Part I: Presentation Present illness: Jim C. is a 42 year old engineering techni
ID: 243274 • Letter: P
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 Jbs, small frame. BP 155/103, right arm, sitting, without postural changes and PR 76. HEENT 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 clear to P&A; (Percussion and Auscultation). Heart regular rhythm, without murmur or gallop. Abdomen slightly obese, soft, and without bruit. Extremities revealed no .) edema. Screening neurological exam, including mental status exam, is wNL Laboratory: Hct 50%, Hgh 158 g/L, glucose 6.55 mmol/L, BUN 6.43 mmol/L, total cholesterol 7.76 mmol/L, LDL cholesterol 5.17 mmol/L, HDL cholesterol 1.29 mmol/L, triglycerides (fasting) 1.35 mmol/L, U/A negative for glucose, protein and blood. EKG revealed normal sinus rhythm with a rate of 80, normal interval no evidence of ische mia, strain, or hypertrophy. CXR was unremarkable. Impression: Essential hypertension and elevated LDL. in a 42 xearold, slightly obese, otherwise healthy male with a positive family history of CHD. Plan: 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 BP check QUESTIONS You are the dietitian for the nutrition outpatient clinic associated with the local University hospital. Mr. C. comes to you for initial dietary counseling with a physician referral which reads the following: Instruct In: 2000 kcal, 2 g sodium, TLC/DASH. You have access to his medical record as outlined in Part L. 1. List the risk factors for CHD that Mr.C has. 2. You assess Mr. C's knowledge of TLC/DASH diet which is limited to "just don't add any salt to food and avoid fried foods". List 3 major points or areas (3 for the TLC diet and 3 for the DASH diet) you will need to explain to Mr C in order for him to follow a TLC/DASH diet..Explanation / Answer
1. Mr. C has the following risk factors for CHD:
2. TLC diet: The major areas of TLC diet are:
Diet changes: Avoid the following in the diet like
Exercise: Atleast minimum of 30 minutes of physical activity is important. Some of the exercises are brisk walking, swimming, gardening, cycling, dancing and bowling.
Weight management: The last area to concentrate is to reduce weight and maintain normal weight. The following can be followed to manage weight.
DASH diet stands for Dietary Approaches to Stop Hypertension. The following steps should be followed.