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21 Cards in this Set
- Front
- Back
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What effect does stress have on metabolism? significance?
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Stress increases the metabolic rate and thus increases the number of calories burned. Thus, if you're body is stressed you need increased nutritional support
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What are the clinical consequences of Metabolic Stress?
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Hypermetabolism
Hypercatabolism Hyperglycemia Peripheral Insulin resistance Fluid/Electrolyte Change |
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Protein Muscle Loss in stressed vs. non-stressed
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Non-Stressed: 75gm/day
Stressed: 250gm/day |
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when does a pt need nutritional support?
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If they're unable or will be unable to meet their needs for 5-10 days
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Different modes of delivery for Parenteral nutrition
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Central Venous Access
Peripheral Venous Access |
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Why Central Venous Access?
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For TPN
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What do you give through Central Access?
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Hyperosmolar solutions
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Why Peripheral Venous Access?
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Its not preferred, but for partial PN.
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What do you give through peripheral access?
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Not as hyperosmolar of a solution, so high volumes given...i.e. not good
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Enteral vs TPN?
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Enteral decreases Infection and Sepsis across the board.
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Why is TPN immunosuppressive?
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Excessive Caloric Delivery-->hyperglycemia
Excessive IV Long Chain Triglyceride (w6)-->pro-inflammatory Non-luminal delivery-->mucosal compromise via GALT atrophy |
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What's up with Insulin therapy in critically Ill?
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Intensive Insulin Therapy makes sure to maintain blood glucose between 80-110. The results of which are decreased hospital stay, dec mortality, dec infections, etc
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What kind of lipids do we need to watch out for? why?
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Omega-6's b/c they can be pro-inflammatory
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Where are the majority of our Ig producing lymphoid cells?
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In the GUT! so when its starts sloughing with TPN, that's BAD
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Different Modes of Enteral Access?
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Nasoenteric: nose to stomach/duodenum
Percutaneous endoscopic Percutaneous radiologic Laproscopic Surgical |
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How do you decide whether or not to us an NG tube?
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If the patient will need it for <4wks otherwise they need a more permanent tube
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Gastic vs Small Bowel feeding
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Gastric is faster
Gastric isn't always as well tolerated due to aspiration. SB also allows for a greater caloric delivery |
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Combining Enteral and TPN
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For immune benefit 15-30% of calories enterally
For visceral blood flow, 10-20% enterally |
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What's up with Enteral Formulas
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They aren't regulated by the FDA.
Lactose There are Disease Specific formulas |
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Goals of Nutrition Support
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Preserve Lean Body Mass
Preserve Immune Fxn Minimize Metabolic Complications |
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How do we avoid immunosuppression?
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Avoid TPN
Avoid Overfeeding Avoid excess omega-6's Meticulous Glycemic Control |
