Question

Charles is 46 and recently divorced. Since he and his wife separated, he noticed that he has been eating a lot of premade processed foods and putting on some extra pounds, and his weight has climbed from 185 to 205 pounds (his height if 5’ 11”) within the past 9 months. He’s been stressed with the divorce settlement and has started smoking again. Both of Charles’s parents had heart disease and he’s been on hypertension medications for 5 years. When he went to see his doctor, his blood pressure was143/85 mmHg and a lipid panel revealed that his total cholesterol is 260 mg/dL with an LDL level of 167 mg/dL and an HDL level of 35 mg/dL. He shared with his doctor that he used to exercise regularly, but had been physically inactive for over 6 months. When asked if he would like to start exercising again, Charles responded, “I definitely know I should, and I remember it used to make me feel so good! I was thinking of buying a new bike!” Charles’s doctor collected a 24-hour recall from Charles , which included the following:

• Breakfast: McDonald’s Sausage McMuffin with egg, 16 oz. orange juice
• Snack: 3.5 oz. Nacho Cheese Doritos
• Lunch: 1 bowl (12 oz.) French onion soup with 3 oz. Swiss cheese, a large serving of French fries with 4 T. ketchup, and 16 oz. Coke
• Dinner: 1 bowl (12 oz.) beef chili with 2 T. bacon crumbles, 3 T. cheddar cheese, and 3 T. sour cream, with 16oz. Coca Cola

When asked what he thought of his diet, Charles responded, “I think my diet’s pretty good. I try to make sure I’m eating three square meals per day and get plenty of protein!”

Assessment and Diagnosis

1. Describe the definition (types), prevalence, and etiology of heart disease. What is the role of serum cholesterol and blood pressure in heart disease risk? Why does smoking increase the risk of heart disease? What are the nutritional considerations?
2. Determine Charles’s risk for developing heart disease. What tools are calculations were used for this assessment? Identify his modifiable and non-modifiable risk factors.
3. What clinical data are used to assess and diagnose his condition and what are the relevant cut-points?
4. Conduct a nutrient analysis of Charles’s 24-hour recall and describe his diet. What are the food groups and nutrients of interest for Charles and why? How does his intake compare to the recommended intake? Be sure to include output reports from dietary analysis software.
5. Assess Charles’s readiness to change various behaviors related to his health condition and provide evidence for your observations. What are some areas of strength and what are some resources? What are some areas of weakness and what are some threats?

Intervention

6. Describe your strategy for counseling Charles . Considering your assessment of his readiness to change, what behaviors would you focus on? What counseling strategies would you implement?
7. Suggest patient resources. Provide a link to a website or handout that you would refer Charles to and include the handout or screenshot. Why did you select it? What specific behaviors are you targeting and what do you hope the outcome will be?

Monitoring and Evaluation

8. Identify 3-5 SMART goals for Charles . Discuss why you would recommend these particular goals and strategies.
9. Describe what the monitoring and follow-up for the patient will be, and how you expect these goals to develop and evolve over time. What information you will use to track Harold’s progress?

Answer 1

Answer :

Assessment and diagnosis :

Q. No. 1. Answer :

Heart disease : it is defined as it is a issues and deformities in the heart, and any disorders that affects the heart.

Types :

* coronary heart diseases

* arrhythmias

* myocardial infarction

* congestive heart failure

* uncontrollable hypertension

* congenital heart diseases like tetralogy of pallot.

Prevalance of heart diseases :

According to 2016 research studies 28.1 million US people diagnosed with heart diseases.

211. 2 deaths per 1,00,000 white males, in that black women were 167.5 per 1,00,000, 132.4 per 1,00,000 Per white women.

Etiology :

* unhealthy diet

* lack of exercises

* being over weight

* smoking

* heriditory

* stress

* alcoholism ect.

The role of serum cholesterol and hypertension in heart diseases is the the excess fat will accumulates in the blood vessels.

It may leads to artherosclerosis, or fat accumulation in the blood vessels.

Due to that narrowing of blood vessels.

And blood pressure may increases.

It may leads to cardiac or heart diseases like ischemic heart diseases and heart attack ect.

The smoking increases the risk of heart diseases due to it is having nicotine, which may decreases the oxygen carrying and damages the lyning of the blood vessels and accumulates the fatty materials in the arteries, and narrowing leads to hypertension and heart diseases and stroke.

Nutritional considerations for heart diseases :

* eat high fiber diet and salt restriction diet.

* avoid to eat fatty diet.

* take vegetables and fruits.

Q. No. 2. Answer :

Charles risk for developing heart disease :

* eating habits, he is eating more processed foods.

* obesity.

* smoking habits

* divorced stress.

* physicallyinactive

* and genetics history

These are the risk factors for Charles developing heart diseases.

Tools are calculations were used for these assessment :

* BODY MASS INDEX calculation

* lab investigations like total cholesterol levels 260 mg per dl.

Ldl 167 mg per dl.

Hdl levels 37 mg per dl.

Q. No. 3. Answer :

Modifiable risk factors :

* dietary patterns Changes

* stress management by de stressing techniques

* physical activity by doing exercises

* by avoiding smoking

These are modifiable risk factors

Non modifiable risk factors :

Hereditary, because his parents are having heart diseases.

Clinical data used to assess and diagnosis his condition is :

Hypertension that is 143 / 83 mm of hg.

Total cholesterol levels is 260 mg per dl.

LDL level are 167 mg per dl.

HDL 35 mg per dl.

BMI is 28.69 so it indicates he is over weight.

INTERVENTION STRATEGIES :

Q. NO. 1. answer :

Counseling Charles regarding :

* his diet has to change that is low fat and slat restriction diet.

* regarding daily exercises and activities we need to educate.

* de stressing techniques like deep breathing and listening music, yoga and meditation these are all we need to educate.

* physical activities like walking and jogging we need to explain.

* counseling regarding strengthening to self. By psychological and emotional support.

* mainly he has to change eating habits and stress management techniques.