Nutrition of the Critically Ill Patient

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Flashcards on Nutrition of the Critically Ill Patient, created by Elizabeth Then on 08/29/2018.
Elizabeth Then
Flashcards by Elizabeth Then, updated more than 1 year ago
Elizabeth Then
Created by Elizabeth Then over 5 years ago
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Question Answer
Metabolism refers to process of anabolism and catabolism
During critical illness metabolic function is compromised: digestion, absorption, immunity, protection
GI physiology and effect of crtical illness role of digestion absorption of nutrients GIT role is immunity and protection
GIT abnormal function digestion and absorption of nutrients are altered gastric acid changes impaired ability of small intestine to absorb nutrients hypoperfusion and decreased oxygenation leading to GIT ischaemia
GIT hypoperfusion and consequences decreased blood flow to GIT disruption of physical barrier to pathogens disruption of chemical control of bacterial overgrowth reduced immunological activities of gut associated lymphoid tissue
Factors affecting malnutrition poor oral intake stress surgery sepsis prolonged bed rest immobility
Malnutrition will lead to impaired immune functino cardiac function ventilatory drive and weak resp muscles prolonged vent dependence increased infectiour morbidity and mortality
Defining malnutrition in adults condition that develops when the body does not get right amount of vitamins, minerals, nutrients, to maintain health tissues and organ function resulting in muscle wasting
Estimating nutritional requirements influnced by: age, gender, body size, activity levels, injury severity, temp, renal function, dialysis, wounds, drains
Nutrition requirements energy - reduce catabolism, preserve lean body mass and provide essential vitamins and minerals protein - promote positive nitrogen balance for wound healing and recovery fluid - adequate hydration vitamins - coenzymes and cofactors in multiple metabolic processes micronutrients - prevent defiency syndrome
Comlication of overfeeding increased metabolic rate increased O2 consumptions and CO2 production ventilator dependence hyperglycaemia - sepsis/infections fatty liver immunosuppression fluid overload electrolyte imbalance
Forms of nutritional support enteral, - tube, parental - iv, vitamin and mineral supplement, orak
Enteral feeding not sued when there is proximal fistula, GIT bleed, hypotension
Monitoring enteral feeding gastric aspirates, abdominal distension, bowel activity , feed delivered, correct rate, prescribed volume regular flushes, correct tape, patient positioning diarrhoead need more than 3 times a day for duration of 3-6 days = cease causes of diarrhoea, infection, sepsis, antibiotics, reduced GIT function
TPN management and indications delivery of pts complete volume administered via CVC or PICC indications - intestinal fistula, prolonged ileus, short bowel syndrome macronuteitns - aminoacids, glucose trace elements, vitamin K weekly monitor for pneumothorax, airembolism, throbosis, site infection, sepsis hyper/hypo glycaemia hynatreamia, hypercalcaemia
Contraindications for TPN functional and usually GIT when aggressive nutrition is not desired
Enteral vs parental feeding enteral feeding cheap, less invasive, better substrate utilisation maintains integrity of gut mucosa less likely to overfeed
Hyperglycaemia and increased insulin resistance characteristics of stress response also associated with poor wound healing higher infection rates higher death rates
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