Bridgitte Carroll

KNH 413

Gretchen Matuszak

24 April 2014

2 g Sodium Diet

  1. Purpose
  2. To help decrease high blood pressure
  3. High sodium intakes will cause fluid retention and vasoconstriction, increasing BP
  4. Population
  5. Assign diet to hypertensive patients, BP > 140/80
  6. 5% of population is affected by a high sodium intake that will increase their BP
  7. General Guidelines
  8. 2 g Sodium per day
  9. Should be paired with a weight loss plan to increase success of blood pressure reduction
  10. Can also use DASH diet, which incorporates fresh fruits and vegetables, whole grains and has a 2,300 mg sodium intake
  11. Aim to decrease blood pressure

Meal / 24-hour recall / Substitutions/Suggestions
Breakfast / 2 Scrambled Eggs with Veggies
Hot Sauce / Eliminate or use Cayenne Pepper in eggs
2 Slices of Bacon
Orange Juice
Lunch / Tomato Soup / Low-sodium variety
Grilled Cheese –
1 whole wheat English muffin / 2 slices of lower sodium whole wheat bread
Kraft American Cheese / Natural Cheese
Milk
Snack / Pretzels / Unsalted nuts or crackers
Dinner / Corn Tortillas
Chicken prepared with season salt / Prepare with Mrs. Dash
Salsa & Hot Sauce / Use Mrs. Dash to flavor, use fresh tomatoes more than salsa
Corn, canned / No salt added variety
Black beans, canned / No salt added variety, wash thoroughly
  1. Education Material
  2. Educate on lower sodium options and substitutions
  3. Mrs. Dash and spices to liven up food instead of salt
  4. Teach patient how to read labels to determine amount of sodium and if it is high/low sodium option

Tips for Reducing Sodium in Your Diet

  • Buy fresh, plain frozen, or canned "with no salt added" vegetables.
  • Use fresh poultry, fish, and lean meat, rather than canned or processed types.
  • Use herbs, spices, and salt-free seasoning blends in cooking and at the table.
  • Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.
  • Choose "convenience" foods that are lower in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings — these often have a lot of sodium.
  • Rinse canned foods, such as tuna, to remove some sodium.
  • When available, buy low- or reduced-sodium, or no-salt-added versions of foods.
  • Choose ready-to-eat breakfast cereals that are lower in sodium.

Top 10 Sources of Sodium in the American Diet

  1. Bread and rolls
  2. Cold cuts/cured meats
  3. Pizza
  4. Fresh and processed poultry
  5. Soups
  6. Sandwiches like cheeseburgers
  7. Cheese
  8. Pasta dishes like spaghetti with meat sauce
  9. Meat dishes like meatloaf with tomato sauce
  10. Snacks, including chips, pretzels, popcorn and puffs
  1. Samples Menu
  2. Foods Recommended – Low- or reduced-sodium, or no-salt-added versions of foods such as soup and vegetables, spices, lower sodium ready to eat breakfast cereals and frozen dinners, natural cheeses, lower sodium breads
  3. Foods Avoided – Condiments, processed cheeses, high sodium breads and rolls, cold cuts/cured meats, high sodium snacks like pretzels and chips
  4. Sample Menu

Breakfast / 1 cup fresh mixed fruits, such as melons, banana, apple and berries, topped with 1 cup fat-free, low-calorie vanilla-flavored yogurt and 1/3 cup walnuts
1 bran muffin
1 teaspoon trans-free margarine
1 cup fat-free milk
Herbal tea
Lunch / Curried chicken wrap made with:
  • 1 medium whole-wheat tortilla
  • 2/3 cup cooked, chopped chicken, about 3 ounces
  • 1/2 cup chopped apple
  • 2 tablespoons fat-free mayonnaise*
  • 1/2 teaspoon curry powder
1/2 cup, or about 8, raw baby carrots
1 cup fat-free milk
Dinner / 1 cup cooked whole-wheat spaghetti with 1 cup marinara sauce, no added salt
2 cups mixed salad greens
1 tablespoon low-fat Caesar dressing
1 whole-wheat roll
1 teaspoon trans-free margarine
1 nectarine
Sparkling water
Snack (anytime) / Trail mix made with:
  • 1/4 cup raisins
  • 1 ounce, or about 22, unsalted mini twist pretzels
  • 2 tablespoons sunflower seeds

  1. (N.A., 2011)
  1. Websites
  2. American Heart Association –
  3. Mayo Clinic – Hypertension
  4. National Heart, Lung and Blood Institute -
  5. Academy of Nutrition and Dietetics -

References

Mayo Clinic Staff.(2012) Hypertension. Mayo Clinic. Retrieved from:

Nelms, M., Sucher, K. P., Lacey, K., & Long Roth, S. (2011).Nutrition therapy & pathophysiology.(2nd ed. ed.). Belmont, CA: Wadsworth, Cengage Learning.

Carolyn Klempay

KNH 413

Diet Instruction

1 gram Sodium Diet

Patient History:

Darla is a 42-yr old wife and mother of three. She loves to cook and enjoys trying new foods and recipes in the kitchen as she cooks meals for her entire family. Darla works full-time, volunteers with her local church, and attends many games and recitals for her children who play soccer and instruments in the school band. With such a full household and hectic schedule, Darla spends all of her time caring for others and has sacrificed her own well-being in the process. With little time to exercise or focus on her own health, she is 5’2” and weighs 160 lbs (72.7kg). Recently Darla went to her doctor’s office and was told she was pre-hypertensive. The doctor said she should meet with a dietitian and ask specifically how to decrease her salt intake.

BMI = wt (kg) / ht2 (m2)

BMI = 72.7 kg / (1.57m)2

BMI = 72.7/2.46

BMI = 29.5 kg/m2

24-hour Dietary Recall:

Breakfast / 2 eggs over-medium with salt and pepper, 2 slices bacon, one medium plain bagel with butter
Lunch / Deli sliced ham sandwich on white bread, Provolone cheese, lettuce, and mustard. 1 medium pickle slice
Dinner / Spaghetti with pork sausage, Parmesan cheese, Italian bread, creamed corn, salad with Italian dressing
Snack / Pretzels with 2 Tbsp peanut butter

24-hour Dietary Recall Analysis:

Food Item / Sodium Content (mg)
2 eggs / 140
1/16 tsp table salt / 145
2 slices bacon / 300
1 medium plain bagel / 400
1 Tbsp salted butter / 80
2 slices white bread / 340
1 oz deli ham / 750
1 oz low-fat provolone cheese / 250
Lettuce / 0
1 tsp mustard / 55
1 medium pickle slice / 370
3 oz Spaghetti pasta with ¼ cup sauce / 300
2 oz pork sausage / 400
1 Tbsp Parmesan cheese / 75
1 slice Italian bread / 120
½ cup creamed corn / 365
Salad with 1 Tbsp Italian dressing / 242
1 oz pretzels / 400
2 Tbsp peanut butter / 150
Total / 4,882 mg sodium

Diet Instruction:

1g (1,000 mg) Sodium Diet

Basic Information on Pre-Hypertension:

-Blood pressure is the force of blood against the walls of arteries

-When BP is elevated for an extended period of time, this is hypertension

-Hypertension makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries)

-Hypertension increases risk of heart attack, stroke, heart failure, kidney disease, and blindness

-Blood pressure between 120/80 and 139/89is pre-hypertension (don’t have high BP now, but likely in the future)

-Above 140/90 is hypertension

-Systolic/Diastolic (BP when heart beats/BP when heart is at rest)

(National Institute of Health)

Basic Information on Sodium:

-Salt is commonly referred to as “Sodium”

-We need salt in our diets for proper functioning of nerves and muscles and correct balances of fluids in our bodies

-Kidneys are responsible for helping regulate our sodium levels

-When we take in too much sodium, our kidneys can’t get rid of it all and it builds up in the blood

 This results in high blood pressure, or hypertension

-Typically, it is recommended to consume less than 2,400 mg sodium (2.4 g) per day (MedlinePlus)

24-hour Dietary Recall Modifications Analysis:

Food Item / Sodium Content (mg) / Food Modifications / Sodium Content (mg)
2 eggs / 140 / 2 eggs / 140
1/16 tsp table salt / 145 / ½ cup honeydew / 30
2 slices bacon / 300 / 8 oz yogurt / 100
1 medium plain bagel / 400 / 1 cup oatmeal / 10
1 Tbsp salted butter / 80 / unsalted pecans & raisins / 0
2 slices white bread / 340 / 2 slices wheat bread / 260
2 oz deli ham / 750 / 3 oz turkey / 60
1 oz low-fat provolone cheese / 250 / 1 oz Swiss cheese / 55
Lettuce / 0 / Lettuce / 0
1 tsp mustard / 55 / 1 tsp mustard / 55
1 medium pickle slice / 370 / 1 cup canned peaches / 10
3 oz Spaghetti pasta with ¼ cup sauce / 300 / 1 cup brown rice, cooked tomatoes & avocado / 10
2 oz pork sausage / 400 / 3 oz ground beef meatballs / 60
1 Tbsp Parmesan cheese / 75 / ½ cup cauliflower / 10
1 slice Italian bread / 120 / sweet potato baked in skin / 40
½ cup creamed corn / 365 / ½ cup cooked broccoli / 30
Salad with 1 Tbsp Italian dressing / 242 / spinach with oil & spices / 65
1 oz pretzels / 400 / 3 cups air popped popcorn / 0
2 Tbsp peanut butter / 150 / 1 oz unsalted almonds / 0
Total / 4,882 mg sodium / Total / 935 mg sodium

Foods to Avoid:

-Salt

-Processed foods

-Canned, frozen foods

-Snack foods

-Packaged starchy foods (stuffing mix)

-Instant cooking foods (potatoes)

-Mixes (biscuits, cake)

-Certain meats and cheeses

-Deli/ lunch meats (ham, bologna)

-Cured/ smoked meats (sausage, bacon)

-Canned meats (Spam, Vienna sausage)

-Cheeses - avoid over 140mg sodium per serving (American cheese, Velveeta)

-Condiments and Sauces

- Ketchup and salad dressings

-Worcestershire, pizza, barbeque, steak, soy

-Pickles and Olives

Low Sodium Foods:

Fruit / -unsalted fresh, frozen, or canned
-fruit juices
Vegetables / -unsalted fresh, frozen, or canned
-vegetable juices, without salt added
-tomatoes
Protein / -plain meats
-fish
-poultry
-eggs
Starch / -shredded wheat
-plain pasta or rice
-homemade yeast breads, made without salt
Dairy / -milk
-yogurt
-low sodium cheese
-hard cheeses (cheddar, Swiss)
Other / -ice cream
-unsalted nuts
-unsalted butter or margarine

Tips to lower Sodium in foods:

-Make foods homemade, you can control the amount of salt that is added

-Choose fresh, frozen, or canned items without added salt

-Snack on fresh fruits, vegetables, or unsalted nuts which are low in sodium

-Read the nutrition facts label!

-Use fresh or salt-free spices to add flavor to foods

-When eating out, ask for gravies and sauces on the side for better portion control

SUMMARY:

Goals:

-Begin 1 gram (1,000 mg) sodium dietary regimen

-Become educated on foods high and low in sodium

-Decrease BP to below 120/80, rid pre-hypertension

Closing Questions:

-Can you name 2 foods high in sodium?

-Can you name 2 foods low in sodium?

-Can you explain 2 changes you are going to implement this week to help reduce your sodium intake?

**Here is my card and I think it would be good to have a follow-up appointment in 2 weeks to see how things are coming along!!

Resources:

Academy of Nutrition and Dietetics.(2013, January).The Basics of the Nutrition Facts Panel.A Guide on How to Read a Nutrition Facts Panel from the Academy. Retrieved February 19, 2014, from

American Heart Association. (2013). Eat Less Salt. - book review by the Academy of Nutrition and Dietetics. Retrieved February 19, 2014, from

ClevelandClinic. (2013). Eat Right. Cleveland Clinic. Retrieved February 19, 2014, from

Columbia Edu. (2012). Sample Menus for the DASH Eating Plan.Mayo Clinic Source. Retrieved February 19, 2014, from

Department of Health and Human Services. (2014, February 18). Low Sodium Foods: Shopping list. Low Sodium Foods: Shopping list. Retrieved February 19, 2014, from

Dugdale, D. C. (2012, September 6). Low-salt diet : MedlinePlus Medical Encyclopedia. U.S National Library of Medicine. Retrieved February 19, 2014, from

FDA. (2013, April 18). Food. Sodium in Your Diet: Using the Nutrition Facts Label to Reduce Your Intake. Retrieved February 19, 2014, from

MayoClinic Staff. (2013). Low-sodium recipes. - Healthy Recipes. Retrieved February 19, 2014, from

Nutrition Care Manual. (2014). NCM Nutrition Care Manual eat right. Public Home Page. Retrieved February 19, 2014, from.

Zernel, M. B. (1997).McKinley Health Center - DASH Diet/1500, 1800, and 2000 calories per day - University of Illinois.McKinley Health Center - DASH Diet/1500, 1800, and 2000 calories per day - University of Illinois. Retrieved February 19, 2014, from

Jessica Anderson

KNH 413

3/21/14

Diet Instruction: 50g Fat Restricted Diet

Patient Description and Diagnosis: Alex Reschke is an 18-year-old Caucasian female, 5’8”, and 218 pounds. She is currently a senior at Mentor High school and a member of the varsity track-and-field team, in which she participates in shot put and discus. The other night, Alex could not sleep. She experienced severe right upper quadrant pain and back pain between the shoulder blades that lasted for hours. Immediately, her parents rushed her to the hospital. After Alex described her symptoms and personal/family health history, the doctor performed an abdominal ultrasound and computerized tomography (CT) scan to analyze and look for signs of gallstones. The scan came back positive for cholelithiasis. Due to the presence of gallstones, the doctor performed a test to check the bile ducts for gallstones. Using a HIDA scan, a dye was used to highlight the bile ducts, determining that a gallstone was blocking the bile duct pathway. Thus, Alex’s severe pain was a result of bilary obstruction, in which the gallstone passed from the gallbladder through the cystic duct and lodged itself into the common bile duct. Alex did not show signs of inflammation. Due to her recent diagnosis of symptomatic cholelilthiasis, specifically choleldocholithiasis (common bile duct stones), as well as her family history of gallbladder cancer, she decided to undergo a cholecystectomy (removal of the gallbladder laproscopically). In about 6-12 weeks, Alex will have undergone surgery. In the meantime, Alex has been asked by her physician to see a Registered Dietitian for instruction on a 50g fat restrictive diet to help relieve her symptoms prior to surgery.

Etiology: Gallstones and bilary tract infections are known to affect 20 million American’s each year. Gallstone related diseases are responsible for about 10,000 deaths per year in the United States. Interestingly, only 1 in 3% of the population complains of symptoms during the course of a year, and fewer than half of these people have symptoms that return. Women are at higher risk of developing gallstones than men, occurring in nearly 25% of women in the US by the age of 60 and as many as 50% by the age of 75. Women are at an increased risk due to estrogen, which stimulates the liver to remove more cholesterol from blood and transfer it into bile. Other risk factors associated with cholelithiasis include being overweight or obese, eating a high fat diet, having a family history of gallstones, having diabetes, and much more. Gallstones may cause no signs or symptoms and may last a few minutes to hours. Symptoms which may appear include sudden and rapidly intensifying pain in upper right or center portion of abdomen, back pain between shoulder blades, pain in the upper right shoulder, as well as high fever with chills and possible yellowing of the skin and whites of eyes (Jaundice). When the gallbladder is removed, the liver continues to make enough bile to digest food; however, the bile drips continuously from the liver into the intestine. The causes of the formation of gallstones is still unclear, but it is suggested that such formation may occur due to bile containing too much cholesterol, bile too high in bilirubin or the gallbladder does not empty correctly. In such abnormal conditions, cholesterol precipitates as gallstones rather than remaining in the solution of bile salts and lecithin in the form of micelles.

Diagnostic Measures: The challenge is diagnosing gallstones is verifying that the abdominal pain is caused by the stones and not other conditions. Ultrasounds and imaging techniques are commonly used in the detection of gallstones. Because gallstones most often do not cause any symptoms, simply finding stones does not necessarily explain a patient’s pain. In diagnosing gallstones, disorders should be ruled out, such as if the patient’s pain lasts less than 15 minutes, frequently coming and going, or not severe enough to limit activities. Disorders with similar symptoms include IBS and Pancreatitis. In patient’s with known gallstones, the doctor can often diagnosis acute cholecystitis based on classic symptoms of constant and severe pain in the upper right quadrant of the abdomen and imaging techniques to confirm the diagnosis. Blood tests can be used to identify abnormalities that may indicate gallstones or complications: bilirubin and enzyme alkaline phosphatase levels elevated, especially in choledocholithiasis; elevated levels of aspartate aminotransferase and alanine when common bile duct stones are present. Additionally, a high white blood cell count is common in many patients with cholecystitis. Imaging and diagnostic techniques for gallstones may include Ultrasonography, Endoscopic Ultrasound, Computed Tomography, Magnetic Resonance Cholangiography, X-rays, HIDA scan (Gallbladder Radionuclide Scan), Virtual Endoscopy, and Endoscopic Retrograde Cholangiopancreatography (ERCP).

Ultrasounds can help in the diagnosis of various conditions: accurately detect stones as small as 2mm in diameter; indicate gangrene when air is present in the gallbladder. In contrast, ultrasounds may not be helpful in the diagnosis of cholecystitis when gallstones are not present in those with symptoms, and may not be helpful in identifying common bile duct stones or imaging the cystic duct. Additionally, X-rays of the abdomen may detect calcified gallstones and gas. An HIDA scan is a nuclear imaging technique that is more sensitive than ultrasound for diagnosing acute cholecystitis and is noninvasive. During this procedure, a tiny amount of radioactive dye is injected intravenously and excreted into the bile. If the dye does not enter the gallbladder, the cystic duct is obstructed, indicating acute cholecystitis. False results are commonly found in alcoholics with liver disease or patients who are fasting or receiving all their nutrition intravenously.

Treatment: Acute pain from gallstones and gallbladder disease is usually treated in the hospital, where diagnostic procedures are performed in ruling out other possible conditions and complications. There are three approaches to gallstone treatment: expectant management (“wait and see”), nonsurgical removal of stones, and surgical removal of gallbladder. For expectant management, a person has no symptoms, the risks of both surgical and nonsurgical treatments for gallstones outweigh the benefits. Those who show no signs of severe pain or complications may be discharged from the hospital with oral antibiotics and pain relievers. Exceptions to this policy are those who show risk for complications for gallstones, including those at risk of gallbladder cancer, Pima Native Americans, and patients with stones larger than 3cm. Because the presence of gallstones at an early age increases ones risk for gallbladder cancer, young adults who do not have symptoms may be recommended to have their gallbladder removed. When gallstones are present without inflammation, patients have the following options: intravenous painkillers for severe pain, elective gallbladder removal, lithotripsy, and drug therapy. In regards to the presence of common bile duct stones, a laparoscopic cholecysectomy has taken a role in the detection and removal of common bile duct stones. Because the gallbladder is not an essential organ, its removal is one of the most common surgical procedures performed on women. The advantage of surgical treatment over the other methods is its ability to eliminate gallstones and prevent gallbladder cancer. Cholecystectomy may be performed within days to weeks after hospitalization for an acute attack, depending on the severity of the condition. During a laparoscopic cholecystectomy, the surgeon separates the gallbladder from the liver and other areas, and removes it through one of the 3 small incisions made in the abdomen. Often times, patients will need to stay in the hospital overnight.