach pain,
abdominal swelling

Albuterol
(oral
inhalation)

90
mcg

4 times
a day

Bronchodilator that
relaxes muscles in
the airways and
increases air slow to
lungs

Difficulty
swallowing,
nausea, vomiting,
gagging

Colchicine

0.6
mg

Daily

Beta-tubulin
interactor, affects
certain proteins,
which relieves gout
symptoms

Nausea, vomiting,
stomach pain,
heartburn

Calcium/Vita
min D

200
Unit
Tab

2 times
a day

Calcium and Vitamin

D is used to prevent
or treat calcium
deficiency

Stomach pain,
vomiting, loss of
appetite

Alendronate

10mg

Daily
(morni
ng
before
meals)

Alendronate is a
bisphosphonate
which works to slow
bone loss

Abdominal or
stomach pain,
difficulty
swallowing,
irritation or pain of
the esophagus,
diarrhea

Allopurinol

100m
g

Daily

Reduces the
production of uric
acid

Abdominal or
stomach pain,
ammonia-like
breath odor,
constipation,
diarrhea, dry
mouth

16

Insulin Aspart
(Novolog)

1-4
units
PRN

Daily

Hormone that lowers

the levels of glucose
in the blood

Dry mouth,
increased hunger,
increased thirst,
loss of appetite

Aspirin

81mg

Daily

A salicylate that
works to reduce
substances in the
body that causes
pain, fever and
inflammation

Vomiting, severe
stomach cramps,
nausea

In-Patient Medications
Medication

Function

Nutritional Implications

Albuterol (oral
inhalation)
(Lipitor)

Bronchodilator that relaxes

muscles in the airways and
increases air slow to lungs

Difficulty swallowing,
nausea, vomiting,
gagging

Alendronate

Alendronate is a
bisphosphonate which
works to slow bone loss

Abdominal or stomach
pain, difficulty
swallowing, irritation or
pain of the esophagus,
diarrhea

Allopurinol

Reduces the production of

uric acid

Abdominal or stomach
pain, ammonia-like
breath odor,
constipation, diarrhea,
dry mouth

Carbidopa
(Levodopa)

Levodopa is converted to
dopamine in the brain to
treat muscle symptoms of
Parkinsons disease

Severe nausea,
vomiting or diarrhea

Dextrose in IV
fluid

Provides fluids containing

various amounts of sugars
when fluids are needed

Hyperglycemia

Docusate
(Senna)

Relieving occasional
constipation and
preventing dry, hard stools
by helping fat and water
into the stool mass to
soften the stool

Bitter taste, bloating,

cramping, diarrhea,
gas,

Furosemide
(Lasix)

Loop diuretic that prevents

fluid retention and the

Sore throat,
constipation, diarrhea,
17

absorption of too much

salt, allowing the salt to
instead be passed in the
urine.

increased hunger,
increased thirst, loss of
appetite, nausea and
vomiting

Glucagon

Peptide hormone, produced

by alpha cells of the
pancreas that raises the
concentration of glucose in
the blood stream

Diarrhea, loss of
appetite, nausea and
vomiting

Insulin Aspart
(Novolog)

Hormone that lowers the

levels of glucose in the
blood

Dry mouth, increased

hunger, increased
thirst, loss of appetite

Losartan

Angiotensin II which keeps

blood vessels from
narrowing, lowering blood
pressure and improves
blood flow

Stomach pain,
increased hunger,
nausea, vomiting

Metoprolol
succinate

Beta-blocker that affects

the blood flow through
arteries and veins

Rapid weight gain

Ondansetron

Blocks the actions of

chemicals in the body that
can trigger nausea and
vomiting

Dry mouth, increased

thirst, loss of appetite

Simvastatin

Reduces levels of lowdensity lipoprotein and

triglycerides in the blood,
while increasing levels of
high-density lipoprotein

Dry mouth, fruit-like

breath odor, increased
hunger, increased
thirst, nausea,
stomachaches, vomiting

Spironolacton
e

For potassium-sparing
diuretic that prevents the
absorption of too much salt
while preventing potassium
levels from getting too low.

Abdominal or stomach
cramping, constipation,
diarrhea, increased
thirst, loss of appetite,
sore throat

Terazosin

Relaxes veins and arteries

for blood to pass through
to treat hypertension.

Nausea and vomiting

18

Glossary
Ascites- the accumulation of fluid in the peritoneal cavity, causing
abdominal swelling
Costophrenic angle- Chest x-ray done to confirm the presence of
pleural fluid
Emesis- the action or process of vomiting
DIA 2000- Diabetic menu plan consisting of 2000 calories.
Hematura- the presence of blood in urine
Hyperplasia- the enlargement of an organ or tissue caused by an
increase in the reproduction rate of its cells, often as an initial stage
in the development of cancer
Inspiration- the drawing in of breath; inhalation
Natriuretic peptide- a peptide which induces natriuresis
- natriuresis- excretion of sodium in the urine
Ventricular volume- the volume of blood in a ventricle at the end of
contraction

References
1. Schoken, DD. "Result Filters." National Center for
Biotechnology Information. U.S. National Library of Medicine, 2
Aug. 1992. Web. 28 Mar. 2015.
2. Dundee, Neil. The Diagnosis and Management of Chronic
Heart Failure in the Older Patient. British Medical Council.
Oxford University Press. 22 Feb. 2006. Web. 28 Mar. 2015
3. Pasini, E. Malnutrition, muscle wasting and cachexia in chronic
heart failure: the nutritional approach. National Center for
Biotechnology Information. U.S. National Library of Medicine, 4
Apr. 2003. Web. 28 Mar. 2015.
4. Figueroa, Michael S. "Respiratory Care." Congestive Heart
Failure: Diagnosis, Pathophysiology, Therapy, and Implications
Apr. 2006. Web. 28 Mar. 2015.

19

20