Claire Millonig and Kelly May Case Study 26: COPD Claire Millonig and Kelly May

Introduction COPD Chronic Obstructive Pulmonary Disease A disease that limits airflow through either inflammation of the lining of the bronchial tubes or destruction of the alveoli Bronchial tubes  bronchitis Destruction of the alveoli  emphysema

Introduction COPD 4th leading cause of death in the United States Number one risk factor is smoking. Lung function decline is normal with age; can happen up to twice as fast in smokers.

Background Name: Stella Bernhardt Age: 62 yr/old Patient Summary: acute exacerbation of COPD, increasing dyspnea, hypercapnia. History: Diagnosed with stage 1 COPD five years ago. Quit smoking last year, previously 46 year 1 ppd history.

Admitting History Harldy able to do anything for herself Feels like she is gasping for air Coughing up phlegm Confused in the morning

Vitals Temp: 98.8 F BP: 130/88 Pulse: 92 Height: 5’3” Resp Rate: 22 Weight: 119 BMI: 21

Anthropometric Data Height: 5’3” Weight: 119 lbs. UBW: 145-150 lbs Last recorded weight: 139 lbs, 1 yr ago

Lab Results Hematology Reference range WBC 4.8-11.8 15.0 ⬆ RBC   WBC 4.8-11.8 15.0 ⬆ RBC 4.2-5.4 F 4.5-6.2 M 4 ⬇ Hemoglobin 12-15 F 14-17 M 11.5 ⬇

Arterial Blood Gases (ABGs)   Reference Range pH 7.35-7.45 7.29 ⬇ pCO2 (mm Hg) 35-45 50.9 ⬆ SO2 (%) greater than 95 92 ⬇ CO2 content (mmol/L) 25-30 31 ⬆ O2 content (%) 15-22 12 ⬇ HCO3 (mEq/L) 24-28 29.6 ⬆

Diagnosis Inadequate oral intake (NI-2.1; 10639) related to low caloric intake as evidenced by 24 hour recall and usual dietary intake. Unintended weight loss (NC-3.2; 10765) related to loss of appetite and early satiety as evidenced by patient’s claims that food does not appeal to her anymore and she is full after only a few bites.

Intervention Inadequate oral intake: advise client to increase caloric intake by 600 kcals/day. Liquid supplements available for clients with COPD that are low in CHO to reduce CO2 released from CHO metabolism. Supplements may be used to assist in reaching caloric goals. Education about nutrient dense foods. Small, frequent meals to avoid bloating or early satiety. Unintended weight loss: advise client to try foods higher in flavor to increase appeal and decrease taste of bitterness and spread meals out.

Monitoring and Evaluation Monitor Weight Monitor protein, albumin, hematocrit, and hemoglobin levels to detect malnutrition and anemia. Food Diary Ask Mrs. Bernhardt to highlight foods that she believes were particularly nutrient dense so that she can see patterns in food choices and be encouraged to make food choices that could increase her ability to receive the nutrients she needs.

Questions?

References Food Log. (n.d.). Retrieved September 24, 2014, from http://www.fitday.com/app/journal/foods#23SEP2014 Military Obstetrics & Gynecology Laboratory. (n.d.). Retrieved September 24, 2014, from http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ABG.htm Milk Products and Mucous in COPD | COPD Foundation Blog. (2012, March 21). Retrieved September 24, 2014, from http://blog.copdfoundation.org/milk-products-and-mucous-in-copd/ Respiratory quotient. (2014, August 29). Retrieved September 24, 2014, from http://en.wikipedia.org/wiki/Respiratory_quotient St. Florian, I. (2009, February 1). Nutrition and COPD - Dietary Considerations for Better Breathing. Retrieved September 24, 2014, from http://www.todaysdietitian.com/newarchives/td_020909p54.shtml