Nutritional support Flashcards
1
Q
List the 5 reasons for utilising feeding plans.
A
To:
1. Deliver daily calorie requirement (DER + RER)
2. Improve recovery time
3. Ensure a nutritionally balanced diet to maintain optimuum bodily functions
4. Prevent or correct nuritional imbalances
5. Prevent the body from catabolizing lean body mass
2
Q
7..
What information do you need in order to create a feeding plan?
A
What the:
* Normal feeding habits are (how often, amount etc, amount)
* Feeding routine is
* What diet is being provided
* Known allergies are
* BCS
* MCS
* VS diet diagnosis of type of diet + approval
3
Q
What are the 5 steps to creating a feeding plan?
A
- Ascertain what the normal feeding habits are; including routine + diet
- Find out from the owner any known allergies or medically relevant reasons to why their diet is being given
- Discuss with VS in charge, what diet should be offered - relevant to clinical condition
- Share BCS + MCS with VS - as they are subjective
- Record on patient’s client record + hospitilisation sheet the diet that must be fed + a list. of alternative foods that could be fed - if unavaliable
4 - Note, that there may be clinically relevant reasons for a high or low BCS or MCS score, which may alter the DCR (Daily Calorie Requirement)
4
Q
What is the BCS for rabbits called?
A
Rabbit Size-0-Meter
5
Q
What is the minimum and maximum score range on the Rabbit Size-0-Meter?
A
- Minimum = 1
(Underweight) - Maximum = 5
(overweight)
6
Q
What is the ideal score on the Rabbit Size-0-Meter?
RS0M = Rabbit Size-0-Meter
A
3
7
Q
What percentage under ideal body weight is a rabbit, with a score of 1, on the RS0M?
BW = Body Weight
A
> 20% below ideal BW
8
Q
What percentage under ideal body weight is a rabbit, with a score of 2, on the RS0M?
A
10 - 20% below ideal BW
9
Q
What percentage over ideal body weight is a rabbit, with a score of 4, on the RS0M?
A
10 - 15% over ideal BW
10
Q
What percentage over ideal body weight is a rabbit, with a score of 5, on the RS0M?
A
> 15% over ideal BW
11
Q
What 6 areas/landmarks are assessed when using the RS0M?
A
- Hip bones
- Ribs
- Spine
- Fat cover
- Muscle mass
- Rump curvature
12
Q
What are the identifying characteristics of a score of 1, on the RS0M?
A
- Hip bones, ribs + spine = sharp to touch
- No fat cover
- Loss of muscle
- Obvious curves of the rump
13
Q
What are the identifying characteristics of a score of 2, on the RS0M?
A
- Hip bones, ribs + spine = easily palpable
- Very little fat cover
- Loss of muscle
- Flat rump
14
Q
What are the identifying characteristics of a score of 3, on the RS0M?
A
- Hip bones + spine = easily palpable, not sharp + feels rounded
- Ribs feel like a pocket of pens
- No abdominal bulge
- Flat rump
15
Q
What are the identifying characteristics of a score of 4, on the RS0M?
A
- Hip bones, ribs + spine = requires pressure to palpate
- Some fat layers
- Rounded rump
16
Q
What are the identifying characteristics of a score of 5, on the RS0M?
A
- Hip bones, ribs + spine = can’t be felt
- Tummy sags
- Obvious fat padding
- Ruump bulges out
17
Q
What does the MCS focus on?
A
Muscle mass
18
Q
Can an obese patient have a low MCS?
A
Yes, this does not mean they’re healthy though
19
Q
Does a healthy BCS mean the patient will have a healthy MCS?
A
No
20
Q
Think of whether they are fast or slow..
What are the most common 2 types of conditions that tend to present with muscle loss?
A
Acute disease + Chronic disease
21
Q
What is the difference between Sarcopenia + Cachexia?
A
Sarcopenia defined as the loss of muscle mass and function associated with aging. (Unrelated to disease)
Cachexia defined as weight loss due to an underlying illness, are muscle wasting disorders. (Associated to disease + morbidity)
22
Q
Name a few causes of cachexia, in relation to chronic disease
A
- Congestive heart faliure (CHF)
- Cancer
- Respiratory disease
- Kidney disease
23
Q
How often should patient MCS be performed?
And why?
A
Every time the patient is seen, to assess how stable their condition is
24
Q
Name 6 potential aspects that muscle loss affects.
A
- Joint health
- Tissue health
- Fitness
- Function
- Immune health
- Wound healing
25
What **association** provides the **feeding guide** that is used in hospitlised patient's, for dogs and cats?
World Small Animal Veterinary Association (WSAVA)
26
What is the **Resting Energy Requirement** (RER) formula?
RER = BW (kg) **x** **30** **+** **70**
27
What does the RER formula work out?
The **calories** required in a **24hr** period, to **maintain bodily functions,** when the animal is **resting**
28
Work out the RER for a **25kg** Border Collie
RER = BW (kg) x 30 + 70
RER = **25kg** x 30 + 70
= **820** kcals **p/24hrs**
29
Work out the RER for a **5kg** DSH
## Footnote
DSH = Domestic Short Hair
RER = BW (kg) x 30 + 70
RER = **5kg** x 30 + 70
= **220** kcals **p/24hrs**
30
Work out the RER for a **2kg** Tea-cup Yorkie
RER = BW (kg) x 30 + 70
RER = **2kg** x 30 + 70
= **130** kcals **p/24hrs**
31
What does **DER** stand for?
**D**aily
**E**nergy
**R**equirements
32
State a few factors that affect RER
* Age - growing patients require greater calories
* **Working** animals (Spingers, collies etc) require more kcals for their high-active lifestyle
* **Pregnant** or **lactating** patientes
* Neonates
* **Immunocompromised** patients
33
What is the **Growth** DER for **Canines**, **under 4 months** old?
RER x **3**
34
What is the **Growth** DER for **Canines**, **over 4 months** old?
RER x **2**
35
What is the **Growth** DER for **Kittens**?
RER x **2.5**
36
What is the **Maintainance** DER for **Adult** **Neutered** **Canine**?
RER x **1.6**
37
What is the **Maintainance** DER for **Adult** **Neutered** **Feline**?
RER x **1.2**
38
What is the **Maintainance** DER for **Adult** **Intact** **Canine**?
RER x **1.8**
39
What is the **Maintainance** DER for **Adult** **Intact** **Feline**?
RER x **1.4**
40
What is the **Maintainance** DER for **Adult** **Obese** **Canine**?
RER x **1.4**
41
What is the **Maintainance** DER for **Adult** **Obese** **Feline**?
RER x **1**
42
What is the **Maintainance** DER for **Adult** **Canine** during **weight loss**?
RER x **1**
43
What is the **Maintainance** DER for **Adult** **Feline** during **weight loss**?
RER x **0.8**
44
What is the **Maintainance** DER for a **Light**-work **working** **Adult** **Canine**?
RER x **2**
45
What is the **Maintainance** DER for a **Heavy**-work **working** **Adult** **Canine**?
RER x **4**-**8**
46
Work out the **RER** for a **2m** old Terrier Cross breed, weighing **2.5kg**
1. **RER** = BW (kg) x 30 + 70
= RER = 2.5kg x 30 + 70
= **145 kcals p/24hr**
2.**DER** = 2m = In 'Up to 4m old' bracket = DER x 3
= RER x 3
= 145 x 3
= **435 kcals p/24hr**
47
Work out the **RER** for a **1 yr** old Cocker Spaniel, weighing **9kg**
1. **RER** = BW (kg) x 30 + 70
= RER = 9kg x 30 + 70
= **340 kcals p/24hr**
2.**DER** = 1 yr = In 'Medium/Heavy work' bracket = DER x 4
= RER x 4
= 340 x 4
= **1360 kcals p/24hr**
48
What are the **10** pieces of **information** you must **ascertain** to **calculate** how many **grams p/24hr** can be given to the patient?
1. Patient **history**
2. Diet
3. Normal feeing habits
4. Relevant medical + surgical conditions
5. BCS
6. MCS
7. **Weight**
8. Discussed with VS in charge, what diet diagnosis, RER calculations
9. Calculate **kcal p/24hrs**
10. Calculate **grams p/24hrs**
49
How do you work out **how many grams** the patient requires to be fed **per day**?
By finding out what the **kcal/g of the selected die**t is + **divide** it **by the kcals p/24hrs**
50
How to work out the kcal per gram of **dry** food.
Using the example below.
## Footnote
Dry food tin = 3756kcals per kg = 376kcals per 100g
**Convert Kg > g.**
= 3756kcal p/g (divided by) **100**
= **3.76** kcal p/gram
## Footnote
Because there is 1000g in a kg
51
How to work out the kcal per gram of **wet** food.
Using the example below.
## Footnote
Wet food can = 286kcals per 354 g can
**Start by converting Kg > g.**
= **kcals p/gram (divided by) amount in the can**
= 286kcal p/g (divided by) **354g**
= **0.8** kcal p/gram
52
How do you work out **how many grams a day** the patient **needs** from that tin of wet or dry food?
**RER** (divided by) **kcals p/gram**
= g p/**24hr**s (divided by) **meals to be given** per day
= g **per feed**
53
Work out how many grams a day does a **25kg** **border collie**, on a selected diet of **dry** Hills z/d, with **3.6kcals per gram**
## Footnote
Hills z/d = z/d = diet name
**Work out RER**
RER = BW (kg) x 30 + 70
= RER = 25kg x 30 + 70
= 820kcals p/24hrs
**Ascertain how many kcals in p/g of diet **
= Diet kcals p/g = 3.6kcal
**Work out how many kcals p/24hrs**
RER (Divided by) kcals p/g = diet kcals p/24hrs
= 830kcals p/g (divided by) 3.6 kcals p/gram
= 227.8g p/24hrs
**Meals required per day = usually 4 **but can be 6 (in paediatric patients)
**Find kcals p/g p/24hrs** (divided by) **meals required** per day = **g per mea**l
= 227.8g p/24hrs (divided by) 4 meals
= **228.56.95g per feed**
54
55
What is **Refeeding Syndrome**?
A **fatal** condition, when the **body prevents protein and muscle breakdown** during period of **starvation**/anorexia/severe malnutrition, **the body adapts by altering it's metabolism**
56
**When** is refeeding syndrome a **high risk** when **providing nutrionally support to newly hospitilised patients** who haven't eaten in a while?
## Footnote
(Malnourishment)
When they **first** **become hospitilised** and **nutritional support is provided**, as it is following a period of starvation for the weak body
57
What should you look for in the patient's **history**, that could **increase the risk** of refeeding syndrome?
A hx of anorexia
58
What **percentage** of **body mass loss will** **increase** the **risk** of refeeding syndrome?
**> than 50%** body mass loss
59
What would a **sudden electrolyte shift**, caused by a **sudden surge** in **Insulin** lead to?
* Hypo**kalemia**
* Hypo**magnesemia**
* Hypo**phosphatemia**
* Death
## Footnote
(Kalemia = Potassium)
60
State as many **reasons** for nutrional support as you can
* Hypothermia
* Vomiting
* Nausea
* Pain
* Foreign body
* Disease
* Viruses
* Pyrexia
* Age/geratric
* Recovering anaesthesia
61
What **3 types** of nursing feeding methods can cause **food aversion**?
1. **Syringe** feeding
2. **Tube** feeding
3. **Parental** feeding
62
What the **difference** between **Inappetence** and **Anorexia**?
**Inappetence** is a **reduction** in **appetite**,
Whereas,
**Anorexia** is a **complete lack** of dietray **intake**.
## Footnote
Note: Remember that clients will see Inappetance as 'being picky'
63
True or False.
If a patient has a history of anorexia, this does not need to be included into the nursing plan, as it is not currently medically relevant.
False, this should always be including into the patient's nursing plan
+
Must be brought to the VS's attention
64
What can abdominal distension be a sign of in patient with problematic GI movements?
Ileus
65
Define Ileus
The absence of propulsive aboral movement of the gastrointestinal tract contents (Intestines)
66
What is meant by 'propulsive aboral movement' ?
Normal muscle contractions along the gastrointestinal tract, i.e. peristalsis
67
What can an absence of propulsive aboral movements in the GI tract cause?
Intestinal impaction
68
Name 2 potential causes of Ileus
1. Enteritis
2. Hypocalcaemia
## Footnote
Enteritis = Inflammation of the SI
69
What may critically ill patients often require prior to nutirional interventions?
Stabilisation!
70
What potential methods could be required to stabilise a patient prior to nutritionally interventions, in critically ill patients?
* Assessment + stabilisation of vital signs
* IVFT
* Oxygen therapy - if **hypodynamically stable**, otherwise the patient can go into **hypovalemic shock,** due to reduced blood flow to the GI tract
* GA or Anaesthesia
71
For non-critical patients, who have a history of anorexia, how many days do they need to be anorexic in order to be considered for nutritional support?
3 days +
72
What can poor perfusion of blood to the GI tact, leading to a decrease in nutrient absorption + digestion, lead to?
Ileus!
73
True or False.
Ileus can increase the risk of regurgitation + vomiting.
True!
74
What 2 potential recurrent conditions can also be considered to increase the risk of regurgitation + vomiting in patients?
1. Pancreatitis
(due to naseua , pain + inflammation)
2. Osteoarthritis
(due to inflammation of GI tract bv's)
## Footnote
Pancreas = produced digestive enzymes
75
What 3 factors should you ensure, within the nursing role, to provide nutrition to patients?
1. Patient's recieve their Daily Energy Requirements (DER)
2. Select a nutriontionally balanced diet, to meet Resting Energy Requirements (RER)
3. Provide adequate nutrition, factoring in disease + dietary requirements
76
What 5 affects can providing appropriate nutrition have for patients?
1. Improved recovery times
2. Ensure appropriate wound healing
3. Maintain muscle + body mass
4. Reduce risk of infection
5. Maintain immune system
77
Whe exactly should you count how long a patient may have been anorexic for, when asking a client?
Start from when the patient stopped eating - exactly (at home)
78
True or False.
If the patient is already malnourished, nutritional support should not be instiuted until they are hemodynamically stable.
True!
79
What is meant by hemodynamically stable?
* Stable heart
* Good circulation
* Good blood pressure
80
What nursing nutritional support should be offered to a patient that has been anorexic for **1- 2 days.**
* No nutritional support required just yet
* Write down feeding orders
* Monitor food intake
* Monitor clinical condition - daily
81
What nursing nutritional support should be offered to a patient that has been anorexic for **3 - 4 days.**
* Nutritional support liekly needed, if recovery is not imminent
* Consider feeding tube placement - requiring anaesthesia
82
What nursing nutritional support should be offered to a patient that has been anorexic for **5 days.**
* Nutritional support required
* Place feeding tube
or
* Initiate parental nutrition
83
Give 5 major reasons for implementing nutritional support to patients
1. **Anorexia**
(Has multiple causes; pain, depression, nausea or ileus)
2. **Inappetence**
3. **Patients with a high, constant, catabolic state** (like burn patients, as it takes a lot of energy + calories to heal)
4. **Inability to eat**
(Oral surgery, trauma to the jaw, skull fracture = feeding tube)
5. **Clinical conditions effecting**:
= Entire GI tract
= Upper GI tract
= Lower GI tract
84
What are the 3 main types of supportive nutrition that can be afforded to patients?
1. Total Parenteral nutrition
2. Partial Partenteral nutrition
3. Enteral nutrition
85
86
87
88
89
90
91
Name an example of an eneteral feed that can be used in the VP
Royal Canin recovery liquid
92
What is meant by 'Prandially'?
Relating to a meal
93
What are the 2 disadvantages of using Nasogastric + Nasosophageal feeding tubes?
1. Requires a liquid diet
2. Can only be used until 5 days
94
What are the advantages of using Nasogastric + Nasosophageal feeding tubes?
They are relatively easy to place
95
What are the 2 advantages of using Esophagostomy feeding tube?
1. Not technically difficult to place
2. Can use canned critical care diet or slurry/blended canned diet
96
What are the disadvantage of using Esophagostomy feeding tube?
Requires general anaesthesia for placement
97
What are the 3 advantages of using Gastrostomy feeding tube?
1. Larger - allowing a thicker diet/blend
2. Easier for clients to manage
3. Long-lasting
98
What are the 2 advantages of using Jejunostomy feeding tube?
1. Enable more distal feeding
2. Bypasses the pancreas - which is benefical for patients with pancreatitis
99
What are the 2 disadvantages of using Gastrostomy + Jejunostomy feeding tubes?
1. Requires surgical placement
(Or endoscopic placement for gastrostomy tubes)
2. Can lead to complications, if removed too early
100
What are the 4 types of feeding tubes?
1. Naso-oesophageal
2. Oesophagostomy
3. Gastrostomy
4. Jejunostomy
101
Name the 4 patient factors which will impact the choice of feeding tubes
1. Duration of intended intervention
2. Underlying disease (Including treatment + prognosis)
3. Necessity + saftey of anaesthesia
4. Tolerance of the tube
102
Name the 4 technical factors which will impact the choice of feeding tubes
1. Clinician's experience
2. Risk of complications
3. Invasiveness
4. Type of diet to be used
103
Are Naso-oesophageal + Nasogastric tubes for short or long-term placement?
Short
104
What part of the GI tract must be working in order to provide short term nutirition with a Naso-oesophageal + Nasogastric tubes?
Upper GI tract
105
Where is the location of the placement of the naso-oesophageal tube?
Distal oesophagus via the nose
106
How long can you keep a naso-oesophageal tube in for?
< 7 days
107
True or False.
Naso-oesophageal tubes can be managed by clients, at home.
True
108
Name the contradications to why a naso-oesophageal tube cannot be used
* Trauma to the head, neck, nasal cavity + oesophagus
* Comatose or recumbent patients
* Can't be used long-term
* Cannot be in patients that are;
= Vomiting
=Abnormal gag-reflex
= Functional or mechanical GI obstruction
109
Are Oesophagostomy tubes for short or long-term placement?
Short + long term (months)
110
Why might Oesophagostomy tubes be used for short or long term used?
Trauma, injury or disease involving mouth + pharynx
111
Where is the location of the placement of the oesophagostomy tube?
Distal oesophagus via surgical placement into the cranial oesophagus, through the skin
112
How long can you keep a oesophagostomy tube in for?
Days > months
113
Name the contradications to why a oesophagostomy tube cannot be used
* Oesophageal disorders
* Vomiting
* Comatosed patients
* Recumbent patients
* Following oesophageal surgery
114
What is another name for Gastrostomy tubes?
PEG tubes
(Percutaneous Endoscopic Gastrostomy)
115
Why might PEG tubes be used for short or long term used?
Injuries or surgery to the:
* Oral cavity
* Larynx
* Pharynx
* Oesophagus
116
Where is the location of the placement of the Gastrostomy tube?
The stomach via surgical:
* Laparotomy
* Endoscopically through the ventrolateral abdominal wall (left)
117
How long can you keep a PEG tube in for?
Mid - Long term
(Months > Years)
118
Name the contradications to why a gastrostomy tube cannot be used
* Primary gastric disease
* Ulceration
* Neoplasia
* Intractable vomiting
* Peritonitis
119
What 4 tubes can be managed at home, with clients?
+
What tube can't?
1. Naso-oesophageal
2. Nasogastric
3. Oesophagostomy
4. Gastrostomy
+
The **Enterostomy** tube, otherwise known as Duodenostomy or Jejunostomy tubes, cannot be maintained at home
120
Are Enterostomy tubes for short or long-term placement?
Long
121
What tube can be used to bypass the part of the stomach or GI tract?
Enterostomy tube
122
Where is the location of the placement of the enterostomy tube?
The SI via surgical laparotomy, through the abdominal wall
or
Endoscopically via gastric tube + through the pylorus
123
How long may enterostomy tubes be kept in place for?
Long term, weeks > months
..But the term is limited due to the requirement of hospitilisation
124
Name the contradications to why a enterostomy tube cannot be used
* Patient must be stable for anaesthesia + surgery
* Dysfunction of the SI
125
What is the RER calculation for an entire adult dog?
1.8 x RER
126
What is the RER calculation for an entire adult cat?
1.4 - 1.6 x RER
127
What is the RER calculation for an neutered adult dog?
1.6 x RER
128
What is the RER calculation for an neutered adult cat?
1.2 - 1.4 x RER
129
What is the RER calculation for an obese-prone adult dog?
1.4 x RER
130
What is the RER calculation for an obese-prone adult cat?
0.8 - 1 x RER
131
What is the RER calculation for an light exercise adult dog?
2 x RER
132
What is the RER calculation for an heavy exercise adult dog?
4 - 8 x RER
133
What is the RER calculation for a senior dog?
1.4 x RER
134
What is the RER calculation for a senior cat?
1.1 - 1.4 x RER
135
What is the RER calculation for a 4 m/o dog?
3 x RER
136
What is the RER calculation for a growing cat?
2.5 x RER
137
What is the RER calculation for a early pregnant bitch?
1.8 x RER
138
What is the RER calculation for a late pregnant bitch?
3 x RER
139
What is the RER calculation for a lactating bitch?
1.9 x RER
(+ 25% p/puppy)
140
What is the RER calculation for a early pregnant queen?
1.6 x RER
141
What is the RER calculation for a queen, during parturition?
2 x RER
142
What is the RER calculation for a lactating queen?
2 - 6 x RER
143
144
How often should a **Finch** be fed?
Q**4** hrs
145
How often should a **Budgie**, **Lovebird**, **Cockatiel** or small **Conure** be fed?
Q**6** hrs
146
How often should a **Amazon** be fed?
Q**8** hrs
147
How often should a large **Cockatoo** or **Macaw** be fed?
Q**8** - **12** hrs
148
When **gavage** feeding birds, how should you position the bird, when handling?
**Gently extend the neck** to ensure the esophagus is straightened, to guide the food into the crop
149
Aside from gavage tubes, what **type** of **feeding needles** are easiest to use when feeding **psittacine** birds?
**Curved stainless steel ball-tipped** feeding needles
150
What gauge of feeding needle should you use for a **Finch**?
16 - 18
151
What size gauge of feeding needle should you use for a **Canary**?
Size 16 - 18
152
What size gauge of feeding needle should you use for a **Bugerigar parakeet**?
Size 14 - 16
153
What size gauge of feeding needle should you use for a **Lovebird**?
Size 12 - 14
154
What size gauge of feeding needle should you use for a **small Conure** or **Cockatiel**?
Size 12 - 14
155
What size gauge of feeding needle should you use for a **large Conure**?
Size 10 - 12
156
What size gauge of feeding needle should you use for a **Amazon Parrot** or **small Cockatoo**?
Size 8 - 10
157
What size gauge of feeding needle should you use for a **large Cockatoo** or **Macaw**?
Size 8 - 10
158
