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Congestive
Heart
Failure
Megan Smith
UMD Dietetic Intern
May 6, 2015
E
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Congestive Heart
Failure
Most common
signs and
symptoms
Fatigue
Edema
Shortness of
breath
Chest
congestion
Md Health
Congestive Heart
Failure
Pixshark
Congestive Heart
Failure
Electrocardiogram
Test that checks
for problems with
the electrical
activity of the
heart.
Ejection Fraction
A test that
determines how
well your heart
pumps with each
beat.
Emory Health
Medical
Considerations
Diagnosis: Acute left systolic heart failure
Nutrition Assessment
Food/Nutrient Related History
Decreased appetite one month PTA
Eating approx. 50% of meals PTA
MD expressed basic understanding of
nutrition and wanted to maximize caloric
intake prior to surgery.
MD is a physician so he understood his
disease state
MD is on feet all day; in training for a
marathon.
Nutrition Assessment
Anthropometric Measurements
Height=168 cm Weight=194 lbs (88.2 kg)
BMI=31
UBW=210 lbs;16 pound wt loss, 7% weight
change in past month
Nutrition Assessment
Client History
PMH: hypertension, dyslipidemia,
hypercholesteremia
No surgical history (hx)
Employed as a physician as Chief of
Orthopedics
Denies family psychiatric hx, alcohol, and drug
use
Nutrition Assessment
Nutrition Focused Physical Findings
No edema present on admission
Vital signs stable on admission
Signs & Symptoms on admission: 3 weeks
SOB, orthopnea, upper back discomfort,
fatigued, lower energy levels during normal
work activities, loss of appetite, weight loss
Nutrition Assessment
Biochemical
BNP levels normal upon admission
BUN slightly elevated: 26 mg/dL on 12/11
XX Labs
Diagnosis
NI-1.2: Inadequate oral intake
Intervention
Nutrition Prescription
Energy Needs: 1870-2066 kcal (Mifflin St. Jeor)
Protein Needs: 65-78 grams (1-1.2 gram/kg)
Fluids: 1760-2200 mL
Intervention
Date
Diet
Average Intake
Nutrition
Supplements and
Intake
December 8th
Patient placed on a
cardiac diet upon
admission
Cardiac Diet
25-50%
25-50%
December 10th
December 11th
NPO
December 12th
CLD/FLD
50-75%
December 13th
Cardiac diet
50-75%
December 14th
Cardiac diet
25-50%
December 15th
Cardiac diet
25-50%
December 16th
Cardiac diet
40%
December 17th
December 9th
Intervention
RC 1.3 Coordination with other providers: Recommend low sodium, cardiac Diet.
Goal: Implement once medically feasible after surgery.
ND-3.1 Medical food supplements: Initiate Ensure Chocolate TID once medically
feasible.
RC 1.3 Coordination with other providers: Recommend Ensure Chocolate TID.
Goal: Implement once advanced to Clear Liquid Diet after surgery.
RC 1.3 Collaboration with other providers: Patient will maintain current weight
throughout hospital stay.
E-1.1 Purpose of Nutrition Education: Prior to discharge educate patient and
patient family on importance of adhering to low sodium, cardiac diet after surgery
and discharge.
E-1.4 Nutrition relationship to health/disease: Prior to discharge help patient
recognize and understand importance of adherence to low sodium cardiac diet in
relation to his CHF
Monitor/Evaluate
FH 1.1.1.1 Energy Intake
FH-1.2.1 Fluid/beverage intake
FH 1.6.2 Sodium Intake
FH 4.1.1 Food and Nutrition Knowledge/Skill
FH 4.1.2 Diagnosis specific food and nutrition
knowledge
Nutrition Implications
Severity of MDs CHF was reflected in the
medical and nutritional therapy.
Many CHF patients will require a fluid-modified
diet (ND-1.2.8)
Nutrition Implications
Self-monitoring (C-2.3)
Reading nutrition labels
Choosing salt-free additives
References
Academy of Nutrition and Dietetics. International Dietetics and Nutrition Terminology (IDNT) Reference Manual. Chicago, IL: American Dietetic Association;
2013;
Academy of Nutrition and Dietetics. Nutrition Care Manual.http://www.nutritioncaremanual.org. Accessed several times from December 2014-February
2015.
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5803&lv2=8585&ncm_toc_id=8585&ncm_heading=Nutrition%20Care
Cotugna N, Wolpert S. Sodium Recommendations for Special Populations and the Resulting Implications. Journal of Community Health. 2011; 36: 874-882.
Ejection Fraction picture Emory Health http://www.emoryhealthsciblog.com
Electrocardiogram American Accreditation HealthCare
commission-http://www.medicalwordmeanings.com/what-is-electrocardiogram-the-meaning-and-diagram/
Evidence Analysis Library. Academy of Nutrition and Dietetics Website. https://www.andeal.org. Accessed several times from December-February 2015.
https://www.andeal.org/topic.cfm?menu=5289&cat=2815
Healthy heart vs. Congested Heart MD Health http://www.md-health.com/Congestive-Heart-Failure.html
Heart El Corazon. http://www.efn.uncor.edu/departamentos/divbioeco/anatocom/Biologia/Los%20Sistemas/Circulatorio/Corazon.htm
Lavid CJ, Ventura HO. Analyzing the Weight of Evidence on the Obesity Paradox and Heart FailureIs there a Limit to the Madness? Congestive Heart
Failure. 2013; 19:158-159.
Lennie TA, Moser DK, Biddle MJ, Walsh D. Nutrition Intervention to Decrease Symptoms in Patients with Advanced Heart Failure. Res Nurs Health. 2013;
36(2): 120-145.
Mahan LK. & S. Escott-Stump. 2012. 13th edition of Krauses Food, Nutrition & Diet Therapy. W.B. Saunders Co.: New York.
Medical Reference Guide-Complementary and Alternative Medicine Guide. University of Maryland Medical Center. January 2012.
http://umm.edu/health/medical/altmed/condition/heart-failure Accessed April 2015.
Riegel B, Moser DK, Anker SD, Appel LJ. State of Science. Promoting Self-Care in Persons with Heart Failure-A Scientific Statement From the American
Heart Association.
Systolic/Diastolic HF picture http://pixshark.com/congestive-heart-failure-prevention.htm