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Advanced Medical Nutrition Therapy > MNT for Neurological Disorders (part 3) > Flashcards

MNT for Neurological Disorders (part 3) Flashcards

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USMLE® Step 1 flashcards
1
Q

A ___ ____ ____ is caused by a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain

A

Traumatic brain injury

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2
Q

What groups of people are at the highest risk for traumatic brain injury?

A

-Infants/children: 0-4 years
-Elderly individuals
-Teenagers: 15-19 years
-Military personnel
-People who experience homelessness
-People who are in correctional and intentional facilities
-Survivors of intimate partner violence

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3
Q

The ____ ____ ____ evaluates the level of consciousness by response to verbal and painful stimuli

A

Glasgow Coma Scale (GCS)

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4
Q

A GCS score of ___-___ indicates a mild TBI

A

13-15

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5
Q

A GSC score of ___-___ indicates moderate TBI

A

9-12

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6
Q

A GCS of ___-___ indicates severe TBI

A

3-8

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7
Q

____ posture results from damage to one or both corticospinal tracts; in this posture, arms are adducted and flexed, with the wrists and fingers flexed on the chest; the legs are stiffly extended and internally rotated with plantar flexion of the feet

A

Decorticate

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8
Q

_____ posture results from damage to the upper brain stem; in this posture, arms are abducted and extended, with the wrists pronated and the fingers flexed; the legs are stiffly extended, with plantar flexion of the feet

A

Decerebrate

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9
Q

What are two ways to classify TBI?

A

-Open head injury (penetrating trauma) vs closed head injury (blunt trauma)
-Primary vs secondary

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10
Q

____ and ____ are types of bruises

A

Contusions and hematomas

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11
Q

What are examples of types of hematomas?

A

-Epidural hematoma
-Subdural hematoma
-Intracerebral hematoma

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12
Q

Contusions and hematomas are ____ ____ ____

A

Observable brain lesions

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13
Q

Damage caused by contusions and hematomas results from…

A

-Compression against the skull at the point of impact
-Rebound effect (damage to front and back of the brain due to movement of head)

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14
Q

____ are the most common type of TBI

A

Concussions

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15
Q

Concussions are caused by a ____ or ____ to the head or a hit to the body causing the head and brain to move rapidly back and forth

A

Blow or jolt

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16
Q

Concussions create ____ changes in the brain, sometimes stretching and damaging brain cells

A

Chemical

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17
Q

Concussions may cause a brief loss of consciousness for less than ___ hours

A

6

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18
Q

A ____ ____ ____ is an injury to neuronal axons caused by stretching and shearing forces

A

Diffuse axonal injury

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19
Q

A diffuse axonal injury results from…

A

-Acceleration/deceleration
-Rotational injuries

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20
Q

With diffuse axonal injury, ___ ___ may be torn

A

Nerve fibers

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21
Q

Diffuse axonal injuries can range from ____ to ____ to ___

A

Mild to moderate to severe

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22
Q

With diffuse axonal injury, loss of consciousness usually lasts for ___ ___ or more

A

6 hours

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23
Q

Diffuse axonal injury can result in severe ___ and ____ deficits

A

Cognitive and affective

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24
Q

What are some manifestations and complications of TBI?

A

-Metabolic response to stress
-Loss of consciousness
-Altered mental status
-Altered memory, attention, and mood
-Paresis
-Seizures
-Increased intracranial pressure
-Dysphagia
-Visual and hearing impairment
-Aphasia
-Headache
-Dizziness
-Hyperglycemia
-Fluid and electrolyte imbalances
-GI complications

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25
Q

____ ____ ____ is the hypermetabolic, catabolic response to acute injury

A

Metabolic stress response

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26
Q

Tissue injury stimulates the release of…

A

-Glucagon
-Cortisol
-Catecholamines
-Cytokines
-Aldosterone and antidiuretic hormone

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27
Q

The net effect of the metabolic stress response is greater availability of substrates for metabolically active tissue via increased glycogenolysis and gluconeogenesis, leading to…

A

-Muscle catabolism
-Lipolysis
-Fluid and sodium retention

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28
Q

Increased intracranial pressure is caused by…

A

-Hemorrhage
-Cerebral edema

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29
Q

Increased intracranial pressure causes secondary brain injury by…

A

-Compression of tissue
-Herniation

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30
Q

What types of medications may be used to manage increased intracranial pressure?

A

-Diuretics
-Pentobarbital (powerful sedative)

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31
Q

Pentobarbital reduces ____ ____

A

Cerebral metabolism

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32
Q

Side effects of increased intracranial pressure:

A

-Decreased GI motility
-Decreased gastric emptying

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33
Q

Management of increased intracranial pressure include…

A

-Drainage of cerebrospinal fluid
-Positioning to increase venous drainage: elevate HOB to 30 degrees (reverse Trendelenburg position)
-Fluid restriction

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34
Q

Hyperglycemia may be caused by…

A

-Metabolic stress
-Infection
-Medication

35
Q

Syndrome of inappropriate antidiuretic hormone causes…

A

-Fluid retention
-Hyponatremia

36
Q

____ ____ caused decreased secretion of antidiuretic hormone (opposite of SIADH)

A

Diabetes Insipidus

37
Q

Diabetes Insipidus causes…

A

-Increased urinary output
-Dehydration

38
Q

What are two possible GI complications of TBI?

A

-Stress Ulcers (AKA Cushing ulcer)
-Delayed gastric emptying

39
Q

Delayed gastric emptying may be due to…

A

-Damage to vagus nerve
-Meds: pentobarbital, morphine

40
Q

People with TBI are at a high risk for ____

A

Malnutrition

41
Q

The goals of MNT for people with TBI:

A

-Lessen catabolism
-Prevent malnutrition
-Provide nutrition via the best route as soon as possible

42
Q

It is difficult to accurately assess someone’s nutrition status in the ____ ____

A

Acute period

43
Q

Why would it be difficult to assess nutrition status in the acute period?

A

-May be unable to obtain a diet history
-Fluid retention may distort anthropometrics

44
Q

What should be included in the nutrition assessment for someone with a TBI?

A

-Diagnosis/current medical status
-Medical history
-Food-drug interactions
-Psychosocial history
-Nutrition/diet history
-Anthropometrics
-Nutrition-focused physical exam
-Biochemical data
-GI function
-Intake and output records

45
Q

Food drug interactions for Mannitol (loop diuretic used for cerebral edema):

A

-Monitor for hypokalemia
-Monitor for hypomagnesemia
-Monitor for hypovolemia
-Monitor for hyperglycemia

46
Q

Food-drug interactions for Barbituates:

A

-May reduce energy requirements

47
Q

Food-drug interactions for Propofol (10% lipid emulsion):

A

-Provides 1.1 kcal/mL

48
Q

Food-drug interactions with Phenytoin (Dilantin):

A

-Decreased absorption if on continuous enteral nutrition
-Hold EN for 1-2 hours before and after drug adminstration

49
Q

Energy needs vary widely from ____-____% of predicated REE

A

100-200%

50
Q

On average, energy requirements are ___-___% of estimated REE

A

120-160%

51
Q

What factors increase energy needs in someone with TBI?

A

-Infections
-Posturing
-Seizures

52
Q

What factors decrease energy needs in someone with TBI?

A

-Sedatives
-Barbituates

53
Q

The highest energy needs are seen in patients with a Glasgow Coma Scale score of ___-___ due to posturing

A

4-5

54
Q

The lowest energy needs are seen in patients who…

A

-Have brain death
-Are on barbituates or musculoskeletal blockers

55
Q

If someone is in a Pentobarbital coma, their energy needs are ___-___% of their REE

A

100-120%

56
Q

It is best to use ____ _____ to determine energy requirements

A

Indirect calorimetry

57
Q

The ideal ____ to estimate energy expenditure for TBI patients has not been established

A

Equation

58
Q

What calculations are often used to determine someone’s energy needs with TBI?

A

-140% of REE
-25-30 kcal/kg
(must individualize based on clinical course)

59
Q

We should ensure someone is getting adequate ___-___ ____ to spare protein

A

Non-protein calories

60
Q

We also need to be careful to avoid ____ patients with TBI

A

Overfeeding

61
Q

People with TBI have high protein needs due to…

A

-Catabolism/increased urinary nitrogen excretion
-Healing

62
Q

Protein requirements for someone with TBI:

A

1.5-2.5 g/kg

63
Q

What are some things to consider when determining fluid needs for someone with TBI?

A

-Increased intracranial pressure
-Additional sources of fluid
-Sources of fluid loss
-Fever
-Constipation

64
Q

If someone has syndrome of inappropriate antidiuretic hormone, they would need a fluid ____

A

Restriction

65
Q

If someone has Diabetes Insipidus, they may need fluid ____

A

Replacement

66
Q

Exact requirements for micronutrients in someone with a TBI are unknown, but we should provide at least ____% of DRI

A

100

67
Q

What are some things to consider when determining micronutrient requirements for someone with TBI?

A

-Wound healing
-Food-drug interactions
-Losses

68
Q

We should provide nutrition in appropriate form as soon as _____ _____

A

Hemodynamically stable

69
Q

We should also avoid prolonged _____ status

A

NPO

70
Q

For those on enteral nutrition, initiate early enteral nutrition within ____-____ hours post-injury

A

24-48

71
Q

Many patients require enteral nutrition support due to…

A

-Decreased level of consciousness
-Intubation
-Severe dysphagia or aspiration risk

72
Q

What are some things to consider when initiating enteral nutrition?

A

-Short vs long-term feeding
-Tube location

73
Q

What are some risks of enteral nutrition?

A

-Delayed gastric emptying
-High risk for aspiration

74
Q

___-___ feeding may be best for those with TBI

A

Post-pyloric

75
Q

If someone is critically ill, they should have ____ ____ of enteral nutrition

A

Continuous adminstration

76
Q

People with TBI should also receive a ____ ____ tube feed formula

A

High protein

77
Q

What may indicate a concentrated tube feed formula?

A

-Syndrome of inappropriate antidiuretic hormone
-Increased intracranial pressure

78
Q

We should consider the use of ___-___ formulas that contain omega-3 fatty acids and extra arginine for patients with TBI

A

Immune-modulating

79
Q

Patients who are ____ are not suitable for oral intake

A

Lethargic

80
Q

A ____ evaluation should be done prior to initiation of oral diet

A

Swallowing

81
Q

When transitioning from tube feeding to oral feeding, consider ___ ___ ___

A

Cyclic tube feeding

82
Q

Once someone has transitioned to oral intake, we should monitor for…

A

-Dysphagia
-Ability to feed self
-GI complaints
-Adequacy of intake

83
Q

Considerations for oral intake:

A

-Nutrient-dense meals and supplements
-Small, frequent meals
-May need texture alterations and thickened liquids

Advanced Medical Nutrition Therapy (14 decks)

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