Nutrition For Patients With Metabolic Or Respiratory Stress

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is body attempt to promote healing and resolve inflammation when homeostasis is disrupted

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stress response

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altered body chemistry assoc w/ body's response to injury or disease

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metabolic stress

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decreased tissue oxygenation and impaired flow of blood to the heart

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shock

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stress response 3 phases

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ebb, phase, flow phase and recovery or resolution phase

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spike in circulating levels of hormones "fight or flight response assoc w/ breakdown of stored nutrients to meet energy needs

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flow phase

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body stores and tissues are catabolized, energy expenditure and metabolic rate increase, creating a state of

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hypercatabolism and hypermetabolism

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o2, c.o., co2 production and body temp increase

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hormonal response to stress

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resolution of the stress leads to the recovery phase which is marked by

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anabolism

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body attempts to destroy infectious agents

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acute phase response

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negative acute phase response , such as alb, prealb and transferrin decrease in response to inflammation

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c-reactive phase protein

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a group name for more than 100 different proteins involved in immune responses - promotes hypercatabolism

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cytokines

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catabolized to provide amino acids for protein, immunie and glucose (increase infection,impaired or delayed wound healing)

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negative nitrogen balance

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acute life threatening condition that occur when sever inflammation last

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SIRS

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elevations of heart rate, rr, wbc or body temp are caused by infection result is

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sepsis

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impaired of two or more organ system - uncontrolled inflammatory response

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multiple organ failure

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indirect estimate of resting energy measures the ratio of co2 expired

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indirect calorimetry

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calories needed maintain basic involuntary activities to sustain life, beating the heart, inflating lungs and secreting enzymes

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Resting Metabolic Rate (RMR)

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is a disorder that may affect many as 34% critically ill patients, producing symptoms range from mild to life

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refeeding syndrome

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most important for wound healing, increased need for critically ill patients

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protein

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enteral formula with anti-inflammatory omega-3 fish oils and antioxidants recommended for what group

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acute lung injury and respiratory distress syndrome

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supplement vitamins may be needed only if low and beyond

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acute phase response

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Enteral nutrition "EN" (tube feeding) is superior

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parenteral nutrition "PN"

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should be int asap post resuscitation and patient hemodynamically stable within 24 to 48 hours

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EN

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EN not right or available, after 7 days, asap resuscitation (malnutrition shown), 5 to 7 days post-op

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PN should be considered

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most severe form of metabolic stress

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burns

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hypermetabolism and hypercatabolism in response phase parallels of

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burn injury

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metabolic rate reaches a maximum of double the normal rate when TBSA

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exceeds 60%

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occurs when gas exchange between the air and blood is impaired, leading to lower levels of oxygen and higher levels co2

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respiratory stress

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may cause hyptermetabolism and loss of muscle mas and function

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respiratory stress

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30% patients with COPD have low

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BMI < 20%

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hypermetabolic (hypercapenia) from increase energy spent on labored breathing

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COPD

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poorer prognosis than well nourished patients

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malnourished patients w/ copd

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flare up of copd patient - calorie needs may be

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140% above RMR

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lesser amounts of carbs yield less

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co2

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formulate enteral products are have higher fat and lower carbs for what type of group

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mechanical ventilated patient

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bowel surgery prep, post-op, maintain hydration,

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clear liquid diet

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contain foods that are pureed, chopped/ground, soft

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mechanically altered diet

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easy to consume, well accepted m ten to leave stomach faster - good choice for between meal - this is use when patient unwilling or unable to eat enough food to meet requirement

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nutritional supplements

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less used but maximizing patient oral intake - also composed of a single nutrient (ex. whey protein)

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modular products

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type 1 or type 2, gestational diabetes, impaired glucose tolerance consistent with emphasis on general nutritional balance

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diabetic or consistent carbs

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the delivery of nutrients by tube, catheter or stoma into GI tract beyond the oral cavity aka tube feeding

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Enteral nutrition "EN"
(partially function GI tract)

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nonfunction GI tract, gastric or intestinal obstruction, paralytic ileus, intractable vomiting, sever diarrhea and GI ischemia

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EN contraindicated

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Transnasal routes (short term) - from the nose to either the stomach or small intestine consist of

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NG (nasogastric) , ND (nasoduodenal) and NJ (nasojejunal) most common NG

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surgically opening (stoma) made to deliver feedings into the stomach or intestines

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ostomy

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classified as regular diet, consistently modified and therapeutic

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oral diet

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delivery of nutrients by vein; outside the intestinal tract

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parenteral nutrition
via central venous access

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dumping syndrome

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bolus feeding

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volume of feeding remains in stomach

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gastric residual

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used when digestion is impaired (renal failure) and low residue or residue free

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hydrolyzed formula

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near isotonic to avoid collapsing small veins, calories it supplies is limited

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PN

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it should be used only when necessary and d/c asap

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PN

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carbs not digested in human gi

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fiber

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gi tract after digestion, fiber, undigested food,

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residue

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BMI over 25 or greater - excessive body weight

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overweight

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bim of 30 or greater - excessive body fat

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obese

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environment and genetics

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obesogenic

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risk of cardiovascular disease and diabetes

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metabolic syndrome

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first goal decrease calorie intake by

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500 to 1000 cal/day (1 to 2 lbs)

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lower weight loss of 5% to 10% effectively

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lower disease