© 2007 Thomson - Wadsworth
Body’s Response to Stress & Injury
• Stress response InfectionBurnsFracturesSurgeryExtensive 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 & norepinephrineStimulate heart
muscleAlter blood flow rateRaise basal
metabolism
• GlucagonReleases nutrients
from storage
• Cortisol Enhances protein
degradation
• Aldosterone & antidiuretic hormoneHelp maintain blood
volumeStimulate kidneys to
reabsorb sodium & water
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The Inflammatory Response
• Serves toContain & destroy
infectious agentsPrevent further
tissue damage
• Dilation of arterioles• Constriction of
venules
• Classic signsSwellingRednessHeatPain
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Nutrition Treatment
• ProblemsHypermetabolism &
negative nitrogen balance
• Wasting
Hyperglycemia & insulin resistance
• Increases infection risk
• Diet goalsPreserve lean tissuesMaintain immune
defensesPromote healing
• Need to balance overfeeding & underfeeding
© 2007 Thomson - Wadsworth
Estimating Requirements
• EnergyHarris-Benedict
equation (BEE)
• Protein1.0-2.0 g/kg
• Carbohydrates: 70% of kcalories
• Lipids: 40% of kcalories
• Vitamins & mineralsMay have
increased needs
© 2007 Thomson - Wadsworth
Approaches to Nutrition Care
• Initial care: maintain fluid & electrolyte balance
• May need enteral and/or parenteral support
• High-kcalorie, high-protein dietTake care not to overfeedReassess frequently
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Nutrition & Respiratory Stress
• Respiratory stressReduced oxygenIncreased carbon
dioxide• Labored breathing
Interferes with food intake
Weight loss & malnutrition
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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
• ConsequencesHypoxemiaHypercapnia HypoxiaAcidosisCyanosis
• CausesObstruction Weakness or
paralysis of musclesEmbolusToxic substancesSevere trauma &
infection
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Treatment
• Support lung function• Correct underlying disorder• Careful monitoring of fluid• Medications
© 2007 Thomson - Wadsworth
Treatment
• Chronic lung diseaseOxygen 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
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
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