Tuesday, March 26, 2013

Rebekah Tucker - Community Trends for cardiac patients in Salt Lake



I talked to Hailey Nielson, a Food and Nutrition Security Coordinator in Cardiology department at the University of Utah hospital, and she said that the biggest health trends for the people at risk for heart attack are diabetes, sodium intake, carbohydrate intake, heart failure, and fat intake/obesity.
Before Hailey sees the patients, the charge nurse and the doctor have both already seen them and she knows all the stats about that person and whether or not they have already had a heart attack. Hailey starts out with a 30 minute session in which she fills out a standardized food frequency question that has a score at the end. The scores are 1-50 is a low risk, 50-70 is a medium risk, 100+ is high risk for heart attack. This allows her to know where their diet stands then she can know how to help the patient.

1.                  Diabetes – Diabetes combined with other factors prospects a severe risk for heart disease if not controlled. Hailey already knows if they have diabetes, and if the person has it then he/she is at an even higher risk. The NIH said, “People who have type 1 or type 2 diabetes can develop [Diabetic Heart Disease (DHD)]. The higher a person's blood sugar level is, the higher his or her risk of DHD.” High blood glucose makes the blood more viscous and hard to move through the circulatory system (Dr. Allen Judd, Pathophysiology professor at BYU). Teaching them and making sure they implement a healthy diet is vital for someone with diabetes. A diet used could include controlling their sugar calories they consume. Hailey reminds them to follow the doctor’s orders with insulin injections and to exercise.

2.                  Sodium intake –The RDA (recommended daily amount) of sodium for the average person is 2300 mg.  What Hailey tries to do is make them aware of how much sodium is being added to their diet. “If you are in the population groups [at risk for heart disease due to high blood pressure], you should consume no more than 1,500 mg of sodium per day” (CDC). High blood pressure is caused by many things including an excess of sodium in the body.  Hailey said that a lot of the people she works with eat a lot of deli sandwiches thinking that they are healthy because of the bread grain and vegetables, but they don't realize it has 8,100 mg of sodium because of the processed meat. Since they are on a 1500 mg restriction they really need to pay attention to what they eat.

3.                  Carbohydrate intake – “A lot of the cardiac patients have a hard time watching their calorie intake because they get sick of trying to pay attention. They don't like being told how much they are allowed to eat of a certain food” (Hailey). Sometime it takes them awhile to get into the swing of keeping track of carbohydrates because it’s so tasty and they don't want to restrict it. “While people need to watch their calorie intake to prevent overweight and obesity, they should consume a diet rich in vegetables, fruits, and whole grains/high-fiber foods daily” (AHA) Hailey said she has a daily intake questionnaire that figures out how many calories the patient is intaking in one day. This is helpful in showing them where they need to cut down on certain foods and increase others.

4.                  Congestive Heart failure (CHF) – CHF is caused by many things and one of those causes is a heart attack. The charge nurse on the cardiovascular floor tells Hailey which patients have CHF. Hailey then goes to them and offers the services they have – cardiac rehab. In the cardiac rehab is where an exercise gym is located. Hailey will go with them and help them exercise as well as talking with them about the barriers that are keeping them at a high risk for another heart attack. If a person with CHF changes their lifestyle, future heart attacks can be prevented (PubMed Heatlh).

5.                  Obesity and fats – Hailey said a person who is at risk for heart attack needs to weigh themselves daily to help prevent. Based on weight you can know whether a Heart attack is coming. If a person gains 3 pounds in 48 hours, 6 pounds in 7 days, then you know they are not excreting water. “If the heart becomes less efficient as a pump, the body will try to compensate for it. One way it attempts to do this is by using hormones and nerve signals to increase blood volume (by water retention in the kidneys). A drop in blood flow to the kidneys will also lead to fluid retention” (heartfailure.org). The weight loss guidelines for males is if he is over 40 inches in waist size then he needs to lose weight and for females it is a waist size over 37 inches. There are those who don’t have a waist and are super skinny. However, this doesn’t mean that they can still eat a lot of fatty foods. Hailey lets them know that even if they a have a stent to keep their valve open, it can still clog due to fat collected around the stent and in the arteries still.

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