Instructions:

Imagine that you are working in a hospital setting as a nutrition educator under the supervision of a Registered Dietitian (RD). On this particular day the supervising dietitian gives you a referral for a new patient that has been admitted into the cardiac care unit. Your task is to be able to summarize the Mr. E's nutritional and clinical status to the supervising dietitian. You will also need to design a realistic meal plan for Mr. E.

Mr. E is a 55 year-old corporate lawyer who was last seen a year ago for a physical examination. At that time he appeared to be in relatively good health. Reported weight is 200 pounds and his height is 5' 10. His blood pressure was 140/85 and total cholesterol was 225 mg/dl. The medical history reveals a history of GERD and occasional constipation. The medication list in his chart does not show any daily prescriptions for the GERD diagnosis. He has no hobbies or outside activities except occasional golf with his friends. His workdays are sometimes long and hectic. During the last check up the doctor advised him to get a daily exercise program and lose 20 lbs. Upon further reading within the referring physician's medical note you see that Mrs. E reports that her husband often chews antacid tablets "like candy" and that he suffers from bouts of constipation that sometimes require the usage of laxatives or enemas that she purchases for him when he becomes "desperate."

From the hospital admission records you were able to gather that three months have passed and that Mr. E collapsed during a meeting at work after a sudden onset of severe chest pain that radiated into his left arm. He was brought to the emergency room pale, frightened, and short of breath. He was cold, sweaty, and vomited shortly after arriving in the emergency room. His nail beds and lips were cyanotic and blood pressure was 100/70.

Mr. E was placed on strict bed rest and a clear liquid diet was ordered after day one and then he was progressed to a full for 2 days. The attending Cardiologist has a standard protocol to progress patients like Mr. E to a low saturated fat, 1200 kcal soft diet the fourth day. You, as the nutrition educator, visited him and reported that his appetite was improving and responding well to the treatment. A regular texture diet was then recommended after you reported your findings to the supervising RD. The MD ordered a 1600 kcal, low-saturated fat, low-cholesterol diet by the end of the week and this diet order was written on the discharge paperwork. The diet
specifications were for cholesterol limited to no more than 300 mg. Daily and total fat was limited to 20% of total kilocalories, with not more than 7% of total calories coming from saturated fats.

Just before discharge, you and the RD met with Mr. E and his wife several times to discuss his home care and dietary regimen. You noticed that the MD did not address the previous GERD and occasional constipation reports. The RD asked you to contact the attending physician's office to get verbal approval for appropriate diet therapy discharge orders that address his heart health, GERD, and constipation. Mr. E showed good general recovery and was willing to continue his new modified food plan, but admitted that his wife would need to be the main source of support and meal preparation.

Respond to the following questions:

1. What is meant by the term "myocardial infarction" and how does it apply to this scenario?

2. What were the predisposing factors in Mr. E's lifestyle that placed him in the high risk category?

3. What were the reasons for modification and progression from liquids to solids and the changes in texture, fats, and total caloric level in each diet prescribed for Mr. E?

4. Explain why it was imperative that you, as the nutrition educator, address his other medical issues when planning the diet that the Cardiologist originally ordered for hearth health promotion.

5. What other advice could you give Mrs. E regarding preparation and shopping for recommended foods on the diet? Be sure to include all aspects of his dietary needs related to the heart healthy aspects as well as the GERD and occasional constipation that requires laxatives/enemas on occasion. If you had time with Mr. E and his wife, what other questions would like to ask about his previous dietary practices and why?

6. Write a sample menu for Mr. E to follow when he arrives home. Show the calorie, total fat, cholesterol, saturated fat, and fiber content and how the food choices meet the guidelines prescribed.