Inflammatory Response
Inflammatory Response is typically brought on by one of these conditions
Major Trauma or Burn
Exacerbation of Disease
Sepsis
Surgery
Energy expenditure at baseline due to altered metabolism is greater than ______% above normal
50
Predictive equations do NOT correlate well with _________
Measurements (indirect calorimetry) of resting energy expenditure
Patients with this preexisting condition are at increased risk for rapid deterioration of muscle mass
Malnutrition
Name two types of short term enteral nutrition feeding tubes
Naso/Oral Gastric
Nasoduodenal (or Dobhoff)
Immediately following the injury is the _____ Phase
Ebb
The body uses glucose, protein and fat for energy to maintain homeostasis. The use of fat for energy is called
Lipolysis
The weight based equation for an obese (BMI 30-50) critical ill patient
11-14 kcal/kg/d based on Actual Body Weight
Two tools validated for screening critically ill patients are
NRS and NUTRIC
Name two types of long term feeding tubes
PEG (percutaneous endoscopic gastrostomy)
PEJ (percutaneous endoscopic jejunostomy)
also Micki button (a type of PEG for kids)
Following initial injury, vital organs are at risk due to
Inadequate Blood Flow
Extracellular water shifts to the interstitial space
This all causes poor blood flow to the tissues, decreased cardiac output and lower body temperature
During Stress the body's goal is _________. During Starvation the body's goal is __________.
Survival (at all costs for acutely increased energy needs).
Preservation (for future energy needs)
Protein requirements in the metabolically stressed patient are
1.2-2g/kg
Clinicians should use this kind f weight when estimating energy needs
Dry weight
This type of feeding is common in the hospital setting or when feeding into the small bowel
Continuous
The second phase of the Inflammatory Response is called the Flow Phase. Another name for this phase is the ______________
HYPERmetabolic Phase and can last for months to weeks post-injury as recovery takes place
Hyperglycemia is seen due to gluconeogenesis and _________
Insulin resistance.
"stress hyperglycemia" induces increased insulin production but there is a relative insulin insufficiency related to increased glucose production
Using gas exchange, this method to measure resting energy expenditure
Indirect Calorimetry
The use of this serum protein marker is not rececommended
Albumin or Prealbumin
This type of feeding is delivered in a short period of time into the stomach a number of times per day
Bolus feeding
Preservation of critical organs is prioritized at the expense of ___________
Lean Body Mass (LBM)
The primary source of the needed amino acids during this state is ____________
Skeletal muscle (or lean body mass), despite the provision of dietary protein that nutrition may provide.
Underfeeding a patient can cause one of these problems
malnutrition, prolonged stay, impaired immune function, delayed healing
Ideally nutrition support is initiated within this time period
24-72 hours after admission (1-3days)
There are several disease specific enteral formulas.
Terms that describe a formula that is best for metabolic stress include:
High in protein
Includes arginine and glutamine
Immune enhancing
Contains omega 3 fatty acids or MCT oil