Critical Care Nutrition (part 2) Flashcards
Who goes to the ICU?
-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)
____ ____ occurs when the pulmonary system is no longer able to perform its normal functions
Respiratory failure
Those with respiratory failure require supplemental ____, and may require mechanical ventilation
O2
Respiratory failure can result from ____ ____ or as a result of acute insult to the lungs
Chronic disease
Causes of respiratory failure:
-Pulmonary disorders
-Neuromuscular disorders
-Neurologic injury
-Cardiovascular disorders
-Respiratory infection
-SIRS/sepsis
-Inhalation of toxic gases
-Drug overdose
-Multiple organ dysfunction syndrome
___ ___ ____ ___ is an acute onset, life-threatening respiratory failure caused by diffuse alveolar injury
Acute respiratory distress syndrome
Tissue damage in the lungs leads to inflammation and increased capillary ____
Permeability
Increased capillary permeability causes a fluid build-up in the alveoli, which leads to decreased transfer of ____ to the bloodstream
O2
Acute respiratory distress syndrome is characterized by…
-Severe hypoxemia
-Pulmonary edema
-Decreased lung compliance
Acute respiratory distress syndrome results in ____ ____
Respiratory failure
Acute respiratory distress syndrome is caused by…
-Primary damage to the lung tissues: pneumonia, inhalation injury, near drowning
-Secondary damage to the lung tissues: systemic inflammatory response syndrome and sepsis
___-___ ventilation is when the ventilator delivers preset breaths in coordination with the respiratory effort of the patient
Assist-Control
____ ____ _____ ventilation uses a combination of machine and spontaneous breaths
Synchronous intermittent mandatory
____ ____ ventilation applies a set positive pressure to a spontaneous inspiratory effort
Pressure support
Impact of malnutrition on respiratory function:
-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
To determine energy needs for someone with respiratory failure, it is best to use ___ ___
Indirect calorimetry
Energy requirements for someone with respiratory failure:
25 kcal/kg estimated dry weight
The goal for respiratory failure is to provide ____, but not excessive kcal to facilitate weaning
Adequate
Protein needs for someone with respiratory failure:
1.5-2.0 g/kg
Fluid needs for someone with respiratory failure should be ____
Individualized
If someone is on mechanical ventilation (orally intubated), they must get ____ nutrition
Enteral
If someone has pulmonary edema, use a ___-___ kcal/mL enteral nutrition formula that restricts fluid
1.5-2
Specialty high-fat/low-carbohydrate enteral nutrition formulas designed to reduce ____ production are NOT recommended for ICU patients with acute respiratory failure
CO2
For those with respiratory failure, we should monitor…
-Phosphorus
-Magnesium
-Potassium
-Serum glucose
-Arterial blood gasses
A ____ is a surgical opening made in the trachea to assist breathing
Tracheostomy
A tracheostomy tube is inserted through a ___ ___ called a stoma
Surgical opening
What are some reasons why a tracheostomy might be needed?
-Bypass an obstruction
-Frequent pulmonary suctioning required
-Deliver O2 to the lungs for individuals unable to breathe
Patients with tracheostomies may be at increased risk for ____ and ____
Dysphagia and aspiration
Prolonged oral intubation can damage the vocal cords and cause atrophy of the ____ muscles, leading to aspiration
Laryngeal
If a patient does experience dysphagia or aspiration, work with SLP to determine the most appropriate _____ of foods and fluids
Consistency
___ ____ ____ is therapy used for patients whose heart and/or lungs are so damaged that they cannot oxygenate the blood
Extracorporeal Membrane Oxygenation (ECMO)
The ECMO machine continuously pumps blood from the patient through a “membrane oxygenator” that removes ____ and adds ____
CO2; O2
ECMO is an extracorporeal technique of providing both ___ and ____ support
Cardiac; respiratory
For patients on ECMO, we should assess for ____ ____
Cardiac cachexia
In those on ECMO, we should monitor for ____ deficiency, as well as losses of ____ and ____
Thiamin; potassium and magnesium
Energy needs for those on ECMO:
25-30 kcal/kg EDW
If someone on ECMO has a BMI over 30, we should recommend ___-___ kcal/kg EDW
11-14
Protein needs for someone on ECMO:
1.2-2 g/kg EDW
If someone on ECMO has a BMI over 30, we should recommend ____ or more grams of protein per kg IBW
2.0
_____ nutrition is frequently used for patients on ECMO
Enteral
____-____ formulas are recommended for those on ECMO due to hemodynamic instability
Fiber-free
Severe congestive heart failure can lead to _____
Hypotension
Individuals who have a mean arterial pressure ____ or less mmHg are at risk for subclinical gut ischemia
50
What are the arterial blood gases?
-Partial pressure of oxygen (PaO2)
-O2 saturation
-pH
-PaCO2
-HCO3
Normal serum pH ranges from ____-____
7.35-7.45
A low pH means someone has a high concentration of ___, indicating acidity
H+
A high pH means someone has a low concentration of H+, indicating _____
Alkalinity
The normal range for the partial pressure of carbon dioxide (PaCO2) is between ____-____ mmHg
35-45
A high PaCO2 means that CO2 is being retained by the lungs via hypoventilation, causing ____ ____
Respiratory acidosis
A low PaCO2 means that excess CO2 is being expelled via hyperventilation, causing ____ ____
Respiratory alkalosis
The normal range for bicarbonate (HCO3) is ____-____ mEq/L
21-28
A high level of bicarbonate indicates _____
Alkalinity
A low level of bicarbonate indicates _____
Acidity
____ ____ can absorb excessive H+ (acid) or OH- (base)
Buffer systems
The lungs compensate for changes in pH by increasing or decreasing ____ ____, leading to elimination or retention of CO2
Alveolar ventilation
The kidneys compensate by changing renal ___ ion excretion and ____ reabsorption and formation
H+; bicarbonate
Metabolic acidosis is indicated by a pH of less than _____ and decreased HCO3
7.35
Causes of metabolic acidosis:
-Increased production of acids: DKA, lactic acidosis
-Decreased H+ excretion-> renal failure
-Loss of bicarbonate-> diarrhea
Clinical manifestations of metabolic acidosis:
-Headache
-Lethargy
-Deep, rapid respirations (Kussmoul)
-Anorexia
-N/V/D, abdominal pain
-Severe-> dysrhythmias
Treatment of metabolic acidosis:
-Determine the cause of metabolic acidosis
-Severe acidosis-> sodium bicarbonate administation
Metabolic alkalosis is indicated by a pH over ____ and increased HCO3
7.45
Metabolic alkalosis is usually caused by loss of ____
Acid
Metabolic alkalosis can be caused by…
-Prolonged vomiting
-NG suctioning
-Diuretics
-Excessive bicarbonate intake
Clinical manifestations of metabolic alkalosis:
-Weakness
-Muscle cramps
-Tetany
-Slow, shallow respirations
-Severe: confusion, seizures, dysrhythmias
Treatment of metabolic alkalosis:
-Determine cause
-Hyperchloremia alkalosis: IV sodium chloride
What indicates respiratory acidosis?
-Decreased pH
-Increased PaCO2 (hypercapnia)
With respiratory acidosis, increased CO2 is retained, leading to increased ____ ____
Carbonic acid
Respiratory acidosis can be ____ or ____
Acute or chronic
Causes of respiratory acidosis:
-COPD
-Sleep apnea
-Asthma
-ARDS
-Neuromuscular disorders leading to decreased respiratory muscle function
-Depression of the respiratory center (brain stem injury, oversedation)
-Overfeeding
Clinical manifestations of respiratory acidosis:
-Lethargy
-Anxiety
-Sleepiness
-Confusion
-Muscle twitching and tremors
-Coma
Treatment of respiratory acidosis:
-Acute: restore adequate alveolar ventilation; may require mechanical ventilation
-Chronic: treat underlying diseases
MNT for respiratory acidosis:
-Avoid overfeeding
-Avoid excessive CHO administration
Respiratory alkalosis is indicated by…
-Increased pH
-Decreased PaCO2
____ can lead to respiratory alkalosis due to exhalation of CO2
Hyperventilation
Causes of respiratory alkalosis:
-Pulmonary disease
-Congestive heart failure
-High altitudes
-Anxiety/panic
-Pain
-Sepsis
-Mechanical ventilation
Clinical manifestations of respiratory alkalosis:
-Dizziness
-Confusion
-Paresthesia
-Convulsions
-Coma
Treatment of respiratory alkalosis:
-Determine and treat the underlying cause
-Correct hypoxemia
Step 1 in interpreting arterial blood gases is to examine the ____
pH
If the pH is under 7.35, it is _____ and if it over 7.45, it is ____
Acidosis, alkalosis
Step 2 in interpreting arterial blood gasses is examining the ____
PaCO2
Normal range for PaCO2 is between 35-45; high would indicate ____ and low would indicate ____
Acidosis; alkalosis
Step 3 in interpreting arterial blood gases is examining the ____
HCO3
Normal range for HCO3 is between 21-28; high would indicate ____ and low would indicate ____
Alkalosis; acidosis
Step 4 of interpreting arterial blood gases is to determine if the imbalance is ____ or ____
Respiratory or metabolic
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
Acid-base
If the PaCO2 follows the pH, the cause is ____
Respiratory
If the HCO3 follows the pH, the cause is ____
Metabolic
The final step of interpreting arterial blood gases is determining the ____ of the acid-base imbalance and determining any MNT to address the cause
Cause
