1. Courtney Pearce & Jenna Paterno
COPD
Courtney Pearce & Jenna Paterno

2. 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

3. 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

4. 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

5. 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

6. 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

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

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

9. 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

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

11. Protein
g/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

12. 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

13. 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

14. 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

15. 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

16. 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

17. c

18. 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

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

20. PES Statement
Protein deficiency (NI-5.7.1) related to poor nutrition of g 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

21. Source
American lung association . (n.d.). Retrieved from 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