Final Exam Flashcards

Question

When we say hydration is not a "set it and forget it" scenario, what do we mean and why could it happen?

Answer 1

-Managing fluids is an ongoing process that requires close monitoring & adjustments, fluid overload can happen if we're not careful -That's why labs are always being checked to see what the patient needs & adjusting fluids accordingly -Na is the most osmotically active lyte, so Na levels are monitored to understand how fluids are shifting in the body -Isotonic fluids: Stay in extracellular space & increases overall FV -Hypotonic fluids: Draw water out of cells into extracellular space

Answer 2

-Comes down to osmolarity of solution & duration of use -Central PN is preferred because solutions tends to be hypertonic & can't be safely administered peripherally -For peripheral PN, max osmolarity that the vein can tolerate is 800 mOsm/L -Another issue is that venous access needs to be changed frequently to keep vein open & irritation limits the use of peripheral fluids to 2x/week -Peripheral is typically reserves for patients not on fluid restriction, since you can increase volume to provide more kcals & protein but it's not always practical for long-term and increased nutrient needs

Answer 3

-Men have higher rates than women and most common cancer is prostate, then lung, followed by colorectal cancer -Most common cancers for women are breast, lung, and colorectal cancer -Black men face the highest rates and Asian American & Pacific Islanders have the lowest rates -Black people have lowest survival rates often due to a later diagnosis & limited access to quality care

Answer 4

-Encourage them by explaining the difference between the two while empowering them with hope & practical steps they can take -Non-modifiable: Genetics, hormones, immune factors -Modifiable: Smoking, weight, drinking, sun exposure, physical activity, healthy diet -It can feel overwhelming but every small step counts, think of it as investing in your health & future one day at a time

Answer 5

-Continuous loss of skeletal muscle with or without fat loss & doesn't fully respond to nutritional support -Shows up in ~1/2 of cancer patients & in up to 80% of those with advanced cancer -Early sign of illness with symptoms like anorexia & weight loss -Associated with a poor prognosis since fat & muscle loss happen when patients start eating less

Answer 6

-Brain-related anorexia: Change in hypothalamic signals reduce appetite, along with diminished senses of taste & smell -Lipolysis: When fat tissue breaks down, FAs are released and making the body inefficient

Answer 7

-Increased proliferation speeds up evolution, allowing only the strongest cells to survive; advantage typically comes from a specific set of mutations that occur in successive clonal generations -Tumors are genetically diverse populations of cancer cells, offering advantage in resisting the body's defense mechanisms; cancer cells evolve resistance to therapies over time, reducing effectiveness of treatment -Tumor microenvironment supports cancer evolution by inducing genetic instability, which fosters therapy-resistant cells and releases pro-inflammatory signals that aid tissue repair creating a supportive stroma around tumor -Continued mutation & evolution in tumor increases cell diversity and aggressiveness; some cells acquire metastatic abilities allowing them to spread -Cancer behaves like an evolving system with cells mutating, adapting & competing, viewing cancer through this lens can help develop more effective treatments

Answer 8

-Condition which stomach contents flow back into the esophagus, often causing discomfort & damage -Happens due to dysfunction in the lower esophageal sphincter (LES), a muscle barrier that normally separates the stomach from the esophagus -LES maintains pressure difference between the 2 areas to prevent reflux, but when it relaxes too frequently or for too long, it can be ineffective -Acidic contents (gastric acid & pepsin) can be moved upward into the esophagus

Answer 9

-Goals are to enhance the competence of the LES, decreasing acid secretion & protecting the esophageal lining -Antacids & histamine blockers can be helpful in neutralizing stomach acid and decreasing its production -Addressing lifestyle factors like quitting smoking, managing, weight & reviewing meds that might aggravate symptoms can be crucial -Surgical options like Nissen fundoplication (where part of stomach is wrapped around LES to strengthen it), partial fundoplication, or Roux-en-Y bypass might be considered -Nutritionally, focus on decreasing gastric acidity and avoiding meals that can relax the LES -Peppermint, chocolate, fried or fatty foods, alcohol & coffee can decrease LES pressure and coffee, alcohol, and pepper can increase gastric secretion -Also consuming smaller, more frequent meals and conducting a dietary trial to identify & exclude foods that may trigger symptoms

Answer 10

-When rapid movement of stomach contents into SI due to increase in osmolar load entering SI too quickly, often due to alteration in gastric function -When stomach is removed, bypassed & otherwise impaired, gastric emptying becomes significantly accelerated -Partially digested food (chyme) enter SI and is hyperosmolar, causing fluid shift from bloodstream into SI to dilute contents -Fluid shift can leads to cramping, abdominal pain, increased intestinal movement & diarrhea; can also affect vascular compartment, causing dizziness, weakness & increased heart rate (tachycardia) -When food moves to colon, fermentation process is carried out by intestinal microflora which can produce gas contributing to abdominal discomfort, cramping & diarrhea -"Late dumping syndrome" occurs 1-3 hours after eating, especially after consuming simple carbs; it is triggered by rapid absorption of glucose in SI leading to surge in insulin release -Insulin causes BG levels to decrease rapidly as it promotes cellular uptake leading to hypoglycemia where one can experience shakiness, sweating & confusion

Answer 11

-Once vomiting has stopped, slowly sip clear fluids like water, apple juice, warm/cold tea, or lemonade -Reintroduce liquids gradually, doubling amount every hour, depending on tolerance -After 8 hours without solids, start slowly by adding one type of food at a time in small amounts to see how body handles it -Avoid foods high in fiber or fat because it can be hard to digest & can produce strong odors/gas -Dry toast, crackers & pretzels and soft proteins like yogurt, baked chicken or eggs

Answer 12

-All impact the digestive system but differentiates in causes, symptoms & treatment -IBS is more about managing symptoms since it doesn't cause any structural damage -Crohn's & UC are inflammatory and can cause real damage to the intestines -Crohn's can affect different parts of the GI tract with deeper inflammation, while UC is confined to the colon & its surface layers -Diverticulitis is a more acute issue with inflamed pouches in colon, often due to dietary & lifestyle factors

Answer 13

-Functional disorder where people experience abdominal pain linked to bowel movement or changes in bowel habits at least once a week -Common, affects 12% of people in North America -Doesn't cause structural damage in gut but symptoms like stomach pain, bloating, gas & D/C can be disruptive -Genetics, an overactive immune response to certain foods, changes in gut bacteria & issues with serotonin regulation can make the gut more sensitive -Treatment includes managing symptoms through diet changes like low-FODMAP, finding foods triggers & managing stress

Answer 14

-Type of IBD and can pop up anywhere in the digestive tract but often show up in the SI/colon -It is more intense because it is chronic inflammation that can go deep into layers of intestinal walls, causing things like fistulas, strictures or blockages -Skip lesions can affect patches of gut while leaving other areas untouched -Stomach pain, weight loss, fatigue & malnutrition can occur due to nutrient absorption issues -Causes include genetic predisposition paired with triggers that set off an overactive immune response -Treatment includes meds to decrease inflammation and sometimes surgery to remove damaged parts of the bowel, nutrition support is also key since patients can become malnourished

Answer 15

-Type of IBD but more contained than Crohn's, only affects colon and rectum & sticks to surface layers of colon -Symptoms include bloody diarrhea, stomach cramps & constant feeling of having to go to bathroom -Due to an overactive immune response but limited to the colon -Treatment includes meds to decrease inflammation and sometimes surgery is an option especially since removing the colon can essentially "cure" UC

Answer 16

-Little pouches (diverticula) form in the colon walls which can get inflamed or infected -Isn't chronic but can come on suddenly with intense symptoms like pain on lower left side of abdomen, fever & nausea -Often linked to a low-fiber diet & constipation, which increases pressure in colon -Risk factors include being overweight, not moving enough & smoking -Treatment includes starting with bowel rest & gradually adding clear liquids before moving to a high fiber diet to prevent future flare-ups; sometimes surgery is needed

Answer 17

-Complex autoimmune condition that occurs in genetically predisposed individuals who are intolerant to gluten -The body mistakenly reacts to gluten leading to SI damage which disrupts nutrient absorption -Condition linked to maldigestion and malabsorption of essential nutrients, vitamins & minerals; patients present with significant weight loss, anemia or clear signs of vitamin/mineral deficiencies -Malabsorption usually affects nutrients absorbed in upper part of SI (iron, folate & calcium); as disease progresses further along intestine, it leads to malabsorption of carbs, fats & fat-soluble vitamins (A, D, E, K) + other micronutrients -There is not cure but adhering to a strict gluten-free diet is crucial in management -Eliminating all sources of gluten, including foods containing wheat, rye & barley; also look out for hidden gluten like hydrolyzed vegetable protein in processed foods & oats are GF but can easily be contaminated in processing

Answer 18

-Liver, specifically in its lobules, produces bile through hepatocytes -Bile: Essential for emulsifying fats & facilitating their absorption in SI, primarily through the formation of micelles -Gallbladder functions as a store & concentration site for bile -It removes water & lytes to increase the bile's concentration, stores it until needed, and regulates its delivery to the duodenum in the form of Na & K salts to aid digestion

Answer 19

-Shared anatomical pathways -Bile is transported through the cystic duct which merges with the common hepatic duct to form the common bile duct -Common bile duct joins the pancreatic duct, which carries digestive enzymes -If cholestasis occurs, where bile secretion is decreased or its flow into the digestive tract is obstructed, it can create a blockage into the bile & pancreatic duct -This obstruction could cause a backup of pancreatic secretions, potentially leading to inflammation of the pancreas (pancreatitis)

Answer 20

-Chronic pancreatitis: Characterized by irreversible inflammation, fibrosis & tissue calcification in pancreas, leading to chronic abdominal pain, diabetes and steatorhhea -Vitamin A deficiency is common due to fat malabsorption as pancreas often produces insufficient enzymes to absorb fat-soluble vitamins -Vitamin A is essential for night vision and maintaining healthy skin as it supports cell turnover -Pt's non-compliance with her Pancreatic Enzyme Replacement Therapy (PERT) regimen likely exacerbates issue preventing adequate absorption of fat-soluble vitamins from diet and contributing to deficiency

Answer 21

-Gallstones form due to prolonged intake of increased dietary fat and low fiber, which increases demand for cholesterol production to synthesize bile for fat digestion -After eating high fat meal, pt experienced pain because gallstones likely blocked bile flow from gallbladder -Fatty meals stimulate gallbladder to contract & release bile for digestion but if a stone becomes lodged in duct, it obstructs flow and causes severe pain during digestion, which lasts for over an hour

Answer 22

-Ascites: Accumulation of fluid in peritoneal cavity commonly caused by liver cirrhosis -Arises from inadequate synthesis of serum proteins & increased sodium retention -Decreased serum protein levels and decreased oncotic pressure lead to fluid shifting in bloodstream into "3rd spaces" causing edema -As BV decreases, urine excretion also decreases, contributing fluid & Na retention -Cirrhosis causes elevated BP in hepatic portal vein and portal HTN forces fluid out of blood vessels into abdominal cavity, culminating in development of ascites

Answer 23

-Triggered by infection/injury to tissue -Key features are fever, altered vascular permeability and biosynthetic & metabolic shifts across organs -Primary initiators are macrophages at the site of infection/injury & monocytes in the bloodstream -These cells release IL-1 & tumor necrosis factor-a (TNF-a) which act as chemical messengers to coordinate inflammatory response -IL-6 regulates inflammatory response & chemokines (MCP-1 & IL-8) attract immune cells to site of injury -These initiate inflammatory cell infiltration and these mediators exert chemotactic & other systemic effects, setting off full-blown APR

Answer 24

-Attempts to restore BP & increase cardiac performance and maximum venous return -Lasts 12-24 hours if initial injury is under control -Tissue & gut hypoperfusion lead to decreased BP and gastric intolerance -Body increases catecholamines (norepinephrine) to regain hemodynamic stability to increase BP -Norepinephrine causes increased contractibility of HR & vasoconstriction -Increased sympathetic nervous system activity and release of norepinephrine & gluconeogenesis -Depending on injury severity, there may be hyperglycemia & also find decreased REE

Answer 25

-Peaks at days 3-5 & resolves at days 7-10 -Starts with increased cardiac output to restore oxygen & nutrients -Then catabolism occurs, breaking down tissues for energy & immune needs -Insulin release increases with catecholamines, glucagon & cortisol -Anabolism causes AAs & FFAs to mobilize from muscle & fat stores; used to support energy and immunoglobulin production -Outcomes include a negative nitrogen balance (protein loss), decreased fat stores & changes in body composition - Changes include losses of protein, carbs & fat stores, accompanied by enlarged extracellular water compartments -This is where most ICU feeding will occur

Answer 26

-Nitrogen balance: Difference between amount of nitrogen consumed through diet (mainly from protein) & amount of nitrogen excreted from the body through urine and feces -It's a steady state technique meant to be given under stable physiologic conditions where amount of protein given has been stable for over a week (none of these criteria are met in the ICU) -In the ICU, all it can tell you is how catabolic you are, not whether you're making use of the protein being fed -Completely invalid statistic in critical care

Answer 27

-In starvation state, body prioritizes energy conservation & adaptation occurs when body lowers BMR -Energy shifts to using fat stores for fuel, sparing lean muscle mass & feeding during starvation halts muscle wasting because body no longer needs to breakdown protein for glucose production (gluconeogenesis) -APR is triggered by inflammation or severe injury/illness (sepsis/trauma) and doesn't halt muscle wasting because inflammatory state overrides anabolic signals from feeding -Protein is still broken down to support immune response, wound healing, acute phase protein synthesis & body remains in a catabolic state despite nutrient provision -Starvation is an adaptive process to conserve muscle mass which is reversible by feeding & ARP is a hypercatabolic process driven by inflammation where feeding can't fully counteract muscle loss due to ongoing cytokine activity

Answer 28

-Overfeeding in any respiratory distress will increase the burden on the lungs & may result in delayed weaning from mechanical ventilation -Decreased caloric intake decreases CO2 production, easing the workload on the respiratory muscles

Final Exam Flashcards

(52 cards)