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Clinical Nutrition 1 > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

Dyspnea =

A

SOB

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2
Q

DOE =

A

Exacerbation of dyspnea

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3
Q

Hypercapnia =

A

Excessive accumulation of Co2 in blood

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4
Q

Breathe in, diaphragm ___

A

Moves down and expands

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5
Q

Breath out, diaphragm ___

A

Move up and contact

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6
Q

Muscles of inspiration? (SSED)

A

Sternocleidomastoids
Scalenes
External intercostals
Diaphragm

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7
Q

Muscles of expiration? (AI)

A
  • Abdominal muscles

- Internal intercostals

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8
Q

Function of lungs besides breathing?

A

Protect against infections, toxins by trapping them in mucus, and cilia expels

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9
Q

Which cells engulf and destroy bacteria?

A

Alveoli cells

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10
Q

2 types of COPD?

A

Chronic bronchitis

Emphysema

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11
Q

CB?

A

Chronic productive cough, excess mucus

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12
Q

Emphysema?

A

Permanent enlargement of alveoli, collapsed bronchiole

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13
Q

Cachexia is the loss of skeletal muscle, fat and LBM which is linked to an underlying illness. Which COPD is it associated with?

A

Emphysema

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14
Q

Obesity increased fat and CVD risk. What kind of emphysema is it associated with?

A

Chronic bronchitis

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15
Q

What is sarcopenic obesity?

A

Loss of muscle mass despite more abdominal or visceral tissues –> Increased CVD risk

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16
Q

Blue bloater =

A

CB

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17
Q

Why blue bloater?

A

CB patients sometimes have RHF, where edema makes patient bloated, neck veins distended and cyanosis of lips and skin, frequent cough, clubbed fingers

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18
Q

What causes clubbing of fingernails?

A

-Thickening of flesh which is caused by vasodilation in circulation and leading to hypertrophy of nail bed tissue

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19
Q

What is the predominant emphysema type?

A

Pink puffer

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20
Q

What causes the pink skin tone?

A

Exacerbation and work of breathing = pink tone in face and constant puffing

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21
Q

Which type of COPD causes increase coughing and expectoration?

A

Blue bloater

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22
Q

Which type of COPD may develop a barrel chest?

A

Pink puffer (emphysema)

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23
Q

What is a major issue with COPD?

A

Malnourishment and 1/3 may experience severe weight loss

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24
Q

___ of COPD patients are at risk of malnutrition

A

60%

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25
Q

What is involuntary weight loss associated with?

A

Increased morbidity and mortality

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26
Q

What is the issue with muscle mass loss and COPD?

A

Decrease respiratory muscles, harder to breathe, immune function may also cease

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27
Q

Besides decrease respiratory muscle mass and immune function, what are the other disadvantages of malnutrition in COPD?

A
  • Low protein/iron and diminished O2 carrying capacity
  • Hypoprotenemia
  • Less surfactant
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28
Q

What does hypoproteinemia lead to?

A

Diminished colloid osmotic pressure and pulmonary edema (Flux of proteins to interstitial fluid instead of blood)

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29
Q

What does less surfactant lead to?

A

Collapsed alveoli and increased work of breathing

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30
Q

Examples of other factors leading to inadequate intake?

A
  • Impairments in ADL
  • Decreased appetite
  • Chronic sputum production
  • Taste and smell changes
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31
Q

Common co-morbidities with COOD?

A
  • DM
  • Cancer
  • CVD
  • Osteoporosis
  • Depression/anxiety
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32
Q

Explain the link between the heat and the lungs

A

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)

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33
Q

What happens when the lungs are not providing adequate gas exchange?

A

RAAS is activated, BP increased

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34
Q

How can we measure pulmonary function?

A
  • Oxygen saturation (pulse oximetry)

- pH (blood test)

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35
Q

How can we measure lung function?

A

Spirometry

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36
Q

What is Forced Expiry Volume?

A

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

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37
Q

The less the FEV1 those more ____

A

severe COPD

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38
Q

Gold 1/Mild COPD?

A

FEV1 >80%

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39
Q

Gold 2/Moderate COPD?

A

FEV1 between 50-80%

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40
Q

Gold 3/Severe COPD?

A

FEV1 between 30-50%

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41
Q

Gold 4/Very Severe COPD?

A

FEV1 < 30%

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42
Q

Gases dissolved in liquids have partial pressures, which measures ____

A

the exertion of pressure against membrane an cells

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43
Q

How is diffusion across epithelial cells determined in part by?

A

The pressure on each side (recall high–>low pressure)

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44
Q

Normal pH?

A

7.35-7.45 (alkaline)

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45
Q

Normal O2 saturation?

A

> 95%

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46
Q

90% of the CO2 is found within the blood is in the form of ____

A

Bicarbonate ion (HCO3-)

47
Q

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?

A

Dissociates into H+ and into HCO3-. Increase in H+ alongside HCO3- means that pH will DECREASE = more acidic

48
Q

Increase Co2 ___ pH

A

Decreases

49
Q

When does respiratory acidosis occur?

A

In hypoventilation when we cannot expire the CO2, blood becomes more acidic as H+ accumulates

50
Q

How does the body compensate in respiratory acidosis?

A

Kidney increases excretion of H+ and will retain HCO3- with either Na+ or K+

51
Q

When does respiratory alkalosis occur?

A

Increase blood pH due to hyperventilation, where more CO2 expired and less H+ within the blood

52
Q

How will the body compensate in respiratory alkalosis?

A

Kidney will conserve H+ and will excrete Na+ or K+

53
Q

What does respiratory alkalosis and acidosis depend on?

A

The amount of CO2 in the blood (NOT the amount of O2)

54
Q

What is metabolic acidosis?

A

All types of acidosis that are NOT causes by excessive CO2 (and therefore H+)

55
Q

What is metabolic alkalosis?

A

All types of alkalosis NOT related by low levels of CO2 (and there fore H+)

56
Q

Example of metabolic acidosis?

A

Extreme diarrhea and loss of base

57
Q

Example of metabolic alkalosis?

A

Severe vomiting and loss of acid

58
Q

What is a common medication prescribed to people with respiratory diseases?

A

Corticosteroids

59
Q

What are the impacts of long term corticosteroid usage?

A
  • Fluid/electrolyte imbalances
  • Hypertension
  • Mood swings
  • Increased appetite
  • Weight gain
  • Osteoporosis
60
Q

Why are corticosteroids prescribed?

A

To reduce the inflammation and suppress the immune system in the bronchial tubules

61
Q

What is long-term corticosteroid use associated with?

A
  • Muscle wasting and protein catabolism

- Decreased BMD, fractures and calcium wasting

62
Q

What are the nutritional implication of corticosteroids?

A

-Low salt/sodium
-High calcium/vit D
-High protein
-Many need high K+, A, C
May need diabetic or heat healthy diet

63
Q

(T/F) Overweight or obese individuals with SEVERE COPD are associated with better survival

A

True

64
Q

(T/F) Normal or overweight individuals with mild and moderate COPD are associated with less survival

A

False, associated with a better prognosis

65
Q

Acute Illness –> MPCM –> Energy intake =

A

<75% of EEE in >7 days

66
Q

Acute Illness –> MPCM –> Weight loss 1 week =

A

1-2%

67
Q

Acute Illness –> MPCM –> Weight loss 1 month =

A

5%

68
Q

Acute Illness –> MPCM –> Weight loss 3 months =

A

7.5%

69
Q

Acute Illness –> SCPM —> Energy intake =

A

<50% of EE in >5 days

70
Q

Acute Illness –> SCPM —> Weight loss 1 week =

A

> 2%

71
Q

Acute Illness –> SCPM —> Weight loss 1 month =

A

> 5%

72
Q

Acute Illness –> SCPM —> Weight loss 3 months =

A

> 7.5%

73
Q

Chronic illness –> MPCM –> Energy intake =

A

<75% EEE in >1 month

74
Q

Chronic illness –> MPCM –> Weight loss 1 month =

A

5%

75
Q

Chronic illness –> MPCM –> Weight loss 3 months =

A

7.5%

76
Q

Chronic illness –> MPCM –> Weight loss 6 month =

A

10%

77
Q

Chronic illness –> MPCM –> Weight loss 1 year =

A

> 20%

78
Q

Chronic illness –> SPCM –> Energy intake =

A

<75% of EE > 1 month

79
Q

Chronic illness –> SPCM –> Weight loss 1 month =

A

> 5%

80
Q

Chronic illness –> SPCM –> Weight loss 3 month =

A

> 7.5%

81
Q

Chronic illness –> SPCM –> Weight loss 6 month =

A

> 10%

82
Q

Chronic illness –> SPCM –> Weight loss 1year =

A

> 20%

83
Q

What is included when diagnosing malnutrition? (FEW-H-BM)

A
  • Fluid
  • Edema
  • Weight loss
  • Handgrip strength
  • Body fat loss
  • Muscle mass wasting
84
Q

Define cachexia

A

A metabolic syndrome where inflammation and underlying illness is the key feature.

85
Q

Cachexia can be an underlying condition of ___

A

sarcopenia

86
Q

What is the prominent clinical feature of cachexia?

A

Weight loss

87
Q

What happens when the GI tract does not receive enough oxygen, such as in COPD?

A

Reduced peristalsis, digestion of food

88
Q

What is included in the Subjective Global Assessment Form? (SGA) - NSFW-M

A
  • Nutrient intake
  • Symptoms
  • Functional capacity
  • Weight
  • Metabolic requirement
89
Q

What does the SGA form help identify?

A

The contributing factors of muscle wasting, either cachexia or sarcopenia

90
Q

What are the 3 SGA ratings?

A
  • Well nourished
  • Mild/Moderately malnourished
  • Severely malnourished
91
Q

COPD energy?

A

25-25 kcal/kg

92
Q

What is energy intake dependent on?

A
  • Weight
  • Weight history
  • Appetite
  • Disease
  • Nutritional deficits
93
Q

Energy intake to promote possible weight gain?

A

30-35 kcal/kg

94
Q

What is often the goal in COPD?

A

To improve the oral intake in patients with reduced E intake

95
Q

Routine diet for COPD patients?

A

Soft, no added salt or sugar

96
Q

Primary goals of nutrition care?

A

1) Maintain energy balance
2) Maintain LBM
2) Correct fluid imbalances
3) Prevent osteoporosis
4) Manage drug-nutrient interactions

97
Q

What can we recommend as nutrition therapy to reduce malnutrition?

A
  • Small, frequent meals high energy and protein
  • Soft foods, easy to chew and swallow
  • Add kcals with nutrient dense foods, beverages
98
Q

In addition to increasing energy and protein, what may need to me limied?

A

Salt and fluid if fluid retention is a problem

99
Q

Protein requirements COPD?

A

1.0-1.5g/kg/day

100
Q

Protein requirements COPD during times of stress, infection or exacerbation?

A

1.2-1.7 g/kg/day

101
Q

What is the consensus with Milk and Mucus?

A

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)

102
Q

When does COPD become DNR?

A
  • Severe, frequent admission and limited imporvement
  • Maximum therapy
  • Dependant on oxygen
  • Severe SOB
103
Q

RQ =

A

Co2 produced/O2 consumed

104
Q

RQ CHO =

A

1

105
Q

Lowest RQ?

A

Fat

106
Q

What was the theory of high fat diets and tube fed patients?

A

If we feed high fat, there will be less CO2 produced per O2 consumed to oxidize the FA (i.e. less work for breathing)

107
Q

Does the high fat/less breathing theory work?

A

No, and high fat meals may induce satiety and GI disturbances –> Lead to less eating

108
Q

(T/F) COPD patients struggle with malabsorption

A

F, more issues with not receiving enough oxygen to GI tract, which means everything is slowed down and in distress

109
Q

Why is overfeeding common?

A

When using the predictive energy equation with stress factors, we may over estimate EE requirement

110
Q

What is the issue with overfeeding?

A

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)

111
Q

When is underfeeding beneficial?

A

When we want to reduce stress on uings in a critical care situation

112
Q

When is enteral feeding required?

A

In mechanical ventilation, as the trachea is opened

113
Q

When may oral feeding be OK?

A

MAYBE for tracheostomy, some foods only. Usually need tube-feeding

Clinical Nutrition 1 (30 decks)

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