Critical Care Part 1 Flashcards
Who goes to the ICU?
respiratory failure
shock, major trauma
MI, CVA, DKA
SIRS/Sepsis
major burns
acute liver failure
transplants
major surgeries
transplants that go to ICU
♡
lung
liver
small bowel
major surgeries that go to ICU
CABG
AAA repair
thoracic surgery
major abdominal surgery
METABOLIC STRESS RESPONSE
The _______, ______ response to acute injury or disease
Can be caused by=> ____, _____, ____, ____, ____
Magnitude of the response correlates with ______
Metabolic alterations begin at the time of injury and persist until healing is complete
hypermetabolic, catabolic
trauma, infection, sepsis, burns, surgery
severity of injury
3 phases of Metabolic stress response
Ebb Phase
Flow phase
adaptive response
Ebb Phase of metabolic stress response
when does this phase occur?
during this phase, you will have decreased ______, _______, _______, and ______
you will also have _______, ________, and _____
Also ______ insulin and ______ glucagon secretion
2-48 hours after injury
BP, cardiac output, metabolic rate, O2 concumption
hypovolemia, tissue hypoxia, shock
decreased
increased
FLOW PHASE OF METABOLIC STRESS RESPONSE
when does it begin?
how long does it last?
You will get increased/decreased ________, ________, ________, and ______
increased release of ________
increased release of pro wound healing substrates such as ______, ______, _____
once hemodynamically stable
several weeks or longer
increases cardiac output, O2 consumption, metabolic rate, and protein catabolism
cytokines
catecholamines, glucagon, cortisol
FLOW PHASE OF METABOLIC STRESS RESPONSE
______ synthesis of positive acute-phase proteins. These protein are for ______, ______, and ______. Examples include _____, _____, ______, and ______
_______ synthesis for negative acute-phase proteins. Examples include _____, ______, _____
increased
inflammation, wound healing, coagulation
c-reactive protein, ceruloplasmin, fibronectin, ferritin
decreased
albumin, prealbumin, transferrin
ADAPTIVE RESPONSE PHASE
Hormonal response _____
Metabolic rate _______
________ predominates but can only occur in the presence of ______
gradually diminishes
normalizes
Anabolism
adequate nutrition
HORMONAL RESPONSE
Tissue injury causes increased levels of __________ hormones such as _____, ____, _____, ____, ____
counterregulatory
glucagon
cortisol
catecholamines
Aldosterone
ADH
Glucagon=> (2)
hepatic glycogenolysis
gluconeogenesis
Cortisol=> (3)
skeletal muscle catabolism to provide aa for hepatic gluconeogenesis & positive acute phase protein synthesis
glycogenolysis
increased lipolysis
Catecholamines=> (5)
glycogenolysis
gluconeogenesis
lipolysis
decrease insulin release
cause temporary insulin resistance
Aldosterone=> (1)
increases Na reabsorption by the kidneys
ADH=> (1)
increases water reabsorption by the kidneys
cell mediated response involves the release of ______
cytokines
examples of cytokines
interleukin-1
interleukin-6
tumor necrosis factor (TNF)
When cell mediated response releases cytokines which are ______ proteins.
Released by _____, ____, and _____ in response to tissue damage, infection, or inflammation.
stimulates ______, _______, ________, and ____
pro-inflammatory
macrophages, T helper, mast cells
muscle catabolism
gluconeogenesis
hepatic aa uptake & positive acute phase protein synthesis
anorexia
what does IL-1 do
decrease serum zinc and iron
METABOLIC STRESS RESPONSE
CHO Metabolism
________ are depleted quickly
________ glucose production and ________ temporary inhibition of _____ release leads to ______
Glycogen stores
Increased
epinephrine’s
insulin
hyperglycemia (“stress diabetes”)
METABOLIC STRESS RESPONSE
PRO METABOLISM
__________ leads to ____________
LBM catabolism
negative nitrogen balance
How LBM catabolism happens
- _____ are oxidized as a source of energy for muscles.
- Provides aa for _______ synthesis
BCAA
acute phase protein
Rapid loss of LBM occurs due to the effect of ____________, imbalance between ___________, and ___________
catabolic hormones and cytokines
energy intake and energy needs
physical immobilization
METABOLIC STRESS RESPONSE
LIPID METABOLISM
________ lipolysis of TG stores due to __________
________ circulation of FFA to be oxidized for energy
_______ ketosis than seen in starvation
Increased
increased levels of counterregulatory hormones
Increased
Less
NET EFFECT OF HORMONAL AND CELL MEDIATED RESPONSE
________ state
________ availability of substrates for metabolically active tissues but ________
______ nitrogen balance
Increased _____, ____, and _____
Hypercatabolic
Greater
poor utilization
Negative
blood volume, BP, & edema
Metabolic Response to Stress vs. Starvation
In Starvation…
REE _________
counter-regulatory hormones ________
_____ ketosis
_______ gluconeogenisis
decreases
do NOT increase
more
decreased (protein spared and fat used)
burn consequences include _____, loss of __________, _______
and _______/_______ with large _______
pain
water and nutrients
infections
hypermetabolism/catabolism
protein
HYDRATION FOR BURNS
During 1st 24-48 hours ____________
volume of fluid needed is based on ____, _____, and ________
after resuscitation consider ______ plus _______
fluid & electrolyte replacement
age, wt, & total body surface area (TBSA) burned
maintenance plus losses
For Hydration, monitor…
_____
________
_______
________
_________
weight
physical signs
serum Na
serum osmolality
I&O records
ENERGY NEEDS FOR BURNS
often _____ needs of other injuries
needs increase with _______
REE can almost ______ for severely burned patients
_______ may not be feasible
exceeds
size of burn
double
weight gain
Best to determine energy needs with _________ conducted ______
common equation for burns is ______ with SF _____
indirect calorimetry
weekly
Harris-Benedict Equation (HBE)
1.5
PROTEIN NEEDS FOR BURNS
Elevated due to _________, wound healing, losses via wounds & urine
1.5-2.0 g/kg
Provide: _______% kcal from protein
May consider use of supplemental ______
gluconeogenesis
1.5-2.0 g/kg
20-25%
arginine
Most patients with <___% TBSA burned can meet their needs with an oral diet:
- High kcal & protein diet with oral nutrition supplements
Those with a poor appetite, orally intubated on a vent, or >___% TBSA burned may require tube feeding
- High protein, high kcal formula
20
20
MICRONUTRIENTS FOR BURNS
________ needs
Rx __________, __________, ___________, and monitor electrolytes
increased
MVI with minerals
Vitamin C: 500 – 1000 mg/d
Zinc: 220 mg ZnSO4 (50 mg of elemental zinc)
Systemic Inflammatory Response Syndrome (SIRS)
Widespread inflammation resulting from=> (6)
infection
severe acute pancreatitis
ischemia
burns
major trauma
hemorrhagic shock
SIRS results in the release of _________, __________, and _________
______ and ________ can occur
also can lead to _____ damage and _____
cytokines (increase capillary permeability)
proteolytic enzymes
toxic oxygen species
hypotension & hypoperfusion
organ damage and MODS
Hypotheses for the Development of SIRS
Excessive production of proinflammatory cytokines
Disruption of gut barrier function leading to bacterial translocation
Multiple Organ Dysfunction Syndrome (MODS)
stages?
primary
secondary
faillure
primary MODS
caused by direct organ injury
secondary MODS
SIRS or sepsis
MODS failure
lungs
kidney
liver
intestines
MNT for SIRS & MODS
Increased ____ and ____ to meet increased metabolic demands
- However, avoid ______
- Use _________
Early _____ (unless hemodynamically unstable)
If prolonged small bowel ileus=>_____
kcal & protein
overfeeding
indirect calorimetry
EN
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