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Hypertension

Case Study
KAITLYN LENAHAN

Patient Information

54 year old, white male

Height: 72 in (182.88cm)

Weight: 190 lbs (86.18 kg)

Father of three

Chemical Engineer, works Monday-Thursday at the office and


Fridays at home. Fairly stressful job.

Lives at home with wife, oldest daughter, and 2 dogs.

Walks dogs/by himself for at least 30 min 1 hour every night

Works out at a gym 3x a week

Patient History

High Blood Pressure about age 45

Heart Attack, 2 blockages March 2015, Age 53

Patients Father: Type 2 Diabetic, heart attack (3 times),


Alzheimers Disease

Patients Mother: High Blood Pressure, early stages of dementia

Medications
Medication

Dosage

Type

What For

When Taken

Diovan

160/12.5 mg,
once a day

ARB inhibitor

High Blood
Pressure

Night

Lisinopril

20mg, once
daily

ACE inhibitor

High Blood
Pressure

Morning

Nitroglycerin

.5 mg
sublingually
(up to 3
doses in 15
minutes)

Nitrate

Chest Pain

As needed, 3
times only

Vitamin D3

2000 iu

Supplement

Vitamin D
Deficiency

Morning

Anthropometric Measures

Height: 72 in (6ft, 182.88cm)

Weight: 190 lbs (86.18 kg)

BMI: 25.8 Overweight

IBW: 166 lbs

UBW: 192 lbs

%UBW: 98.96%

190 192 100 98.96%

Biochemical Data
Test

Started Out

Current

Ideal Range

Status

Blood Pressure

144/84

128/84

<120/<80

Prehypertension

Percent Fat Mass

27.6% of body
weight

21.1% of body
weight

16.1-21.5% of
body weight

Optimal

Lean Body Mass

164lbs of
muscle

152lbs of
muscle

N/A

Loss of 12% of
muscle

Diagnosis

Cardiovascular Disease covers a broad range of types, including


heart attack, arrhythmia, heart valve problems, and stroke.

Cardiovascular diseases kill an estimated 17 million people


worldwide each year. Majority of these are due to heart attacks
and strokes.

High blood pressure is defined as a systolic blood pressure at or


above 140 mmHg and/or a diastolic blood pressure at or above 90
mmHg.

Elevated blood pressure in people less than 50 years old is associated


with an increased cardiovascular risk.

Comparative Standards

Harris-Benedict Equation

66 + (13.7x86.18kg) + (5x72cm) (6.8x54) x 1.75 (Moderately


Active)

Total Calories = 2,169.125.

Fluid

72kg x 30 mL = 2,160 mL or about 9.13 cups

24 Hour Recall
Breakfast
1 container
of Chobani
Greek Yogurt
c Granola
Kind Plus Bar
(Dark
Chocolate
Cherry
Cashew)

Lunch
Steamed
vegetables
Roasted Red
Potatoes

Dinner

Snacks

Rigatoni
Pasta (3 oz)
90% lean
Ground Beef,
cooked (2 oz)

Powerade
Zero (32 fl
oz)
Clif Bar

Applewood
smoked Pork
Tenderloin (2
3oz slices)
Small Apple

Unsweetened
Unsweetened
Black Tea
Black Tea
(18.5 fl oz)
(18.5 fl oz)

Mozzarella
Cheese (1
oz)
No Salt
Added
Marinara
Sauce (.5c)
1 Water
bottle

Chobani
Greek Yogurt
w/ c
granola
100 calorie
Popcorn
(Smart Pop)

Sodium: 1751 mg
Caffeine: 114 mg

24 Hour Recall

Diagnosis

PES Statements:

Increased energy expenditure (NI-1.1) related to the patients self


report of nightly hourly walks and working out three times a week as
evidenced by a loss of 12% lean body mass.

Increased nutrient needs (caffeine) (NI-5.4) related to patients high


blood pressure of 128/84 and previous heart attack as evidenced by
patients 24 hour recall.

Excessive mineral intake (sodium) (NI-5.10.2) related to patients


high blood pressure of 128/84 as evidenced by patients 24 hour
recall.

Adjusted 24 Hour Recall


Breakfast

Lunch

1 container
of Greek
yogurt
c Granola
1 medium
Banana
Egg white
omelet
1 Water
bottle

5 oz of
steamed
Salmon
1 cup Salad
c cooked
Quinoa
c
steamed
broccoli
18.5 oz of
Iced tea

Dinner

Snacks

4 oz of
c granola
whole
wheat pasta
with 1
c mixed
container of
vegetables
Greek
c
yogurt
Granola bar
marinara
1 Small
sauce, low
sodium
apple
1 c salad
1 Water
1 water
bottles
bottle

Total Calories: 2,140


Fluid: 77.2 fl oz (9.65 cups)
Sodium level: 1,520 mg
Caffeine Level: 57 mg

Intervention

Include weight training as a part of gym workout 3x a week

Start out light and gradually increase weight as tolerated

Decrease caffeine intake by replacing iced tea with water

Follow DASH diet to help lower sodium intake

Monitoring &
Evaluation

Check in with patient


monthly to monitor blood
pressure and lean body
mass.

Have patient track sodium


intake and indicate any
troubles

Resources

http://
www.mayoclinic.org/diseases-conditions/high-blood-pressure/exp
ert-answers/blood-pressure/faq-20058543
http://www.world-heart-federation.org/cardiovascular-health/cardi
ovascular-disease-risk-factors/hypertension
/
http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardi
ovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Ar
ticle.jsp
#