Nutrition
complications and causes of malnutrition
edema, muscle wasting, impaired immunity, poor wound healing, fatigue
anorexia, drug induced, depression, catabolism, inability to eat due to dyspnea
what is the apnea hypopnea index (AHI)?
the number of apneas + hypopnea per hour of sleep
how would you identify the difference in OSA VS CSA on a polysom?
no air flow or respiratory effort - CSA
no airflow but there is respiratory effort - OSA
why is pneumonia a risk for pt's with malnutrition
weakened muscles , poor cough and secretion clearance.
anergy is most likely the result of
malnutritio
which of the following is considered when looking at a pt's nutritional needs
poverty, economic status, ability to take care of self, food pref, ignorance, lack of transportation, fatigue
dreaming occurs in which stage of sleep?
REM
risk factors for OSA
obesity, large tongue (macroglossia) thick neck, large tonsils, family hx/genetics, genes (male), daytime somnolence, use of depressants
hypersomnolence leads to
increased MVA, industrial accidents, poor work ethic/attendance
type of shock characterized by widespread vasodilation
distributive
a glucose diet yields a RQ of
1.0
name things a polysomnography test records/monitors
brain waves ( EEG/ sleep stages)
airflow
respiratory effort
oxygen
ekg
limb movement
this sleep disorder is recognized by rapid onset of REM sleep
narcolepsy
what is cleared from the kidneys that is a good indicator of renal function
creatinine
a pt has a PAP of 40/30 and a PCWP of 29, what are you concerned for this leading to
left side heart failure, pulmonary edema
this type of malnutrition is characterized by muscle wasting, unintentional weightloss, loss of appetite, increased metabolism
cachexia
the AHI is clinically significant enough for tx when it exceeds what number?
>15
most definitive tx of OSA
trach
this pulmonary disease produces a catabolic state, that results in weightless even when a normal amount of food is consumed
ephysema , copd
draw on the board a normal arterial waveform and a normal pulmonary artery pressure waveform
arterial more pointy like an 'A'
Pulmonary - more rounded
the gold standard for measuring metabolic needs is, is also used in icu to prevent over/under feeding
indirect calorimetry
restorative sleep happens during what stage of the sleep cycle
3-4
the most commonly reported sleep disorder
insomnia
what systemic effect does OSA have on the cardiovascular system?
increase risk of HTN, MI, CHF, arrhythmias, stroke, pulmonary HTN, etc
what is SVO2?
what does a decrease from 75% to 50% in svo2 indicate for oxygen consumption?
it is mixed venous oxygen concentration.
percentage of oxygen bound to HBG in the blood that is returning to right side of heart. it reflects the balance between oxygen delivery and oxygen consumption.
if low tissues are extracting a lot more oxygen
answer: a increase in oxygen consumption