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Medical Nutrition Therapy > Pulmonary Disease > Flashcards

Pulmonary Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

Small air sacs at the terminal end of the
bronchioles

A

alveoli

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2
Q

alveoli are surrounded by a network of _________ and are responsible for _______

A

capillaries
exchange of gases from air to blood

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3
Q

respiratory muscles

A

diaphragm
intercostal

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4
Q

Impact of Malnutrition on Respiratory Function

  • Decreased respiratory muscle mass, _____, & endurance
  • Reductions in vital ______
  • Decreased ________ drive
  • Decreased ______ leading to decreased lung compliance
  • ______________ leading to pulmonary edema
A

strength
capacity
ventilatory
surfactant
Hypoalbuminemia

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5
Q

Decreased_____ function and ability to fight infection

Diminished oxygen carrying _____ of blood

Low levels of Phos, Ca, Mg, & K+ compromise respiratory ______ function at the cellular level

Prolonged intubation

A

immune
capacity
muscle

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6
Q

Cystic Fibrosis (CF) is an Autosomal-recessive inherited disorder

Dysfunction of the _______ glands=> impaired transport of ______ across cell membranes

Multisystem disorder

Results in=>production of abnormally ________ that obstruct ______

A

exocrine
chloride & Na

thick secretions
glands & ducts

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7
Q

~_______ children & adults in the U.S. have CF

About _____ new cases of CF are diagnosed each year

More common in ______

Survival rates are improving

A

40,000
1,000
Caucasians

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8
Q

Pulmonary Manifestations of CF

  • Mucous is thick and accumulates in the _____
  • Chronic ____ and ____
  • Frequent respiratory infections: _________
  • Permanent lung damage
A

lungs
cough and dyspnea
pneumonia, bronchitis

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9
Q

Pancreatic Manifestations of CF

  • ____% of CF patients have pancreatic insufficiency
  • Plugs of thick mucous reduce the quantity of digestive enzymes & _______ released from the pancreas

resulting in maldigestion & malabsorption of nutrients
(especially fat)

CF-related diabetes mellitus

A

90%
bicarbonate

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10
Q

Excessive fat content in stool causes diarrhea is called ?

Signs & symptoms:
________ stools, oily film in toilet water, foul odor
Weight loss despite adequate intake

A

Steatorrhea

Pale, greasy

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11
Q

Diagnosis of Steatorrhea

Fecal Fat Test
____ hr stool collection
Consume a ____ g fat diet

Normally ____ g fat in stool per day
>____ g/day=> malabsorption

A

72
100 g

2-6 g
7 g

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12
Q

Clinical Manifestations of CF

______ stasis & obstruction
__________ obstruction
Sweat glands=>Lose excessive amounts of _______ in sweat

A

Biliary
Intestinal
Na & Cl

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13
Q

Diagnosis of CF

Prenatal screening for those with a family history
Neonatal screening
Definitive diagnosis=>Genetic analysis and a positive chloride sweat test

Pancreatic insufficiency:
Fecal fat test: >7 g/day
Fecal elastase-1 test: _____ mcg/g of stool

A

<100

fecal elastase-1 is one sample and tests for enzyme

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14
Q

Medical Treatment

  • Chest physiotherapy
  • Mucolytics, bronchodilators
  • Antibiotics
  • Corticosteroids
  • Pancreatic insufficiency=> __________
  • Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies (e.g., ivacaftor)
  • Lung transplant
A

pancreatic enzyme replacement therapy (PERT)

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15
Q

Nutritional Concerns for CF

  1. High risk for _________
  2. Inadequate growth is common

Decreased _____ intake
- Dyspnea, coughing
- GI distress
- Anorexia
- Impaired taste
- Emotional burden
___________
Increased _________ needs

A

malnutrition
oral
Malabsorption
nutritional

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16
Q

for CF patients, perform nutritional assessment including diet history, nutrition focused physical exam, anthropometrics, meds, and biochemical tests, such as _______________

A

fecal fat, fat soluble vitamin levels, and electrolytes

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17
Q

weight goals

newborn to 24 months old ___________
2-20 year old ______________
adult females ________
adult males _________

A

≥50th percentile weight for length

50 - 85 percentile for BMI

BMI 22-27
BMI 23-27

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18
Q

CF energy needs vary widely from ______ to _____ % of estimated energy needs for the healthy population of similar age, sex, and size

must individualize

A

120-150%

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19
Q

protein requirements for CF

A

increased needs of 1.5 g/kg

  • due to inflammation, infections, corticosteroids, and malabsorption
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20
Q

CF patients should consume _____ of total kcal from fat.

fat has _________,
provides _____,
increases _______,
and lowers ____ production

also need __________

A

35-40%

high caloric density
EFA
palatability
CO2

treat fat malabsorption with pancreatic enzyme replacements (NOT NOT NOT 40 g low fat diet)

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21
Q

CF patients should take a MVI with minerals

If pancreatic insufficiency=> high risk for fat-soluble vitamin deficiencies=> supplementation of fat-soluble vitamins required in a __________ (this is in ___________)

Increased ____ requirements=> typical diet should provide adequate amount but ______ may need supplementation

Increased risk for ____ deficiency

A

water-soluble form
addition to the MVIM

Na
infants

zinc

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22
Q

MNT for CF

___________________ diet

Pancreatic insufficiency=> treat with
_______________

A

High kcal, high protein, moderate fat
pancreatic enzymes

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23
Q

Infants:

Breastfed
- ____________

Formula-fed
- Standard formula
- ______________ if needed

A

Human milk fortifier added to expressed milk

Higher kcal formulas

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24
Q

Pancreatic Enzyme Replacement Therapy (PERT)

Contain __________________

Examples:_______________

A

lipase
protease
amylase

Creon
Pancreaze
Viocase

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25
Q

Pancreatic Enzyme Replacement Therapy (PERT) Given _____ with __________

Individually dosed based on individual’s ___________

Infants/small children=> open capsule and mix the microspheres with an ________, easy to swallow food=> _______

A

orally with all meals & snacks

fat intake or weight

acidic
applesauce

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26
Q

Enteral Nutrition Support for CF

  • Supplemental tube feeding may be required to meet nutritional needs
  • Cyclic feeding given at ______
  • Use a calorically dense, high protein formula
  • Most common enteral access route is a ___________
A

night

percutaneous endoscopic gastrostomy (PEG) tube

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27
Q

Enteral Nutrition Support for Pancreatic insufficiency:

______________ formula

No evidence-based guidelines for ______ administration with enteral feeding tubes

Option: Provide pancreatic enzymes _________ of the feeding and then ______ through the feeding

A

Hydrolyzed, semi-elemental

PERT

orally at the beginning
halfway

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28
Q

Chronic Obstructive Pulmonary Disease (COPD) is characterized by slow, progressive __________ that is worse with ________

More ____ is required to expire air and emptying of the lungs is _____

Diseases: ________________
Primary symptom=> _____
Primary cause is ___________

A

obstruction of the airways
expiration

force
slowed

chronic bronchitis & emphysema
dyspnea
cigarette smoking

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29
Q

~_____ million Americans have COPD
More common in ______ than other racial and ethnic groups
_____ leading cause of death among adults in the U.S.

A

12.5
Whites
6th

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30
Q

Chronic Bronchitis is the Inflammation of the bronchi caused by inspired irritants

Characterized by ____________ and chronic ____________that continues for at least _____ months of the
year for at least____ consecutive years

A

hypersecretion of mucus
productive cough
3
2

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31
Q

Chronic Bronchitis

Inspired irritants cause:
1. _______________ which leads to narrowing from edema
2. Increase production of_________
- Bacteria stick in airway secretions and rapidly reproduce
- Increased susceptibility to pulmonary infection

A

Inflammation of bronchial walls
thicker mucus

32
Q

in chronic bronchitis there is increased PaCO2 (________) due to shallow slow breathing called __________

__________ (low levels of O2 in blood)

A

hypercapnia
Hypoventilation

Hypoxemia

33
Q

Clinical Manifestations of Chronic Bronchitis

  • Shortness of breath (SOB)
  • Wheezing
  • Chronic, productive cough
  • Prolonged _________
  • Decreased ________ tolerance
  • ________ (discoloring of skin due to low oxygen)
A

expiration
exercise
Cyanosis

34
Q

Emphysema is Abnormal, permanent _________ &
__________ of _______

Caused by=> _________
- smoking
- air pollution
- _______________ (rare)

A

enlargement
destruction
alveoli

inhaled toxins

alpha 1-antitrypsin deficiency

35
Q

Pathophysiology of emphysema

Destruction of alveolar walls=>
_______________ the alveoli, alveolar ducts, & bronchioles

________ is difficult secondary to loss of _______ which reduces volume of air expired passively

__________ bronchioles

A

Increases volume of air in

Expiration
elastic recoil

Narrowed

36
Q

Clinical Manifestations of Emphysema

  • SOB ____________ progressing over time to at rest
  • Wheezing
  • Prolonged expiration
  • Underweight and often _______
A

Dyspnea on exertion (DOE)
cachectic

37
Q

Complications of COPD

  • Pulmonary infections
  • Hypoxemia
  • Disability
  • Osteoporosis
  • Respiratory failure
  • Pulmonary hypertension
  • ____________ (right-sided heart failure)
  • Death
A

Cor pulmonale

38
Q

Management of COPD

  • Best treatment is prevention
  • Stop _______ will stop disease progression
  • Pharmacotherapy
  • Respiratory therapy
  • Prescribed _________
  • Lung Transplant
A

smoking
exercise

39
Q

Pharmacological Management of COPD

Bronchodilators such as _________

A

albuterol
theophylline

40
Q

Food-drug interactions:

Albuterol ?

Theophylline ?

A

Limit caffeine intake
increases serum glucose
decreases serum K +

anorexia, nausea
Limit caffeine intake
Low CHO, high protein diets increase metabolism of
drug

41
Q

COPD

Antibiotics for _______
Diuretics are used to treat ______ and ________

examples of some diuretics ?

Increase urinary ________ excretion
Can increase _____________
Rx _______ diet

A

infections
edema and right-sided ♡ failure

Thiazide & Loop Diuretics
glucose & serum lipids

K + & Mg
glucose and serum lipids
2 g Na

42
Q

Pharmacological Treatment fro COPD

Corticosteroids for __________
Examples include ?

Can cause=>

A

Anti-inflammatory
Solu-Medrol

hyperglycemia
hyperlipidemia
increased appetite
protein wasting
decreased absorption of Ca
edema

43
Q

Nutritional Concerns in COPD

_________ is common in COPD
Dyspnea
- Increased fatigue during meals
- Hamper ability to shop & prepare meals
- __________=> gastric distention, early satiety
Anorexia
Alterations in energy expenditure
Increased work of breathing; frequent infections

A

Malnutrition
Aerophagia

44
Q

Nutritional Concerns in COPD

  • Chronic _______ resulting in ________

Hyperinflation of lungs=> abdominal discomfort
Depression or anxiety
Food-drug interactions

A

sputum production
Altered taste

45
Q

Pulmonary Cachexia is the Loss of ____________(sarcopenia) in patients with advanced lung disease

The cause of cachexia in ___________
is poorly understood
Anorexia is common
Muscle wasting worsens respiratory function

A

fat-free body mass
advanced COPD

46
Q

_______ is important to asses in pulmonary cachexia

A

hydration status
skin fold measurements
mid arm muscle circumference

47
Q

Biochemical Data for pulmonary cachexia

Serum ______ such as _________

Serum _______
May be increased due to corticosteroids or infection

A

electrolytes
Phos, K+, Ca, Mg, Na

glucose

48
Q

Arterial Blood Gases (ABGs)

A

PaO 2 - Partial Pressure of Oxygen
O2 saturation
pH
PaCO

49
Q

PaO 2 - Partial Pressure of Oxygen
Normal: _______ mmHg

O2 saturation
Normal ______%

pH
Normal serum range: _______

A

80-100
95-100%
7.35-7.45

50
Q

Partial Pressure of Carbon Dioxide (PaCO2)

Normal Range: _______ mm Hg
Measures adequacy of ________

High level => ________=> CO2 is being _______ by the lungs via _______ which results in respiratory _______

Low level => excess _____________ results in respiratory _______

A

35-45
ventilation

hypercapnia
retained
hypoventilation
acidosis

CO hyperventilation
alkalosis

51
Q

COPD

______ kcal/kg of estimated _______

Considerations:
- Activity level
- Complications: infections, respiratory failure
- Undernourished vs. adequate nourishment vs. overweight or obese

A

30
dry wt (EDW)

52
Q

Protein for COPD

Needed to maintain or restore lung muscle strength and promote immune function

Individualize: _______ g/kg ______
~____% of total kcal

Considerations: malnutrition, infections, surgery, corticosteroids

A

1.2-1.5
EDW
20%

53
Q

CHO for COPD

_________% of total kcal
CHO metabolism produces more ______ than fat or protein

COPD patients often retain CO2, so increases ventilatory demand

CHO vs. Fat
- Previous recommendations: low CHO, high fat diet to
decrease PaCO2

***Current recommendations=> DO NOT
OVERFEED TOTAL CALORIES

A

40-55%
CO2

54
Q

Respiratory Quotient (RQ)

RQ = Ratio of ___________ to ___________(________)

Indicates the fuel mixture being metabolized

RQ values:
- Protein: ______
- Fat: _____
- Mixed fuels: ______

mainly eating cars RQ = ____
RQ >1 = _______
RQ<____ = underfed

A

volume of CO2 produced
volume of O2 consumed
VCO2/VO2

0.82
0.7
0.85

1
overfed
0.7

55
Q

Fat for COPD

______% of total kcal

High fat diets may:
- contribute to ________ (______ fa)
- delay __________
- cause hyperlipidemia

___________ fatty acids=> anti-inflammatory

A

30-45%

inflammation
omega-6
gastric emptying

Omega-3

56
Q

Vitamins for COPD

Provide the DRI’s

Smokers have increased needs for _______
______ mg/d greater than the DRI
Monitor serum levels
If ≤____ ng/mL, recommend supplementation

Long-term use of ___________ can cause ________ deficiency

A

vitamin C
16-32
10

furosemide (Lasix)
thiamin

57
Q

Minerals for COPD

Ensure intake of at least the DRI

Phosphorus
____________ can lead to respiratory muscle weakness

Magnesium
Deficiency affects _____________

A

Hypophosphatemia
respiratory muscle strength

58
Q

Minerals for COPD

Calcium
- Important role in ____________
- ____________=>___________ mg Ca supplement

Sodium
- <2 gm Na diet if _____________

Potassium
- Supplementation may be needed if on ___________

A

muscle contraction
corticosteroids
1200-1500 mg

edema or cor pulmonale

loop or thiazide diuretics

59
Q

Fluid for COPD

  • Assess current fluid status
  • _____________ Requires fluid restriction
A

Cor pulmonale

60
Q

MNT for COPD
No specific diet order=> individualize

____________ that are nutritionally dense

If fatigue is a problem:
Rest before meals
Eat ________ when energy level is highest
Home-delivered meals

If underweight=> nutrient dense foods, oral nutritional supplements

A

Small frequent meals
main meal

61
Q

MNT for COPD

Overfeeding should be avoided (especially with _________)

Bloating=> provide education on reducing ____________

Early satiety=> small frequent meals, limit ______ foods

Mechanical ventilation=> _________

A

hypercapnia
aerophagia
high fat
enteral nutrition

62
Q

_________ is Movement of food or fluid into the lungs

Foods that are most easily aspirated=>_____________

Can result in aspiration pneumonia, respiratory failure, & death

A

Pulmonary Aspiration

thin liquids
nuts
popcorn
hard candy
hot dog pieces

63
Q

Risk Factors for Aspiration Pneumonia

  • Impaired level of consciousness
  • ________ from neurologic conditions like stroke or multiple sclerosis
  • GERD
  • Mechanical disruption of _________ because of endotracheal tube
  • Severe vomiting
  • Persistent recumbent position
A

Dysphagia
glottis closure

64
Q

Prevention of Aspiration Pneumonia

Proper body positioning when eating or on tube feeding: Elevate HOB (head of bed) to ______ degrees

Good oral hygiene
Eat slowly and chew thoroughly
Prevent/treat GERD

A

30-45

65
Q

MNT for Aspiration Pneumonia

______ initially

__________ assessment by a speech language pathologist (SLP) to r/o chronic aspiration or dysphagia

Modified diet textures and thickened liquids may be needed to prevent further aspiration

If severe aspiration risk, SLP may recommend _________ to meet nutritional needs

A

NPO
Swallowing
NPO with tube feeding

66
Q

_______________ is chronic lung disease that occurs in premature infants who received supplemental oxygen or mechanical ventilation for acute respiratory distress

Characterized by:
Pulmonary inflammation
Impaired growth and development of the ______

A

Bronchopulmonary Dysplasia (BPD)

alveoli

67
Q

very preterm is ______ and preterm is ____

A

<36
<37

68
Q

Bronchopulmonary Dysplasia (BPD)

Complex & multifactorial etiology
- Large _______ component
- _________ trauma
- Vitamin ____ deficiency

A

genetic
Ventilator
vit A

69
Q

vitamin A is needed for normal alveolar development, _________ production, & regeneration of respiratory epithelial cell

A

surfactant

70
Q

Possible Long-term Complications

  • __________lung function
  • Increase susceptibility to__________
  • Decreased growth rate and ______ development
  • Developmental delays
A

Decreased
infections
muscle

71
Q

Management of BPD

Supplemental ______

Medications: _______________________

Prevention=> Good ________ care and optimal nutrition status of the pregnant mother so the infant will be born full-
term and well-nourished

A

oxygen

bronchodilators, diuretics, corticosteroids, antibiotics

prenatal

72
Q

Nutrition Concerns in BPD

  • Growth Failure
  • Increased ________ needs due to increased work of breathing & infections
  • Inadequate intake
  • ___________=>Infants tire before required breast milk or formula volume is consumed
  • Immature __________ function
  • _____________ limit formula intake
  • Oral aversion
A

energy
Fatigue
swallowing
Fluid restrictions

73
Q

Nutrition Concerns in BPD

_______ (low bone density)

Food-medication interactions

Normal progression of _________ is interrupted

A

Osteopenia
feeding skills

74
Q

Nutritional Requirements for BPD

Increased energy needs
* ______% higher than healthy infants
* _______ kcal/kg during active stages of the disease

Protein: _______ g/kg
Fluid=> may need to be _______ due to pulmonary edema

Use of ______________ formulas

A

15-20%
140-150

3.5-4.0
restricted
concentrated/high calorie

75
Q

Vitamins & Minerals for BPD

  • _________ supplementation
  • ______ associated with increased loss of electrolytes=> Na, chloride, K +, Ca
  • Optimal ___________ intake due to increased risk for osteopenia
A

Vitamin A
Diuretics
calcium & phosphorous

76
Q

Feeding Strategies for BPD

May require ___________ due to mechanical ventilation or poor oral feeding

Calorically dense formulas (>_____ kcal/oz) if needed

Initially may require ____________ if also have necrotizing enterocolitis

For oral feeding, provide ____________ feedings

A

tube feeding
24
parenteral nutrition (PN)
small frequent

Medical Nutrition Therapy (12 decks)

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