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

Critical Care Nutrition (part 3) 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
Primary multiple organ dysfunction syndrome is caused by direct ___ ___
Organ injury
26
Secondary multiple organ dysfunction syndrome is caused by ____/____ in other organs (SIRS)
Inflammation/infection
27
Multiple organ dysfunction syndrome causes failure what organs?
-Lungs -Kidney -Liver -Intestines
28
MNT for systemic inflammatory response and multiple organ dysfunction syndrome:
-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
29
____ is another name for hemodynamic instability
Shock
30
Shock is treated with high doses of...
-Epinephrine -Norepinephrine -Dopamine -Dobutamine
31
If someone is in shock, we should withhold ____ ____
Enteral nutrition
32
Hyperglycemia in the ICU is a large concern; we should promote blood glucose control between ____-____ mg/dL
140-180
33
In order to help avoid hyperglycemia, we should avoid ____
Overfeeding
34
____ ____ are an acute form of peptic ulcer that accompanies severe illness, trauma, or neural injury
Stress ulcers
35
Stress ulcers can manifest in the stomach and duodenum and cause significant ____
Bleeding
36
Stress ulcers are caused by ____ ____
Gastric ischemia
37
A curling stress ulcer results from ____ and a cushing stress ulcer results from ____
Burns; TBI
38
Prevention/treatment for stress ulcers:
Medications to reduce gastric acid production
39
MNT for stress ulcers:
Early, continuous enteral nutrition may decrease risk
40
What should be included in a nutrition assessment for a critically ill patient?
-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
Nitrogen balance is used to assess ____ ___ and also to determine ____ ____
Protein status and protein needs
42
Formula for determining nitrogen balance:
Nitrogen balance= (protein intake/6.25) - (UUN + 4)
43
The goal for healing is a positive nitrogen balance between ___ and ____
+2 to +4
44
The goal for nitrogen balance in someone who is critically ill is _____ (0)
Equilibrium
45
A negative nitrogen balance would indicate...
-Inadequate protein intake -Increased protein needs -Excessive loss of protein
46
Nitrogen balance cannot be accurately calculated in patients with ____ disease or excessive ____ ____
Renal; exudative losses
47
The goal for critically ill patients is to provide adequate nutrition in order to...
-Slow the loss of LBM -Heal wounds -Fight infection
48
We should avoid overfeeding in order to prevent...
-Hyperglycemia -Excessive CO2 production -Lipogenesis
49
____ ____ is the gold standard for calculating energy requirements
Indirect calorimetry
50
Indirect calorimetry estimates energy expenditure by measurement of ____ consumption and ____ production over a given period of time
O2; CO2
51
Indirect calorimetry uses the ____ formula to estimate energy expenditure from gas exchange data
Weir
52
Candidates for indirect calorimetry include patients with...
-Obesity -Cachexia -TBI; SCI -Burns -Failure to wear from ventilator -Delayed wound healing -Amputations
53
Required conditions for indirect calorimetry:
-Fasting (at least 7 hours) or receiving continuous feeding -After a 30-minute resting period -Relaxed and not moving -Thermoneutral environment
54
What are some clinical situations that decrease the validity of indirect calorimetry?
-Air leak -Physical agitation -Unstable body temperature -Unstable pH -ECMO
55
What equation can predict energy needs for critically ill patients?
Penn State 2010 equation
56
The Modified Penn State 2010 equation can be used for...
Critically ill patients with obesity who are over 60 years
57
We can predict energy needs for critically ill patients with ____-____ kcal/kg estimated dry weight
20-30
58
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
Hypocaloric, high protein
59
A hypocaloric, high-protein diet may possibly reduce ____
Complications
60
For hypocaloric, high-protein feeding, we should provide ____-____% of energy requirements measured by indirect calorimetry
65-70
61
Energy needs for someone with a BMI of 30-50 who is getting a hypocaloric, high protein diet are ____-____ kcal/kg **actual body weight**
11-14
62
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**
22-25
63
If someone with a BMI between 30-39.9 is on hypocaloric, high-protein feeding, their protein needs are:
2.0 g/kg **IBW**
64
If someone with a BMI 40 or more is on hypocaloric, high-protein feeding, their protein needs are:
2.5 g/kg **IBW**
65
Protein requirements for non-obese patients in the ICU:
1.2-2 g/kg
66
Fluid needs in the ICU should be individualized using ___ and ____-based guidelines
Age and weight
67
The goal of fluid needs is to maintain adequate ____ _____
Urine output
68
When determining fluid needs, consider ____ and ____ ____ of fluid
Losses and additional sources
69
Oral nutrition in the ICU may be delayed by...
-Inability to chew or swallow -Altered mental status -Mechanical ventilation -Weakness -Anorexia -GI distress -Sedation
70
For nutrition support in the ICU, ____ nutrition is preferred to ____ nutrition
Enteral; parenteral
71
If parenteral nutrition is ordered, confirm the _____
Indication
72
Nutrition cannot abolish the hypermetabolism and catabolism, but may slow the loss of _____
Protein
73
Without exogenous protein intake, there is decreased...
-Wound healing -Immune function
74
Without exogenous protein intake, there is increased risk of...
-Infections -Pressure injuries -Respiratory insufficiency
75
Enteral nutrition should be started within ___-___ hours of admission to the ICU and advanced toward goal kcal during the next 48-72 hours
24-48
76
If someone is on enteral nutrition, we should elevate head of bed ___-___ degrees to prevent aspiration
30-45
77
We should recommend small bowel enteral feeding for...
-Delayed gastric emptying -Supine position -NG suction -High aspiration risk
78
In the ICU, it is common to use ___ ___, ____ enteral nutrition formulas
High protein, polymeric
79
We may consider use of immune-modulating formulas for patients with...
-TBI -Major surgery -Severe trauma
80
Immune-modulating formulas are not recommended for patients with severe ____
Sepsis
81
We can consider the use of a mixed fiber-containing formula if a patient has persistent _____
Diarrhea
82
We should avoid both soluble and insoluble fiber for patients at high risk for...
-Bowel ischemia -Severe dysmotility
83
When determining energy needs, we need to consider additional kcal sources such as...
-Dextrose in IVF: 3.4 kcal/g -Propofol (Divprivan): 1.1 kcal/mL -Clevidipine: 2 kcal/mL -CVVHD -Multiple sources of nutrition
84
What should be monitored in those in the ICU?
-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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