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

3. Nutrition and Pulmonary Health Protein-energy malnutrition--using so much energy just to try and breathe, will be using proteins for energy instead of for rebuilding Antioxidants(will protect lungs; vit C, E, beta-carotene, selenium) and lung function Cigarette smokers--increase intake of vit C Early satiety(fatigue easily), anorexia, weight loss, coughing with eating, dyspnea(shortness of breath) during eating weight history, nutrient intake, what drugs they’re on, biochemical markers

4. Bronchopulmonary Dysplasia (BPD) Growth failure d/t decreased nutrient intake, increased requirements, hypoxemia, delayed skeletal mineralization and osteopenia born premature; immaturity of lungs

5. Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy increased resting metabolic rate Energy and macronutrient needs: 15-20% higher 120-130 kcal/kg/day or higher Protein 3-4 g/kg/day Vitamins and minerals Vitamin A 1500-2800 IUs--would put in formula Closely monitor electrolyte balance Sufficient minerals for bone growth

6. Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy Mechanical ventilation Nutrition support--start on IB nutrition;when ready entral feedings will begin; get them to 3 feedings a day May need fluid and sodium restriction Specialty infant formulas(high protein, high calorie, high phosphorus) Breast milk preferred (supplement it with powder to meet nutrient needs) Education and support to caregivers

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8. Chronic Obstructive Pulmonary Disease COPD – progressive disease which limits airflow through inflammation of bronchial tubes (bronchitis) obsturction of airflow to bronchial tubes--causes breathing difficulty descriction of the alvili or could have both of above^^ Primary risk factor – smoking

9. COPD Nutrition Therapy Low dietary intake Altered taste perceptions(because of chronic mouth breathing) and appetite--could be due to depression Elevated REE(resting energy expenditure)--due to breathing, trying to get enough air in increased inflammation of that area

10. COPD Nutrition Therapy - Interventions Maintain optimal energy balance--preserving body weight; some are at 150% of their energy needs; 25-30 kcals per kilo assessing weight; are they gaining or losing Protein: 1.2-1.7 g/kilo Overfeeding concern with ventilation Glucose >5 mg/kg/min increases CO 2 production Commercial formulas - low CHO (30%) and higher lipid (50%)

11. COPD Nutrition Therapy - Interventions Supplement antioxidants--vitamin C, A, E, beta-carotene Monitor serum phosphate--could be low due to meds they’re taking; essential for ATP Monitor status of calcium and vit. D--1200-1500 mg of calcium, 400 IU’s of vitamin D Identify specific nutrition problems-- Manage weight

13. Cystic Fibrosis Nutrition Poor digestion due to pancreatic insufficiency, absorption, malnutrition of fat soluble vitamins KADE, d/t need pancreatic increased respiratory problems Abnormal growth Risk for osteopenia and osteoporosism(impaired bone growth/brittle bones malabsorb calcium, vitamin D and K, phosphorus, magnesium pulmonary dysfunction causes

14. Cystic Fibrosis Nutrition Assessment National CF Foundation consensus guidelines - nutrition guidelines Special attention to poor growth and nutrition status(diagnosed from birth to 12 months from stunted growth; prior to puberty they have another period of slow growth Use growth charts – CDC--head circumference and length Timeline--risks are greatest if they fall below the 10th-25th percentile rate for length

15. Cystic Fibrosis Pancreatic enzyme therapy Given with food and beverages so it reacts with food Individualized don’t secrete lypase and Adequate kcal for normal growth based on weight gain patterns Higher fat intake (35-45% kcal) MCT--know they are malabsorbing fat give medium chain triglycerides, easiler absorbed into the system/blood stream (6-12 carbon chains, water soluble so they require less bile) Glucose intolerance common--will usually convert to a diabetic in their teen years; the pancreas is so stressed.

17. Cystic Fibrosis Monitor vitamin & mineral status--will definitely supplement KADE Monitor sodium levels--not overloading fluids Assess iron and zinc status--CF is a mineral losing disease state Recommend breast feeding--more kcals as well as immune fighting properties found in breast milk Developmentally appropriate recommendations--concerns with growth, nursing, going from infancy to toddlers and transition to eating their own foods, Formulas or nutritional supplements--can add polycose to moms milk which is a carb powder to increase kcals

18. Respiratory Failure Nutrition Meet nutrition needs trying to preserve lean body mass, esp the respiratory Energy needs vary widely; may be hypermetabolic Avoid overfeeding Indirect calorimetry preferred method to determine calorie needs--in ICU or transplant setting use 25 kcals per kilo, or 130% over the REE(resting energy expenditure) enough protein to retain nitrogen Preserve and restore LBM(lean body mass); respiratory muscle mass patients would be on lung transplant lists

19. Respiratory Failure Nutrition Maintain fluid balance 1.5-2 kcals per CC--supplement Facilitate weaning from ventilation--monitor fluids and carb status Specialty formulas available--pulmacare, oxala EPA (fish oils) and GLA (in specialty products) can reduce severity of inflammation Supplementation with antioxidants--betacarotene, vitamin C Phosphate supplementation