Critical Care Study Guide

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Anonymous
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269105
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Critical Care Study Guide
Updated:
2014-04-03 20:04:31
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Critical Care Study Guide
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  1. what are the 4 general guidelines for timing of ICU EN?
    • -MAP is <60
    • -Cardiac Index is <2.2 L/min/m2
    • -Pt is needing to have increased vasoactive or inotropic agents, or if they have maxed out (dobutamine, dopamine, norepinephrine, epinephrine, vasopressin)
    • -AVO2d (arterial-venous oxygen difference) is >5
  2. What are the vasoactive and inotropic agents that must be analyzed to determine if ICU EN is ok?
    dobutamine, dopamine, norepinephrine, epinephrine, vasopressin
  3. What is AVO2d and what do the numbers mean?
    • diff b/w the O2 content on the arterial side vs the venous side.
    • Greater the #, greater the extraction of O2 from the blood; if elevated, it means that delivery of O2 cannot keep up with O2 needs, or b/c body doesn't have adequate delivery
  4. Can We Feed: describe in general what it is
    • -Helps in initiating early EN in the ICU to determine appropriate
    • intervention of nutrition therapy by considering critical illness severity,
    • age, nutrition risk screening, wait for resuscitation, determine energy
    • requirements, formula, EN access, efficacy, & determining tolerance
  5. Altered GI motility:  what are 3 problems that pts may have in ICU?
    -Delayed gastric emptying, especially common in mechanically ventilated pts

    -Post-operative ileus (often due to hypoxia, hypoperfusion-maybe due to electrolyte disturbance or dehydration)

    -Disturbance in the migrating motor complex (MMC) (often due to disorganization of duodenal & antrum waves, or opioids)
  6. PN in critically Ill:  indications (3)
    -massive small bowel resection with or without colonic resection


    -proximal high-output fistula or perforated small bowel

    -likely presence of symptoms for > 3-7 days:  severe diarrhea or emesis, substantial abdominal distention, partial or complete bowel obstruction, severe GI bleeding, severe hemodynamic instability
  7. PN in critically ill:  contraindications (5)
    • -adequate GI function with access for EN
    • -evidence that PN is unlikely to be needed > 5-7 days
    • -intolerance of the IV fluid load required for PN
    • -severe hyperglycemia
    • -severe electrolyte abnormalities on the planned day of PN
  8. CRRT nutrition requirements
    • -Kcal:  25-35 kcal/kg
    • -Protein:  1.5-2.0 g/kg
    • -Fluid & Na+:  normal amounts b/c dialysis
    • -Electrolytes: may need more Ca+ if citrate is being used as an anticoagulant; K+, Mg+, & P+ are also filtered
    • -Trace elements:  Zn, Cu, chromium, selenium are filtered out tho few studies done
    • -Vitamins: recommend renal multi tho few studies done
  9. Nut & Open Abdomen:  what is lost out of the open abdomen
    • -often in negative nitrogen balance
    • -lose fluid, electrolytes, and protein from exposed viscera
  10. ARDS:  what to feed ppl w/ARDS:  TF formula (____) and what nutrients does the article say people need
    • Oxepa
    • -Protein should be a priority: 2.0-2.5 g /kg; energy needs elevated up to 20% (In obese:  11-14 kcal/kg)
    • -In ICU, daily dose of 7.1-9.8 g omega-3’s (EPA and DHA)
    • -Enteral glutamine for burn, trauma, & ICU pts
    • -Antioxidants (A,C,E) and trace minerals
    • -Fluid restriction for resp failure pts
    • -Aggressive replacement of P+ in pts w/normal renal function
  11. inotropes
    agents that increase myocardial contractility
  12. dilatate blood vessels, which results in lower blood pressure
    ACE inhibitors
  13. lower bp and work by blocking the effects of the hormone epinephrine, also known as adrenaline
    beta-blockers
  14. causes vasoconstriction with diversion of blood flow away from the gut
    dopamine
  15. medications that tend to raise reduced blood pressure
    vasopressors
  16. decreases splanchnic blood flow, increases glucose
    epinephrine
  17. can decrease mucosal blood flow, increases glucose
    norepinephrine

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