Deck 22: Metabolic Stress and the Critically Ill

Question 1

What is the term for reduced blood flow?

A) ​hypotension
B) ​cyanosis
C) ​alkalosis
D) ​hypoperfusion
E) ​vasoconstriction

Answer 1

D

Question 2

What is the key difference between the body's physiological reaction to starvation and metabolic stress?

A) ​adaptation occurs during metabolic stress
B) ​adaptation occurs during starvation
C) ​starvation can lead to death
D) ​weight loss occurs with starvation
E) ​metabolic stress is not related to diet

Answer 2

B

Question 3

What protein is released in response to inflammation?

A) ​insulin
B) ​cysteine
C) ​histamine
D) ​C-reactive protein
E) ​lipase

Answer 3

D

Question 4

What are the three phases of the stress response?

A) ​ebb phase, flow phase, recovery or resolution phase
B) ​injury phase, healing phase, recovery phase
C) ​reaction phase, adjustment phase, resolution phase
D) ​hyper-stress phase, moderation phase, reduction phase
E) ​reaction phase, healing phase, recovery phase

Question 5

What condition causes the highest excretion of nitrogen per day from the body?

A) ​major trauma
B) ​major burn
C) ​starvation
D) ​major surgery
E) ​sleep deprivation

Question 6

Catecholamines (epinephrine, norepinephrine) increase energy availability by stimulating glycogenolysis and increasing the release of what alternative fuel source?

A) ​glucose
B) ​galactose
C) ​amino acids
D) ​polypeptides
E) ​fatty acids

Question 7

During periods of starvation, what is the primary source of fuel?

A) ​protein
B) ​glucose
C) ​lipids
D) ​amino acids
E) ​connective tissue

Question 8

Interleukin 6 (IL-6) increases production of what acute-phase proteins?

A) ​tumor necrosis factor
B) ​C-reactive protein
C) ​leukotrienes
D) ​interferon
E) ​histamine

Question 9

For critically ill patients, when should enteral nutrition be started in the hospital?

A) ​within 3-4 days
B) ​after about 72 hours
C) ​after about 60 hours
D) ​within the first 24-48 hours
E) ​immediately

Question 10

What vitamins should be given to metabolically stressed patients while recovering?​

A) ​vitamins A and B6
B) ​vitamins B7 and C
C) ​vitamins C and E
D) ​vitamins D and E
E) ​vitamins D and K

Question 11

What happens to the basal metabolic rate during starvation?

A) ​no change
B) ​increases
C) ​reduces
D) ​wildly fluctuates
E) ​unpredictable

Question 12

What is the term for a systemic inflammatory response and immunosuppressive process that prevents an adequate response to infection or trauma?

A) ​allergic reaction
B) ​sepsis
C) ​hypoxic injury
D) ​necrotizing fasciitis
E) ​multiorgan distress syndrome

Question 13

How long, on average, does it take for a healthy patient to progress to protein-energy malnutrition (PEM)?

A) ​48 hours
B) ​1 week
C) ​2 weeks
D) ​4 weeks
E) ​8 weeks

Question 14

Which amino acid is a precursor for nitric oxide and may help as a supplement for the metabolically stressed?

A) ​arginine
B) ​lysine
C) ​cysteine
D) ​tyrosine
E) ​glutamine

Question 15

What amino acid supplement is strongly recommended for burn, trauma, and ICU patients?

A) ​arginine
B) ​lysine
C) ​cysteine
D) ​tyrosine
E) ​glutamine

Question 16

What protein is used in copper transport?

A) ​ceruloplasmin
B) ​serum amyloid A
C) ​VLDL
D) ​C-reactive protein
E) ​fibronectin

Question 17

What amino acid is the primary substrate required for gluconeogenesis?

A) ​lysine
B) ​arginine
C) ​alanine
D) ​glutamine
E) ​cysteine

Question 18

What is the metabolic pathway through which glucose is formed from non-carbohydrate sources?

A) ​glycolysis
B) ​glucogenesis
C) ​glycogenesis
D) ​glycogenolysis
E) ​gluconeogenesis

Question 19

During metabolic stress, what supplies the substrate used for gluconeogenesis?

A) ​breakdown of muscle tissue
B) ​breakdown of body fat
C) ​breakdown of connective tissue
D) ​breakdown of bone minerals
E) ​breakdown of brain tissue

Question 20

What amino acid is the primary fuel for enterocytes within the gastrointestinal tract and for T lymphocytes?

A) ​lysine
B) ​arginine
C) ​alanine
D) ​glutamine
E) ​cysteine

Question 21

Parenteral nutrition should be reserved for those cases of prolonged nothing by mouth (NPO) status lasting how long?

A) ​7 days
B) ​10 days
C) ​14 days
D) ​21 days
E) ​28 days

Question 22

What is the best way to estimate his caloric needs?​

A) ​Harris-Benedict equation
B) ​Curreri equation
C) ​Fick equation
D) ​indirect calorimetry
E) ​ESPEN guidelines

Question 23

What are the daily protein requirements for burn victims?

A) ​0.5-0.7 g protein/kg IBW per day
B) ​0.8-1.1 g protein/kg IBW per day
C) ​1.1-1.5 g protein/kg IBW per day
D) ​1.5-2 g protein/kg IBW per day
E) ​1.9-2.4 g protein/kg IBW per day

Question 24

The dietitian should supplement with what amino acid to stimulate the GI tract?

A) ​alanine
B) ​arginine
C) ​glutamine
D) ​lysine
E) ​cysteine

Question 25

The dietitian should look for a formula that contains which of the following to induce an anti-inflammatory response?

A) ​saturated fatty acids
B) ​omega-3 fatty acids
C) ​omega-6 fatty acids
D) ​probiotics
E) ​arginine

Question 26

What mineral supplements are most important for burn victims?

A) ​iron and calcium
B) ​zinc and selenium
C) ​calcium and magnesium
D) ​boron and selenium
E) ​zinc and iron

Question 27

Depending on the burn size and severity, how long can the hypermetabolic stress last in burn patients?​

A) ​4 years
B) ​2 years
C) ​1 year
D) ​6 months
E) ​3 months

Question 28

What are his protein requirements while in the hospital?

A) ​1.5-2.0 g/kg of body weight
B) ​1.1-1.5 g/kg of body weight
C) ​0.9-1.2 g/kg of body weight
D) ​0.7-1.0 g/kg of body weight
E) ​0.5-0.7 g/kg of body weight

Question 29

What would be the best way to feed him while he's in the hospital and cannot eat on his own?​

A) ​keep him NPO (nothing by mouth) indefinitely
B) ​parenteral nutrition
C) ​gastric feeding tube
D) ​enteral feeding to the large bowel
E) ​enteral feeding to the small bowel

Question 30

What is the most common source of burn wounds?

A) ​chemicals
B) ​electricity
C) ​radiation
D) ​magnetic
E) ​heat

Question 31

What cells in the blood are markedly increased during sepsis?​

A) ​granulocytes
B) ​thrombocytes
C) ​platelets
D) ​red blood cells
E) ​white blood cells

Question 32

When should enteral and/or parenteral feeding be initiated after surgery?​

A) ​as soon as possible and safe
B) 12-15 hours post-op
C) ​18- 24 hours post-op
D) ​1-2 days post-op
E) ​at least 72 hours post-op

Question 33

What enteral formula has the highest percentage of lipids?​

A) ​Perative®
B) ​Pivot®
C) ​Crucial®
D) ​Oxepa®
E) ​Impact®

Question 34

What type of burn is typically caused by exposure to hot oil?

A) ​superficial
B) ​superficial partial thickness
C) ​deep partial thickness
D) ​full thickness
E) ​bone dissolving

Question 35

What is post-operative ileus?

A) ​liver damage
B) ​quick drop in blood pressure
C) ​general paralysis of the GI tract
D) ​severe headaches
E) ​reduced stomach acidity

Question 36

What did the National VA Surgical Risk Study find to be the best predictor of complications and mortality following surgical procedures?

A) ​preoperative albumin levels
B) ​liver function
C) ​smoking
D) ​blood pressure
E) ​age

Question 37

Enteral nutrition formulas for burn patients should be high in what nutrients?

A) ​saturated fat and sucrose
B) ​monounsaturated fat and glucose
C) ​essential amino acids and simple carbohydrates
D) ​protein and omega-6 fatty acids
E) ​protein and omega-3 fatty acids

Question 38

What factor is NOT correlated with the severity of electrical burns?

A) ​temperature
B) ​time of exposure
C) ​voltage
D) ​location affected
E) ​presence of water

Question 39

What mineral does ASPEN recommend for supplementation in the critically ill?

A) ​iron
B) ​selenium
C) ​boron
D) ​calcium
E) ​magnesium

Question 40

What happens to blood pressure during sepsis?

A) ​no change
B) ​severe fluctuations
C) ​hypotension
D) ​hypertension
E) ​hyperperfusion

Question 41

Compared to parenteral nutrition, _______________ is more cost-effective and is associated with reduced infectious complications, fewer surgical interventions, and fewer hospital days.

Question 42

Many general surgical procedures do not pose nutritional risk.

Question 43

For normal-weight individuals, _______________ kcal/kg of actual body weight per day are recommended during critical illness.

Question 44

Negative _______________ balance is a consistent marker of metabolic stress.

Question 45

Weaning from nutritional support is recommended when the patient is able to meet at least 25% of nutritional needs orally.

Question 46

Once access to the GI tract has been established, the first step in developing the nutrition prescription is choosing the appropriate enteral formula.

Question 47

When providing nutrition support to the critically ill, it is crucial to avoid _______________ and its subsequent metabolic complications, which include increased _______________ production and hyperglycemia.

Question 48

Multiorgan distress syndrome is also referred to as multisystem organ failure.

Question 49

The depth of the wound and the percentage of the body surface area that is affected are used to classify burn injury.

Question 50

Energy requirements are _______________ during metabolic stress and injury.

Question 51

Release of either glucagon or cortisol can result in _______________ during the stress response.

Question 52

Metabolic stress is the hypermetabolic, catabolic response to acute injury or disease.

Question 53

It was not until the hallmark studies of Dr. Ancel Keys that the manner in which the body responds to starvation through physiological adaptations was understood.

Question 54

In burn patients, enteral nutrition that is initiated within 24 hours of injury has been associated with prevention of Curling's _______________.

Question 55

For critically ill individuals, nutritional needs can normally be met by the oral route.

Question 56

Indirect calorimetry is the method of choice to establish energy and protein requirements for the critically ill.

Question 57

One of the most important distinctions between starvation and metabolic stress is the difference in _______________ and fuel substrate requirements.

Question 58

The degree of metabolic stress is inversely proportionate with the seriousness of the injury.

Question 59

The increased rate of gluconeogenesis during the stress response creates reliance on protein as a source of _______________.

Question 60

Increased levels of glucagon serve to increase glucose production from amino acids - a process called _______________.

Question 61

Burn wounds are described as superficial, superficial partial thickness, _______________ partial thickness, or _______________ thickness.

Question 62

List what four types of external forces can cause burns.

Question 63

Describe the clinical manifestations of the physiological response to stress.

Question 64

Describe how severe burn injuries affect the nutrition assessment.

Question 65

While the degree of hypermetabolism and catabolism correlates with the patient's level of burn injury, researchers agree that the level of hypermetabolism does not increase beyond that reached for a _______________ percent total body surface area burn.

Question 66

Complications of enteral feeding may include metabolic complications, _______________, or mechanical complications.

Question 67

Explain why nutrition therapy is so important for burn injuries.

Question 68

Patients are required to refrain from eating or drinking for at least _______________ hours before surgery.

Question 69

Omega-3 fatty acids can serve to reduce the _______________ cytokines that are involved metabolic stress.

Question 70

Describe the effects general anesthesia can have on the GI tract and how this effects post-operative feeding recommendations.

Question 71

Discuss the importance of glutamine during times of metabolic stress.

Question 72

General anesthesia may result in a post-operative _______________.

Question 73

_______________ burns destroy all layers of the skin and can involve underlying muscle, organs, and bone.

Question 74

Provide a comprehensive definition of sepsis.

Question 75

Inflammation results in vascular _______________, which is caused by high levels of nitric oxide.

Question 76

Explain what methods are used to feed the critically ill and when weaning can occur.

Question 77

Sepsis is actually a(n) _______________ process that prevents an adequate response to infection.

Question 78

Describe the main objectives of nutritional support for the critically ill.

Question 79

Substrates such as inulin, guar gum, and other soluble fibers are fermented in the gut to _______________ and lactate.

Question 80

Describe the metabolic consequences of injury and stress.