FSHN 450-2critical
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| 3 outcomes of acute care | recover, die, chronic acute illness
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| what happens w/ continued low organ perfusion? | anaerobic metabolism, acid build up
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| effect of stress on heart | TNFa and Il1 impact cardiac function, and pulmonary resistance can result in right ventricular overload
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| effect of stress on liver | bacteremia
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| PE are derived from | arachadonic acid
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| Effects of underfeeding | longer stay, nosocomial infections, increased duration of mechanical ventilation that can lead to loss of respiratory muscle strength
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| Effects of overfeeding | stress organs, RQ>1, hypertriglyceridemia, hyperglycemia, n6 exacerbate inflammation
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| GIR | glucose infusion rate, 5-7 mg/kg/min
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| Who is at highest risk for refeeding? | malnourished, low BMI, weight loss
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| Energy critically ill | 25-30 kcal/kg/day
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| PN should provide no more than___ kcal/kg | 25
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| Kcal/day high risk for re-feeding | 10
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| Kcal/day moderate risk for re-feeding | 20
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| Energy to use in critically ill | Penn State 2003b or 2010 if obese (need Tmax and Ve)
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| Permissive underfeeding | 11-14 kcal/kg actual weight
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| Which equation- adult wt management | Mifflin
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| Which equation- chronic kidney disease | 23-35
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| Which equation- AKI w/ CRRT | 25-30
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| Which equation- critically ill non obese/old obese | penn state 2003b
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| Which equation- critically ill obese |
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| Which equation- critically ill ventilated | penn state or ireton jones
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| Which equation- heart failure | Mifflin or harris benedict
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| Which equation- cancer | harris benedict
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| Which equation- unintended weight loss | 25-35 kcal/kg
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| Surgery protein | 1.5-2
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| Traumatic brain injury protein | 1.5-2.2
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| Acute spinal cord injury protein | 2
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| Protein class I/II obese | 2.0 ideal
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| Protein class III obese | 2.5 ideal
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| AKI protein | 1.5-2 dry weight (fluid retention makes bmi useless)
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| Hyperglycemia | 140-180 mg/dL w/ insulin drip
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| 4 factors affecting severity of burns | thickness, extent, location, complicating factors (DM, age, lung/heart disease)
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| major burns | >30 BSAB, high risk, electrical burns
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| minor burns | <10 BSAB
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| energy kids burns | 1.3-1.4 EE
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| energy adults burns | 1.2-1.3 EE (35-45 kcal/kg)
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| Curreri formula | multiplies 40kcal by BSAB (up to 50%)
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| Galveston formula | for children burn patients
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| Curreri junior | changes w/ age
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| Protein <10% BSAB | 1.2g/kg/day
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| Protein >10% BSAB | 1.5-2.0g/kg/day
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| Protein burn kids 0-6 | 3-4.5g/kg/day
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| Protein burns kids >6 | 2.5-3g/kg/day
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| Carbohydrate burns | 40-60% kcal, but can’t exceed 5-7mg/kg/min
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| Fat burns | <30%, <5% n-6
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| Zinc burn patients | often deficient, supplements (but can interfere w/ Cu)
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| What minerals to monitor w/ burns | electrolytes (Na, Mg, K, P)
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| Mg burns | losses through skin are significant
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| Na burns | increased losses w/ silver nitrate treatment
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| Major burns vitamins | multivitamin + vitamin C and vitamin A
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