Pulmonary CS
Pulmonary CS
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Add a little bit more into your intervention otherwise good job
D Inadequate oral intake R/T decreased caloric intake, loss of appetite, and
self-feeding difficulty AEB diet history and low levels of protein and albumin
Questions
1. Mrs. Bernhardt was diagnosed with stage 1 emphysema/COPD
five years ago. What criteria are used to classify this staging?
a. FEV1/FVC ratio of <70%
b. FEV1 value of >80% predicted
c. Presence or absence of chronic symptoms
3. What risk factors does Mrs. Bernhardt have for this disease?
a. Cigarette smoking (1 pack/day) for last 46 years
b. History of bronchitis and upper respiratory infections during
winter months
c. Family history of lung cancer
4. .
a. Identify symptoms described in the MDs history and
physical that are consistent with Mrs. Bernhardts
diagnosis. Then describe the pathophysiology that may
be responsible for each symptom.
i. Decreased breath sounds (SOB) & gasping
1. Loss of surface area in lungs
2. Loss of elasticity in bronchioles
3. Inflammation of bronchiole tubes
4. Damage to the alveoli sac
ii. Build up of mucus (green)
1. Damage to cilia, which prevents it from clearing
away mucus properly
2. Green because build up can cause infection
iii. Persistent coughing
1. Body is trying to get rid of mucus build up
%UBW
(119/145) x 100 = 82% UBW
(119/150) x 100 = 79& UBW
BMI
54.1/(1.6x1.6) = 21.1 kg/m2
o Her %UBW is of concern if this weight loss was recent and due to
her diagnosis. If it was more recent since her diagnosis, I would
be concerned that the weight loss was due to her being
malnourished.
o Her BMI is in the normal healthy range, but that does not mean
that there is no need for nutritional concern.
16. Why may Mrs. Bernhardt be at risk for anemia? Does her
laboratory values indicate that she is anemic?
a. She may be at risk, as her RBC, hemoglobin and hematocrit
levels are low.
17. What factors can you identify from her nutrition interview
that probably contributes to her difficulty in eating?
a. Poor appetite
b. Fills up quickly, after just a few bites (early satiety)
c. Increased coughing
d. Finds food to be unappetizing lately
e. Exhaustion due to increased efforts to breath
f. Improperly fitted dentures
20. For each of the PES statements that you have written,
establish an ideal goal (based on the signs and symptoms) and
an appropriate intervention (based on etiology).
a. Inadequate oral intake
i. Goal
1. Increase kcal intake to 1,650-1,900 kcal/day
2. Consume smaller more frequent meals
3. Choose nutrient dense foods
ii. Intervention
1. Educate on appropriate COPD diet
2. Educate on smaller more frequent meals which are
easy to prepare
b. Self-feeding difficulty
i. Goal
1. Incorporate more flavorful foods by using spices and
other flavorings
2. Consume smaller more frequent meals
3. Rest before meal times
4. Choose nutrient dense foods
ii. Intervention
1. Provide recipes and lists of calorie dense foods which
are easy to prepare
2. Provide recipes and lists of high calorie & high
protein snacks that are also easy to prepare
21. What goals might you set for Mrs. Bernhardt as she is
discharged and beginning pulmonary rehabilitation?
a. Increase total kcal intake
b. Decrease portion sizes, while increasing meal frequency
c. Incorporate more nutrient-dense foods
22. You are now seeing Mrs. Bernhardt at her second visit to
pulmonary rehabilitation. She provides you with the following
information from her food record. Her weight is now 116 lbs.
She explains adjustment to her medications and oxygen at
home has been difficult, so she hasnt felt like eating very
much. When you talk with her, you find she is hungriest in the
morning, and often by evening she is too tired to eat. She is
having no specific intolerances, but she does tell you she
hasnt consumed any milk products because she thought they
would cause more sputum to be produced.