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Surgery II > LEC 5 - Nutritional Management I > Flashcards

LEC 5 - Nutritional Management I Flashcards

1
Q

What is malnutrition?

A

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

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2
Q

What is another term used to describe malnutrition?

A

Protein-calorie malnutrition

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3
Q

What is hyperalmintation?

A

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

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4
Q

What is enteral hyperalimentation?

A

Providing nutrients to functional GI tract by feeding tube

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5
Q

What is parenteral hyperalimentation?

A

Providing nutrients intravenously

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6
Q

What is the initial response to hypo-metabolic disease?

A

Hemodynamic instability

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7
Q

What does hemodynamic instability entail?

A

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

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8
Q

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

A

Refractory shock

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9
Q

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

A

Lactic acidosis, decreased tissue perfusion, and multiple organ failure

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10
Q

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

A

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

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11
Q

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

A

Catabolize lean body mass first.

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12
Q

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

A

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

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13
Q

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

A

Energy from proteolysis

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14
Q

What does catabolism during stress provide for?

A

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

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15
Q

What is the result of muscle metabolism during stress?

A

Negative nitrogen balance and net protein loss

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16
Q

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

A

Wound healing, immune function, and strength

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17
Q

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

A

Gluconeogenesis, protein synthesis, and ATP production

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18
Q

What are the major goals of a nutritional plan?

A

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

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19
Q

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

A

Increases it by a factor of 25 to 35%

20
Q

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

A

> 5 days in small animals

21
Q

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

A

> 10 %

22
Q

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

A
23
Q

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

A

48 to 72 hours

24
Q

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

A

30 to 50% of BER

25
Q

What is the protein needs of a dog?

A

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

26
Q

What is the protein needs of a cat?

A

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

27
Q

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

A

Adjust protein requirements by 1/2

28
Q

What can cause protein intolerance?

A

Renal and hepatic issues

29
Q

What is re-feeding syndrome?

A

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

30
Q

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

A

Collagen and ground substance synthesis

31
Q

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

A

Synthesis of fibronectin, complement, and glucose

32
Q

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

A

Platelets, RBC’s and leukocytes

33
Q

When is enteral hyperalimentation indicated?

A

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

34
Q

When is jejunostomy feedings contraindicated in?

A

Adynamic ileus, bowel obstruction, or diffuse infiltrative disease

35
Q

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

A

80 ml fluid/kg body weight

36
Q

What is the gastric capacity of an anorexic patient?

A

30 to 40 ml fluid/kg body weight

37
Q

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

A

Over 2 to 3 days

38
Q

What is the minimum number of feedings a day

A

3

39
Q

What is trickle feeding?

A

Feeding a liquid diet via CRI

40
Q

When is total parenteral nutrition indicated?

A

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

41
Q

Where is the IV catheter placed for parenteral feeding?

A

Central vein

42
Q

What is the components of total parenteral nutrition?

A

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

43
Q

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

A

Electrolytes, glucose, BUN, albulmin, PCV

44
Q

How is partial parenteral nutrition administered?

A

Peripheral catheter

45
Q

What is partial parenteral nutrition indicated for?

A

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

46
Q

What is the diet that is given parital parenterally?

A

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

Surgery II (6 decks)

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