Pulmonary

Question 1

t/f: mild COPD has a favorable prognosis

Answer 1

true!

Question 2

what makes the prognosis for COPD worse and mortality high?

Answer 2

severe airflow restriction–> 95% of patients will die within 10 years :(

Question 3

what are the 4 most common complications of COPD that are what actually lead to death/

Answer 3

1. infections
2. lung collapse(pneumothorax)
3. arrhythmia
4. cor pulmonale

Question 4

what is cor pulmonale

Answer 4

enlargement and failure of the R heart due to pulmonary hypertension

Question 5

what are the two “stereotypes” of emphysema patients?

Answer 5

pink puffers and blue bloaters

Question 6

what is the main difference between blue bloaters and pink puffers? how does this manifest in the blood?

Answer 6

pink puffers compensate for decreased alveolar gas exchange by hyperventilating–> Hgb oxygenation remains ok(getting enough O2)
blue bloaters do not compensate for decreased gas exchange and therefore are hypoxic/cyanotic

Question 7

typically pink puffers are (thin/obese) while blue bloaters are (thin/obese). Which tends to have a barrel chest?

Answer 7

pink puffers=barrel chested and thin

blue bloaters=obese

Question 8

t/f: both blue bloaters and pink puffers experience chronic bronchitis

Answer 8

true!

Question 9

who retains more CO2? blue bloaters or pink puffers?

Answer 9

blue bloaters

Question 10

what are 3 food-focused interventions for COPD patients that have difficulty eating due to SOB? what are 3 lifestyle interventions focused on meals?

Answer 10

food: nutrient-dense, softer, limit gas-forming veg
meals: rest before, have someone else help with prep, make them small and more frequent

Question 11

t/f: COPD patients have increased energy needs

Answer 11

true! due to increased work of breathing

Question 12

what is the protein req for COPD patients?

Answer 12

1.2-1.7 g protein

Question 13

t/f: the % of total calories from fat should be higher for COPD patients

Answer 13

true… need more dense foods b/c difficult to eat a large volume

Question 14

t/f: pink puffer COPD patients should be given enough calories to gain weight and create a weight “cushion” to prevent the inevitable weight loss

Answer 14

false. patients should be repleted, but not overfed

Question 15

typically, COPD patients experience what symptom in the mornings? why?

Answer 15

headaches/confusion b/c retention of CO2

Question 16

what are the typical gas-producing foods? (4)

Answer 16

cruciferous veg, legumes, alliums, carbonated bevs

Question 17

how should TF be modified for COPD patients?

Answer 17

should be lower CHO

Question 18

in addition to increased labor of breathing, why else might a COPD patient have increased energy needs?

Answer 18

metabolic effect of corticosteriods

Question 19

cystic fibrosis is caused by what? what does it cause?(2 things)

Answer 19

genetics–> pancreatic insufficiency and lung infection

Question 20

a characteristic symptom of cystic fibrosis that used to be used for “diagnosis” was what?

Answer 20

increased NaCl in sweat(docs used to “lick babies”)

Question 21

what demographic is CF more common in?

Answer 21

Caucasians

Question 22

t/f: CF is eventually lethal

Answer 22

true

Question 23

Due to abnormal Cl channels in mucus glands, mucus in CF lungs is __________

Answer 23

dehydrated

Question 24

besides nutrition, what are the 3 treatments for the lung complications in CF? what is the 1 for pancreatic complications?

Answer 24

lungs: antibiotics, chest PT, “clean outs”
pancreas: enzyme replacement therapy (PERT)

Question 25

what are the 3 components of PERT?

Answer 25

amylase, lipase, protease

Question 26

why must PERT tablets be packaged in an acidic medium?

Answer 26

do not want to activate until it hits the basic duodenum

Question 27

how fast do PERT enzymes start working

Answer 27

within 1 hr

Question 28

unlike many other conditions, why should CF patients NOT consume small frequent meals?

Answer 28

because grazing all day makes dosing of PERT difficult

Question 29

if a CF patient eats a high fat meal, what should be done?

Answer 29

increase dose of PERT to accomodate

Question 30

when is PERT NOT needed for CF patients?

Answer 30

if they only consume a simple CHO meal (candy, tea, popsicles, fruit juice, etc.)

Question 31

besides a MVM, what other supplement might CF patients need?

Answer 31

Na tabs... losing more in sweat

Question 32

what are the calorie guidelines for adult and child CF patients? why?

Answer 32

adults: multiply REE by 1.4-1.5 children: multiply by 1.1.-2 **coughing is exhausting and sometimes experience vomiting(need to replete)

Question 33

if CF patients cannot meet increased calorie needs, how can we help?

Answer 33

might provide nocturnal TF

Question 34

t/f: calories from fat in CF patients should be greater than a normal population

Answer 34

true! need 35-40% cal from fat

Question 35

_______________ is a restrictive lung condition caused by a variety of factors but is always characterized by widespread inflammation in the lungs

Answer 35

Acute Respiratory distress syndrome(ARDS)

Question 36

complete the ARDS pathway: inflammatory response--> ____________---> ________________--> _________ and ____________

Answer 36

inflammation--> damaged alveoli--> lung cell necrosis and edema--> decreased gas exchange AND decreased oxygenation of blood

Question 37

what are the hallmark symptoms of ARDS?

Answer 37

acute-onset dyspnea and fluid seen in lungs on an x-ray

Question 38

where will you always find an ARDS patient?

Answer 38

in the ICU