Body composition changes in male patients with chronic obstructive pulmonary disease: Aging or disease process?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) mainly affects middle-age and elderly adults. It is unclear if the presence of muscle wasting and fat accumulation in patients with COPD is age or disease-related. This study investigated the effect of age and COPD disease severity on body composition with the aim of identifying a biomarker(s) for COPD. METHODS: Healthy subjects and patients with COPD of different severity were recruited. Dual-energy X-ray absorptiometry was used to analyze total and segmental body composition. Subjects included in the analysis were classified into four groups: healthy young (aged 20-45 years) (n = 35), healthy old (aged ≥ 60 years) (n = 37), moderate COPD (n = 40), and severe COPD (n = 14). RESULTS: In healthy old adults, leg and limb lean masses were lower by 10.6% and 8.5%, respectively, compared with healthy young adults (P < 0.05). Appendicular lean outcomes were significantly lower in the moderate COPD compared to the healthy old group and were significant lower in subjects with severe COPD compared to those with moderate COPD. All fat depots were similar for both young and old healthy subjects and subjects with moderate COPD, but significantly decreased in patients with severe COPD. CONCLUSIONS: This study examined the changes in total and segmental body composition with aging and COPD severity. It found that aging and COPD altered the body composition differently, and the effect was most pronounced in leg lean mass. Remarkably, differences in appendicular lean masses were seen in mild COPD although no changes in body weight or BMI were apparent compared with healthy young adults. In contrast, fat depot changes were only observed in severe COPD. Aging and COPD processes are multifactorial and additional longitudinal studies are required to explore both the quantitative and qualitative changes in body composition with aging and disease process.

[Caring for a terminal patient with nasopharyngeal carcinoma in the ICU who refuses treatment: a nurse's experience].

This article describes the experience of a nurse directly responsible for the care of a patient with terminal stage nasopharyngeal carcinoma who refused all medical treatment. Tumor bleeding had caused loss of consciousness, which led to the family arranging ICU admission. While in the ICU, the patient was overwhelmed by feelings of hopelessness regarding his disease and believed his family was not emotionally supportive. The patient was verbally non-responsive, angry and lethargic. He also refused to accept any medical care or treatment. The author collected data through observation, physical assessment, interviews and written communication between May 9th, 2007 and May 23rd, 2007. The author confirmed the diagnosis and found that the patient had some related mental health problems, including imbalanced nutrition (less than body requirements), chronic feelings of hopelessness and anxiety. The author established a positive relationship with the patient utilizing Watson's caring theory and case-establishment trust in the nursing process. The author provided disease-related information to the patient, worked as an intermediary to encourage greater family member support and encouragement, helped the patient interact with visitors and encouraged development of the patient's self-esteem. This experience can benefit nursing professionals by fostering a greater understanding of patient self-esteem and the benefits of a positive treatment environment.

[The experience of nursing an AIDS patient whose secret was divulged to his family].

This article concerns an Acquired Immunodeficiency Syndrome (AIDS) patient who had contracted the disease through casual sex. The secret of the nature of his disease was accidentally divulged to his family and friends by his care provider. The patient was rejected by his family and friends. The nursing experience of caring for the physical and psychological symptoms of the patient was reported. The author collected data through observation, physical assessment, interview, and telephone communication from January 20, 2005 to January 31, 2005. Because of the disease and his alienation from family and friends, the patient felt a lack of trust for his care provider, as well as anxiety, fear, a sense of guilt, self-recrimination, sadness and low self-esteem. The psychological symptoms were aggravated by the divulgence to family and friends of the fact that his disease was AIDS. The nursing problems were studied. The Watson theory of care was applied carefully. The patient was cared for with empathy and a positive attitude. A relationship of trust was established and the objective of quality care was accomplished. The nursing experience of caring for AIDS patients is unique. The privacy of the patient must be respected.

[A nursing experience of applying Watson's caring theory to a primary caregiver in an ICU].

The authors present a case study of a nursing experience applying Watson's caring theory to a critical patient's primary caregiver in the intensive care unit. Data were collected by observation, discussion, and telephone interviews between 20th April and 10th May 2004. Major nursing problems were: (1) anxiety, (2) anticipatory grieving, and (3) poor social support system. The authors describe the details of the primary intervention effort, using Watson's caring theory in accordance with the spirit of nursing as conducted by the Mutual Confidence Foundation, providing individual protective nursing, reducing the caregiver's anxiety, facilitating constructive anticipatory grieving, and providing appropriate social resources. This relieved the caregiver's stress caused by physical, mental, emotional and social factors.