Esther is an 80-year-old widow who is a retired secretary. She started smoking when she was 15, and she smoked two packs per day until 7 years ago. She has been diagnosed with COPD and has been admitted to the rehabilitation center with a broken hip following a fall at home. Significant findings are weight 101 lb, height 5’3”, blood pressure 127/65 mm Hg, heart rate 82/minute, respiratory rate 18/minute, temperature 98.6° F, oxygen saturation 95% on 3L of O2. History and physical examination reveal severe dyspnea on exertion, including showering, carrying packages, making the bed, and pushing a vacuum cleaner; orthopnea (two or three pillows); and decreased breath sounds. Prescribed medications include theophylline (300 mg twice daily), prednisone (20 mg once daily in the morning), furosemide 20 mg twice daily, fluticasone (Flovent; 220 mcg, four puffs twice daily), albuterol and ipratropium (Atrovent; two puffs as needed). Over-the-counter medications include vitamin C (250 mg twice daily), and calcium (500 mg daily). She says she has no appetite and is eating very little. Her stated usual weight is 115 lbs and she admits to recent weight loss.
Nutrition Diagnosis Statement
Significant weight loss related to decreased food intake due to lung disease and surgery.
Nutrition Care Questions
1. What dietary interventions can you suggest to increase intake of calories and protein?
2. What are the interrelationships between chronic obstructive pulmonary disease, food intake, and nutrient metabolism?
3. Are there any food-drug interactions that are a concern for Esther? 4. What are the principles of medical nutrition therapy in this clinical situation? Explain the scientific rationale for each.
5. What do you think of Esther’s nutrient supplementation program? Would you have her change it?
6. You are planning a session on nutrition for the clients and their families who participate in the Pulmonary Rehabilitation Program. What topics would you cover? What educational techniques would you use?