MNT goals in the ICU (3) correct answers Preserve lean body mass
Maintain immune function
Prevent metabolic complications
Metabolic Stress
1. Termed the? How does it work?
2. Degree of stress correlates to? Ex? correct answers 1. "Flight or Fight" response - Body attempts to mobilize the ...
MNT goals in the ICU (3) correct answers Preserve lean body mass
Maintain immune function
Prevent metabolic complications
Metabolic Stress
1. Termed the? How does it work?
2. Degree of stress correlates to? Ex? correct answers 1. "Flight or Fight" response -
Body attempts to mobilize the immune system to prevent further injury, support for
healing
2. severity of injury - Motor vehicle accidents (MVA), gun shot wounds (GSW), falls,
drowning, stabbing, burns, severe pancreatitis, cancer, sepsis
3 Phases of Metabolic Stress correct answers 1. "Ebb phase"
2-48 hrs
Shock, hypovolemia (low fluid V), hypo perfusion
2. "Flow phase" - People begin to stabilize here
7-10 days
Stabilization, metabolic response
3. "Recovery phase"
Can last for months
Return to anabolism
Starvation vs Metabolic Stress correct answers Starvation
↓BMR
Lipids for fuel
Preserves lean body mass (LBM)
Metabolic Stress
↑ BMR
Protein for fuel:
↑ glucagon and cortisol -> ↑ gluconeogenesis
- Alanine and glutamine (used to produce more glucose)
↑ epinephrine + norepinephrine ->↑ glycogenolysis
Hyperglycemia - Critically ill blood sugar levels are more like 140 - 180
Consequences of Metabolic Stress (4) correct answers 1. Hypermetabolism and
catabolism
- ↑ glucagon, cortisol, epinephrine, norepinephrine
2. Hyperglycemia
Cannot use albumin/pre-albumin to test nutritional status of critically ill pt, not relevant,
levels expected to be low
Nutrition Assessment
1. What needs to be determined?
2. What part of ABCD's used?
3. Labs? correct answers 1. Determine nutrition status pre-injury
- Often difficult in ICU setting
2. Anthropometrics
Weight: Current, ideal, or adjusted weight for obese
3. Labs
Hgb/Hct, lytes, glucose, WBC, BUN, creat, LFTs
- Use with caution
- Acute phase response
4. Daily intake/output
5. GI function - Abdomen (soft vs firm, do not want firm)), BMs; GRV
6. Hemodynamic stability
- Systolic blood pressure > 80 mmHg
- Mean arterial pressure (MAP) > 60 (avg pressure in pt's arteries)
- Cardiac index > 2.5 L/min (amt of blood ejected by LV in 1 minute)
- HOB >30-45 degrees (Prevent aspiration of tube feeds going into lungs)
Do not have to wait for BM to start tube feeds
ASPEN guidelines re gastric residuals correct answers ASPEN guidelines recommend
NOT checking gastric residual volumes, if you do, should not hold tube feeds if <500
Nutrition Assessment
1. Medications
2. Vent settings
3. Skin breakdowns/wounds correct answers 1. Medications
- Vasopressors = antihypotensive agents (bring UP BP)
-- E.g. Epinephrine, Phenylephrine, Dopamine, Dobutamine
- Sedatives
-- E.g. Propofol, Fentanyl
Propofol - 1.1kcal/mL - take calories into consideration for tube feeds
2. Vent settings
- Fraction of inspired oxygen (FiO2) <60 %
FiO2 - % of Oxygen pt is inhaling, can go up to 100 but we would like it to be <60, too
much CO2 could mean overfeeding but not always
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