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Advanced MNT 2 > Critical Care Part 2 > Flashcards

Critical Care Part 2 Flashcards

1
Q

Pulmonary system is no longer able to perform its normal functions is __________

A

Respiratory Failure

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2
Q

Patient in Respiratory failure requires ___________ and may involve mechanical ventilation

Respiratory failure can result from ______ or as a result of acute insult to the lungs

A

supplemental O2
chronic diseases

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3
Q

Pulmonary Disorders
Neuromuscular Disorders
Neurologic injury
Cardiovascular Disorders
Respiratory infection
Inhalation of toxic gases
Drug overdose
SIRS/sepsis
Multiple Organ Dysfunction Syndrome (MODS)

A

causes of respiratory failure

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4
Q

Acute Respiratory Distress Syndrome (ARDS) is ____ onset, life-threatening respiratory failure caused by ______

characterized by severe _______, pulmonary ______, and decreased _________

results in __________

A

Acute
diffuse alveolar injury

hypoxemia
edema
lung compliance

respiratory failure

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5
Q

Acute Respiratory Distress Syndrome (ARDS) starts with ___________ in the lungs=>
___________=>
increased ____________=>
____________________=>
decreased _______________________

A

Tissue damage
inflammation
capillary permeability
fluid build up in the alveoli
transfer of O2 to the bloodstream

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6
Q

Primary damage to lung causing ARDS

A

pneumonia
inhalation injury
near drowning

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7
Q

secondary damage to lung tissue that causes ARDS

A

SIRS
sepsis

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8
Q

Ventilator delivers preset breaths in coordination with the respiratory effort of the patient

A

Assist-Control Ventilation (A/C)

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9
Q

Combination of machine & spontaneous breaths

A

Synchronous Intermittent Mandatory Ventilation (SIMV)

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10
Q

Applies a set positive pressure to a spontaneous inspiratory effort

A

Pressure Support Ventilation (PSV)

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11
Q

Impact of Malnutrition on Respiratory Function in the lung

Decreased respiratory _____, _____, and _____
Reductions in _______
Decreased __________
Decreased _______=> decreased lung compliance
______________=> pulmonary edema

A

muscle mass, strength, & endurance
vital capacity
ventilatory drive
surfactant
Hypoalbuminemia

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12
Q

Impact of Malnutrition on Respiratory Function on whole body

Decreased ____________
Diminished ______________ of blood

Low serum levels of _______________ compromise respiratory muscle function at the cellular level

Prolonged __________

A

immune function
oxygen carrying capacity
Phos, Ca, Mg, & K+
intubation

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13
Q

MNT FOR RESPIRATORY FAILURE

Energy is ____ kcal/kg of ____
provide adequate but not excessive kcal to facilitate _______

Protein is ______ g/kg

Fluid needs are __________

A

25
EDW
weaning

1.5-2.0

individualized

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14
Q

If Mechanical ventilation (orally intubated)=> give __________

If pulmonary edema, use a _____________

Specialty high-fat/low-CHO EN formulas designed to reduce CO2 production are NOT recommended for ICU patients with acute respiratory failure

Monitor _____, _____, ______, ______, _____

A

enteral nutrition

1.5-2.0 kcal/ml EN formula that restricts fluid

Phos, Mg, K+, serum glucose, ABG’s

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15
Q

Surgical opening made in the trachea to assist breathing is a _________. The specific opening is the ________

A

Tracheostomies
stoma

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16
Q

Reasons tracheostomies are needed

A

Bypass an obstruction

Frequent pulmonary suctioning required

Deliver O2 to the lungs for individuals unable to breathe

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17
Q

Patients with tracheostomies may be at increased risk for _______&_________

Prolonged oral intubation can damage the ________ and cause atrophy of the _________ leading to _________

A

dysphagia & aspiration

vocal cords
laryngeal muscles
aspiration

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18
Q

what is ECMO stand for

A

extracorporeal Membrane Oxygenation

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19
Q

Ecmo is used for ?

A

Therapy used for patients whose heart &/or lungs are so damaged that they cannot oxygenate the blood

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20
Q

ECMO is an extracorporeal technique of providing both ______ and _____ support

A

cardiac and respiratory

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21
Q

ECMO is a continuous process where blood is

1) drained from ______ via a ______

2) pushed by an external pump through a _____________ that ___________

3) returned to the circulation through _________

A

a central vein
cannula

“membrane oxygenator”
removes CO2 and adds O2

another cannula

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22
Q

what are the types of ECMO

A

Veno-arterial (VA) ECMO

Veno-venous (VV) ECMO

23
Q

Veno-arterial (VA) ECMO

Primarily used for __________
the _______ bypassed

A

cardiac failure
♡ and lungs

24
Q

Veno-venous (VV) ECMO

used for patients with _____________
bypasses _________
Can provide sufficiency oxygenation for several ______ and allows ____ to heal

A

respiratory failure to improve gas exchange
lungs but ♡ preserved function
weeks
lungs

25
Q

___________ not used for ECMO

A

indirect calorimetry

26
Q

MNT for Patients on ECMO

Assess for ___________

Monitor for ______ deficiency, losses of ___ and ____

A

cardiac cachexia

thiamin
K+
Mg

27
Q

MNT for Patients on ECMO

ENERGY ???
PRO ???

A

ENERGY
25-30 kcal/kg EDW
If BMI >30, 11-14 kcal/kg EDW

PROTEIN
1.2-2.0 g/kg EDW
If BMI>30, >2.0 g/kg IBW

28
Q

MNT for Patients on ECMO

Monitor for _________
____ frequently used
________ formulas are recommended if at risk for hemodynamic instability

Note: severe CHF can lead to hypotension
Individuals who have a mean arterial pressure ____ mmHg are at risk for _______

A

fluid overload
EN
Fiber-free

<50
subclinical gut ischemia

29
Q

Arterial Blood Gases (ABGs) include what

A

Partial Pressure of Oxygen (PaO2)
O2 saturation
pH
PaCO2
HCO3

30
Q

Normal serum pH range: ________

Low pH = ____ concentration of H+, indicating _____

High pH = _____ concentration H+, indicating _______

A

7.35-7.45
high
acidity

low
alkalinity

31
Q

Partial Pressure of Carbon Dioxide (PaCO2)

Normal Range: _____ mmHg

High level => _______ CO2 by the lungs via _____ventilation => ___________

Low level => _______ CO2 via _____ventilation => _______________

A

35-45
retained
hypo
respiratory acidosis

excess expelled
hyper
respiratory alkalosis

32
Q

what is respiratory acidosis

A

blood too acidic bc respiratory problem

33
Q

Bicarbonate (HCO3)

Normal range: _____ mEq/L
High level=>_______
Low level=>_______

A

21-28
alkalinity
acidity

34
Q

what are Buffer systems purpose?
How do they work?

A

regulate acid-base
can absorb excessive H+ or OH- (base)

35
Q

Compensation:

Lungs=>Compensate for changes in pH by increasing or decreasing __________=> elimination or retention of ____

Kidneys=>Compensate by changing _________ excretion and ________ reabsorption & formation

A

alveolar ventilation
CO2

renal H+ ion
bicarbonate

36
Q

Metabolic Acidosis is when pH is ______ with decreased _____

A

<7.35
HCO3

37
Q

Causes of metabolic acidosis:

Increased production of ____
=> from ______ and ______

Decreased _______
=> from _________

Loss of _________=>

A

acids
DKA
lactic acidosis

H+ excretion
renal failure

bicarbonate
diarrhea

38
Q

Clinical Manifestations of Metabolic Acidosis

A

Headache
Lethargy
Deep, rapid respirations (Kussmaul) *****
Anorexia
N/V/D, abd. pain
Severe=> dysrhythmias

39
Q

Treatment of Metabolic Acidosis

________________
if severe ______________

A

Determine the cause of metabolic acidosis

sodium bicarbonate administration

40
Q

Metabolic Alkalosis

pH ______ with increased ______
Usually caused by ______

A

> 7.45
HCO3

41
Q

Metabolic Alkalosis causes

A

Prolonged vomiting
NG suctioning
Diuretics
Excessive bicarbonate intake

42
Q

Clinical Manifestations of Metabolic Alkalosis

A

Weakness
Muscle cramps
Tetany
Slow, shallow respirations
Severe=> confusion, seizures, dysrhythmias

43
Q

Treatment of Metabolic Alkalosis

A

Determine cause
Hypochloremic alkalosis=> IV sodium chloride

44
Q

Respiratory Acidosis

________ pH; increased ___________

Increased ____ retained=> increased production of ___________

Can be acute or chronic

A

Decreased
PaCO2 (hypercapnia)

CO2
carbonic acid

45
Q

Causes of Respiratory Acidosis

A

COPD
Sleep apnea
Asthma
ARDS
Neuromuscular disorders leading to decreased respiratory muscle function
Depression of the respiratory center (brain stem injury, oversedation)
Overfeeding*****

46
Q

Clinical Manifestations of Respiratory Acidosis

A

Lethargy
Anxiety
Sleepiness
Confusion
Muscle twitching & tremors
Coma

47
Q

Treatment of Respiratory Acidosis

Acute=>_____________, _________

Chronic=> ______________

MNT=> avoid ___________; avoid ___________

A

restore adequate alveolar ventilation
may require mechanical ventilation

treat underlying diseases

overfeeding
excessive CHO administration

48
Q

Respiratory Alkalosis

_________ pH; ____________

_____ventilation leading to loss of ____

A

Increased
decreased PaCO2

Hyperventilation
CO2

49
Q

Causes of Respiratory Alkalosis

A

Pulmonary disease
CHF
High altitudes
Anxiety/panic
Pain
Sepsis
Mechanical ventilation

50
Q

Clinical Manifestations of Respiratory Alkalosis

A

Dizziness
Confusion
Paresthesia
Convulsions
Coma

51
Q

Treatment of Respiratory Alkalosis

A

Determine & treat underlying cause
Correct hypoxemia

52
Q

What are the steps to interpreting ABG’s ?

A
  1. is pH WNL, acidic, or basic
  2. is PaCO2 acidic or alkalosis
  3. is HCO3 acidic or alkaline
  4. Determine if the cause of the imbalance is respiratory or metabolic
  5. What may be the cause of the acid-base imbalance? Is there any MNT to address the cause?
53
Q

for step 4. Determine if the cause of the imbalance is respiratory or metabolic. HOW?

A

Check the PaCO2 & the HCO3 to see which one has the same acid-base status as the pH

If PaCO2 follows the pH = respiratory
If HCO3 follows the pH = metabolic

54
Q

PRACTICE

54 yo male admitted to the ICU with cardiac arrest resulting in acute tubular necrosis (ATN)
PMHx: CHF, CHD, HTN
Current GI status: No N/V/D/C

ABG values: pH 7.32; PaCO2: 34 mmHg (normal range: 35-45 mmHg); HCO3: 17 mEq/L (normal range 21-28 mEq/L)

A

idfk

Advanced MNT 2 (17 decks)

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