{"id":94,"date":"2021-08-14T12:32:35","date_gmt":"2021-08-14T16:32:35","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/dietmods\/?post_type=chapter&#038;p=94"},"modified":"2024-07-30T01:08:31","modified_gmt":"2024-07-30T05:08:31","slug":"htn-assess","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/","title":{"raw":"Assess","rendered":"Assess"},"content":{"raw":"<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-1024x132.png\" alt=\"Step 1: Assess\" width=\"1024\" height=\"132\" class=\"alignnone wp-image-1367 size-large\" \/>\r\n<h1>Setting the Agenda<\/h1>\r\nBefore you begin your assessment or any interaction with a client, make sure to:\r\n<ol>\r\n \t<li>Start out by greeting them and introducing yourself.<\/li>\r\n \t<li>Describe the role of a Registered Dietitian in terms of their health care.<\/li>\r\n \t<li>Invite them to the conversation to build rapport.<\/li>\r\n \t<li>Set the agenda for the appointment by asking about what brings them in and how you can help with the management of their blood pressure or cholesterol.<\/li>\r\n<\/ol>\r\n&nbsp;\r\n\r\n<span style=\"background-color: #ffffff\">[h5p id=\"19\"]<\/span>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">Case Study: Meet David<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n[caption id=\"attachment_851\" align=\"alignnone\" width=\"1024\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-1024x576.png\" alt=\"David Krulicki, our case study patient, is wearing a navy polo shirt and a has a slight grin as he joins the Zoom meeting. Family photos are behind him on the wall of his home office.\" width=\"1024\" height=\"576\" class=\"wp-image-851 size-large\" style=\"color: #373d3f;font-weight: bold;font-size: 1em\" \/> David Krulicki, your client[\/caption]\r\n\r\nYou are a Registered Dietitian (RD) at a Family Health Team. The client you are assessing is a 45 year old male named David Krulicki with hypertension, dyslipidemia, and depression. He is a plumber and lives with his wife Martha, who is responsible for grocery shopping and cooking. <span>He has had financial stressors lately, though does not experience food insecurity.<\/span>\r\n\r\nDavid has agreed to see the RD because would like to implement lifestyle changes and avoid increasing his medications.\r\n\r\n<\/div>\r\n<\/div>\r\n<h1>Gathering Data for an Assessment<\/h1>\r\nWhen gathering data for your assessment make sure to collect information on the patient\u2019s:\r\n<ul>\r\n \t<li>Clinical Data (both Medical History and Social History)<\/li>\r\n \t<li>Anthropometric Data<\/li>\r\n \t<li>Biochemical Data<\/li>\r\n \t<li>Dietary Data<\/li>\r\n<\/ul>\r\n<h1>Clinical Data<\/h1>\r\n<h2>Medical History<\/h2>\r\nWhen gathering clinical data, consider:\r\n<ul>\r\n \t<li><strong>Diagnosis: <\/strong>Have they received a diagnosis from their doctor? Do they have one or more CVD-related\u00a0 diagnoses (hypertension, dyslipidemia)? Are they at risk of developing CVD? Duration of Diagnosis?<\/li>\r\n \t<li><strong>Patient Medical History<\/strong>: Do they have other medical conditions (diabetes, chronic kidney disease, depression)?<\/li>\r\n \t<li><strong>Family History<\/strong>: Did members of their family have CVD or other medical conditions?<\/li>\r\n \t<li><strong>Management: <\/strong>Do they regularly see any other doctors or specialists?<\/li>\r\n \t<li><strong>Medications: <\/strong>Are they on any drug therapies for [pb_glossary id=\"1631\"]HTN[\/pb_glossary] or dyslipidemia? Keep medications in mind when assessing any possible drug nutrient interactions, for example, with many heart medications patients can't drink grapefruit juice.<\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h3 class=\"textbox__title\">David's Medical History<\/h3>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li><strong>Diagnosis<\/strong>: Hypertension (1 year since Diagnosis) and dyslipidemia (5 years since Diagnosis)<\/li>\r\n \t<li><strong>Patient Medical History<\/strong>: Depression<\/li>\r\n \t<li><strong>Medications<\/strong>:\r\n<ul>\r\n \t<li>Losartan and hydrochlorothiazide (Hyzaar) 50 mg + 12.5 mg [pb_glossary id=\"945\"]BID[\/pb_glossary]<\/li>\r\n \t<li>Amlodipine (Norvasc) 10mg [pb_glossary id=\"2302\"]OD[\/pb_glossary], switched from being on Ramipril (Altace) 2 months ago<\/li>\r\n \t<li>Atorvastatin (Lipitor) 80 mg OD<\/li>\r\n \t<li>Fluoxetine (Prozac) 20 mg OD<\/li>\r\n \t<li>1000 IU vitamin D OD<\/li>\r\n \t<li>His primary care provider (PCP) suggested an additional medication to manage his dyslipidemia<\/li>\r\n \t<li>He has come to see you because he does not want to take any additional medications and to try to control it with lifestyle changes<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"list-style-type: none\"><\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h3>Cardiac Medication Classification<\/h3>\r\nWhen gathering medications as part of the nutrition assessment, refer to this <a href=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/Cardiac-Medications-List.pdf\">Cardiac Medications List (PDF).<\/a> It summarizes the various classes of medications for HTN and dyslipidemia, and also details their side effects, nutrition interactions (for example, many HTN medications interact with grapefruit and natural liquorice), and the parts of the body they act on to help control blood pressure and lipids. Some common types of drug classes for HTN and dyslipidemia are listed below.\r\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 30px\" border=\"0\"><caption>Common types of drug classes for HTN and dyslipidemia<\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"width: 50%;height: 15px\" scope=\"col\">Common medications for HTN<\/th>\r\n<th style=\"width: 50%;height: 15px\" scope=\"col\">Common medications for Dyslipidemia<\/th>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 50%;height: 15px\">\r\n<ul>\r\n \t<li>Angiotensin Converting Enzyme (ACE) Inhibitors<\/li>\r\n \t<li>Angiotensin II Receptor Blockers (ARBs)<\/li>\r\n \t<li>Calcium Channel Blockers (CCBs)<\/li>\r\n \t<li>Diuretics<\/li>\r\n \t<li>Beta-Blockers<\/li>\r\n \t<li>Alpha blockers<\/li>\r\n \t<li>Alpha-2 Receptor Agonists<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"width: 50%;height: 15px\">\r\n<ul>\r\n \t<li>Statins<\/li>\r\n \t<li>Bile Acid Sequestrants<\/li>\r\n \t<li>Cholesterol Absorption Inhibitors<\/li>\r\n \t<li>Fibrates<\/li>\r\n \t<li>Lipoprotein Synthesis Inhibitor<\/li>\r\n \t<li>Dietary Supplements<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nA special note on diuretics: it\u2019s important to differentiate between potassium sparing and non-potassium sparing as they greatly affect electrolytes.\r\n<h2>Social History<\/h2>\r\nIt\u2019s also important to gather information on the client\u2019s social history, <span>which will help you to tailor your nutrition plan later on. <\/span>\r\n\r\n<span>When gathering social history, consider:<\/span>\r\n<ul>\r\n \t<li><strong>Housing<\/strong>:\u00a0What is their living situation? Do they live with others\/have a support system?<\/li>\r\n \t<li><strong>Income: <\/strong>Are they currently working? What is their main source of income? Do they have medical coverage?<\/li>\r\n \t<li><strong>Substance use: <\/strong>Smoking? Alcohol use? Any other substances?<\/li>\r\n \t<li><strong>Food security: <\/strong>Has anyone in their household gone without food in the past month because they couldn\u2019t afford it<strong><span>?<\/span><\/strong><\/li>\r\n \t<li><strong>Physical activity<\/strong>: Do they exercise? Do they have an injury or live in an unsafe area making it difficult to get outside to exercise? Do they have access to exercise facilities or equipment?<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h3 class=\"textbox__title\">David's Social History<\/h3>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li><strong>Housing: <\/strong>Lives with wife<\/li>\r\n \t<li><strong>Income<\/strong>: \u00a0Works as a plumber<\/li>\r\n \t<li><strong>Substance use<\/strong>:\r\n<ul>\r\n \t<li>Smoker. Has increased his smoking lately due to stress.<\/li>\r\n \t<li>Drinks 1-2 alcoholic beverages a night (beer, sometimes wine)<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Food security<\/strong>\r\n<ul>\r\n \t<li>Does not indicate any concerns with the ability to purchase foods<\/li>\r\n \t<li>During this conversation, tells you his wife is responsible for grocery shopping and preparing meals<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Physical activity<\/strong>\r\n<ul>\r\n \t<li>Has a lower back injury<\/li>\r\n \t<li>Used to walk with his wife for 15-30 minutes every night. Stopped recently.<\/li>\r\n \t<li>Expresses to you that he enjoys exercise but it causes pain<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Anthropometric Data<\/h1>\r\nWhen gathering anthropometric data from the client, consider:\r\n<ul>\r\n \t<li><strong>Weight:<span>\u00a0<\/span><\/strong>Current body weight in kg. If the client is open to having this taken.<\/li>\r\n \t<li><strong>Weight History:<span>\u00a0<\/span><\/strong>Do they have an interest in weight loss? Have they tried to lose weight before? Has their weight recently fluctuated? What was their highest and lowest adult body weight?<\/li>\r\n \t<li><strong>Waist Circumference:<span>\u00a0<\/span><\/strong>Current waist circumference in cm. If the client is open to having this taken, it can be a valuable screening measurement.<\/li>\r\n \t<li><strong>Height:<span>\u00a0<\/span><\/strong>Current height in cm<span class=\"sa11y-readability-period sa11y-visually-hidden\">.<\/span><\/li>\r\n \t<li><strong>BMI:\u00a0<\/strong>Body Mass Index<span class=\"sa11y-readability-period sa11y-visually-hidden\">. Always consider muscle mass when using this tool.<\/span><\/li>\r\n \t<li><strong>Physical Assessment:<\/strong> What is their muscle tone? Any muscle wasting?<\/li>\r\n<\/ul>\r\nIt\u2019s important to ask if the client is comfortable having these measurements taken as this may trigger stress for some clients. If the client states that weight loss is a goal for them, it can be helpful to know:\r\n<ul>\r\n \t<li>Why that goal is important for them<\/li>\r\n \t<li>If they have tried to lose weight before<\/li>\r\n \t<li>Any diets they have tried in the past<\/li>\r\n \t<li>How their weight has fluctuated over the years<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"list-style-type: none\"><\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Anthropometric Data<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li><strong>Weight<\/strong> = 80 kg<\/li>\r\n \t<li><strong>Height<\/strong> = 175.5 cm<\/li>\r\n \t<li><strong>BMI<\/strong> = 26 kg\/m<sup>2<\/sup><\/li>\r\n \t<li><strong>Weight History\u00a0<\/strong>= David reports his weight has been mostly stable over the past few years, however he has been gaining weight quickly over the past few months. The physician reports this as 15 pounds of weight gain in the past 6 months.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Biochemical Data<\/h1>\r\n<h2>Blood pressure ranges<\/h2>\r\n<table class=\"grid\" style=\"height: 90px;width: 100%\"><caption>Blood pressure values used to diagnose HTN, according to <a href=\"https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/the-facts-about-high-blood-pressure\">American Heart Association guidelines<\/a><\/caption>\r\n<thead>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 364.438px\" scope=\"col\">Blood Pressure Category<\/th>\r\n<th style=\"height: 15px;width: 213.438px\" scope=\"col\">SYSTOLIC mm Hg (upper number)<\/th>\r\n<th style=\"height: 15px;width: 41.7031px\" scope=\"col\">and\/or<\/th>\r\n<th style=\"height: 15px;width: 220.609px\" scope=\"col\">DIASTOLIC mm Hg (lower number)<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">Normal<\/th>\r\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">Less than 120<\/td>\r\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">and<\/td>\r\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">Less than 80<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">Elevated<\/th>\r\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">120 \u2013 129<\/td>\r\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">and<\/td>\r\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">Less than 80<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">High Blood Pressure (Hypertension) STAGE 1<\/th>\r\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">130 \u2013 139<\/td>\r\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">or<\/td>\r\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">80 \u2013 89<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">High Blood Pressure (Hypertension) STAGE 2<\/th>\r\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">140 or higher<\/td>\r\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">or<\/td>\r\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">90 or higher<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">Hypertensive Crisis (consult your doctor immediately)<\/th>\r\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">Higher than 180<\/td>\r\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">and\/or<\/td>\r\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">Higher than 120<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nFor patients with high blood pressure, measurements should be taken and used in forming a treatment plan to reduce their BP to the targets in the table below.\u00a0 Note that target ranges differ for clients with HTN, DM, and by level of CV risk. Target ranges can also vary based on the physician\u2019s assessment of client needs.\r\n<h2>Blood pressure targets<\/h2>\r\n<table class=\"grid\" style=\"width: 100%\"><caption>BP thresholds and treatment targets, according to <a href=\"https:\/\/hypertension.ca\/wp-content\/uploads\/2023\/05\/2020-Guidelines-Highlights.pdf\">Hypertension Canada 2020 guidelines (PDF)<\/a>\r\n<em>*BP treatment threshold and target based on automatic office blood pressure readings (AOBP)<\/em>\r\n<em>**BP treatment threshold and target based on non-AOBP measurements performed in office.<\/em><\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 30px;width: 33.7838%\" rowspan=\"2\" scope=\"col\">Patient Population<\/th>\r\n<th style=\"height: 15px;width: 43.6486%\" colspan=\"2\" scope=\"colgroup\">BP threshold for initiation of antihypertensive therapy<\/th>\r\n<th style=\"height: 15px;width: 22.4324%\" colspan=\"2\" scope=\"colgroup\">BP treatment target<\/th>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 21.3514%\" scope=\"col\">SBP mmHg<\/th>\r\n<th style=\"height: 15px;width: 22.2973%\" scope=\"col\">DBP mmHg<\/th>\r\n<th style=\"height: 15px;width: 11.0811%\" scope=\"col\">SBP mmHg<\/th>\r\n<th style=\"height: 15px;width: 11.3514%\" scope=\"col\">DBP mmHg<\/th>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Hypertension Canada High-Risk Patient*<\/th>\r\n<td style=\"height: 15px;width: 21.3514%\">\u2265 130<\/td>\r\n<td style=\"height: 15px;width: 22.2973%\">N\/A<\/td>\r\n<td style=\"height: 15px;width: 11.0811%\">&lt; 120<\/td>\r\n<td style=\"height: 15px;width: 11.3514%\">N\/A<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Diabetes mellitus**<\/th>\r\n<td style=\"height: 15px;width: 21.3514%\">\u2265 130<\/td>\r\n<td style=\"height: 15px;width: 22.2973%\">\u2265 80<\/td>\r\n<td style=\"height: 15px;width: 11.0811%\">&lt; 130<\/td>\r\n<td style=\"height: 15px;width: 11.3514%\">&lt; 80<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Moderate-to-High Risk (CV risk factors)**<\/th>\r\n<td style=\"height: 15px;width: 21.3514%\">\u2265 140<\/td>\r\n<td style=\"height: 15px;width: 22.2973%\">\u2265 90<\/td>\r\n<td style=\"height: 15px;width: 11.0811%\">&lt; 140<\/td>\r\n<td style=\"height: 15px;width: 11.3514%\">&lt; 90<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Low Risk (no CV risk factors)**<\/th>\r\n<td style=\"height: 15px;width: 21.3514%\">\u2265 160<\/td>\r\n<td style=\"height: 15px;width: 22.2973%\">\u2265 100<\/td>\r\n<td style=\"height: 15px;width: 11.0811%\">&lt; 140<\/td>\r\n<td style=\"height: 15px;width: 11.3514%\">&lt; 90<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Lipid tests<\/h2>\r\nYou also want to collect and assess any blood work they\u2019ve done for lipids, including total cholesterol, HDL, LDL, and non-HDL cholesterol, and triglycerides.\r\n\r\nFor more information, read the <a href=\"https:\/\/ccs.ca\/app\/uploads\/2022\/07\/2022-Lipids-Gui-PG-EN.pdf\">2022 Canadian Cardiovascular Society Dyslipidemia Guidelines (PDF)<\/a>\r\n<table class=\"grid\" style=\"height: 321px\"><caption>Normal and target ranges for lab tests<\/caption>\r\n<tbody>\r\n<tr style=\"height: 29px\">\r\n<th style=\"height: 29px;width: 87.8438px\" scope=\"col\">Lab Test<\/th>\r\n<th style=\"height: 29px;width: 529.719px\" scope=\"col\">Definition<\/th>\r\n<th style=\"height: 29px;width: 84.8125px\" scope=\"col\">Normal<\/th>\r\n<th style=\"height: 29px;width: 84.8594px\" scope=\"col\">Target<\/th>\r\n<\/tr>\r\n<tr style=\"height: 44px\">\r\n<th style=\"height: 44px;width: 87.8438px\" scope=\"row\">TC<\/th>\r\n<td style=\"height: 44px;width: 529.719px\">Total cholesterol: amount of total cholesterol in blood<\/td>\r\n<td style=\"height: 44px;width: 84.8125px\">&lt; 5.2 mmol\/L<\/td>\r\n<td style=\"height: 44px;width: 84.8594px\">\u2264 4.0 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 73px\">\r\n<th style=\"height: 73px;width: 87.8438px\" scope=\"row\">HDL Chol<\/th>\r\n<td style=\"height: 73px;width: 529.719px\">High density lipoprotein: \u201cgood\u201d cholesterol absorbs cholesterol and carries it back to liver<\/td>\r\n<td style=\"height: 73px;width: 84.8125px\">\u2265 1.0 mmol\/L\r\n\r\n&nbsp;<\/td>\r\n<td style=\"height: 73px;width: 84.8594px\">\u2265 1.0 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 44px\">\r\n<th style=\"height: 44px;width: 87.8438px\" scope=\"row\">LDL Chol<\/th>\r\n<td style=\"height: 44px;width: 529.719px\">Low density lipoprotein: \u201cbad\u201d cholesterol leading to plaque build up resulting in heart disease<\/td>\r\n<td style=\"height: 44px;width: 84.8125px\">&lt; 3.5 mmol\/L<\/td>\r\n<td style=\"height: 44px;width: 84.8594px\">\u2264 2.0 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 58px\">\r\n<th style=\"height: 58px;width: 87.8438px\" scope=\"row\">Non-HDL Chol<\/th>\r\n<td style=\"height: 58px;width: 529.719px\">Total cholesterol - HDL = Non-HDL Chol\r\n\r\nIncludes [pb_glossary id=\"1638\"]VLDL[\/pb_glossary], [pb_glossary id=\"2311\"]IDL[\/pb_glossary], [pb_glossary id=\"2312\"]Lp(a)[\/pb_glossary], [pb_glossary id=\"1618\"]LDL[\/pb_glossary], etc.<\/td>\r\n<td style=\"height: 58px;width: 84.8125px\">&lt; 4.0 mmol\/L<\/td>\r\n<td style=\"height: 58px;width: 84.8594px\">\u2264 2.6 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 73px\">\r\n<th style=\"height: 73px;width: 87.8438px\" scope=\"row\">TG<\/th>\r\n<td style=\"height: 73px;width: 529.719px\">Triglycerides: fat found in blood used for energy; excess fat storage<\/td>\r\n<td style=\"height: 73px;width: 84.8125px\">\u2264 1.7 mmol\/L\r\n\r\n&nbsp;<\/td>\r\n<td style=\"height: 73px;width: 84.8594px\">\u2264 1.7 mmol\/L<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Biochemical Data<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div>Often individuals diagnosed with hypertension will measure BP at home. Your client may provide you with a verbal or written list of previous BP readings. This provides you with more information, compared to the BP reading you may perform in your office.<\/div>\r\n<div>\r\n\r\nHere are the BP measurements for David. Use the BP target values provided above to determine if David falls within normal range or is above target. This information will be used when planning the nutrition care plan in the next section.\r\n\r\n<\/div>\r\n<table class=\"grid\" style=\"height: 264px;width: 362px\" width=\"362\"><caption><strong>David's BP measurements<\/strong><\/caption>\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 169.547px\" scope=\"col\">Measurement Date<\/th>\r\n<th style=\"width: 193.641px\" scope=\"col\">BP Result<\/th>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 169.547px\">May 1<\/td>\r\n<td style=\"width: 193.641px\">139\/89<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 169.547px\">May 2<\/td>\r\n<td style=\"width: 193.641px\">145\/92<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 169.547px\">May 3<\/td>\r\n<td style=\"width: 193.641px\">142\/91<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 169.547px\">May 4<\/td>\r\n<td style=\"width: 193.641px\">151\/96<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 169.547px\">May 5<\/td>\r\n<td style=\"width: 193.641px\">141\/90<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<span>[h5p id=\"75\"]<\/span>\r\n\r\n<\/div>\r\n<div class=\"textbox__content\">\r\n<div>Although David does not have diabetes, it is important to consider that his hypertension and dyslipidemia puts him at risk for the development of diabetes. If you have the laboratory data available you should check in on this. Determine which lab values are within target or are elevated.<\/div>\r\n<table class=\"grid\" style=\"height: 90px\"><caption>David's lab test results, compared with target ranges<\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 94.6875px\" scope=\"col\">Lab Test<\/th>\r\n<th style=\"height: 15px;width: 126.094px\" scope=\"col\">Lab Result<\/th>\r\n<th style=\"height: 15px;width: 145.469px\" scope=\"col\">Target Range<\/th>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">A1C<\/th>\r\n<td style=\"height: 15px;width: 126.094px\">5.5%<\/td>\r\n<td style=\"height: 15px;width: 145.469px\">\u2264 6.0%<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">TC<\/th>\r\n<td style=\"height: 15px;width: 126.094px\">6.2 mmol\/L<\/td>\r\n<td style=\"height: 15px;width: 145.469px\">\u2264 4.0 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">LDL<\/th>\r\n<td style=\"height: 15px;width: 126.094px\">4.2 mmol\/L<\/td>\r\n<td style=\"height: 15px;width: 145.469px\">\u2264 2.0 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">HDL<\/th>\r\n<td style=\"height: 15px;width: 126.094px\">0.8 mmol\/L<\/td>\r\n<td style=\"height: 15px;width: 145.469px\">\u2265 1.0 mmol\/L<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">TG<\/th>\r\n<td style=\"height: 15px;width: 126.094px\">4.0 mmol\/L<\/td>\r\n<td style=\"height: 15px;width: 145.469px\">\u2264 1.7 mmol\/L<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nIn David\u2019s case, his A1C is normal. If it was not, you should talk to his [pb_glossary id=\"1085\"]PCP[\/pb_glossary].\r\n\r\n<\/div>\r\n<\/div>\r\n<h1>Dietary Data<\/h1>\r\nWhen gathering dietary data, you should consider the client's:\r\n<ul>\r\n \t<li><strong>Diet History: <\/strong>24-hour recall or 3-day food record. Have they tried any diets in the past? Are they following the Dietary Approach to Stop Hypertension (DASH) diet or the Mediterranean Eating Pattern?<\/li>\r\n \t<li><strong>Eating behaviours\/patterns<\/strong>: How many meals per day and how many hours between their meals and snacks? Eating at home or eating out?<\/li>\r\n \t<li><strong>Cardiac dietary areas of concern: <\/strong>Intake of fibre, saturated fat, unsaturated fat, sodium and other electrolytes<\/li>\r\n \t<li><strong>Food skills and access: <\/strong>Do they have access to a kitchen? Do they have access to a grocery store? Do they get groceries and\/or cook at home, or does someone else do this for them? Previous nutrition education? What do they know about managing their blood pressure or cholesterol with diet choice<\/li>\r\n<\/ul>\r\n<h2>Dietary Strategies<\/h2>\r\n<h3>The Mediterranean Eating Pattern<\/h3>\r\nThe American Heart Association guidelines on lifestyle management to reduce CVD risk recommends following a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats. \u00a0Individuals can achieve this well-balanced dietary pattern by following the Mediterranean diet, Canada's Food Guide (CFG), or the [pb_glossary id=\"1633\"]DASH [\/pb_glossary]diet and adapt it with help from an RD to ensure it suits their energy and protein requirements, personal and cultural food preferences, and meets any nutrition therapy needs for other medical conditions, like diabetes. Following a dietary pattern like this can help clients with HTN and dyslipidemia reduce their CVD risk.\r\n\r\nThe Mediterranean Diet is:\r\n<ul>\r\n \t<li>Low in saturated fat<\/li>\r\n \t<li>Very low in trans fat<\/li>\r\n \t<li>Rich in unsaturated fat<\/li>\r\n \t<li>Rich in starch and fibre<\/li>\r\n \t<li>Rich in nutrients and phytochemicals that support good health<\/li>\r\n \t<li>Plant-based and limited red meats<\/li>\r\n<\/ul>\r\n<h3>DASH Eating Pattern<\/h3>\r\nThe Dietary Approach to Stop Hypertension (DASH) diet has been shown to help manage and even prevent high blood pressure. Similar to the Mediterranean diet and [pb_glossary id=\"1634\"]CFG[\/pb_glossary], it emphasizes whole grains, vegetables and fruits, low-fat dairy products, lean meats, and is low in saturated and trans fats. It also works on a serving size system, so keep in mind that clients using this will have to be educated on serving sizes.\r\n\r\nFor more details, read the <a href=\"https:\/\/www.healthvermont.gov\/sites\/default\/files\/documents\/pdf\/HPDP-Diabetes_dash%20eating%20plan.pdf\">Vermont Department of Health's DASH Eating Plan resource (PDF)<\/a>.\r\n<table class=\"grid\" style=\"width: 100%\"><caption>DASH Eating Plan<\/caption>\r\n<tbody>\r\n<tr style=\"height: 29px\">\r\n<th style=\"height: 29px;width: 226px\" scope=\"col\">Food Group<\/th>\r\n<th style=\"height: 29px;width: 94px\" scope=\"col\">Daily Servings<\/th>\r\n<th style=\"height: 29px;width: 269px\" scope=\"col\">Serving Sizes (1 serving is equivalent to)<\/th>\r\n<\/tr>\r\n<tr style=\"height: 45px\">\r\n<th style=\"height: 45px;width: 226px\" scope=\"row\">Grains<\/th>\r\n<td style=\"height: 45px;width: 94px\">7-8<\/td>\r\n<td style=\"height: 45px;width: 269px\">\r\n<div>1 slice of bread<\/div>\r\n<div>1 ounce of dry cereal<\/div>\r\n<div>\u00bd cup of cooked rice, pasta, cereal<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 226px\" scope=\"row\">Vegetables<\/th>\r\n<td style=\"height: 30px;width: 94px\">4-5<\/td>\r\n<td style=\"height: 30px;width: 269px\">\r\n<div>1 cup raw leafy vegetables<\/div>\r\n<div>\u00bd cup cut up raw or cooked vegetables<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 45px\">\r\n<th style=\"height: 45px;width: 226px\" scope=\"row\">Fruit<\/th>\r\n<td style=\"height: 45px;width: 94px\">4-5<\/td>\r\n<td style=\"height: 45px;width: 269px\">\r\n<div>1 medium piece of fruit<\/div>\r\n<div>\u00bc cup dried fruit<\/div>\r\n<div>\u00bd cup fresh, frozen or canned fruit<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 226px\" scope=\"row\">Fat-free or low-fat dairy products<\/th>\r\n<td style=\"height: 30px;width: 94px\">2-3<\/td>\r\n<td style=\"height: 30px;width: 269px\">\r\n<div>1 cup yogurt<\/div>\r\n<div>1 \u00bd ounce cheese<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 29px\">\r\n<th style=\"height: 29px;width: 226px\" scope=\"row\">Lean meats, poultry, fish<\/th>\r\n<td style=\"height: 29px;width: 94px\">2 or fewer<\/td>\r\n<td style=\"height: 29px;width: 269px\">\r\n<div>3-ounce cooked meats, poultry of fish<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 226px\" scope=\"row\">Nuts, seeds, and legumes<\/th>\r\n<td style=\"height: 30px;width: 94px\">4-5 per week<\/td>\r\n<td style=\"height: 30px;width: 269px\">\r\n<div>1 tbsp of peanut butter or seeds<\/div>\r\n<div>\u00bd cup cooked legumes<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 45px\">\r\n<th style=\"height: 45px;width: 226px\" scope=\"row\">Fats and oils<\/th>\r\n<td style=\"height: 45px;width: 94px\">2-3<\/td>\r\n<td style=\"height: 45px;width: 269px\">\r\n<div>1 tsp margarine (non-hydrogenated)<\/div>\r\n<div>1 tbsp mayonnaise<\/div>\r\n<div>1 tsp vegetable oil<\/div><\/td>\r\n<\/tr>\r\n<tr style=\"height: 29px\">\r\n<th style=\"height: 29px;width: 226px\" scope=\"row\">Sweets<\/th>\r\n<td style=\"height: 29px;width: 94px\">5 per week<\/td>\r\n<td style=\"height: 29px;width: 269px\">\r\n<div>\u00bd ounce jelly beans<\/div><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Dietary Recommendations<\/h2>\r\n<h3>Sodium Recommendations<\/h3>\r\n<ul>\r\n \t<li>To decrease BP, consider reducing sodium intake toward 2000 mg (5 g of salt or 87 mmol of sodium) per day (Grade A).<\/li>\r\n \t<li>Although sodium recommendations are more liberal, compared to healthy people, the majority of people with hypertension consume too much sodium, &gt; 3000 mg\/day.<\/li>\r\n<\/ul>\r\nFor more information, read <a href=\"https:\/\/guidelines.hypertension.ca\/wp-content\/uploads\/2020\/08\/Hypertension-Canada-2020-Comprehensive-Guidelines-for-Prevention-Diagnosis-Risk-Assessment-and-Treatment-of-Hypertension-in-Adults-and-Children.pdf\">Hypertension Canada's 2020 Comprehensive Guidelines for Adults and Children (PDF).<\/a>\r\n<h3>Fat Intake Recommendations<\/h3>\r\nReviewing fat intake and the different types of fat in the diet is key when working with a client who has high cholesterol or dyslipidemia, as intake of food with saturated and trans fat has a greater impact on blood cholesterol levels than intake of dietary cholesterol. Here are the recommendations surrounding intake of the different types of fat, like trans fat, saturated fat, and unsaturated fat, particularly omega 3, 6, and 9.\r\n<table class=\"grid\"><caption><strong>Fat intake recommendations, by fat type<\/strong><\/caption>\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 115.266px\" scope=\"col\">Type of Fat<\/th>\r\n<th style=\"width: 220.719px\" scope=\"col\">Recommendation<\/th>\r\n<th style=\"width: 496.203px\" scope=\"col\">Foods That Contain The Fat<\/th>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 115.266px\" scope=\"row\">Unsaturated Fats<\/th>\r\n<td style=\"width: 220.719px\">Include most often\r\n(2-3 tbsps a day)<\/td>\r\n<td style=\"width: 496.203px\">\r\n<ul>\r\n \t<li>Fish, seafood<\/li>\r\n \t<li>Olives, avocado, mayonnaise, and non-hydrogenated margarines (made with the oils below)<\/li>\r\n \t<li>Oils: olive, canola, peanut and sesame<\/li>\r\n \t<li>Nuts: almonds, cashews, chestnuts, peanuts, hazelnuts, pecans, pistachios and their butters<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 115.266px\" scope=\"row\">Omega 3<\/th>\r\n<td style=\"width: 220.719px\">Include more often\r\n(2-3 servings of fish a week)<\/td>\r\n<td style=\"width: 496.203px\">\r\n<ul>\r\n \t<li>Fatty fish (mackerel, sardines, salmon, and trout), seafood<\/li>\r\n \t<li>Oils: canola, flax, hemp seed.<\/li>\r\n \t<li>Nuts and seeds: chia, walnuts, pumpkin seeds, crushed flax and hemp seed.<\/li>\r\n \t<li>Soybean products, non-hydrogenated margarines (made with above oils)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 115.266px\" scope=\"row\">Omega 6 &amp; 9<\/th>\r\n<td style=\"width: 220.719px\">Include in small amounts<\/td>\r\n<td style=\"width: 496.203px\">\r\n<ul>\r\n \t<li>Oils: grapeseed, corn, safflower, sunflower, soybean, cottonseed<\/li>\r\n \t<li>Sunflower seeds, wheat germ, non-hydrogenated margarines (made with the oils listed above)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 115.266px\" scope=\"row\">Saturated Fats<\/th>\r\n<td style=\"width: 220.719px\">Limit\r\n(&lt;5-10% of total daily fat intake)<\/td>\r\n<td style=\"width: 496.203px\">\r\n<ul>\r\n \t<li>Meat (fresh or processed), dark poultry meat, poultry skin<\/li>\r\n \t<li>High fat dairy products, egg yolk<\/li>\r\n \t<li>Bakery products, butter, lard, bakery products<\/li>\r\n \t<li>Tropical oils: palm oil, palm kernel oil, coconut oil<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 115.266px\" scope=\"row\">Trans Fat<\/th>\r\n<td style=\"width: 220.719px\">Avoid<\/td>\r\n<td style=\"width: 496.203px\">\r\n<ul>\r\n \t<li>Partially hydrogenated vegetable oil and shortening<\/li>\r\n \t<li>Deep fried foods and fast foods<\/li>\r\n \t<li>Some packaged foods: cookies, crackers, potato chips, baked goods and candy bars<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3>Fibre Intake Recommendations<\/h3>\r\nReviewing fibre intake and the different types of fibre in the diet is key when working with a client who has high cholesterol or dyslipidemia, as intake of soluble fibre can reduce cholesterol by inhibiting cholesterol and bile absorption in the small intestine. Women need at least 25 grams of fibre per day, and men need at least 38 grams of fibre per day.\r\n<table class=\"grid\"><caption>Benefits and sources of fibre, by fibre type<\/caption>\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 89.8281px\" scope=\"col\">Fibre Type<\/th>\r\n<th style=\"width: 507px\" scope=\"col\">Benefits<\/th>\r\n<th style=\"width: 235.359px\" scope=\"col\">Food Sources<\/th>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 89.8281px\" scope=\"row\">Soluble Fibre<\/th>\r\n<td style=\"width: 507px\">Can reduce cholesterol by inhibiting cholesterol and bile absorption in the small intestine.<\/td>\r\n<td style=\"width: 235.359px\">\r\n<ul>\r\n \t<li>Oats<\/li>\r\n \t<li>Barley<\/li>\r\n \t<li>Legumes<\/li>\r\n \t<li>Fruit<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 89.8281px\" scope=\"row\">Insoluble Fibre<\/th>\r\n<td style=\"width: 507px\">Provides fecal bulk to help promote regular bowel movements. Can prevent colon cancer and diverticular disease and increases satiety.<\/td>\r\n<td style=\"width: 235.359px\">\r\n<ul>\r\n \t<li>Vegetables and fruit<\/li>\r\n \t<li>Legumes<\/li>\r\n \t<li>Nuts and seeds<\/li>\r\n \t<li>Whole grains (brown rice, quinoa)<\/li>\r\n \t<li>Whole wheat products (pasta, cereal, bread, crackers)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Dietary Data<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div><strong>Food access and food skills:<\/strong><\/div>\r\n<ul>\r\n \t<li>His wife does the grocery shopping and cooking.<\/li>\r\n \t<li>Eats out twice a week at fast food or dine-in restaurants. Mostly for lunch.<\/li>\r\n \t<li>He reports that his meals are consistent and the diet recall represents his typical patterns.<\/li>\r\n \t<li>He reports having no prior nutrition education.<\/li>\r\n<\/ul>\r\n<strong>Diet History (24-hour recall):<\/strong>\r\n<table class=\"grid\"><caption>David's 24-hour diet recall<\/caption>\r\n<tbody>\r\n<tr>\r\n<th scope=\"col\">Meal<\/th>\r\n<th scope=\"col\">David's diet recall<\/th>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Breakfast 9 am<\/th>\r\n<td>2 eggs, 2 pieces bacon, 1 piece of white bread, 15 mL butter on bread, 1 coffee with 2 milk (2%)<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Lunch 1-2 pm<\/th>\r\n<td>Turkey sandwich (2 slices of white bread, 2 slices of deli turkey, tbsp of mayo, tbsp of mustard, 2 slices of cheddar cheese, lettuce, and tomato) with 1 cup of soup (canned tomato or mushroom), 500 mL of water<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Dinner 5:30-6:30 pm<\/th>\r\n<td>6 ounces of meat (beef), 1 cup mashed potatoes, 1 cup of salad, 500 mL of water<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">HS snack<\/th>\r\n<td>1 bowl of cereal (cheerios) with 1 cup of 2% milk and a small bag of chips with 1-2 beers<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<\/div>\r\n<h1>PES Statements for Dietary Data<\/h1>\r\n<h2>Common PES Statement Terminology<\/h2>\r\nAs you interpret the dietary data from the assessment, you can form <span>Problem, Etiology, Symptoms (<\/span>PES) statements or nutrition diagnoses that help identify nutrition concerns that need to be addressed in your plan. If you are not familiar with how to write a PES statement please review this<a href=\"https:\/\/www.ncpro.org\/pub\/file.cfm?item_type=xm_file&amp;id=93467\"> resource from the Academy of Nutrition and Dietetics<\/a>. Here are some common nutrition problems that patients with HTN and dyslipidemia may experience:\r\n<ul>\r\n \t<li>Excessive saturated fat intake<\/li>\r\n \t<li>Less than optimal intake of types of fats (specify)<\/li>\r\n \t<li>Inappropriate intake of fats<\/li>\r\n \t<li>Inadequate vegetable and fruit consumption<\/li>\r\n \t<li>Inadequate fibre intake<\/li>\r\n \t<li>Excessive sodium intake<\/li>\r\n \t<li>Imbalance of nutrients<\/li>\r\n \t<li>Physical inactivity<\/li>\r\n \t<li>Altered nutrition-related laboratory values (specify)<\/li>\r\n \t<li>Food- and nutrition-related knowledge deficit<\/li>\r\n \t<li>Impaired ability to prepare food\/meals<\/li>\r\n \t<li>Not ready for diet\/lifestyle change<\/li>\r\n<\/ul>\r\n<h2>Guiding Questions<\/h2>\r\nUse the dietary assessment data you have collected from David so far to form a PES statement for his intake of sodium, fat, fibre, and DASH diet recommendations.\r\n\r\nYou can use the questions below to guide you:\r\n<ul>\r\n \t<li>Is David meeting the DASH Diet recommended amount of whole grains, vegetables and fruit, dairy products, and lean meats and poultry in his diet recall?<\/li>\r\n \t<li>Is he exceeding the daily recommended amount of sodium?<\/li>\r\n \t<li>Is he consuming excess saturated fat and is his intake of unsaturated fats sources adequate?<\/li>\r\n \t<li>Is his fibre intake adequate?<\/li>\r\n \t<li>Are there any potential drug nutrient interactions?<\/li>\r\n<\/ul>\r\n<span>[h5p id=\"74\"]<\/span>\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">PES Statements for David's Dietary Intake<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nThese are some examples of PES statements that you may have formed for David based on his intake.\r\n\r\nFor example, if we count his fruit and vegetable intake, it looks like he is only getting about 2-3 servings. Therefore, he has an imbalance of nutrients related to food and nutrition knowledge deficit of healthy dietary patterns as evidenced by not meeting DASH diet recommendations for vegetables and fruit. He also has excessive sodium intake, excessive intake of saturated and trans fats, and inadequate intake of fibre.\r\n\r\nThese PES statements will be used later on in the section when forming the nutrition care plan:\r\n<ol>\r\n \t<li>Imbalance of nutrients related to food and nutrition knowledge deficit of healthy dietary patterns as evidenced by not meeting DASH diet recommendations for whole grains, vegetables and fruit, dairy products, lean meats, poultry, fish, fats, and oils.<\/li>\r\n \t<li>Excessive sodium intake related to a knowledge deficit of sodium sources and importance of sodium reduction for blood pressure control as evidenced by high intake of processed foods such as bacon, deli meat, canned soup, etc.<\/li>\r\n \t<li>Excessive intake of saturated and trans fat related to a lack of food preparation knowledge and skills as evidenced by high intake of processed meat, red meat, and chips.<\/li>\r\n \t<li>Inadequate intake of fibre related to a knowledge deficit of food sources of fibre as evidenced by low intake of vegetables and whole grains.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<h1>Simulation Activity: David<\/h1>\r\n[h5p id=\"60\"]\r\n<div class=\"textbox shaded\">\r\n\r\nPART 1: ASSESS COMPLETE. Pause to reflect on the assessment strategies discussed. When you\u2019re ready, move on to Part 2: Plan.\r\n\r\n<\/div>\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;","rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Page Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-69e72a482502e\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-69e72a482502e\" checked aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Setting_the_Agenda\" >Setting the Agenda<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Case_Study_Meet_David\" >Case Study: Meet David<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Gathering_Data_for_an_Assessment\" >Gathering Data for an Assessment<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Clinical_Data\" >Clinical Data<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Medical_History\" >Medical History<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Davids_Medical_History\" >David&#8217;s Medical History<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Cardiac_Medication_Classification\" >Cardiac Medication Classification<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Social_History\" >Social History<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Davids_Social_History\" >David&#8217;s Social History<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Anthropometric_Data\" >Anthropometric Data<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Davids_Anthropometric_Data\" >David&#8217;s Anthropometric Data<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Biochemical_Data\" >Biochemical Data<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Blood_pressure_ranges\" >Blood pressure ranges<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Blood_pressure_targets\" >Blood pressure targets<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Lipid_tests\" >Lipid tests<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Davids_Biochemical_Data\" >David&#8217;s Biochemical Data<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Dietary_Data\" >Dietary Data<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Dietary_Strategies\" >Dietary Strategies<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#The_Mediterranean_Eating_Pattern\" >The Mediterranean Eating Pattern<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#DASH_Eating_Pattern\" >DASH Eating Pattern<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Dietary_Recommendations\" >Dietary Recommendations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Sodium_Recommendations\" >Sodium Recommendations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Fat_Intake_Recommendations\" >Fat Intake Recommendations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-24\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Fibre_Intake_Recommendations\" >Fibre Intake Recommendations<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-25\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Davids_Dietary_Data\" >David&#8217;s Dietary Data<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-26\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#PES_Statements_for_Dietary_Data\" >PES Statements for Dietary Data<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-27\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Common_PES_Statement_Terminology\" >Common PES Statement Terminology<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-28\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Guiding_Questions\" >Guiding Questions<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-29\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#PES_Statements_for_Davids_Dietary_Intake\" >PES Statements for David&#8217;s Dietary Intake<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-30\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-assess\/#Simulation_Activity_David\" >Simulation Activity: David<\/a><\/li><\/ul><\/nav><\/div>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-1024x132.png\" alt=\"Step 1: Assess\" width=\"1024\" height=\"132\" class=\"alignnone wp-image-1367 size-large\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-1024x132.png 1024w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-300x39.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-768x99.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-1536x198.png 1536w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-2048x264.png 2048w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-65x8.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-225x29.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_1-assess-350x45.png 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<h1><span class=\"ez-toc-section\" id=\"Setting_the_Agenda\"><\/span>Setting the Agenda<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Before you begin your assessment or any interaction with a client, make sure to:<\/p>\n<ol>\n<li>Start out by greeting them and introducing yourself.<\/li>\n<li>Describe the role of a Registered Dietitian in terms of their health care.<\/li>\n<li>Invite them to the conversation to build rapport.<\/li>\n<li>Set the agenda for the appointment by asking about what brings them in and how you can help with the management of their blood pressure or cholesterol.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"background-color: #ffffff\"><\/p>\n<div id=\"h5p-19\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-19\" class=\"h5p-iframe\" data-content-id=\"19\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Meeting a new client\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Case_Study_Meet_David\"><\/span>Case Study: Meet David<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<figure id=\"attachment_851\" aria-describedby=\"caption-attachment-851\" style=\"width: 1024px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-1024x576.png\" alt=\"David Krulicki, our case study patient, is wearing a navy polo shirt and a has a slight grin as he joins the Zoom meeting. Family photos are behind him on the wall of his home office.\" width=\"1024\" height=\"576\" class=\"wp-image-851 size-large\" style=\"color: #373d3f;font-weight: bold;font-size: 1em\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-1024x576.png 1024w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-300x169.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-768x432.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-1536x864.png 1536w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-65x37.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-225x127.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor-350x197.png 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/HTN_Actor.png 1920w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption id=\"caption-attachment-851\" class=\"wp-caption-text\">David Krulicki, your client<\/figcaption><\/figure>\n<p>You are a Registered Dietitian (RD) at a Family Health Team. The client you are assessing is a 45 year old male named David Krulicki with hypertension, dyslipidemia, and depression. He is a plumber and lives with his wife Martha, who is responsible for grocery shopping and cooking. <span>He has had financial stressors lately, though does not experience food insecurity.<\/span><\/p>\n<p>David has agreed to see the RD because would like to implement lifestyle changes and avoid increasing his medications.<\/p>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Gathering_Data_for_an_Assessment\"><\/span>Gathering Data for an Assessment<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>When gathering data for your assessment make sure to collect information on the patient\u2019s:<\/p>\n<ul>\n<li>Clinical Data (both Medical History and Social History)<\/li>\n<li>Anthropometric Data<\/li>\n<li>Biochemical Data<\/li>\n<li>Dietary Data<\/li>\n<\/ul>\n<h1><span class=\"ez-toc-section\" id=\"Clinical_Data\"><\/span>Clinical Data<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"Medical_History\"><\/span>Medical History<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>When gathering clinical data, consider:<\/p>\n<ul>\n<li><strong>Diagnosis: <\/strong>Have they received a diagnosis from their doctor? Do they have one or more CVD-related\u00a0 diagnoses (hypertension, dyslipidemia)? Are they at risk of developing CVD? Duration of Diagnosis?<\/li>\n<li><strong>Patient Medical History<\/strong>: Do they have other medical conditions (diabetes, chronic kidney disease, depression)?<\/li>\n<li><strong>Family History<\/strong>: Did members of their family have CVD or other medical conditions?<\/li>\n<li><strong>Management: <\/strong>Do they regularly see any other doctors or specialists?<\/li>\n<li><strong>Medications: <\/strong>Are they on any drug therapies for <button class=\"glossary-term\" aria-describedby=\"94-1631\">HTN<\/button> or dyslipidemia? Keep medications in mind when assessing any possible drug nutrient interactions, for example, with many heart medications patients can&#8217;t drink grapefruit juice.<\/li>\n<\/ul>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h3 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Medical_History\"><\/span>David&#8217;s Medical History<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><strong>Diagnosis<\/strong>: Hypertension (1 year since Diagnosis) and dyslipidemia (5 years since Diagnosis)<\/li>\n<li><strong>Patient Medical History<\/strong>: Depression<\/li>\n<li><strong>Medications<\/strong>:\n<ul>\n<li>Losartan and hydrochlorothiazide (Hyzaar) 50 mg + 12.5 mg <button class=\"glossary-term\" aria-describedby=\"94-945\">BID<\/button><\/li>\n<li>Amlodipine (Norvasc) 10mg <button class=\"glossary-term\" aria-describedby=\"94-2302\">OD<\/button>, switched from being on Ramipril (Altace) 2 months ago<\/li>\n<li>Atorvastatin (Lipitor) 80 mg OD<\/li>\n<li>Fluoxetine (Prozac) 20 mg OD<\/li>\n<li>1000 IU vitamin D OD<\/li>\n<li>His primary care provider (PCP) suggested an additional medication to manage his dyslipidemia<\/li>\n<li>He has come to see you because he does not want to take any additional medications and to try to control it with lifestyle changes<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\"><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h3><span class=\"ez-toc-section\" id=\"Cardiac_Medication_Classification\"><\/span>Cardiac Medication Classification<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>When gathering medications as part of the nutrition assessment, refer to this <a href=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/Cardiac-Medications-List.pdf\">Cardiac Medications List (PDF).<\/a> It summarizes the various classes of medications for HTN and dyslipidemia, and also details their side effects, nutrition interactions (for example, many HTN medications interact with grapefruit and natural liquorice), and the parts of the body they act on to help control blood pressure and lipids. Some common types of drug classes for HTN and dyslipidemia are listed below.<\/p>\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 30px\">\n<caption>Common types of drug classes for HTN and dyslipidemia<\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"width: 50%;height: 15px\" scope=\"col\">Common medications for HTN<\/th>\n<th style=\"width: 50%;height: 15px\" scope=\"col\">Common medications for Dyslipidemia<\/th>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 50%;height: 15px\">\n<ul>\n<li>Angiotensin Converting Enzyme (ACE) Inhibitors<\/li>\n<li>Angiotensin II Receptor Blockers (ARBs)<\/li>\n<li>Calcium Channel Blockers (CCBs)<\/li>\n<li>Diuretics<\/li>\n<li>Beta-Blockers<\/li>\n<li>Alpha blockers<\/li>\n<li>Alpha-2 Receptor Agonists<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 50%;height: 15px\">\n<ul>\n<li>Statins<\/li>\n<li>Bile Acid Sequestrants<\/li>\n<li>Cholesterol Absorption Inhibitors<\/li>\n<li>Fibrates<\/li>\n<li>Lipoprotein Synthesis Inhibitor<\/li>\n<li>Dietary Supplements<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>A special note on diuretics: it\u2019s important to differentiate between potassium sparing and non-potassium sparing as they greatly affect electrolytes.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Social_History\"><\/span>Social History<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>It\u2019s also important to gather information on the client\u2019s social history, <span>which will help you to tailor your nutrition plan later on. <\/span><\/p>\n<p><span>When gathering social history, consider:<\/span><\/p>\n<ul>\n<li><strong>Housing<\/strong>:\u00a0What is their living situation? Do they live with others\/have a support system?<\/li>\n<li><strong>Income: <\/strong>Are they currently working? What is their main source of income? Do they have medical coverage?<\/li>\n<li><strong>Substance use: <\/strong>Smoking? Alcohol use? Any other substances?<\/li>\n<li><strong>Food security: <\/strong>Has anyone in their household gone without food in the past month because they couldn\u2019t afford it<strong><span>?<\/span><\/strong><\/li>\n<li><strong>Physical activity<\/strong>: Do they exercise? Do they have an injury or live in an unsafe area making it difficult to get outside to exercise? Do they have access to exercise facilities or equipment?<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h3 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Social_History\"><\/span>David&#8217;s Social History<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><strong>Housing: <\/strong>Lives with wife<\/li>\n<li><strong>Income<\/strong>: \u00a0Works as a plumber<\/li>\n<li><strong>Substance use<\/strong>:\n<ul>\n<li>Smoker. Has increased his smoking lately due to stress.<\/li>\n<li>Drinks 1-2 alcoholic beverages a night (beer, sometimes wine)<\/li>\n<\/ul>\n<\/li>\n<li><strong>Food security<\/strong>\n<ul>\n<li>Does not indicate any concerns with the ability to purchase foods<\/li>\n<li>During this conversation, tells you his wife is responsible for grocery shopping and preparing meals<\/li>\n<\/ul>\n<\/li>\n<li><strong>Physical activity<\/strong>\n<ul>\n<li>Has a lower back injury<\/li>\n<li>Used to walk with his wife for 15-30 minutes every night. Stopped recently.<\/li>\n<li>Expresses to you that he enjoys exercise but it causes pain<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Anthropometric_Data\"><\/span>Anthropometric Data<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>When gathering anthropometric data from the client, consider:<\/p>\n<ul>\n<li><strong>Weight:<span>\u00a0<\/span><\/strong>Current body weight in kg. If the client is open to having this taken.<\/li>\n<li><strong>Weight History:<span>\u00a0<\/span><\/strong>Do they have an interest in weight loss? Have they tried to lose weight before? Has their weight recently fluctuated? What was their highest and lowest adult body weight?<\/li>\n<li><strong>Waist Circumference:<span>\u00a0<\/span><\/strong>Current waist circumference in cm. If the client is open to having this taken, it can be a valuable screening measurement.<\/li>\n<li><strong>Height:<span>\u00a0<\/span><\/strong>Current height in cm<span class=\"sa11y-readability-period sa11y-visually-hidden\">.<\/span><\/li>\n<li><strong>BMI:\u00a0<\/strong>Body Mass Index<span class=\"sa11y-readability-period sa11y-visually-hidden\">. Always consider muscle mass when using this tool.<\/span><\/li>\n<li><strong>Physical Assessment:<\/strong> What is their muscle tone? Any muscle wasting?<\/li>\n<\/ul>\n<p>It\u2019s important to ask if the client is comfortable having these measurements taken as this may trigger stress for some clients. If the client states that weight loss is a goal for them, it can be helpful to know:<\/p>\n<ul>\n<li>Why that goal is important for them<\/li>\n<li>If they have tried to lose weight before<\/li>\n<li>Any diets they have tried in the past<\/li>\n<li>How their weight has fluctuated over the years<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\"><\/li>\n<\/ul>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Anthropometric_Data\"><\/span>David&#8217;s Anthropometric Data<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><strong>Weight<\/strong> = 80 kg<\/li>\n<li><strong>Height<\/strong> = 175.5 cm<\/li>\n<li><strong>BMI<\/strong> = 26 kg\/m<sup>2<\/sup><\/li>\n<li><strong>Weight History\u00a0<\/strong>= David reports his weight has been mostly stable over the past few years, however he has been gaining weight quickly over the past few months. The physician reports this as 15 pounds of weight gain in the past 6 months.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Biochemical_Data\"><\/span>Biochemical Data<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"Blood_pressure_ranges\"><\/span>Blood pressure ranges<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<table class=\"grid\" style=\"height: 90px;width: 100%\">\n<caption>Blood pressure values used to diagnose HTN, according to <a href=\"https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/the-facts-about-high-blood-pressure\">American Heart Association guidelines<\/a><\/caption>\n<thead>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 364.438px\" scope=\"col\">Blood Pressure Category<\/th>\n<th style=\"height: 15px;width: 213.438px\" scope=\"col\">SYSTOLIC mm Hg (upper number)<\/th>\n<th style=\"height: 15px;width: 41.7031px\" scope=\"col\">and\/or<\/th>\n<th style=\"height: 15px;width: 220.609px\" scope=\"col\">DIASTOLIC mm Hg (lower number)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">Normal<\/th>\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">Less than 120<\/td>\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">and<\/td>\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">Less than 80<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">Elevated<\/th>\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">120 \u2013 129<\/td>\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">and<\/td>\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">Less than 80<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">High Blood Pressure (Hypertension) STAGE 1<\/th>\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">130 \u2013 139<\/td>\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">or<\/td>\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">80 \u2013 89<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">High Blood Pressure (Hypertension) STAGE 2<\/th>\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">140 or higher<\/td>\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">or<\/td>\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">90 or higher<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 364.438px\" scope=\"row\">Hypertensive Crisis (consult your doctor immediately)<\/th>\n<td style=\"height: 15px;width: 213.938px\" data-label=\"SYSTOLIC mm Hg (upper number)\">Higher than 180<\/td>\n<td style=\"height: 15px;width: 42.7031px\" data-label=\"and\/or\">and\/or<\/td>\n<td style=\"height: 15px;width: 221.109px\" data-label=\"DIASTOLIC mm Hg (lower number)\">Higher than 120<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>For patients with high blood pressure, measurements should be taken and used in forming a treatment plan to reduce their BP to the targets in the table below.\u00a0 Note that target ranges differ for clients with HTN, DM, and by level of CV risk. Target ranges can also vary based on the physician\u2019s assessment of client needs.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Blood_pressure_targets\"><\/span>Blood pressure targets<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<table class=\"grid\" style=\"width: 100%\">\n<caption>BP thresholds and treatment targets, according to <a href=\"https:\/\/hypertension.ca\/wp-content\/uploads\/2023\/05\/2020-Guidelines-Highlights.pdf\">Hypertension Canada 2020 guidelines (PDF)<\/a><br \/>\n<em>*BP treatment threshold and target based on automatic office blood pressure readings (AOBP)<\/em><br \/>\n<em>**BP treatment threshold and target based on non-AOBP measurements performed in office.<\/em><\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"height: 30px;width: 33.7838%\" rowspan=\"2\" scope=\"col\">Patient Population<\/th>\n<th style=\"height: 15px;width: 43.6486%\" colspan=\"2\" scope=\"colgroup\">BP threshold for initiation of antihypertensive therapy<\/th>\n<th style=\"height: 15px;width: 22.4324%\" colspan=\"2\" scope=\"colgroup\">BP treatment target<\/th>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 21.3514%\" scope=\"col\">SBP mmHg<\/th>\n<th style=\"height: 15px;width: 22.2973%\" scope=\"col\">DBP mmHg<\/th>\n<th style=\"height: 15px;width: 11.0811%\" scope=\"col\">SBP mmHg<\/th>\n<th style=\"height: 15px;width: 11.3514%\" scope=\"col\">DBP mmHg<\/th>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Hypertension Canada High-Risk Patient*<\/th>\n<td style=\"height: 15px;width: 21.3514%\">\u2265 130<\/td>\n<td style=\"height: 15px;width: 22.2973%\">N\/A<\/td>\n<td style=\"height: 15px;width: 11.0811%\">&lt; 120<\/td>\n<td style=\"height: 15px;width: 11.3514%\">N\/A<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Diabetes mellitus**<\/th>\n<td style=\"height: 15px;width: 21.3514%\">\u2265 130<\/td>\n<td style=\"height: 15px;width: 22.2973%\">\u2265 80<\/td>\n<td style=\"height: 15px;width: 11.0811%\">&lt; 130<\/td>\n<td style=\"height: 15px;width: 11.3514%\">&lt; 80<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Moderate-to-High Risk (CV risk factors)**<\/th>\n<td style=\"height: 15px;width: 21.3514%\">\u2265 140<\/td>\n<td style=\"height: 15px;width: 22.2973%\">\u2265 90<\/td>\n<td style=\"height: 15px;width: 11.0811%\">&lt; 140<\/td>\n<td style=\"height: 15px;width: 11.3514%\">&lt; 90<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 33.7838%\" scope=\"row\">Low Risk (no CV risk factors)**<\/th>\n<td style=\"height: 15px;width: 21.3514%\">\u2265 160<\/td>\n<td style=\"height: 15px;width: 22.2973%\">\u2265 100<\/td>\n<td style=\"height: 15px;width: 11.0811%\">&lt; 140<\/td>\n<td style=\"height: 15px;width: 11.3514%\">&lt; 90<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><span class=\"ez-toc-section\" id=\"Lipid_tests\"><\/span>Lipid tests<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>You also want to collect and assess any blood work they\u2019ve done for lipids, including total cholesterol, HDL, LDL, and non-HDL cholesterol, and triglycerides.<\/p>\n<p>For more information, read the <a href=\"https:\/\/ccs.ca\/app\/uploads\/2022\/07\/2022-Lipids-Gui-PG-EN.pdf\">2022 Canadian Cardiovascular Society Dyslipidemia Guidelines (PDF)<\/a><\/p>\n<table class=\"grid\" style=\"height: 321px\">\n<caption>Normal and target ranges for lab tests<\/caption>\n<tbody>\n<tr style=\"height: 29px\">\n<th style=\"height: 29px;width: 87.8438px\" scope=\"col\">Lab Test<\/th>\n<th style=\"height: 29px;width: 529.719px\" scope=\"col\">Definition<\/th>\n<th style=\"height: 29px;width: 84.8125px\" scope=\"col\">Normal<\/th>\n<th style=\"height: 29px;width: 84.8594px\" scope=\"col\">Target<\/th>\n<\/tr>\n<tr style=\"height: 44px\">\n<th style=\"height: 44px;width: 87.8438px\" scope=\"row\">TC<\/th>\n<td style=\"height: 44px;width: 529.719px\">Total cholesterol: amount of total cholesterol in blood<\/td>\n<td style=\"height: 44px;width: 84.8125px\">&lt; 5.2 mmol\/L<\/td>\n<td style=\"height: 44px;width: 84.8594px\">\u2264 4.0 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 73px\">\n<th style=\"height: 73px;width: 87.8438px\" scope=\"row\">HDL Chol<\/th>\n<td style=\"height: 73px;width: 529.719px\">High density lipoprotein: \u201cgood\u201d cholesterol absorbs cholesterol and carries it back to liver<\/td>\n<td style=\"height: 73px;width: 84.8125px\">\u2265 1.0 mmol\/L<\/p>\n<p>&nbsp;<\/td>\n<td style=\"height: 73px;width: 84.8594px\">\u2265 1.0 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 44px\">\n<th style=\"height: 44px;width: 87.8438px\" scope=\"row\">LDL Chol<\/th>\n<td style=\"height: 44px;width: 529.719px\">Low density lipoprotein: \u201cbad\u201d cholesterol leading to plaque build up resulting in heart disease<\/td>\n<td style=\"height: 44px;width: 84.8125px\">&lt; 3.5 mmol\/L<\/td>\n<td style=\"height: 44px;width: 84.8594px\">\u2264 2.0 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 58px\">\n<th style=\"height: 58px;width: 87.8438px\" scope=\"row\">Non-HDL Chol<\/th>\n<td style=\"height: 58px;width: 529.719px\">Total cholesterol &#8211; HDL = Non-HDL Chol<\/p>\n<p>Includes <button class=\"glossary-term\" aria-describedby=\"94-1638\">VLDL<\/button>, <button class=\"glossary-term\" aria-describedby=\"94-2311\">IDL<\/button>, <button class=\"glossary-term\" aria-describedby=\"94-2312\">Lp(a)<\/button>, <button class=\"glossary-term\" aria-describedby=\"94-1618\">LDL<\/button>, etc.<\/td>\n<td style=\"height: 58px;width: 84.8125px\">&lt; 4.0 mmol\/L<\/td>\n<td style=\"height: 58px;width: 84.8594px\">\u2264 2.6 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 73px\">\n<th style=\"height: 73px;width: 87.8438px\" scope=\"row\">TG<\/th>\n<td style=\"height: 73px;width: 529.719px\">Triglycerides: fat found in blood used for energy; excess fat storage<\/td>\n<td style=\"height: 73px;width: 84.8125px\">\u2264 1.7 mmol\/L<\/p>\n<p>&nbsp;<\/td>\n<td style=\"height: 73px;width: 84.8594px\">\u2264 1.7 mmol\/L<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Biochemical_Data\"><\/span>David&#8217;s Biochemical Data<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div>Often individuals diagnosed with hypertension will measure BP at home. Your client may provide you with a verbal or written list of previous BP readings. This provides you with more information, compared to the BP reading you may perform in your office.<\/div>\n<div>\n<p>Here are the BP measurements for David. Use the BP target values provided above to determine if David falls within normal range or is above target. This information will be used when planning the nutrition care plan in the next section.<\/p>\n<\/div>\n<table class=\"grid\" style=\"height: 264px;width: 362px; width: 362px;\">\n<caption><strong>David&#8217;s BP measurements<\/strong><\/caption>\n<tbody>\n<tr>\n<th style=\"width: 169.547px\" scope=\"col\">Measurement Date<\/th>\n<th style=\"width: 193.641px\" scope=\"col\">BP Result<\/th>\n<\/tr>\n<tr>\n<td style=\"width: 169.547px\">May 1<\/td>\n<td style=\"width: 193.641px\">139\/89<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 169.547px\">May 2<\/td>\n<td style=\"width: 193.641px\">145\/92<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 169.547px\">May 3<\/td>\n<td style=\"width: 193.641px\">142\/91<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 169.547px\">May 4<\/td>\n<td style=\"width: 193.641px\">151\/96<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 169.547px\">May 5<\/td>\n<td style=\"width: 193.641px\">141\/90<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span><\/p>\n<div id=\"h5p-75\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-75\" class=\"h5p-iframe\" data-content-id=\"75\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"David&#039;s BP Range\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<\/div>\n<div class=\"textbox__content\">\n<div>Although David does not have diabetes, it is important to consider that his hypertension and dyslipidemia puts him at risk for the development of diabetes. If you have the laboratory data available you should check in on this. Determine which lab values are within target or are elevated.<\/div>\n<table class=\"grid\" style=\"height: 90px\">\n<caption>David&#8217;s lab test results, compared with target ranges<\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 94.6875px\" scope=\"col\">Lab Test<\/th>\n<th style=\"height: 15px;width: 126.094px\" scope=\"col\">Lab Result<\/th>\n<th style=\"height: 15px;width: 145.469px\" scope=\"col\">Target Range<\/th>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">A1C<\/th>\n<td style=\"height: 15px;width: 126.094px\">5.5%<\/td>\n<td style=\"height: 15px;width: 145.469px\">\u2264 6.0%<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">TC<\/th>\n<td style=\"height: 15px;width: 126.094px\">6.2 mmol\/L<\/td>\n<td style=\"height: 15px;width: 145.469px\">\u2264 4.0 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">LDL<\/th>\n<td style=\"height: 15px;width: 126.094px\">4.2 mmol\/L<\/td>\n<td style=\"height: 15px;width: 145.469px\">\u2264 2.0 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">HDL<\/th>\n<td style=\"height: 15px;width: 126.094px\">0.8 mmol\/L<\/td>\n<td style=\"height: 15px;width: 145.469px\">\u2265 1.0 mmol\/L<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<th style=\"height: 15px;width: 94.6875px\" scope=\"row\">TG<\/th>\n<td style=\"height: 15px;width: 126.094px\">4.0 mmol\/L<\/td>\n<td style=\"height: 15px;width: 145.469px\">\u2264 1.7 mmol\/L<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>In David\u2019s case, his A1C is normal. If it was not, you should talk to his <button class=\"glossary-term\" aria-describedby=\"94-1085\">PCP<\/button>.<\/p>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Dietary_Data\"><\/span>Dietary Data<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>When gathering dietary data, you should consider the client&#8217;s:<\/p>\n<ul>\n<li><strong>Diet History: <\/strong>24-hour recall or 3-day food record. Have they tried any diets in the past? Are they following the Dietary Approach to Stop Hypertension (DASH) diet or the Mediterranean Eating Pattern?<\/li>\n<li><strong>Eating behaviours\/patterns<\/strong>: How many meals per day and how many hours between their meals and snacks? Eating at home or eating out?<\/li>\n<li><strong>Cardiac dietary areas of concern: <\/strong>Intake of fibre, saturated fat, unsaturated fat, sodium and other electrolytes<\/li>\n<li><strong>Food skills and access: <\/strong>Do they have access to a kitchen? Do they have access to a grocery store? Do they get groceries and\/or cook at home, or does someone else do this for them? Previous nutrition education? What do they know about managing their blood pressure or cholesterol with diet choice<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Dietary_Strategies\"><\/span>Dietary Strategies<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"The_Mediterranean_Eating_Pattern\"><\/span>The Mediterranean Eating Pattern<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The American Heart Association guidelines on lifestyle management to reduce CVD risk recommends following a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats. \u00a0Individuals can achieve this well-balanced dietary pattern by following the Mediterranean diet, Canada&#8217;s Food Guide (CFG), or the <button class=\"glossary-term\" aria-describedby=\"94-1633\">DASH <\/button>diet and adapt it with help from an RD to ensure it suits their energy and protein requirements, personal and cultural food preferences, and meets any nutrition therapy needs for other medical conditions, like diabetes. Following a dietary pattern like this can help clients with HTN and dyslipidemia reduce their CVD risk.<\/p>\n<p>The Mediterranean Diet is:<\/p>\n<ul>\n<li>Low in saturated fat<\/li>\n<li>Very low in trans fat<\/li>\n<li>Rich in unsaturated fat<\/li>\n<li>Rich in starch and fibre<\/li>\n<li>Rich in nutrients and phytochemicals that support good health<\/li>\n<li>Plant-based and limited red meats<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"DASH_Eating_Pattern\"><\/span>DASH Eating Pattern<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The Dietary Approach to Stop Hypertension (DASH) diet has been shown to help manage and even prevent high blood pressure. Similar to the Mediterranean diet and <button class=\"glossary-term\" aria-describedby=\"94-1634\">CFG<\/button>, it emphasizes whole grains, vegetables and fruits, low-fat dairy products, lean meats, and is low in saturated and trans fats. It also works on a serving size system, so keep in mind that clients using this will have to be educated on serving sizes.<\/p>\n<p>For more details, read the <a href=\"https:\/\/www.healthvermont.gov\/sites\/default\/files\/documents\/pdf\/HPDP-Diabetes_dash%20eating%20plan.pdf\">Vermont Department of Health&#8217;s DASH Eating Plan resource (PDF)<\/a>.<\/p>\n<table class=\"grid\" style=\"width: 100%\">\n<caption>DASH Eating Plan<\/caption>\n<tbody>\n<tr style=\"height: 29px\">\n<th style=\"height: 29px;width: 226px\" scope=\"col\">Food Group<\/th>\n<th style=\"height: 29px;width: 94px\" scope=\"col\">Daily Servings<\/th>\n<th style=\"height: 29px;width: 269px\" scope=\"col\">Serving Sizes (1 serving is equivalent to)<\/th>\n<\/tr>\n<tr style=\"height: 45px\">\n<th style=\"height: 45px;width: 226px\" scope=\"row\">Grains<\/th>\n<td style=\"height: 45px;width: 94px\">7-8<\/td>\n<td style=\"height: 45px;width: 269px\">\n<div>1 slice of bread<\/div>\n<div>1 ounce of dry cereal<\/div>\n<div>\u00bd cup of cooked rice, pasta, cereal<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 226px\" scope=\"row\">Vegetables<\/th>\n<td style=\"height: 30px;width: 94px\">4-5<\/td>\n<td style=\"height: 30px;width: 269px\">\n<div>1 cup raw leafy vegetables<\/div>\n<div>\u00bd cup cut up raw or cooked vegetables<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 45px\">\n<th style=\"height: 45px;width: 226px\" scope=\"row\">Fruit<\/th>\n<td style=\"height: 45px;width: 94px\">4-5<\/td>\n<td style=\"height: 45px;width: 269px\">\n<div>1 medium piece of fruit<\/div>\n<div>\u00bc cup dried fruit<\/div>\n<div>\u00bd cup fresh, frozen or canned fruit<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 226px\" scope=\"row\">Fat-free or low-fat dairy products<\/th>\n<td style=\"height: 30px;width: 94px\">2-3<\/td>\n<td style=\"height: 30px;width: 269px\">\n<div>1 cup yogurt<\/div>\n<div>1 \u00bd ounce cheese<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 29px\">\n<th style=\"height: 29px;width: 226px\" scope=\"row\">Lean meats, poultry, fish<\/th>\n<td style=\"height: 29px;width: 94px\">2 or fewer<\/td>\n<td style=\"height: 29px;width: 269px\">\n<div>3-ounce cooked meats, poultry of fish<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 226px\" scope=\"row\">Nuts, seeds, and legumes<\/th>\n<td style=\"height: 30px;width: 94px\">4-5 per week<\/td>\n<td style=\"height: 30px;width: 269px\">\n<div>1 tbsp of peanut butter or seeds<\/div>\n<div>\u00bd cup cooked legumes<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 45px\">\n<th style=\"height: 45px;width: 226px\" scope=\"row\">Fats and oils<\/th>\n<td style=\"height: 45px;width: 94px\">2-3<\/td>\n<td style=\"height: 45px;width: 269px\">\n<div>1 tsp margarine (non-hydrogenated)<\/div>\n<div>1 tbsp mayonnaise<\/div>\n<div>1 tsp vegetable oil<\/div>\n<\/td>\n<\/tr>\n<tr style=\"height: 29px\">\n<th style=\"height: 29px;width: 226px\" scope=\"row\">Sweets<\/th>\n<td style=\"height: 29px;width: 94px\">5 per week<\/td>\n<td style=\"height: 29px;width: 269px\">\n<div>\u00bd ounce jelly beans<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><span class=\"ez-toc-section\" id=\"Dietary_Recommendations\"><\/span>Dietary Recommendations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"Sodium_Recommendations\"><\/span>Sodium Recommendations<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>To decrease BP, consider reducing sodium intake toward 2000 mg (5 g of salt or 87 mmol of sodium) per day (Grade A).<\/li>\n<li>Although sodium recommendations are more liberal, compared to healthy people, the majority of people with hypertension consume too much sodium, &gt; 3000 mg\/day.<\/li>\n<\/ul>\n<p>For more information, read <a href=\"https:\/\/guidelines.hypertension.ca\/wp-content\/uploads\/2020\/08\/Hypertension-Canada-2020-Comprehensive-Guidelines-for-Prevention-Diagnosis-Risk-Assessment-and-Treatment-of-Hypertension-in-Adults-and-Children.pdf\">Hypertension Canada&#8217;s 2020 Comprehensive Guidelines for Adults and Children (PDF).<\/a><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Fat_Intake_Recommendations\"><\/span>Fat Intake Recommendations<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Reviewing fat intake and the different types of fat in the diet is key when working with a client who has high cholesterol or dyslipidemia, as intake of food with saturated and trans fat has a greater impact on blood cholesterol levels than intake of dietary cholesterol. Here are the recommendations surrounding intake of the different types of fat, like trans fat, saturated fat, and unsaturated fat, particularly omega 3, 6, and 9.<\/p>\n<table class=\"grid\">\n<caption><strong>Fat intake recommendations, by fat type<\/strong><\/caption>\n<tbody>\n<tr>\n<th style=\"width: 115.266px\" scope=\"col\">Type of Fat<\/th>\n<th style=\"width: 220.719px\" scope=\"col\">Recommendation<\/th>\n<th style=\"width: 496.203px\" scope=\"col\">Foods That Contain The Fat<\/th>\n<\/tr>\n<tr>\n<th style=\"width: 115.266px\" scope=\"row\">Unsaturated Fats<\/th>\n<td style=\"width: 220.719px\">Include most often<br \/>\n(2-3 tbsps a day)<\/td>\n<td style=\"width: 496.203px\">\n<ul>\n<li>Fish, seafood<\/li>\n<li>Olives, avocado, mayonnaise, and non-hydrogenated margarines (made with the oils below)<\/li>\n<li>Oils: olive, canola, peanut and sesame<\/li>\n<li>Nuts: almonds, cashews, chestnuts, peanuts, hazelnuts, pecans, pistachios and their butters<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 115.266px\" scope=\"row\">Omega 3<\/th>\n<td style=\"width: 220.719px\">Include more often<br \/>\n(2-3 servings of fish a week)<\/td>\n<td style=\"width: 496.203px\">\n<ul>\n<li>Fatty fish (mackerel, sardines, salmon, and trout), seafood<\/li>\n<li>Oils: canola, flax, hemp seed.<\/li>\n<li>Nuts and seeds: chia, walnuts, pumpkin seeds, crushed flax and hemp seed.<\/li>\n<li>Soybean products, non-hydrogenated margarines (made with above oils)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 115.266px\" scope=\"row\">Omega 6 &amp; 9<\/th>\n<td style=\"width: 220.719px\">Include in small amounts<\/td>\n<td style=\"width: 496.203px\">\n<ul>\n<li>Oils: grapeseed, corn, safflower, sunflower, soybean, cottonseed<\/li>\n<li>Sunflower seeds, wheat germ, non-hydrogenated margarines (made with the oils listed above)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 115.266px\" scope=\"row\">Saturated Fats<\/th>\n<td style=\"width: 220.719px\">Limit<br \/>\n(&lt;5-10% of total daily fat intake)<\/td>\n<td style=\"width: 496.203px\">\n<ul>\n<li>Meat (fresh or processed), dark poultry meat, poultry skin<\/li>\n<li>High fat dairy products, egg yolk<\/li>\n<li>Bakery products, butter, lard, bakery products<\/li>\n<li>Tropical oils: palm oil, palm kernel oil, coconut oil<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 115.266px\" scope=\"row\">Trans Fat<\/th>\n<td style=\"width: 220.719px\">Avoid<\/td>\n<td style=\"width: 496.203px\">\n<ul>\n<li>Partially hydrogenated vegetable oil and shortening<\/li>\n<li>Deep fried foods and fast foods<\/li>\n<li>Some packaged foods: cookies, crackers, potato chips, baked goods and candy bars<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><span class=\"ez-toc-section\" id=\"Fibre_Intake_Recommendations\"><\/span>Fibre Intake Recommendations<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Reviewing fibre intake and the different types of fibre in the diet is key when working with a client who has high cholesterol or dyslipidemia, as intake of soluble fibre can reduce cholesterol by inhibiting cholesterol and bile absorption in the small intestine. Women need at least 25 grams of fibre per day, and men need at least 38 grams of fibre per day.<\/p>\n<table class=\"grid\">\n<caption>Benefits and sources of fibre, by fibre type<\/caption>\n<tbody>\n<tr>\n<th style=\"width: 89.8281px\" scope=\"col\">Fibre Type<\/th>\n<th style=\"width: 507px\" scope=\"col\">Benefits<\/th>\n<th style=\"width: 235.359px\" scope=\"col\">Food Sources<\/th>\n<\/tr>\n<tr>\n<th style=\"width: 89.8281px\" scope=\"row\">Soluble Fibre<\/th>\n<td style=\"width: 507px\">Can reduce cholesterol by inhibiting cholesterol and bile absorption in the small intestine.<\/td>\n<td style=\"width: 235.359px\">\n<ul>\n<li>Oats<\/li>\n<li>Barley<\/li>\n<li>Legumes<\/li>\n<li>Fruit<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 89.8281px\" scope=\"row\">Insoluble Fibre<\/th>\n<td style=\"width: 507px\">Provides fecal bulk to help promote regular bowel movements. Can prevent colon cancer and diverticular disease and increases satiety.<\/td>\n<td style=\"width: 235.359px\">\n<ul>\n<li>Vegetables and fruit<\/li>\n<li>Legumes<\/li>\n<li>Nuts and seeds<\/li>\n<li>Whole grains (brown rice, quinoa)<\/li>\n<li>Whole wheat products (pasta, cereal, bread, crackers)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Dietary_Data\"><\/span>David&#8217;s Dietary Data<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div><strong>Food access and food skills:<\/strong><\/div>\n<ul>\n<li>His wife does the grocery shopping and cooking.<\/li>\n<li>Eats out twice a week at fast food or dine-in restaurants. Mostly for lunch.<\/li>\n<li>He reports that his meals are consistent and the diet recall represents his typical patterns.<\/li>\n<li>He reports having no prior nutrition education.<\/li>\n<\/ul>\n<p><strong>Diet History (24-hour recall):<\/strong><\/p>\n<table class=\"grid\">\n<caption>David&#8217;s 24-hour diet recall<\/caption>\n<tbody>\n<tr>\n<th scope=\"col\">Meal<\/th>\n<th scope=\"col\">David&#8217;s diet recall<\/th>\n<\/tr>\n<tr>\n<th scope=\"row\">Breakfast 9 am<\/th>\n<td>2 eggs, 2 pieces bacon, 1 piece of white bread, 15 mL butter on bread, 1 coffee with 2 milk (2%)<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Lunch 1-2 pm<\/th>\n<td>Turkey sandwich (2 slices of white bread, 2 slices of deli turkey, tbsp of mayo, tbsp of mustard, 2 slices of cheddar cheese, lettuce, and tomato) with 1 cup of soup (canned tomato or mushroom), 500 mL of water<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Dinner 5:30-6:30 pm<\/th>\n<td>6 ounces of meat (beef), 1 cup mashed potatoes, 1 cup of salad, 500 mL of water<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">HS snack<\/th>\n<td>1 bowl of cereal (cheerios) with 1 cup of 2% milk and a small bag of chips with 1-2 beers<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"PES_Statements_for_Dietary_Data\"><\/span>PES Statements for Dietary Data<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"Common_PES_Statement_Terminology\"><\/span>Common PES Statement Terminology<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>As you interpret the dietary data from the assessment, you can form <span>Problem, Etiology, Symptoms (<\/span>PES) statements or nutrition diagnoses that help identify nutrition concerns that need to be addressed in your plan. If you are not familiar with how to write a PES statement please review this<a href=\"https:\/\/www.ncpro.org\/pub\/file.cfm?item_type=xm_file&amp;id=93467\"> resource from the Academy of Nutrition and Dietetics<\/a>. Here are some common nutrition problems that patients with HTN and dyslipidemia may experience:<\/p>\n<ul>\n<li>Excessive saturated fat intake<\/li>\n<li>Less than optimal intake of types of fats (specify)<\/li>\n<li>Inappropriate intake of fats<\/li>\n<li>Inadequate vegetable and fruit consumption<\/li>\n<li>Inadequate fibre intake<\/li>\n<li>Excessive sodium intake<\/li>\n<li>Imbalance of nutrients<\/li>\n<li>Physical inactivity<\/li>\n<li>Altered nutrition-related laboratory values (specify)<\/li>\n<li>Food- and nutrition-related knowledge deficit<\/li>\n<li>Impaired ability to prepare food\/meals<\/li>\n<li>Not ready for diet\/lifestyle change<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Guiding_Questions\"><\/span>Guiding Questions<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Use the dietary assessment data you have collected from David so far to form a PES statement for his intake of sodium, fat, fibre, and DASH diet recommendations.<\/p>\n<p>You can use the questions below to guide you:<\/p>\n<ul>\n<li>Is David meeting the DASH Diet recommended amount of whole grains, vegetables and fruit, dairy products, and lean meats and poultry in his diet recall?<\/li>\n<li>Is he exceeding the daily recommended amount of sodium?<\/li>\n<li>Is he consuming excess saturated fat and is his intake of unsaturated fats sources adequate?<\/li>\n<li>Is his fibre intake adequate?<\/li>\n<li>Are there any potential drug nutrient interactions?<\/li>\n<\/ul>\n<p><span><\/p>\n<div id=\"h5p-74\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-74\" class=\"h5p-iframe\" data-content-id=\"74\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"David&#039;s PES Statements\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"PES_Statements_for_Davids_Dietary_Intake\"><\/span>PES Statements for David&#8217;s Dietary Intake<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p>These are some examples of PES statements that you may have formed for David based on his intake.<\/p>\n<p>For example, if we count his fruit and vegetable intake, it looks like he is only getting about 2-3 servings. Therefore, he has an imbalance of nutrients related to food and nutrition knowledge deficit of healthy dietary patterns as evidenced by not meeting DASH diet recommendations for vegetables and fruit. He also has excessive sodium intake, excessive intake of saturated and trans fats, and inadequate intake of fibre.<\/p>\n<p>These PES statements will be used later on in the section when forming the nutrition care plan:<\/p>\n<ol>\n<li>Imbalance of nutrients related to food and nutrition knowledge deficit of healthy dietary patterns as evidenced by not meeting DASH diet recommendations for whole grains, vegetables and fruit, dairy products, lean meats, poultry, fish, fats, and oils.<\/li>\n<li>Excessive sodium intake related to a knowledge deficit of sodium sources and importance of sodium reduction for blood pressure control as evidenced by high intake of processed foods such as bacon, deli meat, canned soup, etc.<\/li>\n<li>Excessive intake of saturated and trans fat related to a lack of food preparation knowledge and skills as evidenced by high intake of processed meat, red meat, and chips.<\/li>\n<li>Inadequate intake of fibre related to a knowledge deficit of food sources of fibre as evidenced by low intake of vegetables and whole grains.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Simulation_Activity_David\"><\/span>Simulation Activity: David<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<div id=\"h5p-60\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-60\" class=\"h5p-iframe\" data-content-id=\"60\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Simulation for Hypertension\"><\/iframe><\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p>PART 1: ASSESS COMPLETE. Pause to reflect on the assessment strategies discussed. When you\u2019re ready, move on to Part 2: Plan.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"94-1631\" hidden><p>hypertension; high blood pressure<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-945\" hidden><p>Common medical abbreviation of \"bis in die\", Latin for \"twice per day\".\u00a0<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-2302\" hidden><p>Common medical abbreviation of\u00a0 \"omne in die\", Latin for once per day<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-1638\" hidden><p>Very Low-Density Lipoprotein<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-2311\" hidden><p>Intermediate-Density Lipoproteins<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-2312\" hidden><p>Lipoprotein (a): promotes clotting and inflammation<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-1618\" hidden><p>Low-Density Lipoprotein<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-1085\" hidden><p>Primary Care Provider<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-1633\" hidden><p>Dietary Approach to Stop Hypertension<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"94-1634\" hidden><p>Canada's Food Guide<\/p>\n<\/div><\/div>","protected":false},"author":315,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-94","chapter","type-chapter","status-publish","hentry"],"part":89,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/94","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/users\/315"}],"version-history":[{"count":77,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/94\/revisions"}],"predecessor-version":[{"id":2379,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/94\/revisions\/2379"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/parts\/89"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/94\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/media?parent=94"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapter-type?post=94"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/contributor?post=94"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/license?post=94"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}