This document discusses medical nutrition therapy for pulmonary diseases. It begins by describing the anatomy and functions of the pulmonary system. It then discusses how malnutrition can negatively impact the pulmonary system and vice versa. Specific chronic pulmonary diseases like asthma and COPD are examined in depth, outlining their pathophysiology, diagnosis, treatment, and how nutrition can support management. Food allergens, antioxidants, fatty acids, vitamins and minerals are some of the nutritional factors discussed in relation to pulmonary health.
The Pulmonary system - Artificial organ 2.pptxHusseinMishbak
The pulmonary system, also known as the respiratory system, allows us to breathe by bringing oxygen into the body and removing carbon dioxide. It includes the lungs, airways, blood vessels, and respiratory muscles. The lungs contain millions of alveoli where gas exchange occurs between the blood and air. Lung diseases such as asthma, COPD, and lung cancer can damage the lungs and impair their ability to oxygenate the blood and remove carbon dioxide, potentially leading to hypoxia, hypercapnia, and other health issues. Lung transplantation and artificial lungs can provide life-saving treatment for patients with end-stage lung disease.
This document discusses oxygenation and its relationship to respiratory and cardiovascular function. It covers topics like the physiology of oxygenation, factors that affect oxygenation like age, environment, lifestyle, and health status. Common manifestations of altered respiratory and cardiovascular function are described, like dyspnea, tachypnea, and hypoxia. Life span changes and problems related to respiration and circulation at different ages are outlined. The document also discusses respiratory and cardiac emergencies, and the nursing process for assessment and care planning for patients with respiratory or cardiovascular issues.
This document discusses oxygenation and its relationship to respiratory and cardiovascular function. It covers topics like the physiology of oxygenation, factors that affect oxygenation like age, environment, lifestyle, and health status. Common manifestations of altered respiratory and cardiovascular function are described, like dyspnea, tachypnea, and hypoxia. Life span changes and problems related to respiration and circulation at different ages are outlined. The document also discusses respiratory and cardiac emergencies, and the nursing process for assessment and care planning for patients with respiratory or cardiovascular issues.
1. The document discusses the anatomy and physiology of the respiratory system, including the structure of the lungs and airways, mechanics of breathing, lung volumes, gas exchange, and common respiratory diseases like asthma.
2. It provides details on topics like the branching of the airways, roles of respiratory muscles, factors influencing lung compliance, mechanisms of ventilation and perfusion matching, and pathophysiology of conditions that affect the respiratory system.
3. The case studies examine patients experiencing acute exacerbations of asthma and diffuse interstitial pulmonary fibrosis, illustrating clinical presentations and management of respiratory conditions.
histology of respiratory system upper and lower
rHistology is a vast and complex field, but it provides valuable insights into the structure and function of tissues in various organisms. It has played a major role in advancing our understanding of health, disease, and biology.
histology of respiratory system upper lower
Histology is a vast and complex field, but it provides valuable insights into the structure and function of tissues in various organisms. It has played a major role in advancing our understanding of health, disease, and biology.
The respiratory system is essential for life. It provides your body with the oxygen it needs to function and removes the carbon dioxide that would otherwise build up and be toxic.
The respiratory system is a complex network of organs and tissues that work together to allow you to breathe. Its primary function is to take in oxygen from the air and release carbon dioxide, a waste product of cellular respiration. The system is made up of the following:
Upper respiratory tract: This includes the nose
nasal cavity,
sinuses,
pharynx (throat)
And
larynx (voice box).
Lower respiratory tract: This includes the trachea (windpipe)
bronchi, bronchioles, and alveoli air sacs
in the lungs.
The document provides an overview of the histology of the respiratory system for medical students. It begins with an introduction to histology techniques used to study tissues. It then describes the major components of the respiratory system, including the upper and lower tracts. Several sections focus on detailed histology of specific regions, such as the bronchial tree, bronchioles, alveoli and the gas exchange that occurs. Diagrams and micrographs illustrate the transitions between different cell types and structures in the lungs from the bronchi to the alveoli where oxygen and carbon dioxide are exchanged.
The Pulmonary system - Artificial organ 2.pptxHusseinMishbak
The pulmonary system, also known as the respiratory system, allows us to breathe by bringing oxygen into the body and removing carbon dioxide. It includes the lungs, airways, blood vessels, and respiratory muscles. The lungs contain millions of alveoli where gas exchange occurs between the blood and air. Lung diseases such as asthma, COPD, and lung cancer can damage the lungs and impair their ability to oxygenate the blood and remove carbon dioxide, potentially leading to hypoxia, hypercapnia, and other health issues. Lung transplantation and artificial lungs can provide life-saving treatment for patients with end-stage lung disease.
This document discusses oxygenation and its relationship to respiratory and cardiovascular function. It covers topics like the physiology of oxygenation, factors that affect oxygenation like age, environment, lifestyle, and health status. Common manifestations of altered respiratory and cardiovascular function are described, like dyspnea, tachypnea, and hypoxia. Life span changes and problems related to respiration and circulation at different ages are outlined. The document also discusses respiratory and cardiac emergencies, and the nursing process for assessment and care planning for patients with respiratory or cardiovascular issues.
This document discusses oxygenation and its relationship to respiratory and cardiovascular function. It covers topics like the physiology of oxygenation, factors that affect oxygenation like age, environment, lifestyle, and health status. Common manifestations of altered respiratory and cardiovascular function are described, like dyspnea, tachypnea, and hypoxia. Life span changes and problems related to respiration and circulation at different ages are outlined. The document also discusses respiratory and cardiac emergencies, and the nursing process for assessment and care planning for patients with respiratory or cardiovascular issues.
1. The document discusses the anatomy and physiology of the respiratory system, including the structure of the lungs and airways, mechanics of breathing, lung volumes, gas exchange, and common respiratory diseases like asthma.
2. It provides details on topics like the branching of the airways, roles of respiratory muscles, factors influencing lung compliance, mechanisms of ventilation and perfusion matching, and pathophysiology of conditions that affect the respiratory system.
3. The case studies examine patients experiencing acute exacerbations of asthma and diffuse interstitial pulmonary fibrosis, illustrating clinical presentations and management of respiratory conditions.
histology of respiratory system upper and lower
rHistology is a vast and complex field, but it provides valuable insights into the structure and function of tissues in various organisms. It has played a major role in advancing our understanding of health, disease, and biology.
histology of respiratory system upper lower
Histology is a vast and complex field, but it provides valuable insights into the structure and function of tissues in various organisms. It has played a major role in advancing our understanding of health, disease, and biology.
The respiratory system is essential for life. It provides your body with the oxygen it needs to function and removes the carbon dioxide that would otherwise build up and be toxic.
The respiratory system is a complex network of organs and tissues that work together to allow you to breathe. Its primary function is to take in oxygen from the air and release carbon dioxide, a waste product of cellular respiration. The system is made up of the following:
Upper respiratory tract: This includes the nose
nasal cavity,
sinuses,
pharynx (throat)
And
larynx (voice box).
Lower respiratory tract: This includes the trachea (windpipe)
bronchi, bronchioles, and alveoli air sacs
in the lungs.
The document provides an overview of the histology of the respiratory system for medical students. It begins with an introduction to histology techniques used to study tissues. It then describes the major components of the respiratory system, including the upper and lower tracts. Several sections focus on detailed histology of specific regions, such as the bronchial tree, bronchioles, alveoli and the gas exchange that occurs. Diagrams and micrographs illustrate the transitions between different cell types and structures in the lungs from the bronchi to the alveoli where oxygen and carbon dioxide are exchanged.
1. The nurse plays an important role in optimizing oxygenation and ventilation through positioning, preventing desaturation, promoting secretion clearance, and educating patients and families.
2. Positioning techniques like prone positioning can improve gas exchange, while frequent position changes prevent complications. Oxygenation also requires adequate rest, limiting activity, and controlling fever and anxiety.
3. Nurses monitor patients closely, suction secretions, and start incentive spirometry after extubation to promote lung expansion and prevent pneumonia. Educating patients and families on prevention of exacerbating conditions is also essential.
Techniques of chest physiotherapy and it's importanceKemzyEkam
This document provides an overview of chest physiotherapy for pre- and post-surgical patients. It discusses how surgery can negatively impact pulmonary function and increase the risk of postoperative pulmonary complications. Chest physiotherapy techniques like breathing exercises and chest wall mobilization are recommended both before and after surgery to improve lung function and clearance of secretions, thereby reducing complications. The document reviews the goals, indications, contraindications and relevant anatomy for chest physiotherapy. It focuses on techniques used to drain secretions, improve ventilation and strengthen respiratory muscles in surgical patients.
The document provides an overview of respiratory physiology, covering topics such as:
- The anatomy and functions of the respiratory system from the nose to the alveoli.
- Lung volumes including tidal volume, functional residual capacity, and closing capacity.
- The mechanisms of breathing including the muscles involved and factors that affect work of breathing.
- Gas exchange processes in the lungs and factors that can cause ventilation/perfusion mismatches.
- Control of respiration by the respiratory centers in the brainstem and chemoreceptors in the body.
- The oxygen cascade process of oxygen transport from the air to tissues via the blood.
This document provides information on bronchial asthma (BA), including:
1. BA is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms of wheezing, coughing, chest tightness, and shortness of breath in response to triggers.
2. Pathogenesis involves chronic airway inflammation, intermittent airflow obstruction from bronchoconstriction and remodeling, and bronchial hyperresponsiveness. Principal cells involved are mast cells, eosinophils, and T lymphocytes.
3. Classification of BA severity is based on symptoms, nighttime symptoms, lung function measurements, and exacerbations. Clinical evaluation includes patient history, physical exam assessing respiratory distress, and tests to measure lung function such
Pulmonary rehabilitation is a comprehensive intervention designed to improve the physical and psychological condition of people with chronic respiratory disease. It includes exercise training, education, and behavior change therapies. Pulmonary rehabilitation aims to promote long-term adherence to health-enhancing behaviors. The summary describes restrictive and obstructive lung diseases, as well as various treatments used in pulmonary rehabilitation including exercise, airway clearance techniques, nutrition management, and psychosocial support.
Respiration is the process of gas exchange between the lungs and blood. There are two types of respiration - external respiration which is the exchange of gases between the lungs and blood, and internal respiration which is the exchange between blood and tissues.
The respiratory system consists of the upper respiratory tract from the nose to the larynx, and the lower respiratory tract from the trachea to the alveoli in the lungs. Each lung is enclosed in a pleural sac and divided into lobes. Gas exchange occurs in the alveoli of the respiratory bronchioles.
During inspiration, contraction of the diaphragm and intercostal muscles enlarges the thoracic cavity, decreasing pressure and drawing air into the lungs.
This document provides an introduction to the respiratory system, including its key functions and anatomical structures. It describes how respiration involves the exchange of oxygen and carbon dioxide between the lungs and blood. It also outlines the phases of respiration, the functional anatomy of the respiratory tract, and the non-respiratory functions of structures like the lungs, trachea, and bronchi such as defense against pathogens, regulation of temperature and acid-base balance, and synthesis of hormonal substances.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE BY AKRAM KHANAkram Khan
This document provides information on Chronic Obstructive Pulmonary Disease (COPD). It defines COPD as a disease characterized by airflow obstruction caused by chronic bronchitis or emphysema. The main causes are cigarette smoking, infections, and occupational exposures. Symptoms include cough, sputum production, and dyspnea. Diagnosis involves spirometry and chest imaging. Management focuses on smoking cessation, bronchodilators, corticosteroids, oxygen therapy, lung surgery for severe cases, and dietary modifications. Nursing care includes assessing respiratory status, teaching breathing techniques and airway clearance, administering medications, and addressing nutrition.
General Respiratory conditions
• Diagnostic tests p 566
o Sputum (MC&S)
Smear
Culture
o CXR
o Blood gas
o Pulse oximetry
o CT
o MRI
o Ba swallow
o Bronchoscopy
o Pleural fluid
• Classification of respiratory disorders p 583
o Infective
o Inflammatory
Pneumonia p 585 PCCM p 64
• Definition
• Causes
• Classification
• Risk factors
• Specific pathophysiology
• Clinical manifestations
• Management p 586 PCCM p64
o Lobar PCCM p 61
o Broncho PCCM 64
• General nursing care plan p 587
o SOB
o Coughing
• Complications p 588
• Prevention p 588
• Essential health information
Pneumonia in children p 589 PCCM p 63
• Bronchopneumonia
o Clinical features
In small infants
Infants
Small children
o Management
Cancer of the lungs and bronchi p 597
• Definition
• Causes
• Pathophysiology
• Clinical manifestations
• Treatment
• Essential health information
Thoracic / chest trauma p 262 (T&E Periods)
• # ribs PCCM p 275
• Flail chest
• Pulmonary contusion
• Pneumothorax
• Tension pneumothorax PCCM p 272
• Haemothorax
• Stabbed chest PCCM p 272
The document provides an overview of pulmonology and respiratory medicine. It discusses that pulmonology deals with diseases of the respiratory tract and lungs. The pulmonologist specializes in conditions like pneumonia, asthma, tuberculosis, and lung infections. Diagnostic tests evaluated by pulmonologists include sputum analysis, pulmonary function tests, imaging scans and blood gas measurements. Therapies involve oxygen supplementation, bronchodilators, steroids and antibiotics administered via nebulizers or inhalers.
This document discusses pulmonary drug delivery. It begins with the anatomy and physiology of the respiratory system, describing the upper and lower respiratory tracts. It then covers the advantages of pulmonary drug delivery for treating both respiratory and systemic diseases, such as delivering high drug concentrations directly to the disease site while minimizing systemic side effects. The document discusses the different lung epithelium sites that can absorb drugs and the ability to deliver small hydrophobic drugs, small hydrophilic drugs, and macromolecules systemically through inhalation. Finally, it briefly introduces several pulmonary drug delivery devices, including dry powder inhalers, pressurized metered-dose inhalers, and nebulizers.
Biology For Engineers Module 3 / HUMAN ORGAN SYSTEMS AND BIO-DESIGNS - 2 Dr. Pavan Kundur
The document discusses several human organ systems and related bioengineering solutions. It describes the lungs as a purification system, covering the architecture of the lungs, gas exchange mechanisms, spirometry tests, and conditions like COPD. It then discusses the kidney as a filtration system, describing architecture, filtration mechanisms, chronic kidney disease (CKD), and dialysis systems. Finally, it discusses the muscular and skeletal systems as scaffolds, describing architecture, mechanisms, and bioengineering solutions for conditions like muscular dystrophy and osteoporosis.
pathology of the respiratory system plus review of anatomy and physiology
No copy right infringement is intended. This is a lecture note handout by Carey Francis Okinda
1. The document discusses diagnostic tests and management of various respiratory diseases including bronchitis, pneumonia, tuberculosis, pulmonary embolism, and asthma. It provides details on signs and symptoms, etiology, diagnostic testing, and treatment approaches for each condition.
2. Key diagnostic tests discussed are bronchoscopy, chest X-ray, pulmonary angiography, sputum culture and sensitivity, and arterial blood gas. Treatment approaches focus on relieving symptoms, treating underlying infections, and preventing exacerbations.
3. Nursing priorities for respiratory conditions include monitoring breathing, administering medications, suctioning secretions, providing education and promoting lifestyle changes to improve lung health.
This document summarizes the human respiratory system. It describes the major parts including the nostrils, pharynx, larynx, trachea, bronchi, bronchioles and alveoli. It explains how breathing occurs through inspiration and expiration, driven by contractions of the diaphragm and intercostal muscles. Gas exchange takes place in the alveoli and oxygen and carbon dioxide are transported in the blood and tissues. Regulation of respiration maintains appropriate rates. Common respiratory disorders like asthma and emphysema are also outlined.
This document provides information on interstitial lung disease from a seminar presented by Ms. Saheli Chakraborty. It defines interstitial lung disease as progressive scarring of lung tissue. It discusses the objectives, introduction, definition, etiology, risk factors, pathophysiology, clinical manifestations, diagnostic evaluations, complications, management, nursing management, nursing diagnoses and common types of interstitial lung diseases including sarcoidosis, idiopathic pulmonary fibrosis, interstitial pneumonia, asbestosis and acute interstitial pneumonitis.
Design of artificial respiratory modelShîvãm Gûptå
Design of Artificial Respiratory Model.. Know about the respiratory system.
The respiratory system consists of the upper respiratory tract (nasal passages), the airway conduction system (larynx, trachea, bronchi, bronchioles and terminal bronchioles), and the lower respiratory tract (alveolar ducts and alveoli). Not all segments of the respiratory system mature at the same pace. The olfactory epithelium matures earliest by PND 7. The lung, however, is not considered mature until PND 21, when alveolarization and microvascular maturation are complete. This chapter will discuss the embryological development (briefly), adult histomorphology, and postnatal histologic development of each major component of the respiratory system.
The document defines oxygenation as the delivery of oxygen to body tissues and cells, describes the physiological process of oxygen transport from the lungs to cells, and outlines factors that can affect oxygen levels as well as signs and symptoms of hypoxia. It also provides details on administering oxygen to improve uptake and delivery through various methods and equipment.
End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
1. The nurse plays an important role in optimizing oxygenation and ventilation through positioning, preventing desaturation, promoting secretion clearance, and educating patients and families.
2. Positioning techniques like prone positioning can improve gas exchange, while frequent position changes prevent complications. Oxygenation also requires adequate rest, limiting activity, and controlling fever and anxiety.
3. Nurses monitor patients closely, suction secretions, and start incentive spirometry after extubation to promote lung expansion and prevent pneumonia. Educating patients and families on prevention of exacerbating conditions is also essential.
Techniques of chest physiotherapy and it's importanceKemzyEkam
This document provides an overview of chest physiotherapy for pre- and post-surgical patients. It discusses how surgery can negatively impact pulmonary function and increase the risk of postoperative pulmonary complications. Chest physiotherapy techniques like breathing exercises and chest wall mobilization are recommended both before and after surgery to improve lung function and clearance of secretions, thereby reducing complications. The document reviews the goals, indications, contraindications and relevant anatomy for chest physiotherapy. It focuses on techniques used to drain secretions, improve ventilation and strengthen respiratory muscles in surgical patients.
The document provides an overview of respiratory physiology, covering topics such as:
- The anatomy and functions of the respiratory system from the nose to the alveoli.
- Lung volumes including tidal volume, functional residual capacity, and closing capacity.
- The mechanisms of breathing including the muscles involved and factors that affect work of breathing.
- Gas exchange processes in the lungs and factors that can cause ventilation/perfusion mismatches.
- Control of respiration by the respiratory centers in the brainstem and chemoreceptors in the body.
- The oxygen cascade process of oxygen transport from the air to tissues via the blood.
This document provides information on bronchial asthma (BA), including:
1. BA is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms of wheezing, coughing, chest tightness, and shortness of breath in response to triggers.
2. Pathogenesis involves chronic airway inflammation, intermittent airflow obstruction from bronchoconstriction and remodeling, and bronchial hyperresponsiveness. Principal cells involved are mast cells, eosinophils, and T lymphocytes.
3. Classification of BA severity is based on symptoms, nighttime symptoms, lung function measurements, and exacerbations. Clinical evaluation includes patient history, physical exam assessing respiratory distress, and tests to measure lung function such
Pulmonary rehabilitation is a comprehensive intervention designed to improve the physical and psychological condition of people with chronic respiratory disease. It includes exercise training, education, and behavior change therapies. Pulmonary rehabilitation aims to promote long-term adherence to health-enhancing behaviors. The summary describes restrictive and obstructive lung diseases, as well as various treatments used in pulmonary rehabilitation including exercise, airway clearance techniques, nutrition management, and psychosocial support.
Respiration is the process of gas exchange between the lungs and blood. There are two types of respiration - external respiration which is the exchange of gases between the lungs and blood, and internal respiration which is the exchange between blood and tissues.
The respiratory system consists of the upper respiratory tract from the nose to the larynx, and the lower respiratory tract from the trachea to the alveoli in the lungs. Each lung is enclosed in a pleural sac and divided into lobes. Gas exchange occurs in the alveoli of the respiratory bronchioles.
During inspiration, contraction of the diaphragm and intercostal muscles enlarges the thoracic cavity, decreasing pressure and drawing air into the lungs.
This document provides an introduction to the respiratory system, including its key functions and anatomical structures. It describes how respiration involves the exchange of oxygen and carbon dioxide between the lungs and blood. It also outlines the phases of respiration, the functional anatomy of the respiratory tract, and the non-respiratory functions of structures like the lungs, trachea, and bronchi such as defense against pathogens, regulation of temperature and acid-base balance, and synthesis of hormonal substances.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE BY AKRAM KHANAkram Khan
This document provides information on Chronic Obstructive Pulmonary Disease (COPD). It defines COPD as a disease characterized by airflow obstruction caused by chronic bronchitis or emphysema. The main causes are cigarette smoking, infections, and occupational exposures. Symptoms include cough, sputum production, and dyspnea. Diagnosis involves spirometry and chest imaging. Management focuses on smoking cessation, bronchodilators, corticosteroids, oxygen therapy, lung surgery for severe cases, and dietary modifications. Nursing care includes assessing respiratory status, teaching breathing techniques and airway clearance, administering medications, and addressing nutrition.
General Respiratory conditions
• Diagnostic tests p 566
o Sputum (MC&S)
Smear
Culture
o CXR
o Blood gas
o Pulse oximetry
o CT
o MRI
o Ba swallow
o Bronchoscopy
o Pleural fluid
• Classification of respiratory disorders p 583
o Infective
o Inflammatory
Pneumonia p 585 PCCM p 64
• Definition
• Causes
• Classification
• Risk factors
• Specific pathophysiology
• Clinical manifestations
• Management p 586 PCCM p64
o Lobar PCCM p 61
o Broncho PCCM 64
• General nursing care plan p 587
o SOB
o Coughing
• Complications p 588
• Prevention p 588
• Essential health information
Pneumonia in children p 589 PCCM p 63
• Bronchopneumonia
o Clinical features
In small infants
Infants
Small children
o Management
Cancer of the lungs and bronchi p 597
• Definition
• Causes
• Pathophysiology
• Clinical manifestations
• Treatment
• Essential health information
Thoracic / chest trauma p 262 (T&E Periods)
• # ribs PCCM p 275
• Flail chest
• Pulmonary contusion
• Pneumothorax
• Tension pneumothorax PCCM p 272
• Haemothorax
• Stabbed chest PCCM p 272
The document provides an overview of pulmonology and respiratory medicine. It discusses that pulmonology deals with diseases of the respiratory tract and lungs. The pulmonologist specializes in conditions like pneumonia, asthma, tuberculosis, and lung infections. Diagnostic tests evaluated by pulmonologists include sputum analysis, pulmonary function tests, imaging scans and blood gas measurements. Therapies involve oxygen supplementation, bronchodilators, steroids and antibiotics administered via nebulizers or inhalers.
This document discusses pulmonary drug delivery. It begins with the anatomy and physiology of the respiratory system, describing the upper and lower respiratory tracts. It then covers the advantages of pulmonary drug delivery for treating both respiratory and systemic diseases, such as delivering high drug concentrations directly to the disease site while minimizing systemic side effects. The document discusses the different lung epithelium sites that can absorb drugs and the ability to deliver small hydrophobic drugs, small hydrophilic drugs, and macromolecules systemically through inhalation. Finally, it briefly introduces several pulmonary drug delivery devices, including dry powder inhalers, pressurized metered-dose inhalers, and nebulizers.
Biology For Engineers Module 3 / HUMAN ORGAN SYSTEMS AND BIO-DESIGNS - 2 Dr. Pavan Kundur
The document discusses several human organ systems and related bioengineering solutions. It describes the lungs as a purification system, covering the architecture of the lungs, gas exchange mechanisms, spirometry tests, and conditions like COPD. It then discusses the kidney as a filtration system, describing architecture, filtration mechanisms, chronic kidney disease (CKD), and dialysis systems. Finally, it discusses the muscular and skeletal systems as scaffolds, describing architecture, mechanisms, and bioengineering solutions for conditions like muscular dystrophy and osteoporosis.
pathology of the respiratory system plus review of anatomy and physiology
No copy right infringement is intended. This is a lecture note handout by Carey Francis Okinda
1. The document discusses diagnostic tests and management of various respiratory diseases including bronchitis, pneumonia, tuberculosis, pulmonary embolism, and asthma. It provides details on signs and symptoms, etiology, diagnostic testing, and treatment approaches for each condition.
2. Key diagnostic tests discussed are bronchoscopy, chest X-ray, pulmonary angiography, sputum culture and sensitivity, and arterial blood gas. Treatment approaches focus on relieving symptoms, treating underlying infections, and preventing exacerbations.
3. Nursing priorities for respiratory conditions include monitoring breathing, administering medications, suctioning secretions, providing education and promoting lifestyle changes to improve lung health.
This document summarizes the human respiratory system. It describes the major parts including the nostrils, pharynx, larynx, trachea, bronchi, bronchioles and alveoli. It explains how breathing occurs through inspiration and expiration, driven by contractions of the diaphragm and intercostal muscles. Gas exchange takes place in the alveoli and oxygen and carbon dioxide are transported in the blood and tissues. Regulation of respiration maintains appropriate rates. Common respiratory disorders like asthma and emphysema are also outlined.
This document provides information on interstitial lung disease from a seminar presented by Ms. Saheli Chakraborty. It defines interstitial lung disease as progressive scarring of lung tissue. It discusses the objectives, introduction, definition, etiology, risk factors, pathophysiology, clinical manifestations, diagnostic evaluations, complications, management, nursing management, nursing diagnoses and common types of interstitial lung diseases including sarcoidosis, idiopathic pulmonary fibrosis, interstitial pneumonia, asbestosis and acute interstitial pneumonitis.
Design of artificial respiratory modelShîvãm Gûptå
Design of Artificial Respiratory Model.. Know about the respiratory system.
The respiratory system consists of the upper respiratory tract (nasal passages), the airway conduction system (larynx, trachea, bronchi, bronchioles and terminal bronchioles), and the lower respiratory tract (alveolar ducts and alveoli). Not all segments of the respiratory system mature at the same pace. The olfactory epithelium matures earliest by PND 7. The lung, however, is not considered mature until PND 21, when alveolarization and microvascular maturation are complete. This chapter will discuss the embryological development (briefly), adult histomorphology, and postnatal histologic development of each major component of the respiratory system.
The document defines oxygenation as the delivery of oxygen to body tissues and cells, describes the physiological process of oxygen transport from the lungs to cells, and outlines factors that can affect oxygen levels as well as signs and symptoms of hypoxia. It also provides details on administering oxygen to improve uptake and delivery through various methods and equipment.
Similar to Chapter (34)-new-Medical Nutrition Therapy for Pulmonary Diseases (3).pdf (20)
End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
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English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
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2. • During fetal life, from birth to maturity, and
throughout adulthood, the pulmonary
system is intertwined with nutrition.
• Optimal nutrition permits the proper growth
and development of the respiratory organs,
supporting structures of the skeleton and
muscles, and related nervous, circulatory,
and immunologic systems.
2
3. • A well-functioning pulmonary system enables the
body to obtain the oxygen needed to meet its
cellular demands for energy from macronutrients
and to remove metabolic byproducts.
• Overall, a person’s nutritional well-being and
proper metabolism of nutrients are essential for
the formation, development, growth, maturity,
and protection of healthy lungs and associated
processes throughout life.
3
4. THE PULMONARY SYSTEM
• The respiratory structures include the
nose, pharynx, larynx, trachea, bronchi,
bronchioles, alveolar ducts, and alveoli.
• Supporting structures include the skeleton
and the muscles (e.g., the intercostal,
abdominal, and diaphragm muscles).
• Within a month after conception,
pulmonary structures are recognizable.
4
5. • The pulmonary system grows and matures
during gestation and childhood, and no
new alveoli are produced after
approximately age 20 years.
• As aging occurs, there is a loss of lung
capillaries and the lungs lose elasticity.
5
7. • The lungs enable the body to obtain the
oxygen needed to meet its cellular
metabolic demands and to remove the
carbon dioxide (CO2) produced.
• Healthy nerves, blood, and lymph are
needed to supply oxygen and nutrients to
all tissues.
7
8. • The lungs also filter, warm, and humidify
inspired air.
• The respiratory center is the name for
structures involved in the generation of
rhythmic respiratory movements and
reflexes, and is located in the medulla and
pons.
8
10. • The electrical impulses generated by the
respiratory center are carried by the
phrenic nerves to the diaphragm and other
respiratory muscles.
• Contraction of diaphragm and other
muscles increases the intrathoracic
volume, which creates negative
intrathoracic pressure and allows air to be
sucked in.
10
11. • The air traverses through upper and lower
airways and reaches alveoli.
• The alveoli are surrounded by capillaries
where gas exchange takes place.
• The large pulmonary blood vessels and the
conducting airways are located in a well
defined connective tissue compartment —
the pleural cavity.
11
12. • The lungs are an important part of the body’s
immune defense system, because inspired
air is laden with particles and
microorganisms.
• Mucus keeps the airways moist and traps the
particles and microorganisms from inspired
air.
• The airways have 12 types of epithelial cells,
and most cells that line the trachea, bronchi,
and bronchioles have cilia.
12
13. • The cilia are “hair-like” structures that
move the superficial liquid lining layer from
deep within the lungs, toward the pharynx
to enter the gastrointestinal tract, thereby
playing an important role as a lung defense
mechanism by clearing bacteria and other
foreign bodies.
• Each time a person swallows, the particle-
and microorganism- containing mucus
passes into the digestive tract.
13
14. • When bacteria inhaled by the patient are
not cleared effectively, the patient is prone
to develop recurrent chest infections that
may eventually lead to bronchiectasis.
14
15. • The epithelial surface of the alveoli
contains macrophages. By the process of
phagocytosis, these alveolar macrophages
engulf inhaled inert materials and
microorganisms and digest them.
15
16. • The alveolar cells also secrete surfactant,
a compound synthesized from proteins and
phospholipids that maintains the stability of
pulmonary tissue by reducing the surface
tension of fluids that coat the lung.
16
17. • The lungs have several metabolic
functions. For example, they help regulate
the body’s acid-base balance.
• The body’s pH is maintained partially by
the proper balance of CO2 and O2.
17
18. • The lungs also synthesize arachidonic acid
that ultimately may be converted to
prostaglandins or leukotrienes. These
appear to play a role in bronchoconstriction
seen in asthma.
18
19. • The lungs convert angiotension I to
angiotensin II by the angiotension-
converting enzyme (ACE) found mainly in
the numerous capillary beds of the lungs.
Angiotensin II increases blood pressure.
19
20. • Because of the ultrastructure and the fact
that they receive the total cardiac output,
lungs are well suited to function as a
chemical filter.
• They protect the systemic circulation from
exposure to high levels of circulating
vasoactive substances.
20
21. • Although serotonin, 5-hydroxytryptamine (5
HT), and norepinephrine are totally or
partially eliminated or inactivated in the
pulmonary circulation, epinephrine and
histamines pass through the lungs
unchanged.
21
22. Effect of Malnutrition on the Pulmonary System
• The relationship between malnutrition and
respiratory disease has long been
recognized.
• Malnutrition adversely affects lung
structure, elasticity, and function;
respiratory muscle mass, strength, and
endurance; lung immune defense
mechanisms; and control of breathing.
22
23. • For example, protein and iron deficiencies
result in low hemoglobin levels that
diminish the oxygen- carrying capacity of
the blood.
• Low levels of calcium, magnesium,
phosphorus, and potassium compromise
respiratory muscle function at the cellular
level.
23
24. • Hypoalbuminemia, as measured by serum
albumen, contributes to the development of
pulmonary edema by decreasing colloid
osmotic pressure, allowing body fluids to
move into the interstitial space.
• Decreased levels of surfactant contribute
to the collapse of alveoli, thereby
increasing the work of breathing.
24
25. • The supporting connective tissue of the
lungs is composed of collagen, which
requires ascorbic acid for its synthesis.
• Normal airway mucus is a substance
consisting of water, glycoproteins, and
electrolytes, and thus requires adequate
nutritional intake.
25
26. Effect of Pulmonary Disease on Nutritional Status
• Pulmonary disease substantially increases
energy requirements. This factor explains
the rationale for including body composition
and weight parameters in nutrition
assessment.
• Weight loss from inadequate energy intake
is significantly correlated with a poor
prognosis in persons with pulmonary
diseases.
26
27. • Malnutrition leading to impaired immunity
places any patient at high risk for
developing respiratory infections.
• Malnourished patients with pulmonary
disease who are hospitalized are likely to
have lengthy stays and are susceptible to
increased morbidity and mortality.
27
28. • The complications of pulmonary diseases
or their treatments can make adequate
food intake and digestion difficult.
• Absorption and metabolism of most
nutrients are affected.
28
29. • As pulmonary disease progresses, several
conditions may interfere with food intake
and overall nutrition status.
• For example, abnormal production of
sputum, vomiting, tachypnea (rapid
breathing), hemoptysis, thoracic pain, nasal
polyps, anemia, depression, and altered
taste secondary to medications are often
present.
29
31. Medical Management
• Pulmonary system disorders may be
categorized as primary, such as
tuberculosis (TB), bronchial asthma, and
cancer of the lung; or secondary when
associated with cardiovascular disease,
obesity, human immunodeficiency virus
(HIV) infection, sickle cell disease, or
scoliosis. Conditions also may be acute or
chronic.
31
32. • Examples of acute conditions include
aspiration pneumonia, airway obstruction
from foods such as peanuts, and allergic
anaphylaxis from consumption of shellfish.
• Examples of chronic conditions include
cystic fibrosis (CF) and chronic obstructive
pulmonary disease (COPD).
32
33. • The assessment of pulmonary status
generally starts with physical examination
using percussion and auscultation.
• These bedside techniques provide important
information on the patient’s breathing.
• Numerous diagnostic and monitoring tests
such as imaging procedures, arterial blood
gas determinations, sputum cultures, and
biopsies also can be employed.
33
34. • Signs and symptoms of pulmonary disease
include cough, dyspnea (shortness of
breath), fatigue, early satiety, anorexia, and
weight loss.
34
35. • Pulmonary function tests are used to
diagnose or monitor the status of lung
disease; they are designed to measure the
ability of the respiratory system to
exchange oxygen and CO2.
35
36. • Pulse oximetry is one such test. A small
device called a pulse oximeter, which uses
light waves to measure the oxygen
saturation of arterial blood, is placed on the
end of the finger.
• Normal for a young, healthy person is 95%
to 99%.
36
38. • Spirometry is another common pulmonary
function test.
• This involves breathing into a spirometer
that gives information on lung volume and
the rate at which air can be inhaled and
exhaled.
38
40. CHRONIC PULMONARY DISEASE
ASTHMA
• Asthma is a chronic disorder that affects
the airways and is characterized by
bronchial hyper-reactivity, reversible airflow
obstruction, and airway remodeling.
40
41. • Asthmatic symptoms include periodic
episodes of chest tightness,
breathlessness, and wheezing.
• Asthma has become more prevalent and
has been increasing at the rate of 25% to
75% every decade since 1960 in
westernized countries.
41
42. Pathophysiology
• Asthma is the result of a complex
interaction between environmental
exposures and genetics.
• When people are genetically susceptible,
environmental factors exacerbate airway
hyper-responsiveness, airway
inflammation, and atopy (tendency to
develop allergic reaction) that eventually
leads to asthma.
42
43. • Environmental factors that are linked to the
development of asthma include indoor
allergies (dust mites, animal allergies) and
outdoor allergies (pollen and fungi).
43
44. • Increased risk of asthma development also
has been linked to air pollution, tobacco
smoke exposure, small size at birth,
respiratory infection, and lower
socioeconomic status.
44
45. • Clinicians identify three key areas when
diagnosing asthma:
1. Airflow obstruction that is at least partially
reversible
2. Airflow obstruction that recurs
3. Exclusion of other diagnoses
45
46. • Symptoms such as wheezing, coughing,
shortness of breath, and chest tightness
occur in most patients, and symptoms that
worsen at night is a common feature.
46
47. • Although allergic asthma or “extrinsic
asthma” is due to chronic allergic
inflammation of the airways, “intrinsic
asthma” is triggered by nonallergic factors
such as exercise, certain chemicals, and
extreme emotions.
47
48. • A life-threatening situation with markedly narrow
airways, known as status asthmaticus, can result
when asthma has not been treated properly.
• Corticosteroid therapy is often prescribed, but
chronic use may place the individual at risk for
osteopenia (precursor to osteoporosis), bone
fractures, or steroid-induced hyperglycemia.
• Some evidence supports the effectiveness of
sublingual immunotherapy in the treatment of
asthma and rhinitis, but more studies are needed
on optimal dosages.
48
49. Medical Management
• The essential components of asthma
therapy are routine monitoring of
symptoms and lung function, patient
education, control of environmental
triggers, and pharmacotherapy.
• Pharmacologic treatment must be tailored
to the individual patient and is used in a
stepwise manner.
49
50. • The medications and the regime chosen
depend on the severity of the asthma,
which can be classified as an acute attack,
intermittent, mild persistent, moderate
persistent, or severe persistent. Quick
relief and long-term controller medications
are used as therapy for asthma.
50
51. • Although quick-relief medications include
short-acting beta agonists (bronchodilators)
and steroid pills, long-term controller
medications include inhaled long-acting
beta agonists and leukotriene modifiers.
• Inhaled corticosteroids are the cornerstone
of pharmacologic management with
persistent asthma.
51
52. • Some younger patients with refractory
asthma need maintenance doses of
systemic steroids.
• Because steroids change bone metabolism
and the development of osteoporosis,
these children benefit from increased
calcium intake.
52
54. • Two newer therapies are anti-IgE (anti-
immunoglobulin E) therapy and bronchial
thermoplasty, which are used in selected cases
of severe asthma.
• Immunomodulator therapies with anti-IL-5 (anti-
interleukin-5) antibodies, anti-IL-4 alpha subunit
antibodies, human necrosis factor TNF-alpha
(tumor necrosis factor-alpha) inhibitors, and the
use of macrolide antibiotics for their
antiinflammatory actions are some of the
experimental approaches.
54
55. • Antibiotics for exacerbation of asthma are
not recommended by current clinical
practice guidelines, because respiratory
infection triggering asthma attacks are
more often viral rather than bacterial.
55
56. Medical Nutrition Therapy
• When treating asthma, the dietitian
nutritionist addresses the dietary triggers,
corrects energy and nutrient deficiencies
and excesses in the diet, educates the
patient on a personalized diet that provides
optimal levels of nutrients, monitors growth
in children, and watches for food-drug
interactions.
56
57. • Modulation of antioxidant intake with
nutritional supplementation has a beneficial
effect on the severity and progression of
asthma.
• Although a slight inverse association was
seen between a low vitamin E intake and
wheezing symptoms, no association was
found between vitamin E and asthma.
57
58. • Further studies are required to understand
the mechanism of vitamin E on the
inflammation of the immune system.
• Low blood carotenoid levels also have
been linked with asthma.
58
59. • A diet rich in antioxidants and
monounsaturated fats seems to have a
protective effect on childhood asthma by
counteracting oxidative stress.
• Studies have also associated asthma with
reduced selenium status.
59
60. • In the childhood asthma prevention study
omega-3 polyunsaturated fatty acid (PUFA)
fish oil was supplemented throughout
childhood and wheezing was reduced.
• This effect did not continue into later
childhood. Supplementation of vitamin C
and zinc also have been reported to
improve asthma symptoms and lung
function.
60
61. • In one study an insufficient serum level of
less than 30 ng/dL of vitamin D was
associated with an increase in asthma
exacerbation in the form of ER visits and
hospitalizations.
• In another, high doses of vitamin D
supplementation were not shown to have
any protective effect.
61
62. • A higher than desirable BMI during
childhood is associated with a significant
increase in the development of asthma.
• Institution of diets that help with weight loss
in asthmatic obese children seem to show
improvements with the control of asthma,
static lung function, and improved quality of
life.
62
63. • Gastroesophageal reflux disease (GERD) and
food allergens are the two most common dietary
triggers for asthma. GERD is highly prevalent in
asthmatic patients.
• A critical component of medical nutrition therapy
for asthmatic patients is a diet free of known
irritants such as spicy foods, caffeine,
chocolate, and acidic foods Limiting the intake
of high fat foods and portion control can prevent
gastric secretions, which exacerbate GERD.
63
64. • Food allergens and food additives are
other potential dietary triggers for asthma.
• An immunoglobulin E-mediated reaction to
a food protein can lead to
bronchoconstriction.
• Completely avoiding the allergenic food
protein is the only dietary treatment
currently available for food allergies.
64
65. • Some sulfites, such as potassium
metasulfite and sodium sulfide, used in the
processing of foods, have been found to be
a trigger for asthmatics.
• Some asthma patients need maintenance
oral steroids, and these patients are prone
to develop drug-nutrient interaction
problems.
65
66. CHRONIC OBSTRUCTIVE PULMONARY DISEASE
• COPD is now the third most common cause of
death in the world and is predicted to be the fifth
most common cause of disability by 2020.
• Smoke from cigarettes is a major risk factor,
along with that from biomass fuel used for
cooking and heating in rural areas of developing
countries.
• Occupational smoke or dust, air pollution, and
genetic factors are also factors in the
development of COPD.
66
68. • Patients with COPD suffer from decreased
food intake and malnutrition that causes
respiratory muscle weakness, increased
disability, increased susceptibility to
infections, and hormonal alterations.
68
69. Pathophysiology
• COPD is a term that encompasses chronic
bronchitis (a long-term condition of COPD
in which inflamed bronchi lead to mucus,
cough and difficulty breathing) and
emphysema (a form of long-term lung
disease characterized by the destruction of
lung parenchyma with lack of elastic recoil).
• These conditions may coexist in varying
degrees and are generally not reversible.
69
70. • Patients with primary emphysema suffer
from greater dyspnea and cachexia.
• On the other hand patients with bronchitis
have hypoxia, hypercapnia (increased
amount of carbon dioxide), and
complications such as pulmonary
hypertension and right heart failure.
70
72. • Alpha-1 antitrypsin deficiency is present in
1% to 2% of COPD patients and is likely
underrecognized.
• COPD exacerbations can be caused by
Haemophilus influenzae, Moraxella
catarrhalis, S. pneumonia, rhinovirus,
coronavirus, and to a lesser degree,
organisms such as P. aeruginosa, S.
aureus, Mycoplasma spp., and Chlamydia
pneumoniae.
72
73. • Allergies, smoking, congestive heart failure,
pulmonary embolism, pneumonia, and systemic
infections are the reason for 20% to 40% of
COPD exacerbations.
• Although cigarette smoking is considered a
major risk factor for developing COPD, only
about 20% of smokers develop the disease.
• Osteoporosis in COPD patients not only
predisposes patients to painful vertebral
fractures but also affects lung function by
altering the configuration of the chest wall.
73
74. • Frequent acute exacerbations in COPD patients
increase the severity of chronic system inflammation.
• This leads to bone loss by inhibiting bone
metabolism. Lack of sun exposure and physical
activity with COPD leads to a lack of 25-hydroxy
vitamin D (25-OHD), which regulates bone
metabolism by promoting the absorption of calcium.
• Factors that influence the prognosis of COPD are
the severity of disease, genetic predisposition,
nutritional status, environmental exposures, and
acute exacerbations.
74
75. Medical Management
• In general, COPD therapies have a limited effect
compared with therapies in asthma. No disease-
modifying medications exist that can change the
progression of airway obstruction in COPD.
• Inhaled bronchodilators remain the mainstay of
treatment for COPD patients. Usually these are
given by metered dose inhalers (MDI), but for
severe dyspnea, may be administered in a
nebulized form.
75
76. • Anticholinergic medications such as
ipratropium bromide or Spiriva (tiotropium
bromide), a long-acting anticholinergic
agent with specificity for muscarinic
receptors, can be added to the treatment.
Theophylline continues to be used in some
cases.
76
77. • Inhaled steroids and a trial of oral steroids
may be required for some patients.
• Antibiotics often are prescribed when an
exacerbation is considered to be due to
bacterial infection.
77
78. • Pulmonary hypertension is a risk factor that shortens life
expectancy and is common in advanced COPD.
• The first step in treating pulmonary hypertension in
patients with COPD is appropriate management of their
obstructive lung disease as mentioned earlier.
• The exact indication for pulmonary hypertension specific
therapies in COPD patients is unclear.
• Current recommendations state that pulmonary
hypertension specific therapies should be considered
when pulmonary hypertension is persistent despite
optimization of COPD management and when pulmonary
hypertension is out of proportion to the degree of air flow
obstruction.
78
79. • Patients who are hypoxemic need supplemental oxygen.
Pulmonary rehabilitation may be helpful in advanced
COPD.
• Patients with severe COPD may suffer respiratory failure
related to complications such as pneumothorax,
pneumonia, and congestive heart failure, or due to
uncontrolled administration of high-dose oxygen or
narcotic sedatives.
• The patients in respiratory failure need mechanical
ventilation. In addition to facing major physical
impairment and chronic dyspnea, COPD patients are at
an increased risk of developing depression that should be
identified and treated.
79
81. Medical Nutrition Therapy
• Malnutrition is a common problem
associated with COPD, with prevalence
rates of 30% to 60% due to the extra
energy required by the work of breathing
and frequent and recurrent respiratory
infections.
• Breathing with normal lungs expends 36 to
72 kcal/day; it increases 10-fold in patients
with COPD.
81
82. • Infection with fever increases metabolic rate even
further.
• An independent predictor of increased mortality in
COPD patients is low body weight. Weight loss in
advanced COPD is considered an independent risk
factor for mortality, whereas weight gain reverses
the negative effect of decreased body weight.
• Low body weight is due to poor nutritional intake,
an increased metabolic rate, or both. Inadequate
food intake and poor appetite are the primary
targets for intervention in patients with COPD.
82
83. • These two issues mean COPD patients struggle
to meet their nutritional needs. Depletion of
protein and vital minerals such as calcium,
magnesium, potassium, and phosphorus
contribute to respiratory muscle function
impairment.
• In severe malnutrition inadequate electrolyte
repletion during aggressive nutrition repletion can
lead to severe metabolic consequences related
to refeeding syndrome.
83
84. • There are two main goals in managing the
hypermetabolism seen in stable COPD:
1) the prevention of weight loss, and
2) the prevention of the loss of lean body
mass (LBM).
84
85. • These goals can be achieved by ensuring the
following:
• Small frequent meals that are nutritionally dense
• The patient eats the main meal when energy level is
at its highest
• Adequate calories, protein, vitamins, and minerals to
maintain a desirable weight - a BMI of 20 to 24 kg/m2
• Availability of foods that require less preparation and
can be heated easily in a microwave oven
• Limitation of alcohol to fewer than 2 drinks/day (30 g
alcohol)
• A period of rest before mealtimes
85
86. • People with COPD suffer a poor prognosis
when they have malnutrition that predisposes
them to infections.
• The ability to produce lung surfactant,
exercise tolerance, and respiratory muscle
force are reduced in the presence of
infection.
• Weight loss leads to an increased load on the
respiratory muscles, contributing to the onset
of acute respiratory failure.
86
87. • Many factors affect nutritional status during
the progression of COPD.
• Although body weight and BMI should be
followed because they are easily obtained
markers of nutritional status in patients,
they can underestimate the extent of
nutritional impairment.
87
88. • Current evidence suggests that a prudent
diet pattern helps in protecting smokers
against malnutrition.
• A combination of nutritional counseling and
nicotine replacement seems to optimize
success.
88
89. • Studies have shown an inverse relationship
between dietary iron and calcium intake
and COPD risk.
• Iron deficiency anemia is seen in 10% to
30% of patients with COPD. It has been
seen that correcting the anemia and iron
deficiency by either blood transfusions or
intravenous iron therapy improves dyspnea
in COPD patients.
89
90. • COPD patients are also at higher risk of
developing osteoporosis resulting from
steroid usage, smoking, and vitamin D
depletion.
• Maintaining adequate levels of vitamin D
(25-OHD) is a health-promoting strategy
for COPD patients.
90
91. • The primary goals of nutrition care for
patients with COPD are to facilitate
nutritional well-being, maintain an
appropriate ratio of lean body mass to
adipose tissue, correct fluid imbalance,
manage drug-nutrient interactions, and
prevent osteoporosis.
• Nutritional depletion may be evidenced
clinically by low body weight for height and
decreased grip strength.
91
92. • Calculation of BMI may be insufficient to
detect changes in fat and muscle mass.
• Instead, determination of body composition
helps to differentiate lean muscle mass
from adipose tissue and overhydration
from dehydration.
92
93. • In patients with cor pulmonale (increased
blood pressure which leads to enlargement and
failure of the right ventricle of the heart) and the
resultant fluid retention, weight maintenance, or
gain from fluid may camouflage actual wasting
of lean body mass.
• Thus for patients retaining fluids, careful
interpretation of anthropometric measurements,
biochemical indicators, and functional
measures of nutrition status is Necessary.
93
94. • A combination of nutritional supplements
and anabolic steroids can increase muscle
mass and reverse any negative effects of
weight loss.
• Exercise tolerance has been shown to
improve with a dietary supplement that
contains omega-3 PUFA, which has anti-
inflammatory effects.
94
95. • Adipokines is a generic term for the
bioactive proteins that are secreted by
adipocytes. They include adiponectin,
leptin, IL-6, and TNF-alpha. They play a
vital role in influencing the nutritional status
and regulating the appetite.
95
96. • Leptin (satiety hormone) is secreted
promptly in response to food intake, and
plays a role in suppressing appetite and
enhancing energy expenditure.
• It has been suggested that measuring
levels of leptin in the sputum can be useful
in determining the severity of lung disease
because it has been shown to increase
during acute exacerbations.
96
97. • Adiponectin (a protein involved in fatty
acid breakdown and glucose regulation),
like leptin, is secreted from adipocytes, but
has an opposite effect.
• Adiponectin enhances appetite, has an
antiinflammatory, antidiabetic, and
antiatherosclerotic effect and is considered
beneficial.
97
98. • Resistin, another adipokine, induces
inflammation and insulin resistance.
• In addition to being an appetite stimulant,
ghrelin also stimulates growth hormone
secretion, with antagonistic effects to
leptin.
98
100. Macronutrients
• In stable COPD, requirements for water,
protein, fat, and carbohydrate are determined
by the underlying lung disease, oxygen therapy,
medications, weight status, and any acute fluid
fluctuations.
• Attention to the metabolic side effects of
malnutrition and the role of individual amino
acids is necessary.
• Determination of a specific patient’s
macronutrient needs is made on an individual
basis, with close monitoring of outcomes.
100
stable and unstable
101. Energy
• Meeting energy needs can be difficult. For
patients participating in pulmonary
rehabilitation programs, energy
requirements depend on the intensity and
frequency of exercise therapy and can be
increased or decreased.
• It is crucial to remember that energy
balance and nitrogen balance are
intertwined.
101
zero or positive balance
102. • Consequently, maintaining optimal energy balance is
essential to preserving visceral and somatic proteins.
• Preferably, indirect calorimetry should be used to
determine energy needs and to prescribe and
monitor the provision of sufficient, but not excessive
calories.
• When energy equations are used for prediction of
needs, increases for physiologic stress must be
included.
• Caloric needs may vary significantly from one person
to the next and even in the same individual over time.
102
103. Fat
• Omega-3 and omega-6 are PUFAs that are
essential fatty acids.
• The simplest forms of these fatty acids are the
omega-6 linoleic acid (LA) and alpha-linolenic acid
(ALA). The body is unable to synthesize them, and
they must be consumed in the human diet.
• These fatty acids are desaturated to form long chain
omega-3 PUFAs or omega-6 PUFAs.
Docosahexaenoic acid (DHA) and eicosapentaenoic
acid (EPA) and alpha-linolenic acid (ALA) are the
major omega-3 PUFAs, and the major long-chain
omega–6 fatty acids are linoleic acid (LA) and
arachidonic acid (AA).
103
essential fatty acids
to reduce
inflammation
two omega-3 are EPA and DHA
104. • In theory, intake of long-chain omega-3
PUFAs, which reduces inflammation,
should improve the efficacy of COPD
treatments. PUFA supplementation is
beneficial in COPD, but various factors
such as supplement adherence,
comorbidities, and duration of the
supplementation play vital roles.
104
105. • Dietary supplementation of DHA and AA
has been shown to delay and reduce risk
of upper respiratory infections and asthma,
with lowering the incidence of bronchiolitis
during the first year of life.
• Data from various studies have shown the
positive impact of long-chain PUFAs in
initiating and providing resolution of
inflammation in respiratory diseases.
105
106. • It has been shown that aspirin helps to
trigger resolvin, a molecule naturally made
by the body from omega-3 fatty acids.
• Resolvin resolves or turns off the
inflammation in underlying destructive
conditions such as inflammatory lung
diseases.
106
107. Protein
• Sufficient protein of 1.2 to 1.5 g/kg of dry body
weight is necessary to maintain or restore lung
and muscle strength, as well as to promote
immune function.
• A balanced ratio of protein (15% to 20% of
calories) with fat (30% to 45% of calories) and
carbohydrate (40% to 55% of calories) is
important to preserve a satisfactory respiratory
quotient (RQ) from substrate metabolism use.
107
depends on each
case
COPD needs
more protein
108. • Repletion but not overfeeding is particularly
critical in patients with compromised ability
to exchange gases as excess feeding of
calories results in CO2 that must be
expelled.
• Other concurrent disease processes such
as cardiovascular or renal disease, cancer,
or diabetes affect the total amounts, ratios,
and kinds of protein, fat, and carbohydrate
prescribed.
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109. Vitamins and Minerals
• As with macronutrients, vitamin and
mineral requirements for individuals with
stable COPD depend on the underlying
pathologic conditions of the lung, other
concurrent diseases, medical treatments,
weight status, and bone mineral density.
• For people continuing to smoke tobacco,
additional vitamin C is necessary.
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110. • The role of minerals such as magnesium
and calcium in muscle contraction and
relaxation may be important for people with
COPD.
• Intakes at least equivalent to the dietary
reference intake (DRI) should be provided.
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111. • Depending on bone mineral density test
results, coupled with food intake history
and glucocorticoid medications use,
additional vitamins D and K also may be
necessary.
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112. • Patients with cor pulmonale and
subsequent fluid retention require sodium
and fluid restriction.
• Depending on the diuretics prescribed,
increased potassium supplementation may
be required.
• And other water soluble vitamins,
particularly thiamin, may need to be
supplemented.
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113. • Patients are recommended to drink
adequate fluids and stay hydrated to help
sputum consistency and easier
expectoration.
• The Parenteral and Enteral Nutrition Group
(PENG) recommends a fluid intake of 35
ml/kg body weight daily for adults 18 to 60
years and 30 ml of fluid/kg body daily for
adults over 60 years.
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114. • COPD patients report difficulties with
eating because of low appetite, increased
breathlessness when eating, difficulty
shopping and preparing meals, dry mouth,
early satiety and bloating, anxiety and
depression, and fatigue.
• In addition to the above, inefficient and
overworking respiratory muscles lead to
increased nutritional requirements.
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best time to eat is after resting so they have energy to eat
115. Patients in the Advanced Stage of COPD
• Patients with advanced COPD are
undernourished and in a state of pulmonary
cachexia.
• The cause of cachexia in advanced COPD is
poorly understood. The role for myostatin has
been suggested. Myostatin is a member of the
transforming growth factor-beta super family
that functions as a negative regulator of muscle
growth.
• These cachectic patients have anorexia as a
typical symptom.
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116. • Pulmonary cachexia is an independent risk
factor and is common in the advanced
stage of COPD.
• Pharmacotherapy and non pharmaco
therapeutic treatments such as respiratory
rehabilitation and nutrition counseling are
the mainstays of COPD treatment in such
patients.
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117. • Sarcopenia and cachexia result from the
accelerated loss of lean tissue. This muscle
wasting has a detrimental effect on the
respiratory function.
• Osteoporosis exists as a significant
problem in 24% to 69% of patients with
advanced COPD. Any sudden drop in
height is a mark of developing
osteoporosis.
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important to maintain normal weight
118. • As COPD progresses, osteoporosis results
because of immobility, which also leads to
deconditioning and dyspnea.
• Smoking, low BMI, low skeletal muscle
mass, and corticosteroid usage can lead to
bone loss along with low serum vitamin D
levels.
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