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Advanced Medical Nutrition Therapy II > Critical Care Nutrition (part 2) > Flashcards

Critical Care Nutrition (part 2) Flashcards

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USMLE® Step 1 flashcards
1
Q

Who goes to the ICU?

A

-Respiratory failure
-Shock
-MI
-CVA
-DKA
-Systemic inflammatory response syndrome/Sepsis
-Major trauma
-Major burns
-Acute liver failure
-Transplants (heart, lung, liver, small, bowel)
-After major surgeries (CABG, AAA repair, thoracic surgery, major abdominal surgery)

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2
Q

____ ____ occurs when the pulmonary system is no longer able to perform its normal functions

A

Respiratory failure

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3
Q

Those with respiratory failure require supplemental ____, and may require mechanical ventilation

A

O2

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4
Q

Respiratory failure can result from ____ ____ or as a result of acute insult to the lungs

A

Chronic disease

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5
Q

Causes of respiratory failure:

A

-Pulmonary disorders
-Neuromuscular disorders
-Neurologic injury
-Cardiovascular disorders
-Respiratory infection
-SIRS/sepsis
-Inhalation of toxic gases
-Drug overdose
-Multiple organ dysfunction syndrome

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6
Q

___ ___ ____ ___ is an acute onset, life-threatening respiratory failure caused by diffuse alveolar injury

A

Acute respiratory distress syndrome

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7
Q

Tissue damage in the lungs leads to inflammation and increased capillary ____

A

Permeability

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8
Q

Increased capillary permeability causes a fluid build-up in the alveoli, which leads to decreased transfer of ____ to the bloodstream

A

O2

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9
Q

Acute respiratory distress syndrome is characterized by…

A

-Severe hypoxemia
-Pulmonary edema
-Decreased lung compliance

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10
Q

Acute respiratory distress syndrome results in ____ ____

A

Respiratory failure

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11
Q

Acute respiratory distress syndrome is caused by…

A

-Primary damage to the lung tissues: pneumonia, inhalation injury, near drowning
-Secondary damage to the lung tissues: systemic inflammatory response syndrome and sepsis

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12
Q

___-___ ventilation is when the ventilator delivers preset breaths in coordination with the respiratory effort of the patient

A

Assist-Control

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13
Q

____ ____ _____ ventilation uses a combination of machine and spontaneous breaths

A

Synchronous intermittent mandatory

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14
Q

____ ____ ventilation applies a set positive pressure to a spontaneous inspiratory effort

A

Pressure support

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15
Q

Impact of malnutrition on respiratory function:

A

-Decreased muscle mass, strength, and endurance
-Reductions in vital capacity
-Decreased ventilatory drive
-Decreased surfactant-> decreased lung compliance
-Hypoalbuminemia-> pulmonary edema
-Decreased immune function
-Diminished oxygen-carrying capacity of blood
-Low levels of phosphorus, calcium, magnesium, and potassium compromise respiratory muscle function at the cellular level
-Prolonged intubation

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16
Q

To determine energy needs for someone with respiratory failure, it is best to use ___ ___

A

Indirect calorimetry

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17
Q

Energy requirements for someone with respiratory failure:

A

25 kcal/kg estimated dry weight

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18
Q

The goal for respiratory failure is to provide ____, but not excessive kcal to facilitate weaning

A

Adequate

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19
Q

Protein needs for someone with respiratory failure:

A

1.5-2.0 g/kg

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20
Q

Fluid needs for someone with respiratory failure should be ____

A

Individualized

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21
Q

If someone is on mechanical ventilation (orally intubated), they must get ____ nutrition

A

Enteral

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22
Q

If someone has pulmonary edema, use a ___-___ kcal/mL enteral nutrition formula that restricts fluid

A

1.5-2

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23
Q

Specialty high-fat/low-carbohydrate enteral nutrition formulas designed to reduce ____ production are NOT recommended for ICU patients with acute respiratory failure

A

CO2

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24
Q

For those with respiratory failure, we should monitor…

A

-Phosphorus
-Magnesium
-Potassium
-Serum glucose
-Arterial blood gasses

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25
Q

A ____ is a surgical opening made in the trachea to assist breathing

A

Tracheostomy

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26
Q

A tracheostomy tube is inserted through a ___ ___ called a stoma

A

Surgical opening

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27
Q

What are some reasons why a tracheostomy might be needed?

A

-Bypass an obstruction
-Frequent pulmonary suctioning required
-Deliver O2 to the lungs for individuals unable to breathe

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28
Q

Patients with tracheostomies may be at increased risk for ____ and ____

A

Dysphagia and aspiration

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29
Q

Prolonged oral intubation can damage the vocal cords and cause atrophy of the ____ muscles, leading to aspiration

A

Laryngeal

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30
Q

If a patient does experience dysphagia or aspiration, work with SLP to determine the most appropriate _____ of foods and fluids

A

Consistency

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31
Q

___ ____ ____ is therapy used for patients whose heart and/or lungs are so damaged that they cannot oxygenate the blood

A

Extracorporeal Membrane Oxygenation (ECMO)

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32
Q

The ECMO machine continuously pumps blood from the patient through a “membrane oxygenator” that removes ____ and adds ____

A

CO2; O2

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33
Q

ECMO is an extracorporeal technique of providing both ___ and ____ support

A

Cardiac; respiratory

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34
Q

For patients on ECMO, we should assess for ____ ____

A

Cardiac cachexia

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35
Q

In those on ECMO, we should monitor for ____ deficiency, as well as losses of ____ and ____

A

Thiamin; potassium and magnesium

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36
Q

Energy needs for those on ECMO:

A

25-30 kcal/kg EDW

37
Q

If someone on ECMO has a BMI over 30, we should recommend ___-___ kcal/kg EDW

A

11-14

38
Q

Protein needs for someone on ECMO:

A

1.2-2 g/kg EDW

39
Q

If someone on ECMO has a BMI over 30, we should recommend ____ or more grams of protein per kg IBW

A

2.0

40
Q

_____ nutrition is frequently used for patients on ECMO

A

Enteral

41
Q

____-____ formulas are recommended for those on ECMO due to hemodynamic instability

A

Fiber-free

42
Q

Severe congestive heart failure can lead to _____

A

Hypotension

43
Q

Individuals who have a mean arterial pressure ____ or less mmHg are at risk for subclinical gut ischemia

A

50

44
Q

What are the arterial blood gases?

A

-Partial pressure of oxygen (PaO2)
-O2 saturation
-pH
-PaCO2
-HCO3

45
Q

Normal serum pH ranges from ____-____

A

7.35-7.45

46
Q

A low pH means someone has a high concentration of ___, indicating acidity

A

H+

47
Q

A high pH means someone has a low concentration of H+, indicating _____

A

Alkalinity

48
Q

The normal range for the partial pressure of carbon dioxide (PaCO2) is between ____-____ mmHg

A

35-45

49
Q

A high PaCO2 means that CO2 is being retained by the lungs via hypoventilation, causing ____ ____

A

Respiratory acidosis

50
Q

A low PaCO2 means that excess CO2 is being expelled via hyperventilation, causing ____ ____

A

Respiratory alkalosis

51
Q

The normal range for bicarbonate (HCO3) is ____-____ mEq/L

A

21-28

52
Q

A high level of bicarbonate indicates _____

A

Alkalinity

53
Q

A low level of bicarbonate indicates _____

A

Acidity

54
Q

____ ____ can absorb excessive H+ (acid) or OH- (base)

A

Buffer systems

55
Q

The lungs compensate for changes in pH by increasing or decreasing ____ ____, leading to elimination or retention of CO2

A

Alveolar ventilation

56
Q

The kidneys compensate by changing renal ___ ion excretion and ____ reabsorption and formation

A

H+; bicarbonate

57
Q

Metabolic acidosis is indicated by a pH of less than _____ and decreased HCO3

A

7.35

58
Q

Causes of metabolic acidosis:

A

-Increased production of acids: DKA, lactic acidosis
-Decreased H+ excretion-> renal failure
-Loss of bicarbonate-> diarrhea

59
Q

Clinical manifestations of metabolic acidosis:

A

-Headache
-Lethargy
-Deep, rapid respirations (Kussmoul)
-Anorexia
-N/V/D, abdominal pain
-Severe-> dysrhythmias

60
Q

Treatment of metabolic acidosis:

A

-Determine the cause of metabolic acidosis
-Severe acidosis-> sodium bicarbonate administation

61
Q

Metabolic alkalosis is indicated by a pH over ____ and increased HCO3

A

7.45

62
Q

Metabolic alkalosis is usually caused by loss of ____

A

Acid

63
Q

Metabolic alkalosis can be caused by…

A

-Prolonged vomiting
-NG suctioning
-Diuretics
-Excessive bicarbonate intake

64
Q

Clinical manifestations of metabolic alkalosis:

A

-Weakness
-Muscle cramps
-Tetany
-Slow, shallow respirations
-Severe: confusion, seizures, dysrhythmias

65
Q

Treatment of metabolic alkalosis:

A

-Determine cause
-Hyperchloremia alkalosis: IV sodium chloride

66
Q

What indicates respiratory acidosis?

A

-Decreased pH
-Increased PaCO2 (hypercapnia)

67
Q

With respiratory acidosis, increased CO2 is retained, leading to increased ____ ____

A

Carbonic acid

68
Q

Respiratory acidosis can be ____ or ____

A

Acute or chronic

69
Q

Causes of respiratory acidosis:

A

-COPD
-Sleep apnea
-Asthma
-ARDS
-Neuromuscular disorders leading to decreased respiratory muscle function
-Depression of the respiratory center (brain stem injury, oversedation)
-Overfeeding

70
Q

Clinical manifestations of respiratory acidosis:

A

-Lethargy
-Anxiety
-Sleepiness
-Confusion
-Muscle twitching and tremors
-Coma

71
Q

Treatment of respiratory acidosis:

A

-Acute: restore adequate alveolar ventilation; may require mechanical ventilation
-Chronic: treat underlying diseases

72
Q

MNT for respiratory acidosis:

A

-Avoid overfeeding
-Avoid excessive CHO administration

73
Q

Respiratory alkalosis is indicated by…

A

-Increased pH
-Decreased PaCO2

74
Q

____ can lead to respiratory alkalosis due to exhalation of CO2

A

Hyperventilation

75
Q

Causes of respiratory alkalosis:

A

-Pulmonary disease
-Congestive heart failure
-High altitudes
-Anxiety/panic
-Pain
-Sepsis
-Mechanical ventilation

76
Q

Clinical manifestations of respiratory alkalosis:

A

-Dizziness
-Confusion
-Paresthesia
-Convulsions
-Coma

77
Q

Treatment of respiratory alkalosis:

A

-Determine and treat the underlying cause
-Correct hypoxemia

78
Q

Step 1 in interpreting arterial blood gases is to examine the ____

A

pH

79
Q

If the pH is under 7.35, it is _____ and if it over 7.45, it is ____

A

Acidosis, alkalosis

80
Q

Step 2 in interpreting arterial blood gasses is examining the ____

A

PaCO2

81
Q

Normal range for PaCO2 is between 35-45; high would indicate ____ and low would indicate ____

A

Acidosis; alkalosis

82
Q

Step 3 in interpreting arterial blood gases is examining the ____

A

HCO3

83
Q

Normal range for HCO3 is between 21-28; high would indicate ____ and low would indicate ____

A

Alkalosis; acidosis

84
Q

Step 4 of interpreting arterial blood gases is to determine if the imbalance is ____ or ____

A

Respiratory or metabolic

85
Q

In order to determine if the cause of the imbalance is respiratory or metabolic, we need to check the PaCO2 and the HCO3 to see which one has the same ____-___ status as the pH

A

Acid-base

86
Q

If the PaCO2 follows the pH, the cause is ____

A

Respiratory

87
Q

If the HCO3 follows the pH, the cause is ____

A

Metabolic

88
Q

The final step of interpreting arterial blood gases is determining the ____ of the acid-base imbalance and determining any MNT to address the cause

A

Cause

Advanced Medical Nutrition Therapy II (19 decks)

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