HUN4445 Exam3 Critical Care

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bkheath
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184428
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HUN4445 Exam3 Critical Care
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2012-11-19 13:06:31
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HUN4445 Exam3 Critical Care
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HUN4445 Exam3 Critical Care
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  1. What are the biochemical and physiological
    pathways and characteristics of the initial hypovolemic ebb phase in the
    response to trauma and metabolic stress? (5)
    • (Everything is decreased)
    • ·      Decreased cardiac output
    • ·      Decreased O2 consumption
    • ·      Decreased blood pressure
    • ·      Decreased body temperature
    • ·      Decreased insulin:glucagon ratio
  2. What are the biochemical and physiological pathways and characteristics of the adaptive flow phase in the response to trauma and metabolic stress? (12)  metabolism, losses, secretions, releases
    • (Everything is increased)
    • Increased energy expenditure 
    • Increased glucose production
    • Increased net muscle catabolism
    • Increased lipolysis; limited ketosis
    • Hyperglycemia
    • Increased BCAA (branched chain amino acid) oxidation
    • Loss of LBM and negative N balance
    • Increased ureagenesis and elevated BUN
    • Increased urinary K+, P and Mg losses
    • Secretion of antidiuretic hormone and aldosterone (Na and H20 retention)
    • Secretion of ACTH, norepinephrine, epinephrine, glucagon and cortisol (increased metabolic rate, O2 consumption, body temperature)
    • Release of cytokines and production of acute phase proteins
  3. What are the characteristics of Multiple Organ Dysfunction Syndrome?
    Complication of sepsis and SIRS (systematic inflammatory response syndrome); altered function in 2 or more organs; (typically lungs are first to be affected, so pt is on ventilator; kidneys are also quickly affected-dialysis; if gets to heart, outcome is not good)
  4. What are possible (hypothesized) causes of Multiple Organ Dysfunction Syndrome? (3)
    • Macrophage hypothesis: due to prolonged SIRS caused by continual macrophage stimulation (macrophage themselves cause the failure)
    • Microcirculatory hypothesis:  caused by tissue and
    • cellular oxygen deprivation      
    • Gut hypothesis –gut bacteria are translocated to systemic circulation and sustain SIRS state; (GI tract cells become permeable, and get translocated to systemic circulation
    • where it shouldn’t be)
  5. Why should overfeeding be avoided in critically ill patients? (4)
    • §       Increases infection –hyperglycemia provides glucose (substrate) for bacteria to grow
    • §       Increases O2 consumption and CO2 production
    • §       Stresses heart and lungs 
    • §       Impairs glycemic control
  6. What
    are the impacts of prolonged immobility on patients? (2)
    • •       Calcium and nitrogen losses & further break down of muscle tissue
    • •       Kidney stone and pressure sore formation
  7. What are the calorie and protein needs of critically ill trauma and burn patients?
    • •       Energy Needs
    • ·       Perform indirect calorimetry
    • ·       General guideline: start with 1.5 as an injury factor and monitor response
    • ·       Multiple trauma, burns and sepsis may greatly 
    • increase calorie needs
    • ·       Obese patients:  permissive underfeeding
    • •       Protein Requirements
    • o      1.5-2.0 g/kg/d (in burn or closed head injury)
  8. GI response to stress (4)
    • Reduced blood flow to GI tract
    • Increased ulcer formation
    • Reduced motility-develop ileus
    • Reduced intestinal absorptive surface area and immune function

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