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Chapter 16 Metabolic and Respiratory Stress
Terms in this set (28)
Disruption in the body's chemical environment due to the effects of disease or injury
Cause: broken bones, deep wounds
Characterized by inadequate oxygen and excessive CO2 in the blood and tissues
Body's specific response to a variety of stressors
+Energy nutrients: mobilize from storage
+HR and RR can increase
+Energy diverted from processes that are not life sustaining
HR, RR VS. Growth, Repro, Immunities
Hormones Response to Stress
Hormones released into the blood; soon after the injury occurs
Catecholamines: Fight or flight... epinephrine and norepinephrine
Glucagon: Causes release of nutrients from storage ... (stored form of glucose)
Other hormones that responds to stress
-Enhances muscle and protein degradation --> releases amino acidsf for energy ...gluconeogenesis
- stimulates kidneys to reabsorb more sodium
-Stimulates kidneys to reabsorb more water
State of stress for prolonged period of time will have muscle wasting.. break down PRO, bone CT, Skin, really impairs wound healing.
The Inflammatory Response
+Immune system's nonspecific response to infection or tissue injury
+Purpose of inflammatory response
-contain and destroy injections agents (and their products)
-Prevent further tissue damage
What are classic signs of inflammation?
+Swelling, Redness, Pain, Heat
Mediators of inflammatory response.
+Histamine: released from granules within mast cells, causing vasodilation and capillary permeability
+Cytokines: produced by white blood cells (and some other types of cells)
+Eicosanoids: derived from dietary fatty acids.. help to act as a mediator to assist in the inflammatory process
System effects of inflammation: Acute Phase Response
+Liver: increases production of acute-phase proteins (C-reactive protein, complement, hepcidin, fibrinogen, prothrombin, etc.)
+Plasma concentrations: albumin, iron, and zinc levels fall
Systemic effects of inflammation: acute-phase response
+Muscle catabolism: makes amino acids available for glucose production, tissue repair, etc.
+Systemic inflammatory response syndrome (SIRS): raised heart and respiratory rates, abnormal white blood cell counts, and fever
What is the condition known as shock?
- depriving tissue of O2 and nutrients
Initial treatment for stress
+Administer IV solutions
+Treat infections, repair wounds, drain, abscesses, and remove dead tissue (debridement)
+Provide nutrient assessment and nutrient therapy.
How do we determine nutritional needs during stress?
+Preserve lean (muscle) tissue
+Maintain immune defences
What are complications in assessing the nutritional needs of an acutely stressed patient?
+Labs may not be correct.. some labs will not be predictive of whats going on nutritional wise.
Determining Nutritional Requirements.. estimating energy needs...
Estimating energy needs for acute stress
+One method: multiply the resting metabolic rate (RMR) by a stress factor (Table 16-2)
+Example: equations for estimating energy needs in ventilator-dependent critical care patients (Table 16-3)
Estimating energy needs for acute stress
- quick assessment
Quick method: multiply a person's body weight by a factor appropriate for the medical condition
Protein requirements in acute stress
Nonobese Vs. Obese
Nonobese critically ill patients: 1.2 to 2.0 grams per kilogram body weight per day (what does a healthy adult need? 0.8 grams per kg)
Obese patients given
feedings: 2.0 to 2.5 grams per kilogram ideal body weight per day
Carbohydrate and fat intakes
Carbohydrates: generally 50 to 60 percent of total energy requirements
Micronutrient needs in acute stress
Specific requirements remain unknown
zinc, vit c, a help w/ would healing
NORMAL % RANGES
45-65% needed in normal
20-35% of fat needed normal
10-35% of PRO needed in healthy
Nutrition care in acute stress
+Initial care: simple intravenous solutions
+Enteral feedings or parenteral feedings may be required-- enteral feeding can reduce length of stay.
+Transition to oral feedings
Take care to avoid overfeeding
-wait for pt to become more stable.. why? risk of hyperglycemia..
+Oral supplements often provided...boost, ensure, exedra...
+Conditions characterized by the persistent obstruction of airflow through the lungs
Chronic bronchitis: persistent inflammation and excessive mucus secretions in airways
Emphysema: breakdown of elastic structure and destruction of walls of bronchioles and alveoli
COPD is associated with.. Causes...
+Associated with abnormal levels of oxygen and carbon dioxide in the blood
+Shortness of breath (dyspnea)
+May lead to respiratory or heart failure
Causes of COPD
Primary risk factor: smoking
Treatment of COPD
Prevent the disease from progressing
Relieve major symptoms (dyspnea and coughing)
Obtain flu and pneumonia vaccinations
Bronchodilator medications; supplemental oxygen therapy in severe cases
Nutritional therapy for COPD
Goals.. care plan, enteral!
-Promote the maintenance of a healthy body weight
-Prevent muscle wasting
+Main focus of the nutrition care plan
-Encourage adequate food intake
+Enteral formulas for COPD
-Higher kcalories from fat; lower from carbohydrates
Higher fat formula, lower CHO
Exercise.. for COPD...
Incorporating an exercise program
+Prevent or reverse muscle loss
Helps to build up muscle tissue
+Potentially life-threatening condition Inadequate respiratory function impairs gas exchange between the air and circulating blood: abnormal levels of tissue gases results
+What are possible causes of respiratory failure?
- pulmonary edema
+Acute respiratory distress syndrome (ARDS)
Requires emergency care
-Severe lung damage...
- on the vent.
Respiratory failure consequences..
+Severe hypoxemia: low O2 in blood
+Hypercapnia: excessive CO2 in blood
+Hypoxia: low O2 in tissues
+Acidosis: acid accumulation in tissues
+Cyanosis: bluish cast in the skin
+Headache, confusion, and drowsiness
+Heart arrhythmias and ultimately, coma
Respiratory failure treatment
Treatment plans vary considerably
+Oxygen therapy via face mask or nasal tubing
Nutrition therapy for respiratory failure
Energy? Protein? ARDS? Fluids?
25 to 35 kilocalories per kilogram
Mild or moderate lung injury: 1.0 to 1.5 grams of protein per kilogram of body weight per day
ARDS patients: 1.5 to 2 grams of protein per kilogram of body weight daily
(low calorie, high protein for ARDS, Omega 3 and antioxidants Oxepa)
+Fluids: monitored to prevent imbalances.. prevent pulmonary edema, fluid restriction...
Nutrition support in respiratory failure
Pt. unable to eat meals...
Intestinal feedings preferred over gastric feedings (to prevent aspiration) OJ tubes
Parenteral nutrition support
May be considered
This set is often in folders with...
FCS ch 10
Introduction to NFS 315
Chapter 17 Nutrition and Upper GI
Chapter 18 Nutrition and Lower GI disorders
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