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Definitions
Tachycardia: Heart Rate > 90 beats/ minute
Tachypnea: Respirations/ minute >20
Dyspnea: Shortness of Breath (SOB)
Orthopnea: SOB when in a supine positionParoxysmalNoctural Dyspnea: SOB upon awakeningNocturia: Frequent nightime urination
CONGESTIVE HEART FAILURE
Congestive heart failure (or heart failure) is a condition in which the heart can't pump enough blood to meet the needs of the body's other organs. This can result from
• narrowed arteries that supply blood to the heart muscle
• past heart attack, or myocardial infarction , with scar tissue that interferes with the heart muscle's normal work.
• high blood pressure. • cardiomyopathy . • congenital heart disease. • infection of the heart valves and/or
heart muscle itself - endocarditis and/or myocarditis.
What does CHF feel like?
Because the "failing" heart is an inefficient pump CHF causessufferers to become SOB and tired.
Blood flow from heart
Blood returning to heart“Backs Up” causing tissue tobecome congested
Congestion causes swelling inlegs/ankles and, possibly, the lungs
Heart failure also affects the ability of the kidneys to dispose of sodium and water. The retained water increases theedema.
Congestive heart failure usually requires a treatment program of
• rest • proper diet • modified daily activities • surgery or drugs such as
A.C.E. or angiotensin converting enzyme inhibitors and vasodilators expand blood vessels and decrease resistance
blood then flows more easily and makes the heart's work easier or more efficient.
Some beta blockers can improve the function of the left ventricle .
Digitalis increases the pumping action of theheart.
Diuretics help the body eliminate excess salt and water.
Nutritional Interventions in CHF include:
• < 3 grams Na; if large dose diuretics taken, reduce <2 g Na.
• Eliminate or limit alcohol intake to 1 drink/day.
• Adequate protein/kcal intake so serum albumin > 3.5 g/dlBMI <25.
• Encourage physical activity
• Consider thiamin supplementation if large dose diureticsgiven.
• Avoid excessive fluid intakes; Quit Smoking!
Chronic Bronchitis (an infectious condition)Emphysema (a non-infectious condition)Bronchitis (Asthmatic, Chronic Obstructive et al.)
Most Common COPD condition=
Emphysema + Bronchitis
Chronic Obstructive Pulmonary Disease
Symptomatology in COPD
Patients often present with:
Fatigue, SOB, productive cough,
wheezing
Caused by: Obstructed of airflow out of the lungs
May be accompanied by:Precipitous weight lossPersistent viral illness (e.g.,
colds)
Treatments for COPD are palliative and focused on QOL.
Stop smoking
Maintain a healthy weightEngage in moderate physical activity
Drink lots of fluids (8-12 cups/ day; low caffeine) Vitamin A intake of 25,000-50,000 units/day
(Vegetables and fruit)Limit simple CHO / replace with fat
Causes Treatment Goals
Physiologic Stress Prevent progression (e.g., surgical, infectious, etc.) of resp. failureAspiration Pneumonia Preserve immunePulmonary Emboli system with highAllergic Rxns protein/kcal
without causingThe Problem? respiratory distress
Insufficient oxygenation of tissueswith excess CO2 retention supports lung fxn &
prevents infections
Weak Muscles Less Forceful Breathing
Poor Respiration Poor Circulation
Poor Nutrition Pulmonary InfectionsEdema
Acute Respiratory Failure
Mechanical Ventilator
Fuel Utilization and Lung FunctionFuel Utilization and Lung Function
Respiratory Quotient (RQ): ratio of CORespiratory Quotient (RQ): ratio of CO22 produced produced to Oto O22 consumed. consumed.
RQ RQ
CO2 produced CO2 produced
Workload for respiratoryWorkload for respiratory systemsystem
RQ
Glucose Oxidation = 1.00
Triglyceride Oxidation = 0.71 0.82
Amino Acid Oxidation = 0.80
High Kcals or Adequate Kcals with excessive glucose
Increased Lung Workload
Difficulty in Weaning from Mechanical Ventilator
Decrease Kcals or Replace glucose with fat to lower RQ
Nutrient Requirements
Kcals: 25 to 35 nonprotein kcal/kg/day (maintenance)45 nonprotein kcal/kg/day (anabolism/severe stress)
Protein: 1.5 g/kg2-2.5 g/kg in severe stress
30-60% of kcal lipids
Fluid and Sodium Restrictions
Ease Pulmonary Edema
Lung Muscle Tissue Maintainedby optimal Ca, Mg, PO4
Acid-Base Balance
Acid Base
pH < 7 pH=7 pH > 7
Normal Physiological pH = 7.35-7.45
Extreme acidosis = <6.8
Extreme alkalosis= >7.8
Regulation of Acid-Base Balance
Body has components that act in Seconds,Minutes, and Hours/Days to combat pH changes.
Seconds… Chemical Buffers:
Inside cells: phosphate buffers(NaH2PO4= acid or hydrogen donor; Na2HPO4= base or hydrogen acceptor)In Bloodstream: serum proteins (Hgb)
Minutes… Respiration Rate Controls plasma CO2 plasma CO2 Respiration Rate plasma pH
plasma CO2 Respiration Rate plasma pH
Hours/ Days… Renal Function Controls PlasmaPlasma Bicarbonate (HCO3) Levels.
How to Measure Acid-Base Status?
ABGs = Arterial Blood Gases
All are expressed “partial pressures” because thereare many dissolved gases in blood.
Normal Values: pO2 = 80-100 mm Hg (NL = 90) pCO2 = 35-45 mm Hg (NL = 40)
pH = 7.35-7.45 (NL = 7.4) HCO3
-= 22-26 mEq/L (NL = 24)