Pulmonary Disease Flashcards by Sydney Perry

Small air sacs at the terminal end of the
bronchioles

alveoli

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

capillaries
exchange of gases from air to blood

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respiratory muscles

diaphragm
intercostal

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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

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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

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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

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~_______ 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

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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

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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

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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

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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

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Clinical Manifestations of CF

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

Biliary
Intestinal
Na & Cl

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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

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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)

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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

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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

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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

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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%

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protein requirements for CF

increased needs of 1.5 g/kg

due to inflammation, infections, corticosteroids, and malabsorption

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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)

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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

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MNT for CF

___________________ diet

Pancreatic insufficiency=> treat with
_______________

High kcal, high protein, moderate fat
pancreatic enzymes

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Infants:

Breastfed
- ____________

Formula-fed
- Standard formula
- ______________ if needed

Human milk fortifier added to expressed milk

Higher kcal formulas

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Pancreatic Enzyme Replacement Therapy (PERT)

Contain __________________

Examples:_______________

lipase
protease
amylase

Creon
Pancreaze
Viocase

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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

Pulmonary Disease Flashcards

(76 cards)