Chapter 16

Nutrition in Metabolic &

Respiratory Stress

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 Body’s Response to
Stress & Injury
• Stress response • Nutrients are
 Infection mobilized from
 Burns storage
 Fractures • Heart rate and
 Surgery respiration
 Extensive bleeding increase
• Body focuses on • Blood pressure
immediate survival rises

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Hormonal Response to Stress

• Epinephrine & • Cortisol

norepinephrine  Enhances protein
 Stimulate heart degradation
muscle • Aldosterone &
 Alter blood flow rate antidiuretic hormone
 Raise basal  Help maintain blood
metabolism volume
• Glucagon  Stimulate kidneys to
 Releases nutrients reabsorb sodium &
from storage water

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 The Inflammatory Response
• Serves to • Classic signs
 Contain & destroy  Swelling
infectious agents  Redness
 Prevent further  Heat
tissue damage  Pain
• Dilation of arterioles
• Constriction of
venules

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© 2007 Thomson - Wadsworth
 Nutrition Treatment

• Problems • Diet goals

 Hypermetabolism &  Preserve lean tissues
negative nitrogen  Maintain immune
balance defenses
• Wasting  Promote healing
 Hyperglycemia &
insulin resistance
• Need to balance
• Increases infection risk overfeeding &
underfeeding

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 Estimating Requirements
• Energy • Lipids: 40% of
 Harris-Benedict kcalories
equation (BEE)
• Vitamins &
• Protein
minerals
 1.0-2.0 g/kg
 May have
• Carbohydrates: increased needs
70% of kcalories

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© 2007 Thomson - Wadsworth
Approaches to Nutrition Care

• Initial care: maintain fluid &

electrolyte balance
• May need enteral and/or
parenteral support
• High-kcalorie, high-protein diet
Take care not to overfeed
Reassess frequently

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Nutrition & Respiratory Stress
• Respiratory stress
Reduced oxygen
Increased carbon
dioxide
• Labored breathing
Interferes with food
intake
Weight loss &
malnutrition

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© 2007 Thomson - Wadsworth
 Chronic Obstructive
Pulmonary Disease (COPD)

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 Chronic Obstructive
Pulmonary Disease (COPD)
• Persistent obstruction
of airflow
 Chronic bronchitis
• Excessive mucus
secretions
• Productive cough
 Emphysema
• Breakdown of lung’s
elastic structure
• Dyspnea
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• Causes
 Smoking
 Chronic respiratory
infections
 Occupational exposure to
dusts or chemicals
 Genetic susceptibility
• Goals
 Improve food intake
 Maintain healthy weight
 Prevent muscle loss
 Improve exercise
endurance
 Treatment
• Small, frequent
meals
• Adequate fluids
• Liquid supplements
• Exercise plan

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 Respiratory Failure

• Gas exchange • Causes

between air & blood  Obstruction
is greatly impaired  Weakness or
• Consequences paralysis of muscles
 Hypoxemia  Embolus
 Hypercapnia  Toxic substances
 Hypoxia  Severe trauma &
infection
 Acidosis
 Cyanosis

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 Treatment

• Support lung function

• Correct underlying disorder
• Careful monitoring of fluid
• Medications

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 Treatment

• Chronic lung disease

Oxygen therapy
• Acute respiratory
distress syndrome
(ARDS)
Mechanical ventilation

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 Nutrition Care

• Individualize according to
patient’s condition
• Enough energy & protein to
support lung function
without overtaxing the
respiratory system

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Nutrition in Practice

Multiple Organ Failure

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 Multiple Organ Failure
• Cause of death in ½ • Organs
of ICU patients  Lungs
 Liver
• A failure of two or  Kidneys
more organ systems  GI tract
• Chemical mediators • Causes
can cause systematic  Acute respiratory
response syndrome failure
(SIRS), leading to  Trauma
 Sepsis
shock & organ failure
 Burns
 Extensive surgery
 Pancreatitis

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© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
 Risk Factors

• Age over 55 • Severity of tissue

• Prior chronic injury
illness • Length of time
• Persistent SIRS between injury &
• Major infection arrival at hospital
• Blood • Malnutrition
transfusions

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 Treatment

• Mechanical • Hemofiltration or
ventilation dialysis
• Fluid & • Antibiotic therapy
electrolytes for infection
• Medications to • Enteral &
sustain or parenteral
increase cardiac nutrition
output & blood
pressure

© 2007 Thomson - Wadsworth