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

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)Key Points■■Individuals with COPD have increased energy expenditure related tothe increased work of breathing, increased oxygen consumption,inefficient gas exchange, and increased dead space ventilation (Braun,Dixon, Keim, Luby, Anderegg & Shrago, 1984). They can expend 30-50% moreenergy on breathing when compared to the average individual (Laaban, 1991).The need to promote aggressive nutritional support is critical as fat freemass depletion may occur as a result of repeated exacerbations,dyspnea and systemic inflammation. Hypoxemia may also impairintestinal absorption of nutrients. Protein depletion with or withoutweight loss is often a feature of COPD that creates a reduction ofmuscle function (Demling & De Santi, 2002).■ Years of corticosteroid therapy may lead to osteoporosis.Corticosteroids can increase Vitamin D metabolism that may■■accelerate bone loss (American Association of Cardiovascular and PulmonaryRehabilitation, 1993). It is important that the nutritional intake of calciumand vitamin D be included when educating individuals with COPD.A low body mass index has been associated with an increased rate ofdeath for individuals with COPD. Maintenance of a healthy bodyweight and healthy eating habits are warranted.Referral to a dietitian is warranted, as individuals with COPD requireappropriate nutritional screening and intervention.Assessment of nutritional status should include:■Recording of weight and height■ Calculation of body mass index (BMI) (See Appendix K)■■Asking about eating habits and behaviours (consider attitudes and beliefs about nutrition,food and health)Inspection for ankle edemaInterventions should include the use of Canada’s Food Guide to address healthy eating habits. Potentialproblems that individuals with COPD may encounter should be considered and addressed. See Table 2 forsymptoms and potential nutritional solutions.32