Nutrition & Severe Stress Flashcards
What are the 4 conditions that result in severe stress?
Surgery
burns
infection
trauma
What is your bodies top priority during times of severe stress?
Survival, any process that is not necessary for survival will come last.
what are the two Cathecolamine hormones that kick into gear during times of severe stress?
epinephrine and norepinephrine
what do cathelcolamines do?
- increase metabolic rate
- release fat from adipose tissue
- triggers secretion of glucagon from the pancreas
what does glucagon do?
initiates breakdown of glycogen, as a result blood glucose levels rise
Protein degradation occurs due to what factor being activated/released?
cortisol
Describe the process that cortisol initiates in the body during times of severe stress?
- protein degradation: muscle wasting, raises amino acid in the blood
- glucose formation from amino acids
What are the side effects of protein degradation (cortisol process)?
- suppresses immune response
- impairs wound healing
Bottom line: What 3 processes occur in our bodies in response to stress?
- glycogenolysis
- gluconeogenesis
- lipolysis
What role doe aldosterone and ADH play in the body during times of severe stress?
Maintain Blood Volume by…
-retention of sodium (aldosterone) and water (ADH)
Define Hypermetabolism
- an increase in metabolic rate
why does Hypermetabolism occur during times of severe stress?
the body need extra energy during this time
what happens to glycogen, fatty acids, and protein during Hypermetabolism?
- glycogen in depleted
- fatty acids are converted into glucose
- protein breaks down ( can lead to respiratory, liver, and kidney failure)
what is the difference between fasting and stress?
Fasting = conserve protein, metabolic decrease Stress = protein breaks down, increase in metabolic rate
What happens when a person is already malnourished before experiencing severe stress?
- more difficult for them to bounce back from the stress
- your nutrition highly determines how you will respond to the stress
- more malnourished = more effected
Define Chronic malnutrition
- depletes fat storage, other are adequate
- seen in 3rd world countries
Define Acute malnutrition
- depletes everything but fat
- seen in agricultural countries during a bad crop year
Define Mixed malnutrition
all are depleted
What is the #1 nutritional element to take care of during stress?
fluid/electrolyte replacement
What is a progressive diet?
-slowly introduces intestines back to normal food
ex:
START w/ clear liquids –> full liquids –> low fiber foods –> regular foods
what is the rule of thumb for caloric increase during a fever?
increase caloric intake by 7% for every degree Fahrenheit above the normal body temperature (98 is normal)
why is it important to use a progressive diet?
if food is introduced to quickly, the risk of regurgitation is high
define intestinal distention
- intestines are shut down
- occurs after trauma
define perforation
intestines swell and burst
what happens as a result of intestinal perforation?
regurgitation of stomach contents in to the lungs
Explain Refeeding Syndrome
- occurs from reintroducing nutrients too rapidly
- sudden increase in metabolic rate triggers electrolyte movement from the blood to the cell (stresses the heart and the lungs)
what are some complications of Refeeding Syndrome?
respiratory distress
congestive heart failure
convulsion
coma
Explain the infection aspect during times of severe stress.
- immune system is compromised and is prone to infection
- pathogens use Fe found in our blood
- to prevent the pathogen from using our Fe, the Liver sequesters Fe (binds Fe) allowing it to be saved for use for our bodies and not be taken up by the pathogen
- HOWEVER, this means that our bodies cant access it during this time either, this could lead to iron-deficiency anemia
on the bright side…
- most doctors let this process run its course
- after infection clears the liver will begin releasing Fe back into the blood and the iron-deficiency anemia is resolved
Why is preoperative nutrition state an individual’s body is in so important (not directly before surgery, think farther out)?
- malnourished preoperative patients have an increase probability of complications
- also surgery is a type of severe stress and malnourished individuals do not respond well under severe stress
Why is it important to be NPO at least 8 hrs before surgery?
- to prevent aspiration/complications
- we need the GI tract to be clear and not moving
What needs to happen as soon as possible after surgery in relation to nutrition?
-replenish fluids and electrolytes
Describe the nutritional care of a Organ transplant patient
- every transplant patient is on immunosuppressive drugs to prevent Host vs. Graft
- because their immune system is suppressed extra precautions need to be taken to assure that they avoid foodborne illness
ex: food, sanitation
Describe a 1st degree burn
- epidermis
- redness, pain
ex: sunburn
describe a 2nd degree burn
- epidermis and part of the dermis
- blister
describe a 3rd degree burn
- aka (Full Thickness Burn)
- entire skin thickness
- charred white or black
- not painful
Why is a Full thickness burn (3rd degree) not painful?
the nerves have been damaged
How do we care for Burns (wounds not patients)?
- remove clothing, smoldering material, chemical agents
- submerge burn and flush with copious amount of water (not recommended for all types of burns)
- clean wound/remove debris
- apply topical agents and sterile dressings
What types of burns do we not submerge the burn in water?
acid and chemical burns
why do we apply topical antibacterial agents and sterile dressings to burns?
to prevent secondary infection (immune system is weakened)
Pseudomonas aeurginosa
- skin normal microflora
- resistant to drugs
Staphylococcus Aureus
-skin normal microflora
clostridium perfringens
- obligate anaerobe
- dangerous for burn patients with covered wounds (this is why it is good to expose the burns to air regularly)
streptococcus pyogenes
- narcotizing fasciitis
- “flesh eating disease”
How do we care for burn patients?
- fluid replacement
- diagnosis of metabolic disturbances
- put on high protein diet for more severe burns (help healing process)
- possible immediate oxygen support/mechanical ventilation
- possible GI support
- PAIN CONTROL
What are the metabolic changes burn victims experience?
- hypermetabolism
- tissue breakdown
- alterations in nutrient metabolism
- loss of evaporative water and body heat
- 2nd and 3rd degree burn victims experience substantial loss of protein and micronutrients
- gastrointestinal function may be disrupted
What are the nutritional requirements for burn patients?
- fluid and electrolyte replacement
- high calorie-high protein diet
- protein recommendation is 2-3g per kg body weight
what is the main objective when thinking about nutritional requirements for burn patients?
Nitrogen or is it Nutrient??? Balance and minimize tissue losses
explain the protective mechanisms of the GI Tract
- Villi provide a physical barrier
- Goblet Cells produce mucus secretion
- peyers patches (lymph)
- IgA (antibody) secretion
What exactly are Peyer’s patches and where are they found?
- part of the lymphatic system
- located in the small intestines
Describe Translocation
-movement of bacteria from the intestines to the tissue
What factors affect translocation?
- reduced blood flow to the intestines
- parenteral nutrition
- malnutrition: impaired immune system
- immunosuppressive drugs
- antibiotics (broad spectrum also kills normal microflora)
What is parenteral nutrition
-vein feed
What is enteral feeding?
delivery of nutrients through the GI tract
Glutamine
- most abundant amino acid in the blood
- fuel for intestinal cells
- nucleotide synthesis
- normally not essential but under stress it becomes and essential amino acid
Short Chain Fatty Acids
- 2 to 4 carbons
- can be produced by GI bacteria
- large intestines
- stimulate intestinal cell growth
- stimulate blood flow
