13.3 Implement Nutritional Strategies to Impact Pulmonary Wellness

Holistic Nursing Assessment of the Client

Holistic assessment is should take into consideration the overall health of the client, including their physical, psychological, social, and spiritual well-being.

Client Teaching

The nurse should assess teaching needs and the client and family’s learning ability. Deficits that may interfere with learning, such as language barriers, literacy, numeracy, hearing, and educational levels, must be determined. Appropriate accommodation provides the best opportunity for success and will allow the client to be educated to the fullest. A balanced diet, energy expenditure, adequate protein, higher intake of iron, and small meals are important topics to add to the client’s education so nutritional goals are met. Key summative points for the client include:

• During respiratory distress or illness exacerbation, small frequent meals support increased functional status.
• Dietary changes or supplementation is an important modifiable risk factor and treatment component for clients with both acute and chronic illness.
• Obesity alters the mechanics of the pulmonary system, leading to dyspnea, wheezing, airway hyperresponsiveness, and increased work of breathing.
• Energy expenditure is typically elevated in clients with COPD due to increased efforts to breathe; adequate protein stimulates the ventilatory drive. Clients benefit from protein-rich meals. Foods that are high in protein include milk, eggs, cheese, meat, fish, poultry, and nuts.
• A balanced diet with high protein, complex carbohydrates, and healthy fats is used with differing volumes and portions to support both clients who are malnourished and those who need to reduce weight.
• A healthy diet will increase the client’s likelihood of access to vital nutrients. The need for supplemental drinks, multivitamins, and micronutrient supplements should be discussed with a registered dietitian.
• Control sodium intake by choosing fresh versus packaged food. High sodium levels will cause edema and interfere with breathing, increasing the workload and causing a greater risk of malnutrition.

Implementing the following ideas from the American Lung Association (2023) and the COPD Foundation (2021) can make mealtimes easier and more nutritious by increasing energy and protein without increasing food volume:

• General principles:
  • Consume small, frequent meals.
  • Eat a large meal when well rested, such as the first meal of the day.
  • Encourage the use of high-calorie, high-protein supplements.
  • Swallow as little air as possible when eating.
  • Use easily prepared or nutritious snacks (fruits, carrots, nuts, hard-boiled eggs) to decrease fatigue.
• Clinical and home health care settings:
  • Eat high-calorie foods first.
  • Try more frequent meals and snacks.
  • Add low-sodium margarine or butter, mayonnaise, sauces, gravies, and peanut butter to foods.
  • Limit liquids at mealtimes.
  • Try cold foods, which give less sense of fullness than hot foods.
  • Rest before meals.
• At home:
  • Keep favorite, nutrient-dense foods and snacks on hand.
  • Keep ready-prepared meals available for periods of increased shortness of breath.
  • Eat larger meals when you are not as tired.
  • Avoid foods that cause gas.
  • Add skim milk powder (2 tbsp) or whey protein powder to regular milk (8 oz) to increase protein and calories.
  • Use milk or half-and-half instead of water when making soups, cereals, instant puddings, cocoa, or canned soups.
  • Add low-sodium grated cheese to sauces, vegetables, soups, and casseroles.
  • Choose dessert recipes that contain egg, such as sponge cake, angel food cake, egg custard, bread pudding, and rice pudding.