Monday, March 6, 2017

Nutrition Informatics Interns take on Critical Care

As dietetic interns at the University of Maryland College Park, we have the opportunity to attend joint class days with other internship classes in the area. We recently attended a critical care joint class day hosted by the University of Maryland Medical Center in Baltimore. This day of lectures went in-depth on several critical care topics and really complemented my clinical rotations.

Key points from the critical care lectures:

Nutrition Assessment in Critical Care and Trauma
First, we learned about the starvation and stress responses of the body.  A starvation response occurs in the body when glycogen stores are depleted; this can be reversed by feeding. A stress response occurs when cytokines and counter-regulatory hormones induce a catabolic state; this can be blunted by feeding but cannot be reversed. Nutrition assessment for the critically ill patient includes nutrition status, etiology and severity, and co-morbidities.

Challenges in Enteral Nutrition
Enteral nutrition can be defined as “nutrition support for a patient with a functional and accessible GI tract who cannot or will not meet needs on an oral diet.” Enteral nutrition is strongly preferred over parenteral nutrition, which should only be used when a patient does not have a functioning gut. Although it is preferred over the latter, complications can still arise when using this form of nutrition support. Some complications of enteral nutrition include: high gastric residual volumes, clogged tubes, diarrhea, medication interactions/the need for some medications to be held, hemodynamic instability, refeeding syndrome, and the need for specific formulas based on disease state (e.g. diabetes or chronic kidney disease).

Respiratory Status and Nutrition Considerations
Respiratory failure can be defined as “the failure of the respiratory system to oxygenate or ventilate.” There are two types of respiratory failure: hypoxemic (reduced O2 in the blood), and hypercapnic (elevated CO2 in the blood). For patients experiencing respiratory failure, indirect calorimetry is the best way to estimate nutritional needs. In fact, indirect calorimetry is considered the gold standard for estimating nutritional needs for most patients.

The joint class day at the University of Maryland Medical Center ended with a game of Jeopardy, which was a fun a way of testing what we had just learned.  All internship classes were divided into different teams, allowing us to meet interns from other programs . Overall, our class learned a lot. Even though our program does not have a clinical emphasis, it is still important that we understand complicated conditions that may arise in a clinical setting. We now have a stronger understanding of the nutrition therapy needed for critically ill patients and complicated disease states.

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