Part I: Presentation Present illness: Jim C. is a 42 year old engineering techni

Question

Part I: Presentation Present illness: Jim C. is a 42 year old engineering technician referred to his family physician for evaluation of arterial hypertension detected during a pre-employment examination and confirmed one week later. He relates no prior history of elevated BP but had been warned to "watch his weight". He denies current symptoms of chest pain, shortness of breath (SOB), edema, or visual symptoms. He smokes one pack of cigarettes a day and plays tennis once or twice a week. His body weight has been steadily increasing by 2-4 lbs per year for the last 10 years. Past medical history: He had measles, mumps, and chicken pox in childhood, and an appendectomy approximately 20 years ago. There is no history of rheumatic fever, diabetes, or kidney disease. Family history: Father died at 48 years of age from an acute MI, and mother is being treated for essential hypertension. Social history: Has 2 children; wife works as a legal secretary. Review of symptoms: Patient has no complaints except for occasional mild tension headaches. Physical exam: General: somewhat overweight while male; 5 ft 10 in, 180 lbs, small frame. BP 155/103, right arm, sitting, without postural changes and PR 76. HEENTT fundoscopic exam revealed normal A-V ratio, no A-V nicking, with flat disc and no hemorrhages or exudates. Neck without thyromegaly or venous distension. Lungs or gallop. Abdomen slightly obese, soft, and without bruit. Extremities revealed no Laboratory: Hct 50%, Hgb 158 g/L, glucose 6.55 mmol/L, BUN 6.43 mmol/L, total mmol/L, triglycerides (fasting) 1.35 mmol/L, U/A negative for glucose, protein and clear to P&A; (Percussion and Auscultation). Heart regular rhythm, without murmur edema. Screening neurological exam, including mental status exam, is WNL. cholesterol 7.76 mmol/L, LDL cholesterol 5.17 mmol/L, HDL cholesterol 1.29 blood. EKG revealed normal sinus rhythm with a rate of 80, normal intervals, and rophy. CXR was unremarkable. no evidence of ischemia, strain, or hypert obese, otherwise healthy male with a positive family history of CHD BP check. Impression: Essential hypertension and elevated LDL in a 42.xear.old, slightly lan: Nutrition Clinic referral for instruction in 2000 kcal, 2 g sodium, TLC/DASH diet. Encourage cessation of smoking and increase in exercise. RTC in 2 weeks for

Explanation / Answer

DASH Menu:
?BREAK FAST:
?    --3/4 Cup bran flakes cereal(100 calories, 0.5g of fat,24g carbs per 0.75cup)
? --8 ounces fat-free milk(79 calorie)
?    --1medium banana(105 calorie)
? --1 slice whole wheat toast( 68 calories,1.2 of fat,12.9 carbs)
    --1 teaspoon jelly(51 calories)
    --4 ounces oranges juice(51 calories,total fat 0%)
LUNCH:
? --3 oz skinless chicken breast(124 calories)
    --1 pita bread(total fat 0.7g,fibre 1.3g,protein 5.5g)
?    --1 tablespoon low-fat mayonnaise(57 calories)
?    --Raw vegetables: 3 or 4 carrot sticks,celery sticks,radishes,2 loose lettuce leaves..
    --1 peach(38 calories)
SNACKS:
?    --1/4 cup dried apricots
    1/3 cup mixed,unsalted nuts
--1 cup fat free milk
DINNER:
   --3 ounces grilled salmon
   --1/2 cup brown rice
? --1cup steamed broccoli
--spinach salad with 1 cup raw spinach,2 cherry tomatoes,2 cucumber slices
   --1 tsp low-sodium-home made vinaijnette salad dressing
   --1 cup grape juice
jim.c requirement for daily total fat 44 to 77 grams in his diet
?    225 to 325 grams of carbohydrates
? 50 to 175 grams of protein
   1500mg/day sodium
      18mg of iron
?    4,700mg of potassium
      1300mg of calcium
? 26 grams fiber
   total calories 2000kcal

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