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Advanced MNT 1 > Neurologic Disorders Part 3 > Flashcards

Neurologic Disorders Part 3 Flashcards

1
Q

spinal cord injury is impaired _____________________ due to permanently damaged areas of the spinal cord

A

nerve impulse transmission

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2
Q

incomplete vs complete spinal cord injury

A

INCOMPLETE:
permits some voluntary movement below injury

COMPLETE:
no motor activity or sensation below the level of injury
(paraplegia and tetraplegia)

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3
Q

paralysis of only the lower extremities

A

paraplegia

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4
Q

paralysis of all 4 extremities

A

tetraplegia

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5
Q

cervical nerves control

A

head and neck
diaphragm
deltoids, biceps
wrist
triceps
hand
some chest muscles

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6
Q

thoracic nerves control

A

most chest muscles
abdominal muscles
leg muscles

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7
Q

lumbar nerves control
sacral nerves

A

bowel
bladder
sexual function

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8
Q

acute phase of spinal cord injury is first _______
acute consists of an initial ________ which results in _______

can result in a possible __________

________ state can cause dramatic _____ and loss of ____

can experience ________ but this resolves within ____

dysphagia can occur with SCI of ______

A

4 weeks
spinal shock
severe hypotension

respiratory failure

hypercatabolic
wt loss
LBM

paralytic ileus
72 hours

cervical

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9
Q

effect of weight after initial SCI ?
long term ?

A

severe wt loss and loss of LBM

wt gain due to less LBM and physical inactivity

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10
Q

for IBW use _____ subtracted for paraplegia
and _____ subtracted for tetraplegia

A

5-10%

10-15%

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11
Q

Nutritional concerns with SCI include…

Inability to _______________, which can lead to __________

GI PROBLEMS
Neurogenic bowel=> __________
Neurogenic bladder, ______, _________

________ which Increases risk for _____

___________ and ________

Skin breakdown=> __________

A

obtain food, prepare food, feed self
Malnutrition

constipation
UTI
nephrolithiasis

obesity
CVD

Osteopenia & osteoporosis

pressure injury

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12
Q

acute phase of SCI

_________ is recommended for energy needs
calculation ?
____ kcal/kg

Protein = ____ g/kg IBW

may need enteral nutrition due to intubation
- initiate within _____ hours of admission to ICU

if prolonged small bowel ileum post injury, give ___________

A

indirect calorimetry
REE x AF (1.1) x SF (1.2)
25

2.0

24-48

parenteral nutrition

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13
Q

REHABILITATION PHASE OF SCI

energy for paraplegia = _____ kcal/g
energy for tetraplegia = _____ kcal/kg

protein = _____ g/kg (no pressure injuries or infection)

fluid = _______
elevated fluid needs to prevent _______ and ______

A

28
23

0.8-1.0

30-40 ml/kg
kidney stones
constipation

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14
Q

in rehabilitation phase of SCI…

should get oral nutrition with _______, _____________, and adequate fluid.

________ for CVD prevention
_________ to promote healthy body wt
may need ____________ for eating

A

HBV protein
soluble and insoluble fiber

♡ healthy diet
adequate energy
adaptive devices

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15
Q

If SCI patient has neurogenic bowel

fiber of _____

fluid of _____

A

15 g/d with gradual increase if tolerated

1 ml/kcal + 500 ml/day
OR
40 ml/kg BW + 500 mL/day

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16
Q

A blow or jolt to the head or a penetrating head injury that disrupts the function of the brain

A

Traumatic Brain Injury (TBI)

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17
Q

Persons at Higher Risk for TBI

A

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

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18
Q

Evaluates the level of consciousness by response to verbal & painful stimuli

what score is mild, moderate and severe

A

Glasgow Coma Scale (GCS)

MILD
13-15

MODERATE
9-12

SEVERE
3-8

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19
Q

decerebrate

A

arms extended out and away as well as legs

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20
Q

decorticate

A

arms curled in towards chest

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21
Q

Classification of TBI

A

Open head injury (penetrating trauma) vs. Closed head injury (CHI) (blunt trauma)

Primary vs. Secondary

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22
Q

Characterized by damaged capillaries causing bleeding and edema around damage tissues

Damage results from force of impact

A

Contusions & Hematomas

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23
Q

Most common type of TBI?

cause?

result?

A

Concussions

a blow or jolt to head causing the head and brain to move rapidly back and forth

creates chemical changes in the brain and sometimes stretching and damaging brain cells

brief loss of consciousness <6 hours

24
Q

Injury to neuronal axons caused by stretching & shearing forces (______ can be torn)

results from ?

LOC usually lasts _____

can result in severe ____ and ______ deficits

A

Diffuse Axonal Injury (DAI)
nerve fibers

acceleration/deceleration or rotational injuries

≥6 hours

cognitive and affective

25
Q

The brain has a _______, ________ response to acute injury

Tissue injury stimulates the release of:
1. ___________ such as _______, _______, and _______
2. ________
3. ________

Net effect=> _______ availability of substrates for metabolically active tissues via________ glycogenolysis, gluconeogenesis, muscle catabolism; lipolysis; fluid & Na ______

A

hypermetabolic, catabolic

  1. Counterregulatory hormones=>
    - glucagon
    - cortisol
    - catecholamines
  2. Cytokines
  3. Aldosterone & ADH

Greater
increased
retention

26
Q

Increased Intracranial Pressure (ICP)

Caused by ______ or ______

Causes secondary brain injury=>_______

A

hemorrhage
cerebral edema

compression of tissue, herniation

27
Q

medication for increased ICP

what do they do ?
side effects ?

A

diuretica
pentobarbital

reduce cerebral metabolism
decrease GI motility and gastric emtying

28
Q

non medication ways to manage increased ICP

A

drainage of CSF

position to increase venous draining
- HOB to 30 degrees (reverse trendelenburg position)

fluid restriction

29
Q

hyperglycemia can be caused by _____, ______, or _______ after a brain injury

A

metabolic stress

infection

diuretics

30
Q

Examples of two things that can affect fluid and electrolyte balances after brain injury

A

SIADH (syndrome of inappropriate antidiuretic hormone)

diabetes Insipidus (decreased secretion of ADH)

31
Q

SIADH (syndrome of inappropriate antidiuretic hormone)
can result in _______ and ________

A

fluid retention
hyponatremia

32
Q

diabetes Insipidus can result in __________ and ______

A

increased urinary output
dehydration

33
Q

GI complications of brain injury
___________
___________ due to ________

A

stress ulcers (AKA Cushing ulcers)

delayed gastric emptying due to
- damage to vagus nerve

34
Q

medication for delayed gastric emptying after brain injury

A

pentobarbital
narcotics

35
Q

people with brain injury are at high risk for _________ and it is difficult to accurately assess nutrition status in acute period. how come?

A

malnutrition

fluid retention may distort anthropometrics

36
Q

Food drug interactions

Mannitol=> monitor for
_______
_______
______
_______

A

hypokalemia
hypomagnesemia
hypovolemia
hyperglycemia

37
Q

Food drug interactions

Barbiturates=>_______

A

may reduce energy requirements

38
Q

Food drug interactions

Propofol (10% lipid emulsion)=>________

A

provides 1.1 kcal/ml

39
Q

Food drug interactions

Phenytoin (Dilantin)=> ________

A

decreased absorption if on continuous enteral nutrition (EN)

Hold EN for 1-2 hrs before & after drug administration

40
Q

brain injury Energy Needs vary widely:
_______ of predicted REE

Average: ______ of estimated REE

A

100-200%

120-160%

41
Q

Determinants of energy expenditure:
__________

Factors that increase needs: ________

Factors that decrease needs: _______

A

Severity of TBI

infections, posturing, seizures

sedatives, barbiturates

42
Q

Highest needs for => ____________

Lowest needs for =>_____________ and ____________

Pentobarbital coma=>___________

A

GCS 4-5: posturing

Brain death
patients on barbiturates or musculoskeletal blockers

100-120% REE

43
Q

Use indirect calorimetry for TBI patients

Ideal equation to estimate energy expenditure for TBI patients?

______ of REE or ______ kcal/kg are often used, but must individualize based on clinical course

Adequate _____________- to spare protein
Avoid ____________

A

has not been established

140%
25-30

non-protein calories (NPC)
overfeeding

44
Q

Protein needs for TBI patients higher due to
___________ and __________

________ g/kg

A

Catabolism/increased urinary nitrogen excretion
Healing

1.5-2.5

45
Q

Considerations for fluid for TBI=>
increased _____
additional _______
sources of _______
_____
_________

SIADH=> ________

Diabetes insipidus=> _________

A

ICP
sources of fluid
fluid loss
fever
constipation

fluid restriction

fluid replacement

46
Q

Exact requirements of micronutrients unknown for TBI

Provide at least ______ DRI’s

Considerations=>
__________, ________, and ______

A

100%

wound healing
food-drug interactions
losses

47
Q

Goals of MNT for Patients with TBI

A

Lessen catabolism
Provide nutrition via the best route ASAP
Prevent malnutrition

48
Q

Provide nutrition in appropriate form ASAP

Initiate as soon as _____________

Avoid prolonged _______

For those who require EN, initiate within _____ hours postinjury

A

hemodynamically stable

NPO status

24-48

49
Q

Many patients require enteral nutrition support due to…
1. ________
2. ________
3. _______ or ______

A

decreased LOC
intubation
severe dysphagia or aspiration risk

50
Q

Considerations for enteral nutrition => ________ and ________

A

short vs. long term feeding
tube location

51
Q

Risks of enteral nutrition
________ and _______

what location may be best?

A

delayed gastric emptying
high risk of aspiration

Post-pyloric feeding

52
Q

For Enteral nutrition…

Provide a high _______ formula
If critically ill=> ___________
May need a concentrated formula=> ______ or ______

Consider use of _________ containing __________

A

nitrogen
continuous administration
SIADH or increased ICP

immune-modulating formula
- containing omega-3 fatty acids and extra arginine

53
Q

Transitioning to Oral Feeding Considerations:

Patients who are _______ are not suitable for oral intake
_______________ prior to initiation of oral diet
When transitioning, consider __________

A

lethargic
Swallowing evaluation
cyclic tube feeding

54
Q

To improve nutritional intake…

  1. provide __________
  2. ____________ feedings
  3. ______ if needed
  4. May need____________
A

nutrient dense meals
small frequent feedings
ONS
texture alterations & thickened liquids

55
Q

Once on oral intake Monitor for:

A

Dysphagia
Ability to feed self
GI complaints
Adequacy of intake

56
Q

YAY

A

YOU DONT SUCK!!!!!!

Advanced MNT 1 (20 decks)

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