Courtney Pearce & Jenna Paterno COPD Courtney Pearce & Jenna Paterno

What is COPD? Chronic obstructive pulmonary disease is a progressive disease that limits airflow through either inflammation of the lining of the bronchial tubes (known as bronchitis) or destruction of alveoli (known as emphysema). Both conditions coexist as part of COPD. j

Etiology Cigarette smoking is the number one cause of COPD The longer and heavier a person smokes the greater the chance of developing bronchitis People can also develop bronchitis from second hand smoke j

Case study Stella Bernhardt 62 years old Caucasian, Female 5’3”, Wt. 119 Pounds BMI of 21.1 kg/m2 Married to a 68 year old man who has PMH of CAD Completed two years of college Retired office manager for an independent insurance agency (mention how she lost weight) j

Patient History 5 years ago was diagnosed with stage 1 COPD (emphysema) History of bronchitis and upper respiratory infections during winter months for most of adult life No surgeries Medication: Combivent (metro dose inhaler) 2 inhalations 4X daily Smoked for 46 years- stopped a year ago Avoids Milk- says she has heard it increases mucus production Mother and 2 aunts died from lung cancer j

Physical Exam BP: 130/88- pre hypertensive Very mild pitting edema (+1) Decreased breath sounds in chest/lungs Percussion hyperresonant (due to COPD) Prolonged wheezing j

Normal Levels Mrs. Bernhardt Protein (g/dL) 6-8 5.8 Albumin (g/dL) 3.5-5 3.3 WBC (x103/mm3) 4.8-11.8 15 RBC (x106/mm3) 4.2-5.4 4 Hemoglobin (g/dL) 12-15 11.5 Hematocrit (%) 37-47 35% pH 7.35-7.45 7.29 pCO2 (mm Hg) 35-45 50.9 SO2 % >95 92 j

Nutrition History C Doesn’t drink milk – thinks it increase mucus production Drinks Pepsi throughout the day (3 12 oz)

Tips in Consuming more Calories Smaller but more frequent meals Resting before meals Social Setting Breathing exercise before and while eating Plan medications and breathing treatments around meals Sitting upright to prevent aspiration Trying to use oxygen at meal times Modified diet c

Nutrition Needs BMI: 21.2 kg/m2 %UBW: (100 x 119)/150 = 79.3 % Estimated energy needs: 10 x 54 kg + 6.25 x 160cm -5 x 62 +5= 1235kcals 1235 X 1.2= 1482 kcals/day 1235 X 1.4= 1729 kcals/day c

Protein 1.2-1.7g/kg of protein is necessary to maintain or restore lung and muscle strength as well as promote immune function 54 kg X 1.5= 81 g 54 kg X 1.7= 91.8 g 81g-92g of Protein c

Nutrition Concern Monitor glucose levels to be able to successfully wean patients off ventilation The higher the level of glucose the higher the CO2 production The higher levels of glucose in the system the higher levels of co2 production… which we don’t want because it will be hard to take her off ventilation when needed c

PES Statement Decreased nutrient needs of glucose (NI-5.4) related to high levels of CO2 production in the body as evidence by lab results of 32 mEq/L Inadequate energy intake (NI 4.1)related to poor nutrition practices as evidence by 24-hour diet recall and patients complaint of difficulty eating j

PES #1 Goal: Decrease levels of glucose Intervention: Replace at least 16 ounces of Pepsi with 16 ounces of carbonated water infused with fruit Usually consumes about j

PES #2 Goal: Increase caloric intake by about 500 calories Intervention: Consume about 500 more calories by adding more food and shakes that are dense in nutrients such as smoothies and Ensure with at least one meal a day. j

Mrs. Bernhardt’s 2nd Visit back Weight has decreased to 116 pounds Has had trouble adjusting to medications and oxygen at home so she hasn’t felt like eating much Hungriest in the morning and usually too tired to eat by dinner time c

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Calories have increased which is good… however fat also increased which we want to keep low because foods high in fat are harder to digest in the body However a majority of her calories are coming from her 32 ounces of pepsi c

What do you think Mrs. Bernhardt should do to improve her nutrition?

PES Statement Protein deficiency (NI-5.7.1) related to poor nutrition of 27-47g of protein as evidence by 24- hour diet recall and fatigue Goal: Increase protein intake Intervention: Consume about 60 more grams of protein by adding snacks in between meals that are protein rich such as peanut butter/ nut butter on toast, yogurt, cottage cheese, and eggs. Both

Source American lung association . (n.d.). Retrieved from http://www.lung.org/lung-disease/copd/living-with-copd/copd- management-tools.html Nelms, M. Long, S. & Lacey, K. (2009). Medical nutrition therapy: A case study approach. Belmont, CA: Wadsworth, Cengage Learning. Nelms, M. Sucher, K. Lacey, K. & Roth, S. (2009).Nutrition therapy & pathophysiology. Belmont, CA: Wadsworth What is copd?. (2013, July 31). Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/copd/