Download Lecture One

Definitions
Tachycardia: Heart Rate > 90 beats/ m
Tachypnea: Respirations/ minute >20
Dyspnea:
Shortness of Breath (SO
Orthopnea: SOB when in a supine po
Paroxysmal
Noctural Dyspnea:
SOB upon awak
Nocturia:
Frequent nightime u
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 causes
sufferers to become SOB and tired.
Blood flow from heart
Blood returning to heart
“Backs Up” causing tissue to
become congested
Congestion causes swelling in
legs/ankles and, possibly,
the lungs
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 the
heart.
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/dl
BMI <25.
•
Encourage physical activity
•
Consider thiamin supplementation if large dose diuretics
given.
•
Avoid excessive fluid intakes; Quit Smoking!
Chronic Obstructive Pulmonary Disease
Chronic Bronchitis (an infectious condition)
Emphysema (a non-infectious condition)
Bronchitis (Asthmatic, Chronic Obstructive et al.)
Most Common COPD condition=
Emphysema + Bronchitis
Symptomatology in COPD
Patients often present with:
Fatigue, SOB,
productive cough, wheezing
Caused by:
lungs
Obstructed of airflow out of the
May be accompanied by:
Precipitous weight loss
Persistent viral illness (e.g., colds)
Treatments for COPD are palliative
and focused on QOL.
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
Maintain a healthy weight
Engage in moderate physical activity
Stop smoking
Causes
Physiologic Stress
(e.g., surgical, infectious, etc.)
Aspiration Pneumonia
Pulmonary Emboli
Allergic Rxns
The Problem?
Insufficient oxygenation of tissues
with excess CO2 retention
Treatment Goals
Prevent progression
of resp. failure
Preserve immune
system with high
protein/kcal
without causing
respiratory distress
supports lung fxn &
prevents infections
Weak Muscles
Poor Respiration
Poor Nutrition
Less Forceful Breathing
Poor Circulation
Pulmonary Infections
Edema
Acute Respiratory Failure
Mechanical Ventilator
Fuel Utilization and Lung Function
Respiratory Quotient (RQ): ratio of CO2 produced
to O2 consumed.
RQ
CO2 produced
Workload for respiratory
system
Glucose Oxidation = 1.00
RQ
Triglyceride Oxidation = 0.71
Amino Acid Oxidation = 0.80
0.82
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/kg
2-2.5 g/kg in severe stress
30-60% of kcal lipids
Fluid and Sodium Restrictions
Ease Pulmonary Edema
Lung Muscle Tissue Maintained
by optimal Ca, Mg, PO4
Acid-Base Balance
Acid
pH < 7
Base
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 Plasma
Plasma Bicarbonate (HCO3)
Levels.
How to Measure Acid-Base Status?
ABGs = Arterial Blood Gases
All are expressed “partial pressures” because there
are 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)