Pulmonary Disease Flashcards
Small air sacs at the terminal end of the
bronchioles
alveoli
alveoli are surrounded by a network of _________ and are responsible for _______
capillaries
exchange of gases from air to blood
respiratory muscles
diaphragm
intercostal
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
strength
capacity
ventilatory
surfactant
Hypoalbuminemia
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
immune
capacity
muscle
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 ______
exocrine
chloride & Na
thick secretions
glands & ducts
~_______ children & adults in the U.S. have CF
About _____ new cases of CF are diagnosed each year
More common in ______
Survival rates are improving
40,000
1,000
Caucasians
Pulmonary Manifestations of CF
- Mucous is thick and accumulates in the _____
- Chronic ____ and ____
- Frequent respiratory infections: _________
- Permanent lung damage
lungs
cough and dyspnea
pneumonia, bronchitis
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
90%
bicarbonate
Excessive fat content in stool causes diarrhea is called ?
Signs & symptoms:
________ stools, oily film in toilet water, foul odor
Weight loss despite adequate intake
Steatorrhea
Pale, greasy
Diagnosis of Steatorrhea
Fecal Fat Test
____ hr stool collection
Consume a ____ g fat diet
Normally ____ g fat in stool per day
>____ g/day=> malabsorption
72
100 g
2-6 g
7 g
Clinical Manifestations of CF
______ stasis & obstruction
__________ obstruction
Sweat glands=>Lose excessive amounts of _______ in sweat
Biliary
Intestinal
Na & Cl
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
<100
fecal elastase-1 is one sample and tests for enzyme
Medical Treatment
- Chest physiotherapy
- Mucolytics, bronchodilators
- Antibiotics
- Corticosteroids
- Pancreatic insufficiency=> __________
- Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies (e.g., ivacaftor)
- Lung transplant
pancreatic enzyme replacement therapy (PERT)
Nutritional Concerns for CF
- High risk for _________
- Inadequate growth is common
Decreased _____ intake
- Dyspnea, coughing
- GI distress
- Anorexia
- Impaired taste
- Emotional burden
___________
Increased _________ needs
malnutrition
oral
Malabsorption
nutritional
for CF patients, perform nutritional assessment including diet history, nutrition focused physical exam, anthropometrics, meds, and biochemical tests, such as _______________
fecal fat, fat soluble vitamin levels, and electrolytes
weight goals
newborn to 24 months old ___________
2-20 year old ______________
adult females ________
adult males _________
≥50th percentile weight for length
50 - 85 percentile for BMI
BMI 22-27
BMI 23-27
CF energy needs vary widely from ______ to _____ % of estimated energy needs for the healthy population of similar age, sex, and size
must individualize
120-150%
protein requirements for CF
increased needs of 1.5 g/kg
- due to inflammation, infections, corticosteroids, and malabsorption
CF patients should consume _____ of total kcal from fat.
fat has _________,
provides _____,
increases _______,
and lowers ____ production
also need __________
35-40%
high caloric density
EFA
palatability
CO2
treat fat malabsorption with pancreatic enzyme replacements (NOT NOT NOT 40 g low fat diet)
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
water-soluble form
addition to the MVIM
Na
infants
zinc
MNT for CF
___________________ diet
Pancreatic insufficiency=> treat with
_______________
High kcal, high protein, moderate fat
pancreatic enzymes
Infants:
Breastfed
- ____________
Formula-fed
- Standard formula
- ______________ if needed
Human milk fortifier added to expressed milk
Higher kcal formulas
Pancreatic Enzyme Replacement Therapy (PERT)
Contain __________________
Examples:_______________
lipase
protease
amylase
Creon
Pancreaze
Viocase
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=> _______
orally with all meals & snacks
fat intake or weight
acidic
applesauce
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 ___________
night
percutaneous endoscopic gastrostomy (PEG) tube
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
Hydrolyzed, semi-elemental
PERT
orally at the beginning
halfway
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 ___________
obstruction of the airways
expiration
force
slowed
chronic bronchitis & emphysema
dyspnea
cigarette smoking
~_____ million Americans have COPD
More common in ______ than other racial and ethnic groups
_____ leading cause of death among adults in the U.S.
12.5
Whites
6th
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
hypersecretion of mucus
productive cough
3
2
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
Inflammation of bronchial walls
thicker mucus
in chronic bronchitis there is increased PaCO2 (________) due to shallow slow breathing called __________
__________ (low levels of O2 in blood)
hypercapnia
Hypoventilation
Hypoxemia
Clinical Manifestations of Chronic Bronchitis
- Shortness of breath (SOB)
- Wheezing
- Chronic, productive cough
- Prolonged _________
- Decreased ________ tolerance
- ________ (discoloring of skin due to low oxygen)
expiration
exercise
Cyanosis
Emphysema is Abnormal, permanent _________ &
__________ of _______
Caused by=> _________
- smoking
- air pollution
- _______________ (rare)
enlargement
destruction
alveoli
inhaled toxins
alpha 1-antitrypsin deficiency
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
Increases volume of air in
Expiration
elastic recoil
Narrowed
Clinical Manifestations of Emphysema
- SOB ____________ progressing over time to at rest
- Wheezing
- Prolonged expiration
- Underweight and often _______
Dyspnea on exertion (DOE)
cachectic
Complications of COPD
- Pulmonary infections
- Hypoxemia
- Disability
- Osteoporosis
- Respiratory failure
- Pulmonary hypertension
- ____________ (right-sided heart failure)
- Death
Cor pulmonale
Management of COPD
- Best treatment is prevention
- Stop _______ will stop disease progression
- Pharmacotherapy
- Respiratory therapy
- Prescribed _________
- Lung Transplant
smoking
exercise
Pharmacological Management of COPD
Bronchodilators such as _________
albuterol
theophylline
Food-drug interactions:
Albuterol ?
Theophylline ?
Limit caffeine intake
increases serum glucose
decreases serum K +
anorexia, nausea
Limit caffeine intake
Low CHO, high protein diets increase metabolism of
drug
COPD
Antibiotics for _______
Diuretics are used to treat ______ and ________
examples of some diuretics ?
Increase urinary ________ excretion
Can increase _____________
Rx _______ diet
infections
edema and right-sided ♡ failure
Thiazide & Loop Diuretics
glucose & serum lipids
K + & Mg
glucose and serum lipids
2 g Na
Pharmacological Treatment fro COPD
Corticosteroids for __________
Examples include ?
Can cause=>
Anti-inflammatory
Solu-Medrol
hyperglycemia
hyperlipidemia
increased appetite
protein wasting
decreased absorption of Ca
edema
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
Malnutrition
Aerophagia
Nutritional Concerns in COPD
- Chronic _______ resulting in ________
Hyperinflation of lungs=> abdominal discomfort
Depression or anxiety
Food-drug interactions
sputum production
Altered taste
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
fat-free body mass
advanced COPD
_______ is important to asses in pulmonary cachexia
hydration status
skin fold measurements
mid arm muscle circumference
Biochemical Data for pulmonary cachexia
Serum ______ such as _________
Serum _______
May be increased due to corticosteroids or infection
electrolytes
Phos, K+, Ca, Mg, Na
glucose
Arterial Blood Gases (ABGs)
PaO 2 - Partial Pressure of Oxygen
O2 saturation
pH
PaCO
PaO 2 - Partial Pressure of Oxygen
Normal: _______ mmHg
O2 saturation
Normal ______%
pH
Normal serum range: _______
80-100
95-100%
7.35-7.45
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 _______
35-45
ventilation
hypercapnia
retained
hypoventilation
acidosis
CO hyperventilation
alkalosis
COPD
______ kcal/kg of estimated _______
Considerations:
- Activity level
- Complications: infections, respiratory failure
- Undernourished vs. adequate nourishment vs. overweight or obese
30
dry wt (EDW)
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
1.2-1.5
EDW
20%
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
40-55%
CO2
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
volume of CO2 produced
volume of O2 consumed
VCO2/VO2
0.82
0.7
0.85
1
overfed
0.7
Fat for COPD
______% of total kcal
High fat diets may:
- contribute to ________ (______ fa)
- delay __________
- cause hyperlipidemia
___________ fatty acids=> anti-inflammatory
30-45%
inflammation
omega-6
gastric emptying
Omega-3
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
vitamin C
16-32
10
furosemide (Lasix)
thiamin
Minerals for COPD
Ensure intake of at least the DRI
Phosphorus
____________ can lead to respiratory muscle weakness
Magnesium
Deficiency affects _____________
Hypophosphatemia
respiratory muscle strength
Minerals for COPD
Calcium
- Important role in ____________
- ____________=>___________ mg Ca supplement
Sodium
- <2 gm Na diet if _____________
Potassium
- Supplementation may be needed if on ___________
muscle contraction
corticosteroids
1200-1500 mg
edema or cor pulmonale
loop or thiazide diuretics
Fluid for COPD
- Assess current fluid status
- _____________ Requires fluid restriction
Cor pulmonale
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
Small frequent meals
main meal
MNT for COPD
Overfeeding should be avoided (especially with _________)
Bloating=> provide education on reducing ____________
Early satiety=> small frequent meals, limit ______ foods
Mechanical ventilation=> _________
hypercapnia
aerophagia
high fat
enteral nutrition
_________ is Movement of food or fluid into the lungs
Foods that are most easily aspirated=>_____________
Can result in aspiration pneumonia, respiratory failure, & death
Pulmonary Aspiration
thin liquids
nuts
popcorn
hard candy
hot dog pieces
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
Dysphagia
glottis closure
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
30-45
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
NPO
Swallowing
NPO with tube feeding
_______________ 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 ______
Bronchopulmonary Dysplasia (BPD)
alveoli
very preterm is ______ and preterm is ____
<36
<37
Bronchopulmonary Dysplasia (BPD)
Complex & multifactorial etiology
- Large _______ component
- _________ trauma
- Vitamin ____ deficiency
genetic
Ventilator
vit A
vitamin A is needed for normal alveolar development, _________ production, & regeneration of respiratory epithelial cell
surfactant
Possible Long-term Complications
- __________lung function
- Increase susceptibility to__________
- Decreased growth rate and ______ development
- Developmental delays
Decreased
infections
muscle
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
oxygen
bronchodilators, diuretics, corticosteroids, antibiotics
prenatal
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
energy
Fatigue
swallowing
Fluid restrictions
Nutrition Concerns in BPD
_______ (low bone density)
Food-medication interactions
Normal progression of _________ is interrupted
Osteopenia
feeding skills
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
15-20%
140-150
3.5-4.0
restricted
concentrated/high calorie
Vitamins & Minerals for BPD
- _________ supplementation
- ______ associated with increased loss of electrolytes=> Na, chloride, K +, Ca
- Optimal ___________ intake due to increased risk for osteopenia
Vitamin A
Diuretics
calcium & phosphorous
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
tube feeding
24
parenteral nutrition (PN)
small frequent
