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MEET GLADYS

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GLADYS’s STORY

Born 1949, Bridle Path Toronto
Only child, private schools
Married Hugh in 1965

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StevenM_61

whatsthatpicture

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GLADYS’s STORY con’t

Started smoking at age 16 – one pack per day
Daily cocktails through her adult life
Did not work outside the home
Hired cleaning lady and full-time cook
Two pregnancies
Smoked and drank during both pregnancies

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graywolfx47

Tech.Co (formerly Tech Cocktail)

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GLADYS’s CHILDREN

First born – Paul

Private boarding schools

Second born – Brian

Down syndrome
Lived & schooled at home

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visual.dichotomy

Vanellus Foto

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GLADYS’s HEALTH

1999 – Diagnosed with COPD

2010 – Cognitive changes – diagnosed with Alzheimer’s disease

2015 – Oxygen therapy for COPD

2018 – Health and wellbeing deteriorated – placed in LTC facility

2019 - Dies due to complications of Alzheimer’s disease

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EpicTop10.com

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RESPIRATORY ZONE

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https://openstax.org/books/anatomy-and-physiology/pages/22-1-organs-and-structures-of-the-respiratory-system

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AIRWAY OBSTRUCTION in COPD

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National Institutes of Health (NIH)

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COPD DIAGNOSIS

Lung (pulmonary) function tests:

Pulse oximetry
Blood gases
End tidal CO₂
Spirometry
Peak expiratory flow rate
Bronchial challenge testing
Exercise tests
Respiratory muscle pressure measurement
Lung volumes by helium dilution
Diffusing capacity

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GLADYS’s PULMONARY FUNCTION TEST RESULTS

FEV₁-the forced expiratory volume in 1 second
FVC-the forced vital capacity
Your FEV₁ is influenced by other factors including age, sex, height, and ethnicity. The FEV₁/FVC ratio is used to define obstructive defect and used to diagnose the disease progression.

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https://openstax.org/books/anatomy-and-physiology/pages/22-3-the-process-of-breathing?

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GOLD SYSTEM OF GRADING COPD

GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease. The National Heart, Lung, and Blood Institute, National Institutes of Health, and the World Health Organization started it in 1997.

The GOLD system bases the stage of COPD on several things:

Symptoms
How many times your COPD has gotten worse
Hospitalizations for COPD exacerbation
Spirometry results

See the GOLD 2020 Report for more information

https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf

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COPD STAGES

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Severity	FEV₁/FVC %	FEV₁ %
At risk	> 0.7	> 80
1-Mild COPD	< 0.7	> 80
2-Moderate COPD	< 0.7	50-80
3-Severe COPD	< 0.7	30-50
4-Very Severe COPD	< 0.7	< 30

FEV₁: forced expiratory volume in one second

FVC: forced vital capacity

All values are based on post-bronchodilator

https://www.researchgate.net/publication/242164660_SERIES_%27%27THE_GLOBAL_BURDEN_OF_CHRONIC_OBSTRUCTIVE_PULMONARY_DISEASE%27%27_Edited_by_KF_Rabe_and_JB_Soriano_Number_1_in_this_Series_Epidemiology_and_costs_of_chronic_obstructive_pulmonary_disease/figures?lo=1

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Risk Factors of COPD Among Women

3.17 million deaths (5% of all global deaths) were caused by COPD in 2015
WHO reports a prevalence of 251 million cases of COPD in 2016
More women are being diagnosed with COPD
Higher mortality rates than men
Most common risk factors:

smoking,
exposure to secondhand smoke,
air pollution,
occupational dust and fumes

Influence of sex on COPD involves several factors:

differential susceptibility to the effects of tobacco
anatomic, hormonal, and behavioural differences
differential response to therapy

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How Does Food Relate to Breathing?

The process of changing food to fuel in the body is called metabolism.
Oxygen and food are the raw materials of the process.
Energy and carbon dioxide are the finished products.
Carbon dioxide is a waste product that is exhaled.
Metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used.
Metabolism of fat produces the least.
For some COPD patients, eating a diet with fewer carbohydrates and more fat helps them breathe easier.

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Nutritional Guidelines

Choose complex carbohydrates.
Limit simple carbohydrates.
Eat 20 to 30 grams of fiber each day.
Eat a good source of protein.
Choose mono- and polyunsaturated fats.
Limit foods that contain trans fats and saturated fats.
Vitamins and minerals:

Steroids may increase your need for calcium
Calcium carbonate or calcium citrate with vitamin D
Sodium may cause edema and may increase blood pressure
Drink plenty of water-keeps you hydrated and keeps the mucus thin

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katerha

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Diet Tips

Rest before eating.
Eat more food early in the day if you are usually too tired to eat later on.
Avoid foods that cause gas or bloating. Tends to make breathing more difficult.
Eat 4 to 6 small meals a day. Enables the diaphragm to move freely and lets the lungs fill and empty more easily.
Drinking fluids with meals may make you feel too full. Drink an hour before or after meals.
Consider adding nutritional supplements at night to avoid feeling full during the day.

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One Way Stock

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Physical Activity and COPD

Moderate exercise can improve:

The body’s use of oxygen
Energy levels
Anxiety, stress, and depression
Sleep
Self-esteem
Cardiovascular fitness
Muscle strength
SOB

Exercises help blood circulate and helps your heart send oxygen to your body.

Strengthens your respiratory muscles.

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Types of Exercises for COPD

Pulmonary Rehabilitation-consists of education and exercise classes that teach about lungs, the disease, and how to exercise and be more active with less SOB.

Stretching
Aerobic
Resistance

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pennstatenews

teammarche

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COPD and Emotional Health

Most COPD patients experience feelings of sadness, fear, and worry.

If those feelings start to affect ability to keep up with normal activities and life enjoyment, they may be symptoms of anxiety and depression.

Managing anxiety and depression can increase ability to stick with treatment, improve physical health, and reduce medical costs.

Things to do:

Talk to your healthcare team about your feelings
Take care of yourself
Connect with others who understand

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Medications for COPD

Bronchodilators: relax the muscles around the airways (short- and long-acting)

Beta₂-Agonists relax tightened muscles around airways, opening the airways, making breathing easier
Anticholinergics prevent the muscles around the airways from tightening, helps clear mucus from lungs

Anti-inflammatories:

Known as corticosteroids or steroids
Inhaler device or oral pill
Reduces swelling and mucus production
Long-term use of steroids have serious side effects

Combination Medications:

A corticosteroid, an anticholinergic, and a beta₂-agonist
Most common combinations:

Short-acting beta₂-agonist & short-acting anticholinergic
Long-acting beta₂-agonist and corticosteroid
Long-acting anticholinergic and corticosteroid
Long-acting beta₂-agonist and long-acting anticholinergic
Long-acting beta₂-agonist, long-acting anticholinergic, and corticosteroid

Vaccinations:

Influenza
Pneumonia

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Alzheimer’s Disease

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PET scans showing the differences between a normal older adult’s brain and the brain of an older adult with Alzheimer’s disease.

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Personality & Behaviour Changes in Alzheimer’s

Common Changes in Personality & Behaviour:

Getting upset, worried, and angry more easily
Acting depressed or not interested in things
Hiding things or believing other people are hiding things
Imagining things that aren’t there
Wandering away from home
Pacing a lot
Showing unusual sexual behaviour
Hitting others
Misunderstanding what they see or hear
Stops caring about how they look

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Managing Personality & Behavioural Changes

Keep things simple:

Ask or say one thing at a time
Have a daily routine
Reassurance that they are safe and you are there to help
Focus on their feelings rather than their words
Don’t argue or try to reason with them
Try not to show frustration or anger
Use humor when appropriate
Allow a safe environment for pacing
Try using music, singing, or dancing for distraction
Ask them to help (“let’s set the table” or “I need help folding the clothes”)

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Antonio TwizShiz Edward

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Changes in Communication Skills

Persons with Alzheimer’s may have problems with:

Finding the right word or losing their train of thought when speaking
Understanding what words mean
Paying attention during long conversations
Remembering the steps in common activities
Blocking out background noises
Frustration if communication is not working
Being very sensitive to the tone and loudness of voices

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Making Communication Easier

Understand that Alzheimer’s causes changes in communication skills.

Try some tips that may make communication easier:

Make eye contact and use their name
Beware of your tone, loudness of voice, and body language
Encourage two-way conversation for as long as possible
Use other methods besides speaking, such as gentle touch
Try distraction if communication creates problems
Be patient
Offer simple step-by-step instructions
Try not to interrupt
Don’t talk to the person using “baby talk” or a “baby voice”

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Drug Name	Drug Type & Use	How It Works	Common Side Effects	Manufacturer’s Recommended Dosage
Aricept® (donepezil)	Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer's	Prevents the breakdown of acetylcholine in the brain	Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months Orally disintegrating tablet: Same dosage as above (not available in 23 mg)
Exelon® (rivastigmine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's (patch is also for severe Alzheimer's)	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain	Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness	Capsule: Initial dose of 3 mg/day (1.5 mg twice a day); may increase dose to 6 mg/day (3 mg twice a day), 9 mg/day (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated Patch: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated
Namenda® (memantine)	N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer's	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation	Dizziness, headache, diarrhea, constipation, confusion	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated Oral solution: Same dosage as above Extended-release capsule*: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated
Namzaric® (memantine and donepezil)	NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s	Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain	Headache, nausea, vomiting, diarrhea, dizziness, anorexia	Extended-release capsule*: Initial dose of 28 mg memantine/10 mg donepezil once a day if stabilized on memantine and donepezil If stabilized on donepezil only, initial dose of 7 mg memantine/10 mg donepezil once a day; may increase dose to 28 mg memantine/10 mg donepezil in 7 mg increments at minimum 1-week intervals if well tolerated Only 14 mg memantine/10 mg donepezil and 28 mg memantine/10 mg donepezil available as generic
Razadyne® (galantamine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain	Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache	Tablet: Initial dose of 8 mg/day (4 mg twice a day); may increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated Extended-release capsule: Same dosage as above but taken once a day

https://www.nia.nih.gov/health/how-alzheimers-disease-treated

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Ontario nursing home DNR & DNH orders reduce inappropriate hospitalizations, but not entirely

•3 in 5 nursing home residents had a DNR recorded on admission (Do Not Resuscitate)

•1 in 7 had a DNH (Do Not Hospitalize)

•Residents with a DNR or DNH were less likely to experience hospitalization or in-hospital death

•Hospitalization:

•DNR: 13% less likely/DNH: 30% less likely

•In-hospital death:

•DNR: 40% less likely/DNH: 60% less likely

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*Kid*Doc*One*

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Student Feedback

https://docs.google.com/forms/d/1Z0mA72XgmNmnBjfL80KvZqocPp_lD_mu4OSoLVR4VeU/edit

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Instructor Feedback

https://docs.google.com/forms/d/1PuFqVc78An82mbj_0NIfMdB3Nh-2_3x5JMNWqWj52Iw/edit

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