1 Application of DASH Diet to Control Hypertension Student's Name Institutional Affiliation Course Name and Number Instructor's Name Assignment Due Date 2 Application of DASH Diet to Control Hypertension Introduction In the last five decades, in the United States of America, medical personals including Clinicians, Nurses, and other practitioners have seen rising records in diseases such as Coronary artery diseases, Hypertension, obesity, and diabetes diseases. In the United States, 2000 people are estimated to sacrum daily due to heart diseases. It is estimated that about 30% of adults in the United States are suffering from hypertension (Mahmoodabadet al., 2019). Although the hypertension risk factors can be treated; and fully get controlled to the optimum level by the application and utilization of the DASH diet. In the United States, the primary causes of deaths across all ethnicities are obesity and diet chronic diseases related cases. There have been many improvements and scientific technology advancements in the science world with regards to medications and most advanced diagnostic techniques, there have been multiple increases in the rate at which these chronic diseases attach the U.S people. For the last 20 years, the rate of chronic disease contraction has been steep. Due to the increasing trend in such disease contraction. Organizations have all united and started focusing at the most integrative methods for approach to help manage the growing epidemic. The institutions and organizations which have come together to look for integrative approaches include the National Institute of Health, American Heart Association, and the National Heart, Lung, and Blood Institute. Medication of chronic diseases such as hypertension and diagnostic testing are still in the patient management mainstays. Besides, the benefits of stress reduction, body physical exercise, and diet, and lifestyle behavior cannot be neglected. 3 Functions The majority of typical modern Americans, more-so from the northern hemisphere (North America) diet are full of omega-6 fatty acids, saturated fats, artificial additives, and high glycemic load carbohydrates. In tackling chronic diseases, the habit of unhealthy diet in connection to medical professionals with littles knowledge and nutritional training has been determined as a crucial setback in tackling chronic diseases among Americans. Besides, it has been fortunate enough on the scientific research, as there have been tremendous scientific studies carried out in the last ten or so years examining and elaborating dietary patterns effects on chronic diseases. In the early 1990s, there originated Dietary Approaches to Stop Hypertension (DASH) diet. The National Institute of Health (NIH) specifically in 1992 began funding several scientific research projects to investigate the extent of particular dietary interventions effectiveness in treating hypertension (Mahmoodabad et al., 2019). The research subjects used for the investigations followed the dietary interventions as directed but never included any lifestyle modifications to resist any troubling factors that could arise during the investigation period. From the research, it comes out that only the dietary interventions alone could reduce systolic Blood Pressure. (Sookrah et al., 2019). In both normotensive and Hypertensive people, they had shown an effect of decreased risk of being victims of the chronic diseases. Based on the scientific results conducted by different institutions, in some instances, dietary approaches to stop Hypertension have been advocated for. DASH advocating has been on the high rise as the primary therapy pharmacologically in collaboration with lifestyle modification among the people at risk of such disease. 4 The dietary approaches to stop hypertension include the promotion of consumption of fruits and vegetables, dairy products, and lean meat as well as a menu with micronutrient inclusion. The DASH diet also advocates for low or reduced-sodium consumption in the diet. DASH diet also discourages consumption of processed foods as well as the use of fresh food products. Diets promoted by cardiovascular health patients have many similarities with the DASH diets. Its diet is a culmination of the modern and ancient world. Being that it is a scientific-based diet that is following certain ancient principles of diet, toiled is toiled together r to target specific killer diseases of the modern people in the society. The DASH serving guide menu includes; Vegetables, which should be used for serving five times a day. Fruits should be included in the daily diet about five times per day. Carbohydrates to be used for up to about seven servings per day. Low-fat dairy products should be incorporated in the daily meals for about only two servings. Lean meat products should be served for about two or fewer servings per day while nuts and seeds should be served about two to three times per week. Carbohydrate Carbohydrate is mainly composed of cellulose and starches as the diet component. Being that digestion of cellulose cannot take place in the human body digestion system, carbohydrate is present in plants fiber. Healthy starches are important in the human diet because they contain vital nutrients for energy supply as well as providing protective micronutrients for the healthy human lifestyle. Low carb diets may lead to reduced intake of caloric than recommended for patient body intake of unhealthy fats as a substitute, hence a low carb diet is unhealthy. Under DASH diet regulations, carbohydrates recommended include; low glycemic index fruits, 5 vegetable (green leafy vegetables) like kales, broccoli, spinach, collards, and mustards among other selected vegetables. Whole grains like millets and oats and legumes, and beans. Fats In the development of chronic diseases, fats have been a prime factor for suspicion in the past however scientific researches have proved otherwise currents fats are classified hence distancing food fats and bad fats. Food fats are important in inflammation preventions; it also provides essential fatty acids as well as helping to promote general body health. Consumption of such fats with moderation is vital as it leads to improved HDL and reduction of small heavy or dense LDL particles. Sources of good fats included in the DASH diet are; olive oil, fax seeds, hemp seeds, nuts, avocados, and fish rich in omega-3 fatty acids. Besides, the DASH diet also excluded certain fat like margarine, vegetable shortening, and partially hydrogenated vegetable oils as bad oils. Such bad fats are prone to increasing small LDL particles, small LDL particles promote atherogenesis when included in the human diet and consumed. Due to the high condensed source of energy, fats should be consumed in moderation. Fats should be served in small sizes as compared to other commonest of DASH recommendations consumable nutrients. Proteins According to the DASH recommendations, plant proteins should be the main component of the consumed proteins which includes legumes, seeds, nuts, and soy products. As per DASH recommended, animal proteins should include eggs, fish, lean meats, and low-fat dairy. The nonrecommendable protein as per DASH regulations includes all processed and cured meats because they have shown an effect of hypertension increases and also they contain carcinogens. Foods that are rich in potassium, calcium, and magnesium are also recommended by the DASH diet as 6 these food products prevent endothelial dysfunction and they also promote endothelial and smooth muscle relaxation. Spinach, oranges, and banana are among food rich in potassium. Dairy products and vegetables (green leafy in color) are calcium-rich food products. Magnesium is in food like whole grains, leafy vegetables, seeds, and nuts. Clinical Benefits According to scientific research studies, it has been proved that the DASH diet lowers blood glucose levels, insulin resistance, LDL-C, and triglycerides. From the research, it has shown that the DASH diet is a very crucial adjunct to pharmacological therapy in primary epidemic such as metabolic syndromes in the United States of America and some parts of the world. DASH diet has been also been a tool significant for bodyweight management. DASH diet has been very vital for certain populations for improvement in control of diabetes (type2 diabetes) (Mahmoodabad et al., 2019). For patients with heart failure problems, the DASH diet is preferred due to its emphasis on the sodium consumption dietary and also consumption of more calcium, potassium, and magnesium encouragement as part of the diet by patients. The use of dietary guidelines of DASH diet has been resulted to regulate colorectal cancer incidence mainly in the populations of white individuals. It is also helpful in chronic liver diseases, celiac diseases, and diverticular disease to some extent. All-cause of adults’ mortality is reducible by the implementation of the DASH diet. It is also important in the victims to the chronic heart failure preventions as well as heart failure management. According to the research studies, the DASH diet has been shown to lower rates of incidences of heart failure in people especially women as well as it also reduces the prevalence of hospitalization for heart failure and men’s death. Patients suffering from diabetes mellitus type 2 have shown great improvement 7 when using the dash diet for lowering blood pressure. The patients suffering from diabetes mellitus have the mandate to advocate for adequate blood pressure control. From the research studies about the DASH diet, it is recommendable that DASH dietary implementation is physicians’ crucial tool for tackling chronic diseases in the best intervention possible. DSAH diet has more advantages when compared with other diet recommendations as it has well-elaborated regulations on the serving food groups and sizes which make it simple for physicians to prescribe as well as monitoring patients’ improvement (Pourmand et al., 2020). Conclusion For hypertension control, the DASH diet, a nutritional-based approach has proved to be relevant in the prevention and controls of hypertension. The DASH diet has also shown lower cholesterol blood pressure and saturated fats. Due to that, the recommendation for DASH diet as the best diet for individuals who minds to reduce and maintain a healthy weight and the people who want to lower their blood pressure. The DASH diet should be advocated for to the people who face dietary challenges and be promoted to patients. Though physicians, both pharmacists and nurses play a crucial role in patients’ education on the benefits of the DASH diet. The DASH diet system is more about lifestyle change and healthy eating ways adoptions. Through the DASH approach, patients are advised to regulate the use of some drugs, stop smoking and abstain from taking alcohol, besides doing somebody's physical activities on a daily or regular basis. The diet system also lowers the risk of adverse cardiac events, type 2 diabetes, obesity, and stroke. 8 References Mahmoodabad, S. S. M., Dashti, S., Salehi-Abargouei, A., Fallahzadeh, H., & Soltani, M. H. (2019). The rate of compliance of prehypertension individuals from dietary approaches to stop hypertension (DASH): an application of the theory of planned behavior. Annals of Medical and Health Sciences Research, 9(1). Sookrah, R., Dhowtal, J. D., & Nagowah, S. D. (2019, July). A DASH diet recommendation system for hypertensive patients using machine learning. In 2019 7th International Conference on Information and Communication Technology (ICoICT) (pp. 1-6). IEEE. Mahmoodabad, S. S. M., Dashti, S., Salehi-Abargouei2&3, A., Fallahzadeh, H., & Soltani, M. H. (2019). Determinants of Dietary Approaches to Stop Hypertension (DASH) among Prehypertension Individuals: An Application of Protection Motivation Theory. Pourmand, G., Doshmangir, L., Ahmadi, A., Noori, M., Rezaeifar, A., Mashhadi, R., ... & Gordeev, V. S. (2020). An application of the theory of planned behavior to self-care in patients with hypertension. BMC Public Health, 20(1), 1-8. 9 . STA . . SUMMARY Cardiovascular disease consists of a group of diseases and conditions that affect the heart and blood vessels; they include CAD, HTN, PAD, CHF, and CHD. • CVD risk factors are categorized into three groups: con- trollable, noncontrollable, and predisposing. Controllable or lifestyle factors include tobacco use, diet, and physical inactivity. Noncontrollable factors are gender, age, and family history. Predisposing conditions may be diabetes mellitus, hyper- tension, obesity, and dyslipidemia. Atherosclerosis is the chronic inflammatory development of lesions in coronary arteries that can lead to arterioscle- rosis, angina pectoris, or myocardial infarction. • If thrombosis occurs in a cerebral artery, a cerebrovascular accident or hemorrhagic stroke occurs. CAD risk is assessed through measurement of the total blood cholesterol and the proportions of the different types of lipoproteins that carry cholesterol in the blood. Plasma lipoproteins are synthesized in the liver; contain varying amounts of triglycerides, cholesterol, phospholip- ids, and proteins; and are classified according to composi- tion and density. Kinds of plasma lipoproteins: chylomicrons, high-density lipoproteins (HDLs), low-density lipoproteins (LDLs), and very low-density lipoproteins (VLDLs). Lowering total cholesterol and LDL cholesterol can be achieved by dietary intervention, including weight loss and exercise. Goals of nutrition therapy are to reduce total fat, saturated fat, trans fatty acids, and cholesterol intake in an attempt to reduce plasma total cholesterol, LDL cholesterol, and triglyceride levels. HTN for which the cause is not known is called primary or essential HTN. In secondary HTN, the cause of elevated blood pressure can be identified. Prescribed treatment regimens for HTN are individual- ized and vary because the disease differs in its degree of severity. First line of treatment is usually nonpharmacologic, or focused on lifestyle modifications. Weight reduction and sodium restriction augment antihy- pertensive medications. MIs are the single largest killer of adults in the United States. The purpose of nutrition therapy in patients who have experienced them is to reduce the workload of the heart. CAD, lung disease, complications of hypothyroidism, or damage to the myocardial or cardiac muscle can cause cardiac failure. HF is characterized by decreased blood flow to the kidneys and retention of sodium and fluid. Patients with HF often experience edema of the feet and ankles and shortness of breath. To lessen the workload of the heart, also desirable in HF, nutrition therapy focuses on restricting dietary sodium. Bho Pulmonary disease is characterized by wasting and malnu- trition, largely due to the effect of the disorder or the secondary consequences of treatment on the GI tract. Two categories of pulmonary disorders cause either chronic changes in pulmonary function, such as COPD and cystic fibrosis, or acute changes in pulmonary func- tion, such as RDS and ARF. The goal of nutrition therapy for COPD is to maintain respiratory muscle strength and function while preventing or treating existing malnutrition. As pulmonary disorders progress, nutritional status tends to decline and malnutrition exacerbates, reducing respira- tory muscle function and ventilatory drive. ARF and RDS may develop in patients who are critically ill, in shock, or severely injured, or have sepsis. For ARF and RDS, the function of nutrition therapy is to inhibit tissue destruction by providing the extra nutrients required for hypermetabolic conditions. Malnutrition and the method of refeeding influence the outcome in pulmonary disease or respiratory failure. Cystic fibrosis, tuberculosis, asthma, and related pulmo- nary disorders warrant regularly scheduled contact with a registered dietitian, especially patients at high risk for mal- nutrition and those with multiple disorders. . O THE NURSING APPROACH Case Study: Hypertension and Heart Failure The home health nurse visited Reba, a 70-year-old African American woman who had been diagnosed with heart failure and hypertension. Lab tests revealed elevated triglycerides, cholesterol, and LDL cholesterol. The nurse had first become acquainted with Reba when Reba was discharged from the hospital after an acute episode of pulmonary edema. The physi- cian advised Reba to begin a walking program, starting slowly. The physician prescribed a 2-gram-sodium, low-fat, low-calorie diet. Several medications had been prescribed, including digoxin, a diuretic, and a vasodilator. In a previous visit, the nurse instructed Reba to monitor her pulse and blood pressure daily, and to weigh herself daily. The purpose of this follow-up visit was to determine the patient's compliance with the treat- ment plan and to assess her current health status. binola CHAPTER 17 Nutrition for Cardiopulmonary Diseases 381 THE NURSING APPROACH-cont'd Assessment almost every day." Subjective (from Patient Statements) • "Sometimes I forget whether I have taken my medicines." "I've kept a record of my pulse, blood pressure, and weight "Today I weighed 2 pounds more than I did when I was in "I feel really tired. I get short of breath when I climb stairs (dyspnea). I haven't been going for walks." . "I have trouble breathing when I lie down at night" the hospital." (orthopnea). usually warm up a can of soup or a frozen dinner because I am too tired to cook. I like it when my granddaughter brings me cake and doughnuts. . . Objective (from Physical Examination) Height 5 feet 8 inches, weight 182 pounds with truncal obesity Blood pressure 162/85 mm Hg, temperature 98°F, pulse 92 irregular, respirations 18, unlabored • Lung sounds clear • Pitting edema in ankles • Jugular venous distention Diagnoses (Nursing) 1. Excess fluid volume related to decreased cardiac output and excess sodium intake as evidenced by blood pressure 162/85, pitting edema of ankles, jugular venous distention, weight 2 pounds higher than during hospitalization 2. Decreased cardiac output related to hypertension, weak- ened cardiac muscles, and obesity as evidenced by pulse 92 irregular, fatigue, shortness of breath with activity, and orthopnea Implementation 1. Measured vital signs, reviewed the log that Reba had recorded, and praised Reba for her conscientious efforts. Vital signs help determine the effectiveness of treatments for heart failure and hypertension. Praise often motivates a patient to continue positive behaviors. a. Asked Reba to demonstrate how she takes her pulse and blood pressure, using her home blood pressure monitor- ing equipment b. Compared Reba's results with the nurse's. In order to look for valid trends in results, accuracy of measurement technique is needed 2. Reviewed Reba's record of daily weights and explained how weight increases with excessive sodium intake. a. Taught Reba that sodium causes the body to retain fluid, contributing to weight gain, edema, and dyspnea (diffi- culty breathing). b. Showed Reba how to read labels and choose soups and frozen dinners that are lower in sodium. c. Gave her a list of foods that are high in sodium and thus should be limited or avoided. d. Told her about herbs that can be used in place of salt to flavor food. Patients are more likely to comply with nutrition therapy if they understand the reasons for restrictions and are given practical suggestions as to how to adhere to guidelines 3. Taught Reba guidelines for making healthy food choices based on fat and calories. a. Recommended eating fish and chicken instead of red meat as well as increasing whole grains, fruits and veg etables, and skim milk (with lactase if needed). Omega-3 fatty acids from fish may reduce clot formation, reducing the risk of coronary occlusion. Red meat is a source of cholesterol. Soluble fiber can help reduce LDL cholesterol levels. Lactase additives can be added to milk if necessary because many African Americans have lactose intolerance. b. Explained that low-fat, low-cholesterol foods help mini- mize fatty deposits in the blood vessels and heart. A decrease in saturated fats, cholesterol, and trans fats minimizes formation of atherosclerosis. c. Recommended nutritious low-calorie foods to help Reba lose weight and thus decrease the workload of the heart Obesity increases peripheral resistance and cardiac workload. Reducing high-fat desserts can help with weight loss and reduction of lipid levels. 11. Referred Reba to the American Heart Association for addi- tional information and simple recipes. 12. Recommended small, frequent meals rather than large meals, with rest periods before meal preparation and eating Small meals require less energy for eating and digesting food. Rest periods can reduce oxygen consumption, relieve shortness of breath and fatigue, and help increase appetite 5. Asked Reba to show the nurse her medications, and recom- mended placing medications in a small weekly organizer. Planning Patient Outcomes Short term (at the end of this visit): • Reba will agree to meet with a dietitian to learn about an individualized nutrition plan and healthy food choices. • She will commit to read labels and choose foods lower in sodium and fat. • She will plan to obtain a small medicine organizer. Long term (at follow-up visit in 1 month): • Weight 178 pounds; blood pressure 140/85 . Edema absent or nonpitting, lungs clear • Reports less fatigue; walking short distances regularly Electrolyte values within normal range and lipid levels reduced . Nursing Interventions 1. Check Reba's home records of blood pressure, pulse, and weight. 2. Teach her about general dietary measures to reduce her edema. 3. Set up an appointinent with a dietitian for an individualized plan. 4. Review her medications and teach her when to notify the doctor Continued 382 PART FOUR Overview of Nutrition Therapy AHS THE NURSING APPROACH-cont'd A gain of 1 kg of weight (2.2 pounds) could indicate reten- tion of 1 L of fluid. Hypertension may lead to a stroke, so medications may need to be adjusted. 8. Set up an appointment with a dietitian for an individualized nutrition plan. Because the diet combines several components, it could be confusing to the patient. The DASH (Dietary Approaches to Stop Hypertension) diet focuses on low sodium. The TLC (Therapeutic Lifestyle Changes) diet and low-calorie diets focus on low fat. 9. Encouraged her to begin a walking program for 10 minutes each day, as approved by the doctor. Regular exercise strengthens cardiac muscle and increases peripheral vascular blood flow. It also helps with weight reduction Small medicine holders may designate the days of the week, alerting the patient to whether medicine has been taken on a particular day. a. Asked Reba to tell the nurse the purpose of each medi- cine and when each should be taken. Verifying a patient's understanding of prescribed medica- tions is important for safety and effectiveness b. Informed Reba about special precautions needed when taking her medications. Digoxin increases stroke volume by strengthening cardiac muscles, but if doses are excessive, nausea and vomiting may occur, and the pulse rate may drop too low. The patient should withhold the medicine if the pulse is below 60. Diuretics promote loss of sodium and fluid but may also waste potassium. Frequent lab tests are neces- sary to determine digoxin and potassium levels. Vasodila- tors decrease peripheral resistance, but they can produce orthostatic hypotension. Patients should be advised to rise slowly from bed to avoid becoming dizzy. 6. Drew blood for the lab to check digoxin and electrolyte levels. Told Reba that she may need to eat more foods high in potassium because of the diuretic she was taking. Some diuretics waste potassium, but other medicines may conserve potassium. Electrolytes need to be checked regu- larly because there is danger of death if the potassium levels are too high or too low. Low potassium contributes to digoxin toxicity, so a potassium supplement may be prescribed. Foods high in potassium include fruits (espe- cially bananas and citrus), vegetables (especially green leafy), dairy products, meats, and legumes. 7. Instructed Reba regarding when to call the doctor-for example, when she gains 3 pounds or more in 2 days, when she has difficulty breathing, and when edema gets worse. Also, she should call if her blood pressure is 180/90 or higher and/or her pulse is below 60. Evaluation Short term (at the end of the visit): • Reba agreed to meet with a dietitian. • She said she would read labels and choose foods lower in sodium and fat. • She planned to ask her granddaughter to buy a small medi- cine organizer at the drugstore for her. • Reba made an appointment with the nurse for a visit in 1 month Goals met Discussion Questions 1. Compare and contrast the basic principles of the TLC diet and the DASH diet. 2. Trans fats increase LDL levels and decrease HDL cholesterol levels, so they should be restricted. Which foods are likely to contain trans fats and thus should be avoided? CRITICAL THINKING Clinical Applications Kevin, age 69, is admitted to the coronary care unit of your hospital. He is 6 feet tall, has a medium frame, and weighs 210 pounds. He has gained 30 pounds since he retired 4 years ago, which he attributes to boredom and lack of exercise. Three months before admission, Kevin began to experience chest pain that radiated up his neck and down to his stomach. He has a history of hypertension and elevated serum choles- terol levels. After admission to the hospital, Kevin is diag- nosed with having had an acute myocardial infarction. Test results for serum lipids are as follows: Cholesterol: 300 mg/dL LDL-c cholesterol: 200 mg/dL HDL-c cholesterol: 30 mg/dL Triglycerides: 600 mg/dL Medications prescribed after admission: atenolol (Tenor- min), diltiazem (Cardizem), nitroglycerin Diet order: TLC diet 1. What are the risk factors for cardiovascular disease? 2. What are Kevin's risk factors? 3. Define the term myocardial infarction and describe what happens when a myocardial infarction occurs. 4. What specific guidelines are included in the National Cholesterol Education Program's (NCEP) TLC diet recommendations? While caring for Kevin you learn that he snacks on high- fat cheeses, ice cream, potato chips, corn chips, peanuts, and crackers. He also drinks whole milk and eats a lot of butter on his bread at every meal. What characteristics of Kevin's intake contradict the NCEP's TLC diet recommendations? What are some alternative foods that are appealing to Kevin that he could eat for snacks? WEBSITES OF INTEREST American Heart Association (AHA) www.americanheart.org Conta resources, interactive educational materials, and everyday strategies and support for prevention and treatment of heart disease and stroke.
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