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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)