NHHC chapter 16 ppt
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Transcript of NHHC chapter 16 ppt
![Page 1: NHHC chapter 16 ppt](https://reader036.fdocuments.us/reader036/viewer/2022062523/58a2620e1a28abb92b8b596b/html5/thumbnails/1.jpg)
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition inMetabolic andRespiratory Stress
Chapter 16
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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
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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
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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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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
– Cortisol• Enhances muscle protein degradation
– Aldosterone• Stimulates kidneys to reabsorb more sodium
– Antidiuretic hormone• Stimulates kidneys to reabsorb more water
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Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
![Page 7: NHHC chapter 16 ppt](https://reader036.fdocuments.us/reader036/viewer/2022062523/58a2620e1a28abb92b8b596b/html5/thumbnails/7.jpg)
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?
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Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
![Page 9: NHHC chapter 16 ppt](https://reader036.fdocuments.us/reader036/viewer/2022062523/58a2620e1a28abb92b8b596b/html5/thumbnails/9.jpg)
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
![Page 10: NHHC chapter 16 ppt](https://reader036.fdocuments.us/reader036/viewer/2022062523/58a2620e1a28abb92b8b596b/html5/thumbnails/10.jpg)
Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
![Page 11: NHHC chapter 16 ppt](https://reader036.fdocuments.us/reader036/viewer/2022062523/58a2620e1a28abb92b8b596b/html5/thumbnails/11.jpg)
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
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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
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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 for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
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 for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
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?
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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)
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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
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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
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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 for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
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
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Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
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Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
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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
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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
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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
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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 for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
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
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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
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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
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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
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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