1. Respiratory System
KNH 411

2. Respiratory System
Nutritional status and pulmonary function are interdependent
Macronutrients fueled using oxygen and carbon dioxide
Malnutrition can evolve from pulmonary disorders
And can contribute to declining pulmonary status
Fat, protein and carbohydrates aid the issues

3. Nutrition and Pulmonary Health
Protein-energy malnutrition
Antioxidants and lung function protects the lungs, vitamin c, vitamin e, betacarotene, seleneum
Cigarette smokers increased intake of vitamin C, low fiber and antioxidants
Early satiety, anorexia, weight loss, cough, dyspnea during eating multiple small feedings would be best
Using so much energy just to try to breathe high amount of calories and will be using calories for breathing instead of using for your body
Weight history, nutrient intake, what meds they are on, biochemical markers

4. Bronchopulmonary Dysplasia (BPD)
Growth failure d/t decreased nutrient intake, increased requirements, hypoxemia, delayed skeletal mineralization and osteopenia
Compromised breathing because of the prematurity of the babyl get enough calories in
Caloricly densed foods, or add supplemental calorie needs for mother

5. Bronchopulmonary Dysplasia (BPD)
Treatment/Nutrition Therapy
Energy and macronutrient needs:
15-20% higher
kcal/kg/day or higher
Protein 3-4 g/kg/day
Vitamins and minerals
Vitamin A Ius put in the formula or supplement mother milk that that amount
Closely monitor electrolyte balance
Sufficient minerals for bone growth
Because of increased oxygen needs

6. Bronchopulmonary Dysplasia (BPD)
Treatment/Nutrition Therapy
Mechanical ventilation  infant who is born prematurely to strengthen lungs
Nutrition support Feed, Grow, and Go is the motto
May need fluid and sodium restriction
Specialty infant formulas most have high calorie and high phosperous
Breast milk preferred  human milk fortifier that increases the calories, but still want the enzymes from the mothers milk
Education and support to caregivers

7. © 2007 Thomson - Wadsworth

8. Chronic Obstructive Pulmonary Disease
COPD – progressive disease which limits airflow through inflammation of bronchial tubes (bronchitis)
Primary risk factor – smoking
For adults
Decrease their lung function to less then half, and can still function
obstruction of the brochrial tubes or the obstruction of the alvielali OR BOTH

9. COPD Nutrition Therapy Low dietary intake
Altered taste perceptions and appetite altered mouth breathing, or depression
Elevated REE  related to the breathing
Increased inflammation of that area

10. COPD Nutrition Therapy - Interventions
Maintain optimal energy balance body weight
Overfeeding concern with ventilation
Glucose >5 mg/kg/min increases CO2 production
Commercial formulas - low CHO (30%) and higher lipid (50%)
25-35 calories per kilo
25-156% energy needs meets above
Based on their weight
Unable to eat lower cabohydrates, and higher lipids

11. COPD Nutrition Therapy - Interventions Supplement antioxidants
Monitor serum phosphate could be because of their medication
Monitor status of calcium and vit. D-> 400 Ius of vitamin d, mg of calcium
Identify specific nutrition problems
Manage weight
Vitamin C, A, E, betacarotene

13. Cystic Fibrosis Nutrition
Poor digestion, absorption, malnutrition d/t pancreatic insufficiency
Abnormal growth
Risk for osteopenia and osteoporosis
Stunted growth
Increases respiratory problems
Decreased pulmonary function
Malabsorption and poor digestiong pancreatic dysfunction
Impaired bone function with osteoporosis
Phosphorous, magnesium, vit D, vit K,
Treatment:
Multidisciplinary approach special attention goes towards growth and the nutrition status

14. Cystic Fibrosis Nutrition Assessment
National CF Foundation consensus guidelines - nutrition guidelines
Special attention to poor growth:
Use growth charts – CDC
Timeline
From birth- 12 months of age usually have stunted growth
look at growth right before the reach puberty
Head circumference and their weight and length circumferance risks are if they are following below the 10th percentile they are the greatest risk

15. Cystic Fibrosis Pancreatic enzyme therapy
Given with food and beverages
Individualized
Adequate kcal for normal growth based on weight gain patterns
Higher fat intake (35-45% kcal)
MCT
Glucose intolerance common convert to a diabetic because the pancreas is so stressed, continues to increase in fat and mucus build up converted to diabetic type 2
Do not have lypase and amalyase, proteayse. Take pancreatic enzyme before each meal
Want to give them easily absorbed fat
Water soluble

17. Cystic Fibrosis Monitor vitamin & mineral status Monitor sodium levels
Assess iron and zinc status
Recommend breast feeding more kilocalories, immune fighting properties
Developmentally appropriate recommendations
Formulas or nutritional supplements
Specifically the fat soluble ones
Weight status, head circumference and height length

18. Respiratory Failure Nutrition Meet nutrition needs
Energy needs vary widely; may be hypermetabolic
Avoid overfeeding
Indirect calorimetry preferred method
Preserve and restore LBM; respiratory muscle mass
Would be on lung transplant lists working with them until they get their new lung
Preserve lean body mass
End stages of CF
IC setting using 25 calories per kilo or 130 percent of their resting ending expenditure
calories per kilo

19. Respiratory Failure Nutrition Maintain fluid balance
Facilitate weaning from ventilation
Specialty formulas available
EPA and GLA can reduce severity of inflammation fish oils
Supplementation with antioxidants
Phosphate supplementation helps with the normal contractions of the diaphram
1.5-2 calories per CC is usually a supplement
Batacrotene, vit C prevent or slow down the oxidated damage