Respiratory System
KNH 411
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
Nutrition and Pulmonary Health
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Protein-energy malnutrition
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Chronic obstructive pulmonary disease patients
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Protein for calories, protein for rebuilding tissue: concerns the strength and endurance
Antioxidants and lung function
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Vitamin C
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Vitamin E
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Beta Carotene
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Selenium
Cigarette smokers
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Increased intake of vitamin C- DRI + 35 mg per day
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Usually have extremely low intake of fiber and antioxidants
Early satiety, anorexia, weight loss, cough, dyspnea during eating
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Weight history
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Nutrient intake
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Drug interaction
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Biochemical markers to see where this client is in there stage
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Albumin, pre albumin (shorter term, over days)
Bronchopulmonary Dysplasia (BPD)
 Growth failure d/t decreased nutrient intake, increased
requirements, hypoxemia, delayed skeletal mineralization
and osteopenia
 Lungs not fully developed-compromised breathing b/c of
immaturity of the lungs
 Growth failure due to increased nutrient intake
 A lot of these babies have refluz, their spincheters arent
fully developed and they will reflux during feeding
 Increase it up to calroies per ounce – add calroies to
mothers milk
Bronchopulmonary Dysplasia (BPD)
 Treatment/Nutrition Therapy
 Energy and macronutrient needs:
 15-20% higher b/c of increased oxygen needs
 They have an increased resting metabollic weight
 120-130 kcal/kg/day or higher
 Protein 3-4 g/kg/day
 Vitamins and minerals
 Vitamin A 1500-2800 Ius
 Mothers milk is normally supplemented with this amount in
the hospital setting
 Closely monitor electrolyte balance- anywhere from 100-200 cc
per kilo?
 Sufficient minerals for bone growth
Bronchopulmonary Dysplasia (BPD)
 Treatment/Nutrition Therapy
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Mechanical ventilation
Nutrition support
May need fluid and sodium restriction
Specialty infant formulas
 High calcium high phosphorus
 Want immune properties that are high in mothers milk
 Breast milk preferred
 Best cased scenario is a mother pumping milk and then we are
supplementing it with excess nutrients
 Education and support to caregivers
 Infant born prematurely
 Steroids may be used
© 2007 Thomson - Wadsworth
Chronic Obstructive Pulmonary Disease
 COPD – progressive disease which limits airflow through
inflammation of bronchial tubes (bronchitis)
 Damage could be 2 fold
 Obstruction of air to the bronchial tubes
 Or destruction of the alveoli- or a combination of both:
primary concern is lifestyle
 Conerns
 Low energy intake: do to energy itself
 Decreased appetitie– may be due to depression
 Altered taste perception– b/c of chronic mouth breathing
 Might have increased inflmmation of that indiciudal
 Primary risk factor – smoking
COPD
 Nutrition Therapy
 Low dietary intake
 Altered taste perceptions and appetite
 Elevated REE
COPD
 Nutrition Therapy - Interventions
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Maintain optimal energy balance
Maintain body weight
Anywhere from 125-156% of their energy needs above
BEE (basal energy expenditure) add 25-35% to
1.5 X the harris Benedict equation
Protein about 20% hgih 1.7-1.2 g per kilo
 Overfeeding concern with ventilation
 Glucose >5 mg/kg/min increases CO2 production
 Commercial formulas - low CHO (30%) and higher lipid (50%)
COPD
 Nutrition Therapy - Interventions
 Supplement antioxidants
 Monitor serum phosphate
 Monitor status of calcium and vit. D
 Ca 1200-1500
 Vit D 400 IU of vitamin D
 Identify specific nutrition problems
 Manage weight
Cystic Fibrosis
 Nutrition
 Poor digestion, absorption, malnutrition d/t pancreatic
insufficiency
 Abnormal growth
 Poor growth is one of the main concerns
 Energy needs are sufficiently increasced
 Risk for osteopenia and osteoporosis
 Malapsorption of calcium, phosphorus, vit d , K
 Use steroids to decrease inflammation
 Impaired bone growth and brittle bones
 Vitamin d and vitamin K
Cystic Fibrosis
 Nutrition Assessment
 Diagnosed from birth-12 months of age
(usually have stunted growth)
 National CF Foundation consensus guidelines
- nutrition guidelines
 Special attention to poor growth:
 During th efirst 12 months after diagnosis you
want to focus on growth and status
 Use growth charts – CDC
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-medium chain triglycerides
 Add liquid form to babies formula to boost up the babies
calroies
 Normally baby formula is 20 kcal per oz
 6-12 carbons long--- shorter than regular triglycerides
 Water soluble so require less bile– good for individuals for fat
malabsorbing
 Glucose intolerance common
 Usually they will convert to a diabetic in their teen years
Cystic Fibrosis
 Monitor vitamin & mineral status
 Monitor sodium levels
 Assess iron and zinc status
 Recommend breast feeding
 Immune fighting properties/of higher calorie
 Developmentally appropriate
recommendations
 Formulas or nutritional supplements
Respiratory Failure
 Nutrition
 Meet nutrition needs
 Trying to reserve lean body mass, particularly we are looking at
respiratory muscle
 Energy needs vary widely; may be hypermetabolic
 Avoid overfeeding
 Can cause compromised respiratory function
 Indirect calorimetry preferred method
 Specifically looking at calorie needs
 25 kcal per kilo to try to calculate needs or 130% of REE
 Preserve and restore LBM; respiratory muscle mass
Respiratory Failure
 Nutrition
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Maintain fluid balance
Facilitate weaning from ventilation
Specialty formulas available
EPA and GLA can reduce severity of inflammation
Supplementation with antioxidants
Phosphate supplementation