{"id":96,"date":"2021-08-14T12:32:41","date_gmt":"2021-08-14T16:32:41","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/dietmods\/?post_type=chapter&#038;p=96"},"modified":"2024-07-02T22:37:47","modified_gmt":"2024-07-03T02:37:47","slug":"htn-plan","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/","title":{"raw":"Plan","rendered":"Plan"},"content":{"raw":"<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-1024x132.png\" alt=\"Step 2: Plan\" width=\"1024\" height=\"132\" class=\"alignnone wp-image-1368 size-large\" \/>\r\n<h1>Creating a Nutrition Care Plan<\/h1>\r\nWe are going to use the data we collected in the Assess stage to form a nutrition care plan for HTN and dyslipidemia, considering each of these 9 key areas:\r\n<ul>\r\n \t<li>Medication Adherence<\/li>\r\n \t<li>Dietary Patterns - Mediterranean Diet &amp; DASH Diet<\/li>\r\n \t<li>Sodium Intake<\/li>\r\n \t<li>Saturated and Trans Fat Intake<\/li>\r\n \t<li>Fibre Intake<\/li>\r\n \t<li>Physical Activity<\/li>\r\n \t<li>Smoking<\/li>\r\n \t<li>Alcohol Intake<\/li>\r\n \t<li>Stress<\/li>\r\n<\/ul>\r\n<h1>Medication Adherence<\/h1>\r\nIt is always important to check in with the client on medication adherence. You can ask a few simple questions:\r\n<ul>\r\n \t<li>Are they taking their medication at the times prescribed?<\/li>\r\n \t<li>Do they always take their medication? If not, how frequently do they miss taking a dose? Why are they not taking it?<\/li>\r\n \t<li>Does the client notice any side effects when taking the medication (this may be a reason for other factors reported to you that may influence your plan of care \u2013 i.e. nausea, diarrhea, lack of appetite)?<\/li>\r\n<\/ul>\r\nLiaise with [pb_glossary id=\"1085\"]PCP[\/pb_glossary] regarding medication education or changes, if needed (i.e. client reports a concern or symptom not yet documented).\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Medications<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div>David is taking the listed medications as directed. David tells you that he has been experiencing constipation. This has recently become more frequent and is beginning to bother him.<\/div>\r\n<ul>\r\n \t<li>David recently switched to a new BP medication, Amlodipine (Norvasc) 10mg, which can cause constipation<\/li>\r\n \t<li>In this situation, you could liaise with PCP and consider a different blood pressure medication.<\/li>\r\n \t<li>You may also suggest a fibre supplement, like Metamucil, that can help relieve constipation.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Dietary Patterns - DASH Diet<\/h1>\r\nRevisiting our dietary assessment, we can use the DASH dietary pattern to help us form our nutrition care plan.\r\n\r\nFor more information, read:\r\n<ul>\r\n \t<li>\"<a href=\"https:\/\/dx.doi.org\/10.1056\/NEJM200101043440101\">Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet<\/a>,\" a journal article from The New England Journal of Medicine.<\/li>\r\n \t<li><a href=\"https:\/\/www.healthvermont.gov\/sites\/default\/files\/documents\/pdf\/HPDP-Diabetes_dash%20eating%20plan.pdf\">Vermont Department of Health\u2019s DASH Eating Plan resource (PDF)<\/a><span>.<\/span><\/li>\r\n<\/ul>\r\n<table class=\"grid\"><caption>DASH Eating Plan<\/caption>\r\n<tbody>\r\n<tr>\r\n<th scope=\"col\">Food Group<\/th>\r\n<th scope=\"col\">Daily Servings<\/th>\r\n<th scope=\"col\">Serving Sizes (1 serving is equivalent to)<\/th>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Grains<\/th>\r\n<td>7-8<\/td>\r\n<td>\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>\r\n<th scope=\"row\">Vegetables<\/th>\r\n<td>4-5<\/td>\r\n<td>\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>\r\n<th scope=\"row\">Fruit<\/th>\r\n<td>4-5<\/td>\r\n<td>\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>\r\n<th scope=\"row\">Fat-free or low-fat dairy products<\/th>\r\n<td>2-3<\/td>\r\n<td>\r\n<div>1 cup yogurt<\/div>\r\n<div>1 \u00bd ounce cheese<\/div><\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Lean meats, poultry, fish<\/th>\r\n<td>2 or fewer<\/td>\r\n<td>\r\n<div>3-ounce cooked meats, poultry of fish<\/div><\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Nuts, seeds, and legumes<\/th>\r\n<td>4-5 per week<\/td>\r\n<td>\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>\r\n<th scope=\"row\">Fats and oils<\/th>\r\n<td>2-3<\/td>\r\n<td>\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>\r\n<th scope=\"row\">Sweets<\/th>\r\n<td>5 per week<\/td>\r\n<td>\r\n<div>\u00bd ounce jelly beans<\/div><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Dietary Pattern<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div class=\"textbox\"><strong>PES<\/strong>: Imbalance of nutrients related to food and nutrition knowledge deficit of 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.<\/div>\r\nAs outlined in our assessment, David is not currently following the DASH diet as a method to help control his BP and lipids. Providing an overview of the importance of balanced meals and snacks using the DASH diet, you can target areas beneficial for controlling blood pressure and reducing cholesterol. It\u2019s important that David has a basic understanding of healthy dietary habits and is able to understand it in a practical way.\r\n\r\nWe will use principles from the DASH diet to create a nutrition care plan for David. As you do this, keep in mind:\r\n<ul>\r\n \t<li>Small goals lead to big achievements and motivate the client to pursue a goal.<\/li>\r\n \t<li>You do not have to change the entire diet in one appointment. This can be done in a step-wise manner, which is more likely to result in a successful outcome.<\/li>\r\n \t<li>Always ask the client for their opinion when making suggestions, it is important that they are a part of the process.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Sodium Intake<\/h1>\r\nSome strategies from the DASH diet to consider as part of the plan to reduce sodium in clients with HTN include trying to:\r\n<ul>\r\n \t<li>Choose vegetables and fruits more often (fresh or frozen without added salt).<\/li>\r\n \t<li>Limit processed, smoked, and cured foods.<\/li>\r\n \t<li>Avoid using salt at the table and reduce salt added during cooking.<\/li>\r\n \t<li>Avoid seasonings that contain the word \u2018salt\u2019 or \u2018sodium\u2019 (such as garlic salt, celery salt, or monosodium glutamate [MSG]).<\/li>\r\n \t<li>Flavour foods with herbs, spices, garlic, onion, lemon, or vinegars.<\/li>\r\n \t<li>Limit frozen convenience foods and fast food restaurant meals.<\/li>\r\n \t<li>Use the Nutrition Facts table to determine sodium amounts: try to avoid foods with more than 300 mg of sodium per serving or % DV &lt; 5<\/li>\r\n \t<li>Read food labels to determine sodium amounts: look for \u2018unsalted\u2019 or \u2018no added salt\u2019 or \u2018low in sodium\u2019 or \u2018salt-free\u2019 items. Note that \u00a0\u2018sodium-reduced\u2019 does not necessarily mean low sodium.<\/li>\r\n<\/ul>\r\nFor more information, read Heart and Stroke Foundation of Canada's \"<a href=\"https:\/\/www.heartandstroke.ca\/-\/media\/pdf-files\/canada\/health-information-catalogue\/en-managing-your-blood-pressure.pdf?rev=ad8b90f1eecc4f389360a6d51ba83bf9\">Managing your blood pressure\" (PDF)<\/a> resource.\r\n\r\n&nbsp;\r\n\r\n[h5p id=\"12\"]\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Sodium Intake<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div class=\"textbox\"><strong>PES<\/strong>: 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.<\/div>\r\nAs we noted during the assessment (i.e. medical History, BP readings, dietary recall), David has HTN and a high intake of sodium. To help David control his blood pressure, here are a few suggestions to reduce his sodium intake.\r\n<table class=\"grid\" style=\"width: 100%;height: 421px\"><caption>Suggestions for David's diet to reduce sodium intake, by meal.\r\n<span style=\"background-color: #ffff99\"><em>[*] indicates foods in diet recall most relevant to sodium intake<\/em><\/span><\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"width: 9.19116%;height: 15px\" scope=\"col\">Meal<\/th>\r\n<th style=\"width: 33.2108%;height: 15px\" scope=\"col\">David's diet recall<\/th>\r\n<th style=\"width: 57.4755%;height: 15px\">Suggestions to reduce sodium<\/th>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Breakfast<\/th>\r\n<td style=\"width: 33.2108%;height: 104px\">2 eggs, <span style=\"background-color: #ffff99\">2 pieces bacon*<\/span>, 1 piece of white bread, 15 mL butter on bread, 1 coffee with 2 milk (2%)<\/td>\r\n<td style=\"width: 57.4755%;height: 104px\">\r\n<ul>\r\n \t<li>Tell David that processed meats (such as bacon) are very high in sodium<\/li>\r\n \t<li>Reduce the consumption of bacon towards having it as a \u201ctreat\u201d once a week<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 151px\">\r\n<th style=\"width: 9.19116%;height: 151px\" scope=\"row\">Lunch<\/th>\r\n<td style=\"width: 33.2108%;height: 151px\">Turkey sandwich (2 slices of whole grain bread, <span style=\"background-color: #ffff99\">2 slices of deli turkey*<\/span>, <span style=\"background-color: #ffff99\">tbsp of mayo*, tbsp of mustard*<\/span>, <span style=\"background-color: #ffff99\">2 slices of cheddar cheese<\/span>, lettuce, and tomato) with <span style=\"background-color: #ffff99\">1 cup of soup (canned tomato or mushroom)*<\/span>, 500 mL of water<\/td>\r\n<td style=\"width: 57.4755%;height: 151px\">\r\n<ul>\r\n \t<li>Reinforce that processed meats (such as turkey slices) are high in sodium<\/li>\r\n \t<li>Substitute turkey slices for cooked chicken, turkey, or low-sodium canned tuna<\/li>\r\n \t<li>Reduce condiment serving size, or substitute for hummus<\/li>\r\n \t<li>Substitute the cheddar cheese with a low-fat or reduced fat alternative<\/li>\r\n \t<li>Tell David to seek low-sodium canned soup options using the nutrition facts table<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Dinner<\/th>\r\n<td style=\"width: 33.2108%;height: 104px\">6 ounces of meat (beef), 1 cup <span style=\"background-color: #ffff99\">mashed potatoes*<\/span>, 1 cup of salad, 500 mL of water<\/td>\r\n<td style=\"width: 57.4755%;height: 104px\">\r\n<ul>\r\n \t<li>Ask David if mashed potatoes are pre-made. If so...<\/li>\r\n \t<li>Substitute pre-made mashed potatoes for quinoa, whole grain pasta or brown rice (as the starch component) at every other dinner<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 47px\">\r\n<th style=\"width: 9.19116%;height: 47px\" scope=\"row\">HS snack<\/th>\r\n<td style=\"width: 33.2108%;height: 47px\">1 bowl of cereal (cheerios) with 1 cup of 2% milk and a <span style=\"background-color: #ffff99\">small bag of chips* <\/span>with 1-2 beers<\/td>\r\n<td style=\"width: 57.4755%;height: 47px\">\r\n<ul>\r\n \t<li>Reinforce the importance of avoiding packaged foods<\/li>\r\n \t<li>Treat chips as a \"treat\"<\/li>\r\n \t<li>Substitute chips for air-popped popcorn<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nFor David, the key message here is to reduce the amount of processed and packaged foods.\r\n\r\n<\/div>\r\n<\/div>\r\n<h1>Saturated and Trans Fat Intake<\/h1>\r\nTo reduce saturated and trans fats, clients can be encouraged to try to:\r\n<ul>\r\n \t<li>Choose unsaturated fats (olive oil, canola oil, soft non-hydrogenated margarine) more often than saturated fats (butter, cream) when cooking.<\/li>\r\n \t<li>Include fatty fish in a meal two to three times a week.<\/li>\r\n \t<li>Use skim or 1% milk rather than 2% or 3.25% milk or cream.<\/li>\r\n \t<li>Choose lean meat and poultry and trim off the fat and skin before cooking.<\/li>\r\n \t<li>Add nuts and seeds to salads and use nut butters as spreads.<\/li>\r\n \t<li>Limit fast food and processed food that is high in trans fats.<\/li>\r\n<\/ul>\r\n<div>\r\n\r\nFor more information, read Heart and Stroke Foundation of Canada's \"<a href=\"https:\/\/www.heartandstroke.ca\/-\/media\/1-stroke-best-practices\/resources\/patient-resources\/hs-f20-cholesterol-brochure-en-v3\">How to Manage Your Cholesterol\" (PDF)<\/a> resource.\r\n\r\n<\/div>\r\n&nbsp;\r\n\r\n[h5p id=\"14\"]\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Saturated and Trans Fat Intake<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div class=\"textbox\"><strong>PES<\/strong>: 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, butter, red meat, and chips.<\/div>\r\nAs we noted during the assessment (i.e. History data, elevated lipid levels, dietary recall), David has dyslipidemia and high intake of saturated and trans fat. To help David control his dyslipidemia and reduce his LDL, here are a few suggestions to reduce his intake of saturated and trans fat.\r\n<table class=\"grid\" style=\"width: 100%;height: 421px\"><caption>Suggestions for David's diet to reduce intake of saturated and trans fat, by meal.\r\n<em><span style=\"background-color: #ffff99\">[*] indicates foods in diet recall most relevant to saturated and trans fat<\/span>\u00a0<\/em><\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"width: 9.19116%;height: 15px\" scope=\"col\">Meal<\/th>\r\n<th style=\"width: 33.2108%;height: 15px\" scope=\"col\">David's diet recall<\/th>\r\n<th style=\"width: 57.4755%;height: 15px\">Suggestions to reduce saturated and trans fat<\/th>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Breakfast<\/th>\r\n<td style=\"width: 33.2108%;height: 104px\"><span style=\"background-color: #ffff99\">2 eggs<\/span>, <span style=\"background-color: #ffff99\">2 pieces bacon*<\/span>, 1 piece of white bread, <span style=\"background-color: #ffff99\">15 mL butter on bread*<\/span>, 1 coffee with 2 milk (2%)<\/td>\r\n<td style=\"width: 57.4755%;height: 104px\">\r\n<ul>\r\n \t<li>Tell David that bacon is a significant source of both sodium <em>and<\/em> saturated fat<\/li>\r\n \t<li>Substitute butter for a nut-based butter (e.g. peanut, almond, etc.), as these are sources of unsaturated fats<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 151px\">\r\n<th style=\"width: 9.19116%;height: 151px\" scope=\"row\">Lunch<\/th>\r\n<td style=\"width: 33.2108%;height: 151px\">Turkey sandwich (2 slices of whole grain bread, <span style=\"background-color: #ffff99\">2 slices of deli turkey<\/span>, tbsp of mayo, tbsp of mustard, <span style=\"background-color: #ffff99\">2 slices of cheddar cheese<\/span>, lettuce, and tomato) with <span style=\"background-color: #ffff99\">1 cup of soup (canned tomato or mushroom)<\/span>, 500 mL of water<\/td>\r\n<td style=\"width: 57.4755%;height: 151px\">\r\n<ul>\r\n \t<li>Substitute deli turkey with real turkey or other meats for the sandwich<\/li>\r\n \t<li>Reduce the cheddar cheese to 1 slice\u00a0 or skip it<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Dinner<\/th>\r\n<td style=\"width: 33.2108%;height: 104px\"><span style=\"background-color: #ffff99\">6 ounces of meat (beef)*<\/span>, 1 cup mashed potatoes, 1 cup of salad, 500 mL of water<\/td>\r\n<td style=\"width: 57.4755%;height: 104px\">\r\n<ul>\r\n \t<li>Tell David it is OK to have a source of meat with dinner, but beef is a higher source of saturated fat than other types of meat<\/li>\r\n \t<li>Substitute beef for lean meats (e.g. chicken) or fatty fish (e.g. salmon) as his source of protein<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 47px\">\r\n<th style=\"width: 9.19116%;height: 47px\" scope=\"row\">HS snack<\/th>\r\n<td style=\"width: 33.2108%;height: 47px\">1 bowl of cereal (cheerios) with 1 cup of 2% milk and a <span style=\"background-color: #ffff99\">small bag of chips with 1-2 beers*<\/span><\/td>\r\n<td style=\"width: 57.4755%;height: 47px\">\r\n<ul>\r\n \t<li>Tell David that chips are a\u00a0significant source of both sodium <em>and<\/em> saturated fat<\/li>\r\n \t<li>Reduce consumption of chips is a stable recommendation throughout<\/li>\r\n \t<li>Reduce alcohol consumption, as it may contribute to an increase in triglycerides (this will be discussed later in the section content)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<\/div>\r\n<h1>Fibre<\/h1>\r\nTo increase fibre intake, clients can be encouraged to try to:\r\n<ul>\r\n \t<li>Choose whole vegetables and fruit instead of juice.<\/li>\r\n \t<li>Add extra vegetables and legumes to pasta, curries, casseroles, and soups.<\/li>\r\n \t<li>Leave the skin on vegetables and fruits.<\/li>\r\n \t<li>Add nuts and seeds to salads, yogurt, and cereal.<\/li>\r\n \t<li>Include oatmeal with ground flaxseed as a breakfast food.<\/li>\r\n \t<li>Choose grain products with \u201cwhole grain\u201d as the first ingredient.<\/li>\r\n \t<li>Look for 2-4 grams fibre per serving on the Nutrition Facts table.<\/li>\r\n \t<li>Add psyllium husk (like Metamucil) to meals or snacks once per day.<\/li>\r\n<\/ul>\r\nMake sure to add in fibre slowly and increase fluid intake to prevent constipation.\r\n\r\n&nbsp;\r\n\r\n[h5p id=\"15\"]\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Fibre Intake<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div class=\"textbox\"><strong>PES<\/strong>: Inadequate intake of fibre related to a knowledge deficit of food sources of fibre as evidenced by low intake of vegetables and whole grains.<\/div>\r\nAs we noted during the assessment, David has inadequate fibre. Here are a few suggestions to help David increase his fibre intake.\r\n<table class=\"grid\" style=\"width: 100%;height: 421px\"><caption>Suggestions for David's diet to increase intake of fibre, by meal.\r\n<em><span style=\"background-color: #ffff99\">[*] indicates foods in diet recall most relevant to fibre<\/span><\/em><\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"width: 9.19116%;height: 15px\" scope=\"col\">Meal<\/th>\r\n<th style=\"width: 33.2108%;height: 15px\" scope=\"col\">David's diet recall<\/th>\r\n<th style=\"width: 57.4755%;height: 15px\">Suggestions to increase fibre intake<\/th>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Breakfast<\/th>\r\n<td style=\"width: 33.2108%;height: 104px\">2 eggs, 2 pieces bacon, <span style=\"background-color: #ffff99\">1 piece of white bread*<\/span>, 15 mL butter on bread, 1 coffee with 2 milk (2%)<\/td>\r\n<td style=\"width: 57.4755%;height: 104px\">\r\n<ul>\r\n \t<li>Note: It is often easier to \"substitute\" or add in other beneficial foods to a client's diet rather than try to \"remove\" everything<\/li>\r\n \t<li>Substitute the white bread for whole grain bread<\/li>\r\n \t<li>Consider oatmeal as another breakfast option, as it provides a source of soluble fibre<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 151px\">\r\n<th style=\"width: 9.19116%;height: 151px\" scope=\"row\">Lunch<\/th>\r\n<td style=\"width: 33.2108%;height: 151px\">Turkey sandwich (<span style=\"background-color: #ffff99\">2 slices of white bread*<\/span>, 2 slices of deli turkey, tbsp of mayo, tbsp of mustard, 2 slices of cheddar cheese, lettuce, and tomato) with <span style=\"background-color: #ffff99\">1 cup of soup*<\/span> (canned tomato or mushroom), 500 mL of water<\/td>\r\n<td style=\"width: 57.4755%;height: 151px\">\r\n<ul>\r\n \t<li>Substitute the white bread for whole grain bread (same as breakfast)<\/li>\r\n \t<li>Add extra vegetables to the soup<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Dinner<\/th>\r\n<td style=\"width: 33.2108%;height: 104px\">6 ounces of meat (beef), 1 cup mashed potatoes, <span style=\"background-color: #ffff99\">1 cup of salad*<\/span>, 500 mL of water<\/td>\r\n<td style=\"width: 57.4755%;height: 104px\">\r\n<ul>\r\n \t<li>Add legumes or nuts and seeds to the salad<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 47px\">\r\n<th style=\"width: 9.19116%;height: 47px\" scope=\"row\">HS snack<\/th>\r\n<td style=\"width: 33.2108%;height: 47px\">1 bowl of cereal (<span style=\"background-color: #ffff99\">cheerios*<\/span>) with 1 cup of 2% milk and a small bag of <span style=\"background-color: #ffff99\">chips*<\/span> with 1-2 beers<\/td>\r\n<td style=\"width: 57.4755%;height: 47px\">\r\n<ul>\r\n \t<li>Substitute cheerios for a bowl of oatmeal<\/li>\r\n \t<li>Substitute chips for air-popped popcorn<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<\/div>\r\n<h1>Physical Activity<\/h1>\r\nPhysical activity is an important component of health. It can help control blood pressure. Clients can be encouraged to try the following:\r\n<ul>\r\n \t<li>To achieve health benefits, and improve functional abilities, adults should accumulate at least 150 minutes of moderate- to vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more.\r\n<ul>\r\n \t<li>Examples of moderate-to-vigorous intensity activity: brisk walking, dancing, jogging, biking<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>It is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week.\r\n<ul>\r\n \t<li>Major muscle groups: chest, shoulders, back, arms, abs, legs<\/li>\r\n \t<li>Examples of muscle and bone strengthening activity: jumping rope, weight-lifting, sports (tennis, badminton)<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Those with poor mobility should perform physical activities to enhance balance and prevent falls.<\/li>\r\n<\/ul>\r\nFor more information, read the Canadian Society for Exercise Physiology's <a href=\"https:\/\/csepguidelines.ca\/\">24-Hour Movement Guidelines<\/a>.\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Physical Activity<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li>David is not currently interested in engaging in more physical activity, as he would like to focus on dietary changes first.<\/li>\r\n \t<li>Main barrier is the lower back injury.<\/li>\r\n \t<li>Consider speaking to David and his PCP about involving a registered kinesiologist or physiotherapist regarding this barrier.<\/li>\r\n \t<li>No physical activity plan at this time.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Smoking<\/h1>\r\nSmoking affects blood pressure in 2 ways:\r\n<ol>\r\n \t<li>Nicotine in cigarette smoke causes blood vessels to narrow, which increases blood pressure.<\/li>\r\n \t<li>Smoking makes blood pressure medications work less effectively.<\/li>\r\n<\/ol>\r\nSmoking also increases the risk for the buildup of plaque inside the arteries (atherosclerosis).\r\n\r\nCounselling on smoking cessation is not within a dietitian\u2019s scope, however, if a client is interested in quitting smoking you can provide the following tips:\r\n<ol>\r\n \t<li><strong>Set a Quit Date:<\/strong> Choose a date within the next seven days when you will quit smoking.<\/li>\r\n \t<li><strong>Choose a method for quitting:<\/strong> Stop all at once OR cut down the number of cigarettes per day until you stop completely.<\/li>\r\n \t<li><strong>Decide if you need medication or other assistance to quit:<\/strong> A dietitian can act as a motivator and check in on smoking cessation goals. However, clients should talk to their PCP or be referred to a smoking cessation program to determine if they would benefit from nicotine replacement therapy (NRT).<\/li>\r\n<\/ol>\r\n<div>\r\n\r\nFor more information on quitting smoking, read Heart and Stroke Foundation of Canada's \"<a href=\"https:\/\/www.heartandstroke.ca\/-\/media\/pdf-files\/canada\/health-information-catalogue\/en-managing-your-blood-pressure.pdf?rev=ad8b90f1eecc4f389360a6d51ba83bf9\">Managing your blood pressure\" (PDF)<\/a> resource.\r\n\r\n<\/div>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Smoking<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li>David is not currently interested in quitting smoking. He wants to try and achieve his goals with nutrition-related changes.<\/li>\r\n \t<li>He is open to revisiting this in the future.<\/li>\r\n \t<li>No smoking cessation plan at this time.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Alcohol Intake<\/h1>\r\nDrinking alcohol can lead to:\r\n<ul>\r\n \t<li>High blood pressure by interfering with the blood flow to and from the heart.<\/li>\r\n \t<li>Possible increase in triglycerides.<\/li>\r\n \t<li>Increase in the release of [pb_glossary id=\"1638\"]VLDL[\/pb_glossary].<\/li>\r\n \t<li>Increase the flow of free fatty acids to the liver from fat tissue.<\/li>\r\n \t<li>Impede the body\u2019s ability to break down fat.<\/li>\r\n<\/ul>\r\nAlcohol can be addictive and high intakes are associated with physical abuse and accidental injury or death. <strong>There is a need for individual consideration.<\/strong>\r\n\r\nAs per Canada's updated 2023 Guidance on Alcohol and Health, consuming 7 or more standard drinks per week places individuals at an increasingly high risk of alcohol-related consequences.\r\n\r\nOverall, to prevent hypertension and reduce BP in adults, individuals should limit alcohol consumption to \u22642 drinks per week.\r\n\r\nFor more information on recommendations surrounding alcoholic beverages, read the Canadian Centre on Substance Use and Addictions\u00a0 <a href=\"https:\/\/www.ccsa.ca\/canadas-guidance-alcohol-and-health\">\u00a0\"2023 Canada's Guidelines for Alcohol and Health\"<\/a>.\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Alcohol Intake<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li>David reported having 1-2 beers per night (7-14 beers per week).<\/li>\r\n \t<li>David's alcohol consumption places him at an increasingly high risk of alcohol-related consequences, he should consider the\u00a0effect on his blood pressure and triglycerides (which are above the target range).<\/li>\r\n \t<li>Reducing his alcohol intake may or may not have beneficial outcomes on improving his biochemical data.<\/li>\r\n \t<li>After discussion with David, he does not want to give up alcohol entirely, but wants to try to reduce consumption.<\/li>\r\n \t<li>Plan could be to start by reducing alcohol consumption to 1 beer per night.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Stress<\/h1>\r\nTo help with stress using positive coping strategies clients can try:\r\n<ul>\r\n \t<li>Physical activity<\/li>\r\n \t<li>Socializing<\/li>\r\n \t<li>Laughter<\/li>\r\n \t<li>Engaging in hobbies<\/li>\r\n \t<li>Breathing exercises<\/li>\r\n<\/ul>\r\nAvoid unhealthy stress busters such as:\r\n<ul>\r\n \t<li>Smoking<\/li>\r\n \t<li>Alcohol<\/li>\r\n<\/ul>\r\nIf additional help is needed, consider a social worker, therapist, or psychologist.\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's Stress<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li>He tells you that he is coping well with his depression since seeing a therapist a couple years ago, and the medication he takes daily has helped.<\/li>\r\n \t<li>He plans to reduce his alcohol intake and is considering smoking cessation in the future.<\/li>\r\n \t<li>He also reports he talks to his wife and socializes with friends to relieve his stress, and doesn\u2019t feel it is impacting his health and quality of life at this point.<\/li>\r\n \t<li>No plan for coping with stress is needed at this time.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h1>Summary of Nutrition Care Plan Recommendations<\/h1>\r\nNow that we have gone through all 9 of the key areas to investigate when creating a nutrition care plan, here is a summary of the recommendations.\r\n<table class=\"grid\" style=\"height: 499px;width: 744px\"><caption>Summary of NCP recommendations, by area of concern<\/caption>\r\n<tbody>\r\n<tr style=\"height: 29px\">\r\n<th style=\"height: 29px;width: 131.344px\" scope=\"col\">\u00a0Area of Concern<\/th>\r\n<th style=\"height: 29px;width: 475.781px\" scope=\"col\">Recommendations<\/th>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Medication Adherence<\/th>\r\n<td style=\"height: 30px;width: 475.781px\">\r\n<ul>\r\n \t<li>Check if taking as prescribed<\/li>\r\n \t<li>Consider liaising with PCP if changes needed<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Dietary Pattern<\/th>\r\n<td style=\"height: 30px;width: 475.781px\">\r\n<ul>\r\n \t<li>Follow the DASH diet or Mediterranean Eating Pattern as a general guideline to healthy eating<\/li>\r\n \t<li>Check for any drug nutrient interactions<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Sodium Intake<\/th>\r\n<td style=\"height: 30px;width: 475.781px\">\r\n<ul>\r\n \t<li>Aim for &lt; 2000 mg of sodium per day<\/li>\r\n \t<li>Limit processed foods with more than 400 mg per serving and eating out at restaurants<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Fat Intake<\/th>\r\n<td style=\"height: 30px;width: 475.781px\">\r\n<ul>\r\n \t<li>Choose unsaturated fats most often<\/li>\r\n \t<li>Limit saturated fat and avoid trans fat<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Fibre Intake<\/th>\r\n<td style=\"height: 30px;width: 475.781px\">\r\n<ul>\r\n \t<li>Increase intake of vegetables, fruit, and legumes<\/li>\r\n \t<li>Choose \u201cwhole grain\u201d products with 2-4 g per serving<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 72px\">\r\n<th style=\"width: 131.344px;height: 72px\" scope=\"row\">Physical Activity<\/th>\r\n<td style=\"width: 475.781px;height: 72px\">\r\n<ul>\r\n \t<li>150 minutes moderate to vigorous exercise each week<\/li>\r\n \t<li>Resistance exercise 2-3 times per week<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<th style=\"width: 131.344px;height: 56px\" scope=\"row\">Smoking<\/th>\r\n<td style=\"width: 475.781px;height: 56px\">\r\n<ul>\r\n \t<li>Smoking cessation is recommended to reduce the risk of CVD<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 104px\">\r\n<th style=\"width: 131.344px;height: 104px\" scope=\"row\">Alcohol<\/th>\r\n<td style=\"width: 475.781px;height: 104px\">\r\n<ul>\r\n \t<li>Moderate consumption (1 drink per day) for women and men may reduce the risk of CVD<\/li>\r\n \t<li>Consider reduction, if appropriate, as alcohol intake can increase BP and TG<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 88px\">\r\n<th style=\"width: 131.344px;height: 88px\" scope=\"row\">Stress<\/th>\r\n<td style=\"width: 475.781px;height: 88px\">\r\n<ul>\r\n \t<li>Use positive coping strategies (socializing) to deal with stress rather than negative methods<\/li>\r\n \t<li>Consider referral to [pb_glossary id=\"1639\"]SW[\/pb_glossary], therapist, etc.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nWhen working with clients with hypertension and dyslipidemia,\u00a0 you can refer to this summary and the<a href=\"https:\/\/guidelines.hypertension.ca\/prevention-treatment\/health-behaviour-management\/\"> Hypertension Canada's\u00a0 Health Behaviour Management Guidelines.<\/a>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">David's NCP Recommendations<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nDavid\u2019s Nutrition Care Plan could be to:\r\n<ul>\r\n \t<li>Incorporate the principles of the DASH diet\r\n<ul>\r\n \t<li>Incorporate the recommended daily servings of whole grains, vegetables and fruits, low-fat dairy products, lean meats, nuts, seeds, legumes, fats, and oils.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Reduce sodium by:\r\n<ul>\r\n \t<li>Reducing intake of processed deli meats and replacing with baked lean meat.<\/li>\r\n \t<li>Reduce intake of processed foods like boxed mashed potatoes, chips, and canned soup.<\/li>\r\n \t<li>Use Nutrition Facts table to look for low sodium options.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Replace saturated fat intake with unsaturated fats by:\r\n<ul>\r\n \t<li>Using nut butter instead of butter.<\/li>\r\n \t<li>Having lean meats, like chicken, or fish instead of beef and bacon.<\/li>\r\n \t<li>Reducing potato chips as [pb_glossary id=\"1624\"]HS[\/pb_glossary] snack.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>\r\n<div>Increase fibre by:<\/div>\r\n<ul>\r\n \t<li>\r\n<div>Choosing whole grain bread instead of white bread.<\/div><\/li>\r\n \t<li>\r\n<div>Adding extra vegetables to soup.<\/div><\/li>\r\n \t<li>\r\n<div>Adding legumes or nuts and seeds to salads.<\/div><\/li>\r\n \t<li>\r\n<div>Choosing oatmeal instead of cheerios.<\/div><\/li>\r\n \t<li>\r\n<div>Start taking Metamucil once per day with lunch.<\/div><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>\r\n<div>Reduce alcohol consumption to 1 beer per day<\/div>\r\n<ul>\r\n \t<li>\r\n<div>Evaluate the impact as current consumption patterns are within guidelines.<\/div><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>These recommendations do not have to be implemented all at once.\u00a0<\/strong> In the next chapter we\u2019ll discuss how to work with David to target his areas of interest and create SMART goals to implement the plan.\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n\r\nPART 2: PLAN COMPLETE. Pause to reflect on the strategies discussed and the potential factors we could include in David's nutrition care plan. When you\u2019re ready, move on to Part 3: Implementation.\r\n\r\n<\/div>\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-69d59fe57a2bc\" 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-69d59fe57a2bc\" 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-plan\/#Creating_a_Nutrition_Care_Plan\" >Creating a Nutrition Care Plan<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Medication_Adherence\" >Medication Adherence<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_Medications\" >David&#8217;s Medications<\/a><\/li><\/ul><\/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-plan\/#Dietary_Patterns_%E2%80%93_DASH_Diet\" >Dietary Patterns &#8211; DASH Diet<\/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-plan\/#Davids_Dietary_Pattern\" >David&#8217;s Dietary Pattern<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Sodium_Intake\" >Sodium Intake<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_Sodium_Intake\" >David&#8217;s Sodium Intake<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Saturated_and_Trans_Fat_Intake\" >Saturated and Trans Fat Intake<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_Saturated_and_Trans_Fat_Intake\" >David&#8217;s Saturated and Trans Fat Intake<\/a><\/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-plan\/#Fibre\" >Fibre<\/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-plan\/#Davids_Fibre_Intake\" >David&#8217;s Fibre Intake<\/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-plan\/#Physical_Activity\" >Physical Activity<\/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-plan\/#Davids_Physical_Activity\" >David&#8217;s Physical Activity<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Smoking\" >Smoking<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_Smoking\" >David&#8217;s Smoking<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Alcohol_Intake\" >Alcohol Intake<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_Alcohol_Intake\" >David&#8217;s Alcohol Intake<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Stress\" >Stress<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_Stress\" >David&#8217;s Stress<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Summary_of_Nutrition_Care_Plan_Recommendations\" >Summary of Nutrition Care Plan Recommendations<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/htn-plan\/#Davids_NCP_Recommendations\" >David&#8217;s NCP Recommendations<\/a><\/li><\/ul><\/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_2-plan-1024x132.png\" alt=\"Step 2: Plan\" width=\"1024\" height=\"132\" class=\"alignnone wp-image-1368 size-large\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-1024x132.png 1024w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-300x39.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-768x99.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-1536x198.png 1536w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-2048x264.png 2048w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-65x8.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-225x29.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_2-plan-350x45.png 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<h1><span class=\"ez-toc-section\" id=\"Creating_a_Nutrition_Care_Plan\"><\/span>Creating a Nutrition Care Plan<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>We are going to use the data we collected in the Assess stage to form a nutrition care plan for HTN and dyslipidemia, considering each of these 9 key areas:<\/p>\n<ul>\n<li>Medication Adherence<\/li>\n<li>Dietary Patterns &#8211; Mediterranean Diet &amp; DASH Diet<\/li>\n<li>Sodium Intake<\/li>\n<li>Saturated and Trans Fat Intake<\/li>\n<li>Fibre Intake<\/li>\n<li>Physical Activity<\/li>\n<li>Smoking<\/li>\n<li>Alcohol Intake<\/li>\n<li>Stress<\/li>\n<\/ul>\n<h1><span class=\"ez-toc-section\" id=\"Medication_Adherence\"><\/span>Medication Adherence<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>It is always important to check in with the client on medication adherence. You can ask a few simple questions:<\/p>\n<ul>\n<li>Are they taking their medication at the times prescribed?<\/li>\n<li>Do they always take their medication? If not, how frequently do they miss taking a dose? Why are they not taking it?<\/li>\n<li>Does the client notice any side effects when taking the medication (this may be a reason for other factors reported to you that may influence your plan of care \u2013 i.e. nausea, diarrhea, lack of appetite)?<\/li>\n<\/ul>\n<p>Liaise with <button class=\"glossary-term\" aria-describedby=\"96-1085\">PCP<\/button> regarding medication education or changes, if needed (i.e. client reports a concern or symptom not yet documented).<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Medications\"><\/span>David&#8217;s Medications<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div>David is taking the listed medications as directed. David tells you that he has been experiencing constipation. This has recently become more frequent and is beginning to bother him.<\/div>\n<ul>\n<li>David recently switched to a new BP medication, Amlodipine (Norvasc) 10mg, which can cause constipation<\/li>\n<li>In this situation, you could liaise with PCP and consider a different blood pressure medication.<\/li>\n<li>You may also suggest a fibre supplement, like Metamucil, that can help relieve constipation.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Dietary_Patterns_%E2%80%93_DASH_Diet\"><\/span>Dietary Patterns &#8211; DASH Diet<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Revisiting our dietary assessment, we can use the DASH dietary pattern to help us form our nutrition care plan.<\/p>\n<p>For more information, read:<\/p>\n<ul>\n<li>&#8220;<a href=\"https:\/\/dx.doi.org\/10.1056\/NEJM200101043440101\">Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet<\/a>,&#8221; a journal article from The New England Journal of Medicine.<\/li>\n<li><a href=\"https:\/\/www.healthvermont.gov\/sites\/default\/files\/documents\/pdf\/HPDP-Diabetes_dash%20eating%20plan.pdf\">Vermont Department of Health\u2019s DASH Eating Plan resource (PDF)<\/a><span>.<\/span><\/li>\n<\/ul>\n<table class=\"grid\">\n<caption>DASH Eating Plan<\/caption>\n<tbody>\n<tr>\n<th scope=\"col\">Food Group<\/th>\n<th scope=\"col\">Daily Servings<\/th>\n<th scope=\"col\">Serving Sizes (1 serving is equivalent to)<\/th>\n<\/tr>\n<tr>\n<th scope=\"row\">Grains<\/th>\n<td>7-8<\/td>\n<td>\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>\n<th scope=\"row\">Vegetables<\/th>\n<td>4-5<\/td>\n<td>\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>\n<th scope=\"row\">Fruit<\/th>\n<td>4-5<\/td>\n<td>\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>\n<th scope=\"row\">Fat-free or low-fat dairy products<\/th>\n<td>2-3<\/td>\n<td>\n<div>1 cup yogurt<\/div>\n<div>1 \u00bd ounce cheese<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Lean meats, poultry, fish<\/th>\n<td>2 or fewer<\/td>\n<td>\n<div>3-ounce cooked meats, poultry of fish<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Nuts, seeds, and legumes<\/th>\n<td>4-5 per week<\/td>\n<td>\n<div>1 tbsp of peanut butter or seeds<\/div>\n<div>\u00bd cup cooked legumes<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Fats and oils<\/th>\n<td>2-3<\/td>\n<td>\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>\n<th scope=\"row\">Sweets<\/th>\n<td>5 per week<\/td>\n<td>\n<div>\u00bd ounce jelly beans<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Dietary_Pattern\"><\/span>David&#8217;s Dietary Pattern<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div class=\"textbox\"><strong>PES<\/strong>: Imbalance of nutrients related to food and nutrition knowledge deficit of 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.<\/div>\n<p>As outlined in our assessment, David is not currently following the DASH diet as a method to help control his BP and lipids. Providing an overview of the importance of balanced meals and snacks using the DASH diet, you can target areas beneficial for controlling blood pressure and reducing cholesterol. It\u2019s important that David has a basic understanding of healthy dietary habits and is able to understand it in a practical way.<\/p>\n<p>We will use principles from the DASH diet to create a nutrition care plan for David. As you do this, keep in mind:<\/p>\n<ul>\n<li>Small goals lead to big achievements and motivate the client to pursue a goal.<\/li>\n<li>You do not have to change the entire diet in one appointment. This can be done in a step-wise manner, which is more likely to result in a successful outcome.<\/li>\n<li>Always ask the client for their opinion when making suggestions, it is important that they are a part of the process.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Sodium_Intake\"><\/span>Sodium Intake<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Some strategies from the DASH diet to consider as part of the plan to reduce sodium in clients with HTN include trying to:<\/p>\n<ul>\n<li>Choose vegetables and fruits more often (fresh or frozen without added salt).<\/li>\n<li>Limit processed, smoked, and cured foods.<\/li>\n<li>Avoid using salt at the table and reduce salt added during cooking.<\/li>\n<li>Avoid seasonings that contain the word \u2018salt\u2019 or \u2018sodium\u2019 (such as garlic salt, celery salt, or monosodium glutamate [MSG]).<\/li>\n<li>Flavour foods with herbs, spices, garlic, onion, lemon, or vinegars.<\/li>\n<li>Limit frozen convenience foods and fast food restaurant meals.<\/li>\n<li>Use the Nutrition Facts table to determine sodium amounts: try to avoid foods with more than 300 mg of sodium per serving or % DV &lt; 5<\/li>\n<li>Read food labels to determine sodium amounts: look for \u2018unsalted\u2019 or \u2018no added salt\u2019 or \u2018low in sodium\u2019 or \u2018salt-free\u2019 items. Note that \u00a0\u2018sodium-reduced\u2019 does not necessarily mean low sodium.<\/li>\n<\/ul>\n<p>For more information, read Heart and Stroke Foundation of Canada&#8217;s &#8220;<a href=\"https:\/\/www.heartandstroke.ca\/-\/media\/pdf-files\/canada\/health-information-catalogue\/en-managing-your-blood-pressure.pdf?rev=ad8b90f1eecc4f389360a6d51ba83bf9\">Managing your blood pressure&#8221; (PDF)<\/a> resource.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"h5p-12\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-12\" class=\"h5p-iframe\" data-content-id=\"12\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Reducing David&#039;s sodium intake\"><\/iframe><\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Sodium_Intake\"><\/span>David&#8217;s Sodium Intake<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div class=\"textbox\"><strong>PES<\/strong>: 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.<\/div>\n<p>As we noted during the assessment (i.e. medical History, BP readings, dietary recall), David has HTN and a high intake of sodium. To help David control his blood pressure, here are a few suggestions to reduce his sodium intake.<\/p>\n<table class=\"grid\" style=\"width: 100%;height: 421px\">\n<caption>Suggestions for David&#8217;s diet to reduce sodium intake, by meal.<br \/>\n<span style=\"background-color: #ffff99\"><em>[*] indicates foods in diet recall most relevant to sodium intake<\/em><\/span><\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"width: 9.19116%;height: 15px\" scope=\"col\">Meal<\/th>\n<th style=\"width: 33.2108%;height: 15px\" scope=\"col\">David&#8217;s diet recall<\/th>\n<th style=\"width: 57.4755%;height: 15px\">Suggestions to reduce sodium<\/th>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Breakfast<\/th>\n<td style=\"width: 33.2108%;height: 104px\">2 eggs, <span style=\"background-color: #ffff99\">2 pieces bacon*<\/span>, 1 piece of white bread, 15 mL butter on bread, 1 coffee with 2 milk (2%)<\/td>\n<td style=\"width: 57.4755%;height: 104px\">\n<ul>\n<li>Tell David that processed meats (such as bacon) are very high in sodium<\/li>\n<li>Reduce the consumption of bacon towards having it as a \u201ctreat\u201d once a week<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 151px\">\n<th style=\"width: 9.19116%;height: 151px\" scope=\"row\">Lunch<\/th>\n<td style=\"width: 33.2108%;height: 151px\">Turkey sandwich (2 slices of whole grain bread, <span style=\"background-color: #ffff99\">2 slices of deli turkey*<\/span>, <span style=\"background-color: #ffff99\">tbsp of mayo*, tbsp of mustard*<\/span>, <span style=\"background-color: #ffff99\">2 slices of cheddar cheese<\/span>, lettuce, and tomato) with <span style=\"background-color: #ffff99\">1 cup of soup (canned tomato or mushroom)*<\/span>, 500 mL of water<\/td>\n<td style=\"width: 57.4755%;height: 151px\">\n<ul>\n<li>Reinforce that processed meats (such as turkey slices) are high in sodium<\/li>\n<li>Substitute turkey slices for cooked chicken, turkey, or low-sodium canned tuna<\/li>\n<li>Reduce condiment serving size, or substitute for hummus<\/li>\n<li>Substitute the cheddar cheese with a low-fat or reduced fat alternative<\/li>\n<li>Tell David to seek low-sodium canned soup options using the nutrition facts table<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Dinner<\/th>\n<td style=\"width: 33.2108%;height: 104px\">6 ounces of meat (beef), 1 cup <span style=\"background-color: #ffff99\">mashed potatoes*<\/span>, 1 cup of salad, 500 mL of water<\/td>\n<td style=\"width: 57.4755%;height: 104px\">\n<ul>\n<li>Ask David if mashed potatoes are pre-made. If so&#8230;<\/li>\n<li>Substitute pre-made mashed potatoes for quinoa, whole grain pasta or brown rice (as the starch component) at every other dinner<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 47px\">\n<th style=\"width: 9.19116%;height: 47px\" scope=\"row\">HS snack<\/th>\n<td style=\"width: 33.2108%;height: 47px\">1 bowl of cereal (cheerios) with 1 cup of 2% milk and a <span style=\"background-color: #ffff99\">small bag of chips* <\/span>with 1-2 beers<\/td>\n<td style=\"width: 57.4755%;height: 47px\">\n<ul>\n<li>Reinforce the importance of avoiding packaged foods<\/li>\n<li>Treat chips as a &#8220;treat&#8221;<\/li>\n<li>Substitute chips for air-popped popcorn<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>For David, the key message here is to reduce the amount of processed and packaged foods.<\/p>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Saturated_and_Trans_Fat_Intake\"><\/span>Saturated and Trans Fat Intake<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>To reduce saturated and trans fats, clients can be encouraged to try to:<\/p>\n<ul>\n<li>Choose unsaturated fats (olive oil, canola oil, soft non-hydrogenated margarine) more often than saturated fats (butter, cream) when cooking.<\/li>\n<li>Include fatty fish in a meal two to three times a week.<\/li>\n<li>Use skim or 1% milk rather than 2% or 3.25% milk or cream.<\/li>\n<li>Choose lean meat and poultry and trim off the fat and skin before cooking.<\/li>\n<li>Add nuts and seeds to salads and use nut butters as spreads.<\/li>\n<li>Limit fast food and processed food that is high in trans fats.<\/li>\n<\/ul>\n<div>\n<p>For more information, read Heart and Stroke Foundation of Canada&#8217;s &#8220;<a href=\"https:\/\/www.heartandstroke.ca\/-\/media\/1-stroke-best-practices\/resources\/patient-resources\/hs-f20-cholesterol-brochure-en-v3\">How to Manage Your Cholesterol&#8221; (PDF)<\/a> resource.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<div id=\"h5p-14\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-14\" class=\"h5p-iframe\" data-content-id=\"14\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Reducing David&#039;s saturated and trans fats\"><\/iframe><\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Saturated_and_Trans_Fat_Intake\"><\/span>David&#8217;s Saturated and Trans Fat Intake<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div class=\"textbox\"><strong>PES<\/strong>: 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, butter, red meat, and chips.<\/div>\n<p>As we noted during the assessment (i.e. History data, elevated lipid levels, dietary recall), David has dyslipidemia and high intake of saturated and trans fat. To help David control his dyslipidemia and reduce his LDL, here are a few suggestions to reduce his intake of saturated and trans fat.<\/p>\n<table class=\"grid\" style=\"width: 100%;height: 421px\">\n<caption>Suggestions for David&#8217;s diet to reduce intake of saturated and trans fat, by meal.<br \/>\n<em><span style=\"background-color: #ffff99\">[*] indicates foods in diet recall most relevant to saturated and trans fat<\/span>\u00a0<\/em><\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"width: 9.19116%;height: 15px\" scope=\"col\">Meal<\/th>\n<th style=\"width: 33.2108%;height: 15px\" scope=\"col\">David&#8217;s diet recall<\/th>\n<th style=\"width: 57.4755%;height: 15px\">Suggestions to reduce saturated and trans fat<\/th>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Breakfast<\/th>\n<td style=\"width: 33.2108%;height: 104px\"><span style=\"background-color: #ffff99\">2 eggs<\/span>, <span style=\"background-color: #ffff99\">2 pieces bacon*<\/span>, 1 piece of white bread, <span style=\"background-color: #ffff99\">15 mL butter on bread*<\/span>, 1 coffee with 2 milk (2%)<\/td>\n<td style=\"width: 57.4755%;height: 104px\">\n<ul>\n<li>Tell David that bacon is a significant source of both sodium <em>and<\/em> saturated fat<\/li>\n<li>Substitute butter for a nut-based butter (e.g. peanut, almond, etc.), as these are sources of unsaturated fats<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 151px\">\n<th style=\"width: 9.19116%;height: 151px\" scope=\"row\">Lunch<\/th>\n<td style=\"width: 33.2108%;height: 151px\">Turkey sandwich (2 slices of whole grain bread, <span style=\"background-color: #ffff99\">2 slices of deli turkey<\/span>, tbsp of mayo, tbsp of mustard, <span style=\"background-color: #ffff99\">2 slices of cheddar cheese<\/span>, lettuce, and tomato) with <span style=\"background-color: #ffff99\">1 cup of soup (canned tomato or mushroom)<\/span>, 500 mL of water<\/td>\n<td style=\"width: 57.4755%;height: 151px\">\n<ul>\n<li>Substitute deli turkey with real turkey or other meats for the sandwich<\/li>\n<li>Reduce the cheddar cheese to 1 slice\u00a0 or skip it<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Dinner<\/th>\n<td style=\"width: 33.2108%;height: 104px\"><span style=\"background-color: #ffff99\">6 ounces of meat (beef)*<\/span>, 1 cup mashed potatoes, 1 cup of salad, 500 mL of water<\/td>\n<td style=\"width: 57.4755%;height: 104px\">\n<ul>\n<li>Tell David it is OK to have a source of meat with dinner, but beef is a higher source of saturated fat than other types of meat<\/li>\n<li>Substitute beef for lean meats (e.g. chicken) or fatty fish (e.g. salmon) as his source of protein<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 47px\">\n<th style=\"width: 9.19116%;height: 47px\" scope=\"row\">HS snack<\/th>\n<td style=\"width: 33.2108%;height: 47px\">1 bowl of cereal (cheerios) with 1 cup of 2% milk and a <span style=\"background-color: #ffff99\">small bag of chips with 1-2 beers*<\/span><\/td>\n<td style=\"width: 57.4755%;height: 47px\">\n<ul>\n<li>Tell David that chips are a\u00a0significant source of both sodium <em>and<\/em> saturated fat<\/li>\n<li>Reduce consumption of chips is a stable recommendation throughout<\/li>\n<li>Reduce alcohol consumption, as it may contribute to an increase in triglycerides (this will be discussed later in the section content)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Fibre\"><\/span>Fibre<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>To increase fibre intake, clients can be encouraged to try to:<\/p>\n<ul>\n<li>Choose whole vegetables and fruit instead of juice.<\/li>\n<li>Add extra vegetables and legumes to pasta, curries, casseroles, and soups.<\/li>\n<li>Leave the skin on vegetables and fruits.<\/li>\n<li>Add nuts and seeds to salads, yogurt, and cereal.<\/li>\n<li>Include oatmeal with ground flaxseed as a breakfast food.<\/li>\n<li>Choose grain products with \u201cwhole grain\u201d as the first ingredient.<\/li>\n<li>Look for 2-4 grams fibre per serving on the Nutrition Facts table.<\/li>\n<li>Add psyllium husk (like Metamucil) to meals or snacks once per day.<\/li>\n<\/ul>\n<p>Make sure to add in fibre slowly and increase fluid intake to prevent constipation.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"h5p-15\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-15\" class=\"h5p-iframe\" data-content-id=\"15\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Increasing David&#039;s fibre intake\"><\/iframe><\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Fibre_Intake\"><\/span>David&#8217;s Fibre Intake<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div class=\"textbox\"><strong>PES<\/strong>: Inadequate intake of fibre related to a knowledge deficit of food sources of fibre as evidenced by low intake of vegetables and whole grains.<\/div>\n<p>As we noted during the assessment, David has inadequate fibre. Here are a few suggestions to help David increase his fibre intake.<\/p>\n<table class=\"grid\" style=\"width: 100%;height: 421px\">\n<caption>Suggestions for David&#8217;s diet to increase intake of fibre, by meal.<br \/>\n<em><span style=\"background-color: #ffff99\">[*] indicates foods in diet recall most relevant to fibre<\/span><\/em><\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"width: 9.19116%;height: 15px\" scope=\"col\">Meal<\/th>\n<th style=\"width: 33.2108%;height: 15px\" scope=\"col\">David&#8217;s diet recall<\/th>\n<th style=\"width: 57.4755%;height: 15px\">Suggestions to increase fibre intake<\/th>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Breakfast<\/th>\n<td style=\"width: 33.2108%;height: 104px\">2 eggs, 2 pieces bacon, <span style=\"background-color: #ffff99\">1 piece of white bread*<\/span>, 15 mL butter on bread, 1 coffee with 2 milk (2%)<\/td>\n<td style=\"width: 57.4755%;height: 104px\">\n<ul>\n<li>Note: It is often easier to &#8220;substitute&#8221; or add in other beneficial foods to a client&#8217;s diet rather than try to &#8220;remove&#8221; everything<\/li>\n<li>Substitute the white bread for whole grain bread<\/li>\n<li>Consider oatmeal as another breakfast option, as it provides a source of soluble fibre<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 151px\">\n<th style=\"width: 9.19116%;height: 151px\" scope=\"row\">Lunch<\/th>\n<td style=\"width: 33.2108%;height: 151px\">Turkey sandwich (<span style=\"background-color: #ffff99\">2 slices of white bread*<\/span>, 2 slices of deli turkey, tbsp of mayo, tbsp of mustard, 2 slices of cheddar cheese, lettuce, and tomato) with <span style=\"background-color: #ffff99\">1 cup of soup*<\/span> (canned tomato or mushroom), 500 mL of water<\/td>\n<td style=\"width: 57.4755%;height: 151px\">\n<ul>\n<li>Substitute the white bread for whole grain bread (same as breakfast)<\/li>\n<li>Add extra vegetables to the soup<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 9.19116%;height: 104px\" scope=\"row\">Dinner<\/th>\n<td style=\"width: 33.2108%;height: 104px\">6 ounces of meat (beef), 1 cup mashed potatoes, <span style=\"background-color: #ffff99\">1 cup of salad*<\/span>, 500 mL of water<\/td>\n<td style=\"width: 57.4755%;height: 104px\">\n<ul>\n<li>Add legumes or nuts and seeds to the salad<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 47px\">\n<th style=\"width: 9.19116%;height: 47px\" scope=\"row\">HS snack<\/th>\n<td style=\"width: 33.2108%;height: 47px\">1 bowl of cereal (<span style=\"background-color: #ffff99\">cheerios*<\/span>) with 1 cup of 2% milk and a small bag of <span style=\"background-color: #ffff99\">chips*<\/span> with 1-2 beers<\/td>\n<td style=\"width: 57.4755%;height: 47px\">\n<ul>\n<li>Substitute cheerios for a bowl of oatmeal<\/li>\n<li>Substitute chips for air-popped popcorn<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Physical_Activity\"><\/span>Physical Activity<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Physical activity is an important component of health. It can help control blood pressure. Clients can be encouraged to try the following:<\/p>\n<ul>\n<li>To achieve health benefits, and improve functional abilities, adults should accumulate at least 150 minutes of moderate- to vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more.\n<ul>\n<li>Examples of moderate-to-vigorous intensity activity: brisk walking, dancing, jogging, biking<\/li>\n<\/ul>\n<\/li>\n<li>It is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week.\n<ul>\n<li>Major muscle groups: chest, shoulders, back, arms, abs, legs<\/li>\n<li>Examples of muscle and bone strengthening activity: jumping rope, weight-lifting, sports (tennis, badminton)<\/li>\n<\/ul>\n<\/li>\n<li>Those with poor mobility should perform physical activities to enhance balance and prevent falls.<\/li>\n<\/ul>\n<p>For more information, read the Canadian Society for Exercise Physiology&#8217;s <a href=\"https:\/\/csepguidelines.ca\/\">24-Hour Movement Guidelines<\/a>.<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Physical_Activity\"><\/span>David&#8217;s Physical Activity<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>David is not currently interested in engaging in more physical activity, as he would like to focus on dietary changes first.<\/li>\n<li>Main barrier is the lower back injury.<\/li>\n<li>Consider speaking to David and his PCP about involving a registered kinesiologist or physiotherapist regarding this barrier.<\/li>\n<li>No physical activity plan at this time.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Smoking\"><\/span>Smoking<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Smoking affects blood pressure in 2 ways:<\/p>\n<ol>\n<li>Nicotine in cigarette smoke causes blood vessels to narrow, which increases blood pressure.<\/li>\n<li>Smoking makes blood pressure medications work less effectively.<\/li>\n<\/ol>\n<p>Smoking also increases the risk for the buildup of plaque inside the arteries (atherosclerosis).<\/p>\n<p>Counselling on smoking cessation is not within a dietitian\u2019s scope, however, if a client is interested in quitting smoking you can provide the following tips:<\/p>\n<ol>\n<li><strong>Set a Quit Date:<\/strong> Choose a date within the next seven days when you will quit smoking.<\/li>\n<li><strong>Choose a method for quitting:<\/strong> Stop all at once OR cut down the number of cigarettes per day until you stop completely.<\/li>\n<li><strong>Decide if you need medication or other assistance to quit:<\/strong> A dietitian can act as a motivator and check in on smoking cessation goals. However, clients should talk to their PCP or be referred to a smoking cessation program to determine if they would benefit from nicotine replacement therapy (NRT).<\/li>\n<\/ol>\n<div>\n<p>For more information on quitting smoking, read Heart and Stroke Foundation of Canada&#8217;s &#8220;<a href=\"https:\/\/www.heartandstroke.ca\/-\/media\/pdf-files\/canada\/health-information-catalogue\/en-managing-your-blood-pressure.pdf?rev=ad8b90f1eecc4f389360a6d51ba83bf9\">Managing your blood pressure&#8221; (PDF)<\/a> resource.<\/p>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Smoking\"><\/span>David&#8217;s Smoking<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>David is not currently interested in quitting smoking. He wants to try and achieve his goals with nutrition-related changes.<\/li>\n<li>He is open to revisiting this in the future.<\/li>\n<li>No smoking cessation plan at this time.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Alcohol_Intake\"><\/span>Alcohol Intake<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Drinking alcohol can lead to:<\/p>\n<ul>\n<li>High blood pressure by interfering with the blood flow to and from the heart.<\/li>\n<li>Possible increase in triglycerides.<\/li>\n<li>Increase in the release of <button class=\"glossary-term\" aria-describedby=\"96-1638\">VLDL<\/button>.<\/li>\n<li>Increase the flow of free fatty acids to the liver from fat tissue.<\/li>\n<li>Impede the body\u2019s ability to break down fat.<\/li>\n<\/ul>\n<p>Alcohol can be addictive and high intakes are associated with physical abuse and accidental injury or death. <strong>There is a need for individual consideration.<\/strong><\/p>\n<p>As per Canada&#8217;s updated 2023 Guidance on Alcohol and Health, consuming 7 or more standard drinks per week places individuals at an increasingly high risk of alcohol-related consequences.<\/p>\n<p>Overall, to prevent hypertension and reduce BP in adults, individuals should limit alcohol consumption to \u22642 drinks per week.<\/p>\n<p>For more information on recommendations surrounding alcoholic beverages, read the Canadian Centre on Substance Use and Addictions\u00a0 <a href=\"https:\/\/www.ccsa.ca\/canadas-guidance-alcohol-and-health\">\u00a0&#8220;2023 Canada&#8217;s Guidelines for Alcohol and Health&#8221;<\/a>.<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Alcohol_Intake\"><\/span>David&#8217;s Alcohol Intake<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>David reported having 1-2 beers per night (7-14 beers per week).<\/li>\n<li>David&#8217;s alcohol consumption places him at an increasingly high risk of alcohol-related consequences, he should consider the\u00a0effect on his blood pressure and triglycerides (which are above the target range).<\/li>\n<li>Reducing his alcohol intake may or may not have beneficial outcomes on improving his biochemical data.<\/li>\n<li>After discussion with David, he does not want to give up alcohol entirely, but wants to try to reduce consumption.<\/li>\n<li>Plan could be to start by reducing alcohol consumption to 1 beer per night.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Stress\"><\/span>Stress<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>To help with stress using positive coping strategies clients can try:<\/p>\n<ul>\n<li>Physical activity<\/li>\n<li>Socializing<\/li>\n<li>Laughter<\/li>\n<li>Engaging in hobbies<\/li>\n<li>Breathing exercises<\/li>\n<\/ul>\n<p>Avoid unhealthy stress busters such as:<\/p>\n<ul>\n<li>Smoking<\/li>\n<li>Alcohol<\/li>\n<\/ul>\n<p>If additional help is needed, consider a social worker, therapist, or psychologist.<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_Stress\"><\/span>David&#8217;s Stress<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>He tells you that he is coping well with his depression since seeing a therapist a couple years ago, and the medication he takes daily has helped.<\/li>\n<li>He plans to reduce his alcohol intake and is considering smoking cessation in the future.<\/li>\n<li>He also reports he talks to his wife and socializes with friends to relieve his stress, and doesn\u2019t feel it is impacting his health and quality of life at this point.<\/li>\n<li>No plan for coping with stress is needed at this time.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Summary_of_Nutrition_Care_Plan_Recommendations\"><\/span>Summary of Nutrition Care Plan Recommendations<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>Now that we have gone through all 9 of the key areas to investigate when creating a nutrition care plan, here is a summary of the recommendations.<\/p>\n<table class=\"grid\" style=\"height: 499px;width: 744px\">\n<caption>Summary of NCP recommendations, by area of concern<\/caption>\n<tbody>\n<tr style=\"height: 29px\">\n<th style=\"height: 29px;width: 131.344px\" scope=\"col\">\u00a0Area of Concern<\/th>\n<th style=\"height: 29px;width: 475.781px\" scope=\"col\">Recommendations<\/th>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Medication Adherence<\/th>\n<td style=\"height: 30px;width: 475.781px\">\n<ul>\n<li>Check if taking as prescribed<\/li>\n<li>Consider liaising with PCP if changes needed<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Dietary Pattern<\/th>\n<td style=\"height: 30px;width: 475.781px\">\n<ul>\n<li>Follow the DASH diet or Mediterranean Eating Pattern as a general guideline to healthy eating<\/li>\n<li>Check for any drug nutrient interactions<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Sodium Intake<\/th>\n<td style=\"height: 30px;width: 475.781px\">\n<ul>\n<li>Aim for &lt; 2000 mg of sodium per day<\/li>\n<li>Limit processed foods with more than 400 mg per serving and eating out at restaurants<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Fat Intake<\/th>\n<td style=\"height: 30px;width: 475.781px\">\n<ul>\n<li>Choose unsaturated fats most often<\/li>\n<li>Limit saturated fat and avoid trans fat<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 131.344px\" scope=\"row\">Fibre Intake<\/th>\n<td style=\"height: 30px;width: 475.781px\">\n<ul>\n<li>Increase intake of vegetables, fruit, and legumes<\/li>\n<li>Choose \u201cwhole grain\u201d products with 2-4 g per serving<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 72px\">\n<th style=\"width: 131.344px;height: 72px\" scope=\"row\">Physical Activity<\/th>\n<td style=\"width: 475.781px;height: 72px\">\n<ul>\n<li>150 minutes moderate to vigorous exercise each week<\/li>\n<li>Resistance exercise 2-3 times per week<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 56px\">\n<th style=\"width: 131.344px;height: 56px\" scope=\"row\">Smoking<\/th>\n<td style=\"width: 475.781px;height: 56px\">\n<ul>\n<li>Smoking cessation is recommended to reduce the risk of CVD<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 104px\">\n<th style=\"width: 131.344px;height: 104px\" scope=\"row\">Alcohol<\/th>\n<td style=\"width: 475.781px;height: 104px\">\n<ul>\n<li>Moderate consumption (1 drink per day) for women and men may reduce the risk of CVD<\/li>\n<li>Consider reduction, if appropriate, as alcohol intake can increase BP and TG<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 88px\">\n<th style=\"width: 131.344px;height: 88px\" scope=\"row\">Stress<\/th>\n<td style=\"width: 475.781px;height: 88px\">\n<ul>\n<li>Use positive coping strategies (socializing) to deal with stress rather than negative methods<\/li>\n<li>Consider referral to <button class=\"glossary-term\" aria-describedby=\"96-1639\">SW<\/button>, therapist, etc.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>When working with clients with hypertension and dyslipidemia,\u00a0 you can refer to this summary and the<a href=\"https:\/\/guidelines.hypertension.ca\/prevention-treatment\/health-behaviour-management\/\"> Hypertension Canada&#8217;s\u00a0 Health Behaviour Management Guidelines.<\/a><\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Davids_NCP_Recommendations\"><\/span>David&#8217;s NCP Recommendations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p>David\u2019s Nutrition Care Plan could be to:<\/p>\n<ul>\n<li>Incorporate the principles of the DASH diet\n<ul>\n<li>Incorporate the recommended daily servings of whole grains, vegetables and fruits, low-fat dairy products, lean meats, nuts, seeds, legumes, fats, and oils.<\/li>\n<\/ul>\n<\/li>\n<li>Reduce sodium by:\n<ul>\n<li>Reducing intake of processed deli meats and replacing with baked lean meat.<\/li>\n<li>Reduce intake of processed foods like boxed mashed potatoes, chips, and canned soup.<\/li>\n<li>Use Nutrition Facts table to look for low sodium options.<\/li>\n<\/ul>\n<\/li>\n<li>Replace saturated fat intake with unsaturated fats by:\n<ul>\n<li>Using nut butter instead of butter.<\/li>\n<li>Having lean meats, like chicken, or fish instead of beef and bacon.<\/li>\n<li>Reducing potato chips as <button class=\"glossary-term\" aria-describedby=\"96-1624\">HS<\/button> snack.<\/li>\n<\/ul>\n<\/li>\n<li>\n<div>Increase fibre by:<\/div>\n<ul>\n<li>\n<div>Choosing whole grain bread instead of white bread.<\/div>\n<\/li>\n<li>\n<div>Adding extra vegetables to soup.<\/div>\n<\/li>\n<li>\n<div>Adding legumes or nuts and seeds to salads.<\/div>\n<\/li>\n<li>\n<div>Choosing oatmeal instead of cheerios.<\/div>\n<\/li>\n<li>\n<div>Start taking Metamucil once per day with lunch.<\/div>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<div>Reduce alcohol consumption to 1 beer per day<\/div>\n<ul>\n<li>\n<div>Evaluate the impact as current consumption patterns are within guidelines.<\/div>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>These recommendations do not have to be implemented all at once.\u00a0<\/strong> In the next chapter we\u2019ll discuss how to work with David to target his areas of interest and create SMART goals to implement the plan.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p>PART 2: PLAN COMPLETE. Pause to reflect on the strategies discussed and the potential factors we could include in David&#8217;s nutrition care plan. When you\u2019re ready, move on to Part 3: Implementation.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"96-1085\" hidden><p>Primary Care Provider<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"96-1638\" hidden><p>Very Low-Density Lipoprotein<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"96-1639\" hidden><p>Social worker<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"96-1624\" hidden><p>Common medical abbreviateion for Latin \"hora somni\", meaning \"bedtime\". <\/p>\n<\/div><\/div>","protected":false},"author":315,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-96","chapter","type-chapter","status-publish","hentry"],"part":89,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/96","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":40,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/96\/revisions"}],"predecessor-version":[{"id":2359,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/96\/revisions\/2359"}],"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\/96\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/media?parent=96"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapter-type?post=96"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/contributor?post=96"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/license?post=96"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}