LEC 5 - Nutritional Management I

Question 1

What is malnutrition?

Answer 1

Progressive loss of lean body mass and adipose tissue caused by inadequate intake of or increased demand for protein and calories.

Question 2

What is another term used to describe malnutrition?

Answer 2

Protein-calorie malnutrition

Question 3

What is hyperalmintation?

Answer 3

Administration of adequate nutrients to malnourished patients or those at risk of malnourishment.

Question 4

What is enteral hyperalimentation?

Answer 4

Providing nutrients to functional GI tract by feeding tube

Question 5

What is parenteral hyperalimentation?

Answer 5

Providing nutrients intravenously

Question 6

What is the initial response to hypo-metabolic disease?

Answer 6

Hemodynamic instability

Question 7

What does hemodynamic instability entail?

Answer 7

Decreased energy expenditure, hypothermia, protein catabolism, Decreased cardiac output , and poor tissue perfusion.

Question 8

What can hemodynamic instability lead to unless there is an intervention?

Answer 8

Refractory shock

Question 9

What occurs due to refractory shock due to hypo-metabolic disease?

Answer 9

Lactic acidosis, decreased tissue perfusion, and multiple organ failure

Question 10

What happens to a healthy animal when it is deprived of calories?

Answer 10

Lose fat. Glycogen stores used as primary source of energy at first. Then metabolic shift to fat stores. Spares lean muscle tissue.

Question 11

What happens to a sick or injured animal that is malnourished?

Answer 11

Catabolize lean body mass first.

Question 12

Why is there catabolism of lean body mass first in sick patients?

Answer 12

Inflammatory response triggers alterations to cytokines and hormones. Shifting metabolism to catabolic state.

Question 13

What is the predominant source of energy in sick patients when malnourished?

Answer 13

Energy from proteolysis

Question 14

What does catabolism during stress provide for?

Answer 14

Glucogenic precursors in the liver. Other AA’s used for glucose and acute phase proteins.

Question 15

What is the result of muscle metabolism during stress?

Answer 15

Negative nitrogen balance and net protein loss

Question 16

What negative effects are seen when there is lean body mass loss?

Answer 16

Wound healing, immune function, and strength

Question 17

The substrates provided in nourishment would be for what three major processes in the body?

Answer 17

Gluconeogenesis, protein synthesis, and ATP production

Question 18

What are the major goals of a nutritional plan?

Answer 18

restore proper hydration, correct electrolyte/acid-base imbalance, and achieve hemodynamic stability

Question 19

What does post-surgical stress do to a patients BER?

Answer 19

Increases it by a factor of 25 to 35%

Question 20

How long does it take anorexia to last to cause protein-calorie malnutrition?

Answer 20

> 5 days in small animals

Question 21

How much weight loss has occurred to make a diagnosis of protein-calorie malnutrition?

Answer 21

> 10 %

Question 22

What is the level of albumin at which you can diagnosis protein -calorie malnutrition?

Question 23

how long should it take for you to meet BER when giving nutrition to your patient?

Answer 23

48 to 72 hours

Question 24

What should you start providing for your protein-calorie malnourished patient?

Answer 24

30 to 50% of BER

Question 25

What is the protein needs of a dog?

Answer 25

4 to 6 grams per 100k (15 to 25% total energy requirement)

Question 26

What is the protein needs of a cat?

Answer 26

6 to 8 grams per 100kcal (25 to 35% total energy requirement)

Question 27

What should be done with patients that have a protein in tolerance when providing nutrients?

Answer 27

Adjust protein requirements by 1/2

Question 28

What can cause protein intolerance?

Answer 28

Renal and hepatic issues

Question 29

What is re-feeding syndrome?

Answer 29

Severely malnourished patients are fed too aggressively. Can lead to hypophsophatemia (unsure why this occurs)

Question 30

What are AA's and carbohydrates needed for in the cells, in regards to tissue synthesis?

Answer 30

Collagen and ground substance synthesis

Question 31

What three major things does the liver need energy and protein for, in regards to tissue synthesis and repair?

Answer 31

Synthesis of fibronectin, complement, and glucose

Question 32

What does bone marrow need nutrients for in regards to tissue synthesis and repair?

Answer 32

Platelets, RBC's and leukocytes

Question 33

When is enteral hyperalimentation indicated?

Answer 33

Any animal with overt or impending PCM. Those that are hypermetabolic, anorexic, or malnourished.

Question 34

When is jejunostomy feedings contraindicated in?

Answer 34

Adynamic ileus, bowel obstruction, or diffuse infiltrative disease

Question 35

What is the gastric capacity of a normal dog or cat?

Answer 35

80 ml fluid/kg body weight

Question 36

What is the gastric capacity of an anorexic patient?

Answer 36

30 to 40 ml fluid/kg body weight

Question 37

How long of a period of time should you gradually increase the amount of food given to a malnourished patient?

Answer 37

Over 2 to 3 days

Question 38

What is the minimum number of feedings a day

Answer 38

3

Question 39

What is trickle feeding?

Answer 39

Feeding a liquid diet via CRI

Question 40

When is total parenteral nutrition indicated?

Answer 40

Intestines can't adequately absorb nutrients. Malabsorptive syndromes or severe/prolonged pancreatitis

Question 41

Where is the IV catheter placed for parenteral feeding?

Answer 41

Central vein

Question 42

What is the components of total parenteral nutrition?

Answer 42

Amino acids, lipids, 50% dextrose, and B-vitamins

Question 43

What should be monitored if patient is on a parenteral diet?

Answer 43

Electrolytes, glucose, BUN, albulmin, PCV

Question 44

How is partial parenteral nutrition administered?

Answer 44

Peripheral catheter

Question 45

What is partial parenteral nutrition indicated for?

Answer 45

Non-debilitated patients who are unable to tolerate full enteral feeding

Question 46

What is the diet that is given parital parenterally?

Answer 46

Same as TPN except 5% dextrose, not as hypertonic as TPN