Respiratory System KNH 411. Respiratory System Nutritional status and pulmonary function are interdependent Macronutrients fueled using oxygen and carbon.

Respiratory System

KNH 411

Respiratory System

Nutritional status and pulmonary function are interdependentMacronutrients fueled using oxygen and carbon

dioxideMalnutrition can evolve from pulmonary disordersAnd can contribute to declining pulmonary status

Nutrition and Pulmonary HealthProtein-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

Bronchopulmonary Dysplasia (BPD)

Growth failure d/t decreased nutrient intake, increased requirements, hypoxemia, delayed skeletal mineralization and osteopenia

Bronchopulmonary Dysplasia (BPD)

Treatment/Nutrition TherapyEnergy and macronutrient needs:

15-20% higher- because of increased oxygen needs 120-130 kcal/kg/day or higher (infants) Protein 3-4 g/kg/day (infants)

Vitamins and minerals- key= vit A, electrolyte, Vitamin A 1500-2800 IUs- supplement mothers milk with Closely monitor electrolyte balance Sufficient minerals for bone growth- Ca, P, Mg, D

Bronchopulmonary Dysplasia (BPD)

Treatment/Nutrition TherapyMechanical ventilationNutrition support- steroids to strengthen lungs

GOAL- feed, grow, go, get on enthrall feedingMay need fluid and sodium restrictionSpecialty infant formulas- high cal, pro, Mg, PBreast milk preferred- human milk fortifier, increase

calories, but anti-infection benefits of mother’s milk Education and support to caregivers- suppot mother

© 2007 Thomson - Wadsworth

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, lifestyleDecrease to less than half and be able to function

Ob of airflow to bronchial tubes Destruction of the alveoli Or both

COPDNutrition 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

COPDNutrition Therapy - Interventions

Maintain optimal energy balance, maintain body weight!!125-156% of REE above- 25-35 calories/ kilogram BW

(based on weight) HB equation add 25-50% of thatProtein 1.2- 1.7 g/kg BWVery 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

COPDNutrition 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 1200-1500 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

Cystic Fibrosis

NutritionPoor 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

Cystic Fibrosis

Nutrition Assessment- multidiseplinary approach

National CF Foundation consensus guidelines - nutrition guidelines

Special attention to poor growth:Early detectionBirth-12 years of age, prepubesence (stunted

growth)

Use growth charts – CDC

Timeline

Cystic FibrosisPancreatic 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

Cystic FibrosisMonitor 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

Respiratory FailureNutrition

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- 1.2-1.5 grams

Preserve and restore LBM; respiratory muscle mass

Respiratory FailureNutrition

Maintain fluid balanceFacilitate weaning from ventilation- keySpecialty formulas availableEPA 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)