Atrial Fibrillation and Nutrition
CL is an 86 year old white female who was brought into the hospital by her children on 11/4/11. On admission, she was diagnosed with recurring syncope episodes. She said that she gets weak and then just passes out. Other than her fainting spells, she claims to feel an overall sense of health and wellness. Her past medical history includes hypertension, arrhythmia (atrial fibrillation), dementia, diverticulitis, and a cardiovascular accident that occurred five years ago. When I spoke to her doctor, he stated that he believed her arrhythmia played a very large part in her syncope episodes. Upon researching atrial fibrillation we found that the electrical impulses that serve the heart are irregular; the atria contract very quickly and not in a normal pattern. As a result, the ventricles beat abnormally leading to an elevated pulse (Lewis, 826). Put simply, the heart is unable to pump as much blood as the body needs. In CL’s case, the lack of blood to the brain is causing her to faint at times.
Upon meeting the patient, I performed a brief physical. She weighed 175lbs and was 5’5. Her BMI was 29.1 which classified her as overweight. Before I began she informed me that she was very weak and became tired easily so I tried to perform the assessment as quickly but efficiently as I could. I began with her level of consciousness. Although she has been diagnosed with dementia, the patient was able to answer all of my questions without hesitation and perform all of the tasks I asked of her.
As I continued my assessment, I noticed that she was breathing normally with symmetrical chest rise. Her anterior and posterior breath sounds were clear in all lobes with no wheezes, rales, or rhonchi. She reported no cough or pain when breathing but did claim that it was easier for her to breathe if she was lying down rather than standing or sitting up. Her stomach was soft and flat with bowel sounds present in all four quadrants. She had an INT in her right forearm that had been running ½ normal saline but was now discontinued. Table I
48 Hour Recall
Date| Breakfast (0700-0800)| Lunch (1200-1300)| Dinner (1700-18000| Daily Total| 11-07-11 (Hospital)| (~80%) -2 scrambled eggs-1 slice of bacon-1 biscuit -240mL Coffee-120mL Orange juice -120mL Water| (< 50%) -1 slice of cooked ham - ½ c cabbage - ½ c cauliflower -1 slice of cornbread-1 chocolate chip cookie -240ml Root beer-240ml Sweet tea| (~50)- ½ c of beef stew -1 c chef salad -1 slice of apple pie -240mL Water-240mL Sweet tea-240mL Root beer | 1827 Calories -Grains (6oz): 4 ½oz-Vegetables (2 ½ cups): 1 ¾ c-Fruits (2 cups): 1 ¾ c-Dairy (3 cups): ¼ c-Protein (5 ½ oz): 5oz-Extras (< 260 cal): 524 calories| 11-08-11 (Hospital)| (100%) -2 scrambled eggs -1 slice bacon -1 biscuit-240mL Coffee -120mL Orange juice| (~50%) -1 sliced of turkey- ½ c of dressing- ½ c of green beans- ½ c of mashed potatoes-1 chocolate chip cookie-240mL Root beer -240mL Sweet tea| (~90%) -1 fish sandwich - ½ c of green beans - ½ c of potatoes-1 chocolate chip cookie-240mL Root beer-240mL Sweet tea-240mL Water| 1929 Calories-Grains (6oz): 5 ½oz-Vegetables (2 ½ cups): 2 ¼ c-Fruits (2 cups): 1c-Dairy (3 cups): 0c-Protein (5 ½ oz): 4½ oz -Extras (< 260 cal): 615 calories|
The client is on a normal diet at home, so she was not restricted to what she could have to eat at the hospital. On 11-07-11, CL had a slightly less than normal appetite. It seems as though a large portion of her overall calories came from her extras, such as root beer and sweet tea. While she did eat a good amount of grains and protein, she did not eat an adequate amount of vegetables or dairy products. Next on 11-08-11, CL’s appetite was better on this day than the day before, but again, a large portion of her calories came from extras like soda and cookies. While she came close to meeting her goals for grains, vegetables, and protein,...