Mrs. Hemandez is a 72-year-old, underweight, African-American patient with a his

Question

Mrs. Hemandez is a 72-year-old, underweight, African-American patient with a history of hypertension, depression, and chronic obstructive pulmonary disease (COPD). She was recently seen by her primary health care provider for signs of ilness: fever, loss of appetite, fatigue, chills, and dyspnea. She was diagnosed with bronchitis and started on a bronchodilator and corticosteroid nebulizer treatments as well as an oral antibiotic. However, she continued to feel ill without improvement, and became very confused with increased shortness of breath. She was taken to the hospital by ambulance and admitted with a diagnosis of pneumonia, and then started on 2 liters of oxygen via a nasal cannula and intravenous antibiotics. Mrs. Hernandez was placed on a regular diet. However, she ate sparingly and was not receiving the nutrients she needed 1. What are the main goals of medical nutrition therapy for patients with COPD? 2. What factors interfere with food intake for patients with COPD? her hospitalization? 4. Why should fluids be encouraged?

Explanation / Answer

1.Registered dietitians should provide medical nutrition therapy (MNT) for patients with COPD that focuses on preventing and treating weight loss and other comorbidities. The goals of the therapy is to supply adequate proteins,calories,vitamins and minerals to maintain the desirable body weight,energy level and nutritional status. Provide small and frequent meals with nutrient dense foods such as peanut butter,easily consumed foods like eggs,yogurt,cottage cheese etc. Recommend food that require little preparation Limited alcohol consumption restricted to one or two drinks per day for women. Timing the main meal when the patients energy level is the highest. 2.Major cause of undernutrition in COPD patients, effects of humoral factors such as inflammatory cytokines, adipokines, and hormones on nutrition have been pointed out. Reasons for poor nutritional intake include the following:difficulty swallowing or chewing due to dyspnea;chronic mouth breathing, which can alter the taste of food;chronic mucous production;coughing;fatigue;morning headache or confusion due to hypercapnia;anorexia;depression; and side effect of medications. 3.Include high-fiber foods — such as vegetables, fruits, cooked dried peas and beans (legumes), whole-grain foods, bran, cereals, pasta, rice, and fresh fruit — in the diet. Fiber is the indigestible part of plant food. Fiber helps move food along the digestive tract, better controls blood glucose levels, and might reduce the level of cholesterol in the blood. Control the sodium intake in food. Vitamin D rich foods should be included like milk, cheese, yogurt, ice cream, and pudding. 4.For people with chronic obstructive pulmonary disease (COPD), staying hydrated is a key part of managing the disease. Staying hydrated means drinking enough of the right kinds of liquids every day. Staying well hydrated is important for everyone, but it is especially important for people with COPD. The disease can make the mucus produced by the lungs become thick, sticky, and difficult to clear out by coughing. Drinking enough water can thin the mucus and make it much easier to cough up. This clears the lungs and makes it easier to breathe. Drinking enough water can also help COPD patients fight off infections. COPD patients who are on oxygen therapy sometimes have symptoms of dryness and irritation in the nasal passages and airways because of the therapy. Drinking enough water can help prevent this.

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