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132 Cards in this Set
- Front
- Back
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Match the energy factor needed for each:
-Sepsis: -Cancer: -Fever: -20-40% burns: -Elective surgery: |
-1.2-1.4
-1.1-1.45 -1.2 -1.5-1.85 -1-1.2 |
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With _____ there are hormonal and metabolic changes.
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metabolic stress
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_____ Subdue immune system’s ability to protect the body
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metabolic stress
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_____ is if impaired nutritional status accompanies metabolic stress
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further depressed
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Within your ______ a deadly cycle can develop
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immune system
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When you can have a deadly cycle in your immune:
-______ leads to increased risk of disease -______ impairs nutritional status Compromised _____ further impairs immunity |
Impaired immunity
Disease nutritional status |
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Immune system recovery requires that ______
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the deadly cylce be broken
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Serious problems with malnutrition and infections: (4)
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-severe medical problems
-major metabolic stress -disease state |
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Diseased states that deal with the role of nutrition cause:
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-metabolic stress
-decreased nutrient intake -nutrient malabsorption |
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Poor nutritional intakes result of _______
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socioeconomic conditions
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Compromised nutritional status creates a ______
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vulnerable immune system
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It is difficult to mount both a ______ an _____ when confronted with a metabolic stress
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stress response & immune response
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Specific nutrient factor results in symptoms when patient is ______
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malnourished
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It is difficult to determine a comprised nurtritional status because overlapping nutrient deficiencies combined with illness and are accompanied by weakness, anorexia, and infection
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illness
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Immune system components affected by malnutrition: (7)
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Mucous membrane, Skin, Gastrointestinal tract, T-lymphocytes, Macrophages, Granulocytes, Antibodies
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With malnutrition, microvilli become flat and _____ & _____
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Reduces nutrient absorption
Decreases antibody secretions |
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With malnutrition, skin integrity may be compromised and it ______ & _______
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It loses density
Wound healing is slowed |
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With malnutrition, it causes injury to the gastrointestinal tract, it may incease the risk for infection-causing bacteria that ____
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spread from the inside tract to the intestinal system
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With malnutrition, distribution of _____ is depressed
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T-lymphocytes
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With malnutrition, Macrophages and granulocytes take more time to:
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phagocytosis, kill them
lymphocyte activiation |
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With malnutrition, antibodies may be less avaiable due to damage to the ____
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antibody response
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Metabolic changes take place throughout the body in:
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Uncomplicated stress (altered food intake or altered physical activity)
Multifarious stress (trauma or diseases) |
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Inadequate food intake and nourishment
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Starvation
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Occurs when your nutrient intake is below metabolic needs
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Starvation
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In this state body extracts stored carbohydrate, fat, and protein (from muscles and organs) to meet energy demands
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Starvation
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Used to maintain normal blood glucose levels
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Early starvation
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In early starvation, Glycogen stores usually depleted after _____ hours
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8 to 12
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In early starvation as liver glycogen decreases free fatty acids mobilized from _____ to provide energy for nervous system
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adipose tissue
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In early starvation, brain cells use mainly _____ for energy
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glucose
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In early starvation, brain uses glucose produced from _____
(Gluconeogenesis) |
muscle protein
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Sources of amino acids: (6)
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Lean body mass
Heart muscle Enzymes Hormones Immune system components Blood proteins |
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In late starvation, muscle protein is still being _____ at a much lower rate, using more ____ for energy
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catabolized
fat |
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In late starvation _______ produced from fatty acids
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ketone bodies
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Additional defense mechanism for late starvation of the body to conserve ________
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energy
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Late starvation slows metabolic rate by:
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-body temperature drops
-activity level decreases -sleep periods increase |
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In late starvation, if starvation contiunes to occur ________ necessary for respiration are lost. Which can lead to _____ & ______
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Intercostal muscles
pneumonia & respiratory failure |
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Late starvation will continue until _____ are exhausted
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adipose stores
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With both ______ & _____, bodies reaction is the same for both as it is durign starvation with some changes/differences
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accidental and necessary stress
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With severe stress, body's metabloic rate _____ profoundly.
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rises (Hypermetabolic)
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With severe stress, the body's response to stress is summarized by two phases:
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1. Ebb phase
2. Flow phase |
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The Ebb _____ phase begins immediately after injury.
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early
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Ebb early phase is indentified by:
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-decreased oxygen consumption
-Hypothermia -Lethargy |
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Major medical concern of Ebb phase is ______
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maintain cardiovascular effectiveness and tissue perfusion
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As the body responds to injury, Ebb phase evolves into ______
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flow phase
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Flow phase usually evloves about _____ hours after injury
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36-48
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Flow phase is characterized by: (4)
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Increased oxygen consumption
Hyperthermia Increased nitrogen excretion Expedited catabolism of carbohydrate, protein, and triglycerides |
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Flow phase will last for ____
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days, weeks, or months until injury is healed
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Protein requirements for moderate metabolic stress:
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0.8 to 1.5 g/kg body weight
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Protein requirements for severe metabolic stress:
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1.5 to 2 g/kg body weight
(ex. thermal injuries exceeding 20% total body surface area) |
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Vitamin and mineral requirements increase during _____
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stress
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Tissue repair from stress especially depends on adequate intakes
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Vitamin C
Zinc Calcium Magnesium Manganese Copper |
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Nutrients should be consumed, preferably from ______rather than from _______
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foods
vitamin or mineral supplements |
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Energy needs often determined by formulas :
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Basal energy
Activity level Severity of injury |
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Fluid need during hypermetabolic stress based on age:
-Adults <55 years -Adults ages 55 to 75 years -Adults >age 75 |
A-dults <55 years
35 to 40 mL/kg body weight -Adults ages 55 to 75 years 30 mL/kg body weight -Adults >age 75 25 mL/kg body weight |
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Protein (skeletal muscle) is mobilized for energy
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-Even if adequate carbohydrate and fat are available
-Decreased uptake of amino acids by muscle tissue -Increased urinary excretion of nitrogen -Glutamine mobilized in large quantities from skeletal muscle and lung |
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Glutamine mobilized in large quantities from skeletal muscle and lung is used directly as a fuel source by _______
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intestinal cells
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Glutamine mobilized in large quantities from skeletal muscle and lung play a significant role in maintaining _______
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intestinal immune function
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Glutamine mobilized in large quantities from skeletal muscle and lung supports ____, _______, and ______
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-lymphocyte
-macrophages proliferation -fibroblast function |
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Glutamine sources include:
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Beef
Chicken Fish Eggs Diary |
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For glutamine sources, a typical dietary intake for dairy is _____
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1-6g
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External products such as _____ can be used for Glutamine sources.
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Juven
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therapeutic nutrition; meant to help build and maintain lean body mass and support healing.
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Juven
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Carbohydrate metabolism during stress, causes ____ production to increase
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Hepatic glucose
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In carbohydrate metabolism during stress, Hepatic glucose production that increases is disseminated to ________.
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peripheral tissues
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During carbohydrate metabolism during stress _____ & _____ increase
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insulin levels & glucose
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Fat mobilized from adipose stores to provide:
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-Lipolysis
-increased levels of catecholarmines & decreased insulin production |
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If ________, patients not fed during fat metabolism during stress period
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hypermetabolic
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If hypermetabolic patients not fed during fat metabolism during stress period:
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Fat stores and proteins are rapidly depleted
Susceptibility to infection increased |
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Increased fluid losses:
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Fever (increased perspiration)
Increased urine output Diarrhea Draining wounds Diuretic therapy |
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During stress, vitamin and mineral needs increase, with special attention to _____ that promotes collagen formation necessary for optimal wound healing
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Vitamin C
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With fluid lose during stress, Vitamin C supplements of _____ are recommended
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500 to 1000 mg/day
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With fluid lose during stress, _____ & _____ promotes healing process and antioxidants.
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Vitamin A and ß-carotene
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Increases tensile strength of healing wound
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Zinc
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Zinc supplements of
______ zinc sulfate (orally) when stable |
220 mg/day
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Additional ______ may be necessary if there are unusually large intestinal losses
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zinc
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Inadequate intake of energy and/or protein
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Protein Energy Malnutrition
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Acute or chronic protein deficiency
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Protein energy malnutrition (PEM)
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Protein Energy Malnutrition can be ______ or _____
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primary or secondary
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Result of inadequate intake of nutrients
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Primary PEM
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Inadequate nutrient consumption resulting from disease state
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Secondary PEM
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Secondary PEM: (3)
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Impairs food consumption
Interferes with nutrient absorption, or Increases nutritional requirements |
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Kwashiorkor may develop in as little as ______
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2 weeks
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Appears that normal adaptive response of protein sparing seen in fasting fails
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Kwashiorkor
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With ____ one appears to be adequately nourished, tending to have normal fat reserves and muscle mass (or above normal)
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Kwashiorkor
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Signs of Kwashiorkor:
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-easily pluckable hair
-edema -skin breakdown -delayed wound healing |
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__________:
Serum albumin (<2.8 g/dL) Transferrin (<150 mg/dL) Reduced iron-binding capacity (<200 mcg/dL) Depressed immune function (<1500 lymphocytes/mm3) |
Severely depressed visceral proteins
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Severe loss of fat and muscle tissue
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Marasmus
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Marasmus: (3)
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Result of chronic energy deficiency
Will appear thin Weak and listless |
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With Marasmus, visceral protein stores preserved at expense of ________
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skeletal muscle
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Marasmus is:
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Chronic rather than acute condition
have normal lab values Avoid refeeding syndrome |
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Develops when acute stress is experienced by someone who has been chronically malnourished
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Marasmus-Kwashiorkor Mix
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_____ becomes life threatening, high risk of infection
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Marasmus-Kwashiorkor Mix
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Involves progressive failure of two or more organ systems at the same time
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Multiple Organ Dysfunction Syndrome
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With mulitiple organ dysfunction syndrome, the following may occur:
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Trauma
Severe burns Infection Shock |
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With Mulitiple organ dysfunction syndrome, _____ usually results in initiation of the stress response
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Pathogenesis
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With Multiple Organ Dysfunction Syndrome, Pathogenesis:
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Complex
Usually results in initiation of the stress response Release of catecholamines |
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With mulitiple organ dysfunction syndrome, higher levels of ____ & _____ necessary to meet increased metabolic demands
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kcal and protein
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Mulitiple Organ Dysfunction Syndrome, feeding modality is also important:
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Early enteral feedings appear to maintain gut mucosal mass and barrier function
Promote normal enterocytic growth in the gut Not possible with parenteral feedings |
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Before surgury, patients typically limited to _____ to prevent aspiration
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(NPO) nothing by mouth
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Oral intake generally resumed when bowel sounds return, usually ______ after surgery
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24-48 hours
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Postoperative diet usually progresses from _____ to ____ as tolerated
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clear liquid to solid foods
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Burns (thermal injury) is defined as:
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-electrical
-thermal -chemical -radioactive |
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____ produce tissue destruction and result in circulatory and metabolic alterations
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burns (thermal injury)
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Generally classified by physical appearance and symptoms associated with the affected skin
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burns
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Burns are often described in terms of ______
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% of body surface burned
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Partial-thickness injury
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First-Degree Burns
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Involve epidermis only
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First-Degree Burns
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Results in simple reddening of the area
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First-Degree Burns
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No injury to underlying dermal or subcutaneous tissue
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First-Degree Burns
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First-degree burns heal within ____ without scarring
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3 to 5 days
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Superficial partial-thickness injury and deep partial-thickness injury
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Second-degree burns
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Second-degree burns are two categories of burn depth with distinctly different characteristics
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Superficial partial-thickness burns
Deep partial-thickness burns |
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Redness and blistering that affects epidermis and some dermis
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Superficial partial-thickness burns
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Destruction of epidermis and dermis
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Deep partial-thickness burns
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Second-degree burns take ____ to heal
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weeks to months
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Full-thickness injury
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Third-Degree Burns
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Third-Degree Burns are the distruction of:
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Entire epidermis
Dermis Frequently the underlying subcutaneous tissue Occasionally muscle or bone tissue may be destroyed |
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Third-degree burns, do not heal and require _____
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skin grafts
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With the treatment of burns, the first 24-48 hours are used to:
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Dedicated to replacement of fluid and electrolytes
Total body surface area (TBSA) burned |
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Wounds from burns heal only if the patient is in ______
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anabolic state
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Feeding of a burned patient can be begun as soon as ___
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patient has been hydrated
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With treatment of burns, very early enteral feeding occurs within _____ hours of hospitalization
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4 to 12 hours
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Very early enteral feeding is successful in:
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Decreasing hypercatabolic response
Decreasing release of catecholamines and glucagon Reducing weight loss Shortening the length of the hospital stay |
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It is not uncommon for a burn patient to need _____ kcal
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4000-5000 kcal
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Energy needs of burned patients vary according to ____
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the size of the burn
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With burn patients, protein is lost through _____ and ____
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urine and wounds
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Burn patients require increased protein needs:
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Protein lost through urine and wounds
Increased protein use for gluconeogenesis Wound healing |
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With burned patients, important kcal from protein not calculated into _____
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total energy needs
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With burned patients _____ & _____ used for protein sparing
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carbohydrates and fats
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For burned patients adequate amounts of energy or protein best evaluated by:
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Wound healing
Graft take Basic nutritional assessment parameters |
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With burn patients, mineral and vitamin needs generally increase. Special consideration should be given to:
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Vitamin C (collagen synthesis, immune function)
Vitamin A (immune function and epithelialization) |
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During the first 24 to 48 hours after a major burn, the focus of nutrition care is:
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replacement of fluids and electrolytes
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