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Nutrition > 18 - Critically Ill > Flashcards

18 - Critically Ill Flashcards

1
Q

Critically ill is assoc w state of…

A

catabolic stress characterized by

  • systemic inflammation
  • multipl-orgn dysfnctn
  • prolonged hospitalitn
  • disproportnt mortality
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2
Q

nutrition support aids in

A
  • metab response to stress
  • prevent oxidative cellular injury
  • decr exaggerated immune response
  • reduce infectious morbidity
  • reduve ventilator dependency
  • decr protein catabolism
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3
Q

disruption in homeostasis elicits a…

A

body wide stress response

  • characterized by hormonal + inflammatory/metab changes for healing
  • ebb + flow
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4
Q

ebb + flow phase of stress response

A

1 initial shock/ebb
2 catabolic flow
3 anabolic flow

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5
Q

initial shock or ebb

A

hemodynamic instability

-24-48 hr

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6
Q

initial shock or ebb characteristics

A
  • shock
  • hypo vol
  • low perfusn
  • low CO, O consumption, temp
  • high HR, gluc, acute phase proteins
  • activated immune systm
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7
Q

initial shock or ebb Tx

A
  • restore blood flow to organs
  • maintain oxygenation
  • stop bleed
  • replace fluids
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8
Q

Catabolic Flow

A

metabolic instability + catabolism

  • 3-10 days
  • spike in circulatory hormones (fight/flight)
  • promotes breakdown of stored nutrients (glycogen>glucose, muscle>amino acids, fat>fatty acids)
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9
Q

Catabolic Flow

characteristics

A
  • insulin resistance
  • high CO, O consumptn, temp, BMR, total body protein catabolism
  • length of phase depends on severity or whether complications develop*
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10
Q

positive/negative nitrogen balance

A

+ protein synth

- protein catabolism/breakdwn

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11
Q

Catabolic Flow

Nutrition goals

A
  • fluid/electro balance
  • minimize body protein catabolism
  • meet caloric protein
  • micronutrient needs
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12
Q

Anabolic Flow Phase

characteristic + nutrition needs

A
  • [+] nitrogen balance> protein synth

- needs calories, protein, nutrients for anabolism

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13
Q

hormone response includes….

A
  • catecholamines, glucagon, + cortisol»> release stored macros to meet incr demands, hyperglycemia,
  • excess cortisol is damaging when prolonged»> inhibits protein synth even when intake is high, promotes insulin resistance, suppress immune response
  • aldosterone + antidiuretic> maintain blood volume
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14
Q

acute phase response

A

quick inflammatory response to destroy infectious agents, prevent further damage, promote healing

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15
Q

inflammation causes increase in positive acute proteins such as… and decrease in negative acute proteins such as…

A
  • c-reactive protein

- albumin, prealbumin, transferrin

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16
Q

cytokines

A
  • more than 100 types of proteins involved in immune response
  • responsible for regulating acute-phase proteins
  • produce changs in other cells that cause accelerated catabolism> anorexia, fever, lethargy, wt loss
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17
Q

prolonged or exaggerated inflammatory response is compensated by…

A
  • increasing the ANTIinflammatory response to counter
  • disproportionate shift towards ANTIinflammtn can lead to endothelial damage, organ failure, immune suppression, metab abnormalities, + loss of body mass
  • weakened immune system is unable to destroy pathogens> immunocompromised
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18
Q

sepsis

A

abnormal systemic host response to infection

  • causes life-threatening organ dysfunction
  • primary cause of death fr infectn
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19
Q

septic shock

A

underlying circulatory + cellular metabolism abnormalities are severe enough to substantially incr risk f death

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20
Q

why is there malnutrition w inflammatory response?

A

hypermetabolism + catabolism quickly deplete protein stores

21
Q

nutrition support

A

via enteral tubes or parenteral catheters

22
Q

an oral intake that meets __% of client’s needs from days 3-7 is considered adequate

A

70%

23
Q

if enteral feed is indicated, it should be initiated as soon as…

A

fluid resuscitation is complete + client is hemodynamically stable
-preferably w/in 24-48 hr

24
Q

polymeric enteral formula

A

intact macros

-1-1.5 cal/mL

25
Q

enteral formula for obese

A

low-caloric density formula

  • reduced nonprotein calorie-to-nitrogen ratio
  • less cals fr fat + carb than protein
26
Q

enteral formula for surgical ICU, or severe trauma

A

immune-modulating formula that provides arginine, fish oil, glutamine

27
Q

disease specific formula

A

no benefit for critically ill

28
Q

weight based calories

A

BMI<30: 25-30 cal/kg
BMI 30-50: 11-14 cal/kg
BMI>50: 22-25 cal/kg

29
Q

protein intake based on BMI

A

<30: 1.2-2 g/kg
30-40: 2 g/kg
>40: 2.5 g/kg

** higher amounts may be needed for certain illnesses like burns

30
Q

supplemental enteral glutamine

A

not recommended to be added

-no benefits

31
Q

supplemental vitamins + minerals

A 
antioxidant vit (E + C)
trace minerals (selenium, zinc, copper)

esp w burns, trauma, + pt that needs mechanical ventilation

32
Q

formula for clients with persistent diarrhea

A

fiber containing formula
or semi-elemental formula
or soluble fiber supplement

33
Q

indirect calorimetry

A

analysis of O2 + CO2 of inspired + expired air

  • gold standard for determining cal needs
  • not done routinely bc limited availability + costly
34
Q

how often should calorie calculation should be reevaluated?

A

more than once a week

35
Q

how to avoid overfeeding

A

early full EN + PN should not be given to critically ill
-should be achieved w/in 3-7 days

  • unless severely malnourished or high nutrition risk, then advance to goal quickly over 24-48 hr
  • –monitor for refeeding syndrome
36
Q

monitor malnourished clients such as …… for refeeding syndrome

A
  • alcoholic
  • chronic undernutrition
  • morbid obesity w massive wt loss
  • prolonged fasting
  • long-term use of simple IV hydratn
  • cardiac/cancer cachexia
37
Q

sudden availability of carb stimulates…

A
  • insulin secretion

- incr need for thiamin + minerals involved in carb metab

38
Q

thiamin deficiency can cause..

A

acidosis, hyper vent, neurologic impairments

39
Q

initial provision of ___% of calculated cals is reasonable in msot young or well nourished clients

A

100-70%

40
Q

extubation care

A
  • oral intake is commonly inadequate right after bc pain, anorexia, GI upset, etc
  • monitor oral intake closely
  • small frequent high cal + protein
  • nutrient dense
  • oral or EN supplements may be needed
41
Q

protein is for..

A
  • replace lean body mass lost fr catabolic phase
  • restore blood vol + plasma proteins
  • replace loss fr immobility
  • meet incr need for tissue replare
  • resistance to infection
42
Q

calories is for…

A
  • spare protein

- restore norm wt

43
Q

vitamin c is for

A
  • capillary formation
  • tissue synth
  • wound healing thru collagen formation
  • antibody formation
44
Q

thiamin, niacin, riboflavin is for

A

increased metab rate

45
Q

folic acid + B12 is for

A
  • cell prolif> tissue synth
  • maturation of RBC
  • impaired folic acid synth or impaired b12 absorptn fr some abx
46
Q

vit A is for

A
  • immune functn
  • protein synth
  • cell differentiatn
  • epithelial cells
47
Q

vit K is for

A
  • blood clotting

- impaired intestinal synth bc abc

48
Q

zinc is for

A
  • protein synth
  • wound heal
  • norm lymph + phagocyte response

Nutrition (18 decks)

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