Exam III Due: Friday March 21st, 2014
Total Points: 100
Since this is a take home exam, you may use notes/references.
Cardiovascular & Congestive Heart Failure (Total points: 58)
- Which lipoprotein normally returns most of the cholesterol to the liver for disposal? (2pt)
High-density lipoprotein (HDL) is involved in eliminating excess cholesterol via the liver.
- Which nutritional factors contribute significantly to the rise of total serum cholesterol over time? (4pts)
- Dietary cholesterol
- Total fat
- Saturated fat
- Trans fat
- Excess calories
- Omega-6:
- Omega-3:
Seafood
Meat
- What is C-reactive protein and how does it relate to cardiovascular disease? (4pts)
C-reactive protein (CRP) is a protein that can be measured in your blood. It appears in higher amounts when there's swelling (inflammation) somewhere in your body
C-reactive protein is elevated in the blood when there is widespread inflammation somewhere in the body. The evidence now available indicates that inflammation and molecules such as C-reactive protein associated with inflammation may be as important as cholesterol in determining the development of atherosclerosis ("hardening of the arteries") and heart disease.
- What is a desirable lipoprotein profile? (2pt)
- Total cholesterol:
Lower than 240 mg/dl
- LDL:
Less than 130 mg/dl
- HDL:
Higher than 35 mg/dl
- Triglycerides:
Lower than 250 mg/dl
- Metabolic syndrome (4pts)
- What is metabolic syndrome?
Metabolic Syndrome, also known as Syndrome X, refers to a number of conditions that occur simultaneously and increase the risk of diabetes, stroke and heart disease. People with metabolic syndrome have high blood sugar levels, hypertension (high blood pressure), too much fat around their belly, and unhealthy cholesterol and triglyceride levels.
- What is the diagnostic criterion for metabolic syndrome?
Increased waist circumference: ethnicity specific - eg, Caucasian men ≥94 cm and women ≥80 cm; South Asian men ≥90 cm and women ≥80 cm.
If body mass index is over 30 kg/m2, central obesity can be assumed and waist circumference does not need to be measured.
- You are assessing a patient with CAD and you decide she needs 1850 kcals per day. Based on the TLC diet guidelines, determine this patient’s nutrient needs by providing the information below. (12pts)
- Fill in the table below:
- What is the criteria for determining kcal needs for CAD patients when using the TLC diet as a guide (why calculate kcal needs)? (4pt)
- You have a patient on your schedule who has congestive heart failure. What are the nutrition concerns r/t CHF you will look for as you assess this patient? (4pts)
- Patient 3: Mr. Vitelli : Mr. Vitelli has severe CHF. CBW: 190 lbs; Ht: 5’10”. UBW: 175 lbs. Wt fluctuate up and down. Edema and ascites present. SOB. Fatigue. BP: 149/95. Medications: Lasix, Nitroglycerine and Slow-K. The patient knows that for heart disease he needs to control his fat intake so he made changes to his diet to try to reduce overall dietary fat. He says recently his appetite has decreased. He used to eat “like a horse”, but now he eats much less food. He said he sometimes is too tired to eat. A 24-hr diet recall shows the following:
Medications: takes with 1 cup of water
Breakfast: 1 egg scrambled, 2 patties turkey sausage, 1 cup orange juice
Lunch: ½ sandwich- (whole wheat bread, ham, low-fat Swiss cheese, mustard), 1 cup soup (usually canned tomato). 10 fl. oz. diet coke, 1 cup low fat frozen yogurt
Snack:1 cup pretzels and 1 oz. low-fat cheddar cheese. 10 fl. oz. diet coke
Dinner: 3-4oz. Lean meat (mostly chicken or fish baked with seasoning salt, barbecue sauce, or teriyaki sauce), ¼ cup starch (potatoes or noodles with 1 tsp margarine), occasionally ¼ cup vegetables, 8oz water. 1 cup strawberry flavored gelatin.
Snack: 6-10 saltine crackers, 1 cup skim milk
The following questions (a-d) are associated with this case.
- Why do you think Mr. Vitelli is taking Slow-K? (2pts)
- Based on the 24-hr recall and other subjective and objective data provided, what is your assessment of Mr. Vitelli’s nutrition status and overall diet? (6.5pts)
- Provide one possible nutrition diagnosis for Mr. Vitelli. Write the diagnosis in proper PES format. (3pts)
- Provide a nutrition plan for this patient. Estimate his kcal needs and provide recommendations for any other nutrient(s) that is(are) pertinent to this patient. You can list your plan numerically (i.e. 1. Consume 2500 kcal/day, 2. Limit________ to ________ per day). Show your work. (6.5pts)
