A client with chronic obstructive pulmonary disease reports recent weight loss and poor appetite. The client states that bloating, exhaustion, and shortness of breath make eating "not worth the effort." Which statements by the nurse are appropriate to help improve the client's nutritional status? Select all that apply.

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Consuming adequate nutrition is difficult for clients with advanced chronic obstructive pulmonary disease (COPD), as chewing and swallowing increase work of breathing and a full stomach increases pressure on the diaphragm. As a result, clients often lose weight because their energy expenditure is greater than their nutritional intake. To optimize nutritional intake, clients should: Drink fluids between meals, rather than before or during, to prevent stomach distension and decrease pressure on the diaphragm while eating (Option A). Eat small, frequent meals, snacks, and supplements that are high in calories and protein. Smaller meals require less energy to chew and swallow, resulting in less fatigue and dyspnea (Option B). Perform oral hygiene before meals. Chronic mouth breathing leads to dry mouth; excessive sputum and medication side effects can alter the taste of food, decreasing the appetite (Option E). (Option C) For clients with advanced COPD, exercise is discouraged for 1 hour before and 1 hour after eating as it increases oxygen demand and fatigue. (Option D) Gas-forming foods (eg, broccoli, beans, cabbage) and carbonated beverages should be avoided as they cause intestinal bloating and increased pressure on the diaphragm. Educational objective: Consuming adequate nutrition is difficult for clients with advanced chronic obstructive pulmonary disease as eating increases dyspnea and fatigue. To optimize nutrition, clients should avoid drinking fluids while eating; eat small, frequent, high-calorie, high-protein meals and snacks; avoid exercising for 1 hour before and 1 hour after eating; and perform oral hygiene before meals.

A Client with Chronic Obstructive Pulmonary Disease Reports Recent Weight