Learning Outcomes
By the end of this section, you should be able to:
- 13.2.1 Identify nutritional habits that optimize pulmonary wellness.
- 13.2.2 Generate solutions to optimize pulmonary wellness utilizing nutritional habits.
Poor dietary habits are a modifiable risk factor and treatment target for clients with both acute and chronic illness. A client with a cold, influenza, or pneumonia may need immune support (vitamin C and zinc), while a client with chronic conditions needs a comprehensive approach to nutritional intervention. Healthy People 2030, the U.S. Department of Health and Human Services’ public health initiative, identifies health behaviors focused specifically on nutrition and food. The healthy-eating objectives include increasing fruit, vegetable, and whole-grain consumption, decreasing intake of sugary drinks and sodium, reducing food insecurity, increasing intake of vitamins and minerals, increasing number of infants breastfeeding, and reductions in obesity. MyPlate utilizes evidence-based data from the Dietary Guidelines for Americans 2020–2025 and is a pictorial representation of the types and quantities of food that should be consumed at meals.
Table 13.4 identifies some specific nutrition recommendations to impact pulmonary health. These principles designed to promote general health are particularly useful for clients with chronic pulmonary conditions. Additional strategies may include a focus on protein-rich foods that are easily digested.
| Nutrient | Food Source | Consideration |
|---|---|---|
| Antioxidants (vitamin C, vitamin E, and beta carotene) |
|
Reduce inflammation, strengthen the immune system, support lung function, and reduce asthma symptoms |
| Vitamin D |
|
Supports lung function and reduces upper respiratory infections |
| Antioxidants (flavonoids) and selenium |
|
Anti-inflammatory benefits and promote normal lung tissue |
| Whole grains |
|
May reduce asthma symptoms promote better asthma control |
| Sulfites (preservative) |
|
May be an allergen for some clients and trigger reactions or asthma attacks |
The following nutritional supports and actions are available to optimize function and health in pulmonary conditions for infancy through adulthood:
- Infants–Breast milk (Figure 13.5) is best in the first year, supporting optimal nutrition (vitamin A) and development of immune system, and is associated with less allergic disease and as a protective mechanism in later childhood against illness (wheezing, asthma, and viral illness). As an alternative, formula in the first year is acceptable, although not protective against atopic disease or asthma. Cow’s milk and soy milk should be avoided in the first year (CDC, 2022c); they are difficult for an infant to digest, and cow’s milk can cause for iron deficiency and iron deficiency anemia (Calcaterra et al., 2021).
- Children–Combine preferences with a balanced diet plan. Consider finger foods; establish an eating routine (i.e., sitting for meals, focused mealtime, pleasant environment for eating); educate on nutrition content, balanced diet, MyPlate, and reading labels; create games that make nutrition fun; avoid sugary drinks; encourage exercise and active play. Apples, kiwi fruit, spinach, garlic, avocados, broccoli and bananas are easy to eat or add to other dishes; these are excellent fruits and vegetables for children with asthma due to the nutrient content (minerals, vitamin C, vitamin E, and antioxidants) and the anti-inflammatory properties.
- Adolescents–Combine preferences with balanced diet plan. Educate about nutritional needs for growth and on how to choose healthy options when eating out. Convenience foods that are easy to grab on the go and may appeal to adolescents but that also contain antioxidants include oranges, strawberries, carrots, nuts, and sunflower seeds.
- Adults–Educate on the impact of diet on health conditions, meal planning, and use of Mediterranean diet, MyPlate, or nutrient dense meals.
Pulmonary rehabilitation assists in reducing respiratory symptoms, improving function, and increasing emotional and physical participation in activities that promote quality of life. The rehabilitation team will vary based on the facility but often includes physical therapist, occupational therapist, respiratory therapist, and dietitian along with the client’s health care provider. Instruction on nutrition, breathing techniques, and exercise assist in maximizing energy.
For clients with dyspnea, frequent coughing, or fatigue, the following additional instructions and guidance from the American Lung Association (2023) may be useful in supporting the opportunity for improved nutrition:
- Take smaller bites of food and eat slowly.
- Sit upright while eating.
- Take a break between bites and practice deep breathing exercises.
- Eat more food early in the morning if too tired to eat later in the day.
- Avoid foods that cause gas or bloating, which tend to make breathing more difficult.
- Eat 4–6 small meals a day to enable the diaphragm to move freely and let the lungs fill with air and empty out more easily.
- Limit liquids with meals or drink after meals if drinking liquids causes a feeling of fullness, but continue to strive for 6–8 glasses of water daily.
- Consider adding a nutritional supplement at night to avoid feeling full during the day.
Planning Nutritional Goals
The goal of nutrition therapy for pulmonary wellness is to maintain adequate respiratory function to decrease or prevent malnutrition and obesity. Avoiding malnutrition will help preserve muscle strength and help maintain the integrity of the immune system. Adequate and proper nutrition is the primary goal in pulmonary wellness; this involves achieving a total daily caloric intake that meets the client’s metabolic needs with foods from a variety of food groups and an emphasis on including antioxidants. If mucus overproduction and/or retention is problematic, as with COPD, chronic bronchitis, emphysema, cystic fibrosis, and asthma, reducing foods high in histamine (such as processed meat, aged cheese, legumes) is advised. Clients should avoid empty calories (calories lacking nutritional value).
Trending Today
Pulmonary Wellness Through Holistic Care Strategies
As you work through this Trending Today feature, recall that nurses should rely on evidence-based practice (EBP), which uses scientific evidence rather than anecdotal evidence, to inform their practice and care of clients. Nurses should encourage clients to evaluate nutritional information on social media with the same scrutiny.
Holistic care is a prevailing trend for nutritional venues promoting pulmonary wellness. Focusing on the apothecary found through herbs, @healingartsapothecary promotes a variety of nutritional components that assist with bronchial drainage, liquefying mucus, and minimizing lung secretions. These herbs, from oregano oil to wild cherry bark tea, can promote lung health year round but may be especially helpful during seasons that exacerbate respiratory issues. Facebook followers can visit LUNGevity Foundation, which promotes the use of specific foods to minimize treatment side effects encountered by individuals diagnosed and living with lung cancer.
Take some time to review the following social media content and think critically about the information provided and its appeal to clients.
- @healingartsapothecary (TikTok)
- LUNGevity Foundation (Facebook)
Now answer the following questions:
- Which account did you prefer when viewing or reading? Explain.
- What is the purpose of the content you viewed or read?
- How would you evaluate these sources for use of EBP, and which sources used EBP?
- If a client came to you with this information, how would you educate them to critically use these sources?
- What alternative sources would you recommend to clients to educate them about this topic?
Carbohydrates, Fiber, Proteins, and Fats
The nurse should advise clients to choose complex carbohydrates, such as whole-grain bread and pasta, fresh fruits, and vegetables, and to limit simple carbohydrates such as table sugar, candy, cake, and soft drinks and sugary beverages. Women should aim for about 25 g/day of fiber; men should aim for 38 g/day (or 14 g for every 1000 calories) (Larson, 2021). Fiber is contained in bread, pasta, nuts, seeds, fruits, and vegetables. For clients prone to gas or bloating, it can make breathing more difficult, so avoiding beans, legumes, and gas-producing vegetables, such as Brussels sprouts, broccoli, cauliflower, and cabbage, may be necessary.
Proteins play a major role in preventing malnutrition and the integrity of the immune system. Protein requirements increase according to illness severity ranging from 0.8–1.2 g/kg of protein per day for mild or moderate illness up to 1.2–1.5 g/kg of protein per day for clients with severe illness (Deer & Volpi, 2018). Good sources of protein include milk, eggs, cheese, meat, fish, poultry, nuts, and peas. Clients who are malnourished should choose protein with a higher fat content, while clients who are overweight or obese should choose low-fat or leaner options. To increase protein intake, add peanut butter, whey, or soy (vegan) protein powder during food preparation, or add a protein drink or shake as a supplement.
The client should choose healthier unsaturated fats from plant sources such as canola and olive oils, which do not contain cholesterol and are liquid at room temperature. To reduce inflammation and support cellular rebuilding, the client should choose omega-3 fatty acids and other healthy fats that are found in nuts, eggs, avocados, and fish. The client should avoid artificial trans fats and saturated fats. Adding healthy fats to protein-based meals is a way to add extra calories to food for undernourished clients who need them. To lose weight, clients will want to limit fat intake.
Vitamins, Minerals, and Antioxidants
Multivitamins will likely help support overall nutrient balance. Additionally, older clients or those with chronic pulmonary illness requiring corticosteroid use may also benefit from calcium carbonate or calcium citrate and vitamin D supplements for general bone health and the prevention of osteoporosis. All use of supplements should be discussed with the health care provider.
Too much sodium may cause edema and impact blood pressure and fluid volume (American Lung Association, 2023). Processed and prepared foods, such as food that comes in cans, bottles, jars, or frozen packaging, may have high sodium content. Clients should look for packages marked as low sodium. During food preparation, spices and herbs can season foods instead of additional salt. They should also avoid adding salt to food after it is prepared.
Clients with COPD and hypoxemia will benefit from a lycopene-enriched diet. Fruit, vegetables, whole grains, and nuts are rich in antioxidants and encouraged.
Identifying Challenges to Nutritional Goals
The client will face numerous challenges that make achieving nutritional goals challenging, if not impossible. Challenges based on normal physiologic changes occurring with age, such as decreased taste and smell, may be improved by utilizing spices, herbs, colorful foods, and preferred foods or those with pleasant food memories. Fatigue, particularly in clients with dyspnea or increased work in breathing, will be best addressed through small frequent meals and increased functional status. The involvement of physical therapy, occupational therapy, and opportunities for strength building is essential. Increased energy requirements for clients who are underweight or malnourished will require frequent calorie-dense meals, snacks, and likely nutritional supplementation with whey or soy (vegan) protein drinks. Protein drinks provide high protein amounts in low-volume portions and may provide the nutritional components necessary for muscle synthesis and improved muscle strength (Ahmadi et al., 2020).
The health care provider must develop strategies to improve or overcome these challenges to ensure the client consumes adequate and proper nutrition for pulmonary wellness. The involvement of a registered dietitian for a consult and for maintenance support will emphasize the importance of nutrition. Continued nutritional support and individualized nutritional intervention by a dietitian over the course of 6 months lowers mortality in polymorbid older adults after hospital discharge (Gomes et al., 2018).
Clients with limited function and impaired health due to significant pulmonary disease, obesity, or lack of strength and energy secondary to malnutrition may struggle with isolation, depression, and anxiety. These may produce fear, food avoidance, reliance on highly processed foods due to convenience, or various other barriers to quality nutrition. Optimum management of pulmonary conditions is an excellent initial step in managing the associated mental health conditions. Additional nutritional considerations may be the Mediterranean-style diet and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, which have cognitive and neurotransmitter benefits, reduce stress and anxiety, increase energy, and lower the change of depression and psychological distress (Grajek et al., 2022).
Financial limitations, access to resources, and religious or cultural barriers may also exist. Clients may need considerations for social support and referrals (government or charitable resources), such as financial assistance or meal-delivery programs. The Congregate Nutrition Program and the Home-Delivered Nutrition Program provide meals to low-income and older adults, while the Supplemental Nutrition Assistance Program (SNAP) is the largest hunger safety net in the U.S., assisting with the purchase of food items. Unfortunately, additional barriers exist in accessing these programs due to lack of awareness, confusion about eligibility, application challenges, lack of transportation to a meal site, and stigma due to the desire for autonomy and independence (Burris et al., 2021). Social services offices at the organizational, city, or county level, along with non-profits (senior centers and community groups), provide some individualized support in addressing these barriers and accessing essential resources.
Religious and cultural barriers may exist related to locating and understanding how to select nutritious items that are kosher or halal. Maximizing nutrition in shorter periods of time may be a challenge that clients face during periods of fasting observed by Muslims during Ramadan, and Catholics, Protestants, Greek Orthodox, or those of Jewish faith during religious holidays or selected periods of spiritual discipline. Involvement of community groups, specialized websites, and members of faith communities, as well as provider and dietitian support, can assist a client to address these barriers.
Unfolding Case Study
Part B
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.
Katrice is in today for a routine asthma follow-up. The provider collects and reviews the 24-hour food recall with Katrice and her parents, praising the few high-quality food choices and providing education about MyPlate as a guide for the types and quantities of food that will better support Katrice’s nutrition. Katrice admits to having donuts or other sweet items for breakfast because they are “easy to grab and have in the car.” She also has candy daily and fast-food meals at least 4–5 times a week. The provider explains the physiologic changes associated with obesity and increased BMI, which can worsen Katrice’s asthma and impact her health during sports and play. Katrice and her parents verbalize understanding. They will implement the new knowledge over the next 2 weeks, and return for follow-up, bringing a food log with them and any questions. The provider also discusses a referral to physical therapy for assessment and post-exercise stretches to support less pain and need for medication. The provider educates about the risks of bronchospasm with NSAID use and recommends acetaminophen instead. Katrice’s parents verbalize understanding and are receptive to education.