Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S&P - Nutrition > Critical Illness > Flashcards

Critical Illness Flashcards

1
Q

What are the effects of undernutrition?

A
  1. Ventilation – loss of muscle and hypoxic responses
  2. Liver fatty change, functional decline necrosis, fibrosis
  3. Impaired wound healing
  4. Impaired immunity and gut integrity
  5. Anorexia
  6. Micronutrient deficiency
  7. Depression and apathy
  8. Decreased CO
  9. RENAL function – loss of ability rto excrete na and h2o
  10. Hypothermia
  11. Loss strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is nutrition affected by Metabolic Stress? What happens in the 3 stages?

A

Refers to the physiological effects of severe injury, infection, trauma, critical illness or major surgery.

3 phases of metabolic stress
Ebb Phase = Stress (0-24 hours)
•	↓ Cardiac Output
•	↓ Tissue perfusion
•	↓ Oxygen Consumption
•	↓ REE

Flow Phase = Catabolic (24+ hours)
• ↑ Cytokines
• ↑ Counterregulatory hormones and↑ catecholamines
• ↑ Insulin, – ↑ O2 consumption,↑ REE, – ↑ Catabolism
• Hyperglycemia, + fluid balance, - N balance
• The acute flow phase generally peaks 3 or 4 days after injury. It ends in 7 to 10 days, if no complications have occurred

Repletion Phase = anabolism or adaptive flow phase again:
• Can last for months
• May need up to 130% REE to support tissue repair, repletion, and recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s the aim of Nutrition in Sepsis/ICU?

A

Aiming to support nutritional needs, minimise losses.

Protein losses: 12.5-16% total body protein lost in 10 day ITU stay, 70% of this from skeletal muscle: hampers recovery hugely.

Excess nitrogen: Uraemia and too much stress on kidneys, can exacerbate protein losses!

Excess carbohydrate: doesn’t prevent gluconeogenesis, enhances stress, worsens hyperglycaemia when already insulin resistant with sepsis, do not exceed glucose oxidation rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the Complications Relative to Loss of Lean Body Mass (LBM)?

A

10 % loss total LBM– impaired immunity, inc infection
20 – less healing, weakness infection
30 – too weak to sit, kpa sores, pneumonia, no healing
40 – death, usually from pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which assessments are used in monitoring?

A

• Pre-albumin – is the preferred serum marker for assessing short term nutritional changes in ICU

  • Retinol binding protein: good short term measure of nutrition however renal dysfunction affects the clearance
  • Weights!!
  • Estimating requirements
  • Indirect Calorimetry!!! (Gold Standard)

• ESPEN range from 20-25kcal (kg) or 25-30kcal (kg)
o +- stress factor

• Protein: 1.2-2g(kg) actual body wt/day (SCCM’ 2016)

• Nitrogen: 0.2gn/kg (weight/ideal body weight) (0.25g/kg if on filter, 0.16g/kg if RF and not on filter)
• 30-35ml fluid/kg/24 hours.
o Add 100-200ml/day for each degree of temperature
o Account for excess losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which patients should be fed?

A

All malnourished patients, but especially:
◦ Elderly
◦ Obese
◦ Underweight
◦ Paralysed
All patients who are unlikely to regain normal oral intake within 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is best to feed?

A

The optimal time of when to feed pt on ICU is unknown. It is recommended that in critical ill pts to commence feeding within 24-48 hours if stable.

(ESPEN 2009, SCCM 2016):
Pt undergone surgery, 5 -10 days was reasonable to commence feeding

Feeding within 36 hours post surgery/admission showed:
Decrease in infection/and infectious complications
Decrease in hospital length of stay

Feeding within 24-48 hours showed:
A decreased mortality when compared to delayed nutrient intake
A decrease in infection and infectious complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the routes of feeding?

A

Nasogastric tube
Gastrostomy tube
Nasoduodenal tube
Nasojejunal tubejejunostomy tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does one check correct NGT placement?

A

pH
Chest x-rays and the NPSA
Ryles tubes versus fine bores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are non-feed energy sources?

A

dextrose, propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does underfeeding cause?

A

Cumulative energy & protein deficits result in:
Increased infections
Increased LOS
Increased mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name and explain sources of 5 interal feeding complications?

A

Nausea

  • -> High enteral feed volume
  • -> Medication induced

Vomiting

  • -> GI obstruction / ileus (post-op patients)
  • -> Medication induced
  • -> Delayed gastric emptying

Delayed Gastric Emptying

  • -> Stress of severe illness – nerve damage, elevated icps, increase endogenous levels of endorphins
  • -> Diabetes
  • -> Gastric surgery
  • -> Medications – sedation, paralysis, opioids, inotropes
  • -> Mechanical ventilation

Diarrhoea

  • -> Osmotic overload
  • -> Medications
  • -> Intestinal infection
  • -> Malabsorption – bowel oedema, gut atrophy, pancreatic insufficiency

Constipation

  • -> Insufficient fluid intake
  • -> Decreased intestinal mobility – medications, hypokalaemia or hypomagnesemia
  • -> Ileus / obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which drugs can affect enteral feeds by causing diarrhoea?

A
  • Elixirs - Sorbitol containing
  • Antibiotics
  • Magnesium antacids
  • Laxatives
  • Phosphate supplements
  • Sando K
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens to patients who develop AKI?

A

CRRT/CVV Hemofiltration/CVV Hemodiafiltration may be necessary.

These remove small and middle molecules including Cr, Ur, electrolytes, amino acids, inflammatory cytokines, vitamins and trace elements, Nitrogen & Micronutrients
Patients are left with increased energy requirements (hypothermia associated with RRT), losses with low dextrose dialysate

For pts on RRT: provide 25-30kcals/kg

1.5g Protein/kg dry weight/day (0.25gn), up to 1.7g max to achieve less negative or almost positive balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should we use parenteral feeding?

A

Functioning GI Tract?
Yes - Oral Diet / Supplements OR Enteral Feeding

No - Parenteral Feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is a PN decided?

A
  • Doctors/Surgeon’s/Dietitian decide patient needs it
  • Dietitian sees patient
  • Decides best regime
  • Orders bag from pharmacy
  • Made up aseptically to requirements
  • Start low and build up
  • Monitor bloods, Temp, CBG
17
Q

Describe access for PN?

A

Usually central line in ICU – keep a clean port if PN may be needed.

Short term PN – can have PIC (need a different formula) or PICC

Long-term TPN – tunnelled subclavian catheter (Hickman) or subcutaneous port is usually inserted – OBSERVE STRICT ASEPSIS if handling these lines.

18
Q

Name PN Indications

A
  • Prolonged GI ileus
  • Proximal high output or enterocutaneous fistula
  • Severe acute pancreatitis where EN cannot be established
  • Intractable vomiting
  • Oral mucositis (not so much here)
  • MOF where EN has failed
  • Long term PN (IBD, scleroderma, Short bowel syndrome, chronic malabsorption, radiation enteritis)
19
Q

Describe cons and pros of PN Support?

A

Direct perfusion of nutrients into the circulatory system bypassing the gastrointestinal system

• Pros
o Do not need the gut
o Can provide nutritional needs

•	Cons
o	Line complications:
	Length of insertion
	Pneumothorax
	Catheter blockage
	Central vein thrombosis
	Line sepsis
o	Metabolic:
	Hyperglycaemia
	Lipaemia
	Deranged lfts
o	Fluid overload
o	Electrolyte imbalance
o	Expensive
20
Q

Compare Enteral Vs Parenteral Nutrition?

A

EN:
better prognosis
fewer infectious complications
increased risk of aspiration
lower nutritional intake based on delivery of nutrition issues.
more physiological: nutrients absorbed via the liver (PN, liver is bypassed)
GIT has +++ micro-organisms and toxins, dependent on enteral stimulation by the presence and absorption of food from the lumen for its immunological health and integrity

PN
cholestasis
fat used can be poorly tolerated by liver, hypertriglyceridaemia
deranged lfts
PN not given for constipation which is VERY common on ICU

Enteral Nutrition given unless GIT not functioning/accessible

21
Q

Refeeding Syndrome: What is it?

A

Severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding

Lead to cardiac, respiratory, neuromuscular, hepatic, GI problems
Low K, PO4, Mg, Altered glucose metabolism, fluid balance abnormalities, vitamin deficiencies

22
Q

What could doctors do to ps with refeeding syndrome In icu?

A

Patients at risk are those who have had multiple surgeries, on the ward for a while lingering, (chronic malnutrition) anorexia, alcoholics, chemotherapy patients

What to do: B vitamin back-up, feed slowly, monitor and correct

23
Q

Describe the management of Refeeding Syndrome in detail?

A
  • Check baseline levels of Ca2+, Mg2+, K+ and P04
  • Supplement low levels of electrolytes prior to feeding
  • Pabrinex I+II should be administered 30 minutes before feeding and then daily for a further 9 days
  • As soon as the patient is absorbing enterally, instead of Pabrinex, give Thiamine, Vitamin B Co-Strong, and Multivitamin up to 10 days
  • EN: Commence Jevity at 30mls/hr and continue at this rate and contact Dietitian asap (trust guidelines)
  • PN: Commence 50% of out of hour’s bag over 24 hours and contact the Dietitian asap (trust guidelines)
  • Contact Dietitian

S&P - Nutrition (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions