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GENERAL INFORMATION
The patient’s name is Mr. George Fernandez Baniel, 53 years old. He was
admitted at FEU- NRMF on March 29, 2009 and stayed at room 506 B. He was
discharged on April, 28,2009.
The present illness started prior 1 week before the admission when the
patient had swollen feet with associated scrotal swelling, occasional difficulty
of breathing and easy fatigability. No other accompanying symptoms like
fever, coughs and cols. No medications were taken and no consultation was
done.
1 day prior to the admission, still with the same condition stated above,
patient’s urine output had decreased. Still no consultation was done.
Then, few hours prior to admission, the condition stated above persisted
and accompanied by cough, productive whitish sputum, low grade fever and
chills.
THEORETICAL CONSIDERATIONS
Disease Conditions
Definition
A. Etiology
CHF: Many disease processes can impair the pumping efficiency of the
heart to cause congestive heart failure. The most common causes of congestive
heart failure are:
Less common causes include viral infections of the stiffening of the heart
muscle, thyroid disorders, disorders of the heart rhythm, and many others.
It should also be noted that in patients with underlying heart disease, taking
certain medications can lead to the development or worsening of congestive heart
failure. This is especially true for those drugs that can cause sodium retention or
affect the power of the heart muscle. Examples of such medications are the
commonly used nonsteroidal antiinflammatory drugs (NSAIDs), which include
ibuprofen (Motrin and others) and naproxen (Aleve and others) as well as certain
steroids, some diabetic medication, and some calcium channel blockers.
CAD: Research suggests that coronary artery disease (CAD) starts when certain
factors damage the inner layers of the coronary arteries. These factors include:
• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes
When damage occurs, your body starts a healing process. Excess fatty tissues
release compounds that promote this process. This healing causes plaque to build
up where the arteries are damaged.
The buildup of plaque in the coronary arteries may start in childhood. Over time,
plaque can narrow or completely block some of your coronary arteries. This reduces
the flow of oxygen-rich blood to your heart muscle.
Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to
clump together and form blood clots at the site of the cracks. This narrows the
arteries more and worsens angina or causes a heart attack.
B. Incidence
CHF: Each year, there are an estimated 400,000 new cases. (Source:
excerpt from NHLBI, Congestive Heart Failure Data Fact Sheet: NHLBI)
C. Pathology
Congestive heart failure can affect many organs of the body. For example,
the weakened heart muscles may not be able to supply enough blood to the
kidneys, which then begin to lose their normal ability to excrete salt (sodium)
and water. This diminished kidney function can cause to body to retain more
fluid. The lungs may become congested with fluid (pulmonary edema) and the
person's ability to exercise is decreased. Fluid may likewise accumulate in the
liver, thereby impairing its ability to rid the body of toxins and produce essential
proteins. The intestines may become less efficient in absorbing nutrients and
medicines. Over time, untreated, worsening congestive heart failure will affect
virtually every organ in the body.
Coronary Artery Disease is characterized by an inadequate supply of
oxygen-rich blood to the heart muscle (myocardium) because of narrowing or
blocking of a coronary artery by fatty plaques. If the oxygen depletion is
extreme, the effect may be a myocardial infarction (heart attack); if the
deprivation is insufficient to cause infarction (death of a section of heart muscle),
the effect may be angina pectoris, or spasms of pain in the chest. Both
conditions can be fatal because they can cause heart failure or ventricular
fibrillation—an uncontrolled and uncoordinated contraction of the ventricles (the
lower chambers of the heart) that induces sudden death. Middle-aged men,
especially those with a family history of the disease, are particulary vulnerable
to developing coronary heart disease, as are individuals with hereditary
conditions such as familial hypercholesterolemia (a disorder in which the body’s
tissues are incapable of removing cholesterol from the bloodstream). Coronary
artery bypass surgery or balloon angioplasty may be necessary if medications
and diet and lifestyle changes such as frequent exercise and cessation of
smoking are not effective.
D. Clinical Manifestations
• As the body becomes overloaded with fluid from congestive heart failure,
swelling (edema) of the ankles and legs or abdomen may be noticed.
• The extra fluid in the body may cause increased urination, particularly at
night.
Angina may feel like pressure or a squeezing pain in your chest. You also
may feel it in your shoulders, arms, neck, jaw, or back. This pain tends to get
worse with activity and go away when you rest. Emotional stress also can
trigger the pain.
The severity of these symptoms varies. The symptoms may get more
severe as the buildup of plaque continues to narrow the coronary arteries.
Prognosis
• the degree to which other organ systems are involved and the severity of
other accompanying conditions,
In the U.S., coronary artery disease is the leading killer of both men and
women. In 2003, nearly 500,000 people died because of CAD. On the positive
side, heart attack mortality rates have been declining. Half of men and 63% of
women who die of heart disease do not have angina or other warning symptoms
prior to their fatal attacks. Although at this time no tests can reliably predict
whether a heart attack will occur, experts estimate that up to 30% of fatal
attacks and many follow-up surgeries could be avoided with healthy lifestyle
changes and by sticking to medical treatments. Two-thirds of patients who have
suffered a first heart attack, however, do not take the necessary steps to
prevent another.
The head of the family is George Baniel and his wife is Celia Baniel.
They have three children, one female and two males. Their family is
nuclear.
B. Educational background
C. Type of residence
D. Occupation
The head of the family, George Baniel, drives a bunch of car for his
boss. He works as a family driver.
E. Religion
F. Income bracket
During free time or day offs, George enjoys playing basketball with
neighbors or co-workers or sometimes with the family.
H. Cultural influences
They originally came from Cebu. Obviously, they are much oriented
and influenced by the Visayan culture and traits.
A. Anthropometry
Weight- 65 kg
= 63.16 63 kg
B. Biochemical Assessment
Patient’s Normal Variance Rationale
Laborator Values (High/Lo For
y w) Variance
Values
BUN 3.0-9.2 High Indicates increased protein in the diet
(14.30) mmoL/L and as a result of congestive heart
failure
( which decreases blood flow in the
kidneys )
Creatinine 62-115 High Indicates increased protein in the diet
(130.0) mmoL/L and as a result of congestive heart
failure
( which decreases blood flow in the
kidneys )
SGOT/AST 5-34 U/L Normal Liver is normal
(26.0)
RBS/CBG < Normal Blood Sugar Levels are normal
(201) 300mg/day
Total 64-83 g/L Normal No indication of liver disease
Protein
(74)
Albumin 35-50 g/L Low Indicates the presence of a disease
(33) which enables kidneys to control
albumin leakage from the blood to the
urine
Globulin 29-33 g/L High Presence of infection/inflammation (UTI)
(41)
SGPT/ALT 0-48 U/L High Caused by congestive heart failure
(83)
ALP 40-150 U/L Normal Liver function normal
(67)
Sodium 135-148 High Indicates increased blood pressure
(150.30) mmoL/L
Potassium 3.50-5.30 Normal Potassium levels are regulated (to
(5.26) mmoL/L monitor condition and effect of
treatment)
Magnesium 0.65-1.25 Normal Status of digestive
(0.94) mmoL/L system/gastrointestinal tract is WNL
Ionized 3.0-9.2 Low Relatively caused by low
Calcium mmoL/L Albumin levels
(1.30)
C. Clinical assessment
Skin (sole of the foot) Large amount of skin that Vitamin A, Water, Vitamin
is peeling off C, Protein and Vitamin E
Skin (total body)
Dry
D. Dietary assessment
The patient usual food intake for a day is mostly kimchi- a Korean food
composed of vegetables seasoned with great amount of salt, spices and additional “
bagoong” that is fried in large or the fat of animals with or without rice (mostly
without) – from lunch up to dinner. His breakfast is consisted of fried fish or
vegetables and rice. In eating kimchi, the ingredients are no longer measured. The
amount of each ingredient varies with every serving.
1. Food preferences
Likes: fish and kimchi
The diets prescribed by the doctor are low salt and low fat diets. The low salt
diet is used for the client having diseases that affect fluid balance or where a
decrease in his body fluid volume will relieve symptoms of the disease/s. His health
conditions where control may be indicated are severe heart failure and high blood
pressure. On the other hand, low-fat diet is a diet that consists of little fat,
especially saturated fat and cholesterol, which can lead to increased blood
cholesterol levels and heart disease risk. In the case of the client, to reduce the risk
of incidence of heart problems and complications of the problem being experienced,
this diet can be of great help in minimizing the client’s diseased state. We do agree
with the diets given by the doctor behind the fact that the diets really fit the client
e.g. in terms of prevention of the development of health threats, pursuing the diets
will actually prevent potential health problems that may arise from the actual
problems and another, in terms of curative when it comes to taking the right
nutrients in order to diminish some manifestations of the client’s health problems.
Vegetables
3-5 servings per day fresh, frozen, or canned without added fat, sauce, or salt
Fruits
Dairy Products
2-3 servings per day Fat-free, 1/2%, 1% milk, buttermilk, yogurt, cortage, cheese,
fat-free and low-fat cheese
Eggs
Lean cuts loin, leg, round, extra lean hamburger; cold cuts made with lean meat or
soy protein; skinless poultry; fish
Amount adjusted to caloric level: unsaturated oils; soft or liquid margarines and
vegetable oil spreads; salad dressings, seeds, and nuts
Many grain-based snacks, including chips, cheese puffs, snack mix, regular
crackers, buttered popcorn
Vegetables
Fruits
Dairy Products
Eggs
Higher fat meat cuts: ribs, t-bone steak, regular hamburger, bacon, sausage; cold
cuts: salami, bologna, hot dogs; organ meats: liver, brains, sweetbreads; poultry
with skin-fried meat; fried poultry; fried fish
Given:
DBW = 64 kg
TER = ?
CHO = ?
CHON = ?
FAT = ?
Energy Contributions:
Breakfast
1 medium banana
1 c fat-free milk
2 tsp jelly
Lunch
1 T mustard
Salad:
Dinner
1 T chopped scallions
1 medium peach
1 c fat-free milk
Snack
1 c orange juice
1/4 raisins
References:
• Client’s records
• http://www.labtestsonline.org
• http://www.weight-loss-professional.com
LEARNING INSIGHTS
One intervention a nurse can perform is diet education for the patient.
This study can be a reference for nurses in conducting health teaching to the
client involved herein and the like. Diet education for the hospitalized patient
is often overlooked because no referral is made for education or the diet is
related to an old diagnosis. It is sometimes difficult for the nurse to discern
how much information to provide. Often patients are dealing with more
urgent medical issues and cannot give full attention to learning a new diet. It
is essential to let the amount of education be patient-guided to avoid
overwhelming him or her. Using valuable time to teach an uninterested
patient could result in missing an educational opportunity with a motivated
patient. The best course of action is to: inform the patient of the diet; be
available for questions; provide basic written information; verbally
emphasize a few memorable key points; and provide contact information or
refer the motivated patient to the dietitian.
Emphasizing a few key points is the crux of diet teaching. For the
purpose of this experience, we are referring to these points as “nursing
skills.”
We hope you will find these nursing skills useful. It is important to feel
comfortable with the nutrition education you provide to your patients.