Chapter 16 book notes Flashcards
1
Q
Metabolic stress:
A
- a disruption in the body’s internal chemical environment
2
Q
metabolic stress can result from:
A
-uncontrolled infections or extensive tissue damage,
3
Q
respiratory stress,
A
-characterized by insufficient oxygen and excessive carbon dioxide in the blood and tissues
4
Q
Both metabolic and respiratory
stress can lead
A
-hypermetabolism
-wasting
5
Q
hypermetabolism:
A
-a higher-than-normal metabolic rate.
6
Q
stress response:
A
-the chemical and physical changes that occur
within the body during stress.
7
Q
During periods of stress, the metabolic processes that support immediate survival are given ??? , while those of lesser consequence are ??
A
-priority
-delayed
8
Q
Energy is of primary importance, so the energy
nutrients are mobilized from
A
-storage and made available in the blood.
9
Q
Heart rate and respiration (breathing rate) ?? to deliver oxygen and nutrients to cells more quickly, and blood pressure rises
A
-increases
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)
11
Q
stress response is mediated by several ?? , which are released into the blood soon after the onset of injury
A
-hormones
12
Q
The catecholamines—often called the fight-or-flight hormones:
A
- epinephrine and norepinephrine
13
Q
epinephrine and norepinephrine stimulate what in response to stress?
A
-stimulate heart muscle, raise blood pressure, and increase metabolic rate.
14
Q
?? also promotes glucagon secretion from the pancreas, prompting the release of nutrients from storage
A
-Epinephrine
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.
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.
17
Q
the combined effects of these hormones contribute to ?, which often accompanies critical illness
A
hyperglycemia
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
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
20
Q
Excess cortisol also leads to ??? , contributing to
hyperglycemia, and ?? , increasing susceptibility to infection
A
-insulin resistance
-suppresses immune responses
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.
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.
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.
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
25
The various changes in blood vessels attract immune cells that can
destroy
-foreign agents and clear cellular debris
26
Among the first cells to arrive are the
??, which slip through gaps between the ?? cells that form the blood
vessel walls.
-phagocytes
-endothelial cells
27
actions of phagocytes
- engulf microorganisms and destroy them with reactive
forms of oxygen and hydrolytic enzymes
28
When inflammation becomes chronic, these
normally useful products of phagocytes can damage ??
-healthy tissue
29
Mediators of Inflammation:
-chemical substances that control the inflammatory process.
-histamine, cytokines, eicosanoids
30
mediators are released from
-damaged tissue,
-blood vessel cells,
-activated immune cells
31
Histamine, a small molecule similar to an amino acid in structure, is released from ?? within mast cells, causing:
-granules
- vasodilation and capillary permeability
32
cytokines:
-participate in inflammatory process
-produced by white blood cells
33
eicosanoids:
-20-carbon molecules derived from dietary fatty acids that help to regulate blood pressure, blood clotting, and other body functions.
34
major precursor for the eicosanoids is ?? ,
-arachidonic acid
-which derives from the omega-6 fatty acids in vegetable oils
35
acute-phase response:
-changes in body chemistry resulting from
infection, inflammation, or injury;
-characterized by alterations in plasma proteins.
36
Within hours after inflammation, infection, or severe injury, the liver steps up its production of certain plasma proteins (called acute-phase proteins) including:
-C-reactive protein,
-hepcidin,
-blood-clotting proteins such as fibrinogen and prothrombin, and others.
37
At the same time, plasma concentrations of what minerals fall?
-albumin, iron, and zinc fall
38
The acute phase response is accompanied by muscle catabolism to make
-amino acids available for glucose production, tissue repair, and immune protein synthesis
-resulting in negative nitrogen balance
39
Other clinical features of the acute-phase response may include: (6)
-fever,
-elevated metabolic rate,
-increased pulse rate and blood pressure,
-increased blood neutrophil levels,
-lethargy,
-anorexia.
40
If inflammation does not resolve, the continued production of pro-inflammatory
cytokines may lead to the -
systemic inflammatory response syndrome (SIRS)
41
systemic inflammatory response syndrome (SIRS):
-a whole-body inflammatory response caused by severe illness
-characterized by raised heart and respiratory rates, abnormal white blood cell counts, and fever.
42
If these problems result from a severe infection, the condition is called .
-sepsis
43
If the reduction in blood flow is severe enough to deprive the
body’s tissues of oxygen and nutrients what can happen?
-a condition known as shock
-multiple organs fails simultaneously
44
Immediate concerns during severe stress are to restore:
-restore lost fluids and electrolytes and remove underlying stressors.
45
initial treatments include administering… (5)
-intravenous solutions to correct fluid and electrolyte imbalances
-treating infections
-repairing wounds
-draining abscesses (pus)
-removing dead tissue (debridement)
46
Notable metabolic changes in patients undergoing metabolic
stress include (4)
-hypermetabolism,
-negative nitrogen balance,
insulin resistance,
-hyperglycemia
47
what can lead to muscle wasting and impair organ function and delay recovery?
-hypermetabolism
-negative nitrogen balance
48
??? increases the
risk of infection, which can lead to complications and higher
mortality risk.
-Hyperglycemia
49
??can worsen negative nitrogen balance and
increase lean tissue losses.
-Underfeeding
50
??increases the risks of
refeeding syndrome and its associated hyperglycemia
-Overfeeding
51
refeeding syndrome:
-aggressive refeeding in severely malnourished persons;
-characterized by shifts in fluid and electrolyte levels that can lead to
organ failure and other complications.
52
what is the ideal method in determining energy requirements in critically ill patients?
-indirect calorimetry
53
indirect calorimetry:
-a method of estimating resting energy expenditure by measuring a person’s oxygen consumption and carbon dioxide production
54
This is because the RMR closely reflects total
energy expenditure in
-bedridden, nonfasting patients.
55
Some predictive equations used for estimating energy needs include built-in factors to account for
-stress, injury, or intensive treatment.
56
Another common method for estimating energy needs during acute illness is to multiply a person’s body weight by a factor considered
-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
hypocaloric feeding:
-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
amino acids ?? and ?? are sometimes added to the diets of acutely stressed and immunocompromised patients.
-glutamine and arginine
-may be beneficial for some patient populations but harmful to others
59
the appropriate amounts may vary according to the patient’s
medical condition, as well as their risks for ???
-hyperglycemia and hypertriglyceridemia.
60
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
-150
61
Fat supplies both energy and essential fatty acids, but excessive amounts may promote
-hypertriglyceridemia and immune suppression
62
Supplementation with antioxidants such as ??? is sometimes recommended to counter oxidative stress
-vitamin C, vitamin E, and selenium
63
Vitamin C supplementation in patients with ?? injuries has been associated with decreased infections
-burn
64
Zinc has critical roles in
-immunity and wound healing
-supplementation may speed recovery
65
Blood concentrations of trace minerals are monitored in patients receiving ??? to ensure
that excessive amounts are not given intravenously
-parenteral nutrition support
66
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
- 24 to 48
-hospital stays as compared with delayed feedings.
67
If enteral nutrition is not possible, malnourished patients may receive ?? nutrition support soon after admission to the hospital
-parenteral
68
In previously healthy patients, however, parenteral nutrition
support may be withheld during the first ?? days of hospitalization to avoid the risk of infectious complications.
-seven
69
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
-high calorie, high protein
-refeeding syndrome or hyperglycemia.
70
Some medical problems upset the process of gas exchange between the air and blood and result in
-respiratory stress
71
respiratory stress
-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
labored breathing caused by many respiratory disorders entails a higher ?? than normal breathing does, raising energy needs and increasing ?? production further.
-energy cost
-carbon dioxide
73
dangerous outcomes of some types of respiratory illnesses?
-weight loss
-malnutrition
74
Chronic obstructive pulmonary disease (COPD)
-a group of conditions characterized by the persistent
obstruction of airflow through the lungs.
75
main airways=
air sacs=
-bronchi and bronchioles
-alveoli
76
two main types of COPD
-chronic bronchitis
-emphysema
77
Chronic bronchitis
-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
Emphysema
-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
Both chronic bronchitis and emphysema are associated
with abnormal levels of
-oxygen and carbon dioxide in the blood
-shortness of breath (dyspnea)
80
COPD may eventually lead to
-respiratory or heart failure
-together with other chronic respiratory illnesses,
ranks as the fourth leading cause of death in the United
States.
81
primary risk factor for COPD:
-smoking
82
??to ??percent of heavy smokers develop COPD:
35 to 50%
83
what inherited disorder accounts for 2% of COPD cases?
-Alpha-1-antitrypsin deficiency
-people have inadequate blood levels of a plasma protein that inhibits the enzymatic breakdown of proteins in lung tissue.
84
Individuals with COPD are encouraged to
quit ?? to prevent disease progression and to get vaccinated against
-smoking
-influenza, pneumonia, and COVID-19
85
most frequently prescribed medications are
??? , which improve airflow, and inhaled ?? (anti-inflammatory medications), which help to relieve
symptoms and prevent exacerbations;
-bronchodilators
-corticosteroids
86
main focus of the nutrition care plan of COPD is to encourage adequate
-food intake,
-promote the maintenance of a healthy body weight,
-prevent muscle wasting.
87
energy needs may lessen over the course of illness
because?? generally decreases as the condition worsens
-physical activity
88
In non-obese adults with COPD, an intake of ?? kcalories per kilogram of body weight per day may meet average energy requirements
-30
89
What equation can help determine a patient with COPD energy needs?
-Harris–Benedict equation
-adjust the value according to the patient’s level of activity
90
why does food intake decreases as COPD progresses?
-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
The lower energy content of small meals reduces
the??? load, and the smaller meals may produce less
-carbon dioxide
--abdominal discomfort and dyspnea
92
Some individuals may eat better if they receive supplemental oxygen at
??
-mealtimes
93
Enteral formulas designed for use in severe COPD (and other
pulmonary conditions) provide more kcalories from ?? and fewer from ??
than standard formulas.
-fat and fewer from carbs
94
The ratio of carbon dioxide production to oxygen
consumption is ?? when fat is consumed, so theoretically these formulas should lower respiratory requirements
-lower
95
Patients with severe dyspnea who are unable to continue steady exercise for long periods (20 to 60 minutes) can engage in ??
-interval exercise training
96
Any of a large number of conditions that cause?? or impair ??can be the underlying cause of respiratory failure.
examples include:
-lung injury
-lung function
-pneumonia, COVID, sepsis, physical trauma, smoke inhalation,etc.
97
acute respiratory distress syndrome
(ARDS):
-respiratory failure triggered by severe lung injury;
-dyspnea and pulmonary edema
-requires mechanical ventilation.
98
Later stages of ARDS are associated with a proliferation of lung
cells, resulting in
-fibrosis
99
A dangerous complication of ARDS is the progression to
-multiple organ dysfunction syndrome
100
Respiratory failure is characterized by severe:
-hypoxemia (insufficient oxygen in blood)
-hypercapnia (excessive carbon dioxide in blood)
101
hypoxia can lead to
-can impede cellular function and lead to cell death
102
Severe hypercapnia can cause ??
-acidosis
103
acidosis:
acid accumulation in body tissues;
-depresses the central nervous system and may lead to
disorientation and, eventually, coma.
104
To compensate for respiratory failure, a person
breathes
-more rapidly,
-the heart rate increases
-skin becomes sweaty
-cyanosis (blue skin)
-headache confusion
105
Severe cases of respiratory failure can cause
-heart arrhythmias and, ultimately, coma
106
?? positioning may reduce mortality risk in some patients with moderate to severe cases of ARDS
prone
107
??? may be prescribed to help remove the fluid that has
accumulated in lung tissue
-diuretics
108
For mild or moderate
lung injury, protein recommendations range from ??to
??grams of protein per kilogram of body weight per day.
-1 to 1.5
109
Patients with ARDS may require ?? to ??grams of protein
per kilogram of body weight daily
1.5 to 2
110
intestinal feedings may be preferred over
gastric feedings because they reduce the risk of ?? .
-aspiration
