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FSHN 450-2critical

3 outcomes of acute care recover, die, chronic acute illness
what happens w/ continued low organ perfusion? anaerobic metabolism, acid build up
effect of stress on heart TNFa and Il1 impact cardiac function, and pulmonary resistance can result in right ventricular overload
effect of stress on liver bacteremia
PE are derived from arachadonic acid
Effects of underfeeding longer stay, nosocomial infections, increased duration of mechanical ventilation that can lead to loss of respiratory muscle strength
Effects of overfeeding stress organs, RQ>1, hypertriglyceridemia, hyperglycemia, n6 exacerbate inflammation
GIR glucose infusion rate, 5-7 mg/kg/min
Who is at highest risk for refeeding? malnourished, low BMI, weight loss
Energy critically ill 25-30 kcal/kg/day
PN should provide no more than___ kcal/kg 25
Kcal/day high risk for re-feeding 10
Kcal/day moderate risk for re-feeding 20
Energy to use in critically ill Penn State 2003b or 2010 if obese (need Tmax and Ve)
Permissive underfeeding 11-14 kcal/kg actual weight
Which equation- adult wt management Mifflin
Which equation- chronic kidney disease 23-35
Which equation- AKI w/ CRRT 25-30
Which equation- critically ill non obese/old obese penn state 2003b
Which equation- critically ill obese
Which equation- critically ill ventilated penn state or ireton jones
Which equation- heart failure Mifflin or harris benedict
Which equation- cancer harris benedict
Which equation- unintended weight loss 25-35 kcal/kg
Surgery protein 1.5-2
Traumatic brain injury protein 1.5-2.2
Acute spinal cord injury protein 2
Protein class I/II obese 2.0 ideal
Protein class III obese 2.5 ideal
AKI protein 1.5-2 dry weight (fluid retention makes bmi useless)
Hyperglycemia 140-180 mg/dL w/ insulin drip
4 factors affecting severity of burns thickness, extent, location, complicating factors (DM, age, lung/heart disease)
major burns >30 BSAB, high risk, electrical burns
minor burns <10 BSAB
energy kids burns 1.3-1.4 EE
energy adults burns 1.2-1.3 EE (35-45 kcal/kg)
Curreri formula multiplies 40kcal by BSAB (up to 50%)
Galveston formula for children burn patients
Curreri junior changes w/ age
Protein <10% BSAB 1.2g/kg/day
Protein >10% BSAB 1.5-2.0g/kg/day
Protein burn kids 0-6 3-4.5g/kg/day
Protein burns kids >6 2.5-3g/kg/day
Carbohydrate burns 40-60% kcal, but can’t exceed 5-7mg/kg/min
Fat burns <30%, <5% n-6
Zinc burn patients often deficient, supplements (but can interfere w/ Cu)
What minerals to monitor w/ burns electrolytes (Na, Mg, K, P)
Mg burns losses through skin are significant
Na burns increased losses w/ silver nitrate treatment
Major burns vitamins multivitamin + vitamin C and vitamin A
Created by: melaniebeale



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