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28 Cards in this Set
- Front
- Back
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What is metabolic Stress?
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-sepsis: infection
-trauma: MVA, falls, burns, gunshot, stab wounds -Surgery -Activation of the systemic response: physio & metabolic changes |
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What is the metabolic response to stress?
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Accelerated metabolism: LBM, muscle wasting + negative nitrogen balance
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What are the counter-regulatory hormone responses that lead to proteolysis?
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glucagon
epinephrine norepinephine cortisol growth hormone |
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Ebb Phase: the immediate response to injury
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*DO NOT START EN UNTIL FLOW PHASE!
hypervolemia: decreased cardiac output decreased: tissue perfusion, 02 consumption, body temp, BMR, and insulin levels |
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Flow Phase: acute response follows fluid and 02 restoration (catabolic)
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increased: cardiac output, BP, 02, and body temp
BMR and energy needs increased fat & muscle is broken down for energy in catabolism |
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Flow Phase: adaptive response (anabolic)
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lower hormonal response and hypermetabolism
increase body protein restoration increase wound healing + recovery |
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hormonal and cell mediated responses:
counter-regulatory hormones cause protein catabolism |
1. Acute phase proteins cause rapid loss of LBM: (-) nitrogen balance
2. Hyperglycemia 3. Na + water retention 4. proinflammatory cytokines |
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Starvation vs. Stress
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starvation: REE decreases, uses fat for fuel, high ketones
stress: REE increases, everything except ketones increases |
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What is the definition of sepsis?
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infection of identifiable organism
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what is SIRS (systemic inflammatory response syndrome)?
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widespread inflammation in metabolic stress.
often occurs in healthy tissues remote from the injury. |
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what is MODS and why does it occurs?
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multiple organ dysfuction - from SIRS and becoming hypermetabolic
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The diagnosis of SIRS requires 2 or more of the following symptoms + what?
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**Site of infection established +
- body temp >38 or <38`C - HR >90 bpm - Respiration >20 breaths/min - hyperventilation - WBC >12,000 or <4000 - bandemia |
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how do you treat SIRS/MODS?
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*you can only treat pt. once they are hemodynamically stable.
- reduce catabolism - meet E req. w/o overfeeding use indirect calorimetry ~25-30kcals CBW.....maintain glycemic control!! - PRO: 1.2-2.0g/kg : Loss of LBM |
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What happens during shock?
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gut hypoperfusion: lack of peristalsis in the ileus
a lack of gut stimulation leads to mucosal atrophy, loss of GALT, causes bacteria translocation the use of EN will keep gut integrity |
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what happens physiologically during burns?
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- hypermetabolic
- increased REE drastically - PRO lost thru wound site, pro catabolism, & urinary Nitrogen excretion - fluids + electrolytes*** - start EN/PN stat! |
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wound healing only occurs in what physiological state?
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anabolic
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what are the MNT goals for burn patients?
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1. maintain gut integrity thru EN
2. fluids for first 24-48 hrs 3. volume of fluid needs is determined by TBSA of burn 4. minimize metabolic stress 5. prevent weight loss of greater than 10% BW |
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establishing energy needs in major burn patients
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- Curreri formula used > actual EE
- Ireton Jones calculation for est. EE (age, weight, gender, trauma, + burn) |
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what is the maximum glucose load in burn patients on EN/PN?
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7mg/kg/min
anything greater converts to fat |
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what does increased CHO in burn patients lead to?
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hyperglycemia, dehydration, and respiratory difficulty
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Protein needs in major burn victims
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- increased for gluconeogenesis + healing
- 20-25% kcal or 2.0-2.5g/kg (monitor BUN, creatinine, hydration) - BCAAs no benefit - possibly arginine + glutamine |
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what does vitamin C do for burn pts?
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vitamin C: collagen synthesis + immune function
500mg 2x/d |
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What does Vitamin A do for burn patients?
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Vit A: for immune function and epithelialization
5000 IU/1000kcal of EN |
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What minerals are important for burn patients?
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deacresed levels of: Na, K, Ca, Mg, PO4, & Zn can occur
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When is EN/PN appropriate for burn victims?
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if the TBSA is >20%
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UUN is used to evaluate the degree of hypermetabolism, what are the 4 stages?
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1. 0-5: no stress
2. 5-10: mild stress 3. 10-15: moderate hypermetabolism 4. >15: severe Level 3 |
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Traumatic Brain Injury: Nutritional Concerns
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- severe hypermetabolism + catabolism
- impairments may be physiological + cognitive = intake concerns |
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MNT for closed head injury
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TEE: 90-140% of usual
PRO: 1.6 - 2.0 FAT: 30-40% CHO: 50-55% |
