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Advanced MNT 2 > Critical Care Part 1 > Flashcards

Critical Care Part 1 Flashcards

1
Q

Who goes to the ICU?

A

respiratory failure
shock, major trauma
MI, CVA, DKA
SIRS/Sepsis
major burns
acute liver failure
transplants
major surgeries

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2
Q

transplants that go to ICU

A

♡
lung
liver
small bowel

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3
Q

major surgeries that go to ICU

A

CABG
AAA repair
thoracic surgery
major abdominal surgery

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4
Q

METABOLIC STRESS RESPONSE

The _______, ______ response to acute injury or disease

Can be caused by=> ____, _____, ____, ____, ____

Magnitude of the response correlates with ______

Metabolic alterations begin at the time of injury and persist until healing is complete

A

hypermetabolic, catabolic

trauma, infection, sepsis, burns, surgery

severity of injury

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5
Q

3 phases of Metabolic stress response

A

Ebb Phase
Flow phase
adaptive response

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6
Q

Ebb Phase of metabolic stress response

when does this phase occur?

during this phase, you will have decreased ______, _______, _______, and ______

you will also have _______, ________, and _____

Also ______ insulin and ______ glucagon secretion

A

2-48 hours after injury

BP, cardiac output, metabolic rate, O2 concumption

hypovolemia, tissue hypoxia, shock

decreased
increased

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7
Q

FLOW PHASE OF METABOLIC STRESS RESPONSE
when does it begin?
how long does it last?

You will get increased/decreased ________, ________, ________, and ______

increased release of ________

increased release of pro wound healing substrates such as ______, ______, _____

A

once hemodynamically stable
several weeks or longer

increases cardiac output, O2 consumption, metabolic rate, and protein catabolism

cytokines

catecholamines, glucagon, cortisol

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8
Q

FLOW PHASE OF METABOLIC STRESS RESPONSE

______ synthesis of positive acute-phase proteins. These protein are for ______, ______, and ______. Examples include _____, _____, ______, and ______

_______ synthesis for negative acute-phase proteins. Examples include _____, ______, _____

A

increased
inflammation, wound healing, coagulation
c-reactive protein, ceruloplasmin, fibronectin, ferritin

decreased
albumin, prealbumin, transferrin

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9
Q

ADAPTIVE RESPONSE PHASE

Hormonal response _____
Metabolic rate _______

________ predominates but can only occur in the presence of ______

A

gradually diminishes
normalizes

Anabolism
adequate nutrition

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10
Q

HORMONAL RESPONSE
Tissue injury causes increased levels of __________ hormones such as _____, ____, _____, ____, ____

A

counterregulatory

glucagon
cortisol
catecholamines
Aldosterone
ADH

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11
Q

Glucagon=> (2)

A

hepatic glycogenolysis

gluconeogenesis

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12
Q

Cortisol=> (3)

A

skeletal muscle catabolism to provide aa for hepatic gluconeogenesis & positive acute phase protein synthesis

glycogenolysis

increased lipolysis

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13
Q

Catecholamines=> (5)

A

glycogenolysis
gluconeogenesis
lipolysis
decrease insulin release
cause temporary insulin resistance

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14
Q

Aldosterone=> (1)

A

increases Na reabsorption by the kidneys

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15
Q

ADH=> (1)

A

increases water reabsorption by the kidneys

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16
Q

cell mediated response involves the release of ______

A

cytokines

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17
Q

examples of cytokines

A

interleukin-1
interleukin-6
tumor necrosis factor (TNF)

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18
Q

When cell mediated response releases cytokines which are ______ proteins.

Released by _____, ____, and _____ in response to tissue damage, infection, or inflammation.

stimulates ______, _______, ________, and ____

A

pro-inflammatory

macrophages, T helper, mast cells

muscle catabolism
gluconeogenesis
hepatic aa uptake & positive acute phase protein synthesis
anorexia

19
Q

what does IL-1 do

A

decrease serum zinc and iron

20
Q

METABOLIC STRESS RESPONSE
CHO Metabolism

________ are depleted quickly

________ glucose production and ________ temporary inhibition of _____ release leads to ______

A

Glycogen stores

Increased
epinephrine’s
insulin
hyperglycemia (“stress diabetes”)

21
Q

METABOLIC STRESS RESPONSE
PRO METABOLISM
__________ leads to ____________

A

LBM catabolism
negative nitrogen balance

22
Q

How LBM catabolism happens
- _____ are oxidized as a source of energy for muscles.
- Provides aa for _______ synthesis

A

BCAA
acute phase protein

23
Q

Rapid loss of LBM occurs due to the effect of ____________, imbalance between ___________, and ___________

A

catabolic hormones and cytokines

energy intake and energy needs

physical immobilization

24
Q

METABOLIC STRESS RESPONSE
LIPID METABOLISM

________ lipolysis of TG stores due to __________

________ circulation of FFA to be oxidized for energy

_______ ketosis than seen in starvation

A

Increased
increased levels of counterregulatory hormones

Increased

Less

25
Q

NET EFFECT OF HORMONAL AND CELL MEDIATED RESPONSE

________ state

________ availability of substrates for metabolically active tissues but ________

______ nitrogen balance

Increased _____, ____, and _____

A

Hypercatabolic

Greater
poor utilization

Negative

blood volume, BP, & edema

26
Q

Metabolic Response to Stress vs. Starvation
In Starvation…
REE _________
counter-regulatory hormones ________
_____ ketosis
_______ gluconeogenisis

A

decreases
do NOT increase
more
decreased (protein spared and fat used)

27
Q

burn consequences include _____, loss of __________, _______

and _______/_______ with large _______

A

pain
water and nutrients
infections

hypermetabolism/catabolism
protein

28
Q

HYDRATION FOR BURNS

During 1st 24-48 hours ____________

volume of fluid needed is based on ____, _____, and ________

after resuscitation consider ______ plus _______

A

fluid & electrolyte replacement

age, wt, & total body surface area (TBSA) burned

maintenance plus losses

29
Q

For Hydration, monitor…
_____
________
_______
________
_________

A

weight
physical signs
serum Na
serum osmolality
I&O records

30
Q

ENERGY NEEDS FOR BURNS

often _____ needs of other injuries
needs increase with _______
REE can almost ______ for severely burned patients
_______ may not be feasible

A

exceeds
size of burn
double
weight gain

31
Q

Best to determine energy needs with _________ conducted ______

common equation for burns is ______ with SF _____

A

indirect calorimetry
weekly

Harris-Benedict Equation (HBE)
1.5

32
Q

PROTEIN NEEDS FOR BURNS

Elevated due to _________, wound healing, losses via wounds & urine

1.5-2.0 g/kg
Provide: _______% kcal from protein

May consider use of supplemental ______

A

gluconeogenesis

1.5-2.0 g/kg
20-25%

arginine

33
Q

Most patients with <___% TBSA burned can meet their needs with an oral diet:
- High kcal & protein diet with oral nutrition supplements

Those with a poor appetite, orally intubated on a vent, or >___% TBSA burned may require tube feeding
- High protein, high kcal formula

A

20

20

34
Q

MICRONUTRIENTS FOR BURNS
________ needs

Rx __________, __________, ___________, and monitor electrolytes

A

increased

MVI with minerals

Vitamin C: 500 – 1000 mg/d

Zinc: 220 mg ZnSO4 (50 mg of elemental zinc)

35
Q

Systemic Inflammatory Response Syndrome (SIRS)

Widespread inflammation resulting from=> (6)

A

infection
severe acute pancreatitis
ischemia
burns
major trauma
hemorrhagic shock

36
Q

SIRS results in the release of _________, __________, and _________

______ and ________ can occur
also can lead to _____ damage and _____

A

cytokines (increase capillary permeability)
proteolytic enzymes
toxic oxygen species

hypotension & hypoperfusion
organ damage and MODS

37
Q

Hypotheses for the Development of SIRS

A

Excessive production of proinflammatory cytokines

Disruption of gut barrier function leading to bacterial translocation

38
Q

Multiple Organ Dysfunction Syndrome (MODS)
stages?

A

primary
secondary
faillure

39
Q

primary MODS

A

caused by direct organ injury

40
Q

secondary MODS

A

SIRS or sepsis

41
Q

MODS failure

A

lungs
kidney
liver
intestines

42
Q

MNT for SIRS & MODS

Increased ____ and ____ to meet increased metabolic demands
- However, avoid ______
- Use _________

Early _____ (unless hemodynamically unstable)

If prolonged small bowel ileus=>_____

A

kcal & protein
overfeeding
indirect calorimetry

EN

PN

43
Q
A

Advanced MNT 2 (17 decks)

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