Medical Nutritional Therapy(MNT) AHD 3233Question 6: Chronic Obstructive Pulmonary Disease-Saifullah Osman-Al- Abdullah Jaffar-Muhamad Arif Abdullah-Muhammad Kamil Mashor-Muhammad Luqman Hakim Romali
QuestionMr S is a 59 years old man. He was diagnosed with stage 1 Chronic ObstructivePulmonary Disease (emphysema) 5 years ago. Previous medical history showedthat he suffered bronchitis and upper respiratory infections especially during coldweather. He was a smoker for 46 years and quit smoking about 1 year ago. Currentdiagnosis is acute exacerbation of COPD 2º to bacterial pneumonia. He was unableto do anything by himself, even taking a bath or getting dressed makes him shortof breath.He responded well to treatment for the emphysema, however COPD hasprogressed. He was discharged home O2 therapy and bronchodilators, andreferred to an outpatient pulmonary rehabilitation programHe was referred to dietitian for diet consultation, as patient has poor appetite, andexperienced weight loss, 6 month ago he was 68 kg and now is 59kg and hisheight is 167 cm. He avoids milk as he believed that milk will increase the mucusproduction
Nutrition Status AssessmentAnthropometry dataWeight : 59kgHeight : 1.67mBody Mass Index : 59 (1.67 x 1.67) : 21.15 kg/m BMI of the patient is normal range.
Nutrition Status AssessmentBio-chemical Data Patient value Normal value IndicationWhite Blood Cell 15 x 103 mm3 4.3 - 10 x 103 mm3 Inflammatory (high) responseHemoglobin 11.5 g/dl 12.0 – 16.0 g/dl -Total protein 59 g/L 67 – 88 g/L Muscle wasting (low)Albumin 29 g/L 35 – 50 g/L Muscle wasting (low)
Objectives and PrinciplesObjectives:1) Screen early and correct any malnutrition. Because there less oxygen available for adenosine triphosphate (ATP) formation, the patient will less active and there are less blood flow to GI tract and muscle. Malnutrition will increase the like hood of infection.2) Delay progression of COPD, by improving pulmonary function3) Prevent respiratory infection or reparatory acidosis from decrease CO2 elimination. Decrease excess CO2 production4) Ensure adequate flavor of foods because appetite is often minimized
Objectives and PrinciplesPrinciples: 1) The diet should 40-55% carbohydrate, 30-45% fat and 15-20% protein. 2) A soft diet (not tough or stringy foods) recommended. 3) Avoid gas forming foods to avoid excess formation CO2. 4) Enrich the diet with antioxidant to support lung function. 5) Use small frequent feeding at frequent intervals to lessen the fatigue 6) Ensure high fluid intake 7) Limit salt intake, too much sodium will cause water retention that may interfere with breathing.
Objectives and PrinciplesPatient Education:1) Explain the patient to conserve energy while preparing meals at home. Choose food that easily prepared.2) Explain how to concentrate protein and calories in small feedings.3) Encourage rest periods before and after meals4) Encourage slow eating.5) Improve physical conditioning with planned exercises , especially strength exercise.
Nutrition InterventionEnergy requirement:1) Quick MethodDue to patient BMI is normal, so we use the current body weight (59kg) and canconsider having sedentary lifestyle as the statement stated unable to do anything byhimself.= 59 kg x 30 kcal/kg= 1770 kcal= 1770
Nutrition Intervention2) Harris- Benedict EquationMale:Basal Energy Expenditure (BEE) = 66.47 + (13.75 x Weight) + (5 x Height) – (6.76 x Age)= 66.47 + (13.75 x 59) + (5 x 167) – (6.76 x 59)= 1315 kcalTotal Energy Intake = BEE x Injury Factor (1.5) x Activity Factor (1.3)= 1315 x 1.5 x 1.3=2564 kcal
Nutrition Distribution Table Distribution Macronutrients Carbohydrate Protein FatGeneral 40 % 17 % 43 %Enteral 300 kcal = 10% 177.86 kcal = 5.93 % 586.8 kcal = 19.6 %FeedingPercentage (%) 1 can RTH = 235ml 1 day x 3 can = 705 ml 235 ml x 1.5 kcal = 352.5 kcal 705 ml x 1.5 kcal = 1057.5 kcal Total CHO = 25.0 g Total CHO/day = 75.0 g Total Protein = 14.8 g Total Protein/day= 44.4 g Total Fat = 22.1 g Total Fat/ day = 66.3 gNormal Diet 40 % - 10 % = 30 % 17% - 5.93 % = 11.07% 43% - 19.6% = 23.4 %Percentage (%) =30 x 2200 kcal =11.07 x 2200 kcal = 23.4 X 2200 kcal 100 100 100 =660 kcal =243.5 kcal = 514.8 kcal =660 =243.5 = 514.8 4 4 9 = 165 g =60.87 – (14+8) = 57.2 – (3.5+10+3+8) =165 7 5 15 =5.5 ex = 6.5 ex =11 Ex
Nutrition Distribution TableExchange distribution table:
Menu PlanningEnteral Feeding:Pulmocare EN products:Information PULMOCARE® is a high-calorie, low-carbohydrate liquidformula, designed to help reduce carbon dioxide production,thereby minimizing CO2 retention.Nutrient density (Cal/mL) : 1.5Protein (% Cal) : 16.7Carbohydrate (% Cal) : 28.1Fat (% Cal) : 55.2Feeding time:1 tin (235ml) - Mid-morning - Mid- afternoon - Supper
Menu PlanningBreakfast:½ cup oat + ½ desert spoon raisin + 1/3 tsp sugar + ½ glass Full Cream Milk(blended)1 glass of plain waterMid-morning:1 medium size potato mashed + pepper + salt]1 scrambled egg (gred c) + 1 tsp heap mayonese + minced onions and garlics + 1tsp oil1 glass Pulmocare + ½ berangan banana + 1 tsp sugar (blended)1 glass of plain waterLunch:1 slice of whitebread (peeled outer skin) + 1 tsp peanut butter1.5 cube chicken soup + salt +pepper + 1/3 thin sliced of carrots + bunga lawang+ cinnamon + 1 tsp oil1 glass of plain water
Menu PlanningMid-afternoon:1 slice watermelon1 glass Pulmocare + 6 pieces strawberry + 1/3 tsp sugar (blended)A glass of plain waterDinner:2 slices whitebread (peel outer skin) + 1 tsp heap mayonese2 desertspoons sardine + 1/3 minced chillie, kasturi ½ lime (the juice andcontent only) + salt + 1 tsp oil½ slice of cheeseA glass of plain waterSupper:1/2 cup rice porridege1 cube fish soup + salt + onions + garlic + bunga lawang + cinnamon + ½potato in the soup + few celery + onions leaves1 glass pulmocare + ½ of a slice of watermelonA glass of plain water