Supportive Feeding And Hydration Flashcards
1
Q
What is inappetence?
A
A reduction in appetite
2
Q
What is anorexia?
A
A complete lack of dietary intake
3
Q
What are reasons for reduced appetite?
A
- illness
- nausea
- pain
- depression
- trauma
- concurrent medical conditions
4
Q
What can a reduced appetite result in?
A
- reduced immune function
- poor healing
- affects drug metabolism
5
Q
Factors to consider during supportive feeding?
A
- if patient has history of anorexia mist be included in nursing plan and highlighted by staff
- critical patients require stabilisation before nutritional intervention
- history of anorexia from 3+ days should be considered
- supportive feeding should not be provided to unstable or recovering patients
6
Q
The nurses role during supportive feeding?
A
- ensure the patient receives their daily caloric requirements
- select nutritionally balanced diet to allow RER consumptions in reasonable quantities
- provide adequate nutrition factoring in disease process and dietary requirements
7
Q
Signs to look for during assessments?
A
- patients that have been unable or unwilling to eat for 3 days or more require assisted feeding
- BCS3/5 or 5/9 ideal
- recent weight loss more than 10% of body weight
- is it severe cachexia or a paediatric patient
8
Q
What are the 3 types of supportive nutrition?
A
Total parenteral nutrition
Partial parenteral nutrition
Enteral nutrition
9
Q
What is total parenteral nutrition?
A
- it is a nutritionally balanced solution
- delivered via a central line (intravenous)
- provides both nutrients and calories
10
Q
What is partial parenteral nutrition?
A
- delivers part of patients nutrients and calories
- delivered via peripheral intravenous catheters
11
Q
What is enteral nutrition?
A
- it is any feeding incorporating the gastrointestinal tract
12
Q
What must be gathered before providing support?
A
- understand their normal feeding routine including brand, frequencies and treats
- BCS and up to date weight
- evaluate abilities including temperaments
- actions to prevent or treat nausea
- what diet the patient will be fed and the end goal weight
13
Q
What is Resting Energy Requirements (RER)?
A
It ensures the patient receives sufficient calories, calculations are performed based on their weight and decides the quantity they should be fed
14
Q
What are the 2 RER calculation formulas?
A
RER(30xBW)+70=kcal/day (patients over 2kg)
RER 70(BW)^0.75=kcal/day (patients under 2kg)
15
Q
What forms of encouragement can be used?
A
- normal diets and treats
- change their feeding bowl
- clean any discharge from their face
- use warm or smelly foods
- hand feeding
- put food on lips or paws, little and often
- drugs. Any be prescribed by the vet to stimulate appetite
16
Q
Factors to consider when syringe feeding?
A
- not likely to be successful in dogs or cats
- only used on conscious patients
- care to avoid aspiration
- stressful
- short term
- slow administration behind teeth/at diastema and allow to swallow naturally
17
Q
What are the 6 tube feeding methods?
A
- naso-oesophageal/naso-gastric
- pharyngeal
- oesophagostomy
- stomach tube
- peg tube
- jejunostomy tube
18
Q
Factors to consider when using nasal-oesophageal feeding tubes?
A
- stomach and intestine must be functioning for use
- liquid food syringed into tube
- flushed with water pre and post administration
- placed via nares and ends in oesophagus
- tube must be measured
19
Q
Factors to consider when using naso-gastric tubes?
A
- diet selection limited due to width of tubes
- can easily become blocked
- less invasive method
20
Q
Steps to follow when placing an NG tube?
A
- measure the tube
- appropriate restraint
- administer local anaesthetic drops to a red
- lubricators tube
- gentle pressure between nares can facilitate placement
- one confident smooth motion
- place until marker is reached
- patient should swallow as inserted
- secure tube
21
Q
How to feed when using a NG tube?
A
- wear gloves, prep diet, flush, bring to body temp
- check placement of tube
- sterile swab top of tube pre and post use
- monitor during for signs of discomfort and aspiration
- flush tube with water prior and monitor the response
- slowly administer selected diet (20-60 mins)
- flush tube after to prevent blockage
22
Q
How to properly remove NG tube?
A
- cut suture with blade
- gently pull tube out
23
Q
Factors to consider when using oesophagostomy tubes?
A
- for long term support
- owners can be trained to use
- width allows for easy administration and wider range of feeds to choose from
- requires GA to allow placement
- skilled procedure
- placement must be checked radiographically
- can lead to inflammation or stoma site infections
24
Q
Factors to consider when using gastronomy tubes?
A
- used in patients with oral or oesophageal conditions
- GA required for placement
- long term feeding solution only
- placed surgically during abdominal exploration or endoscopically via a flank approach
- accurate patient monitoring is essential
25
Factors to consider when using jejunostomy tubes?
- food bypasses stomach and enters via small intestine
- used in patients with upper GI conditions
- must be in site for over 10 days
- requires GA and takes skill and precision
- placed endoscopically, surgically or nasojejunal
- monitored closely for signs of abdominal pain
26
Factors to consider when using parenteral feeding?
- central vein is used
- used where gastrointestinal tract is not functioning
- specialist technique
- monitoring is essential
- is expensive
27
What information is required to effectively evaluate supportive feeding?
- food should be weighed and reweighed when removed to calculate how many grams have been eaten
- tube feeding, mls given should be recorded
- if patient is eating voluntarily but not eating full RER then kcal of total grams eaten has to be deducted from RER kcal requirement
- monitor body weight , BCS and MCS
28
How to re-introduce food?
- feed little and often, introduce gradually (over 4 days)
- feed slowly
- warm food in sitting position or sternal recumbency
- observe for signs of aspiration, discomfort or nausea
29
What are the different routes of water intake?
- diet
- drinking
- therapeutic medications
- metabolism
30
What are the different routes of water loss?
- urination
- faeces
- respiration
- sweating
- urinary infections
- renal damage
31
What are abnormal routes of water loss?
- vomiting
- diarrhoea
- panting excessively
- blood loss
32
What is the normal rate for fluid intake?
50mls/kg/24hr (1-2ml/kg/hr)
33
What is polydipsia?
- excessive drinking
- >100ml/kg/24hr
- often an indicator of underlying condition
- can cause regurgitation, vomiting and nausea
34
What should be included in the patient assessment?
- their normal drinking habits
- their normal eating habits (quantity, wet or dry)
- preferred bowl material
- toileting habits
- previous surgeries (neutered)
- health conditions or medications
- weight, age, mobility, activity levels
- for cats must consider indoor/outdoors and water placement
35
What are the 5 different levels for assessing hydration?
1%
5%
7%
10%
12%
36
Describe the signs of 1% hydration loss?
- slight loss in skin elasticity
- hair standing on end
37
Describe the signs of 5% hydration loss?
- tacky dry mucus membranes
- loss in skin elasticity
- increase in urine specific gravity (SG)
38
Describe the signs of 7% hydration loss?
- marked loss in skin elasticity
- increased urine specific gravity (SG)
- sunken eyes
- decreased urine output
- tachycardia
- slightly prolonged capillary refill time
39
Describe the signs of 10% hydration loss?
- skin tenting
- eyes sunken
- oliguria then Anura
- weak pulses
- prolonged capillary refill time
- signs of shock
- lethargy
40
Describe the signs of 12% hydration loss?
- depression
- collapse
- shock
- moribund
- death
41
Methods of measuring fluid loss?
- collect urine in kidney dish every time they urinate, then measure and check specific gravity
- weigh bedding prior to placing in kennel, weigh if soiled
- weigh patient regularly, affected by fluid gains/losses
- weigh faecal output if using inco pads
- weigh faecal catheter bag, if being used
- weigh cat litter tray or use non-absorbent litter
42
How to monitor patient fluid in-take?
- measure the water prior to placing in kennel
- measure again before disposing
- calculate how much has been drunk
- spills should also be noted, also note bowl raiser can be used for larger breeds
43
What are the 4 routes of fluid administration and when is each used?
Oral = mild dehydration, short term illness, small patients or animals with feeding tubes
Subcutaneous = mild dehydration, patients not hospitalised
Intravenous = dehydration, anorexia, surgical procedures, IV drug administrations
Intraosseous = cardiovascular collapse, lack of IV access, avian patients, neonates or short term use
44
Why is intravenous fluid therapy used?
- helps supplement electrolytes
- provides constant rate infusions of medications
- supports patients through surgery, where blood loss is suspected
- helps support organs such as kidneys
- caution used in patients with cardiac disease
45
Nurses role when caring for patients on IVFT?
- check access site for swelling, bruising and pain
- check line regularly for kinks, blockages and interference
- check fluid running, and the volume of fluid to be administered
- monitor clinical signs for hydration levels, use mucus membrane or specific gravity
- monitor ongoing losses of vomiting or diarrhoea
- check for signs of over hydration such as moist cough, dyspnoea, tachypnoea, lethargy, or increases urine output
46
Who calculates fluid requirements for patients?
- veterinary surgeon provides fluid rate for patient
- veterinary surgeon prescribes fluid of choice
- veterinary surgeon advises total amount to be administered over a period of time (12-24hours)
47
What are the 3 maintenance requirements?
Cat/Small Dog (1-10kg) - 60ml/kg/24hr
Medium Dog (11-25kg) - 50ml/kg/24hr
Large Dog (26-50kg) - 40ml/kg/24hr
48
How should hydration status be monitored?
- should be frequently checked minimum every 12hrs
- if on high rate of fluids or fluid bolos, hydration check every 2-5hrs depending on VS preference
- VS informed, if patient eating and drinking improve means IVFT support can be reduced/removed
- VS aware if patient stops eating or drinking as-well may want to provide supportive care/ increase rate
- feedback concerns if showing concerns of over infusion or dehydration
