Updates

1
Updates

• Review of Test 5
• Updated Syllabus
• The Renal group is coming 11/15
• Group Discussion

2
Ch. 27 Energy- and Protein-Modified Diets for
Acute Stress

• Stress Any threat to a persons physiological
  or psychological well-bring
• Physiological Stress stresses that fall within
  bodys normal and healthy functioning
• Severe/Acute Stress Pathological (caused by
  injury or disease) disruptions that lie beyond
  bodys normal and healthy functioning

3
Responses to Acute Stress

• Describe bodys immune and hormonal responses to
  stress and its symptoms
• Immune system responses
• Protects from spread of infection
• Sepsis in blood streamcan affect blood flow to
  organresulting in failure shock

4
Responses to Stress

• Hormonal Changes
• Metabolic rate rises
• Hyperglycemia and Negative N Balance
• Water sodium retained
• Potassium excreted
• Effect of Stress on GI Tract
• Reduction of blood flow
• GI tract motility reduced
• Stomach affected by gastric juices (ulcers)

5
Inflammatory Response
6
Responses to Stress

• Effect of hypermetabolic illness on nutritional
  status/malnutrition/organs
• Effects of stress on Nutritional Status
• Energy Protein Stores
• Protein isnt stored like fat and carbs
• Loss of vital protein
• Immune system, GI and immune system

7
Responses to Stress

• Acute Malnutrition
• Causes of Malnutrition Associated with Severe
  StressTable 27-2, p. 689
• Immune system compromised
• Organ failure including heart, lungs, kidneys,
  and GI Tract

8
Nutrition Therapy for Acute Stress

• Immediate Responses by Health Care team to
  Hypermetabolic Reactions
• Nutritional Goals in Response to Hypermetabolism
• Minimize nutrient losses
• Preserve organ function
• Maintain immune defenses

9
Affect of Acute Stress on Nutritional Needs

• Feeding the acutely stresseda challenge
• Underfeeding
• Increases risk of infection
• Delays healing
• Compromises lungs
• Refeeding Syndrome
• Malabsorption
• Cardiac insufficiency CHF
• Renal function compromise
• Respiratory distress

10
Refeeding Syndrome

• Those most at risk
• Chronic malnutrition
• Anorexia Nervosa
• Chronic alcohol abuse
• Little nutritional support for a week or more

11
Fluids and Electrolytes

• Necessary for efficient use of nutrients and
  medications unable to e delivered to cells,
  affecting organs
• Fluids
• Closely monitored to prevent stress on heart and
  kidneys
• BP, HR, Urinary output, and body temperature
  closely monitored
• Electrolyte Replacement Monitoring

12
Nutrient Needs

• Determine energy and protein needs during severe
  stress
• Metabolic Carts vs. Harris Benedict
• Stress raises energy needs
• Too much support raises metabolic rate
• Increases CO2 production
• Stress on heart and lungs
• Fatty liver
• Tailor macro micro-nutrient needs

13
Review Questions

• Which of the following is not a function of the
  kidneys?
• A. Help regulate blood pressure
• B. Produce erythropoietin
• C. Convert vitamin K to its active form
• C. Maintain acid-base balance
• Answer is C

14
Review Questions

• Which of the following fluids may actually raise
  the likelihood of kidney stone formation?
• A. Wine
• B. Grapefruit juice
• C. Tea
• D. Coffee
• Answer is B

15
Review Questions

• Phosphorus appears in many foods that are also
  high in ______
• A. Protein
• B. Carbohydrate
• C. Vitamin C
• D. Sugar
• Answer is A

16
Review Questions

• One of the first body organ systems affected by
  the stress response is the
• A. Kidneys
• B. Liver
• C. GI tract
• D. None of the above
• Answer is C

17
Review Questions

• All of the following are examples of pathological
  stresses except
• A. Surgery
• B. Burns
• C. Taking a test
• D. Uncontrolled infections
• Answer should be C