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Respiratory Disease pg. 134 - Coggle Diagram
Respiratory Disease pg. 134
COPD
A common, preventable/treatable disease characterised by persistent airflow limitation that's progressive/associated w/ enhanced chronic inflammatory response (isn't reversible)
Symptoms
dyspnoea, chronic cough, chronic sputum production
Breakdown of alveoli in lungs = reduction in diffusing capacity.
Hyperinflated lungs = downward pressure on diaphragm impacting gastric space = pts complaining of breathless after/during meals, early satiety, poor appetite
Nutritional Complications
anorexia, reduced fat mass, fatigue, malnutrition, early satiety, increased nutrient reqs, medications, weight gain, inactivity, diabetes, recurrent infections, weight loss
Factors affecting energy requirements
Basal requirements:
age, sex, wt, body comp, ambient temp, nutritional intake, smoking
Disease state:
metabolic state, disease severity, inflammatory response, GI function, medical interventions, surgery, pharma interventions, pain, psychological state
Goals of treatment:
dx, prognosis, duration of nutritional support
Activity:
mobility, level of consciousness, neuro-muscular function
4 faces of malnutrition
Undernutrition/anorexia:
inadequate intake of energy/protein leading to primary loss of fat mass.
Frailty:
3 or more of following; unintentional wt loss, exhaustion, weakness, slow walking speed, inactivity (focus on HPHE link w/ physios).
Sarcopenia:
protein deficient diet, lack of PA leading to loss of muscle mass masked by expansion of FM (inactive pts not given HEHP as = ^ FM
Cachexia:
catabolic state w/ ^ inflammatory markers, loss of both fat/muscle.
Nutritional Reqs
classified as moderately hypermetabolic during IECOPD: 125-145kj/day and 1.2-1.5g protein/kg/d
REE = (11.5 X wt) + 952 (Moore & Angelillo).
25-35kcal/kg body weight (NEMO, NICE)
Fluid shifts common/makes assessment difficult (pedal oedema)
Inflammation likely to alter biochem (^TNFa, IL-6, CRP, decreased alb - inflammation induced capillary damage resulting in loss of blood proteins to interstitial space)
Ensure pts are meeting calcium reqs + taking vit D supplement to improve immunity and reduce osteoporosis
Evidence (PEN)
5-10% increase in REE during acute episodes due to inflammation
issues on diet intake:
fatigue, dry mouth, poor appetite, GI effects, poor dentition, dysphagia.
Meds can lead to unintentional wt loss, GI complaints
ONS providing 300-1000kcal/d for min 2wks to individuals with COPD who are undernourished = wt gain, improvements in pulmonary function, functional capacity, QOL
pts benefit from taking smaller frequent doses of ONS than larger volumes to avoid complications + improve compliance
Cardiopulmonary Cachexia
Chronic illness -> anorexia, inflammation, insulin resistance, hypogonadism, anaemia -> fat loss/muscle wasting -> wt loss/weakness + fatigue (reduced muscle strength, VO2 max, PA)
Cachexia Dx:
wt loss of at least 5% in 12 mths or less (or BMI <20kg/m2) AND 3 of 5: decreased muscle strength, fatigue, anorexia, low fat-free mass, abnormal biochem (^ inflammatory markers (IL-6/CRP), anaemia (Hb <12g/dl), low serum albumin (<3.2g/dl)
Research
Inpatients:
ONS increased energy (+16%) and protein (+38%), no impact on oral intake from food, ONS achieved protein intake than those not on ONS. however limited time to intervene
Outpatients:
significant improvement in energy with ONS, those given 6/12 supply of milk powder and individualised diet advice gained 2kg + maintained it. Provision of food and milk powder is effective
Nutrition support
Hospital:
HEHP menu, low volume ready to drink ONS
Home:
HEHP diet, low volume ready to drink ONS
Home:
HEHP diet, powdered ONS
Home:
HEHP diet