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Nutrition for Nurses

14.1 The Impact of Nutrition on Pulmonary Wellness Across the Lifespan

Nutrition for Nurses14.1 The Impact of Nutrition on Pulmonary Wellness Across the Lifespan

Learning Outcomes

By the end of this section, you should be able to:

  • 14.1.1 Describe the impact of nutrition on the pulmonary system during pregnancy.
  • 14.1.2 Describe the impact of nutrition on the pulmonary system during infancy.
  • 14.1.3 Describe the impact of nutrition on the pulmonary system during childhood.
  • 14.1.4 Describe the impact of nutrition on the pulmonary system during adolescence.
  • 14.1.5 Describe the impact of nutrition on the pulmonary system during adulthood.
  • 14.1.6 Describe the impact of nutrition on the pulmonary system during later adulthood.

Pregnancy

Nurses must be skilled in assessing the holistic aspects of client care across the lifespan. One of the critical aspects often overlooked but of incredible value is the nutritional intake of clients. Nurses must comprehend the pulmonary system from pregnancy and infancy to older age, as they assess the dietary aspect and provide education and advocacy for the clients they treat.

As clients progress through the reactions and lifestyle modifications that occur during pregnancy, considering nutrition and how it impacts the pulmonary system is yet another area of importance. Pregnancy elicits various responses from the pregnant client (Dokuhaki et al., 2021). The body undergoes various physiological changes to adapt to the introduction and adjusts to a growing fetus. The pregnant client’s nutritional needs transform to accommodate the developing fetus and consider the client’s physiological changes (Widysanto & Mathew, 2022). Maternal nutritional needs and deficiencies are vital to fetal lung development and prevention of fetal and childhood complications (Arigliani et al., 2018; Baiz et al., 2019; Fandino et al., 2019; Rocha et al., 2021).

Physiological Changes to the Pulmonary System During Pregnancy

Upper-airway changes that occur during pregnancy include nasal congestion, called rhinitis, because of hyperemia, edema, plasma leakage into the stroma, glandular hypersecretion, increased phagocytic activity, and increased mucopolysaccharide content. Hyperemia occurs as a result of a higher-than-normal blood flow. The exact etiology of rhinitis during pregnancy is unknown but is thought to be related to increased blood volume and hormonal fluctuations. Complications of rhinitis in pregnancy include snoring and sleep-disordered breathing, both related to hypertension and preeclampsia.

The chest wall structurally adapts in pregnancy to anticipate the growing uterus and maternal weight gain as the subcostal angle of the rib cage widens between 68.5° and 103.5° and the circumference of the lower chest wall increases by 5–7 cm in girth while the diaphragm shifts upward. With pregnancy, total body blood volume increases 40% (Sanghavi & Rutherford, 2014; Soma-Pillay et al., 2016). The rise in the relaxin hormone initiates relaxation and loosening of ligament attachments in the lower ribs.

Nutritional Needs and Deficiencies Related to Pulmonary System During Pregnancy

Pregnant clients have additional specialized dietary needs that support the physiological changes of the client and growth of the fetus. A balance in macronutrients such as protein are vital for healthy pregnancies and babies (Herring et al., 2018). Baiz et al. (2019) recommend consuming eggs and raw or cooked vegetables to limit the effects of allergic rhinitis during pregnancy.

Under- or overnutrition of a pregnant client causes imbalances of nutrients such as amino acids and increases blood cortisol levels and oxidative stress (Herring et al., 2018). If malnutrition prevails during pregnancy, the results equate to “impairment of offspring growth and development, maternal insulin resistance, cretinism, IUGR [intrauterine growth restriction], birth defects, cognitive and behavioral defects, postpartum complications, preeclampsia, eclampsia, anemia, preterm birth, maternal hemorrhaging, and additional long-term effects for both mother and offspring” (Herring et al., 2018).

Maternal needs and nutritional deficiencies related to malnutrition negatively impact the pulmonary system during pregnancy. Undernutrition in a pregnant client alters hormones that disrupt the lung maturation of the fetus (Fandino et al., 2019). Macronutrient and micronutrient recommendations are discussed further in the next section.

Maternal Nutritional Impact on the Fetus

Adequate maternal nutrition prevents intrauterine complications such as intrauterine growth restriction (IUGR) and lung development in the growing fetus (Bendix et al., 2020; Fandino et al., 2019; Voraphani et al., 2022). See Figure 14.2 for the stages of lung development. IUGR results from below-average fetal development and equates to babies that are small for gestational age and have an abnormal growth trajectory; it is linked with placental dysfunction and malnutrition. The term IUGR is often interchanged with small for gestational age (SGA), but the terms vary in that SGA means the fetus is small for gestational age but has an average growth trajectory. The clinical definition of IUGR is a baby weighing less than two standard deviations below the mean or remaining below the tenth percentile at a specified gestational age (Bendix et al., 2020). Infants with IUGR are at risk for complications such as asphyxia, hypothermia, hypoglycemia, and polycythemia. Long-term complications include growth limitations, neurodevelopmental handicaps, and disease processes linked to the cardiovascular, renal, and immunological systems. Even if the growth occurs in incremental units, the fetus may experience IUGR or meet poor outcomes from maternal malnutrition (Arigliani et al., 2018; Fandino et al., 2019; Rocha et al., 2021).

A diagram of the stages of fetal lung development. At the beginning of the fourth week, there is a pharynx, laryngotracheal tube, and the splanchnic mesoderm. These form into the esophagus, trachea, and tracheal buds. By the end of the fourth week, the trachea and bronchial buds have formed. Next, the trachea bifurcates into more defined bronchial buds. As development continues, more bronchial buds appear. By the eighth week, the right lung has developed into defined upper, middle, and lower lobes, while the left lung has defined upper and lower lobes. There are defined bronchial buds in each of these lobes.
Figure 14.2 Fetal lung development occurs in distinct phases during different weeks of gestation. When development is complete the fetus is prepared for breathing that takes place outside of the womb. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

If a pregnant client has inadequate nutrition, the infant with IUGR is at a higher risk for reduced nutrient availability and oxygen related to placental insufficiency. Undernutrition during pregnancy leads to impaired alveolarization and suppressed surfactant protein expression, diminished pulmonary vascular development, lower alveolar surface area, increased extracellular matrix, and thickened blood-gas barrier, limiting compliance and capacity. Causes of IUGR include severe maternal starvation and suppressed pregnancy weight gain, high altitude, maternal hypoxia, diabetes, and infections such as tuberculosis. Inadequate protein intake during pregnancy leads to embryonic losses, IUGR, and reduced postnatal growth, leading to a deficiency in amino acids critical for cellular metabolism and function (Herring et al., 2018). In contrast, high protein intake during pregnancy may also cause IUGR and embryonic death related to amino acid excess and ammonia toxicity (Herring et al., 2018). Nurses must assess and educate the pregnant client on the importance of moderate protein consumption. The recommended protein intake for the first trimester is 46 g/day and increases to 71 g/day during the second and final trimesters (Murphy et al., 2021).

Infancy

Infancy is a stage that begins the lifespan. It follows pregnancy and birth and is characterized by rapid growth, development, and adaptations. During infancy, the baby experiences rapid weight and height gains. Generally, depending on the source, babies are considered infants from birth up to age 1. Cognitive development during infancy includes exploration, attention, memory, inquisitiveness, and communication acquisition. An infant’s milestones include holding their head up, rolling over, sitting with support, crawling, standing, and walking. Infants form bonds with their caregivers that are shared through eye contact, touch, responsive care, and body language. Infants rely on their parents or caregivers for full support.

The pulmonary system undergoes significant adaptations to support the transition between the in-utero and outside world. The fundamental pulmonary changes include the lungs’ transition from fluid-filled to breathing outside air (Arigliani et al., 2018; Fandino et al., 2019; Rocha et al., 2021). Surfactant production increases late in pregnancy and continues through development and maturation during the first few weeks of life. The lungs can expand and stretch, allowing for growing volume capacity. The airways continue to grow and mature. Infants obtain antibodies through breast milk in colostrum (in the first few days of life) and immunoglobulin A (after the first few days) to help infants fight infection and support their immune systems.

Nutritional Impact During Infancy

Nutrition is crucial in lung growth, development, and repair in fetuses, preterm infants, infants, and children (Arigliani et al., 2018; Bendix et al., 2020; Fandino et al., 2019; Rocha et al., 2021). One of the primary systems to develop in a fetus is the respiratory system, which begins on day 22 after conception. Although the process begins early with the trachea, lungs, bronchi, and alveoli, complete development does not occur until around age 8 (Rehman & Bacha, 2022). If a child is born with IUGR or SGA, health care providers must assess nutritional aspects to determine if undernutrition or malnutrition contributes to stunted growth. Micronutrients that play a role in lung maturation include vitamins A, D, E, selenium, and omega-3 fatty acids (Arigliani et al., 2018).

Childhood

Alveolarization continues from infancy through approximately 8 years of age. Even if pulmonary development and function is normal at birth, insulting exposures can cause setbacks. Some scientists have traced poor lung function from infancy through childhood to identify potential events associated with decreasing optimal pulmonary development and capacity. A child born without any difficulty in pulmonary function but exposed to second-hand smoke may experience stunted growth (Schultz et al., 2018). According to Schultz et al. (2018), in the same study, when individuals demonstrated limitations at age 8 in lung function, they maintained these lower levels of function even when retested at age 16. When 8-year-old children have developmental limitations and are exposed to second-hand smoke, their lung function diminishes. Maternal smoking habits throughout pregnancy also play a role in decreased lung development. Schultz et al. (2018) study results further support the view that being born prematurely increases the risk for diminished lung development and function as the child grows. These children do not recover the lost development with age. They also are at an increased risk for developing asthma, wheezing, and declination of lung function during respiratory infection season.

Nutritional Impact During Childhood

Nutrition plays a significant role in the development and function of the respiratory system throughout childhood. Adequate nutritional intake during childhood maintains a healthy growth pattern, aids lung tissue repair, and supports the immune system to prevent and treat infection (Gozzi-Silva et al., 2021). Intake of adequate amounts of macronutrient protein and micronutrients vitamins A, C, E, omega-3 fatty acids, and zinc is important for lung function. Inadequate consumption of the proper nutrients causes impaired lung function and respiratory problems. Improper nutritional intake affects the immune system, which protects the lungs from infection and inflammation. Malnutrition throughout childhood increases the risk for infection and exacerbates conditions like asthma. Childhood obesity causes detrimental effects on lung capacity by reducing lung capacity, expiratory reserve, and residual volume due to excessive adipose tissue increasing the intraabdominal pressure on the diaphragm, altering full chest expansion (Ferreira et al., 2020).

Adolescence

Childhood progresses into the adolescence stage through physiological alterations (Han et al., 2019; Schultz et al., 2018). These changes include increased lung volume, respiratory muscle strength, airway resistance, susceptibility to respiratory tract infection (RTI), and decreased respiratory rate, as follows:

  • Lung volume increases as the child grows. The lung capacity and volume continue to grow as long as there are no underlying factors hindering growth (Schultz et al., 2018).
  • Increased respiratory muscle strength continues, and muscles increase the ability to exchange air in the lungs.
  • Increased airway resistance occurs because of functional and structural changes during adolescence.
  • Increased susceptibility to respiratory infections occurs as changes to the immune system and lack of adequate nutritional intake influence.

Overall, the physiological changes that occur during adolescence contribute to or deter from pulmonary capacity and function. Although RTI susceptibility increases and asthma can be challenging during adolescence, the pulmonary systems of most adolescents experience growth.

Nutritional intake during adolescence is crucial as the pulmonary system grows and develops (Gozzi-Silva et al., 2021). Adequate macronutrient and micronutrient intake also aids in the immune system’s development. Protein consumption should include 0.85–1.2 g of protein per kilogram of body weight per day (Hudson et al., 2021). Solid recommended sources of protein include lean meats, poultry, fish, eggs, dairy products, beans, tofu, legumes, and nuts.

Micronutrient intake for adolescents should focus on vitamins A, C, and E, omega-3 fatty acids, magnesium, and water (Gozzi-Silva et al., 2021; Scoditti et al., 2019). Vitamins A, C, and E are essential antioxidants that protect the lungs from oxidative stress and inflammation. See Table 14.1 for a list of vitamins and possible food sources. Finally, adolescents must remain hydrated, which is essential for all life functions.

Micronutrient Food Source
Vitamin A
  • Carrots
  • Liver
  • Spinach
  • Sweet potatoes
Vitamin C
  • Citrus fruits
  • Kiwi
  • Strawberries
  • Tomatoes
Vitamin E
  • Leafy green vegetables
  • Nuts
  • Seeds
  • Vegetable oils
Magnesium
  • Chia seeds
  • Leafy green vegetables
  • Legumes
  • Nuts
  • Seeds
  • Whole grain
Omega-3 fatty acids
  • Chia seeds
  • Flaxseeds
  • Mackerel
  • Salmon
  • Sardines
  • Walnuts
Table 14.1 Micronutrient Food Sources (source: Gozzi-Silva et al., 2021)

Diets full of fruits, vegetables, whole grains, lean proteins, and healthy fats all regulate the development of lung tissue and repair, promoting a healthy immune system. In addition to these specified nutrients, adolescents need to consume a balanced and varied diet (Gozzi-Silva et al., 2021) and exercise regularly to support proper pulmonary function.

Unfolding Case Study

Part A

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Unlike many other American adolescents, Kai grew up eating fresh fruits and vegetables. His family had fruit trees in his yard, so he grew up picking fresh fruits from their source. His mother would obtain the rest of their food items from the local food market, with everything being grown locally. Kai’s mother would cook all their meals at home, and he would walk to school and play football to get plenty of exercise. No one in his family smoked, and they rarely ate outside of the home.

1.
What lifestyle choices in Kai’s adolescence might lead the nurse to believe that Kai comprehends the benefits of good lifestyle choices?
  1. His family growing their own fruit
  2. His family’s history of eating fresh fruits and vegetables and his daily exercise
  3. His screen time
  4. His family not eating outside of the home
2.
What information from Kai’s past can the nurse incorporate into the dietary client’s education plan?
  1. Previous history of adolescent exercise and dietary selection
  2. Smoking cessation
  3. History of food sourcing
  4. History of being a football star

Adulthood

Adulthood is a developmental stage after adolescence and typically lasts until later adulthood. During this period, individuals reach physical and cognitive maturity and assume adult responsibilities, such as career development, marriage, and parenthood. Fewer physiological changes occur as the state of health stabilizes, and fewer rapid developmental changes occur. The body does gradually change in function and structure during the aging process. Some of these changes occur in the pulmonary system, so it is vital for nurses to advocate for healthy lifestyle modifications and perform regular health screenings to promote optimal pulmonary health throughout adulthood.

The physiological changes during this time include lung size and function, respiratory muscle strength, respiratory diseases, immune function, and lifestyle habits (Han et al., 2019; Schultz et al., 2018; Rogers & Cismowski, 2018). By adulthood, lung growth and development are maximized, and function begins to decline. Respiratory muscle strength improves during adolescence but declines as one ages. In adulthood, respiratory disease risk increases related to unhealthy lifestyle choices such as smoking, occupational exposure (chemical plant workers, construction workers, and health care providers exposed to chemicals such as chemotherapy), and not exercising. The immune system protects the respiratory system as one of its functions from infection and inflammation. When a client reaches adulthood, immune function diminishes gradually, making individuals more susceptible to illnesses throughout aging.

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.

When Kai moved out of his parent’s house at age 20, he found it difficult to get a job, so he started working with a local construction company at age 24. Kai began smoking when he was 25 while working on the construction sites. He stated, “Smoking used to help me decompress.” The local construction company required Kai to work long hours, making healthy food choices and exercise incorporation challenging. Kai found himself relying on fast food options and the hard work on the construction sites as his daily “exercise.” Kai moved through the ranks and is now a foreman, where he supervises the employees under him at the job sites. He sits more frequently than he used to and found himself putting on more weight, jumping from 255 lb to 280 lb.

3.
What lifestyle choices occur during adulthood might lead Kai to an increased risk for respiratory disease later in life?
  1. Construction work, smoking, and eating fast foods
  2. Smoking, drinking alcohol, and exercising
  3. Eating fast foods, construction work, and drinking lots of water
  4. Smoking, construction work, and working long hours
4.
What lifestyle changes can Kai make early on to decrease his chance of developing a chronic respiratory disease?
  1. Working out
  2. Smoking cessation and eating better
  3. Different job
  4. Go back to school

Nutritional Needs Related to Pulmonary System for the Adult

Nutritional support is essential throughout the lifespan in maintaining healthy lung function (Collins et al., 2019; Scoditti et al., 2019; Sharifi-Rad et al., 2019; Vahid & Rahmani, 2021; Voraphai et al., 2022; Yuan et al., 2021). As lung function and capacity decline as a client ages, the importance of healthy lifestyles and nutrient-rich dietary choices cannot be overstated. The dietary choices include antioxidant-rich foods that protect the lungs from free radical damage (discussed in the next section) and oxidative stress. Fruits and vegetables are excellent sources of antioxidant-rich foods, especially berries, citrus fruits, leafy greens, and tomatoes. Omega-3 fatty acids hold anti-inflammatory properties that reduce inflammation in the lungs. Excellent sources of omega-3 fatty acids include salmon, mackerel, sardines, flaxseeds, chia seeds, and walnuts. Lean protein is an essential macronutrient to aid in repairing lung tissue and is found in skinless chicken, fish, beans, and legumes. Avoiding harmful environmental substances, not smoking, avoiding excessive alcohol intake, and getting regular exercise promotes lung function and health.

Later Adulthood

As people age, their progression parallels their risk for chronic disease. The lungs experience physiological changes as people age, leading to altered lung capacity and increased risk for infection. The lungs also suffer a barrage of continuous assaults over their lifetime. These assaults are chemical, mechanical, biological, immunological, and xenobiotic. These insults lead to oxidative stress in the lung tissue because of antioxidant capacity depletion.

Free radicals are unstable molecules that contain unpaired electrons in an atomic orbit that participate in phagocytosis's cellular destruction mechanism through macrophages and granulocytes (Sharifi-Rad et al., 2020). Phagocytosis is the process of phagocytes ingesting and eliminating larger particles. Free radicals are kept at bay by the body’s antioxidant system. Adverse effects occur when homeostasis of the free radicals is not maintained. Research studies indicate the free radicals of oxygen play a role in chronic disease and deoxyribonucleic acid (DNA) damage (Sharifi-Rad et al., 2020). Increasing the amounts of free radicals cause cellular damage and apoptosis (the death of cells). Antioxidants counteract the free radical destruction process.

Nutritional Needs Related to Pulmonary System for the Older Adult

The nurse treating older clients must recognize the need for antioxidant supplements. The current American diet is high in processed foods and additives. These food choices increase the risk for oxidative stress in the body, depleting the antioxidant capacity. The pulmonary system’s reaction to oxidative stress includes activating the inflammatory response, which further compromises the lungs and cascades further oxidative stress. These oxidative reactions to the stressors are directly linked to chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer (Rogers & Cismowski, 2018).

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