1.
MNT in a
Patient with
Congestive
Heart Failure
Megan Smith
UMD Dietetic Intern
May 6, 2015
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2.
Congestive Heart Failure
Most common
signs and
symptoms
• Fatigue
• Edema
• Shortness of
breath
• Chest
congestion
Md Health

3.
Congestive Heart Failure
Systolic Heart failure: Occurs when the heart cannot
pump, or eject, blood efficiently out of the heart.
Diastolic Heart Failure: Occurs when the heart
cannot properly fill with blood.
Pixshark

4.
Congestive Heart Failure
Etiology most commonly includes:
• Coronary Artery Disease
• Myocardial Infarction
• Uncontrolled Hypertension
• Arrythmias, valve problems, drugs,and alcohol can
also contribute
Leading Predictors
• Coronary artery disease
• Poorly controlled blood pressure
• Elevated B natriuretic peptides

5.
Congestive Heart Failure
Electrocardiogram
Test that checks for
problems with the
electrical activity of
the heart.
Ejection Fraction
A test that determines
how well your heart
pumps with each beat.
American Accreditation HealthCare Commission
Emory Health

6.
Meet the Patient
• XX is a 59 year-old Caucasian male
• Married with two daughters
• Lives at home with wife
• Employed as a physician by a local
Baltimore Hospital

7.
Medical Considerations
Diagnosis: Acute left systolic heart failure with
aortic insufficiency. Broadly referred to as CHF.
PMH: hypertension
Echocardiogram: Ejection Fraction was 20-25%
Signs/Symptoms: Fatigue, loss of appetite, SOB

8.
Nutrition Assessment
Food/Nutrient Related History
•Decreased appetite one month PTA
•Eating approx. 50% of meals PTA
•MD expressed basic understanding of nutrition
and wanted to maximize caloric intake prior to
surgery.
•MD is a physician so he understood his disease
state
• MD is on feet all day; in training for a marathon.

9.
Nutrition Assessment
•Height=168 cm Weight=194 lbs (88.2 kg) BMI=31
•UBW=210 lbs;16 pound wt loss, 7% weight change in
past month
Anthropometric Measurements

10.
Nutrition Assessment
Client History
•PMH: hypertension, dyslipidemia, hypercholesteremia
•No surgical history (hx)
•Employed as a physician as Chief of Orthopedics
•Denies family psychiatric hx, alcohol, and drug use

11.
Nutrition Assessment
Nutrition Focused Physical Findings
•No edema present on admission
•Vital signs stable on admission
•Signs & Symptoms on admission: 3 weeks SOB,
orthopnea, upper back discomfort, fatigued, lower
energy levels during normal work activities, loss of
appetite, weight loss

12.
Nutrition Assessment
Biochemical
BNP levels normal upon admission
BUN slightly elevated: 26 mg/dL on 12/11
XX Labs were not nutritionally significant
throughout his stay in the hospital

13.
Diagnosis
NI-1.2: Inadequate oral intake related to
decreased desire to consume sufficient
energy 2/2 to CHF symptoms of
shortness of breath and fatigue as
evidenced by patient report of poor po
intake (50% of meals) over last month.
NC-3.2: Unintended weight loss related
to decreased appetite 2/2 inadequate
oral intake caused by CHF symptoms
as evidenced by 15 pound weight loss
in past month (7% weight change).

14.
Intervention
Nutrition Prescription
Energy Needs: 1870-2066 kcal (Mifflin St. Jeor)
Protein Needs: 65-78 grams (1-1.2 gram/kg)
Fluids: 1760-2200 mL

15.
Intervention
Date Diet Average Intake Nutrition
Supplements and
Intake
December 8th Patient placed on a
cardiac diet upon
admission
25-50% -
December 9th Cardiac Diet 25-50% Ensure Chocolate TID
ordered, Patient
consumed one Ensure
before surgery
December 10th NPO at midnight for
impending surgery
- -
December 11th NPO - -
December 12th CLD/FLD 50-75% Ensure Clear TID
ordered, 1 consumed
December 13th Cardiac diet 50-75% Ensure Clear TID
ordered, 1 consumed
December 14th Cardiac diet 25-50% Ensure Clear TID
ordered, 2 consumed
December 15th Cardiac diet 25-50% Ensure Chocolate TID
ordered, 2 consumed
December 16th Cardiac diet 40% Ensure Chocolate TID, 3
consumed
Magic Cup x 1/day,
consumed
December 17th Cardiac diet, patient
discharged today
- -

16.
Intervention
RC 1.3 Coordination with other providers: Recommend low sodium, cardiac Diet.
Goal: Implement once medically feasible after surgery.
ND-3.1 Medical food supplements: Initiate Ensure Chocolate TID once medically
feasible.
RC 1.3 Coordination with other providers: Recommend Ensure Chocolate TID.
Goal: Implement once advanced to Clear Liquid Diet after surgery.
RC 1.3 Collaboration with other providers: Patient will maintain current weight
throughout hospital stay.
E-1.1 Purpose of Nutrition Education: Prior to discharge educate patient and
patient family on importance of adhering to low sodium, cardiac diet after surgery
and discharge.
E-1.4 Nutrition relationship to health/disease: Prior to discharge help patient
recognize and understand importance of adherence to low sodium cardiac diet in
relation to his CHF

17.
Monitor/Evaluate
FH 1.1.1.1 Energy Intake
FH-1.2.1 Fluid/beverage intake
FH 1.6.2 Sodium Intake
FH 4.1.1 Food and Nutrition Knowledge/Skill
FH 4.1.2 Diagnosis specific food and nutrition
knowledge

18.
Nutrition Implications
•Severity of MD’s CHF was reflected in the medical
and nutritional therapy.
•Dietary Approaches to Stop Hypertension (DASH)
•Implemented to help client make better choices
after surgery
•2000 mg sodium/day
•Many CHF patients will require a fluid-modified diet
(ND-1.2.8)
• XX was not experiencing edema or
hypernatremia

19.
Nutrition Implications
•Self-monitoring (C-2.3)
•Reading nutrition labels
•Choosing salt-free additives

20.
ReferencesAcademy of Nutrition and Dietetics. International Dietetics and Nutrition Terminology (IDNT) Reference Manual. Chicago, IL: American Dietetic Association;
2013;
Academy of Nutrition and Dietetics. Nutrition Care Manual®. http://www.nutritioncaremanual.org. Accessed several times from December 2014-February
2015. ϖ https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5803&lv2=8585&ncm_toc_id=8585&ncm_heading=Nutrition%20Care
Cotugna N, Wolpert S. Sodium Recommendations for Special Populations and the Resulting Implications. Journal of Community Health. 2011; 36: 874-882.
“Ejection Fraction picture” Emory Health http://www.emoryhealthsciblog.com
“Electrocardiogram” American Accreditation HealthCare commission-http://www.medicalwordmeanings.com/what-is-electrocardiogram-the-meaning-and-diagram/
Evidence Analysis Library. Academy of Nutrition and Dietetics Website. https://www.andeal.org. Accessed several times from December-February 2015.
https://www.andeal.org/topic.cfm?menu=5289&cat=2815
“Healthy heart vs. Congested Heart” MD Health http://www.md-health.com/Congestive-Heart-Failure.html
“Heart” El Corazon. http://www.efn.uncor.edu/departamentos/divbioeco/anatocom/Biologia/Los%20Sistemas/Circulatorio/Corazon.htm
Lavid CJ, Ventura HO. Analyzing the Weight of Evidence on the Obesity Paradox and Heart Failure—Is there a Limit to the Madness? Congestive Heart
Failure. 2013; 19:158-159.
Lennie TA, Moser DK, Biddle MJ, Walsh D. Nutrition Intervention to Decrease Symptoms in Patients with Advanced Heart Failure. Res Nurs Health. 2013;
36(2): 120-145.
Mahan LK. & S. Escott-Stump. 2012. 13th edition of Krause’s Food, Nutrition & Diet Therapy. W.B. Saunders Co.: New York.
Medical Reference Guide-Complementary and Alternative Medicine Guide. University of Maryland Medical Center. January 2012.
http://umm.edu/health/medical/altmed/condition/heart-failure Accessed April 2015.
Riegel B, Moser DK, Anker SD, Appel LJ. State of Science. Promoting Self-Care in Persons with Heart Failure-A Scientific Statement From the American
Heart Association.
“Systolic/Diastolic HF picture” http://pixshark.com/congestive-heart-failure-prevention.htm