2. TRAUMA FROM MOTOR VEHICLE
ACCIDENTS,GUNSHOTS,WOUNDS,FALLS, AND
BURNS ARE MAJOR CAUSES OF DISABILITY AND
DEATH .
MAJOR CAUSES OF DEATH :
1. HEART DISEASE
2. CANCER
3. STROKE
4. CHRONIC LOWER RESPIRATORY DISEASE
5. UNINTENTIONAL INJURIES (METABOLIC STRESS)
4. STARVATION DIFFERENT WITH STRESS RELATEDTO OUR
METABOLIC
1. STARVASI
DECREASED ENERGY EXPENDITURE,DIMINISHED
GLUCONEOGENESIS,INCREASED KETONE
PRODUCTION,DECREASED UREAGENESIS
2. STRESS
ENERGY EXPENDITURE INCREASED,AS ARE
GLUCONEOGENESIS,PROTEOLISIS, AND UREAGENESIS
STARVATION :
1. EARLY STARVATION
2. ADAPTIVE STARVATION
3. LATE STARVATION
5. patient has a documented infection and
an identifiable organism. It’s toxins lead to a
strongeer inflammatory ressponse (they are :
viruses,fungi and parasites).
Therapy for these patients are :
1. Medical nutrition therapy
2. Nutrition Support therapy ( additional )
6. critically ill patient enters an intensive care
unit (ICU) cause of cardiopulmonary
diagnosis,intra-operative or post-operative
complication,multiple trauma,burn injury or
sepsis.
Severely injured patient is usually enable to
provide a dietary history.
Serum albumin should not be used as a marker
of nutritional status.
Prealbumin and transferin often drop
precipitiously inflammation induced
decrease in hepatic synthesis and changes.
7. Assesment focuses on the
preadmission,preoperative,preinjury
nutrition status,presence of any organ
system dysfunction,the need for early
support therapy , and optionsthat exist for
PN or EN.
When monitoring critically ill patients,one
must focus on laboratory data,not to define
or determine nutrition status but to design
the nutrition prescription.
8. Incorporates early EN when feasible,appropriate
macro and micronutrients delivery,and glycemic
control.
Goals :
1. Minimalization of starvation
2. Prevention or correction of spesific nutrient
deficiencies
3. Provision of adequate calories
4. Minimizing associated metabolic complications
5. Fluid and electrolyte management
6. Maintain adequate urine output and normal
homeostasis
7. Modulating immune response
9. Establishing hemodynamic stability
Important to :
a. Follow the patients heart rate
b. Blood pressure
c. Cardiac ouput
d. Mean arterial pressure
e. Oxygen saturation
These are key factors to asses hmodynamic
stability and whether nutrition support therapy
can commence. Dietitians must recognize the
significant contributions of dextrose in PN and
its influence on glycemic control.
10. 1. Energy
Oxygen consumption is an essential
component in the determination of energy
expenditure. Energy requirements may be
calculated as 25-30 kcal/kg/day.
Avoidance of overfeeding in the critically ill
patients is important.
Excess calories can result in complications.
11. Determination of protein requirements is
difficult for critically ill patients. Patients
typically requires 1,2-2 g/kg/day depending
on their baseline nutritional status,degree of
injury,metabolic demand, and abnormal
losses.
Excessive amounts of proteins will not
decrease the characteristic net.
12. No spesific guidelines exist.
Micronutrient needs are elevated during
acute illness.
Increased need for B vitamins,particularly
thiamin and niacin.
Fluids and electrolytes should be provid to
maintain adequate urine output and normal
serum electrolytes.
13. 1. Oral dietary
2. Often requires combinatons of oral nutrition
supplement,enteral tube nutrtion,and PN.
3. When EN failed,PN support should be
initiated.
14. 1. Within the first 24-48 hours of ICU
admission and advanced toward goal during
the next 48-72 hours.
2. Intake of 50%-65 % of goal calories during
the first week of hospitalization.
15. abdominal trauma,bowel distention,and
states of shock,some patients experienced
intra-abdominal pressure leading to
hypoperfusion and ischemia of the intestines
and other peritoneal and retropertoneal
structures. Patients has severe metabolic
alterations.
16. Severe trauma,energy requirements can
increase as mush as 100% above resting energy
expenditures depends on the extent and depth
of the injury.
Medical Managements :
Fluid and Electrolyte Repletion for the first 24-48
hours.
The volume of fluid needed is based on the age
and weight of the patient and the length,depth
of injury.
18. Increasing energy requirements by 20% to
30%is necessary.
Additional calories needed because of
fever,sepsis,multiple traumas or the stress of
surgery.
Weight maintenance should be the goal for
overweight patients.
19. Providing 20% to 25% of total calories as
protein of high biological value is also
recommended.
Best evaluated through monitoring wound
healing,”graft take”,and basic nutrition
assesment parameters.
Wound healing may be delayed if weight loss
exceeds 10%.
20. 1. Minimize metabolic stress response by :
Controlling environmental temperature
Maintaining fluid and electrolyte balance
Controlling pain and anxiety
Covering wounds early
2. Meet nutritioanl needs by :
Providing adequate calories to prevent weight loss.
Providing adequate protein for positive nitrogen balance and
maintenance.
Providing vitamins and mineral supplementation as indicated
3. Providing “curling stress ulcer” by :
Providing antacids or continous enteral feedings
21. With feeding tube or PN.
PN may be needed to prevent interuption
from feeding tube.
22. is a matter of life and deathin surgical
and critical care unit. Obese patient has a
higher surgical risk.
PN sshould be initiated 5-7 days before
preoperatively and continued into the post-
oprative period.
23. 1. Preoperative nutrition care
Witholding solids for 6 hours pre-operatively
and clear liquids for 2 hours prior to
introduction of anesthesia.
Pre-operative fasting is not possible and
surgery should be timed according to
urgency,patients are treated as if the
stomach is full.
24. Should receive early EN unless there is an
absolute contraindication.
If oral feeding is not possible, or an extended
NPO period is anticipated,an access device for
EN feeding should be inserted at the time of
surgery.
The timing of introduction of solid food fter
surgery depends on the patients degree of
alertness and condition of GI tract.
Clear liquids to full liquids and finally solid foods.
Surgical patients can be fed a regular solid foods
diet than a clear liquid diet.
