Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

Nursing Best Practice GuidelineNutritional StrategiesNurses should consider and understand the impact of dyspnea, dysphagia, dyspepsia, depression, anxiety,physical limitations, social/financial considerations, food allergies, and drug/alcohol consumption onnutritional status for individuals with COPD (Bourbeau, Nault & Borycki, 2002). The role of nutritional educationis an important aspect of health promotion for individuals with COPD.An individual with COPD has increased energy expenditure to breathe which results in increased caloricintake needs (Branson & Hurst, 1988). Individuals with COPD often experience an imbalance between energyintake and expenditure despite a normal diet. This may be a reflection of increased catabolism and muscleproteolysis involved in the wasting process (Bourbeau et al., 2002). The use of systemic corticosteroid therapyduring acute exacerbations may also contribute to depletion of fat free mass (Bourbeau et al., 2002).According to Demling and De Santi (2002), complications of involuntary weight loss and protein energymalnutrition are: increased disability (decreased activity, discomfort, decreased appetite, progressingprotein energy malnutrition); impaired lung function (acute and chronic); weakness and increased infection.Protein depletion is a common feature of COPD and may be present in an individual who maybe of normalweight, under weight or obese. This depletion often results in a reduction of muscle function. The role ofnutritional screening by a registered dietitian is crucial for appropriate intervention. Nutritional treatmentof protein energy malnutrition associated with COPD may positively affect body composition as well asmuscle strength and respiratory function (Cederholm, 2002).A low body mass index (BMI) (weight in kilogram [kg] divided by the square of height in meters [m]) hasbeen associated with an increased rate of death (Schols, Slangen, Volovics & Wouters, 1998). A BMI below 21 hasbeen associated with an increased risk of death (Landbo, Prescott, Lange, Vestbo & Almdal, 1999). Detectingsudden weight changes in the earlier stages and intervening appropriately is critical.Years of corticosteroid therapy may lead to osteoporosis. Corticosteroids may increase Vitamin Dmetabolism, which in turn may accelerate bone loss (American Association of Cardiovascular and PulmonaryRehabilitation, 1993). Individuals with COPD need to understand the importance of calcium and vitamin D intheir diet.31