Cardiovascular Disease Part II

Question 1

Protein requirement in CHF

Answer 1

1.1-1.4 g/kg of ACTUAL body weight

Question 2

Sodium requirement in CHF

Answer 2

2,000 -3,000 mg.day (HIGHER than RDA)

Question 3

Fluid requirements for CHF

Answer 3

1-2L/day (LOWER than AI)

Question 4

Fluid restriction in mild CHF?

Answer 4

1-2L/day

Question 5

Fluid restriction in more severe CHF or severe hyponatremia?

Answer 5

1-1.5L/day

Question 6

What should be adjusted in foods to allow for adequate energy intake without discomfort?

Answer 6

Texture and timing

Question 7

Alcohol in CHF?

Answer 7

Limit to 1 drink/day

Question 8

When is abstinence from alcohol mandatory?

Answer 8

When alcohol is considered to be a causative factor in heart failure

Question 9

What is difficult to asses in CHF?

Answer 9

BMI, as there may be fluid retention

Question 10

How is energy assessed in CHD?

Answer 10

Individualize and estimate - use ACTUAL WEIGHT, and then titrate towards weight-loss/weight gain

Question 11

Weight gain?

Answer 11

30-35 kcal/kg

Question 12

Weight maintenance?

Answer 12

25-30 kcal/kg

Question 13

Weight loss?

Answer 13

20-25 kcal/kg

Question 14

Energy in advanced heart failure?

Answer 14

22-24kcal/kg

Question 15

What is cardiac cachexia?

Answer 15

End result of heart failure, where weight loss occurs, sig loss of LBM including cardia muscle –> Heart is soft and flabby

Question 16

What is the consequence of cardiac cahcexia?

Answer 16

Inadequate blood supply to GI tract, anorexia, nausea, feeling of fullness, constipation, abdominal pain, loss of normal bowel function

Question 17

Identification of 2 out of what 6 factors will indicate adult malnutrition? (MS.WEFF)

Answer 17

• Loss of muscle mass
• Loss of subcutaneous fat
• Weight loss
• Insufficient energy intake
• localized/general fluid accumulation
• diminished functional status (measured by hand grip strength)

Question 18

Acute illness or injury may result in?

Answer 18

Moderate or Acute Protein Calorie Malnutrition

Question 19

How is energy intake indicative of MPCM in acute illness?

Answer 19

<75% of EEE in 7 days

Question 20

How is weight loss indicative of MPCM and in acute illness?

Answer 20

1-2% in 1 wk
5% 1 month
1.5% 3 months

Question 21

How is energy intake indicative of SPCM in acute illness?

Answer 21

<50% ofEE in > 5 days

Question 22

How is weight loss indicative of SPCM in acute illness?

Answer 22

> 2% in 1 week
5% in 1 month
7.5% in 3 months

Question 23

How is energy indicative of of MPCM in chronic illness?

Answer 23

<75% of EE > 1 month

Question 24

How is weight loss indicative of MPCM and SPCM in chronic illness?

Answer 24

5% in 1 month
7.5% in 3 months
10% in 60 months
20% in 1 year

anything greater than = SPCM

Question 25

If large abdomen, what should be monitored?

Answer 25

Watch for signs of muscle wasting in areas where fluid tends to NOT accumulate

Question 26

What could a a large abdomen be due to?

Answer 26

Ascites

Question 27

Which areas of muscle wasting may be problematic?

Answer 27

• Eyes
• Shoulders
• Clavicle
• Knees