Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Dietetics 2 > Critical Care > Flashcards

Critical Care Flashcards

1
Q

Describe what the flow phase is and the nutritional/metabolic consequences of this are

A

A phase of metabolic instability and catabolism.

Characterised by:
1. hypermetabolism
2. hypercatabolism
3. lean body mass wasting
4. hyperglycaemia
5. fluid accumulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is protein energy malnutrition affected by duration of critical illness?

A

More likely to occur in prolonged periods of critical illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the ebb phase of metabolic responses o stress

A

the early phase of haemodynamic instability = management is most intense during this phase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Impact of acute phase/ebb phase on the body’s nutrition status/metabolic consequences

A
  1. body = in rapid catabolism i.e. super metabolic, using a lot of nutrient stores from within the body
  2. Insulin resistance = the degree of hyperglycaemia is parallel to the severity of injury/illness
  3. Amino acids and other key substrates are mobilised from various body storage sites (esp. muscle)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is it important to provide rapidly available energy when patient is in ebb/acute phase?

A

so that enough energy is provided for the immune system and other key organs as patient fights to survive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a negative consequence of cachexia in ebb phase?

A

A lot of muscle wasting = harder to fight infections and injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long does ebb phase last and what is the effect on metabolic activity, oxygen consumption and temperature.

Where does body get energy from?

A

First 24-48 hours

  1. reduced metabolic activity
  2. reduced oxygen consumption
  3. reduced body temperature

Energy reserves (glycogen from liver into glucose; and fatty acids from adipose tissue) = mobilised but there is impaired ability to utilise them.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long does flow phase last and what is the effect on metabolic activity, oxygen consumption and temperature.

A

Can last a long time.

  1. hyper metabolism
  2. catabolism
  3. increased oxygen consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are mechanisms in the body mediated by? (3)

A
  1. cytokines
  2. hormones
  3. changes in nutrient metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the mechanism by which counter regulatory hormones induce catabolism and glucose intolerance

A
  1. increased levels of hormones, catecholamines, glucagon and cortisol = increased protein metabolism and therefore catabolism
  2. can = hyperglycaemia and insulin resistance
  3. glucagon stimulates gluconeogenesis; cortisol increases net protein catabolism and catecholamines => glucose intolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do cytokines stimulate lean tissue breakdown?

A
  1. increased circulating levels of pro- and anti-inflammatory cytokines

IL-1 ; IL-6 and TNF-alpha = major pro-inflammatory mediators

in conjunction with hormones that have an effect on hepatic and peripheral tissue to increase lean muscle has breakdown and loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the time frame for initiating nutrition therapy in ICU patients?

A

All ICU patients >48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the aim of nutrition therapy in ICU patients? (4)

A
  1. help reduce disease severity
  2. diminish complications
  3. improve patient outcome
  4. attenuate rate of lean tissue loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a symptom caused by non-invasive respiratory support that can limit oral intake?

A
  1. dry mouth
  2. unable to eat or drink enough because of having to remove ventilator support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the maximum rate of glucose provision?

A

5mg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens after ebb and flow phases have passed - what impact does this have on metabolism and aim of nutritional therapy?

A
  1. catabolism reduces
  2. flow phase progresses to anabolic phase
  3. metabolic rate decreases
  4. fluid status and insulin sensitivity return to pre-injury levels
  5. increased appetite and ambulation present

Nutrition therapy aim = increase protein synthesis and restore some of the lost muscle mass

17
Q

What are some nutritional consequences of being in ICU and impact on metabolism and ability to eat? (6)

A
  1. Need to ensure that nutrition recommendations are safe and appropriate
  2. Different settings on mechanical ventilator can affect the work effort of breathing = affects energy requirements
  3. Endotracheal tubes = difficulty coordinating swallowing. Avoid oral intake because of dysphagia and aspiration risk
  4. Tracheostomy = swallowing difficulties, work with SLT
  5. Airflow cooling blanket = significantly reduces energy expenditure. Use predictive equations that account for temperature
  6. continuous renal replacement therapy = low of electrolytes (phosphate and magnesium); low of 5-10 G protein/day; loss of water soluble vitamins; low of trace elements (selenium)
18
Q

Dietitian considerations when looking after patients in ICU

A
  1. route and timing of nutritional support
  2. most appropriate access route
  3. assessment of nutritional requirements for current condition
  4. the use of EN and PN products
  5. adjust care plan secondary to disease state and changes in patient condition
19
Q

In the acute phase how much of nutritional requirements do you feed to? What time frame do you feed at each rate for?

A
  1. 70% of EE
  • after day 3 caloric delivery can be increased up to 80-100%

Aim is to try and protect the body without over-challenging the body to digest and metabolise

20
Q

What are consequences of over feeding in ICU? (>110% of EE)

A
  1. insulin resistance = huge negative impact on recovery
  2. hyperglycaemia
  3. hepatic steatosis
  4. prolonged organ support i.s. mechanical ventilation
  5. increased mortality
21
Q

What threshold of propofol administration do you take nutritional content into consideration energy requirement calculations? How many kcal/ml in propofol?

A

> 10 ml/hr

Lipid based medication

1ml = 1.1 kcal

22
Q

What symptoms would require bypass of stomach when feeding?

A
  1. motility issues
  2. vomiting
  3. reflux
  4. delayed gastric emptying
  5. very very high aspiration risk

Keeps a one way system of excretion through the GI tract

23
Q

What effect can laxatives have on nutrient absorption?

A

reduces absorption but also helps prevent focal impaction

24
Q

How would you estimate energy requirements in ICU patients?

A

PENG

Use 70% on days 1-2 then work up as appropriate

Day 3 - increase caloric delivery to 80_100% of EE

25
Q

How would you calculate protein requirements for ICU patients? What limit should you not go under?

A

PENG

Don’t go under 1.3g/kg/day

26
Q

Who manages fluid balance and administration in ICU patients?

A

medical team. Work with them but this is their remit

27
Q

What consequences can overfeeding in ICU have?

A
  1. disrupted nitrogen balance
  2. respiratory function (acid-base balance)
  3. carbohydrate metabolism (hyperglycaemia)
  4. lipid metabolism (hepatic steatosis)
28
Q

What is the term for disrupted nitrogen balance?

A

azotaemia

29
Q

What are potential consequences of underfeeding in ICU patients?

A
  1. impaired immune response
  2. prolonged hospital stay
  3. increase in mortality
30
Q

How many hours would you deliver nutrition to ICU patient?

A

16-24 hours daily to keep rate low and support steady glycemic control

31
Q

What volume should you start feed at?

A

25-30 mls/hour

Some need to start at 10ml/hr and increase every 8 hours

Clinical Dietetics 2 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions