Nutrition Therapy for Cardiovascular Diseases

Atherosclerosis
Meaning
Atherosclerosis is the hardening of the arteries. It refers to the thickening of the inside walls of the blood vessels.
It is caused by the accumulation of fatty materials including a high proportion of cholesterol as well as other substances.
Atherosclerosis is the most common cause of heart attacks. Those who are most susceptible to this condition and
to other heart diseases are the following:
1. Male between ages 45 and 64 years
2. Overweight persons
3. Diabetics
4. Persons with high blood pressure
5. Persons consuming a diet high in saturated fat
6. Persons with high cholesterol levels
7. Persons whose family has a history of heart and blood vessel diseases
8. Sedentary individuals
9. Persons who have much tension, frustration, and stress
10. Heavy smokers

Signs and symptoms

● Chest pain or pressure (angina)
● Sudden arm or leg weakness or numbness
● Slurred speech or difficulty speaking
● Brief loss of vision in one eye
● Drooping facial muscles
● Pain when walking
● High blood pressure
● Kidney failure

Characteristics of diet/Diet therapy

1. Low-fat diet, low in saturated fat and cholesterol
2. Increase in monounsaturated fatty acids to lower plasma total cholesterol and LDL cholesterol levels
3. Increase in polyunsaturated fats, the omega-6 and omega-3 fatty acids at least 2 servings per week to decrease
plasma cholesterol levels
4. A total of 300 mg cholesterol intake per day
5. Increase in complex carbohydrate intake and restriction of simple sugars
6. Dietary fiber - 25 – 30 g/day
7. Restriction of calories to 1200 - 1600 for women and 2000 - 2500 for men.
Micronutrients and Macronutrients needed
A healthy diet rich in nutrient-dense foods may help reduce the risk of developing clogged arteries. Research has
shown that adding foods like cruciferous vegetables, fish, berries, olive oil, oats, onions, greens, and beans to their diet
may be an effective way to prevent atherosclerosis.

Food Preparation
A healthy diet rich in nutrient-dense foods may help reduce your risk of developing clogged arteries. Research has
shown that adding foods like cruciferous vegetables, fish, berries, olive oil, oats, onions, greens, and beans to your diet
may be an effective way to prevent atherosclerosis.

Treatment
Drugs and diet

Complete 24-hour meal pattern/menu plan

Nursing Care Plan

Congestive heart failure (CHF)

Definition
Congestive heart failure (CHF) or cardiac failure is circulatory congestion resulting in the heart’s inability to
maintain adequate blood supply to meet the oxygen demands.
Heart failure is characterized by shortness of breath (dyspnea)and abnormal fluid retention, which usually results
in swelling (edema) of the feet and legs.

Signs and symptoms

● Shortness of breath with activity or when lying down.
● Fatigue and weakness.
● Swelling in the legs, ankles and feet.
● Rapid or irregular heartbeat.
● Reduced ability to exercise.
● Persistent cough or wheezing with white or pink blood-tinged mucus.
● Swelling of the belly area (abdomen)

Diet therapy
1. Sodium-restricted diet is used for the prevention, control, and elimination of edema.
a. Mild restriction (2-3 g Na)
 b. Moderate restriction (1,000 mg Na)
c. Strict restriction (500 mg Na)
d. Severe restriction (250 mg Na)
2. Calorie control is applied to reduce the work of the heart.
3. Texture control is applied in acute stages to aid in digestion.
4. Caffeine should be limited.

Micronutrients and Macronutrients needed

Micronutrients (including coenzyme Q10, zinc, copper, selenium and iron) are required to efficiently convert
macronutrients to ATP. (DI PA TAPOS)

Food Preparation
Choosing foods that are low in salt, such as fresh meats, poultry, fish, dry and fresh legumes, eggs, milk and
yogurt. Plain rice, pasta and oatmeal are good low-sodium choices. However, the sodium content can increase if salt or
other high-sodium ingredients are added during their preparation.

Treatment
Medicines are the main treatment for heart failure, but for some people surgery may help. Operations that can
help with heart failure include: heart valve surgery.

Complete 24-hour meal pattern/menu plan

Nursing Care Plan

Hypertension
Definition
Hypertension is also known as high blood pressure. Having blood pressure measures consistently above normal
may result in a diagnosis of high blood pressure (or hypertension). It is common among males rather than females, 55
years and below.

Signs and Symptoms

● Blurry or double vision.
● Lightheadedness/Fainting.
● Fatigue.
● Headache.
● Heart palpitations.
● Nosebleeds.
 ● Shortness of breath.
● Nausea and/or vomiting.

Diet therapy
1. A mild restriction of sodium and occasionally a 1000 mg Na diet may be ordered.
2. Weight reduction may facilitate the lowering of blood pressure.
3. Low-fat diet with emphasis on unsaturated oils is recommended.

Micronutrients and Macronutrients needed

Food Preparation
● Eating more fruits, vegetables, and low-fat dairy foods.
● Cut back on foods that are high in saturated fat, cholesterol, and trans fats.
● Eating more whole-grain foods, fish, poultry, and nuts.
● Limit sodium, sweets, sugary drinks, and red meats.

Treatment
Lifestyle modifications, nutritional therapy

Complete 24-hour meal pattern/menu plan

Nursing Care Plan

Myocardial infarction (MI)

Definition
Myocardial infarction (MI) or heart attack, results from atherosclerosis of the coronary arteries. This happens
when one or more areas of the heart muscle don't get enough oxygen. This happens when blood flow to the heart muscle
is blocked.

Signs and Symptoms

● Chest pain or discomfort
● Shortness of breath
● Pain or discomfort in the jaw, neck, back, arm, or shoulder
● Feeling nauseous, light-headed, or unusually tired.
Diet therapy
1. Liquid diet on the initial stages and as the condition improves, progresses to foods of regular consistency
2. Small, frequent meals
3. Restriction on caffeine-containing beverages to avoid myocardial stimulation
4. Sodium, cholesterol, fat, and calorie restriction
5. Consumption of omega-3 fatty acid-rich foods to reduce blood clots

Micronutrients and Macronutrients needed

macronutrients include plant protein and fiber
coenzyme Q10, thiamine, riboflavin, L-carnitine, and taurine (DI PA TAPOS)

Food Preparation
Focus on vegetables, fruits, beans, nuts, and seeds for the vitamin, mineral, and fiber content. Choose healthier
fats such as extra virgin olive oil, nuts, and avocado. Avoid fried foods and animal fats. Include whole grains. A diet low
in saturated fats and high in fiber and plant foods can substantially reduce the risk of developing heart disease.

Treatment
Reduced workload of the heart

Complete 24-hour meal pattern/menu plan

Nursing Care Plan

Nutrition Therapy for Diseases of the Kidneys

Acute glomerulonephritis
Definition
Acute glomerulonephritis may be a deferred hypersensitivity reaction initiated by infectious agents related with
tonsillitis or scarlet fever or is a consequence when an antigen-antibody complex reaction in which some of the complexes
become ensnared in the glomeruli leads to swelling.

Signs and Symptoms

● Pink or cola-colored urine from red blood cells in your urine (hematuria)
● Foamy or bubbly urine due to excess protein in the urine (proteinuria)
● High blood pressure (hypertension)
● Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen.
 ● Urinating less than usual.
● Nausea and vomiting.

Treatment
Nutritional therapy

Diet Therapy
1. Usually a short-term condition so overall nutrition is of greater concern with adequate rather than restricted
protein
2. No sodium restriction unless edema is seen
3. High-calorie diet chiefly from carbohydrates and fat to spare tissues from being used as an energy source

Micronutrients and Macronutrients needed

Food Preparation

Treatment

Complete 24-hour meal pattern/menu plan

Nursing Care Plan

Nephrotic syndrome
Nephrotic syndrome describes a composite of symptoms that can occur as a result of injury to the capillary walls
of the glomerulus. It is characterized by massive loss of protein in the blood and edema.

Treatment
Nutritional therapy

Diet therapy
1. Diet high in protein, 100 - 150 g daily
2. High calorie intake to spare proteins for tissue synthesis and to provide energy
3. Sodium restriction (500 mg)
Acute renal failure (ARF)
Acute renal failure (ARF) is a sudden decline of kidney function or abrupt loss of kidney function.
Three phases of ARF:
1. Oliguric phase - this phase lasts from 24 hours to 3 weeks
2. Diuretic phase - this phase lasts from 2 - 3 weeks
3. Recovery phase - this phase lasts from 3 - 12 months

Micronutrients and Macronutrients needed

Food Preparation

Treatment

Complete 24-hour meal pattern/menu plan

Nursing Care Plan

Chronic renal failure (CRF)

Chronic Renal Failure (CSF) is the decline of kidney function.

Treatment
Diuretics, nutritional therapy

Diet therapy
1. Protein low to moderate according to tolerance: 30 - 50 g
2. Carbohydrates relatively high for every: 300 - 400 g
3. Fat relatively moderate 70 - 90 g
4. Calories adequate for maintenance to prevent tissue breakdown: 2000 - 2500 g daily
5. Sodium control according to serum levels and excretion capacities varying from 1300 - 1900 mg
6. Potassium control according to excretion about 800 - 1000 mL; careful intake-output records vital
Renal Calculi (Urolithiasis)
Renal calculi (Urolithiasis) is the formation of renal or urinary calculi in the urine that precipitate as stones in the
urinary passages.

Treatment
Nutritional therapy

Diet therapy
1. Fluid intake - large fluid intake to dilute urine and help prevent concentration of stone constituents
2. Urinary pH - an attempt to control the solubility factor by increased acidity or alkalinity, depending on the
composition of the stones formed
3. Stone composition - reduction of material composing the stone

Diet according to Type of Stone

a. Calcium oxalate stones - potassium-rich foods and water are increased.
b. Uric acid stones - protein is limited to 58 - 67 g/day with emphasis on milk, fruits, and decreased intake of
bread products.
c. Cystine stones - high fluid intake is recommended.

Renal Surgery
a. Post-operative nutritional needs
1. Protein - increased protein caused by protein losses and catabolic period recovery and tissue recovery and
tissue healing; a period of negative nitrogen balance initially
2. Calories - adequate amount to supply energy and spare proteins for tissue building
3. Water - adequate fluid therapy to avoid dehydration caused by large fluid losses
4. Minerals - replacement of deficiencies and assurance of continued adequacy essential to maintain
electrolyte balance.
5. Vitamins - Vitamin C especially needed for tissue synthesis and wound healing; B-complex vitamins
essential in energy production and tissue-building
b. Dietary Management
1. Initial IV therapy - for water and electrolytes, but oral intake needed as soon as possible for adequate nutrition
2. Hyperalimentation - parenteral nutrition of high nutrient density to avoid thrombosis in peripheral veins
3. Post-operative diet - liquid, soft, to full diet as soon as possible to supply nutritive demands

Special Gastrointestinal Surgery

a. Mouth, throat or neck surgery - oral liquid feeding tube feedings, either blenderized food mixtures or special
formula preparations
b. Gastric resection
 1. Immediate postoperative period - gradual build-up of foods a few at a time until until tolerance is
established
2. “Later-dumping syndrome” may develop, rapid food passage draws water from surrounding blood volume
causing shock symptoms
3. Cholecystectomy - low fat following surgery which avoids pain from constriction at wound site; general
voidance of heavy fat intake on a continuing basis
4. Ileostomy and colostomy - initial period of reduced residue diet to be indicated, but return to regular full
diet as soon as possible for both nutritional and psychological reasons
5. Rectal surgery - non-residue diet given immediately; then low-residue diet given as needed with return to
full diet as soon as possible

Burns
a. Immediate shock period - days 1 to 3
1. Initial fluid and electrolyte problems, massive flooding edema at burn site pulling water from other parts of
the body, as well as protein loss and electrolyte loss (sodium); potassium drawn from cells to replace
sodium loss with rising serum levels of potassium
2. Immediate parenteral - protein through blood or plasma expander (dextran), sodium and chloride
replacement through lactated Ringer’s solution, water (dextrose solution) to cover losses
b. Recovery period - dyas 3 to 5
1. As fluid and electrolytes are reabsorbed, pattern shifts and sudden diuresis follows.
2. Oral liquid solutions may not be tolerated
c. Secondary feeding period - days 6 to 15
1. Critical nutrition stage tissue regeneration, turning from initial catabolic period of negative nitrogen balance
to an active tissue rebuilding stage
2. Diet therapy - high protein (150 - 400 g) with protein supplements, high calorie (3500 - 5000), high
vitamins especially for wound healing and B-complex vitamins for energy and protein metabolism; record
keeping of intake vital to ensure meeting the high-nutrient requirements
d. Follow-up reconstruction period - from second week on
1. Grafting and plastic surgery - continued optimum nutrition
2. Rehabilitation period - rebuilding the patient both physically and emotionally