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This 8 page Class Notes was uploaded by Harley Dinetz on Tuesday September 29, 2015. The Class Notes belongs to NSD at Syracuse University taught by Jane Uzcategui in Fall 2015. Since its upload, it has received 15 views.
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Date Created: 09/29/15
Critical IllnessNotes 5 09152015 Critical illness 0 Acute life threatening illness or injury o It requires more intense medical and nursing care and organ support Respiratory Cardiac Hemodynamic Hematological Neurological Renal Nutrition support Causes of critical illness 0 Trauma o Laceration Abrasions Punctures Fractures Traumatic brain injury 0 Burns 0 Infection 0000 0 Acute exacerbation of chronic illness 0 They all elicit an in ammatory response which leads to a change in nutrient needs 0 Increased risk of malnutrition 0 Increased need for energy requirement and calories 0 Bene ts of short term in ammatory responses 0 Enhance organ function 0 lnduce cellular immune response 0 Mobilize nutrient substrates in the body Consequences of excess prolonged in ammatory response 0 Can lead to debilitation erosion of body cell mass 0 Organ dysfunction or failure Endothelial damage lmmunosuppression susceptibility to nosocomial infections 0 Metabolic abnormalities 0 The in ammatory response more then actual diagnosis leads to patients metabolic requirements Critical illness and nutrition 0 Critically ill patients are at nutrition risk 0 Hypermetabolic state and inability to eat leads to negative energy balance o Catabolic state leads to loss of lean body mass 0 In ammatory state leads to increase of energy requirements which increase the negative energy balance 0 Consequences include 0 Increased length of stay 0 Impaired would healing o Compromised immune function 0 Organ dysfunction 0 Properly applied nutrition support decreased risk of complication in critical illness 0 Timing 0 Amount Starvations and traumatic injury 0 The metabolic response to traumatic injury is somewhat similar to the metabolic response to starvation Same 0 Protein is catabolized o Adipose is catabolized o Glucogensis happens 0 Different 0 Metabolic rate increases 0 All 3 types of energy nutrients are used 0 There are a lot of proteolysis 00000 There a lot more live protein synthesis There a lot more uragensusis There a lot more glucogensis There only a small amount of ketogensis Hormonal response of trauma multiples the nutritional effect Surgery trauma and sepsis o Traumatic injury results in profound metabolic alteration 0 000000 Motor vehicle accident Gunshot wound Falls Thermal injury Head injury Penetrating injury Critically ill and intensive care patients 0 Other crucial injuries and illness that cause metabolic stress OOOOO Sever in ammation Acute pancreatitis Sepgs Hypoxic injury Tissue necrosis 0 Acute respiratory distress syndrome 0 Multisystem organ failure In ammatory response 0 All cause an in ammatory response 0 A nonspeci c part of the immune system 0 Mediators of in ammatory response Hormone Cytokines 0 Increased protein synthesis in central organs 0 Release substrate from peripheral tissue Nutrition risk and critical illness 0 Patient is nutritionally at risk when they are at risk for poorer outcome than if they were not malnourished Goal for medical nutrition therapy improve outcomes 0 Days on a ventilator 0 Days in the ICU o Infections Without causing complication o Hyperglycemia 0 Infection 0 To minimize starvation and protein energy malnutrition Metabolic response to trauma Hormonally mediated Acute phase protein synthesis 0 Hypermetabolsim Increase reliance on glucogensis o Fluid shifts There are 3 phases 0 EBB phases 2 to 48 hours It occurs immediately after the injury 0 Flow phase The patient is more stable There is a higher level of glucose The normal level is between 70110 It can alter fat metabolism 0 Recovery Systemic in ammatory response syndrome 0 A widespread in ammation that can occurs with infection 0 In ammation is present in areas outside the primary injury Sepsis systemic in ammatory response with a documented infection Multiple organ dysfunction syndrome Sepsis can progress and then lead to multiple organ damage o It may occur following trauma burns and infection 0 The general sequence 0 O O O LungsfaH Liver fail lntestine fail Kidneys fail These patients have high mortality 0 Edema is high in almost all intensive care patients Client history 0 Client history OOOOO Past medical history and existing condition Current problems Medications IV uids Vital signs Body temperature Pulse Breathing rate Pulse rate Blood pressure 0 Presence of systemic in ammatory response syndrome Nutrition prescription for critical illness 0 The nutrition prescription is de ned as the patients individualized recommended dietary intake of energy selected food or nutrients based on current reference standards and dietary guidelines and health recommendations Monitoring and evaluation 0 Food and nutrition history 0 Weight changes 0 Lab parameters 0 Clinical Actual intake of energy and protein compared to target and goal 0 The gastrointestinal function and feeding tolerance Stool output Gastric residuals Presence of abdominal distention
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