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 Antioxidants and lung function Cigarette smokers Early satiety, anorexia, weight loss, cough, dyspnea during eating

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

5. Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy 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 Closely monitor electrolyte balance Sufficient minerals for bone growth

6. Bronchopulmonary Dysplasia (BPD) Treatment/Nutrition Therapy Mechanical ventilation Nutrition support May need fluid and sodium restriction Specialty infant formulas Breast milk preferred Education and support to caregivers

7. © 2007 Thomson - Wadsworth

8. Chronic Obstructive Pulmonary Disease COPD – progressive disease which limits airflow through inflammation of bronchial tubes (bronchitis) Primary risk factor – smoking

9. COPD Nutrition Therapy Low dietary intake Altered taste perceptions and appetite Elevated REE

10. COPD Nutrition Therapy - Interventions Maintain optimal energy balance 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 Monitor serum phosphate Monitor status of calcium and vit. D Identify specific nutrition problems Manage weight

13. Cystic Fibrosis Nutrition Poor digestion, absorption, malnutrition d/t pancreatic insufficiency Abnormal growth Risk for osteopenia and osteoporosis

14. Cystic Fibrosis Nutrition Assessment National CF Foundation consensus guidelines - nutrition guidelines Special attention to poor growth: Use growth charts – CDC Timeline

15. 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 Glucose intolerance common

17. Cystic Fibrosis Monitor vitamin & mineral status Monitor sodium levels Assess iron and zinc status Recommend breast feeding Developmentally appropriate recommendations Formulas or nutritional supplements

18. Respiratory Failure Nutrition Meet nutrition needs Energy needs vary widely; may be hypermetabolic Avoid overfeeding Indirect calorimetry preferred method Preserve and restore LBM; respiratory muscle mass

19. Respiratory Failure Nutrition Maintain fluid balance Facilitate weaning from ventilation Specialty formulas available EPA and GLA can reduce severity of inflammation Supplementation with antioxidants Phosphate supplementation