LEC 6 - Nutritional Management II

Question 1

What are the factors that can allow you to make a diagnosis of protein-calorie malnutrition?

Answer 1

Weight loss of > 10%. Anorexia/hyporexia of more than 5 days. Increased nutrient loss (v/d or severe wounds). Albulmin

Question 2

What happens when there is decreased albulmin?

Answer 2

Slower healing and drug distribution is altered

Question 3

What are the two major ways of providing nutrition?

Answer 3

Enteral and parenteral

Question 4

How do you know which of the two major ways of providing nutrition is the best?

Answer 4

Whether the patient has a functional GI tract

Question 5

What are the indications for total parenteral nutrition?

Answer 5

When intestines cannot absorb nutrients or there is severe pancreatitis/malnutrition

Question 6

What are the characteristics of TPN?

Answer 6

Customized diets. Sterile catheter only used for feeding. Infusion pump. Expensive formulas.

Question 7

What are side effects of TPN?

Answer 7

Sepsis, hyperglycemia, hypophosphatemia, hyperlipidemia, and azotemia

Question 8

How is partial parenteral nutrition given/

Answer 8

Through peripheral catheter

Question 9

What are the five method used in tube enteral feeding?

Answer 9

Nasoesophageal, pharyngostomy, esophagostomy, gastrostomy, and enterostomy

Question 10

What supplements are given with oral feedings?

Answer 10

Potassium, vitamin B-complex, and zinc

Question 11

What are the five medications that MAY aid in increasing your PCM patient?

Answer 11

Cyproheptadine, mirtazopine, diazepam, oxezepam, and Vitamin B12

Question 12

When should enteral nutrition be used?

Answer 12

In PCM patients that — hypermetabolic, 5 to 7 days of anorexia, postoperative management of cancer patients, patients mental status prevents self-feeding

Question 13

What might cause a patient to go into a hypermetabolic state?

Answer 13

Severe burns, sepsis, postsurgical stress, trauma, or cancer

Question 14

When should a 5 fr tube be used for feedings?

Answer 14

Nasoesophageal or enterostomy

Question 15

When should a 8 fr tube be used for feeding?

Answer 15

Nasoesophageal or enterostomy > 15 kg dogs

Question 16

When should a 16 fr tube be used?

Answer 16

Pharyngostomy, esophagostomy, or gastrostomy

Question 17

What happens if you pass the sphincter with the nasoesophageal tube?

Answer 17

increase the chance of acid reflux. make sure to stay in the caudal esophagus

Question 18

What are the indications for nasoesophageal intubation?

Answer 18

Oral or Pharyngeal (esophagus, gastric, or biliary tract surgery)

Question 19

Where is a nasoesophageal tube placed?

Answer 19

Ventrolateral aspect of nares

Question 20

Where should the nasoesophageal tube be secured? On who?

Answer 20

Lateral portion of the neck in dogs

Question 21

What are some possible complications with a nasoesophageal tube?

Answer 21

Comes out of esophagus and into the trachea (make sure to confirm placement with x-ray)

Question 22

Where is a pharyngostomy tube placed?

Answer 22

Just behind the hyoid apparatus

Question 23

How is the placement of a pharyngostomy tube checked?

Answer 23

Push a contrast through the tube and follow up with an xray

Question 24

When is a esophagostomy tube indicated?

Answer 24

Disorders of the oral cavity or pharynx. Functional GIT distal to the esophagus

Question 25

When is the use of esophagostomy tube contraindicated?

Answer 25

esophageal stricture, esophageal FB, esophagitis, or megaesophagus

Question 26

What makes esophagostomy tubes so good?

Answer 26

Easy to place, large tubes mean a blenderized diet can be given, can eat/drink around the tube, and can remove at any time

Question 27

How do esophagostomy tubes compare to pharyngostomy tubes?

Answer 27

Esophagostomy tubes have less coughing, laryngospasms, and apspiration associated with them.

Question 28

When should a gastrostomy tube be used?

Answer 28

Anorexic patients with functional GIT distal to the stomach. Surgery of the oral cavity, larynx, pharynx, or esophagus

Question 29

What are the disadvantages of gastrostomy tubes?

Answer 29

need general anesthesia +/- special equipment, can’t start feeding for 12 to 24 hours

Question 30

When can a gastrostomy tube be removed?

Answer 30

Has to be in for at least 10 to 12 days

Question 31

What are contraindications to gastrostomy placement?

Answer 31

Primary gastric disease or vomiting

Question 32

What needs to be touching for there to be a permanent gastric plexy?

Answer 32

Muscle to muscle contact, this is decreased when there is a plexy done with a tube

Question 33

What are the indications for a enterostomy tube?

Answer 33

Gastric, intestinal, or pancreatic disease. Biliary tract surgery, or vomiting.

Question 34

What are the advantages to a enterostomy tube?

Answer 34

Immediate feeding and can be removed right away if needed

Question 35

What is the MOST IMPORTANT component of placing a enterostomy tube?

Answer 35

Must attach the small intestine to the abdominal wall. This is because with peristalsis the tube will be pulled out of the intestines and you will end up feeding into the abdomen

Question 36

What is contained within monomeric diets?

Answer 36

AA’s, glucose/oligosachharides, safflower oil

Question 37

What is polymetric diets made from?

Answer 37

Large molecular weight proteins, fats, and CHO.

Question 38

What determines whether you use a monomeric diet or polymetric?

Answer 38

Can’t use polymetric unless you have a fully functional digestion process.

Question 39

What is the normal capacity of a stomach?

Answer 39

80 ml/kg

Question 40

What is the capacity in the stomach of a patient with anorexia?

Answer 40

30 to 40 ml/kg

Question 41

How do you feed a anorexic patient with a small stomach?

Answer 41

Gradually increase feedings, with a minimum of 3 feedings per day