1. © 2007 Thomson - Wadsworth Chapter 16 Nutrition in Metabolic & Respiratory Stress

2. © 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

3. © 2007 Thomson - Wadsworth Hormonal Response to Stress Epinephrine & norepinephrine Stimulate heart muscle Alter blood flow rate Raise basal metabolism Glucagon Releases nutrients from storage Cortisol Enhances protein degradation Aldosterone & antidiuretic hormone Help maintain blood volume Stimulate kidneys to reabsorb sodium & water

4. © 2007 Thomson - Wadsworth The Inflammatory Response Serves to Contain & destroy infectious agents Prevent further tissue damage Dilation of arterioles Constriction of venules Classic signs Swelling Redness Heat Pain

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6. Nutrition Treatment Problems Hypermetabolism & negative nitrogen balance Wasting Hyperglycemia & insulin resistance Increases infection risk Diet goals Preserve lean tissues Maintain immune defenses Promote healing Need to balance overfeeding & underfeeding

7. © 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

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9. 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

10. © 2007 Thomson - Wadsworth Nutrition & Respiratory Stress Respiratory stress Reduced oxygen Increased carbon dioxide Labored breathing Interferes with food intake Weight loss & malnutrition

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12. Chronic Obstructive Pulmonary Disease (COPD)

13. © 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

14. © 2007 Thomson - Wadsworth Treatment Small, frequent meals Adequate fluids Liquid supplements Exercise plan

15. © 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

16. © 2007 Thomson - Wadsworth Treatment Support lung function Correct underlying disorder Careful monitoring of fluid Medications

17. © 2007 Thomson - Wadsworth Treatment Chronic lung disease Oxygen therapy Acute respiratory distress syndrome (ARDS) Mechanical ventilation

18. © 2007 Thomson - Wadsworth Nutrition Care Individualize according to patient’s condition Enough energy & protein to support lung function without overtaxing the respiratory system

19. © 2007 Thomson - Wadsworth Nutrition in Practice Multiple Organ Failure

20. © 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

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23. 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

24. © 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