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Nutrition Therapy in Pulmonary Diseases.pptx

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Nutrition Therapy in Pulmonary Diseases.pptx

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It contains several pulmonary diseases such as cystic fibrosis, asthma, COPD with their pathophysilology and medical nutrition therapy.

It contains several pulmonary diseases such as cystic fibrosis, asthma, COPD with their pathophysilology and medical nutrition therapy.


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Nutrition Therapy in Pulmonary Diseases.pptx

  1. 1. Pulmonary system
  2. 2. CYSTIC FIBROSIS (CF) Cystic fibrosis is a genetic condition. It's caused by a gene mutation in [cystic fibrosis transmembrane conductance regulatory gene CFTR/ chromosome no.7]. The gene mutation affects the movement of salt and water in and out of cells. This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the body's tubes and passageways – particularly the lungs and digestive system. • Inherited autosomal recessive disorder • CF incidence of 1:2500 live births • Survival is improving; median age of patients has exceeded 30 years • Epithelial cells and exocrine glands secrete abnormal mucus (thick) • Affects respiratory tract, sweat, salivary, intestine, pancreas, liver, reproductive tract
  3. 3. Organs Affected by Cystic Fibrosis • Lungs • Sinus • Intestines • Panaceas • Liver
  4. 4. Symptoms • The dysfunctional CFTR protein channel is found all over GI tract • It causes elevated Sweat- Electrolyte balance. • A persistent cough that produces thick mucus (sputum) • Wheezing • Exercise intolerance • Repeated lung infections • Inflamed nasal passages or a stuffy nose • Recurrent sinusitis
  5. 5. DIAGNOSIS OF CYSTIC FIBROSIS • Neonatal screening provides opportunity to prevent malnutrition in CF infants • Sweat test (Na and Cl >60 mEq /L) • Chronic lung disease • Malabsorption • Family history
  6. 6. Complications of CF • Damaged airways • Coughing up blood (hemoptysis) • Chronic infections • Pneumothorax • Respiratory failure
  7. 7. NUTRITIONAL IMPLICATIONS OF CF • Infants born with meconium ileus are highly likely to have CF. • 85% of persons with CF have pancreatic insufficiency Plugs of mucus reduce the digestive enzymes released from the pancreas causing mal- digestion of food and malabsorption of nutrients. • Decreased bicarbonate secretion reduces digestive enzyme activity. • Decreased bile acid reabsorption contributes to fat malabsorption. • Excessive mucus lining in the GI tract prevents nutrient absorption by the microvilli.
  8. 8. GASTROINTESTINAL COMPLICATIONS • Bulky, foul-smelling stools • Cramping and intestinal obstruction • Pancreatic damage causes impaired glucose tolerance • (50% of adults with CF) and development of diabetes
  9. 9. COMMON TREATMENTS Pancreatic enzyme replacement • Adjust macronutrients for symptoms • Nutrients for growth • Meconium ileus causes the intestinal obstruction So, enzymes, fiber, fluids, exercise, stool softeners are given. Digestive Enzymes: • Enteric-coated enzyme microspheres withstand acidic environment of the stomach, they release enzymes in the duodenum, where they digest protein, fat and carbohydrate.
  10. 10. NUTRITIONAL CARE GOALS • Control malabsorption. • Provide adequate nutrients for growth or maintain weight for height or pulmonary function. • Prevent nutritional deficiencies.
  11. 11. In children energy requirement should be based on the weigh gain and growth. Energy need for CF children without ventilation are comparable to healthy children (100 – 110% of RDA). In case of significant lung disease, malabsorption, ER increase 120 - 150% of RDA Medical Nutrition Therapy
  12. 12. Protein Requirement: Protein needs are increased in CF due to malabsorption If energy needs are met, protein needs are usually met by following 15-20% protein or use RDA Or 2.2/kg b/w
  13. 13. Fat Requirement: • Fat intake 35-40% of calories (in fat malabsorption), as tolerated • Helps provide required energy, essential fatty acids and fat-soluble vitamins. • Limits volume of food needed to meet energy demands and improves palatability of the diet • Essential Fatty Acids deficiency sometimes occurs in CF patients despite intake and pancreatic enzymes. • Fat restriction is not recommended • Important energy sources, fat used = MCT oil, fish oil.
  14. 14. CHO Requirement : • Eventually intake may need to be modified if glucose intolerance develops. • Some patients develop lactose intolerance. Vitamins requirement: • With pancreatic enzymes, water soluble vitamins usually adequately absorbed with daily multivitamin will need high potency supplementation of fat soluble vitamins (A, D, K, E)
  15. 15. FEEDING STRATEGIES: INFANTS • Breast feeding with supplements of high-calorie formulas and pancreatic enzymes. • Calorie dense infant formulas (20-27 kcals/oz) with enzymes. • Protein hydrolysate formulas with MCT oil if needed.
  16. 16. FEEDING STRATEGIES: CHILDREN ANDADULTS • Regular mealtimes • Large portions • Extra snacks • Nutrient-dense foods • Nocturnal enteral feedings • Intact or hydrolyzed formulas • Add enzyme powder to feeding or take before and during
  17. 17. PNEUMONIA It is a infection in the lungs caused by the microbe invasion in lungs. It causes inflammation of air sacs. Bacterial Pneumonia • Streptococcus Pneumoniae • Mycoplasma Pneumoniae • Staphylococcus Aureus Viral Pneumonia • Haemophilus Influenzae
  18. 18. Alveoli fill with pus and fluid making gas exchange difficult.
  19. 19. Air Passage in Lungs
  20. 20. Defense System of Lungs
  21. 21. Hospital Acquired Pneumonia (Nosocomial) • A person gets it when he is admitted in the hospital with any other disease condition. • Microbes in hospitals are more antibiotic resistant. • Example: MRSA Community Acquired Pneumonia • A person gets it outside a hospital setting, either from the environment. • The infection causes deterioration of lung resulting in fluid accumulation and breathing difficulties. Types and Occurrence of Pneumonia
  22. 22. Ventilator Acquired Pneumonia • It is a subset of Hospital acquired pneumonia. • It happens when a person is on ventilator. Aspiration Pneumonia • Aspiration is when a Food, Drugs, Gastric Content passes into the trachea. • Material like, saliva, nasal secretion, bacteria, foods. • The food items have microorganisms on it that causes infection which ultimately leads to pneumonia.
  23. 23. Sign and Symptoms • Dyspnea [shortness of breath] • Confusion • Chest Pain • Productive cough • Fatigue • Fever/ Sweating • Chills • Nausea, vomiting
  24. 24. Diagnosis • Breathing Issues [shortness of breath] • Chest X-ray • Tactile Vocal Fremitus [More vibrations from back] • Bronchial breath sounds Treatment •Anti-biotics •Cough suppressants •Pain Medications
  25. 25. NUTRITION IMPLICATION Patients admitted to the hospital due to CAP (community acquired Pneumonia), most important risk factor associated to mortality. • Low serum albumin (<3.0 g/dl) • The depress albumin is associated to the inflammation response rather than malnutrition. Other indices of poor nutrition status associate to death are low triceps skinfold (TSF) and low BMI.
  26. 26. Medical Nutrition Therapy • Energy required is based on the underlying diseases (often hypermetabolic/ Elevate Resting Energy Expenditure), 1.2 – 1.4 x BEE. REMEMBER do not over feed the patient. • Overfeeding Increase CO2 production. • The provision 25 kcal/kg appears to be adequate to most pt. • Protein requirement: 1.2 – 1.5 g/kg. • CHO may be given according to pt. needs. • Fluid balanced should be monitor closely as pulmonary effusion can occur. • Pulmonary edema, the use of fluid restricted enteral formulation (1.5 – 2 kcal/cc) may be helpful, for those need for fluid restriction. • Supplementation of potassium, calcium, and magnesium may be administered as these are lost in the urine.
  27. 27. • Among the pulmonary infections with nutritional implications is pneumonia. The role of vitamin A in treating pneumonia yields some possible results. • Because of their role in inflammation and immunity, epidemiologic researches investigating the role of EFAs. Such research shows a possible protective effect against pneumonia by the ingestion of a-linolenic and linoleic acids. • Pneumonia usually occurs as a nosocomial infection or as a consequences of aspiration of food, fluid, or secretions such as saliva. • Optimal nutrition status and proper feeding techniques aid in preventing this pulmonary infection. Aspiration is common in infants, children, and adults who are frail, have frequent coughing spasms, are unable to effectively chew or swallow their foods and beverages or have inadequate head and neck control during eating.
  28. 28. RESPIRATORY FAILURE In respiratory failure, the gas exchange between the air and circulating blood is severely impaired, resulting in abnormal levels of tissue gases that can be life threatening. The normal value of arterial partial pressure of oxygen and carbon dioxide is, PAO2: 10.6 -13.3kPa PACO2: 4.7 -6.0 kPa Hypoxemia: PAO2: < 10.6 kPa Hypercapnia: PACO2: >6 Kpa Respiratory failure PAO2: <8kPa PACO2: >6.7 kPa
  29. 29. Causes Of RF: Any of a large number of conditions that cause lung injury or impair lung function can be the underlying cause of failure; examples include infection (such as pneumonia or sepsis), physical trauma, neuromuscular disorders, smoke inhalation, and airway obstruction. Occur when the respiratory system is no longer able to perform its normal function. It result from long standing chronic lung disease like COPD, CF or as a result of an acute abuse to the lung such as acute respiratory distress syndrome (ARDS). Categories of acute respiratory distress syndrome: • Directly cause injured to the lung e.g. Pneumonia, aspiration or inhalation injury. • Indirectly cause injury precipitated by event outside the lung e.g. sepsis, trauma, or pancreatitis.
  30. 30. Medical Nutrition Therapy • Energy required is based on the underlying diseases (often hypermetabolic) 1.2 – 1.4 x BEE * REMEMBER do not over feed the patient as it increases CO2 production • Increase ventilator demand associated with overfeeding; • Excess glucose administration (>5 mg/kg per min). • The provision 25 kcal/kg appears to be adequate to most patient • Fluid balanced should be monitor closely • Protein requirement: 1.2 – 1.5 g/kg (to promote nitrogen retention without being excessive) • Pulmonary edema, the use of fluid restricted enteral formulation (1.5 – 2 kcal/cc)may be helpful, for those need for fluid restriction.
  31. 31. •Acute respiratory distress is associate with production of oxygen free radical and inflammatory mediators, recent study shows: • EPA in fish oil and GLA in borage oil can reduce the severity of inflammatory injury. • High level of antioxidant: α-tocopherol, β-carotene and vit C at higher level than DRI • Increase serum α-tocopherol, β-carotene & prevent further oxidative damage. • Phosphate is essential for optimal pulmonary function and normal diaphragm contraction. • Hypophosphatemia increase hospital stay and dependence to ventilation. Need to monitor phosphate and supplementation should be initiated in hypophosphatemia
  33. 33. TUBERCULOSIS Caused by a bacillus bacterium
  34. 34. Nutritional factors that increase risk of TB: • Many patients are developing drug-resistant TB • Nutritional factors that increase risk of TB: • Protein-energy malnutrition: affects the immune system; debate whether it is a cause or consequence of the disease • Micronutrient deficiencies that affect immune function (vitamin D, A, C, iron, zinc)
  35. 35. Nutritional consequences: • Increased energy expenditure • Loss of appetite and body weight • Increase in protein catabolism leading to muscle breakdown • Malabsorption causing diarrhea, loss of fluids, electrolytes
  36. 36. Medical Nutrition Therapy • Energy: 35-40 kcals/kg of ideal body weight • Protein: 1.2-1.5 grams/kg body weight, or 15% of energy or 75-100 grams/day • Multivitamin-mineral supplement at 100-150% DRI. • Provide energy dense foods to overcome overfeeding. • Provide colorful fruits and vegetables rich in antioxidants. • Foods rich in Vitamin A, C and E and Zinc.
  37. 37. Thank You!

Editor's Notes

  • CFTR gene codes CFTR protein – which is a chloride channel – It help the ions to move in and out.
    Epithelial cells are the cells that covers inside and outside surface of body
  • Inflammation and infection of sinus. As it effects the Epithelium layer in upper respiratory tract.
    The mucous blocks the digestive enzymes from reaching the intestines. So Fats and proteins are not digested properly. Pancreas and Intestines cant work properly
  • Whistling sounds while breathing
  • The dark green substance forming the first faeces of a newborn infant.
    Meconium ileus is a bowel obstruction that occurs when the meconium in your child's intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum. Most infants with meconium ileus have a disease called cystic fibrosis.
  • Fat soluble vitamins.
  • Inflammatory response– WBS, protein, fluid and WBC
  • Inflammation can cause fluid retention in alveoli
  • Alveoli are tiny air sacks in grape like structure that has capillaries in it. The gas exchange occurs in alveoli.
  • With the air we inhale certain microorganisms. Mucociliary escalator has tiny villi that structure that prevents the micrograms. Macrophages engulfs the microorganisms.
  • sthethoscope
  • Protein needs are increased in patients with lung inflammation or Acute Respiratory Distress Syndrome.
    For mild or moderate lung injury, protein recommendations range from 1.0 to
    1.5 grams of protein per kilogram body weight per day
  • a-linolenic and linoleic acids is present in sunflower seeds, nuts, soybean, canola oil.
    EFAs [essential fatty acids]
  • The rate of oxygen diffusion across the alveoli capillary membrane with respect to elimination of co2
    Movement of substance from higher concentration to a lower conc.
  • Protein needs are increased in patients with lung inflammation or ARDS.
    For mild or moderate lung injury, protein recommendations range from 1.0 to
    1.5 grams of protein per kilogram body weight per day
  • Gama Linoleic acid
    Alpha tocopherol: prevents blood clotting, anti oxidant [free radical damage]
    Beta carotene : Anti oxidant