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one malnutrition visible sign is weight loss

when being in a facility care, it's less enjoyable than eating at home

important nutrients: proteins, lipids, fibres, calcium, zinc, iron

25-40% of patients who suffer from COPD are underweight

50% of elderly COPD patients are malnourished

malnutrition affects muscle strength --> worsens COPD due to low performance of respitory muscles

poor nutrition affects rate of exacerbation of COPD

smoking increases food craving (high-fat & fast food fats)

smoking creates an appetite suppressant effect

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Deterioration of COPD and quality of life 

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Deterioration of COPD and quality of life 

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Sexual encounters are difficult due to Mr. Ziraldo's shortness of breath

Mrs. Ziraldo’s urinary incontinence impacts her self confidence and she is embarrassed which makes intimacy harder

Mr. Ziraldo could be suffering from erectile dysfunction as many men his age are

Mrs. Ziraldo could be suffering from vaginal dryness as many women her age are

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Nicotine Replacement Therapies (NRT):

Patches, gum, lozenges

Behavioral support (counselling)

They help reduce withdrawal symptoms and ease discomfort

Non-Nicotine Medications :

Varenicline (Chantix): Works better in combination with NRTs

Bupropion (Wellbutrin)

Best results are achieved by combining behavioral therapy and medication

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• She felt the need to have a meeting with the nurse

she is worried about her husband’s condition and is most likely to experience anxiety

She is also experiencing many heath problems such as: urinary incontinence, cataract, worried about her sexual life

All of these things can increase the risk of depression

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Mr. Ziraldo smokes socially.

When his friends smoke and play cards with him, it causes him to want to smoke.

Instead of smoking together, they could do another activity like drinking coffee together to lessen the social triggers that cause Mr. Ziraldo to smoke.

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• Mr. Ziraldo takes medication to help with his COPD

• Trelegy Ellipta

Reduce airway inflammation, decreases mucus production, relax the airways and alleviates COPD symptoms

• Ventolin (bronchodilator: opens airways)

Quickly relieves asthma symptoms

• Pravastatin

Increases HDL (high-density lipoprotein) production, which helps with preventing the progression of COPD

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COPD has a Significant negative impact on mental health status

higher risk of comorbid conditions such as stress, anxiety and depression

COPD patients may have higher rates of both anxiety and depression due to social isolation

Symptoms such as fatigue, reduced motivation, tiredness, and insomnia are both symptoms of COPD and depression

Shame and ambarrassement for having a smoking-related disease and functional limitations may contribute to isolation that can lead to anxiety and depression

being stressed and depressed can also make COPD symptoms worse and harder to treat

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• Her vision is blurry

Her risk of falls is high

•She cannot cook for Mr. Ziraldo and might start having difficulties doing things she enjoys that require sight like dancing.

Surgery may be the only option to improve her sight.

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Mr. Ziraldo has been smoking for 60 years

He reduced his smoking amount from 2 packs a day to 4 cigarettes a day

Impact on the respiratory system

Chronic Obstructive Pulmonary Disease (COPD)

Pneumonia

Lung cancer

Smoking leads to the proliferation of langerhan cells as well as destruction of the bronchial structure

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Importance of patient education

Language barrier can impact the quality of the care

It is important to acknowledge the 2 people