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Advanced Medical Nutrition Therapy II > Critical Care Nutrition (part 3) > Flashcards

Critical Care Nutrition (part 3) Flashcards

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USMLE® Step 1 flashcards
1
Q

Cause of acute kidney injury in the ICU:

A

Acute tubular necrosis

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2
Q

What are risk factors for acute tubular necrosis:

A

-Decreased renal perfusion
-Nephrotoxic medications
-Sepsis or systemic inflammatory response syndrome

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3
Q

Treatment options for acute tubular necrosis:

A

-No dialysis
-Intermittent hemodialysis
-Continuous renal replacement therapy (CRRT)

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4
Q

One example of continuous renal replacement therapy is ____ ____ ____

A

Continuous venovenous hemodialysis

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5
Q

Continuous venovenous hemodialysis removed ___, ___, and ____ products

A

Water, electrolytes, and waste

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6
Q

Protein loss is an issue with continuous venovenous hemodialysis; people lose about ___-___ g of protein per day

A

10-15

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7
Q

People can also absorb ___-___% of dextrose from dialysate

A

35-45%

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8
Q

Energy needs for someone with acute kidney injury:

A

25-30 kcal/kg

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9
Q

Protein needs for someone with acute kidney injury who is not on dialysis:

A

1.2-2 g/kg

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10
Q

Protein needs for someone with acute kidney injury who is having frequent intermittent hemodialysis:

A

1.0-1.5 g/kg

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11
Q

Protein needs for someone with acute kidney injury who is on continuous venovenous hemodialysis:

A

1.5-2.5 g/kg

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12
Q

For non-obese patients, we should use ____/____ to calculate kcal and protein needs

A

UBW/EDW

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13
Q

For critically ill patients with obesity, we should use ____ to calculate kcal and protein needs

A

IBW

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14
Q

Fluid needs for someone with acute kidney injury in critical illness:

A

Replace output + 500 mL

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15
Q

Fluid ____ is not usually necessary on continuous renal replacement therapy

A

Restriction

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16
Q

____ and ____ are usually well-cleared with continuous venovenous hemodialysis, so an electrolyte restriction is not necessary

A

Potassium and phosphate

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17
Q

Electrolytes (potassium and phosphate) may need to be restricted with ____

A

Hemodialysis

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18
Q

If someone with acute kidney injury is on enteral nutrition, use a ___-___ enteral formula that meets ICU recommendations for protein and kcal

A

Non-renal

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19
Q

If someone with acute kidney injury has significant electrolyte abnormalities, consider a ____ ____ enteral nutrition formula

A

Renal failure

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20
Q

Systemic inflammatory response syndrome causes widespread inflammation resulting from…

A

-Infection
-Severe acute pancreatitis
-Ischemia
-Burns
-Major trauma
-Hemorrhagic shock

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21
Q

Systemic inflammatory response syndrome causes the release of…

A

-Cytokines
-Proteolytic enzymes
-Toxic oxygen species

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22
Q

Cytokines increase ____ ____

A

Capillary permeability

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23
Q

____ and ____ can occur with systemic inflammatory response syndrome, which can lead to organ damage and multi-organ dysfunction syndrome

A

Hypotension and hypoperfusion

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24
Q

What are two hypotheses for the development of systemic inflammatory response syndrome?

A

-Excessive production of pro-inflammatory cytokines
-Disruption of gut barrier function, leading to bacterial translocation

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25
Q

Primary multiple organ dysfunction syndrome is caused by direct ___ ___

A

Organ injury

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26
Q

Secondary multiple organ dysfunction syndrome is caused by ____/____ in other organs (SIRS)

A

Inflammation/infection

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27
Q

Multiple organ dysfunction syndrome causes failure what organs?

A

-Lungs
-Kidney
-Liver
-Intestines

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28
Q

MNT for systemic inflammatory response and multiple organ dysfunction syndrome:

A

-Increased kcal and protein to meet increased metabolic demands (however, avoid overfeeding and use indirect calorimetry if possible)
-Early enteral nutrition (unless hemodynamically unstable)
-If prolonged small bowel ileus, initiate parenteral nutrition

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29
Q

____ is another name for hemodynamic instability

A

Shock

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30
Q

Shock is treated with high doses of…

A

-Epinephrine
-Norepinephrine
-Dopamine
-Dobutamine

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31
Q

If someone is in shock, we should withhold ____ ____

A

Enteral nutrition

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32
Q

Hyperglycemia in the ICU is a large concern; we should promote blood glucose control between ____-____ mg/dL

A

140-180

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33
Q

In order to help avoid hyperglycemia, we should avoid ____

A

Overfeeding

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34
Q

____ ____ are an acute form of peptic ulcer that accompanies severe illness, trauma, or neural injury

A

Stress ulcers

35
Q

Stress ulcers can manifest in the stomach and duodenum and cause significant ____

A

Bleeding

36
Q

Stress ulcers are caused by ____ ____

A

Gastric ischemia

37
Q

A curling stress ulcer results from ____ and a cushing stress ulcer results from ____

A

Burns; TBI

38
Q

Prevention/treatment for stress ulcers:

A

Medications to reduce gastric acid production

39
Q

MNT for stress ulcers:

A

Early, continuous enteral nutrition may decrease risk

40
Q

What should be included in a nutrition assessment for a critically ill patient?

A

-Many traditional parameters may not be available
-Not recommended: albumin, prealbumin
-NFPE is critical
-Food-medication interactions (in the context of acute illness/injury)
-Nitrogen balance

41
Q

Nitrogen balance is used to assess ____ ___ and also to determine ____ ____

A

Protein status and protein needs

42
Q

Formula for determining nitrogen balance:

A

Nitrogen balance= (protein intake/6.25) - (UUN + 4)

43
Q

The goal for healing is a positive nitrogen balance between ___ and ____

A

+2 to +4

44
Q

The goal for nitrogen balance in someone who is critically ill is _____ (0)

A

Equilibrium

45
Q

A negative nitrogen balance would indicate…

A

-Inadequate protein intake
-Increased protein needs
-Excessive loss of protein

46
Q

Nitrogen balance cannot be accurately calculated in patients with ____ disease or excessive ____ ____

A

Renal; exudative losses

47
Q

The goal for critically ill patients is to provide adequate nutrition in order to…

A

-Slow the loss of LBM
-Heal wounds
-Fight infection

48
Q

We should avoid overfeeding in order to prevent…

A

-Hyperglycemia
-Excessive CO2 production
-Lipogenesis

49
Q

____ ____ is the gold standard for calculating energy requirements

A

Indirect calorimetry

50
Q

Indirect calorimetry estimates energy expenditure by measurement of ____ consumption and ____ production over a given period of time

A

O2; CO2

51
Q

Indirect calorimetry uses the ____ formula to estimate energy expenditure from gas exchange data

A

Weir

52
Q

Candidates for indirect calorimetry include patients with…

A

-Obesity
-Cachexia
-TBI; SCI
-Burns
-Failure to wear from ventilator
-Delayed wound healing
-Amputations

53
Q

Required conditions for indirect calorimetry:

A

-Fasting (at least 7 hours) or receiving continuous feeding
-After a 30-minute resting period
-Relaxed and not moving
-Thermoneutral environment

54
Q

What are some clinical situations that decrease the validity of indirect calorimetry?

A

-Air leak
-Physical agitation
-Unstable body temperature
-Unstable pH
-ECMO

55
Q

What equation can predict energy needs for critically ill patients?

A

Penn State 2010 equation

56
Q

The Modified Penn State 2010 equation can be used for…

A

Critically ill patients with obesity who are over 60 years

57
Q

We can predict energy needs for critically ill patients with ____-____ kcal/kg estimated dry weight

A

20-30

58
Q

A ____, ___ ____ diet can be used for critically ill patients with obesity to promote steady-state weight loss while preventing the loss of lean body mass

A

Hypocaloric, high protein

59
Q

A hypocaloric, high-protein diet may possibly reduce ____

A

Complications

60
Q

For hypocaloric, high-protein feeding, we should provide ____-____% of energy requirements measured by indirect calorimetry

A

65-70

61
Q

Energy needs for someone with a BMI of 30-50 who is getting a hypocaloric, high protein diet are ____-____ kcal/kg actual body weight

A

11-14

62
Q

If indirect calorimetry cannot be used for someone getting hypocaloric, energy needs for someone with a BMI of over 50 are ____-____ kcal/kg ideal body weight

A

22-25

63
Q

If someone with a BMI between 30-39.9 is on hypocaloric, high-protein feeding, their protein needs are:

A

2.0 g/kg IBW

64
Q

If someone with a BMI 40 or more is on hypocaloric, high-protein feeding, their protein needs are:

A

2.5 g/kg IBW

65
Q

Protein requirements for non-obese patients in the ICU:

A

1.2-2 g/kg

66
Q

Fluid needs in the ICU should be individualized using ___ and ____-based guidelines

A

Age and weight

67
Q

The goal of fluid needs is to maintain adequate ____ _____

A

Urine output

68
Q

When determining fluid needs, consider ____ and ____ ____ of fluid

A

Losses and additional sources

69
Q

Oral nutrition in the ICU may be delayed by…

A

-Inability to chew or swallow
-Altered mental status
-Mechanical ventilation
-Weakness
-Anorexia
-GI distress
-Sedation

70
Q

For nutrition support in the ICU, ____ nutrition is preferred to ____ nutrition

A

Enteral; parenteral

71
Q

If parenteral nutrition is ordered, confirm the _____

A

Indication

72
Q

Nutrition cannot abolish the hypermetabolism and catabolism, but may slow the loss of _____

A

Protein

73
Q

Without exogenous protein intake, there is decreased…

A

-Wound healing
-Immune function

74
Q

Without exogenous protein intake, there is increased risk of…

A

-Infections
-Pressure injuries
-Respiratory insufficiency

75
Q

Enteral nutrition should be started within ___-___ hours of admission to the ICU and advanced toward goal kcal during the next 48-72 hours

A

24-48

76
Q

If someone is on enteral nutrition, we should elevate head of bed ___-___ degrees to prevent aspiration

A

30-45

77
Q

We should recommend small bowel enteral feeding for…

A

-Delayed gastric emptying
-Supine position
-NG suction
-High aspiration risk

78
Q

In the ICU, it is common to use ___ ___, ____ enteral nutrition formulas

A

High protein, polymeric

79
Q

We may consider use of immune-modulating formulas for patients with…

A

-TBI
-Major surgery
-Severe trauma

80
Q

Immune-modulating formulas are not recommended for patients with severe ____

A

Sepsis

81
Q

We can consider the use of a mixed fiber-containing formula if a patient has persistent _____

A

Diarrhea

82
Q

We should avoid both soluble and insoluble fiber for patients at high risk for…

A

-Bowel ischemia
-Severe dysmotility

83
Q

When determining energy needs, we need to consider additional kcal sources such as…

A

-Dextrose in IVF: 3.4 kcal/g
-Propofol (Divprivan): 1.1 kcal/mL
-Clevidipine: 2 kcal/mL
-CVVHD
-Multiple sources of nutrition

84
Q

What should be monitored in those in the ICU?

A

-Changes in medical status
-Biochemical data: glucose, electrolytes, BUN, Cr, TG, LTF’s, ABG’s, CBC
-Weight changes
-NFPE
-GI status
-Nitrogen balance
-Fluid status
-All sources of kcal
-TF: tolerance, total volume received
-PN tolerance
-Readiness to transition to another mode of feeding

Advanced Medical Nutrition Therapy II (19 decks)

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