Find a dietary assessment tool that can be used either generally or for a specific alteration in health.

When you have found your assessment tool, answer the following questions:

• What is the purpose of this tool?
• Do you believe that the purpose is fulfilled based on the questions being asked? Why?
• In what ways does the tool account for the individual perceptions and needs of the client?
• Is there a nutritional history included? What does it cover?
• Is the tool easy to use? Why or why not?
• Does the tool provide enough information to determine next steps or interventions? Explain.

The writing assignment should be no more than 2 pages and APA Editorial Format must be used for citations and references used. Attach a copy of the assessment tool.

  

Cardiovascular system

A 70 year old black American female who has the following preexisting conditions;

Hypertension (HTN): longterm

Heart failure (CHF) : 2 months

Coronary artery disease (CAD) : longterm

Myocardial infarction (MI) : five years ago

Ejection (EF) of 55% : 2 months ago

Socioeconomic data:

Widow, Lives alone, independent ADL’s, Nonsmoker, Nondrinker

Pharmacologic data:

Aspirin (acetylsalicylic acid, ASA)

Clopidogrel bisulfate (Plavix)

Lisinopril (Prinivil, Zestril)

Carvedilol (Coreg)

Furosemide (Lasix)

Potassium chloride (KCL)

Client Profile: 

70 year old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Diagnosed with heart failure 2 months age and is followed up at home with a visiting nurse every other week for to assist is managing her heart failure symptoms. She is being referred to the nurse practitioner for follow up of changes in her symptoms.

Assessment:

At the office the following subjective and objective data was supplied: 

“I noticed my legs were getting a bit bigger and they are achy, too.”

She has gained 10 pounds over the last 5 days.

She gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath. 

Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds. 

She denies any chest, arm, or jaw pain or nausea.

She denies any back pain, stomach pain, confusion, dizziness, or a feeling faint. 

She admits only to feeling a little more tired than usual.

Eats Southern Cooking when at home.

Vital signs :  

T= 97.6 F (36.4C), BP 140/70, P 93, R 22. 

Labs ordered:

complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), troponin, creatine kinase (CPK), creatine kinase-MB (CKMB), and albumin. The APN also prescribes oral (PO) Furosemide and arranges an outpatient electrocardiogram (ECG, EKG), chest X-ray, and echocardiogram.

Questions

1. Which assessment findings during this visit are consistent with heart failure?

2. Why did the APN ask about back pain, stomach pain, confusion, dizziness or a feeling that she might faint?

3. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction and central venous pressure. Is an ejection fraction of 55% significant. Provide rationale.

5. Discuss the body’s compensatory mechanisms during hear failure. Include an explanation of the Frank-Starling law in your discussion.

6. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association (NYHA) and using the ACC/AHA (American Heart Association) guidelines. Explain these four classification systems and the signs and symptoms that characterize each. Which Classification fits this patient?

7. Provide a rationale for why each of the following medications have been prescribed: Aspirin, Clopidogrel bisulfate (Plavix), Lisinopril(Prinivil/Zestril) , and Carvedilol (Coreg).

8. What information will each of the following tests provide: CBC, BMP, BNP, Troponin, CPK, CKMB, and albumin, EKG, CXR, and Echocardiogram