COPD You deliver D.Z.\'s dietary tray, and he comments how hungry he is. As you

Question

COPD

You deliver D.Z.'s dietary tray, and he comments how hungry he is. As you leave the room, he is rapidly consuming the mashed potatoes. When you pick up the tray, you notice that he hasn't touched anything else. When you question him, he states, "I don't understand it. I can be so hungry, but when I start to eat, I have trouble breathing and I have to stop."

One theory for the increased work of breathing is based on carbohydrate (CHO) loading. D.Z.'s wife approaches you in the hallway and says, "I don't know what to do. My husband used to be so active before he retired 6 months ago. Since then he's lost 35 pounds. He is afraid to take a bath, and it takes him hours to dress—that's if he gets dressed at all. He has gone downhill so fast that it scares me. He's afraid to do anything for himself. He wants me in the room with him all the time, but if I try to talk with him, he snarls and does things to irritate me. I have to keep working. His medical bills are draining all of our savings, and I have to be able to support myself when he's gone. You know, sometimes I go to work just to get away from the house and his constant demands. He calls me several times a day asking me to come home, but I can't go home. You may not think I'm much of a wife, but quite honestly, I don't want to come home anymore. I just don't know what to do."

How would you respond to her statement?

What education will you provide for this patient and his wife?

Explanation / Answer

For most people, breathing is unconscious and perceived as effortless. Yet, for many patients with COPD, breathing requires a conscious effort. Because of this added effort, patients can increase their resting energy expenditure (REE) by up to 10% to 15%.4

Reasons for his weight loss are difficulty swallowing or chewing due to dyspnea, chronic mouth breathing, which can alter the taste of food, chronic mucous production, coughing, fatigue, morning headache or confusion due to hypercapnia, anorexia, depression and side effect of medications.

Proper nutrition can help reduce carbon dioxide levels and improve breathing. Specifically, it is important to focus on the percentages of total carbohydrate, fat, and protein that patients consume to see how their diet composition impacts their respiratory quotient (RQ), which is defined as the ratio of carbon dioxide produced to oxygen consumed. Metabolism, carbohydrate, fat, and protein are all converted to carbon dioxide and water in the presence of oxygen. This means that eating carbohydrates will yield the most carbon dioxide. High-fat, low-carbohydrate diet would reduce the carbon dioxide production.

Based on her statements : I will clearly listen to her problems and observe her husband’s condition and behavior. First I will encourage her that not to worry abput anything and thing will be there only for temporary, She can overcome with it if she understands the condition and knows few methods to implement. people who suffers from chronic health problem they may develop some depression, anxiety confusion etc. that is the reason why he is behaving like this. With proper counseling, nutrition and medication we can improve his condition and we can let him to go on his work in few days.

Education to the patient and his Wife:-

-First counsel him and make him free from all his fears

- Maintain proper nutrition provide adequate energy and avoid weight loss.(Low carbohydrate and high - fat)

-Improve pulmonary status (With effective breathing by nebulaization and all)

-Educate his wife- do not get irritated and try adjust for a while and do not neglect him, provide love and affection.

-Ask patient to play some games

-Send him for the counseling as he is having psychiatric symptoms

-Use medication in time

-Educate her how to take care of him, how to bring him from his depression thoughts by taking to him, going out for walk, acompany him in every task, ask him to play games, solve puzzles and appreciate him for his succes

-Appreciate him for everyhting so that he will be boosted and would recover faster.

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