Critical Care Nutrition (part 2) Flashcards by perjunke fibers

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)

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

Respiratory failure

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

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

Chronic disease

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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

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

Acute respiratory distress syndrome

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

Permeability

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

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Acute respiratory distress syndrome is characterized by…

-Severe hypoxemia
-Pulmonary edema
-Decreased lung compliance

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Acute respiratory distress syndrome results in ____ ____

Respiratory failure

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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

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

Assist-Control

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

Synchronous intermittent mandatory

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

Pressure support

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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

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

Indirect calorimetry

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Energy requirements for someone with respiratory failure:

25 kcal/kg estimated dry weight

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

Adequate

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Protein needs for someone with respiratory failure:

1.5-2.0 g/kg

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Fluid needs for someone with respiratory failure should be ____

Individualized

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

Enteral

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

1.5-2

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

CO2

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For those with respiratory failure, we should monitor…

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

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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

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 ____

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