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COPD By Bridget Finn Katlyn Wynne

COPD By Bridget Finn Katlyn Wynne. COPD. Chronic Obstructive Pulmonary Disease  Progresive obstruction of airways Emphysema Desruction of alveoli walls Abnormal and permanent elargement of alveoli Chronic Bronchitis chronic and productive cough Inflammation of bronchi. Emphysema.

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COPD By Bridget Finn Katlyn Wynne

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  1. COPD By BridgetFinn KatlynWynne

  2. COPD • Chronic Obstructive Pulmonary Disease •  Progresive obstruction of airways • Emphysema • Desruction of alveoli walls • Abnormal and permanent elargement of alveoli • Chronic Bronchitis • chronic and productive cough • Inflammation of bronchi

  3. Emphysema • Decreased recoil of alveoli walls • Irreversible • Causes difficulty exhaling • Leads to hypercapnia • Mild hypoxemia and normal Hematocryt • Can lead to CorPulmonale • Right sided heart failure due to enlargement of vesicles brought on by stress associated with chronic lung disease • Typical Patient: older, thin, smokers

  4. ChronicBronchitis • Inflammation of bronchi due to changes in lung tissues • Hypoxemia and elevated Hematocryt • Development of CorPulmonale occurs early • Typical Patient: Normal to overweight

  5. CausesofCOPD • Tobacco smoke • Environmental pollution • Genetics Medications for Treatment • Bronchodialators • Decrease shortness of breath by opening and relaxing airways • Coticosteroids • Can be inhaled or in pill form • Decrease inflamation of bronchi

  6. General MNT • Patients have increased resting energy expenditure • 125%-156% above BEE • Protein 1.2-1.7 g/kg • In hospital pt usually requires support feeding • Recommend vitamin consumption: C, A , E and Beta Carotene

  7. Catabolic/Anabolic Balance and Muscle Wasting in Patients With COPD. • Evaluated the relationship between levels of catabolic factors(interleukin, cortisol), anabolic factors (bioavailable testosterone, dehydroepiandrosterone sulfate, and insulin-like growth factor), and mid-thigh muscle cross-sectional area in patients with COPD to classify levels of muscle wasting •  45 men diagnosed with COPD and 16 healthy, sedentary men participated • 22% of participants with COPD exhibited elevated levels of testosterone (campared to 0% of control) •  COPD patients had lower DHEAS levels than healthy participants • Ratios of catabolic factors to anabolic factors were greater in COPD patients • Shifting toward a catabolic state and possible muscle wasting • Debigaré, Richard; Marquis, Karine; Côté, Claude H.; Tremblay, Roland R.; Michaud, Annie; LeBlanc, Pierre; Maltais, François. Catabolic/Anabolic Balance and Muscle Wasting in Patients with COPD. CHEST, Jul2003, Vol. 124 Issue 1, p83

  8. Dietary support to underweight patients with end-stage pulmonary disease assessed for lung transplantation • Randomized Control Study • Test 71 paitents • 49 Under weight • 29 Normal weight • Study found that underweight group given a calorie dense meal with supplement lead to an average of 1.2 kg weight gain in 13 days

  9. Both generic and disease specific health-related quality of life are deteriorated in patients with underweight COPD. • Cohort Study • Patients were COPD stable and getting once a month check- ups • Study Found that underweight participants had a lower quality of life rating due to shortness of breath, inability to exercise and bodily pain

  10. Investigation into the nutritional status, dietary intake and smoking habits of patients with chronic obstructive pulmonary disease. • Cross Sectional Study • Split 103 participants into 2 groups: Nourished and Malnourished • Malnourished group • Lower lung function • More Dietary problems • Lower nutritional intake compared to counter parts

  11. PatientBackgroundInfo Age: 65 Sex: Male Chief Complaint: Shortness of breath due to emphysema Medical History: Emphysema 10 years COPD due to Tobacco Use Admitting Medical Diagnosis: Chest Radiograph shows tension pneumothorax in left lung Daishi Hayato

  12. Lifestyle & Home Life • Family status: Married, four grown Children • Wife prepares meals • She reports appetite decline in past several weeks • Ethnicity: Asian American • Education: Bachelor’s Degree • Occupation: Retired Grocery Store Manager • Religious Affiliation: Methodist • Smokes 2 ppd for past 50 years • Continues to smoke

  13. Assessment Anthropometrics Ht: 64” BMI: 20.9 normal Wt: 122 lbs IBW: 130 lbs UBW: 135 %IBW: 94%normal % UBW: 90%mildly depleted energy stores Vitals Respiration Rate: 36 breaths per min Blood Pressure: 110/ 80 Temperature: 97.6 °F Heart Rate: 118 bpm LDL/ HDL : 142/32 Allergies Penicillin

  14. Medical History • COPD secondary to tobacco use • Emphysema diagnosed more than 10 yrs ago • Cholecystectomy 20 yrs ago • Total dental extraction 5 yrs ago • Intermittent claudication • Reports swelling in lower extremities • History of dyspnea • Two pillow orthopnea • Family History • Father suffered from lung cancer

  15. Medications • Combivent Inhaler - 2 inhalations 4x a day • Bronchiodilator • Potential risk if allergic to: peanuts, soy and soy lecithin • Caution if taken with diuretics • Lasix – 40 mg daily • Diuretic • Decrease strain on blood vessels and heart • May reduce potassium levels in blood • Increase sensitivity to sun • Oxygen – 2 L/hr via nasal cannula only at night

  16. Food Intake Kcal needs: (66.5 + (13.8 x 55.45kg) + (5 x 137.16 cm) – (6 x 65)) x 1.2 x 1.6 = 2165 kcals • Usual Intake • Breakfast • Egg • Hot Cereal • Bread or Muffin • Hot Tea w/ milk and sugar • Lunch • Soup • Sandwich • Hot Tea w/ milk and sugar • Dinner • Small amount of Meat • Rice • 2-3 types of Vegetables • Hot Tea w/ milk and sugar • * No known food allergies • 24 Hour Recall • Breakfast • 2 scrambled Eggs • Few bites cream of wheat • Bite of toast • Sips of hot tea • throughout the day • Ate Nothing Else • Estimated Calorie Intake: 400-500 calories * No Daily Vitamin Intake

  17. Enteral Nutrition According to the American Lung Association a person with COPD requires 10 times as many calories to breathe than a healthy person. (Trendel) • Pros: • Allows for adequate calorie intake • Provides for sufficient high protein needs • Gives patient fluids • Maintains integrity of the gut! • Eliminates meal time stress (Katsura et al 2005) • Cons: • Discomfort for patient

  18. Diagnosis Inadequate oral food and beverage intake (NI-2.1) related to difficulty swallowing (NI-1.1) due to dyspnea as evidenced by unintentional weight loss of 13 lbs, patient food recall and limited appetite.

  19. Intervention • ND-1: Modify distribution, type, or amount of food and nutrients within meals or specified time • Diet • Small frequent calorically dense meals high in protein • 15-20% Protein • 30-45% Fat • 40-55% Carbohydrates • Avoid foods that lower LES pressure (Barrett) • Avoid gas producing foods that cause stomach to push on diaphragm • Avoid sodas • Avoid alcohol • Eat slowly, chew well, rest before meal time • Use Oxygen during and after meal time (Wouters) • Add a dietary supplement at meal time (Forli et al 2001) • Especially Vitamin C

  20. Diet Ideas • Breakfast: • Eggs • Oatmeal with Peanut Butter • Whole Wheat toast with Peanut Butter • Orange Juice • Hot Tea (caffeine Free) with multivitamin • Mid Morning Snack • Ensure • Lunch • Usual Sandwich • Yogurt • Hot Tea • Mid Afternoon Snack • Rice and Beans • Water • Dinner • Meat (in small pieces) • Veggies • Mashed potatoes • Hot Tea

  21. Intervention • Supplemental Feeding • High Protein, High Calorie supplemental • Nutrition Education • Suggest trying to limit smoking ? • Educate what are gas producing foods • Foods that lower LES pressure • Smart eating behavior • Encourage family support and involvement

  22. Goals • Short Term • Prevent additional weight loss • Regain 5 lbs within 1 month • Increase food intake to minimum caloric needs of 2165 kcals per day • Long Term • Return UBW within 6 months • Increase physical activity to 15 minutes a day • Monitor and Evaluation of Goals: • Patient to return in 2 weeks with wife to check anthropometrics, food intake and diet tolerance • Once significant progress change to monthly check up

  23. References Katsura H, Yamada K, Kida K. Both generic and disease specific health-related quality of life are deteriorated in patients with underweight COPD. Respiratory Medicine 2005;99:624-30. Forli L, Pedersen JI, Bjortuft O, Vatn M, Boe J.  Dietary support to underweight patients with end-stage pulmonary disease assessed for lung transplantation.  Respiration 2001;68(1):51-7. Regional COPD Working Group. COPD prevalence in 12 Asia–Pacific countries and regions: Projections based on the COPD prevalence estimation model. Respirology. June 2003, Vol. 8, Issue 2, Pgs. 192-198 Cai B, Zhu Y, Ma Y, Xu Z, Zao Y, Wang J, Lin Y, Comer GM.  Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients.  Nutrition 2003;19(3):229-232. Wouters, Emil, Creutzberg, Eva, Schols, Annemie. Systemic Effects in COPD. CHEST May 2002. Vol 121, Issue 5 Supplement. Pgs. 127S-130S

  24. More References Debigaré, Richard; Marquis, Karine; Côté, Claude H.; Tremblay, Roland R.; Michaud, Annie; LeBlanc, Pierre; Maltais, François. Catabolic/Anabolic Balance and Muscle Wasting in Patients with COPD. CHEST, Jul2003, Vol. 124 Issue 1, p83 Cochrane WJ, Afolabi OA.  Investigation into the nutritional status, dietary intake and smoking habits of patients with chronic obstructive pulmonary disease.  J Hum Nutr Diet 2004;17(1):3-11

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