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Nutrition for Nurses

12.1 The Impact of Nutrition on Cardiovascular Wellness Across the Lifespan

Nutrition for Nurses12.1 The Impact of Nutrition on Cardiovascular Wellness Across the Lifespan

Learning Outcomes

By the end of this section, you should be able to:

  • 12.1.1 Describe the impact of nutrition on the cardiovascular system during pregnancy.
  • 12.1.2 Describe the impact of nutrition on the cardiovascular system during infancy.
  • 12.1.3 Describe the impact of nutrition on the cardiovascular system during childhood.
  • 12.1.4 Describe the impact of nutrition on the cardiovascular system during adolescence.
  • 12.1.5 Describe the impact of nutrition on the cardiovascular system during adulthood.
  • 12.1.6 Describe the impact of nutrition on the cardiovascular system during later adulthood.

Pregnancy

During pregnancy, multiple changes occur within the cardiovascular system. As cardiac output increases, vascular volume increases, and there is a decrease in systemic vascular resistance and subsequent blood pressure. The vessels also dilate, which leads to lower blood pressure in the second trimester. After 20 weeks of gestation, blood pressure increases but typically remains near pre-pregnancy levels. These changes are designed to provide perfusion—the flow of blood to tissues and organs—to the fetus (Kepley, Bates, & Mohiuddin, 2023). To best support this growth and development of the fetus, the cardiovascular system of the client needs to be properly supported.

The pregnant client should increase caloric intake by 340–450 calories daily during the second and third trimesters. Increasing folic acid, iron, and choline are important as well. Pregnant clients should avoid all alcohol, decrease or eliminate caffeine intake, and avoid uncooked meats and fish. Although for clients with a pre-existing condition such as hypertension (high blood pressure) and obesity, other measures will need to be incorporated into the nutritional plan (meal plan) to help prevent complications (Lu et al., 2018; Anderson-Villaluz & Quam, 2022).

The food that the expectant client eats can also affect the fetus’s growing organs. Nutritional recommendations include consuming skim or low-fat milk, yogurt, and cheese; healthy, lean proteins including oily fish; fresh fruits and vegetables; and whole grains to help the fetus’s heart grow healthy. Pregnant clients are encouraged to avoid food high in fat, cholesterol, and sodium as this does not only affect the client, but the fetus as well (Advent Health, 2021).

Research shows that optimal nutrition during pregnancy is linked with other healthy behaviors such as an increase in physical activity and avoidance of smoking and alcohol.

Impact on the Client’s Health During Pregnancy

The demands of pregnancy on the client significantly changes the physiological functioning of the cardiovascular system (Kepley, Bates, & Mohiuddin, 2023). The increase in metabolic demand promotes optimal uteroplacental circulation—the transfer of oxygen and nutrients from client to fetus through umbilical cord and placenta—that is needed by the fetus for growth and development. The increase in the cardiac output affects the client and the fetus by increasing pressure on the vena cava from the weight of the extra fluid within the placenta and the weight of the fetus. Vasodilation begins early in pregnancy, with a decrease in systemic vascular resistance. Maternal heart rate also increases. Other changes that occur to the cardiovascular system due to the developing fetus include rotation of the heart due to the pressure on the diaphragm, increase in heart rate, and mild hypertrophy due to the increase in vascular volume (Gersh, 2022).

Maintaining healthy nutrition for heart health during pregnancy is important because it allows the heart to cope with the stress of pregnancy. Implementing healthy heart behaviors positively impacts pregnancy and can help during delivery and the postpartum period. Healthful measures that can be taken are using added salt sparingly, increasing water intake to at least 64 oz daily, increasing protein in the diet, decreasing the amount of fried foods, exercising, avoiding alcohol and caffeine, and elevating the feet during the day (American Pregnancy Association, 2023).

Many symptoms—such as shortness of breath, increase in heart rate, and swelling—experienced during pregnancy are linked to cardiovascular changes. Decreased venous return to the head can cause the pregnant client to experience syncope in which the client loses consciousness for a brief time or near-syncope episodes where the client feels like they may pass out or have some lightheadedness or dizziness. The nurse should advise the client to change positions slowly to minimize the associated risks for falls if this happens. The client may experience dyspnea or difficulty breathing with exertion and/or visible pulsations of the jugular veins, as well as edema of the lower extremities. Research also shows that not only the mother’s health is affected during pregnancy, but also the developing fetus. The choices the mother makes nutritionally can affect the fetus’s risk for heart disease, kidney disease, and metabolic disease in adulthood (Cunningham & LaMarca, 2018). Consistent themes found in the research to best promote cardiovascular health during pregnancy through nutrition focus on decreasing total cholesterol levels, regulating fasting glucose levels, and maintaining normal blood pressure readings.

It is important to teach clients what food choices are best. Suggestions include educating clients on how to drink water or milk and eat fresh fruits and vegetables. When choosing meats, choose meat that is grilled rather than fried and avoid raw fish. Eating a plant-based or vegetarian diet during pregnancy has been associated with higher risks of congenital heart defects in the neonate at birth (Yang et al., 2019). Salads are typically a good source of nutrition but can have many hidden calories in the dressings and various toppings that can be included in the salad. Clients should choose low-fat salad dressing and eat desserts sparingly (Howland, 2018).

The Client with Pre-existing Cardiovascular Disease

Cardiovascular disease is a leading cause of complications in pregnant females (Cleveland Clinic, 2022a). The pregnant client may be unaware of previous cardiovascular issues until they become pregnant. People with previously undiagnosed cardiac issues may experience new cardiovascular-related health concerns and diagnoses due to the increase in cardiac output and decreased systemic resistance. Heart murmurs, chest pain, and generalized swelling should be evaluated by a health care provider (Gersh, 2022).

Clients with congenital heart disease can experience an exacerbation of related cardiovascular issues from pregnancy-related physiological and hormonal changes (Ifitkhar & Biswas, 2023). There is an increased risk for both maternal and fetal death associated with cardiovascular disease and pregnancy. Clients who have pre-existing cardiovascular diseases need to be counseled about the additional risk factors that they could potentially encounter during pregnancy, and they need to be counseled on ways to help keep their heart and their fetus’s heart healthy.

The amount of weight that the client gains during pregnancy can impact cardiovascular health by increasing the need for higher cardiac output. For the client who gains more weight than what is recommended, the baby can be too big and lead to complications during delivery according to the Centers for Disease Control (CDC, 2022b). Studies have shown that only about one-third of pregnant women gain the recommended weight during pregnancy. The recommended weight gain varies according to the pre-pregnancy body mass index (BMI) and if the client is pregnant with one or more fetuses (CDC, 2022). To help prevent cardiovascular disease, the client should try to meet the expected weight gain during pregnancy by increasing calories during the second (340 additional calories) and third trimester (450 additional calories). The nurse should track and monitor pregnancy weight gain and encourage the client to eat a well-balanced diet to help prevent cardiovascular problems during pregnancy (CDC, 2022).

Unfolding Case Study

Part A

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Upon arrival at the labor and delivery department, Tara is placed on a fetal monitor, blood work and urine are collected, and her vital signs are obtained.

Vital Signs Laboratory Results
Temperature: 37.4ºC
  • Urine shows protein
  • Liver enzymes are slightly elevated
Blood pressure: 224/200 mm Hg
Heart rate: 92 beats/min
Respiratory rate: 22 breaths/min
Oxygen saturation: 96% on room air
Table 12.1

Tara is started on a labetalol drip for blood pressure control. The fetal monitor shows no distress to the fetus, so she is transferred to the intensive care unit for blood pressure monitoring and labetalol infusion.

Tara spends 4 days in the intensive care unit to get her blood pressure under control and to monitor her liver enzymes and kidney function. Her liver enzymes and kidney function normalize, and her blood pressure is now down to 120/76 mm Hg. She is converted to oral labetalol and will be ready to discharge home in the next day or two for a follow-up with the obstetrician within 3–4 days.

The nurse is providing nutritional education to Tara since she has a history of hypertension and developed pre-eclampsia. They both understand that nutrition and lifestyle modifications play a significant role in controlling blood pressure and helping prevent Tara’s blood pressure from spiking.

1.
Which part of Tara’s assessment or history is concerning due to the possibility of complications during pregnancy?
  1. Respiratory rate of 22 per min
  2. Hypertension
  3. Heart rate of 92 beats per min
  4. Temperature of 37.4ºC
2.
Tara asks about going out to dinner since she has a busy schedule. Which foods would be the best for her to choose for her diet?
  1. Fried chicken fingers and fries
  2. Well-grilled chicken salad with full-fat cheddar cheese and ranch dressing
  3. Raw sushi and rice
  4. Well-grilled steak and steamed broccoli

Impact on the Fetus

The fetus of a client with cardiovascular disease is at an increased risk for morbidity, cardiovascular disorders—inherited and congenital—premature delivery, and a restriction in fetal growth and development (Russell, 2022). Fetal growth and development restriction, related to inadequate placental perfusion, also increases the risk for fetal demise. Additionally, infants born to clients experiencing poorly controlled cardiovascular disease complications during pregnancy were noted to experience small gestational weight measurements and extreme prematurity. An infant who is preterm also has reduced cardiomyocyte proliferation, which affects the total number of cardiac cells they have. The decrease in myocytes affects the heart’s ability to repair itself and can decrease the function of the heart (Bensley et al., 2018). Some cardiac problems that infants can develop from prematurity include, but are not limited to, patent ductus arteriosus (Figure 12.2) and low blood pressure (Mayo Clinic, 2023c).

An illustrated cutaway of the heart muscle shows how blood flows when the ductus arteriosus remains open.
Figure 12.2 Patent ductus arteriosus is a common cardiac effect seen in premature fetuses. (credit: modification of work from Anatomy & Physiology 2e. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Superior nutrition during pregnancy is important not only for the client but for the developing fetus. Those who have a limited intake of fruits, vegetables, fish, meats, and dairy can have infants who are stillborn or have a low birth weight; the fetus could also have developmental delays. Those who lack nutrients such as iodine, folate, calcium, and zinc can have complications during pregnancy that could potentially result in material death (UNICEF, 2023). Research shows that if a pregnant person has gestational diabetes, there are cellular changes that occur within the developing heart of the fetus. It is important to monitor the client’s blood glucose and if they do have diabetes, make sure the glucose is under control. Cellular changes that occur during the development of the heart of the fetus have been linked to high glucose levels in the pregnant client (Garg, 2020).

Unfolding Case Study

Part B

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Tara is at an advanced maternal age. As an already busy mom and working full-time, she regularly has a very hectic schedule. Meals are often whatever she can pick up quickly. Tara has gained more weight in the second trimester than her obstetrician recommends; the doctor is concerned about her elevated blood pressure, cholesterol and glucose levels, heartburn, and lower leg edema.

Upon examination, fundal height is appropriate for gestation and fetal heart tones are normal. Considering Tara’s busy schedule and the three children she is already caring for, Tara is concerned about how to feed her family and keep herself healthy.

3.
While preparing education for Tara, which information does the nurse need to include in the educational packet to help keep Tara and her fetus healthy?
  1. Decrease food intake
  2. Exercise 60 minutes daily
  3. Increase fruits and vegetables
  4. Increase salt in the diet
4.
Which finding in Tara would be the most concerning for premature birth?
  1. Busy schedule
  2. High blood pressure
  3. Fundal height
  4. Pregnant with one fetus

Infancy

For healthy infants born without cardiovascular disorders, research data indicates that breastfeeding for the first 6 months is best because it provides the infant with optimal nutrition. The goal is to breastfeed infants for a full year while introducing solid foods (CDC, 2023e). Infants who are breastfed have a decreased risk for subsequent cardiovascular-related diseases such as obesity and type 1 diabetes. Commercially made formulas are developed to mimic breast milk. Infant formulas must meet the nutritional requirements that are set by the federal government (FDA, 2023). The FDA recommends that formula preparations include calcium, fats, folate, iron, protein and carbohydrates in the appropriate amounts for infants. Additionally, micronutrients of zinc, vitamins A, C, D, E, K, and B vitamins are included in the recommendations (Watson, 2022). To ensure the infant receives the correct amount of these macro and micronutrients, it is important to provide the formula as prepared or reconstitute as directed. Watering down the formula will not provide the infant with the nutrients needed to support growth and development.

Complementary foods can be added to the diet after the infant is 6 months old. Complementary foods include iron-fortified infant cereals, pureed vegetables, and fruits. As more food is introduced to the infant, food choices should include fruits and vegetables, whole grains, and whole milks, such as pumpkin, apples, pears, carrots, peas, and pureed lean meats. Commercially prepared infant foods are available in various stages of infant development. Home-prepared foods should be pureed to a consistency that is easy for the baby to eat with all peelings and seeds removed (Advent Health, 2021) or cut into small pieces to avoid choking.

Special Considerations

Foods and Drinks to Avoid with Infants

Specific food items should be avoided until 12 months of age. Infants under 12 months should avoid honey, due to the potential for botulism, unpasteurized drinks/foods, foods high in salt or sugar, caffeinated drinks, cow’s milk, and fish high in mercury (CDC, 2023b). Other foods that should be avoided that could potentially cause harm are nuts, sunflower seeds, cherries with pits, raw carrots, popcorn, hard candy, raw apples and pears, grapes, cheese cubes, and hot dogs or sausage because these have the potential to lodge in the infant’s trachea and block the airway. Peanut butter and chewing gum can also make the mouth sticky and get lodged in the airway (Nemours Children’s Health, 2023).

Infants with congenital heart disease require additional calories to support growth and development (Royal Brompton and Harefield Hospitals, 2021). Babies with congenital heart disease may experience fatigue and typically require more calories daily than the average infant. Many of these babies cannot eat or drink enough to meet their caloric needs. The pediatrician can recommend supplementing breast milk or prescribe a high calorie formula. Baby foods that are higher in calories are bananas with tapioca, mango with tapioca, prunes and rice, mixed vegetables, and sweet potatoes. Many others can be obtained from the grocery store in the baby food aisle (American Heart Association, 2023; Royal Brompton and Harefield Hospitals, 2021). Formulas that the provider can prescribe include Infatrini and Similac High Energy with 100 calories and 2.6 g of protein per 100 mLs, in comparison to the standard formula, which has 70 calories and 1.5 g of protein per 100 mLs (Royal Brompton and Harefield Hospitals, 2021). Infants who have heart issues also may require nasogastric tube feeds to help keep up with their nutritional needs.

Feeding during infancy is an opportunity to introduce infants to a heart-healthy diet and encourage food likes that will extend throughout their lifecycle. Promoting a rainbow of foods and allowing the infant to explore a variety of textures and consistencies will promote a healthy relationship with food as a fuel source that will encourage and sustain growth and development. Limiting processed, high-fat, high-sugar, and high-sodium foods in infancy will develop a pattern of utilizing nutrient-dense foods for fuel across the lifespan.

Childhood

The heart healthy eating behaviors of infancy should also be followed in childhood, including calorie consumption that supports the growth and developmental needs of the child. As these needs fluctuate, children should take the lead on how much food they consume; parents and caregivers can allow then to stop eating when they are full rather than promoting a clean plate (American Heart Association, 2018). Foods low in added sugar, saturated fats, cholesterol, and salt should be the focus of a healthy childhood diet. A childhood diet should be rich in a variety of colorful foods; 30–35% of daily caloric intake should be mono- or polyunsaturated fats from olive oil or canola oil. See Table 12.2 for the nutritional needs of an average 3-year-old.

Nutritional Needs Measurements
Dairy 2 cups
Lean meats and beans 2 oz
Vegetables 1 cup
Fruits 1 cup
Grains 3 oz (with half of that from whole grains)
Table 12.2 Daily Nutritional Needs for a 3-Year-Old (source: AHA, 2010)

Developing a meal-time routine as a family—where the child is involved in the meal preparation—helps to build life-long healthy eating habits. Including children in the preparation of food and teaching them to make healthy nutritional choices is something parents can incorporate into their meals each day. Kids can help by washing the fruits and vegetables, setting the table, and helping prepare things that are at their cognitive and coordination levels. Involving children in meal preparation makes them feel they have choices in what they eat, and with the parents’ help they are making healthier choices. When eating fast food children can learn to choose healthy options such as carrot sticks instead of French fries, yogurt instead of hashbrowns or other sides that are fried in grease, and fresh fruit instead of baked goods high in added sugar.

Childhood is the optimal time to develop and reinforce heart-healthy dietary eating behaviors that support growth and development throughout life. Heart-healthy nutritional patterns such as watching portion sizes, eating low-fat dairy, limiting saturated fats, and increasing fruits and vegetables in the diet can help decrease the likelihood of obesity, hyperlipidemia, and hypertension in childhood and later as an adult (Cleveland Clinic, 2022c).

Unfolding Case Study

Part C

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Tara’s 3-year-old son, Carter, attends preschool Monday through Friday from 7 a.m. until 5:30 p.m. Other than several upper respiratory tract viral infections and several rounds of otitis media, Carter is relatively healthy. At his latest well-child visit, the health care provider was concerned with Carter’s high weight due to subsequent health issues related to childhood obesity.

When discussing a normal 24-hour diet for Carter, Tara shares that he typically eats breakfast, lunch, and a snack at preschool. They typically pick up food for dinner on the way home from work/preschool. As Tara often works from home on the weekends, she admits that Carter tends to get more screen time than she would like.

5.
With Carter’s height charted at 36 inches and weight at 54 lb, calculate his BMI and indicate his BMI category. You may use this BMI calculator: https://www.cdc.gov/healthyweight/bmi/calculator.html.
  1. 29.3; severe obesity
  2. 19.2; healthy weight
  3. 16.2; underweight
  4. 32.2; severe obesity
6.
While teaching Tara about healthy food choices for Carter, which statement is most appropriate?
  1. “Make sure Carter eats all of his food at each meal and that his plate is clean.”
  2. “Let Carter help you prepare meals in the kitchen while you are cooking.”
  3. “Since you are busy, Carter can have a cheeseburger and fries daily to help you.”
  4. “Screen time is good for Carter since you work and need to keep him occupied.”

Adolescence

Some important modifiable risk factors for cardiovascular disease in adolescents include poor dietary quality and obesity, which can lead to early-onset atherosclerosis (Raeside, 2019). Preventing the occurrence of cardiovascular disease in adolescents reduces the risk for early death from cardiovascular disease in later life. Although the information presented previously focuses on nutrient-dense, heart-healthy foods is equally applicable to adolescents, it is also imperative to integrate teaching strategies in ways meaningful for this age group.

To decrease the risk for long-term cardiovascular disease, preventing or delaying the occurrence of negative, modifiable risk factors is essential (Dahm et al., 2016). Promoting the high consumption of fruits and vegetables, as well as whole grains, lean meats, and fish, while minimizing the intake of processed foods, sodium, and artificial trans fats during adolescence has been shown to decrease the incidence of cardiovascular disease in adulthood. Refer to Table 12.3 for the daily nutritional needs of adolescents.

Foods Female – 1,800 Calories Male – 2,200 Calories
Dairy 3 cups 3 cups
Lean meats and beans 5 oz 6 oz
Vegetables 2.5 cups 3 cups
Fruits 1.5 cups 2 cups
Grains 6 oz (with half of that from whole grains) 7 oz (with half of that from whole grains)
Table 12.3 Daily Nutritional Needs for the Average, Healthy 15-Year-Old (source: AHA, 2018)

Although many aspects of social media are not viewed positively, social media can provide information about heart-healthy behavior in a way that positively impacts adolescent behaviors (Mayo Clinic, 2022a). The use of digital media has been noted to be effective in providing adolescents with information when and where they seek it (Mayo Clinic, 2022a). Additionally, utilizing social media assists teens in establishing a feeling of connection with their peers, which can foster healthy behaviors (Anderson et al., 2022). Social media also reduces barriers to information, increasing the accessibility of heart-healthy information available to this age group. Parents and nurses can balance the positive implications with an awareness of the negative implications of social media. Research has indicated one of the best ways to help alleviate negative impacts that social media can play on the teen is for parents and guardians to have open communication with their teens.

Eating disorders, such as purging, binging, or limiting food/not eating certain foods, are more prevalent among female adolescents than males. In the U.S. it is estimated that 10 in 100 young women have an eating disorder (American Academy of Child & Adolescent Psychiatry, 2018). Teens can become withdrawn, and family may recognize weight loss in individuals suffering from eating disorders. Recognizing these symptoms is crucial to the health of the teenager.

In addition to diminished mental health, eating disorders lead to diminished physical health: electrolyte imbalances, such as hypokalemia and hyponatremia; increased liver enzymes; increased bilirubin levels; anemia; and leukopenia. These changes can affect the electrocardiogram by prolonging QT intervals, causing bradycardia, and ventricular tachycardia. The effects of these disorders can decrease the blood pressure and cause a higher risk for heart problems, such as cardiomyopathy, by causing the larger walls of the heart to become thicker and lose their ability to pump blood (Sarder et al., 2015). Clients with anorexia typically have an amino acid deficiency because they do not consume enough protein, which is essential for bodily function. Without enough protein, the body will use the available protein for vital functions and the other nonessential functions will shut down. Nails become brittle, menstruation ceases, muscles begin to thin and waste, and the essential functions that help to regulate the heart become altered. Heart abnormalities are commonly seen in severe anorexia due to cardiac muscle cell death (Comprehensive Psychiatric Resources, 2023).

Adulthood

Cardiovascular disease is occurring in younger adults more often because other diseases that can cause cardiovascular disease are happening at younger ages. Risk factors for developing heart disease include hypertension, hyperlipidemia, smoking, obesity, diabetes, sedentary lifestyle, and poor dietary choices (CDC, 2023c).

Cardiovascular disease (CVD) is a broad category, but includes four subtypes: coronary heart disease, stroke, peripheral artery disease, and aortic disease. Table 12.4 includes a complete description of each.

Disease Subtype Description
Coronary heart disease (CHD) Plaque builds up on the walls of the arteries that supply blood to the heart, which decreases blood flow to the heart. This causes angina, which is chest pain from the lack of oxygen delivery to the heart.
Transient ischemic attack (TIAs) The temporary period of symptoms that are like a stroke and is caused by the occlusion of the arteries leading to the brain. TIAs typically only last a few minutes and the client usually recovers without any permanent damage.
Stroke The vessels leading up to the brain are blocked, stopping blood from flowing to the brain. Brain cells are damaged or possibly die, which can lead to long-term disability.
Peripheral artery disease (PAD) A blockage in the arteries to the extremity, usually the leg. This can produce pain in the legs while walking.
Aortic disease This is a broad category for any condition that impacts the ability of the aorta to function correctly. The most common type is aortic aneurysm.
Table 12.4 Subtypes of Cardiovascular Disease (sources: CDC, 2023f; Mayo Clinic, 2022c)

When arteries become built up with plaque, it causes a narrowing of the artery (National Heart, Lung, and Blood Institute, 2022), which impacts blood flow away from the area of stenosis (narrowing). Nutritional intake, along with lifestyle choices and heredity, can affect a client’s risk for developing atherosclerosis. See Figure 12.3 for a graphic depiction of normal versus abnormal blood flow due to atherosclerosis.

Three cutaway illustrations show what the artery wall looks like and how blood flows through it during different stages of atherosclerosis. The first illustrates a normal artery. The artery wall has no plaque formations inside of it and blood is able to flow through it unrestricted. The second illustrates an artery with mild atherosclerosis. There is mild plaque build up inside the artery wall, which restricts the blood flow slightly. The third illustrates an artery with advanced atherosclerosis. There is a lot of plaque build up inside the artery wall, reducing the space blood has to flow through by nearly half. This narrowed artery causes abnormal blood flow.
Figure 12.3 Atherosclerosis is due to plaque buildup which causes a narrowing of the artery and impacts blood flow distal to the area of stenosis. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Risks for heart disease include high cholesterol and high triglyceride levels, high blood pressure, and a diet high in saturated fats (Mayo Clinic, 2023d). There are two types of blood cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. Health care providers commonly refer to LDL as bad cholesterol because it contributes to the development of plaque deposits in arteries; HDL is referred to as good cholesterol as it provides some protection against heart disease (CDC, 2023d). Table 12.5 outlines cholesterol levels in the desirable, borderline, and high ranges.

Laboratory Test Desirable Borderline Risk High Risk
Total cholesterol < 200 mg/dL 200–239 mg/dL > 240 mg/dL
LDL cholesterol < 100 mg/dL 100–159 mg/dL > 160 mg/dL
HDL (varies dependent on sex) > 60 mg/dL 40–59 mg/dL < 40 mg/dL
Triglycerides < 150 mg/dL 150–199 mg/dL 200–499 mg/dL
Blood pressure < 120/80 mm Hg 120–129/< 80 mm Hg > 130/80 mm Hg
Table 12.5 Normal Cholesterol Levels (sources: CDC, 2021; National Heart, Lung, and Blood Institute, 2023; National Library of Medicine, 2022)

The use of the heart-healthy diet has been shown to help lower bad cholesterol (LDL) and increase good cholesterol (HDL). Additionally, avoiding or minimizing processed foods and high-sugar foods and drinks has a positive impact on heart health. Foods, such as red meats and high-fat dairy products that are high in saturated fat, should be reduced to help lower LDL levels. Adding whey protein to the diet can help decrease LDL and total cholesterol (Amirani et al., 2020). Increasing intake of omega-3—by increasing foods such as salmon, mackerel, and walnuts—can reduce blood pressure. Clients can increase soluble fiber in the diet by eating oatmeal, kidney beans, and apples, which can help decrease the absorption of cholesterol in the body leading to overall changes in cholesterol levels. Exercise and quitting smoking can also help improve HDL levels (Mayo Clinic, 2023b). Adhering to these dietary patterns can impact individual cholesterol levels to decrease the risk for developing atherosclerosis and further cardiovascular diseases.

Alcohol consumption has been shown to have negative effects on cardiovascular health, leading to hypertension, heart failure, and stroke. Drinking excessively—women more than 4 drinks per day and men more than 5 drinks per day—can also lead to cardiomyopathy, which affects the ability of the heart to pump effectively (Johns Hopkins Medicine, 2023). An alcoholic drink is defined as 0.6 of fluid ethanol per drink (National Institute on Alcohol Abuse and Alcoholism, 2022). In a study that consisted of 371,463 participants, Biddinger et al (2022), showed an increased risk for hypertension and coronary artery disease with alcohol consumption.

In addition to educating clients on controlling cholesterol, triglyceride, and blood pressure levels and avoiding alcohol, nurses should inform clients about appropriate nutritional plans to combat cardiovascular disease. Nutritional plans should be low in processed food, sugary drinks, saturated fats, fatty dairy products, and sodium (Mayo Clinic, 2023e). The Dietary Approaches to Stop Hypertension (DASH) diet is an appropriate recommendation because it includes a diet high in fruits and vegetables, unsaturated fats, whole grains, fish, legumes, and low-fat dairy. Refer to Table 12.6 for the daily nutritional needs of adults.

Food 1,800 Calories 2,200 Calories
Dairy 3 cups 3 cups
Lean meats and beans 5 oz 6 oz
Vegetables 2.5 cups 3 cups
Fruits 1.5 cups 2 cups
Grains 6 oz (with half of that from whole grains) 7 oz (with half of that from whole grains)
Table 12.6 Daily Nutritional Needs for the Average Healthy Adult (source: U.S. Department of Agriculture, n.d.)

Unfolding Case Study

Part D

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, and C.

Tara is a busy mother who typically does not like to cook. She does have 4 children ranging from ages 12 years to 2 weeks. While her husband’s parents help care for the children, it is typically Tara who cares for them daily. Tara’s husband is usually away on business 3–4 nights a week leaving Tara to care for the children herself.

At her last annual physical, her blood pressure was 148/84 mm Hg; total cholesterol was 248 mg/dL and triglycerides showed 173 mg/dL. Her health care provider discussed risk factors associated with cardiovascular disease.

Because school provides breakfast, lunch and a snack for Carter, Tara typically drinks several cups of coffee for breakfast, grabs lunch at work and picks up dinner on the way home from picking up her children from her in-law’s house. She works at home on the weekends, but believes she has time to make positive changes in their normal eating routine to include heart healthy meals.

7.
Which would be the best choice for Tara to include in her dietary menu planning?
  1. Macaroni and cheese
  2. Fried chicken
  3. Pork sausage
  4. Apples
8.
What are ways in which Tara could decrease her cholesterol instead of being placed on medication?
  1. Increase fiber in her diet
  2. Drink more sodas
  3. Increase intake of fatty meats
  4. Eat more processed foods

Later Adulthood

Later adulthood can be further broken down as youngest-old adults between 65 and 74, middle-old adults between 75 and 84, with oldest-old age 85 and older (Lee et al., 2018). Although preventative care fostering a healthy cardiovascular system is the optimal desire, research indicates that there is an increase in cardiovascular disease as people age. The incidence of cardiovascular disease increases from approximately 40% in adults ages 40–59 to 75% from ages 60–79, and approximately 86% in those above age 80 (Rodgers et al., 2019). Depending on the activity level of the client, the older adult typically needs about 2000 calories daily. Additionally, healthy older adults need increased dietary fiber, calcium, vitamin D, and potassium; healthy older adults should decrease their consumption of saturated fats, sodium, and added sugars (FDA, 2022a). See Table 12.7 for the recommended nutritional needs for later adulthood.

Nutrient Recommended Daily Amount
Dietary fiber 28 g
Calcium 1000 mg
Vitamin D 600 IU
Potassium 3400 mg
Saturated fats < 10% daily caloric intake
Sodium < 2300 mg
Added sugars < 10% daily caloric intake
Table 12.7 Daily Nutritional Needs for Later Adulthood (source: U.S. Department of Agriculture, 2020a)

As people age, many age-related changes occur that can affect nutritional needs. Many adults experience heart complications from coronary artery disease, valvular disease, high cholesterol, heart failure, and arrhythmias. These clients are typically placed on multiple medications to treat their condition. However, the nurse can educate clients on nutrition and other lifestyle strategies to help clients manage their symptoms. Nutritional needs for a healthy heart include eating a variety of fruits and vegetables; eating whole grains; choosing healthy proteins such as nuts, fish, and seafood; decreasing intake of highly processed foods; minimizing intake of added sugars; using herbs instead of salt for seasoning or choosing low-sodium foods; and limiting alcohol intake. The nurse should also instruct clients on the importance of smoking cessation (American Heart Association, 2021). Another consideration is how nutrition can interact with medications clients take to treat their heart disease.

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