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clinical nutrition > Chapter 16 book notes > Flashcards

Chapter 16 book notes Flashcards

1
Q

Metabolic stress:

A
  • a disruption in the body’s internal chemical environment
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2
Q

metabolic stress can result from:

A

-uncontrolled infections or extensive tissue damage,

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3
Q

respiratory stress,

A

-characterized by insufficient oxygen and excessive carbon dioxide in the blood and tissues

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4
Q

Both metabolic and respiratory
stress can lead

A

-hypermetabolism
-wasting

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5
Q

hypermetabolism:

A

-a higher-than-normal metabolic rate.

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6
Q

stress response:

A

-the chemical and physical changes that occur
within the body during stress.

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7
Q

During periods of stress, the metabolic processes that support immediate survival are given ??? , while those of lesser consequence are ??

A

-priority
-delayed

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8
Q

Energy is of primary importance, so the energy
nutrients are mobilized from

A

-storage and made available in the blood.

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9
Q

Heart rate and respiration (breathing rate) ?? to deliver oxygen and nutrients to cells more quickly, and blood pressure rises

A

-increases

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10
Q

Meanwhile, energy is diverted from processes that
are not life sustaining, such as

A

-growth, reproduction, and long-term immunity
-if stress continues for a long period of time these processes may begin to cause damage (growth impairment or illness)

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11
Q

stress response is mediated by several ?? , which are released into the blood soon after the onset of injury

A

-hormones

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12
Q

The catecholamines—often called the fight-or-flight hormones:

A
  • epinephrine and norepinephrine
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13
Q

epinephrine and norepinephrine stimulate what in response to stress?

A

-stimulate heart muscle, raise blood pressure, and increase metabolic rate.

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14
Q

?? also promotes glucagon secretion from the pancreas, prompting the release of nutrients from storage

A

-Epinephrine

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15
Q

The steroid hormone cortisol enhances muscle

A

-protein degradation
-raising amino acid levels in the blood and making amino acids available for conversion to glucose.

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16
Q

All of these hormones have similar effects on glucose and fat metabolism, causing the breakdown of

A
  • glycogen,
    -the production of glucose from amino acids, and
    -the breakdown of triglycerides in adipose tissue.
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17
Q

the combined effects of these hormones contribute to ?, which often accompanies critical illness

A

hyperglycemia

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18
Q

Two other hormones induced by stress, aldosterone and antidiuretic hormone, help to maintain:

A

-blood volume by stimulating the kidneys to reabsorb more sodium and water
-aldosterone=sodium reabsorption in kidneys
-antidiuretic=water reabsorption in kidneys

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19
Q

In excess, cortisol causes the depletion of protein in ??? . It
impairs wound healing, so high cortisol levels may be especially dangerous for a patient with ??

A

-muscle, bone, connective tissue, and the skin
-severe injuries

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20
Q

Excess cortisol also leads to ??? , contributing to
hyperglycemia, and ?? , increasing susceptibility to infection

A

-insulin resistance
-suppresses immune responses

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21
Q

pharmaceutical forms of cortisol (such as cortisone and prednisone) are common anti-inflammatory medications; their long-term use can cause undesirable side effects such as:

A
  • muscle wasting, thinning of the skin, diabetes, and early osteoporosis.
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22
Q

As in the stress response, however, there is a delicate balance
between a response that protects tissues from further injury and an

A

-excessive response that can cause additional damage to tissue.

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23
Q

The inflammatory response begins with the dilation of
arterioles and capillaries at the site of injury, which increases

A
  • blood flow to the affected area.
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24
Q

The capillaries within the damaged tissue become more permeable, allowing:

A

-some blood plasma to escape into the tissue and cause local edema

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25
Q

The various changes in blood vessels attract immune cells that can
destroy

A

-foreign agents and clear cellular debris

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26
Q

Among the first cells to arrive are the
??, which slip through gaps between the ?? cells that form the blood
vessel walls.

A

-phagocytes
-endothelial cells

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27
Q

actions of phagocytes

A
  • engulf microorganisms and destroy them with reactive
    forms of oxygen and hydrolytic enzymes
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28
Q

When inflammation becomes chronic, these
normally useful products of phagocytes can damage ??

A

-healthy tissue

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29
Q

Mediators of Inflammation:

A

-chemical substances that control the inflammatory process.
-histamine, cytokines, eicosanoids

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30
Q

mediators are released from

A

-damaged tissue,
-blood vessel cells,
-activated immune cells

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31
Q

Histamine, a small molecule similar to an amino acid in structure, is released from ?? within mast cells, causing:

A

-granules
- vasodilation and capillary permeability

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32
Q

cytokines:

A

-participate in inflammatory process
-produced by white blood cells

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33
Q

eicosanoids:

A

-20-carbon molecules derived from dietary fatty acids that help to regulate blood pressure, blood clotting, and other body functions.

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34
Q

major precursor for the eicosanoids is ?? ,

A

-arachidonic acid
-which derives from the omega-6 fatty acids in vegetable oils

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35
Q

acute-phase response:

A

-changes in body chemistry resulting from
infection, inflammation, or injury;
-characterized by alterations in plasma proteins.

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36
Q

Within hours after inflammation, infection, or severe injury, the liver steps up its production of certain plasma proteins (called acute-phase proteins) including:

A

-C-reactive protein,
-hepcidin,
-blood-clotting proteins such as fibrinogen and prothrombin, and others.

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37
Q

At the same time, plasma concentrations of what minerals fall?

A

-albumin, iron, and zinc fall

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38
Q

The acute phase response is accompanied by muscle catabolism to make

A

-amino acids available for glucose production, tissue repair, and immune protein synthesis
-resulting in negative nitrogen balance

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39
Q

Other clinical features of the acute-phase response may include: (6)

A

-fever,
-elevated metabolic rate,
-increased pulse rate and blood pressure,
-increased blood neutrophil levels,
-lethargy,
-anorexia.

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40
Q

If inflammation does not resolve, the continued production of pro-inflammatory
cytokines may lead to the -

A

systemic inflammatory response syndrome (SIRS)

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41
Q

systemic inflammatory response syndrome (SIRS):

A

-a whole-body inflammatory response caused by severe illness
-characterized by raised heart and respiratory rates, abnormal white blood cell counts, and fever.

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42
Q

If these problems result from a severe infection, the condition is called .

A

-sepsis

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43
Q

If the reduction in blood flow is severe enough to deprive the
body’s tissues of oxygen and nutrients what can happen?

A

-a condition known as shock
-multiple organs fails simultaneously

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44
Q

Immediate concerns during severe stress are to restore:

A

-restore lost fluids and electrolytes and remove underlying stressors.

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45
Q

initial treatments include administering… (5)

A

-intravenous solutions to correct fluid and electrolyte imbalances
-treating infections
-repairing wounds
-draining abscesses (pus)
-removing dead tissue (debridement)

46
Q

Notable metabolic changes in patients undergoing metabolic
stress include (4)

A

-hypermetabolism,
-negative nitrogen balance,
insulin resistance,
-hyperglycemia

47
Q

what can lead to muscle wasting and impair organ function and delay recovery?

A

-hypermetabolism
-negative nitrogen balance

48
Q

??? increases the
risk of infection, which can lead to complications and higher
mortality risk.

A

-Hyperglycemia

49
Q

??can worsen negative nitrogen balance and
increase lean tissue losses.

A

-Underfeeding

50
Q

??increases the risks of
refeeding syndrome and its associated hyperglycemia

A

-Overfeeding

51
Q

refeeding syndrome:

A

-aggressive refeeding in severely malnourished persons;
-characterized by shifts in fluid and electrolyte levels that can lead to
organ failure and other complications.

52
Q

what is the ideal method in determining energy requirements in critically ill patients?

A

-indirect calorimetry

53
Q

indirect calorimetry:

A

-a method of estimating resting energy expenditure by measuring a person’s oxygen consumption and carbon dioxide production

54
Q

This is because the RMR closely reflects total
energy expenditure in

A

-bedridden, nonfasting patients.

55
Q

Some predictive equations used for estimating energy needs include built-in factors to account for

A

-stress, injury, or intensive treatment.

56
Q

Another common method for estimating energy needs during acute illness is to multiply a person’s body weight by a factor considered

A

-appropriate for the medical problem
-example: many critical care patients require between 25-30 kcalories per kilogram of body weight per day.
a person weighing 160lbs will require 1818 to 2182 kcalories per day

57
Q

hypocaloric feeding:

A

-a reduced kcalorie regimen that includes sufficient protein and micronutrients to maintain nitrogen balance and prevent malnutrition
-used in critically ill obese patients
-energy intake is 11-14 kcalories per kilogram of actual body weight

58
Q

amino acids ?? and ?? are sometimes added to the diets of acutely stressed and immunocompromised patients.

A

-glutamine and arginine
-may be beneficial for some patient populations but harmful to others

59
Q

the appropriate amounts may vary according to the patient’s
medical condition, as well as their risks for ???

A

-hyperglycemia and hypertriglyceridemia.

60
Q

In general, patients should be provided with at least ?? grams of carbohydrate daily to meet the needs of tissues that rely on glucose as an energy source

A

-150

61
Q

Fat supplies both energy and essential fatty acids, but excessive amounts may promote

A

-hypertriglyceridemia and immune suppression

62
Q

Supplementation with antioxidants such as ??? is sometimes recommended to counter oxidative stress

A

-vitamin C, vitamin E, and selenium

63
Q

Vitamin C supplementation in patients with ?? injuries has been associated with decreased infections

A

-burn

64
Q

Zinc has critical roles in

A

-immunity and wound healing
-supplementation may speed recovery

65
Q

Blood concentrations of trace minerals are monitored in patients receiving ??? to ensure
that excessive amounts are not given intravenously

A

-parenteral nutrition support

66
Q

For acutely ill patients with a functional GI tract, early enteral feedings—started in the first?? hours after hospitalization—are associated with fewer complications and shorter

A
  • 24 to 48
    -hospital stays as compared with delayed feedings.
67
Q

If enteral nutrition is not possible, malnourished patients may receive ?? nutrition support soon after admission to the hospital

A

-parenteral

68
Q

In previously healthy patients, however, parenteral nutrition
support may be withheld during the first ?? days of hospitalization to avoid the risk of infectious complications.

A

-seven

69
Q

Once patients can tolerate oral feedings, what kind of diet is prescribed? AND although care must be taken not to overfeed patients who are at risk of developing

A

-high calorie, high protein
-refeeding syndrome or hyperglycemia.

70
Q

Some medical problems upset the process of gas exchange between the air and blood and result in

A

-respiratory stress

71
Q

respiratory stress

A

-characterized by a reduction in the blood’s oxygen
supply and an increase in carbon dioxide levels.
-Excessive carbon dioxide in the blood may disturb the breathing pattern enough to interfere with food intake

72
Q

labored breathing caused by many respiratory disorders entails a higher ?? than normal breathing does, raising energy needs and increasing ?? production further.

A

-energy cost
-carbon dioxide

73
Q

dangerous outcomes of some types of respiratory illnesses?

A

-weight loss
-malnutrition

74
Q

Chronic obstructive pulmonary disease (COPD)

A

-a group of conditions characterized by the persistent
obstruction of airflow through the lungs.

75
Q

main airways=
air sacs=

A

-bronchi and bronchioles
-alveoli

76
Q

two main types of COPD

A

-chronic bronchitis
-emphysema

77
Q

Chronic bronchitis

A

-characterized by persistent inflammation and excessive secretions of mucus in the airways of the lungs,
-Chronic bronchitis may be diagnosed
when a chronic, productive cough persists for at least
three consecutive months in at least two consecutive
years.

78
Q

Emphysema

A

-is characterized by the breakdown of the lungs’ elastic structure and destruction of the walls of the smallest bronchioles and alveoli
-reduces the surface area available for respiration.

79
Q

Both chronic bronchitis and emphysema are associated
with abnormal levels of

A

-oxygen and carbon dioxide in the blood
-shortness of breath (dyspnea)

80
Q

COPD may eventually lead to

A

-respiratory or heart failure
-together with other chronic respiratory illnesses,
ranks as the fourth leading cause of death in the United
States.

81
Q

primary risk factor for COPD:

A

-smoking

82
Q

??to ??percent of heavy smokers develop COPD:

A

35 to 50%

83
Q

what inherited disorder accounts for 2% of COPD cases?

A

-Alpha-1-antitrypsin deficiency
-people have inadequate blood levels of a plasma protein that inhibits the enzymatic breakdown of proteins in lung tissue.

84
Q

Individuals with COPD are encouraged to
quit ?? to prevent disease progression and to get vaccinated against

A

-smoking
-influenza, pneumonia, and COVID-19

85
Q

most frequently prescribed medications are
??? , which improve airflow, and inhaled ?? (anti-inflammatory medications), which help to relieve
symptoms and prevent exacerbations;

A

-bronchodilators
-corticosteroids

86
Q

main focus of the nutrition care plan of COPD is to encourage adequate

A

-food intake,
-promote the maintenance of a healthy body weight,
-prevent muscle wasting.

87
Q

energy needs may lessen over the course of illness
because?? generally decreases as the condition worsens

A

-physical activity

88
Q

In non-obese adults with COPD, an intake of ?? kcalories per kilogram of body weight per day may meet average energy requirements

A

-30

89
Q

What equation can help determine a patient with COPD energy needs?

A

-Harris–Benedict equation
-adjust the value according to the patient’s level of activity

90
Q

why does food intake decreases as COPD progresses?

A

-dyspnea interferes with chewing and swallowing
-medications
-depression
-altered taste perception
-physical changes in lungs and diaphragm reduces abdominal volume leading to early satiety.

91
Q

The lower energy content of small meals reduces
the??? load, and the smaller meals may produce less

A

-carbon dioxide
–abdominal discomfort and dyspnea

92
Q

Some individuals may eat better if they receive supplemental oxygen at
??

A

-mealtimes

93
Q

Enteral formulas designed for use in severe COPD (and other
pulmonary conditions) provide more kcalories from ?? and fewer from ??
than standard formulas.

A

-fat and fewer from carbs

94
Q

The ratio of carbon dioxide production to oxygen
consumption is ?? when fat is consumed, so theoretically these formulas should lower respiratory requirements

A

-lower

95
Q

Patients with severe dyspnea who are unable to continue steady exercise for long periods (20 to 60 minutes) can engage in ??

A

-interval exercise training

96
Q

Any of a large number of conditions that cause?? or impair ??can be the underlying cause of respiratory failure.
examples include:

A

-lung injury
-lung function
-pneumonia, COVID, sepsis, physical trauma, smoke inhalation,etc.

97
Q

acute respiratory distress syndrome
(ARDS):

A

-respiratory failure triggered by severe lung injury;
-dyspnea and pulmonary edema
-requires mechanical ventilation.

98
Q

Later stages of ARDS are associated with a proliferation of lung
cells, resulting in

A

-fibrosis

99
Q

A dangerous complication of ARDS is the progression to

A

-multiple organ dysfunction syndrome

100
Q

Respiratory failure is characterized by severe:

A

-hypoxemia (insufficient oxygen in blood)
-hypercapnia (excessive carbon dioxide in blood)

101
Q

hypoxia can lead to

A

-can impede cellular function and lead to cell death

102
Q

Severe hypercapnia can cause ??

A

-acidosis

103
Q

acidosis:

A

acid accumulation in body tissues;
-depresses the central nervous system and may lead to
disorientation and, eventually, coma.

104
Q

To compensate for respiratory failure, a person
breathes

A

-more rapidly,
-the heart rate increases
-skin becomes sweaty
-cyanosis (blue skin)
-headache confusion

105
Q

Severe cases of respiratory failure can cause

A

-heart arrhythmias and, ultimately, coma

106
Q

?? positioning may reduce mortality risk in some patients with moderate to severe cases of ARDS

A

prone

107
Q

??? may be prescribed to help remove the fluid that has
accumulated in lung tissue

A

-diuretics

108
Q

For mild or moderate
lung injury, protein recommendations range from ??to
??grams of protein per kilogram of body weight per day.

A

-1 to 1.5

109
Q

Patients with ARDS may require ?? to ??grams of protein
per kilogram of body weight daily

A

1.5 to 2

110
Q

intestinal feedings may be preferred over
gastric feedings because they reduce the risk of ?? .

A

-aspiration

clinical nutrition (26 decks)

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