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Download Chpt 16 - Nutrition and Respiratory Stress
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Chapter 16 Nutrition in Metabolic & Respiratory Stress © 2007 Thomson - Wadsworth Body’s Response to Stress & Injury • Stress response Infection Burns Fractures Surgery Extensive bleeding • Body focuses on immediate survival • Nutrients are mobilized from storage • Heart rate and respiration increase • Blood pressure rises © 2007 Thomson - Wadsworth Hormonal Response to Stress • Epinephrine & norepinephrine • Cortisol Enhances protein degradation Stimulate heart muscle • Aldosterone & Alter blood flow rate antidiuretic hormone Raise basal Help maintain blood metabolism volume • Glucagon Stimulate kidneys to reabsorb sodium & Releases nutrients water from storage © 2007 Thomson - Wadsworth The Inflammatory Response • Serves to • Classic signs Contain & destroy infectious agents Prevent further tissue damage • Dilation of arterioles • Constriction of venules Swelling Redness Heat Pain © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Nutrition Treatment • Problems • Diet goals Hypermetabolism & negative nitrogen balance • Wasting Hyperglycemia & insulin resistance • Increases infection risk Preserve lean tissues Maintain immune defenses Promote healing • Need to balance overfeeding & underfeeding © 2007 Thomson - Wadsworth Estimating Requirements • Energy Harris-Benedict equation (BEE) • Protein 1.0-2.0 g/kg • Carbohydrates: 70% of kcalories • Lipids: 40% of kcalories • Vitamins & minerals May have increased needs © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Approaches to Nutrition Care • Initial care: maintain fluid & electrolyte balance • May need enteral and/or parenteral support • High-kcalorie, high-protein diet Take care not to overfeed Reassess frequently © 2007 Thomson - Wadsworth Nutrition & Respiratory Stress • Respiratory stress Reduced oxygen Increased carbon dioxide • Labored breathing Interferes with food intake Weight loss & malnutrition © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Chronic Obstructive Pulmonary Disease (COPD) © 2007 Thomson - Wadsworth Chronic Obstructive Pulmonary Disease (COPD) • Persistent obstruction of airflow Chronic bronchitis • Excessive mucus secretions • Productive cough Emphysema • Breakdown of lung’s elastic structure • Dyspnea • Causes Smoking Chronic respiratory infections Occupational exposure to dusts or chemicals Genetic susceptibility • Goals Improve food intake Maintain healthy weight Prevent muscle loss Improve exercise endurance © 2007 Thomson - Wadsworth Treatment • Small, frequent meals • Adequate fluids • Liquid supplements • Exercise plan © 2007 Thomson - Wadsworth Respiratory Failure • Gas exchange between air & blood is greatly impaired • Consequences Hypoxemia Hypercapnia Hypoxia Acidosis Cyanosis • Causes Obstruction Weakness or paralysis of muscles Embolus Toxic substances Severe trauma & infection © 2007 Thomson - Wadsworth Treatment • Support lung function • Correct underlying disorder • Careful monitoring of fluid • Medications © 2007 Thomson - Wadsworth Treatment • Chronic lung disease Oxygen therapy • Acute respiratory distress syndrome (ARDS) Mechanical ventilation © 2007 Thomson - Wadsworth Nutrition Care • Individualize according to patient’s condition • Enough energy & protein to support lung function without overtaxing the respiratory system © 2007 Thomson - Wadsworth Nutrition in Practice Multiple Organ Failure © 2007 Thomson - Wadsworth Multiple Organ Failure • Cause of death in ½ of ICU patients • A failure of two or more organ systems • Chemical mediators can cause systematic response syndrome (SIRS), leading to shock & organ failure • Organs Lungs Liver Kidneys GI tract • Causes Acute respiratory failure Trauma Sepsis Burns Extensive surgery Pancreatitis © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Risk Factors • Age over 55 • Prior chronic illness • Persistent SIRS • Major infection • Blood transfusions • Severity of tissue injury • Length of time between injury & arrival at hospital • Malnutrition © 2007 Thomson - Wadsworth Treatment • Mechanical ventilation • Fluid & electrolytes • Medications to sustain or increase cardiac output & blood pressure • Hemofiltration or dialysis • Antibiotic therapy for infection • Enteral & parenteral nutrition © 2007 Thomson - Wadsworth
