This document discusses nutrition therapy for patients with respiratory distress and chronic kidney diseases. It covers chronic obstructive pulmonary disease (COPD), explaining its symptoms and treatments which include smoking cessation, medications, exercise and maintaining nutrition. It also discusses nephrotic syndrome, renal stones, and acute renal failure, outlining their causes and dietary recommendations such as restricting protein, sodium, and fat intake and increasing fluid intake to prevent further health complications.

1. Nutrition Therapy For Patients
With Respiratory Distress

2. Chronic obstructive pulmonary disease
(COPD)
• Chronic obstructive pulmonary disease (COPD) is
an incurable condition that results in progressive
obstruction and inflammation of the airways.
• COPD is the umbrella term for chronic bronchitis,
emphysema, and a range of lung disorders.

3. Chronic obstructive pulmonary disease
(COPD)
• COPD results from airway obstruction and reduced
expiratory flow.
• The main symptoms of COPD include dyspnea,
possibly accompanied by wheezing, and a persistent
cough with sputum production

4. • Clubbing, which is a thickening of the flesh under
the toenails and fingernails, is a common physical
trait found in patients with COPD.
• Cyanosis, is a blue coloration of the skin and
mucous membranes caused by the presence of
deoxygenated hemoglobin in blood vessels near
the skin surface.
Chronic obstructive pulmonary disease
(COPD)

5. Treatment of COPD
• Medical management of COPD includes:
• Smoking cessation or avoidance of environmental
smoke and pollution;
• Pharmacologic therapy (eg, bronchodilators,
corticosteroids and antibiotics
• Pulmonary rehabilitation through aerobic exercise
and upper extremity strength training or oxygen
therapy;
• Maintenance of nutritional status

6. Nutrition Assessment and Diagnosis
• Malnutrition is associated with the wasting and
subsequent weakness of respiratory muscles.
• The prevalence of malnutrition was as high as
30%, and the risk of COPD related death doubled
with weight loss.
• Long term corticosteroid therapy, play an
important role in wasting syndromes by inhibiting
protein synthesis and promoting protein
catabolism

7. • Protein requirements do not increase with COPD.
• In patients with Acute Respiratory Distress
Syndrome, high levels of protein may cause
further fatigue,
• Patients with COPD might benefit from a high
carbohydrate diet and moderate fat diet
• (eg, 40% to 55% carbohydrate, 30% to 40% fat,
and 15% to 20% protein).
Nutrition Intervention

8. Nutrition and Renal Diseases

9. 1- Nephrotic syndrome
Nephrotic syndrome is the condition resulting from loss of
the glomerular barrier to protein, characterized by:
1- Excess albuminuria (3.0 g/24 h)
2- Hypoalbuminaemia
3- Massive peripheral edema
4- Hyperlipidemia
5- Hypertension.

10. Dietary needs of patients with
Nephrotic syndrome
• The main goals of medical nutrition therapy in
patients with Nephrotic syndrome are:
1- The reduction of protein losses in urine
2- The provision of sufficient energy, to prevent
malnutrition
3- The prevention of the evolution of Nephrotic
syndrome to chronic renal failure

11. 1- Moderate protein intake of 0.8 g/kg ideal body
weight (IBW) per day,
2- Sodium restriction to less than 6 g/day is also
necessary, in order to minimize edema and
hypertension
3- Regarding hyperlipidemia in these patients, low-
fat, low-cholesterol, high-complex-carbohydrate diets,
should be prescribed
Dietary needs of patients with
Nephrotic syndrome

12. 2- Renal stone
• Renal stones are generally generated when the
concentration of components in the urine is
above the level that allows crystallization.
According to their chemical constituents, they are
classified as:
1- Calcium stones
2- Uric acid stones
3- Cysteine stones

13. 1- Regardless of the type of renal stone, patients
should be encouraged to increase their fluid intake
in order to produce at least two liters of urine per
day.
2- uric acid stones, patients should be advised to
decrease their protein intake, especially from
sources with a high purine content.
Dietary needs of patients with Renal
stones

14. 3- Reduction of dietary oxalate is advised, as the
majority of urinary calculi contain oxalate.
The principal dietary sources of oxalate are spinach,
strawberries, chocolate, peanuts, tea and tomatoes.
4- As vitamin C is important for the formation of
oxalic acid in the human body, the supplemental
intake of this vitamin should be avoided
Dietary needs of patients with Renal
stones

15. 3- Acute renal failure
• Acute renal failure (ARF) is a condition
characterized by the sudden reduction in the
glomerular filtration rate (GFR) and an
alteration in the kidney’s ability to excrete
metabolic wastes, leading to uremia, metabolic
acidosis, and fluid and electrolytic imbalances

16. 3- Acute renal failure
• Causes:
a- Inadequate renal perfusion (pre-renal ARF)
b- Diseases within the kidney (intrinsic ARF),
mainly due to nephrotoxic drugs
c- Obstruction, often due to renal tumors or renal
stones (post-renal ARF)

17. 1- Provision of 30–40 kcal/kg IBW seems to be sufficient
for the majority of the patients.
2- In the early stages of ARF, patients are likely to be
anorexic and unable to tolerate oral nutrition,, total
parenteral nutrition (TPN) may be considered,
2-Regarding the dietary protein intake, the
recommendations suggest a protein intake ranging from
0.6–0.8 g/kg IBW for non-dialyzed patients to 1.0–2.0
g/kg IBW for those undergoing dialysis.
management of patients with ARF