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Advanced Medical Nutrition Therapy II > Critical Care Nutrition (part 1) > Flashcards

Critical Care Nutrition (part 1) Flashcards

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USMLE® Step 1 flashcards
1
Q

The metabolic stress response is a ____, ____ response to acute injury or disease

A

Hypermetabolic, catabolic

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2
Q

The metabolic stress response can be caused by…

A

-Trauma
-Surgery
-Burns
-Infection
-Sepsis

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3
Q

The magnitude of the metabolic stress response correlates with the _____ of the injury

A

Severity

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4
Q

Metabolic alterations begin at the time of injury and persists until ____ is complete

A

Healing

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5
Q

What are the three phases of the metabolic stress response?

A

-Ebb phase (2-48 hours after injury)
-Flow phase
-Adaptive response

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6
Q

What might be seen in the ebb phase of the metabolic stress response?

A

-Decreased BP, cardiac output, O2 consumption, and metabolic rate
-Hypovolemia, tissue hypoxia, and shock
-Decreased insulin and increased glucagon secretion

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7
Q

The flow phase begins as the patient becomes _____ ____

A

Hemodynamically stable

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8
Q

What might be seen in the flow phase of the metabolic stress response?

A

-Increased release of catecholamines, glucagon, and cortisol-> increased substrates for wound healing
-Increased cardiac output and O2 consumption
-Increased metabolic rate and protein catabolism
-Increased release of the cytokines
-Increased positive acute-phase protein synthesis for inflammation, wound healing, and coagulation
-Decreased synthesis of negative acute-phase proteins

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9
Q

What are positive acute-phase proteins?

A

-C-reactive protein
-Ceruloplasmin
-Fibronectin
-Ferritin

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10
Q

What are negative acute-phase proteins?

A

-Albumin
-Transferrin
-Prealbumin

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11
Q

The flow phase lasts for several ____ or longer

A

Weeks

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12
Q

What happens during the adaptive response phase of the metabolic stress response?

A

-Hormonal response gradually diminishes
-Metabolic rate normalizes
-Anabolism predominates (anabolism can only occur in the presence of adequate nutrition)

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13
Q

Tissue injury causes increased levels of ____ ____

A

Counterregulatory hormones

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14
Q

What are three counterregulatory hormones?

A

-Glucagon
-Cortisol
-Catecholamines

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15
Q

Role of glucagon:

A

-Hepatic glycogenolysis
-Gluconeogensis

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16
Q

Roles of cortisol:

A

-Skeletal muscle catabolism to provide amino acids for hepatic gluconeogenesis and positive acute phase protein synthesis
-Glycogenolysis
-Increased lipolysis

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17
Q

Roles of catecholamines:

A

-Glycogenolysis
-Gluconeogenesis
-Lipolysis
-Decrease in insulin release
-Causes temporary insulin resistance

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18
Q

Aldosterone is also released in the hormonal response to stress; it causes…

A

-Increased Na reabsorption by the kidneys

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19
Q

Anti-diuretic hormone is also released, which leads to…

A

-Increased water reabsorption by the kidneys

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20
Q

Examples of cytokines:

A

-Interleukin-1
-Interleukin-6
-TNF

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21
Q

Cytokines are ____ proteins

A

Proinflammatory

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22
Q

Cytokines are released by macrophages, T helper cells, and mast cells in response to…

A

-Tissue damage
-Infection
-Inflammation

23
Q

Cytokines stimulate…

A

-Muscle catabolism
-Gluconeogenesis
-Hepatic amino acid uptake
-Positive acute phase protein synthesis

24
Q

A release of cytokines may lead to ____

A

Anorexia

25
Q

Release of interleukin-1 leads to decreased serum levels of ____ and ____

A

Zinc and iron

26
Q

What are the effects of the metabolic response to stress on carbohydrate metabolism?

A

-Glycogen stores are depleted quickly
-Increased glucose production and epinephrine’s inhibition of insulin release-> hyperglycemia (AKA “stress diabetes”)

27
Q

What are the effects of the metabolic response to stress on protein metabolism?

A

-Lean body mass catabolism (BCAA are oxidized as a source of energy for muscles; provides amino acids for positive acute phase protein synthesis)
-Rapid loss of lean body mass causes negative nitrogen balance

28
Q

Muscle wasting occurs due to…

A

-Effect of catabolic hormones
-Imbalance between energy intake and energy needs
-Physical immobilization

29
Q

What are the effects of the metabolic response to stress on lipid metabolism?

A

-Increased lipolysis of triglyceride stores due to increased levels of counterregulatory hormones
-Increased circulation of FFA
-Increased beta-oxidation
-Less ketosis than seen in starvation

30
Q

What are the net effects of the hormonal and cell-mediated response to stress?

A

-Hypercatabolic state
-Greater availability of substrates for metabolically active tissues
-Negative nitrogen balance
-Increased blood volume and edema

31
Q

In contrast to the metabolic response to stress, starvation causes…

A

-Decreased REE
-No increase in counter-regulatory hormones
-Ketosis
-Decreased gluconeogenesis (protein is spared and fat is the primary fuel used)

32
Q

Consequences of burns:

A

-Pain
-Loss of water and nutrients via wound
-Infection
-Hypermetabolism and catabolism with large protein losses

33
Q

What should be included in the nutrient assessment for burn patients?

A

-Diet history
-Weight-> consider fluid status; use dry weight to calculate BMI
-Comorbidities
-Food-medication interactions
-Biochemical assessment
-NFPE
-Monitor wound healing

34
Q

In the first 24-48 hours, someone with burns will need ___ and ___ replacement

A

Fluid and electrolyte

35
Q

The volume of fluid needed for those with burns is based on…

A

-Age
-Weight
-Total body surface area burned

36
Q

After resuscitation, someone should get maintenance hydration, plus extra fluid to replace ____

A

Losses

37
Q

In someone with burns getting hydration, we should monitor…

A

-Weight
-Physical signs
-Serum Na
-Serum osmolality
-Intake and output records

38
Q

____ needs for someone with burns often exceeds that of any other injury

A

Energy

39
Q

Energy needs increase with the ____ of the burn

A

Size

40
Q

REE can almost ____ for severely burned patients

A

Double

41
Q

____ ____ in someone with severe burns may not be feasible

A

Weight gain

42
Q

There are many predictive equations for energy needs for those with burns available, but most have been found to _____ needs

A

Overestimate

43
Q

The best way to determine energy needs for patients with burns is ____ ____

A

Indirect calorimetry

44
Q

Protein needs in patients with burns are elevated due to…

A

-Gluconeogenesis
-Wound healing
-Losses via wounds and urine

45
Q

Protein needs for someone with burns:

A

1.5-2.0 g/kg

46
Q

We should provide ___-___% of kcal from protein for those with burns

A

20-25%

47
Q

We may consider the use of supplemental ____ in those with burns

A

Arginine

48
Q

Those with burns have ____ micronutrient needs

A

Increased

49
Q

We should prescribe a ____ with minerals to those with burns

A

Multivitamin

50
Q

We should recommend ____-____ mg/d of vitamin C

A

500-1000

51
Q

We should recommend ____ mg of ZnSO4 (50 mg of elemental zinc)

A

220

52
Q

We should also monitor ____ in those with burns

A

Electrolytes

53
Q

Most patients with <___% total body surface area burned can meet their needs with an oral diet (high kcal and protein diet with oral nutrition supplements)

A

20

54
Q

Those with a poor appetite or >20% total body surface area burned may require ____ ____ with high protein, high kcal formula

A

Tube feeding

Advanced Medical Nutrition Therapy II (19 decks)

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