Case Study

BySayali Vilas ParabP.G.Diploma 2014-15

PATIENT’S PROFILE

ANTHROPOMETRIC MEASUREMENTS

ADMISSION DETAILS

PHYSICAL EXAMINATION

BIOCHEMICAL PARAMETERS

1) Haematolgy

2) Serum Test

3) Liver Function Tests

4) Lipid Profile Test

MEDICATIONS PRESCRIBED BY THE HOSPITAL

PATHOPHYSIOLOGY1) Ischemic Heart Disease

It is a condition of recurring chest pain or discomfort that occurs when a part of the heart does not receive enough blood.

Develops when cholesterol particles in the blood begin to accumulate on the walls of the arteries that supply blood to the heart.

Deposits called plaques also known as atherosclerosis. These deposits narrow the arteries and block the flow of blood. Decrease in blood flow reduces the amount of oxygen supplied to

the heart muscle.  Symptoms

Chest pain typically on the left side of the body (angina pectoris) Chest pressure Rapid breathing (tachypnea) or Shortness of breath Clammy skin Nausea with or without vomiting Pain in the neck or jaw Shoulder or arm pain

Causes It may develop slowly, as plaque builds up over time. Or it may occur quickly if an artery is suddenly blocked. Occurs most frequently in people who have atherosclerosis (buildup of plaque on the walls of the coronary arteries), blood clots, coronary artery spasm, or severe illnesses that increase the heart’s need for oxygen. A number of factors increase the risk of developing ischemic heart disease. Risk factors for ischemic heart disease include:

Diabetes Family history of heart disease High blood cholesterol High blood pressure High blood triglycerides Obesity Physical inactivity Smoking and other tobacco use

TreatmentMedications used to treat ischemic heart disease:Drug therapy is commonly used for treatment of ischemic heart disease and includes:

Angiotensin Angiotensin receptor blockers (ARBs) Anti-ischemic agents such as ranolazine (Ranexa) Antiplatelet drugs Calcium channel blockers Nitrates, which dilate the blood vessels Statins, which lower cholesterol

Surgical procedures used to treat ischemic heart disease:Surgical procedures includes:

Angioplasty and stent placement (procedure to remove plaque and restore blood flow in clogged arteries)

Coronary artery bypass graft (procedure that helps restore blood flow to the heart by routing the flow through transplanted arteries)

Dietary Fat

Low fat diet is recommended in CVD.

Oxidized LDL converts microphages into foam cells whereas HDL decreases number & activity of macrophages which prevents plaque destruction & thrombus formation.

LDL = consumption of saturated fat

HDL = consuming more Omege-3 fatty acid & physical exercise.

Saturated fat increases the platelet count whereas PUFA have opposite effect. Omega-3 fatty acid enhances thromboxin A3 synthesis & thereby suppress platelets activation.

2) Hypertension

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.

It is influenced by the force at which the heart pumps blood, the diameter of the blood vessel and volume of circulating blood.

PreventionIf the following factors are changed it can show effective prevention and control of hypertension.

Excessive weight High salt intake Alcohol consumption Physical inactivity is strongly associated with hypertension.

DASH (Dietary Approaches to Stop Hypertension) diet

Low-fat eating plan that is high in fruits, vegetables and low-fat dairy foods; shown to reduce blood pressure.

To prevent & treat HTN, DASH diet can be used. It decreases the systolic B.P. by average of 6-11mm Hg.

The high number of fruits & vegetables consumed on the DASH diet is a marked change from typical patterns. To achieve the to 10 servings, 2 to 3 fruits & vegetables are consumed at each meal.  

24 HOUR HOSPITAL DIET RECALL Early morning: 1 cup of Tea

Breakfast: 1 glass of Milk + Biscuits

Mid morning: 1 Fruit

Lunch: 2 Chapatis + 1 bowl Rice + 1 bowl Dal + 1 bowl

Sabzi (green vegetables) + 1 bowl Curd/ Chaas

Evening Snack: 1 cup of Tea + Biscuits

Dinner: 2 Chapati + 1 bowl Rice + 1 bowl of Dal/Kadhi + 1

bowl Sabzi (green vegetables) + 1 bowl Curd

24 HOUR HOME DIET RECALL

DIET PLANNING CalculationBMI= 27.76 (Grade II obesity)IBW= 153-105= 48kgsEnergy requirement = 48x25…….. (Sedentary Work) = 1200 kcalCHO = 60% = 720kcal = 180 gProtein = 21% = 252 kcal = 63 gmFat = 19% = 228 kcal = 25.3 g

Exchange List

Meal Planning

Note: She can eat only 3gm of salt i.e.1/2 tsp. (i.e. 1000mg of Na) daily. She can not have more than that.

JUSTIFICATION

In mid morning, I am giving her Chapati & Sabzi because she has a habit of eating Chapati & Sabzi or Chapati with tea.

In lunch, I am giving her Rice & Lentil Dal because of its low Na content. Also in Palak-Paneer, both Palak & Paneer has low Na content.

In evening snacks, I am giving her Upma because it is easy to digest & requires less oil. Also Rawa has low Na content.

In dinner she eats Bhakari or Chapati. She never eats Rice at dinner time. Therefore I had given her Bhakari.

In Egg curry only Egg-white is included because Egg yolk contains more fat. And she is already overweight.

I am giving her salad because eating salad will fulfill her stomach.

She should include only 3gms of salt because high salt consumption leads to more complications( Hypertension).

SUGGESTION

In early morning or in morning breakfast, she can eat one Fruit (Apple, Orange, etc.). She can also eat Ghavane which is made up of Rice with Chutney.

In mid morning, she can eat any Sabzi (green leafy vegetables) & Chapati or instead of this she can eat fruit also.

In lunch, instead of Dal & Rice she can eat vegetable Pulav with Salad or Chapati & Sabzi.

In snacks, instead of Upma she can also eat Shira or Rava Kheer or Fruit.

In dinner, instead of Bhakari & Egg-curry she can have Egg-rice or Egg-pulav (Egg-white only).

LIFE STYLE MODIFICATIONS

Lose weight

Increase aerobic physical activity to 30-45 mins most days of the week

Reduce Na intake to no more than 1500mg/day.

Maintain adequate intake of dietary Potassium (approx 90mmol/day)

Maintain adequate intake of dietary Calcium & magnesium for general health

Reduce intake of dietary saturated fat and Cholesterol for overall cardiovascular health

Reduce oil intake

THANK YOU.......