Krause\'s Food & the Nutrition Care Process 14th edition chapter 12 case study H
ID: 82305 • Letter: K
Question
Krause's Food & the Nutrition Care Process 14th edition chapter 12 case study
Hellen is a 60-year-old female who was referred from her primary care pro- vider for evaluation of her dietary supplements. Medical history includes hypertension, hypercholesterolemia, osteopenia, mild depression, and memory problems. Two years ago, she had angioplasty (PTCA) with a stent placement in her coronary artery. Hellen is a retired school teacher, married, and has two grown children. Her neighbor works in a supplement store and recommended some herbs and supplements to address Hellen’s health concerns.
At the initial consult Hellen reports she is taking the following supple- ments: calcium carbonate 1200 mg/d, garlic (Allium sativum) 500 mg/d, Ginkgo biloba 240 mg/d, and St. John’s wort (Hypericum perforatum) 900 mg/d. Her prescription medications include warfarin, simvastatin, sertra- line, and atenolol.
Height: 64 Weight 165 lbs BMI: 28.4
Blood pressure readings: 134/92, 140/95 “This is higher than it usually is”
Hellen reports. Recent labs:
Total cholesterol: 284 mg/dl
HDL: 36 mg/dl
LDL: 140 mg/dl
Prothrombin times (INR) has been inconsistent lately.
Typical dietary intake includes the following:
Breakfast: Total cereal with milk and calcium fortified orange juice for breakfast
Lunch: Frozen entree—beef and broccoli with rice and a diet coke
Snack: Strawberry yogurt and pretzels, coffee with milk
Dinner: Meatloaf, mashed potatoes with gravy and carrots. Glass of red wine. Dessert: Chocolate ice cream, coffee with milk
1. Go to the Office of Dietary Supplements Fact Sheet and Box 12-7 for Garlic - https://ods.od.nih.gov/factsheets/list-all/Garlic/, is there good evidence to support Hellen’s use of garlic?
2. Collect the same information for Gingko, should she continue taking Gingko?
3. Collect the same information for St. John’s Wort- what should she know if she continues taking this?
4. List her medications and possible nutrient interactions
5. Hllen is taking a blood thinner (Warfarin), what foods should she watch because intake of Vitamin ________?
6. List potential at risk populations for dietary supplements
7. What is the most common reason to use CAM (in the United States)?
8. You recommend that Hellen consider Massage – what category of Holistic (NCCIH) therapy is this considered?
9. Would you recommend Hellen use green tea? Why?
10. What will you discuss with Hellen regarding her calcium supplement usage and her history of cardiovascular disease?
Explanation / Answer
1. Answer : NO
According to https://ods.od.nih.gov/factsheets, evidence is less to show that it decreases blood cholesterol and high blood pressure.
2. Answer : NO
According to https://ods.od.nih.gov/factsheets,
The Ginkgo doesn’t help prevent or slow dementia or cognitive decline, according to studies, including the long-term Ginkgo Evaluation Memory Study, which enrolled more than 3,000 older adults and was funded in part by the National Center for Complementary and Integrative Health (NCCIH).
And the side effects listed are : headache, stomach upset, and allergic skin reactions and older people have known bleeding risk.
3. It interacts with blood thinner, Warfarin and also has potential negative interaction with sertra- line.
4. Vitamin K with warfarin: Vitamin reduces the effect of warfarin
Simvastatin with red wine and juice (mainly grape): Grape increases the level of Simvastatin
Atenolol with calcium : Calcium interfere with absorption of Atenolol
5. Vitamin K which play important role in blood clotting is rich in broccoli and yogurt so it can reduce the effect of warfarin.
6. People with poverty, pregnant women, elders, adolescent women, vegans, smokers and alcoholics.
7. Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. It is an alternative to conventional medicine.
8. Manipulative and body-based methods is one of the five categories of CAM and massage therapy is part of this category.
9. Yes. As per the https://ods.od.nih.gov/factsheets, green tea enhances mental alertness and the limited evidence currently available suggests that both green and black tea might have beneficial effects on some heart disease risk factors, including blood pressure and cholesterol.
10. Increased calcium intake leads to deposition of calcium in arteries and plaque formation and which increases the risk of heart attack or stroke
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