1. Definitions
Tachycardia: Heart Rate > 90 beats/ minute
Tachypnea: Respirations/ minute >20
Dyspnea: Shortness of Breath (SOB)
Orthopnea: SOB when in a supine position
Paroxysmal
Noctural Dyspnea: SOB upon awakening
Nocturia: Frequent nightime urination

2. 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.

3. Because the "failing" heart is an inefficient pump CHF causes
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
Heart failure also affects the ability of the kidneys to dispose of sodium and water.
The retained water increases the
edema.

4. 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.

5. 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.

6. 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!

7. Smoking Causes COPD Most Common COPD condition= Emphysema + Bronchitis
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
Smoking Causes COPD

8. Patients often present with: Fatigue, SOB, productive cough, wheezing
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 loss
Persistent viral illness (e.g., colds)

9. Stop smoking Drink lots of fluids (8-12 cups/ day; low caffeine)
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

10. Acute Respiratory Failure
Causes Treatment Goals
Physiologic Stress Prevent progression
(e.g., surgical, infectious, etc.) of resp. failure
Aspiration Pneumonia Preserve immune
Pulmonary Emboli system with high
Allergic Rxns protein/kcal
without causing
The Problem? respiratory distress
Insufficient oxygenation of tissues
with excess CO2 retention supports lung fxn &
prevents infections

11. Building Pulmonary Infections
Weak Muscles Less Forceful Breathing
Poor Respiration Poor Circulation
Poor Nutrition Pulmonary Infections
Edema
Acute Respiratory Failure
Mechanical Ventilator

12. 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
Triglyceride Oxidation =
Amino Acid Oxidation = 0.80 RQ

13. 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

14. Fluid and Sodium Restrictions
Ease Pulmonary Edema
Lung Muscle Tissue Maintained
by optimal Ca, Mg, PO4

15. Death! Acid-Base Balance Acid Base pH < 7 pH=7 pH > 7
Normal Physiological pH =
Extreme acidosis = <6.8
Extreme alkalosis= >7.8
Death!

16. 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

17. 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 = mm Hg (NL = 90)
pCO2 = mm Hg (NL = 40)
pH = (NL = 7.4)
HCO3-= mEq/L (NL = 24)