1. Respiratory System KNH 411
NB- 1.1 Food and nutrition related knowledge deficit related to high fat diet and consumption of large meals as evidence by constant indigestion and heartburn (Example of a good PES statement)
Bring calculator
Cardiovascular for the exam!!!!!
ADIME

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
Very complex, carbs, pro, fat= manipulation of these

3. Nutrition and Pulmonary Health
Protein-energy malnutrition- PEM, using up so much energy to try breathe- COPD, emph, reduction of lung capacity, respiratory infection- eat up calories
Antioxidants and lung function- Vit C, E, beta-carotene, selenium
Cigarette smokers- increase Vit C DRI + 35 mg- diet not huge concerns for them
Early satiety, anorexia, weight loss, cough, dyspnea- SOB during eating- want small meals
Want weight history, nut intake, meds for drug nut interaction, biochemical markers- albumin (over months), prealbumin (over days)

4. Bronchopulmonary Dysplasia (BPD)
Growth failure d/t decreased nutrient intake, increased requirements, hypoxemia, delayed skeletal mineralization and osteopenia
Lungs not fully developed, immaturity- work with to get enough calories to avoid complications, reflux, don’t want to nurse take a bottle, easily fatiguing during feeding, calorically dense, nut dense products.

5. Bronchopulmonary Dysplasia (BPD)
Treatment/Nutrition Therapy
Energy and macronutrient needs:
15-20% higher- because of increased oxygen needs
kcal/kg/day or higher (infants)
Protein 3-4 g/kg/day (infants)
Vitamins and minerals- key= vit A, electrolyte,
Vitamin A IUs- supplement mothers milk with
Closely monitor electrolyte balance
Sufficient minerals for bone growth- Ca, P, Mg, D

6. Bronchopulmonary Dysplasia (BPD)
Treatment/Nutrition Therapy
Mechanical ventilation
Nutrition support- steroids to strengthen lungs
GOAL- feed, grow, go, get on enthrall feeding
May need fluid and sodium restriction
Specialty infant formulas- high cal, pro, Mg, P
Breast milk preferred- human milk fortifier, increase calories, but anti-infection benefits of mother’s milk
Education and support to caregivers- suppot mother
Back milk used for nutrition calorically dense, Fore milk is for the fluid needs

7. Immune fighting properties of mother’s milk= GOOD
© 2007 Thomson - Wadsworth

8. Chronic Obstructive Pulmonary Disease
COPD – progressive disease which limits airflow through inflammation of bronchial tubes (bronchitis)
Primary risk factor – smoking, get them to quit smoking, lifestyle
Decrease to less than half and be able to function
Ob of airflow to bronchial tubes
Destruction of the alveoli
Or both

9. COPD Nutrition Therapy Low dietary intake
Deceased appetite- disease state, depressed
Altered taste perceptions and appetite- trying to get air in
Elevated REE- BECAUSE OF BREATHING
Increased inflammation of the area

10. COPD Nutrition Therapy - Interventions
Maintain optimal energy balance, maintain body weight!!
% of REE above calories/ kilogram BW (based on weight) HB equation add 25-50% of that
Protein g/kg BW
Very hard to meet these needs!
Overfeeding concern with ventilation
Glucose >5 mg/kg/min increases CO2 production
Must look at composition and macronutrients
Carbs can compromise- so want higher fat/pro intake
45-50% carbs
Commercial formulas - low CHO (30%) and higher lipid (50%)
Pulmicare- one brand

11. COPD Nutrition Therapy - Interventions
Supplement antioxidants- vit C,A,E,betac
Monitor serum phosphate
Compromised Phosphate level, essential for ATP, need to check
Monitor status of calcium and vit. D
mg Ca, 400 IU vit D per day
Identify specific nutrition problems
Low estrogen levels, decrease BMI, vit D, decreased mobility, PA, good nutrition, osteoporosis
Manage weight

12. Hugh task, to set a plate in front of an individual and have them eat it.
Limiting salty foods

13. Cystic Fibrosis Nutrition
Poor digestion, absorption, malnutrition d/t pancreatic insufficiency, poor digestion of fat, Vit ADEK, malnutrition related to pan insufficiency
Abnormal growth
Risk for osteopenia (impaired bone growth/ function) and osteoporosis
Malabsorp- Ca, P, Mg, Vit D/K- compounded by cortical steroids
Increased pro and calories at night
Genetic condition, starts early on, stunted growth, increased respiratory problem, poor digestion and absorption

14. Cystic Fibrosis Nutrition Assessment- multidiseplinary approach
National CF Foundation consensus guidelines - nutrition guidelines
Special attention to poor growth:
Early detection
Birth-12 years of age, prepubesence (stunted growth)
Use growth charts – CDC
Timeline
Head circumference, length (height), keep them on track, when they fall below 10th percentile weight for length
10th-20th very high risk
Below 10th- very big concern, nutrition failure

15. Cystic Fibrosis
Pancreatic enzyme therapy- no lipase, amylase, protiase secretion (they cannot secrete on their own)
Given with food and beverages
Individualized (need to follow on their own path)
Adequate kcal for normal growth based on weight gain patterns
Higher fat intake (35-45% kcal)
MCT- medium chain triglycerides (easy to digest)
6-12 carbons, shorter in length than long chain, water soluble= less bile
Because they malabsorb fat and are underweight
Glucose intolerance common- will convert to a diabetic in teen years, type 2

16. Combine both CF and diabetic diet
Warning signs, advanced pulmonary involvement, malnutrition, very underweight (low BMI)
May need PEG
Don’t want to put a calorie restriction but do want to teach them to spread carbohydrates throughout the day.

17. Cystic Fibrosis Monitor vitamin & mineral status
Monitor sodium levels- know they are not fluid overloaded
Assess iron and zinc status- CF a mineral losing disease state, steroids can take away iron
Recommend breast feeding- more kilocalories, immune fighting properties
Developmentally appropriate recommendations
COULD HAVE TROBLUE NURSING
Could have trouble with hand-mouth coordination
Weight status, head circumference, height in length
Formulas or nutritional supplements
110% of kilocalories
24, 27, 30 calories per ounce- formula, make more calorie dense

18. Respiratory Failure Nutrition
Meet nutrition need- preserve lean body mass (particularly their respiratory muscle)
Energy needs vary widely; may be hypermetabolic
Avoid overfeeding- avoid overfeeding carbohydrates (up protein and fat for calories)
Indirect calorimetry is the preferred method- ICU setting, 25 calories per kilogram body weight or 130% REE grams
Preserve and restore LBM; respiratory muscle mass
Latter stages of CF, COPD- on transplant lists

19. Respiratory Failure Nutrition Maintain fluid balance
Facilitate weaning from ventilation- key
Specialty formulas available
EPA and GLA can reduce severity of inflammation (fish oils beneficial to respiratory status, another nutrient that decreases inflammation)
Supplementation with antioxidants (Vit, C, beta carotene, prevent slow, oxidative damage)
Phosphate supplementation (helps with normal contraction of the diaphragm, essential for respiratory function)
calories/ Cc usually a supplement, OXEPA- calorie dense. PulmiCare