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Diet Therapy > Ch. 24 Metabolic stress > Flashcards

Ch. 24 Metabolic stress Flashcards

1
Q

When does metabolic stress occur?

A
  1. after uncontrolled infection
  2. after extensive tissue damage

*does this to sustain life. most important body processes given priority.

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2
Q

Major functions impacted by acute metabolic stress?

A
  1. Metabolic rate ^
  2. Heart rate & respiration rate ^
  3. Blood pressure ^
  4. Hormonal status: altered
  5. Nutrient metabolism: altered
  6. Inflammatory response: initiated
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3
Q

group name of the fight or flight hormones?

A

catecholamines

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4
Q

What are catecholamines?

A

“Fight or flight hormones”

  • Epinephrine and norepinephrine
  • Released into blood and stimulate heart muscle, raise blood pressure and increase metabolic rate.
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5
Q

Functions of epinephrine?

A
  1. Trigger breakdown of TG’s to fatty acids for energy

2. Promotes glucagon secretion from pancreas

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6
Q

What is the purpose of glucagon secretion from the pancreas?

A
  1. stimulates glycogenolysis: glycogen to glucose
  2. Stimulates gluconeogenesis: amino acid conversion to glucose

*result is glucose and TG’s are available in the blood stream for energy

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7
Q

Function of cortisol?

A
  1. Increase breakdown of proteins: Raises amount of amino acids in blood which are readily available to be used to make glucose
  2. Stimulates breakdown of stored TG’s from adipose tissue
  3. Inhibits protein synthesis
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8
Q

Function of aldosterone?

A

stimulate kidneys to reabsorb sodium

*this maintains blood volume

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9
Q

Function of Antidiuretic hormone(ADH)?

A

Stimulate kidneys to reabsorb water

*This maintains blood volume

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10
Q

Long term effects of stress?

A

Cortisol

  1. Total protein depletion
  2. poor wound healing
  3. insulin resistance
  4. lowered immune response
  5. lowered protein synthesis
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11
Q

What issues have elevated cortisol levels been observed in?

A
  • severe trauma
  • obesity
  • anorexia
  • sleep deprivation
  • low estrogen
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12
Q

Mechanism for inflammation?

A
  1. Injury
  2. capillary vessels and arterioles dilate
  3. increased blood flow to affected area plus increased permeability of vessels
  4. Blood plasma flows from vessels to damaged tissues
  5. Localized edema
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13
Q

Role of phagocytes in immune response?

A

slide through gaps in capillaries and engulf microorganisms. once engulfed they destroy them with hydrolytic enzymes and reactive oxygen.

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14
Q

3 types of inflammation regulators?

A
  1. Mast cells: (histamine) cause vasodilation and increase capillary permeability
  2. WBC: (cytokines) Regulate various parts of immune cell function
  3. Dietary fatty acids: (eicosanoids) regulate blood pressure, blood clotting, and other functions
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15
Q

What is SIRS and mechanism?

A

“Systemic inflammatory response syndrome”

Unresolved inflammation cause pro-inflammatory cytokines continually being released which causes a whole body response.

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16
Q

Symptoms of SIRS?

A

Increased: Heart rate, respiratory rate, WBC count, Fever

17
Q

Result of SIRS from infection?

A

“SEPSIS” or blood poisoning

18
Q

Complications of SIRS?

A
  1. Fluid retention
  2. Tissue edema
  3. Shock: severe reduction in blood flow which deprives tissues of nutrients and oxygen which lowers blood pressure and causes muscle weakness.

*Untreated could lead to MODS (multiple organ dysfunction syndrome)

19
Q

What is the complication of SEPSIS?

20
Q

Most common organ affected by MODS?

A

Lungs, liver, kidneys, GI tract

21
Q

Medical management of stress response?

A
  1. remove underlying stressors
  2. correct fluid and Elec. imbalances
  3. treat infections
  4. repair wounds
  5. drain abscesses
  6. remove dead tissue
22
Q

Goals of medical nutrition therapy?

A
  1. preserve lean tissue
  2. maintain immune function
  3. promote healing

*All deal with protein

23
Q

Challenges of MNT?

A
  1. Hypermetabolism
  2. negative nitrogen balance
  3. hyperglycemia
  4. insulin resistance
24
Q

Steps of MNT for acute stress?

A
  1. Determine energy requirements: RMR
  2. Multiply RMR by disease specific stress factor ad activity factor

*stress factors given. If mobile add activity factor of 1.2. if not then no activity factor

25
Q

Protein requirements for acute stress?

A
  1. Non-obese critically ill: 1.2-2.0 g/kg body weight
  2. Obese critically ill: 2.0-2.5 g/kg IBW
  3. Burns: 2-3 g/kg body weight
26
Q

Carb and fat requirements?

A
  1. 50-60% carbs UNLESS sever hyperglycemia
  2. Up to 50% if sever hyperglycemia
  3. Fat restriction if TG’s are too high
27
Q

Micronutrient requirements?

A
  1. Supplement
  2. Extra B-Vitamin complex suggested to help energy metabolism
  3. A,C, Zinc important for wound healing
28
Q

Fluid recommendations for burns?

A

Replace fluids based on age, weight, and extent of burns

29
Q

Look at info for “feeding the stressed patient”

Diet Therapy (9 decks)

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