Respiratory Diseases Flashcards
Dyspnea =
SOB
DOE =
Exacerbation of dyspnea
Hypercapnia =
Excessive accumulation of Co2 in blood
Breathe in, diaphragm ___
Moves down and expands
Breath out, diaphragm ___
Move up and contact
Muscles of inspiration? (SSED)
Sternocleidomastoids
Scalenes
External intercostals
Diaphragm
Muscles of expiration? (AI)
- Abdominal muscles
- Internal intercostals
Function of lungs besides breathing?
Protect against infections, toxins by trapping them in mucus, and cilia expels
Which cells engulf and destroy bacteria?
Alveoli cells
2 types of COPD?
Chronic bronchitis
Emphysema
CB?
Chronic productive cough, excess mucus
Emphysema?
Permanent enlargement of alveoli, collapsed bronchiole
Cachexia is the loss of skeletal muscle, fat and LBM which is linked to an underlying illness. Which COPD is it associated with?
Emphysema
Obesity increased fat and CVD risk. What kind of emphysema is it associated with?
Chronic bronchitis
What is sarcopenic obesity?
Loss of muscle mass despite more abdominal or visceral tissues –> Increased CVD risk
Blue bloater =
CB
Why blue bloater?
CB patients sometimes have RHF, where edema makes patient bloated, neck veins distended and cyanosis of lips and skin, frequent cough, clubbed fingers
What causes clubbing of fingernails?
-Thickening of flesh which is caused by vasodilation in circulation and leading to hypertrophy of nail bed tissue
What is the predominant emphysema type?
Pink puffer
What causes the pink skin tone?
Exacerbation and work of breathing = pink tone in face and constant puffing
Which type of COPD causes increase coughing and expectoration?
Blue bloater
Which type of COPD may develop a barrel chest?
Pink puffer (emphysema)
What is a major issue with COPD?
Malnourishment and 1/3 may experience severe weight loss
___ of COPD patients are at risk of malnutrition
60%
What is involuntary weight loss associated with?
Increased morbidity and mortality
What is the issue with muscle mass loss and COPD?
Decrease respiratory muscles, harder to breathe, immune function may also cease
Besides decrease respiratory muscle mass and immune function, what are the other disadvantages of malnutrition in COPD?
- Low protein/iron and diminished O2 carrying capacity
- Hypoprotenemia
- Less surfactant
What does hypoproteinemia lead to?
Diminished colloid osmotic pressure and pulmonary edema (Flux of proteins to interstitial fluid instead of blood)
What does less surfactant lead to?
Collapsed alveoli and increased work of breathing
Examples of other factors leading to inadequate intake?
- Impairments in ADL
- Decreased appetite
- Chronic sputum production
- Taste and smell changes
Common co-morbidities with COOD?
- DM
- Cancer
- CVD
- Osteoporosis
- Depression/anxiety
Explain the link between the heat and the lungs
Heart will pump blood to lungs which will become oxygenated and then heart will redistribute to tissues. This means that if one organ is affected (i.e. lungs are affected in COPD .. and therefore will likely also impact the heart)
What happens when the lungs are not providing adequate gas exchange?
RAAS is activated, BP increased
How can we measure pulmonary function?
- Oxygen saturation (pulse oximetry)
- pH (blood test)
How can we measure lung function?
Spirometry
What is Forced Expiry Volume?
Volume of air that can forcibly be blown out in one second after the full inspiration, could serve to measure the severity of the disease
The less the FEV1 those more ____
severe COPD
Gold 1/Mild COPD?
FEV1 >80%
Gold 2/Moderate COPD?
FEV1 between 50-80%
Gold 3/Severe COPD?
FEV1 between 30-50%
Gold 4/Very Severe COPD?
FEV1 < 30%
Gases dissolved in liquids have partial pressures, which measures ____
the exertion of pressure against membrane an cells
How is diffusion across epithelial cells determined in part by?
The pressure on each side (recall high–>low pressure)
Normal pH?
7.35-7.45 (alkaline)
Normal O2 saturation?
> 95%
90% of the CO2 is found within the blood is in the form of ____
Bicarbonate ion (HCO3-)
Since CO2 is dissolved within the blood (H2O), this will produce carbonic acid. What does carbonic acid dissociate into?Does this increase or decrease ph?
Dissociates into H+ and into HCO3-. Increase in H+ alongside HCO3- means that pH will DECREASE = more acidic
Increase Co2 ___ pH
Decreases
When does respiratory acidosis occur?
In hypoventilation when we cannot expire the CO2, blood becomes more acidic as H+ accumulates
How does the body compensate in respiratory acidosis?
Kidney increases excretion of H+ and will retain HCO3- with either Na+ or K+
When does respiratory alkalosis occur?
Increase blood pH due to hyperventilation, where more CO2 expired and less H+ within the blood
How will the body compensate in respiratory alkalosis?
Kidney will conserve H+ and will excrete Na+ or K+
What does respiratory alkalosis and acidosis depend on?
The amount of CO2 in the blood (NOT the amount of O2)
What is metabolic acidosis?
All types of acidosis that are NOT causes by excessive CO2 (and therefore H+)
What is metabolic alkalosis?
All types of alkalosis NOT related by low levels of CO2 (and there fore H+)
Example of metabolic acidosis?
Extreme diarrhea and loss of base
Example of metabolic alkalosis?
Severe vomiting and loss of acid
What is a common medication prescribed to people with respiratory diseases?
Corticosteroids
What are the impacts of long term corticosteroid usage?
- Fluid/electrolyte imbalances
- Hypertension
- Mood swings
- Increased appetite
- Weight gain
- Osteoporosis
Why are corticosteroids prescribed?
To reduce the inflammation and suppress the immune system in the bronchial tubules
What is long-term corticosteroid use associated with?
- Muscle wasting and protein catabolism
- Decreased BMD, fractures and calcium wasting
What are the nutritional implication of corticosteroids?
-Low salt/sodium
-High calcium/vit D
-High protein
-Many need high K+, A, C
May need diabetic or heat healthy diet
(T/F) Overweight or obese individuals with SEVERE COPD are associated with better survival
True
(T/F) Normal or overweight individuals with mild and moderate COPD are associated with less survival
False, associated with a better prognosis
Acute Illness –> MPCM –> Energy intake =
<75% of EEE in >7 days
Acute Illness –> MPCM –> Weight loss 1 week =
1-2%
Acute Illness –> MPCM –> Weight loss 1 month =
5%
Acute Illness –> MPCM –> Weight loss 3 months =
7.5%
Acute Illness –> SCPM —> Energy intake =
<50% of EE in >5 days
Acute Illness –> SCPM —> Weight loss 1 week =
> 2%
Acute Illness –> SCPM —> Weight loss 1 month =
> 5%
Acute Illness –> SCPM —> Weight loss 3 months =
> 7.5%
Chronic illness –> MPCM –> Energy intake =
<75% EEE in >1 month
Chronic illness –> MPCM –> Weight loss 1 month =
5%
Chronic illness –> MPCM –> Weight loss 3 months =
7.5%
Chronic illness –> MPCM –> Weight loss 6 month =
10%
Chronic illness –> MPCM –> Weight loss 1 year =
> 20%
Chronic illness –> SPCM –> Energy intake =
<75% of EE > 1 month
Chronic illness –> SPCM –> Weight loss 1 month =
> 5%
Chronic illness –> SPCM –> Weight loss 3 month =
> 7.5%
Chronic illness –> SPCM –> Weight loss 6 month =
> 10%
Chronic illness –> SPCM –> Weight loss 1year =
> 20%
What is included when diagnosing malnutrition? (FEW-H-BM)
- Fluid
- Edema
- Weight loss
- Handgrip strength
- Body fat loss
- Muscle mass wasting
Define cachexia
A metabolic syndrome where inflammation and underlying illness is the key feature.
Cachexia can be an underlying condition of ___
sarcopenia
What is the prominent clinical feature of cachexia?
Weight loss
What happens when the GI tract does not receive enough oxygen, such as in COPD?
Reduced peristalsis, digestion of food
What is included in the Subjective Global Assessment Form? (SGA) - NSFW-M
- Nutrient intake
- Symptoms
- Functional capacity
- Weight
- Metabolic requirement
What does the SGA form help identify?
The contributing factors of muscle wasting, either cachexia or sarcopenia
What are the 3 SGA ratings?
- Well nourished
- Mild/Moderately malnourished
- Severely malnourished
COPD energy?
25-25 kcal/kg
What is energy intake dependent on?
- Weight
- Weight history
- Appetite
- Disease
- Nutritional deficits
Energy intake to promote possible weight gain?
30-35 kcal/kg
What is often the goal in COPD?
To improve the oral intake in patients with reduced E intake
Routine diet for COPD patients?
Soft, no added salt or sugar
Primary goals of nutrition care?
1) Maintain energy balance
2) Maintain LBM
2) Correct fluid imbalances
3) Prevent osteoporosis
4) Manage drug-nutrient interactions
What can we recommend as nutrition therapy to reduce malnutrition?
- Small, frequent meals high energy and protein
- Soft foods, easy to chew and swallow
- Add kcals with nutrient dense foods, beverages
In addition to increasing energy and protein, what may need to me limied?
Salt and fluid if fluid retention is a problem
Protein requirements COPD?
1.0-1.5g/kg/day
Protein requirements COPD during times of stress, infection or exacerbation?
1.2-1.7 g/kg/day
What is the consensus with Milk and Mucus?
Milk does NOT increase mucus, may be the feeling of saliva and milk that has sensation of mucus. Milk products should encourage as they are important source of protein, fat, energy and vit D/calcium (nutrients needed in COPD)
When does COPD become DNR?
- Severe, frequent admission and limited imporvement
- Maximum therapy
- Dependant on oxygen
- Severe SOB
RQ =
Co2 produced/O2 consumed
RQ CHO =
1
Lowest RQ?
Fat
What was the theory of high fat diets and tube fed patients?
If we feed high fat, there will be less CO2 produced per O2 consumed to oxidize the FA (i.e. less work for breathing)
Does the high fat/less breathing theory work?
No, and high fat meals may induce satiety and GI disturbances –> Lead to less eating
(T/F) COPD patients struggle with malabsorption
F, more issues with not receiving enough oxygen to GI tract, which means everything is slowed down and in distress
Why is overfeeding common?
When using the predictive energy equation with stress factors, we may over estimate EE requirement
What is the issue with overfeeding?
If we provide too many calories, and patient is not properly ventilated they may not consume enough O2 for the O2 produced in metabolism –> Metabolic acidosis (lots of H+ build-up)
When is underfeeding beneficial?
When we want to reduce stress on uings in a critical care situation
When is enteral feeding required?
In mechanical ventilation, as the trachea is opened
When may oral feeding be OK?
MAYBE for tracheostomy, some foods only. Usually need tube-feeding
