Advanced Clinical Nutrition 1

Question 1

Why is nutrition important?
3 answers

Answer 1

• good for patient management
• reduces morbity and mortality rates
• reduces length of hospitalisation and complications

Question 2

What are the indicators for malnutrition?

Answer 2

• loss of muscle condition
• over 5-10% unexplained weightloss
• poor coat condition
• reduced appetite for more than 2-3 days
• large protein losses
• burns
• head trauma

Question 3

What is simple starvation?

Answer 3

• normal metabolic adaptations
• conservation of protein
• fat usage increased

Question 4

What is stress starvation?

Answer 4

• hypermatabolism
• breakdown of protein/muscle wastage
• less time to state of malnutrition
• likely unwell

Question 5

What is cachexia?

Answer 5

muscle loss in presence of disease

Question 6

What are we assessing first for malnutrition?

Answer 6

hydration, elctrolytes, acid-base balance, pain

Question 7

What are the short term aims for nutrition?

Answer 7

• provide ongoing nutritional requirements
• prevent or correct nutritional deficiencies or imbalances
• minimise metabolic derangements
• prevent further catabolism of lean body mass

Question 8

What are the long term nutritional aims?

Answer 8

• Restoration of optimal body condition
• provision of required nutrients within the animals own environment

Question 9

What is enteral feeding?

Answer 9

tube feeding

Question 10

What are the 4 types of feeding tubes?

Answer 10

• naso-oesophgeal/gastric
• oesophagostomy
• gastrstomy
• jujunostomy

Question 11

Which of the 4 types of feeding tubes are short erm?

Answer 11

naso-oesophageal

Question 12

How can you determine which feeding tube to use?

Answer 12

• patient - tolerance, risk of GA, duration
• technical - clinician experience, complications, diet
• owner - cost, compliance

Question 13

What is classed as short term?

Answer 13

5-7 days

Question 14

Which feeding tube doesn’t require GA?

Answer 14

naso-oesophageal

Question 15

What is re-feeding syndrome?

Answer 15

metabolic derangements occuring when enteral or parenteral nutrition is fed to extremely malnourished patients, or occuring after prolonged starvation

Question 16

What state are patients with refeeding sydrome changing from?

Answer 16

catabolic to anabolic states

Question 17

What metabolic states can be seen due to increased insulin release?

Answer 17

• severe hypophosphataemia
• hypokalaemia
• hyponatraemia
• hyperglycaemia
• hypocalcaemia

Question 18

What are the signs associated with re-feeding syndrome?

Answer 18

• peripheral oedema
• haemolytic anaeamia
• cardiac failure
• neurological dysfunction
• respiratory failure

Question 19

When would you remove a feeding tube?

Answer 19

Once the patient is voluntarily eating over 85% of the RER

Question 20

Why is it good to introduce oral rehydration fluids

Answer 20

it prepares the gut for feeding before calories

Question 21

How do you re introduce feeding?

Answer 21

• small frequent meals
• gradual introduction
  risk assessment regarding malnutrition

Question 22

What is parenteral nutrition?

Answer 22

proving nutriton intravenously when enteral nutrtion isn’t possible

Question 23

How do you provide parenteral nutrtion?

Answer 23

through a peripheral line

Question 24

What should you monitor when providing parenteral nutrition?

Answer 24

• signs of phelbitis
• infection
• metabolic complications
• sepsis
• occlusion or dislogement of line
• patient interference

Question 25

How do you calculate parenteral nutrition?

Answer 25

standard RER / 100 X 4-5 (dogs) 6 (cats) / 100kcal
50:50 lipid:dextrose

Question 26

What preventative measures should be in place with parenteral nutrtion?

Answer 26

• experieced personnel
• clear protocols and procedures in place
• aseptic techniques
• patient interference
• regular monitoring and recording