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Advanced Medical Nutrition Therapy > MNT for Neurological Disorders (part 3) > Flashcards

MNT for Neurological Disorders (part 3) Flashcards

1
Q

A ___ ____ ____ is caused by a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain

A

Traumatic brain injury

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2
Q

What groups of people are at the highest risk for traumatic brain injury?

A

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

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3
Q

The ____ ____ ____ evaluates the level of consciousness by response to verbal and painful stimuli

A

Glasgow Coma Scale (GCS)

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4
Q

A GCS score of ___-___ indicates a mild TBI

A

13-15

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5
Q

A GSC score of ___-___ indicates moderate TBI

A

9-12

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6
Q

A GCS of ___-___ indicates severe TBI

A

3-8

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7
Q

____ posture results from damage to one or both corticospinal tracts; in this posture, arms are adducted and flexed, with the wrists and fingers flexed on the chest; the legs are stiffly extended and internally rotated with plantar flexion of the feet

A

Decorticate

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8
Q

_____ posture results from damage to the upper brain stem; in this posture, arms are abducted and extended, with the wrists pronated and the fingers flexed; the legs are stiffly extended, with plantar flexion of the feet

A

Decerebrate

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9
Q

What are two ways to classify TBI?

A

-Open head injury (penetrating trauma) vs closed head injury (blunt trauma)
-Primary vs secondary

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10
Q

____ and ____ are types of bruises

A

Contusions and hematomas

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11
Q

What are examples of types of hematomas?

A

-Epidural hematoma
-Subdural hematoma
-Intracerebral hematoma

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12
Q

Contusions and hematomas are ____ ____ ____

A

Observable brain lesions

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13
Q

Damage caused by contusions and hematomas results from…

A

-Compression against the skull at the point of impact
-Rebound effect (damage to front and back of the brain due to movement of head)

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14
Q

____ are the most common type of TBI

A

Concussions

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15
Q

Concussions are caused by a ____ or ____ to the head or a hit to the body causing the head and brain to move rapidly back and forth

A

Blow or jolt

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16
Q

Concussions create ____ changes in the brain, sometimes stretching and damaging brain cells

A

Chemical

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17
Q

Concussions may cause a brief loss of consciousness for less than ___ hours

A

6

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18
Q

A ____ ____ ____ is an injury to neuronal axons caused by stretching and shearing forces

A

Diffuse axonal injury

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19
Q

A diffuse axonal injury results from…

A

-Acceleration/deceleration
-Rotational injuries

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20
Q

With diffuse axonal injury, ___ ___ may be torn

A

Nerve fibers

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21
Q

Diffuse axonal injuries can range from ____ to ____ to ___

A

Mild to moderate to severe

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22
Q

With diffuse axonal injury, loss of consciousness usually lasts for ___ ___ or more

A

6 hours

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23
Q

Diffuse axonal injury can result in severe ___ and ____ deficits

A

Cognitive and affective

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24
Q

What are some manifestations and complications of TBI?

A

-Metabolic response to stress
-Loss of consciousness
-Altered mental status
-Altered memory, attention, and mood
-Paresis
-Seizures
-Increased intracranial pressure
-Dysphagia
-Visual and hearing impairment
-Aphasia
-Headache
-Dizziness
-Hyperglycemia
-Fluid and electrolyte imbalances
-GI complications

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25
____ ____ ____ is the hypermetabolic, catabolic response to acute injury
Metabolic stress response
26
Tissue injury stimulates the release of...
-Glucagon -Cortisol -Catecholamines -Cytokines -Aldosterone and antidiuretic hormone
27
The net effect of the metabolic stress response is greater availability of substrates for metabolically active tissue via increased glycogenolysis and gluconeogenesis, leading to...
-Muscle catabolism -Lipolysis -Fluid and sodium retention
28
Increased intracranial pressure is caused by...
-Hemorrhage -Cerebral edema
29
Increased intracranial pressure causes secondary brain injury by...
-Compression of tissue -Herniation
30
What types of medications may be used to manage increased intracranial pressure?
-Diuretics -Pentobarbital (powerful sedative)
31
Pentobarbital reduces ____ ____
Cerebral metabolism
32
Side effects of increased intracranial pressure:
-Decreased GI motility -Decreased gastric emptying
33
Management of increased intracranial pressure include...
-Drainage of cerebrospinal fluid -Positioning to increase venous drainage: elevate HOB to 30 degrees (reverse Trendelenburg position) -Fluid restriction
34
Hyperglycemia may be caused by...
-Metabolic stress -Infection -Medication
35
Syndrome of inappropriate antidiuretic hormone causes...
-Fluid retention -Hyponatremia
36
____ ____ caused decreased secretion of antidiuretic hormone (opposite of SIADH)
Diabetes Insipidus
37
Diabetes Insipidus causes...
-Increased urinary output -Dehydration
38
What are two possible GI complications of TBI?
-Stress Ulcers (AKA Cushing ulcer) -Delayed gastric emptying
39
Delayed gastric emptying may be due to...
-Damage to vagus nerve -Meds: pentobarbital, morphine
40
People with TBI are at a high risk for ____
Malnutrition
41
The goals of MNT for people with TBI:
-Lessen catabolism -Prevent malnutrition -Provide nutrition via the best route as soon as possible
42
It is difficult to accurately assess someone's nutrition status in the ____ ____
Acute period
43
Why would it be difficult to assess nutrition status in the acute period?
-May be unable to obtain a diet history -Fluid retention may distort anthropometrics
44
What should be included in the nutrition assessment for someone with a TBI?
-Diagnosis/current medical status -Medical history -Food-drug interactions -Psychosocial history -Nutrition/diet history -Anthropometrics -Nutrition-focused physical exam -Biochemical data -GI function -Intake and output records
45
Food drug interactions for Mannitol (loop diuretic used for cerebral edema):
-Monitor for hypokalemia -Monitor for hypomagnesemia -Monitor for hypovolemia -Monitor for hyperglycemia
46
Food-drug interactions for Barbituates:
-May reduce energy requirements
47
Food-drug interactions for Propofol (10% lipid emulsion):
-Provides 1.1 kcal/mL
48
Food-drug interactions with Phenytoin (Dilantin):
-Decreased absorption if on continuous enteral nutrition -Hold EN for 1-2 hours before and after drug adminstration
49
Energy needs vary widely from ____-____% of predicated REE
100-200%
50
On average, energy requirements are ___-___% of estimated REE
120-160%
51
What factors increase energy needs in someone with TBI?
-Infections -Posturing -Seizures
52
What factors decrease energy needs in someone with TBI?
-Sedatives -Barbituates
53
The highest energy needs are seen in patients with a Glasgow Coma Scale score of ___-___ due to posturing
4-5
54
The lowest energy needs are seen in patients who...
-Have brain death -Are on barbituates or musculoskeletal blockers
55
If someone is in a Pentobarbital coma, their energy needs are ___-___% of their REE
100-120%
56
It is best to use ____ _____ to determine energy requirements
Indirect calorimetry
57
The ideal ____ to estimate energy expenditure for TBI patients has not been established
Equation
58
What calculations are often used to determine someone's energy needs with TBI?
-140% of REE -25-30 kcal/kg (must individualize based on clinical course)
59
We should ensure someone is getting adequate ___-___ ____ to spare protein
Non-protein calories
60
We also need to be careful to avoid ____ patients with TBI
Overfeeding
61
People with TBI have high protein needs due to...
-Catabolism/increased urinary nitrogen excretion -Healing
62
Protein requirements for someone with TBI:
1.5-2.5 g/kg
63
What are some things to consider when determining fluid needs for someone with TBI?
-Increased intracranial pressure -Additional sources of fluid -Sources of fluid loss -Fever -Constipation
64
If someone has syndrome of inappropriate antidiuretic hormone, they would need a fluid ____
Restriction
65
If someone has Diabetes Insipidus, they may need fluid ____
Replacement
66
Exact requirements for micronutrients in someone with a TBI are unknown, but we should provide at least ____% of DRI
100
67
What are some things to consider when determining micronutrient requirements for someone with TBI?
-Wound healing -Food-drug interactions -Losses
68
We should provide nutrition in appropriate form as soon as _____ _____
Hemodynamically stable
69
We should also avoid prolonged _____ status
NPO
70
For those on enteral nutrition, initiate early enteral nutrition within ____-____ hours post-injury
24-48
71
Many patients require enteral nutrition support due to...
-Decreased level of consciousness -Intubation -Severe dysphagia or aspiration risk
72
What are some things to consider when initiating enteral nutrition?
-Short vs long-term feeding -Tube location
73
What are some risks of enteral nutrition?
-Delayed gastric emptying -High risk for aspiration
74
___-___ feeding may be best for those with TBI
Post-pyloric
75
If someone is critically ill, they should have ____ ____ of enteral nutrition
Continuous adminstration
76
People with TBI should also receive a ____ ____ tube feed formula
High protein
77
What may indicate a concentrated tube feed formula?
-Syndrome of inappropriate antidiuretic hormone -Increased intracranial pressure
78
We should consider the use of ___-___ formulas that contain omega-3 fatty acids and extra arginine for patients with TBI
Immune-modulating
79
Patients who are ____ are not suitable for oral intake
Lethargic
80
A ____ evaluation should be done prior to initiation of oral diet
Swallowing
81
When transitioning from tube feeding to oral feeding, consider ___ ___ ___
Cyclic tube feeding
82
Once someone has transitioned to oral intake, we should monitor for...
-Dysphagia -Ability to feed self -GI complaints -Adequacy of intake
83
Considerations for oral intake:
-Nutrient-dense meals and supplements -Small, frequent meals -May need texture alterations and thickened liquids

Advanced Medical Nutrition Therapy (14 decks)

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