Review Question and Main Points Related to Metabolic Stress/Thermal Injury/TBI

Question 1

Be able to compare the metabolic response for starvation to the metabolic response to stress: Starvation

Answer 1

Starvation: REE and RQ lower (hypometabolic rate burning fat)
Stress: REE and RQ higher (hypermetabolic rate and burning mixed diet) Increased urinary nitrogen loss and gluconeogenesis (fat stores cannot be utilized to meet energy needs).

Question 2

What are the three phases of metabolic stress?

Answer 2

Ebb phase, Flow phase (acute), and Flow phase (adaptive).

Question 3

Ebb phase

Answer 3

hypovolemic shock (decrease metabolic stress, lasts 2-48 hours, decreased BP, cardiac output and urinary output)

Question 4

Flow phase (acute response)

Answer 4

hypermetabolism and catabolism peak 3-4 days (days/catabolism)

Question 5

Flow phase (Adaptive response)

Answer 5

Anabolism resolves in 9-14 days. decreased hypermetabolic rate (weeks/anabolism)

Question 6

How are energy and protein needs measured?

Answer 6

indirect calorimetry and nitrogen balance studies.

Question 7

What overall changes in metabolism are associated with metabolic stress?

Answer 7

Hyperglycemia, increased protein and energy needs

Question 8

Describe the impact of metabolic stress on nutrient absorption and the GI tract

Answer 8

1) intestinal villi shrink and up to 90% function can be lost 2) decreased gastric motility 3) GI tract compromised

Question 9

Define Therapeutic hypothermia. How is it performed? How does it potentially benefit the patient?

Answer 9

1) Deliberate reduction of the core body temperature to 32-34 degree C or 89.6 - 93.2 degrees F 2) utilize ice packs, cooling blankets and helmets, infusion of cold fluids 3) decreases the rate of cell death, cerebral edema, improves response to defibrillation.

Question 10

Identify three important goals of MNT in the treatment of burn wounds

Answer 10

COP 1) Counteract the effects of the burn metabolic state 2) optimize the immune system 3) promote the healing of the burn wounds.

Question 11

Identify factors which have the greatest influence on the individual’s ability to survive the burn injury. Which two are most important?

Answer 11

1) depth of burn 2) percentage of body surface area (BSA). Others (age, nutritional status, overall health status

Question 12

Superficial Burns

Answer 12

1st degree do not normally require skin grafting and scarring is not common.

Question 13

Superficial partial-thickness burns

Answer 13

2nd degree (blisters, weeping, moist, and painful to air and pressure) heal in 7-20 days. does not normally require skin grafting and scarring is not common

Question 14

Deep Partial-Thickness burns

Answer 14

3rd degree healing greater than 21 days, retain perception of pressure only. Require surgery to excise eschar and skin grafting. Scarring and contracture are a definite risk

Question 15

Full thickness burns

Answer 15

4th degree. Sensation to deep pressure only. (never heal) require surgery to remove eschar and skin grafting. Scarring and contracture are a definite risk.

Question 16

How is percent BSA determined? Why is it important to estimate percent BSA as accurately as possible? How is assessing body surface for infants different for adults?

Answer 16

1) Rule of 9s 2) Fluid, energy, medication, and skin grafting considerations 3) children have different proportions.

Question 17

What is the priority of treatment for the burn patient during the first 24 hours?

Answer 17

1) assessment of the airway and ventilation status 2) fluid/electrolyte resuscitation 3) Maintain vital organ function

Question 18

In the burn patient energy and protein needs are directly proportional to….

Answer 18

the depth of the burn and the percentage BSA burned and decrease as the burn wounds heal.

Question 19

What is the gold standard in determining the level of nutrition to give to the burn patient?

Answer 19

indirect calorimetry

Question 20

Serum albumin in burns

Answer 20

Remains depressed until the burn is healed

Question 21

Protein need assessment in the burn patient

Answer 21

1) nitrogen balance studies 2) adjust for nitrogen loss from the burn area

Question 22

Identify macronutrients which are routinely supplemented for patients with burn injuries to aid in wound healing.

Answer 22

1) Glutamine ( 0.2 - 0.4 g/kg/day) 2) Vitamin C to aid in collagen synthesis/ wound repair 3) Zinc (wound repair and protein metabolism)

Question 23

What is the role of enteral feeding in meeting the patient’s needs

Answer 23

1) patient can’t consume calories 2) preserve lean body mass 3) ileus present.

Question 24

Heat/smoke/toxin inhalation

Answer 24

60-80% of fatalities from burn injuries; cause upper respiratory edema (need to intubate)

Question 25

Silver sulfadiazine cream/Silver nitrate

Answer 25

Treat bacterial/fungal infection

Question 26

Oxandrolone

Answer 26

anabolic steroid promotes protein synthesis in severe burns

Question 27

Debridement

Answer 27

removal of eschar so that wound can close

Question 28

Dermabrasion

Answer 28

minimize the appearance of scars, restore function

Question 29

Skin grafts

Answer 29

autograft (own skin) full thickness (all dermis less scarring; partial dermal layer takes better. allograft (another persons skin)

Question 30

Skin substitutes

Answer 30

synthetic skins temp/promote wound healing

Question 31

xenograft

Answer 31

skin from a different organism

Question 32

Contractures

Answer 32

loss of joint function in people with burns; skin tight as wound heals tx: PT

Question 33

curling ulcer

Answer 33

stress ulcer. Acute gastric erosion

Question 34

TBI

Answer 34

Physical damage to the brain that disrupts its function

Question 35

Brain stem

Answer 35

basic functions breathing, heartbeat, and blood pressure

Question 36

Cerebellum

Answer 36

balance, movement, and posture

Question 37

Cerebrum

Answer 37

Thoughts, actions, and decision making, problem solving, smell, vision.

Question 38

Most common causes of TBI. Who is at risk? What age group?

Answer 38

Falls, motor accidents, violent assaults, sports, Males ( 0 -4 and 15-19)

Question 39

Compartment syndrome D, C, TX

Answer 39

D: Excessive pressure build up in an enclosed space in the body. C: burns, bone fractures TX: fasciotomy

Question 40

Focal damage vs diffuse damage

Answer 40

Focal damage: The point where the head hits an object or where object enters Diffuse: brain moves back and forth in the skull

Question 41

Why are speech and language abilities commonly negatively impacted by a TBI?

Answer 41

Because that region of the brain sits in pockets of the skull that allow for more movement than normal.

Question 42

Describe what happens in Shaken Baby Syndrome

Answer 42

1) baby violently shaken 2) weak neck muscles and large heavy head 3) fragile brain bounces back and forth 4) causes bruising, swelling, and bleeding in the brain

Question 43

What is the glascow coma scale?

Answer 43

Measures the patients level of consciousness and the ability to respond to (ocular, motor, or verbal stimuli). scale 1-15

Question 44

What is the ranchos los amigos scale?

Answer 44

Measures the levels of awareness, cognition, behavior, and interactions with the environment

Question 45

What two features of TBI result in the most fatalities?

Answer 45

Bleeding and edema; lead to seizures, stroke; TX: Reduce pressure, partial lobectomy, or craniectomy

Question 46

Describe how TBI impacts energy and protein needs. What additional considerations exist which often impact the patient’s nutrition?

Answer 46

1) SIRS 2) hypermetabolism, hyperglycemia, lipolysis, if no MNT 15% of body weight loss. 3) 40% increase in caloric intake (determined by indirect calorimetry) 4) Protein (1.5 -2.2 g/kg).