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Nutrition 222 Exam 4 Lecture 17
Terms in this set (57)
The body's response to severe stress can alter
A disruption in the body's chemical environment due to the effects of disease or injury.
Metabolic stress is characterized by
Changes in metabolic rate, heart rate, blood pressure, hormonal status, and nutrient metabolism
A condition characterized by abnormal oxygen and carbon dioxide levels in body tissues due to abnormal gas exchange between the air and blood
A higher-than-normal metabolic rate
The body's nonspecific response to a variety of stressors such as burns, fractures, infection, surgery, and wounds.
______ is of primary importance during the stress response.
During stress response, energy nutrients
Are mobilized from storage and made available to the blood.
During stress response heart rate, respiration rate, and blood pressure
Known as the "fight-or-flight hormones"
Metabolic effects of catecholamines
Stimulates heart muscle, raises blood pressure, and increases metabolic rate. Epinephrin also promotes glucagon secretion which prompts the release of nutrients from storage.
Most hormones have similar effects on glucose and fat metabolism
Causing the breakdown of glycogen, the production of glucose from amino acids, and the breakdown of triglycerides in adipose tissue.
Aldosterone and antidiuretic hormones
Help to maintain blood volume by stimulating kidneys to reabsorb more sodium and water
Harmful: In excess can cause the depletion of protein in muscle, bone, connective tissue, and skin. Impairs wound healing. Insulin resistance, suppress immune responses.
Helpful: Inhibits protein synthesis
A group of nonspecific immune responses to infection or injury.
The inflammatory response serves to
Contain and destroy potential for infection and prevent further tissue damage.
Classic signs of inflammatory response
Swelling, redness (tissue is dilating, blood close to skin), heat production, pain
A small molecule similar to an amino acid in structure that is released from granules within mast cells that cause vasodilation and capillary permeability
Signaling proteins produced by the body's cells; those produced by white blood cells regulate various aspects of immune function
20-carbon molecules derived from dietary fatty acids that help to regulate blood pressure, blood clotting, and other body functions.
Acute phase response
Changes in body chemistry resulting from infection, inflammation, or injury; characterized by alterations in serum proteins.
Systemic inflammatory response syndrome
A whole-body inflammatory response caused by severe illness or trauma; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and fever.
A whole-body inflammatory response caused by a severe infection; characterized by symptoms similar to those of SIRS
Persistant, severe inflammation may lead to _____ and increase the risk of multiple organ failure
Nutritional treatment of acute stress
Restore fluid & electrolytes
Remove underlying stressors
Debride dead tissue
Problems associated with nutritional treatment of acute stress
Hypermetabolism & negative nitrogen balance
Hyperglycemia & insulin resistance
-Increases risk of infection
-Worsten negative Nitrogen balance increasing - lean tissue losses
-Increases risks of referring syndrome ------------------ (hyperglycemia)
What are the principle diet goals of nutrition therapy?
To preserve lean muscle tissue, maintain immune defenses, and promote healing.
Estimating energy needs for acute stress
RMR * stress factor
Estimating protein requirements for acute stress
Normal: 0.8 g/kg per day
Recovering non-obese: 1.2-2.0 g/kg per day
Obese patients given hypo caloric feeding: 2.0-2.5
Why is nitrogen balance hard to achieve during acute stress?
Because of hormonal changes encouraging the degradation of body protein
Estimating carbohydrate requirements for acute stress
50-60% of total energy requirements
In patients with hyperglycemia fat may supply up to 50% kcalories
Condition characterized by a reduction in the blood's oxygen supply and an increase in carbon dioxide levels.
Elevated carbon dioxide levels in blood which causes a change in the breathing pattern. This can raise energy needs leading to a reduction in food intake, malnutrition, and weight loss.
Chronic obstructive pulmonary disease (COPD)
Refers to a group of conditions characterized by the persistent obstruction of airflow through the lungs. Are categorized into either chronic bronchitis or emphysema
Productive cough for 3 months out of the year for two consistent years
Reduced lung elasticity, breakdown of lung tissue, destruction of the walls of the bronchioles and alveoli, dyspena
Shortness of breath
______ is the 3rd leading cause of death in the United States
Causes of COPD
Chronic respiratory infections
Occupational exposure to dust/chemicals
The main goals of nutrition therapy for COPD
Improve food intake
Maintain healthy weight
Prevent muscle loss
Improve exercise endurance
Treatment of COPD
Small frequent meals
The most frequently prescribed medications for COPD are
Bronchodilators (improve airflow) and inhaled corticosteroids (anti-inflammatory drugs)
Gas exchange between air and blood is greatly impaired
Causes of respiratory failure
Infection (pneumonia or sepsis)
Aspiration of stomach contents
Acute Respiratory Distress Syndrome (ARDS)
AKA Severe Respiratory Failure: triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation.
What are the consequences of respiratory failure?
Hypoxemia: low oxygen levels in blood
Hypercapnia: excessive carbon dioxide in blood
Hypoxia: Low oxygen in body tissues
Acidosis: Acid accumulation in body tissues; depresses the central nervous system and may lead to disorientation and, eventually, coma
Cyanosis: A bluish cast in the skin due to the color of deoxygenated hemoglobin. Cyanosis is most evident in individuals with lighter, thinner skin; it is mostly seen on lips, cheeks, and ears and under nails.
Treatment of respiratory failure
Supporting lung function
Correct the underlying disorder
Careful monitoring of fluid
Nutrition therapy for respiratory failure
Energy: Overfeeding should be avoided because it can cause excessive carbon dioxide production and worsen respiratory function
Protein: Mild-Moderate 1-1.5 g/kg per day
ARDS 1.5-2 g/kg per day
Is enteral or parenteral treatment preferred for ARDS?
What are enteral formulas fortified with for treating ARDS?
Omega-3 fatty acids
Multiple Organ Dysfunction Syndrome (MODS)
The progressive dysfunction of two or more of the body's organ systems. Frequent cause of death in intensive care patients. Chemical mediators can cause systematic inflammatory response syndrome (SIRS) leading toe hock and organ failure.
Which organs are affected by MODS?
Systematic inflammatory response syndrome (SIRS)
When the inflammatory response moves through the entire body causing organ failure usually caused by injury or surgery
Pattern of organ failure
Lungs -> Liver -> Kidneys, GI tract, heart
Symptoms of SIRS & Sepsis
Elevated respiratory rate
Elevated heart rate
Abnormal body temperature
Abnormal white blood cell count
Treatment for MODS
-Mechanical ventilation (lung support)
-Fluid & electrolytes
-Medications to sustain or increase cardiac output & blood pressure (support of heart function)
:Assuming that system starts to fail
-Hemofiltration or dialysis (kidney support)
-Antibiotic therapy for infection
-Enteral & parenteral nutrition
Factors that influence risks of MODS
Age over 55
Prior chronic disease
Severity of tissue injury
Length of time between injury and arrival at hospital
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