Nursing Application: Nutrition and Cardiovascular Health

Knowing that Roy will be taking atenolol after going home, which medication or food interaction should the nurse emphasize during discharge teaching?​

"Avoid alcoholic beverages while taking the medication due to decreased potency." *Rational: Alcohol and beta blockers result in decreased potency of the medication. It is best to avoid alcohol completely, but if a client refuses to stop, ensure that medication is taken 6-8 hours earlier or later than alcohol to avoid this complication. Activity does not change absorption, and neither do foods taken with the medication. It is important to take the beta blocker even if angina is present. If angina is present, the client should take nitroglycerin also. ​

During his 6-week follow-up appointment, Roy reports he is feeling well and he has lost 5 pounds. Roy's lab values are​: -Serum LDLc 155 mg/dL​ -Serum HDLc 53 mg/dL​ -Serum triglycerides 256 mg/dL​ Based on this information, which current recommendation should the nurse reinforce?

"Continue dietary and lifestyle changes." *Rational: Because assessment data and Roy's statements indicate current interventions are working (losing weight, feeling well, and positive changes in lab values), the nurse should reinforce to Roy that he continues his current plan of dietary and lifestyle changes and compliance with the medication regimen.​ Returning to pre-hospitalization activities (including diet) after his cholesterol levels improve can lead to increased levels, so the nurse should also reinforce that the changes Roy made should be maintained for the rest of his life. The nurse does not have the authority to change Roy's medication.​

Roy is being discharged from the hospital after having a myocardial infarction. What is the best example of a dietary change that the nurse should suggest to help with hypertension?

"Drinking skim milk instead of soda" *Rational: ​Skim milk is a healthier option than soda. Soda is extremely high in sugar and increases the risk for weight gain and hypertension. The other changes in diet will aid in the reduction of risk for cardiovascular disease.​

____ refers to high levels of LDL or triglycerides. ​____ can refer to levels that are either higher or lower than the normal range for those blood fats.

"Hyperlipidemia" "Dyslipidemia" *Rational: Hyperlipidemia refers to high levels of LDL or triglycerides. Dyslipidemia can refer to levels that are either higher or lower than the normal range for those blood fats. Both hypoxemia and ischemia cause decreased levels of oxygen within the body. Hypoxemia is the medical term for low serum (blood) oxygen levels and ischemia is the term for decreased oxygen in the cells and tissues.​

Which salad is the best choice for a client implementing therapeutic lifestyle changes (TLC) to reduce the risk of coronary artery disease?

"Mixed greens with olive oil vinaigrette" *Rational: Mixed greens with olive oil vinaigrette is the healthiest option of the salads presented. Mayonnaise is full of fat, Caesar salad has fatty, rich dressing, and the Greek salad has ham and olives, which are high in salt and preservatives.

The nurse is teaching a client about trans fats. The client would verbalize understanding when they indicate that trans fats ____ LDL levels and ____ HDL levels, and therefore, they should be restricted.

"increase" "decrease" *Rational: Trans fats increase LDL levels and decrease HDL levels; therefore, they should be restricted. Trans fats are the unhealthy types of fats. ​

The Dietary Approaches to Stop Hypertension (DASH) diet is a lifelong approach to healthy eating. The DASH diet encourages a person to reduce ____ in their diet and eat a variety of foods rich in nutrients that help ____ blood pressure.

"sodium" "lower" *Rational: The DASH diet is a lifelong approach to healthy eating that's designed to help treat or prevent high blood pressure. The DASH diet plan was developed to lower blood pressure without medications. ​

Select the risk factors for cardiovascular disease that are present in Roy's assessment.​ Roy (pronouns he, him, his), 64 years old, is admitted to the intensive care unit of the hospital. He is 5 feet, 9 inches tall, has a medium frame, and weighs 205 pounds. He has gained 25 pounds since changing jobs within the past 6 months. He admits the new job requires more manual effort, so exercise has been abandoned. A couple of months before admission, Roy began to experience chest pain that radiated up the left side of his neck while he was cutting grass with a push mower. The pain did not stop when he sat down to rest, and it continued "off and on recently." History of hypertension, family coronary artery disease, and hyperlipidemia.

"weighs 205 pounds" "64 years old" "gained 25 pounds" "exercise has been abandoned" "hypertension", "coronary artery disease", "hyperlipidemia" *Rational: Roy's risk factors are male gender, ageing, physical inactivity, hypertension, his weight (including his recently gained 25 pounds), a family history of coronary artery disease, and hyperlipidemia. ​ Roy's height and new job that requires more manual effort are not risk factors for cardiovascular disease. His chest pain, the fact that the pain did not stop with rest, and that it has been on and off recently are cues to his cardiovascular health, not risk factors.​

The registered dietitian is counseling a client living with heart failure and their partner on how to adhere to a heart healthy diet while dining outside of their home. Which statements by the client's partner indicate they understand? Select all that apply.

-"I can prepare a main dish that is heart healthy to bring to the neighborhood block party next month." -"Eating salad for the main course is healthy, as long as we leave off high-sodium foods like bacon or ham." -"We can plan when dining out by looking for a menu and nutritional information on their website before we leave home." *Rational: Dietary restrictions do not need to interfere with eating healthy outside one's home when people take time to plan. Activities like bringing a healthy dish to a block party, asking that high sodium items be left off a salad, and finding a menu and nutritional information online to know what foods are most aligned with a person's dietary needs will allow them to be social and adhere to a heart healthy diet.​ Staying at home for all meals can limit the couple's contact with friends and relatives and is not the best choice for their well-being and sense of community.​ Even when they limit the number of times they eat out each week, if the client is not eating healthy for those meals, poor nutrition could exacerbate their heart failure. ​

A client demonstrates knowledge of foods that contain low amounts of partially hydrogenated oils when they include which items in their weekly meal plan? Select all that apply.​

-Apple slices​ -Mixed nuts *Rational: Mixed nuts and apple slices do not contain partially hydrogenated oils. ​Many commercially made foods contain partially hydrogenated oils:​ bakery goods—cakes, pies, cookies, and crackers​ premixed products—pancake mix and chocolate drink mix​ fried foods—corn chips, french fries, fried chicken, and fried fish​ snack foods—chips (e.g., corn, tortilla, potato) and microwave popcorn​

Which data reflects a positive outcome for a client using nutrition to improve their cardiovascular health? Select all that apply.​

-Dietary modifications -Improvements in vital signs -Evaluation of adherence to medication ​ -Increase activity

Roy shares that he snacks on high-fat cheeses, ice cream, potato chips, corn chips, peanuts, and crackers. He also drinks whole milk and eats buttered bread with every meal.​ What are some alternative healthier, snack food options that the nurse can recommend to Roy? Select all that apply.

-Fruits - Air-popped popcorn -Fat-free ice cream or sorbet - Low-fat cheeses -Vegetables

The nurse should include which alterations in health that are linked to atherosclerosis when educating clients recently diagnosed with the disorder? Select all that apply.​

-Ischemic heart disease -Cerebrovascular disease -Hypertension *Rational: If atherosclerosis is left untreated it can lead to: Ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and hypertension.​ Rheumatoid is an inflammatory disease affecting the joints. Bradycardia is a slow heart rate is not directly linked to diet.

Which of Roy's assessment findings should the nurse be concerned about? Select all that apply​.

-Low-density lipoprotein cholesterol (LDLc) -Triglycerides -Cholesterol (TC) -Weight increased 25 pounds in 6 months

Diseases of which body system are the leading cause of human death around the world?​

Cardiovascular *Rational: Cardiovascular disease remains one of the world's leading causes of death due to genetic and lifestyle influences. Selecting a heart healthy diet and adopting an active lifestyle will help decrease the risk for development of cardiovascular disease, which can lead to multiple health complications. ​ Diseases of the immune, neuromuscular, and endocrine systems are not the leading cause of death in humans around the world.​

The nurse is caring for a client with secondary hypertension. For each factor below, indicate if the nurse should recognize it as a contributing factor or a non-contributing factor linked to variations in blood pressure.

Contributing: Genetics factor, Aging, Increased salt intake, Obesity Non-Contributing: Reduced stress, Reduction in alcohol consumption