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Pulmonary Disease

Categories of Pulmonary System Diseasea. Primary - tuberculosis (PTB), bronchial asthma, cancer of the lungb. Secondarythose associated with cardiovascular disease, obesity, acquired immunodeficiency syndrome (AIDS),

sickle cell disease, and scoliosis

Signs and symptoms of Pulmonary Disease: cough, early satiety, anorexia, weight loss, dyspnea, (shortness of breath)

during preparing of food and eating, and fatigue

Adverse effects of lung disease on nutritional status

Increased energy expenditureIncreased work of breathingChronic infectionMedical treatments (e.g.

bronchodilators, chest physicaltherapy)

Reduced intakeFluid restrictionShortness of breathDecreased oxygen saturation when

eatingAnorexia due to chronic diseaseGastrointestinal distress and vomiting

Additional limitationsDifficulty preparing food due to

fatigueLack of financial resourcesImpaired feeding skills (infants and

children)Altered metabolism

Asthma

a condition of hypersensitive airways from allergic and non-allergic causes, generated by immunologic responses*a disease of bronchial hyper-responsiveness and airway inflammation, leading to airflow destruction

Diet1. Avoid salt intake2. Avoid alcoholic beverages since congeners in alcohol can cause asthmatic symptoms in sensitive patients

Bronchitisacute or chronic inflammation of the membrane lining the bronchial tubes

I. Typesa. Acutemay be due to an extension of infection from the upper respiratory tractb. Chronicmay be caused by irritants in polluted air, particularly smoke or gas fumes

II. Dieta. High kilocalories and protein to help reduce infectionb. Small frequent feedings and allow frequent rest periods while eating when there is difficulty in breathingc. Avoid milk if it tends to produce mucus

Chronic Obstructive Pulmonary Disease (COPD)a process characterized by the presence of chronic bronchitis,emphysema, or both, leading to the development of airway obstruction-it is characterized by slowly progressive obstruction of the airways-cigarette smoking is the most important risk factor

Two categories:1. Emphysema (Type I)

-patients are genereally thin, often cathetic; they are older and have mild hypoxemia but normal haematocrit values-cor pulmonale (a heart condition characterized by right ventricular enlargement and failure that results fromresistance to the passage of blood through the lungs) develops late in the course of the disease

2. Chronic bronchitis (Type II)-patients have normal weights and often overweight; have hypoxemia; haematocrit values are increased-cor pulmonale develops early

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Consequences of COPD: lungs gradually lose their functional surface area and strength so that it is difficult to deliveroxygen to the blood and remove carbon dioxide. This results in pulmonary infections, respiratory failure, and heart failure

Progressive Respiratory Failurefailure of the pulmonary gas exchange of oxygen and carbon dioxide

I. SymptomsA. Hypoxemia - deficient oxygenation of the bloodB. Hypercapnia excess carbon dioxide in the bloodC. Nutritional wastinglow body weight and triceps skinfold measurementsD. Weakness

II. Nutritional CareObjective: maintenance of an acceptable weight for height; management of drug-nutrient interactions and fluid

balance

Diet1. Energy requirements vary; if underweight, may give 150% of REE

-25-35 kcal/day for maintenance based on weight-45 kcal/kg/day for anabolism to restore lean body mass

2. Fat is the preferred source of energy due to its low respiratory quotient (RQ) value (RQ=0.7); 40% of totalkilocalories3. Carbohydrate should provide 50% of non-protein kilocalories; large amounts will increase oxygen

consumption and carbon dioxide production and retention (RQ=1.0)4. Protein is high if underweight to counteract the catabolic effect of illness but not over 15% of total

kilocalories; high biologic value; too much may increase ventilator value drive (RQ=0.8)5. Give five to six small feedings of easily digested food6. Monitor fluid intake due to tendency to retain water7. Sodium restriction (2-3g/day with edema)8. Supplemental vitamins and minerals9. Enteral/parenteral feeding if needed. Appropriate commercial formulas based on recommended nutrient

ratios are available

Emphysema and Pulmonary Tuberculosis*refer to Febrile Conditions, Infections, and Communicable Diseases