ch. 16 nutrition in metabolic & respiratory stress

protein requirement during acute stress - elderly

0.8 - 1 g/kg/day

protein requirement during acute stress - healthy adult

0.8 g/kg/day

estimating fluid needs in acute stress - __ ml/kcal of RMR

1

____ breathing entails a higher energy cost than normal breathing, raising energy needs

labored

another goal of medical nutrition therapy is to preserve ____ tissue and promote immunity and healing

lean

eicosanoids are __

local

whats the defining characteristics of resp stress?

lower than normal oxygen levels, higher than normal carbon dioxide levels

what order do organ fail?

lungs, liver, then kidneys

the inflammatory response is ____

nonspecific

the stress response is the bodies ____ responses to a variety of stressors

nonspecific

in stress, energy eventually starts coming from _____ stores and that causes wasting

protein

for negative nitrogen balance provide ____

proteins

what is respiratory stress characterized by?

reduction in the bloods oxygen supply and an increase in carbon dioxide levels

overfeeding can lead to ___ syndrome

refeeding syndrome

what are immediate concerns during severe stress?

restore lost fluids and electrolytes

if symptoms result in severe infections its called ____

sepsis

if the reduction in blood flow is severe enough to deprive the bodys tissues of oxygen and nutrients, ___ occurs

shock

what are symptoms of COPD?

smoking - 15% of smokers genetic susceptibility - alpha 1 antitrypsin respiratory infection occupational exposure - dusts, chemicals, etc

examples of metabolic stress

uncontrolled infection extensive tissue damage - deep penetrating wounds or multiple broken bones

what is permissive underfeeding?

underfed ppl who are overweight or obese will do better bc they can draw on their fat stores, decreasing infection, hospital days, and hyperglycemia

lung diseases make physical activity difficult and can lead to muscle _____

wasting

vitamin ____ are coenzymes for energy metabolism and need to be increased during hypermetabolism

B

what are the hormones involved in the stress response?

1. catecholamines - eli and norepi 2. glucagon 3. cortisol 4. aldosterone, ADH

the method of delivering calories and nutrients depends on GI function and nutrient needs:

1. high-calorie, high-protein diet with oral supplement 2. enteral nutrition 3. parental nutrition (IV)

SYSTEMIC effects of inflammation - in the acute phase of the response, what are the signs?

1. hypermetabolism 2. muscle wasting 3. increased BP 4. lethargy 5. anorexia 6. fever

an additional goal of medical nutrition therapy is to address what 3 things?

1. hypermetabolism 2. negative nitrogen balance 3. hyperglycemia

SYSTEMIC effects of inflammation - in the acute phase of the response, there is a decrease in what 3 things?

1. serum albumin 2. iron 3. zinc

protein requirement during acute stress - critically ill

1.2 - 2 g/kg/day

% of resting metabolic rate from chart

120 - minor trauma 160 - major trauma 180 - major burn

protein requirement during acute stress - severe burns

2 - 3 g/kg/day

for critically ill -

20 - 30 kcal/kg/day

for weight loss -

20-25 kcal/kg/day

for acutely ill pts with a functional GI tract, early enteral feedings - usually __ to __ hours after hospitalization are associated with fewer complications and shorter stays then delayed feeding

24-48

estimating fluid needs in acute stress - __ ml/kg body weight

30

quick method for estimating energy needs- ____kcal/kg/day for weight MAINTENANCE

30

for weight gain -

35 - 40 kcal/kg/day

what vitamins are needed for wound healing?

A, C, zinc

SYSTEMIC effects of inflammation - in the acute phase of the response (within hours of injury), there is an increase in proteins such as

C-reactive proteins blood clotting proteins - fibrinogen, prothrombin complement hepcidin

malnutrition and COPD

COPD causes difficulty eating --> malnutrition; increases BMR --> malnutrition

what are factors that affect vitamin and mineral needs?

GI losses hypermetabolism cutaneous losses - burns wound healing renal function refeeding syndrome

*use the lowest of ___ or ___

IBW or ABW

a common method for determining energy needs of acutely stressed pts is to estimate or measure the ____ and then multiply by a stress factor to account for the increased energy requirements of stress and healing

RMR

total energy expenditure =

RMR x stress factor

if stress response continues, pt could end up with ___

SAM (severe acute malnutrition)

what are initial treatments of acute stress?

administering IV fluids, treating infections, repairing wounds, draining abscesses (pus), and removing dead tissue (debridement)

___ & ____ hormone are part of the renal system and maintain BP by increasing the reabsorption of water and sodium

aldosterone antidiuretic

estimating fluid needs in acute stress - fluid counts:

all foods that are fluid at room temp plus IV fluids

emphysema is progressive damage to bronchioles and _____

alveoli

refeeding syndrome develops when a severely malnourished person is aggressively fed, whats it associated with?

fluid and electrolyte imbalances and hyperglycemia

what can nutritional needs be complicated?

fluid imbalances prevent accurate weight measurements and lab data may reflect the metabolic alterations of illness rather than the persons nutrition status

all hormones cause what effects?

breakdown of glycogen, production of glucose from AA, and breakdown of triglycerides in adipose tissue

chronic ___ is an inflammation and mucus secretion in the main airways

bronchitis *more of a productive cough persists for at least 3 months of year

what is the inflammatory response?

immune response to infection and injury

shock -

insufficient blood flow edema decreased BP muscle weakness multi-organ failure

for hypermetabolism, provide ____

calories

in medical nutrition therapy, deliver adequate ___ & ____

calories and protein

excessive ____ ____ in the blood can disturb breathing pattern enough to interfere with food intake

carbon dioxide

overfeeding can also cause over production of ___ ____ making resp problems worse

carbon dioxide

what is metabolic stress?

chemical & physical changes due to stress from disease or injury

whats the limitation of this equation?

choice of stress factor by clinician is subjective

COPD -

chronic bronchitis emphysema or both

whats the initial goal of medical nutrition therapy?

correct fluid and electrolyte imbalance with IV solution

_____ is a steroid hormone that enhances muscle protein degradation, raising amino acid levels in the blood and making amino acids available for conversion to glucose

cortisol

___ produce WBC

cytokines

COPD can cause what 2 things?

decreased muscle strength impaired aerobic capacity

whats the purpose of the inflammatory response?

destroy infectious agents, prevent further tissue damage

the inflammatory response begins with ___ of arterioles increases blood flow to the cite causing redness and heat, then ____ (WBC) destroy antigens at site

dilation phagocytes

_____ are derived from dietary omega 6 fatty acids in vegetable oils

eicosanoids *can be counteracted by omega 3 (fatty fish, fish oils, flaxseeds, walnuts)

emphysema is a break down of the ___ structure of the lungs

elastic

_____ is of primary importance and therefore energy nutrients are mobilized from storage and made available in blood

energy

the body needs ___ & ____

energy and glucose

what does the harris-benedict equation estimate?

energy needs - RMR

catecholamines like ____ &_____ are the fight or flight hormones and stimulate HR, BP, and metabolic rate

epinephrine norepinephrine

*increase values for moderate or vigorous ____

exercise

epinephrine promotes ____ secretion for the pancreas, prompting the release of nutrients from storage

glucagon

possible addition of specific amino acids _____ & ____ may improve wound healing and immunity but research is controversial

glutamine arginine

where can we get glucose?

glycogen glycerol amino acids

what is COPD?

group of conditions characterized by persistent obstruction of airflow through lungs

energy is diverted from process that are not life sustaining like

growth, reproduction, long term immunity

_____ is released from mast cells causing vasodilation and capillary permeability

histamine

despite high intakes of protein, nitrogen balance is difficult to achieve during acute stress because of ___ changes that encourage the degradation of body protein

hormonal

the stress response is ____

hormonal

cortisol is good in short term, but not long term. it can cause

hyperglycemic attack because of increased insulin resistance, suppress immune response, depletion of protein in muscle, bone, connective tissue, and skin. impairs wound healing

metabolic and resp stress lead to _____ & ___

hypermetabolism wasting

what is respiratory stress?

inadequate gas exchange between air and blood

energy needs __ with severity of disease, mechanical ventilation, burns, wounds, fever

increase

what are the symptoms of systemic inflammatory response system (SIRS)?

increase HR and resp abnormal WBC count fever

metabolic stress _____ metabolic rate, HR, BP, resp, & hormones

increases *increases risk for malnutrition

estimating fluid needs in acute stress - increased with ___ losses like fever, swearing, hyper metabolism & GI losses - vomiting, diarrhea

insensible

chemical ___ are released from damaged tissue, blood vessel cells, and activated immune cells

mediators

metabolic stress involves _____ from storage and ___ of energy

mobilization metabolism

in medical nutrition therapy, its important to balance ___ & ___

overfeeding underfeeding

HR and resp increase to deliver ___ and nutrients to cells more quickly

oxygen

chemical mediators stimulate ___ receptors

pain

if enteral not possible, malnourished pts may receive ____ nutrition support soon after admission. in pre venously healthy pts it may be withheld during the first 7 days of admission to avoid risk of infectious complications

parental

most common infection during the process is?

pneumonia

if inflammation does not resolve, the continued production of pro-inflammatory cytokines may lead to _____ ____ ____ ____

systemic inflammatory response system (SIRS)

systemic inflammatory response system (SIRS) and sepsis is a ____ body response over a few days

whole