nhhc chapter 16 ppt

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition inMetabolic andRespiratory Stress

Chapter 16

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Introduction

• Metabolic stress– Disruption in the body’s chemical environment

due to the effects of disease or injury• Respiratory stress

– Characterized by inadequate oxygen and excessive carbon dioxide in the blood and tissues

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

The Body’s Responses to Stress and Injury• Stress response

– Body’s nonspecific response to a variety of stressors

• Energy nutrients: mobilized from storage• Heart rate and respiration (breathing rate) increase• Blood pressure rises• Energy diverted from processes that are not life

sustaining

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

The Body’s Responses to Stress and Injury (cont’d.)• Hormonal responses to stress

– Hormones released into the blood: soon after the injury occurs

– Catecholamines• Fight-or-flight hormones: epinephrine and

norepinephrine– Glucagon

• Causes release of nutrients from storage

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The Body’s Responses to Stress and Injury (cont’d.)• Hormonal responses to stress

– Cortisol• Enhances muscle protein degradation

– Aldosterone• Stimulates kidneys to reabsorb more sodium

– Antidiuretic hormone• Stimulates kidneys to reabsorb more water

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

The Body’s Responses to Stress and Injury (cont’d.)• The inflammatory response

– Immune system’s nonspecific response to infection or tissue injury

– Purpose• Contain and destroy infectious agents (and their

products)• Prevent further tissue damage

– What are classic signs of inflammation?

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

The Body’s Responses to Stress and Injury (cont’d.)• The inflammatory response

– Mediators: assist in regulating inflammatory process

• Histamine: released from granules within mast cells, causing vasodilation and capillary permeability

• Cytokines: produced by white blood cells (and some other types of cells)

• Eicosanoids: derived from dietary fatty acids

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

The Body’s Responses to Stress and Injury (cont’d.)• The inflammatory response

– Systemic effects of inflammation: acute-phase response

• Liver: increases production of acute-phase proteins (C-reactive protein, complement, hepcidin, fibrinogen, prothrombin, etc.)

• Plasma concentrations: albumin, iron, and zinc levels fall

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

The Body’s Responses to Stress and Injury (cont’d.)• The inflammatory response

– Systemic effects of inflammation: acute-phase response

• Muscle catabolism: makes amino acids available for glucose production, tissue repair, etc.

• Systemic inflammatory response syndrome (SIRS): raised heart and respiratory rates, abnormal white blood cell counts, and fever

• What is the condition known as shock?

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Nutrition Treatment of Acute Stress

• Initial treatments– Administer intravenous solutions– Treat infections, repair wounds, drain

abscesses, and remove dead tissue (debridement)

– Following stabilization• Provide nutrient assessment and nutrient therapy

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Nutrition Treatment of Acute Stress (cont’d.)• Determining nutritional requirements

– Principle goals of nutrition therapy• Preserve lean (muscle) tissue• Maintain immune defenses• Promote healing

– What are complicating factors in assessing the nutritional needs of an acutely stressed patient?

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition Treatment of Acute Stress (cont’d.)

• Determining nutritional requirements– Estimating energy needs for acute stress

• One method: multiply the resting metabolic rate (RMR) by a stress factor (Table 16-2)

• Example: equations for estimating energy needs in ventilator-dependent critical care patients (Table 16-3)

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition Treatment of Acute Stress (cont’d.)

• Determining nutritional requirements– Estimating energy needs for acute stress

• Quick method: multiply a person’s body weight by a factor appropriate for the medical condition

– Protein requirements in acute stress• Nonobese critically ill patients: 1.2 to 2.0 grams per

kilogram body weight per day• Obese patients given hypocaloric feedings: 2.0 to

2.5 grams per kilogram ideal body weight per day

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition Treatment of Acute Stress (cont’d.)

• Determining nutritional requirements– Carbohydrate and fat intakes in acute stress

• Carbohydrates: generally 50 to 60 percent of total energy requirements

• Patients with severe hyperglycemia: fat may supply up to 50 percent of kcalories

– Micronutrient needs in acute stress• Specific requirements remain unknown

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition Treatment of Acute Stress (cont’d.)

• Nutrition care in acute stress– Initial care: simple intravenous solutions– Enteral feedings or parenteral feedings may

be required– Transition to oral feedings

• Take care to avoid overfeeding• Oral supplements often provided

• Case Study – Patient with a Severe Burn

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Nutrition and Respiratory Stress

• Chronic obstructive pulmonary disease (COPD)– Conditions characterized by the persistent

obstruction of airflow through the lungs– Main categories

• Chronic bronchitis: persistent inflammation and excessive mucus secretions in airways

• Emphysema: breakdown of elastic structure and destruction of walls of bronchioles and alveoli

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• COPD

– Associated with abnormal levels of oxygen and carbon dioxide in the blood

– Shortness of breath (dyspnea)– May lead to respiratory or heart failure

• Causes of COPD– Primary risk factor: smoking– Genetic factors

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Treatment of COPD

– Primary objectives • Prevent the disease from progressing• Relieve major symptoms (dyspnea and coughing)

– Recommendations• Quit smoking• Obtain flu and pneumonia vaccinations

– Bronchodilator medications; supplemental oxygen therapy in severe cases

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Nutrition therapy for COPD

– Main goals• Correct malnutrition• Promote the maintenance of a healthy body weight• Prevent muscle wasting

– Main focus of the nutrition care plan• Encourage adequate food intake

– Enteral formulas for COPD• Higher kcalories from fat; lower from carbohydrates

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Incorporating an exercise program

– Prevent or reverse muscle loss• Aerobic training• Resistance exercise

• Case Study – Elderly Man with Emphysema

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Nutrition and Respiratory Stress (cont’d.)• Respiratory failure

– Potentially life-threatening condition• Inadequate respiratory function impairs gas

exchange between the air and circulating blood: abnormal levels of tissue gases results

– What are possible causes of respiratory failure?

– Acute respiratory distress syndrome (ARDS)• Requires emergency care

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Respiratory failure consequences

– Severe hypoxemia: low O2 in blood

– Hypercapnia: excessive CO2 in blood

– Hypoxia: low O2 in tissues– Acidosis: acid accumulation in tissues– Cyanosis: bluish cast in the skin– Headache, confusion, and drowsiness– Heart arrhythmias and ultimately, coma

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Respiratory failure treatment

– Treatment plans vary considerably• Oxygen therapy via face mask or nasal tubing• Mechanical ventilation• Diuretics• Medications

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Nutrition therapy for respiratory failure

– Energy needs• 25 to 35 kilocalories per kilogram

– Protein needs• Mild or moderate lung injury: 1.0 to 1.5 grams of

protein per kilogram of body weight per day• ARDS patients: 1.5 to 2 grams of protein per

kilogram of body weight daily– Fluids: monitored to prevent imbalances

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Respiratory Stress (cont’d.)• Nutrition support in respiratory failure

– Patient unable to eat meals– Enteral feedings

• Intestinal feedings preferred over gastric feedings– Parenteral nutrition support

• May be considered