Crtical Care

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Wafa

Cards (50)

  • Nutrition

    The process of taking in food and using it for growth, metabolism, and repair
  • Nutritional stages

    1. Ingestion
    2. Digestion
    3. Absorption
    4. Transport
    5. Assimilation
    6. Excretion,,,,• Factors suggest the need for a period of bowel rest rather than persisting with feeding and addition of prokinetics.
    Increasing Abdominal Distension Pain/Discomfort
    Large Gastric Aspirates Diarrhea
  • Nutritional solutions

    A nourishing substance delivered to hospitalized patients via an IV or I/G tube,The six main nutrients are Vitamins, minerals, protein, fats, water, and carbohydrates. • The WHO divide these nutrients into two categories:
    A. Micronutrients
    a. Vitamins
    b. Minerals
    • Although the body only needs small amounts of them, a deficiency can cause ill health.
    B. Macronutrients
    a. Water
    b. Carbohydrates c. Protein
    d. Fats
    • Macronutrients are nutrients that a person needs in larger amounts.
  • • Enteral feeding providesMore complete diet than parenteral nutrition Maintains structural integrity of the gut Improves bowel adaptation after resectionReduces infection risk.
    • Routes include Nasogastric Nasoduodenal/ Nasojejunal  Gastrostomy Jejunostomy
  • Management of enteral nutrition

    1. Start 30ml/h full strength standard feed immediately
    2. After 4h, stop for 30min prior to aspiration of the stomach
    3. Acceptable aspirate of <200mL as evidence of gastric emptying
    4. Increase the infusion rate to 60mL/h
    5. Repeat process until target feed rate is achieved
  • Management of enteral nutrition

    1. Start 30ml/h full strength standard feed immediately
    2. After 4h, stop for 30min prior to aspiration of the stomach
    3. Acceptable aspirate of <200mL as evidence of gastric emptying
    4. Increase the infusion rate to 60mL/h
    5. Repeat until target feed rate is achieved
    6. Thereafter, aspiration of the stomach can be reduced to 8-hourly
  • Aspiration of the stomach
    Reduce to 8-hourly after target feed rate is achieved
  • If gastric aspirate volume >200mL

    • Do not increase infusion rate, though feed is continued
    • Consider either prokinetics (e.g. metoclopramide, erythromycin)
  • If not gastric empty, do not increase infusion
  • If gastric aspirate volume >200mL

    The infusion rate is not increased though feed is continued
  • Consider

    Prokinetics (e.g. metoclopramide, erythromycin)
  • If not gastric empty, do not increase infusion
  • Nutrition

    The process of taking in food and using it for growth, metabolism, and repair
  • Nutritional stages

    • Ingestion
    • Digestion
    • Absorption
    • Transport
    • Assimilation
    • Excretion
  • Nutritional solutions

    A nourishing substance delivered to hospitalized patients via an IV or I/G tube
  • Benefits of nutrition

    • Improves wound healing
    • Restore immune competence
    • Decrease mortality
    • Decrease hospital stay
  • Nutrient

    A substance used by an organism to survive, grow, and reproduce
  • Balanced diet

    A diet that contains differing kinds of foods in certain quantities and proportions so that the requirement for calories, proteins, minerals, vitamins and alternative nutrients is adequate and a small provision is reserved for additional nutrients to endure the short length of leanness
  • Main nutrients

    • Vitamins
    • Minerals
    • Protein
    • Fats
    • Water
    • Carbohydrates
  • Micronutrients

    • Vitamins
    • Minerals
  • Macronutrients

    • Water
    • Carbohydrates
    • Protein
    • Fats
  • Malnutrition

    A serious condition that happens when your diet does not contain the right amount of nutrients. It means "poor nutrition" and can refer to undernutrition (not getting enough nutrients) or over-nutrition (getting more nutrients than needed)
  • Effects of malnutrition

    • Increased risk of infection due to immune compromise, increased fatigability and inability to wean/mobilize due to loss of muscle bulk, poor wound healing
  • Essential nutrient

    A nutrient required for normal physiological function that cannot be synthesized in the body – either at all or in sufficient quantities – and thus must be obtained from a dietary source
  • Essential nutrients

    • Amino acids (8-10)
    • Fatty acids (2)
    • Vitamins (13)
    • Minerals (16)
  • Calories

    A measure of how much energy food or drink contains. The amount of energy you need will depend on age, lifestyle, and size
  • A simple and practical approach assumes that patients require 25 to 30 kcal/kg daily
  • Calorie content of macronutrients
    • Carbohydrates: 4 kcal/g
    • Proteins: 4 kcal/g
    • Fats: 9 kcal/g
  • Normal daily requirements (for a 70kg adult): 25–30 kcal/kg/day total energy, 5 gm/kg/day carbohydrate, 0.8–1.5 g protein (0.13–0.24 g nitrogen)/kg/day, 30–35 ml fluid/kg/day, 20% to 35% of total calories from fat
  • Stress factor

    • Mild illness: 1 – 1.25
    • Moderate illness: 1.25 – 1.50
    • Severe illness: 1.50 – 1.75
  • Factors suggesting need for bowel rest
    • Increasing abdominal distension
    • Pain/discomfort
    • Large gastric aspirates
    • Diarrhea
  • Enteral nutrition

    Indicated when swallowing is inadequate or impossible but GI function is otherwise intact
  • Parenteral nutrition

    Indicated when the GI tract cannot be used to provide adequate nutritional support, e.g. obstruction, ileus, high small bowel fistula, or malabsorption
  • Parenteral nutrition may be used to supplement enteral nutrition
  • Benefits of enteral nutrition

    • Provides more complete diet than parenteral nutrition
    • Maintains structural integrity of the gut
    • Improves bowel adaptation after resection
    • Reduces infection risk
  • Enteral feeding routes

    • Nasogastric
    • Nasoduodenal/Nasojejunal
    • Gastrostomy
    • Jejunostomy
  • Management of enteral nutrition
    1. Start with 30ml/h full strength standard feed
    2. Stop for 30min prior to aspiration of the stomach
    3. Acceptable aspirate of <200mL as evidence of gastric emptying
    4. Increase the infusion rate to 60mL/h
    5. Repeat until target feed rate is achieved
    6. Thereafter, aspirate the stomach 8-hourly
    7. If gastric aspirate volume >200mL, do not increase infusion rate though feed is continued
    8. Consider prokinetics if gastric emptying is poor
  • Complications of enteral nutrition
    • Tube misplacement
    • Reflux
    • Pulmonary aspiration
    • Nausea and vomiting
    • Abdominal distension
    • Refeeding syndrome
    • Diarrhea
    • Constipation
    • Metabolic (dehydration, hyperglycemia, electrolyte imbalance)
  • Central venous parenteral feeding route

    A dedicated catheter (or lumen of a multi-lumen catheter) is placed under sterile conditions. Allows infusion of hyperosmolar solutions, providing adequate energy intake in reduced volume.
  • Peripheral venous parenteral feeding route
    Requires a solution with osmolality < 800mOsm/kg. Either the volume must be increased or the energy content (particularly from carbohydrate) reduced. Peripheral cannula sites must be changed frequently.