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Clinical Nutrition Flashcards

1
Q

What are six basic classes of nutrients in a balanced diet?

A 
Protein
Fat
Carbohydrates
Minerals
Vitamins
Water
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2
Q

Describe vitamins and their importance.

A 
Organic compounds
A, D, E, K + B and C
Energy metabolism
Biochemical reactions
Deficiency syndromes
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3
Q

What are the macrominerals?

A 
Calcium
Phosphorous
Magnesium
Sodium
Potassium
Chloride
Sulphur
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4
Q

What are the microminerals?

A 
Iron
Copper
Zinc
Manganese
Iodine
Selenium
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5
Q

Describe protein.

A

Composed of chains of amino acids - all animals needs all 23 amino acids
Many can be synthesised within the body
Others are termed ‘essential’ amino acids
Cats are obligate carnivores - Taurine required in diet

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6
Q

What is the function of protein?

A

Regulation of metabolism
Cells and muscle fibre structure
Tissue growth and repair
Energy source

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7
Q

What can occur if protein is in excess in the diet?

A

Liver/kidney problems
Care in ageing animals
Increase for young

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8
Q

What can occur from a protein deficiency?

A 
Poor growth, muscle and weight loss
Dull hair
Reduced immunity
Oedema (hypoalbuminaemia)
Death
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9
Q

What is the function of fat in the diet?

A 
Provide energy
Aid absorption of fat-soluble vitamins
Enhance palatability
Source of essential fatty acids - linoleic/linolenic/arachidonic acids
DHA - neural development
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10
Q

What can occur from inadequate fat intake?

A

Energy deficiency

Essential fatty acids deficiency - impaired reproduction/wound healing, dry coat, flaky skin, eczema

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11
Q

What are the 3 main groups of carbohydrate?

A

Monosaccharides - glucose/fructose
Disaccharides - maltose/lactose/sucrose
Polysaccharides - starch/glycogen/fibre (complex carbs)

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12
Q

What is the function of carbohydrates?

A

Energy - may be converted to fat
Metabolic requirement for glucose (precursors - amino acids/glycerol)
Enzymes required for disaccharides (lactase, sucrase)

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13
Q

Describe dietary fibre.

A 
Indigestible polysaccharides (cellulose/lignin/pectin)
Mainly constitute of plant cell walls
Relatively indigestible in the intestines of dogs/cats
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14
Q

What is the function of dietary fibre?

A

Add bulk to the faeces
Prevent constipation and diarrhoea
Role in correction of obesity
Role in regulating blood glucose levels in diabetics

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15
Q

What are the possible consequences of obesity?

A 
Hepatic lipidosis
Joint disease
Diabetes mellitus
Skin disease
Cardiorespiratory disease
Surgical implications
Feline Lower Urinary Tract disease (FLUTD) - males
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16
Q

How can we implement weight loss and what is a safe amount of loss?

A 
Safe weight loss = 1-2% per week
Diet changes
Exercise plan
Behavioural changes
Calculate maintenance energy requirement (MER) based on ideal weight, not current weight
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17
Q

What are the benefits of obesity diets?

A

Nutritionally balanced - correct levels of vitamins/minerals
High protein - preserves lean body mass, reduced net energy, satiety, palatability
Joint health - helps maintain, reduces the need to supplement (glucosamine/chondroitin)

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18
Q

Why might L-carnitine be supplemented in obesity diets?

A

Non-essential amino acid
Helps encourage use of fat for energy and reduce fat storage
Helps reduce the risk of hepatic lipidosis in cats

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19
Q

What does a GI diet contain?

A 
Highly digestible proteins and starch
Prebiotics (MOS / FOS)
Omega 3 essential fatty acids (EPA / DHA)
Fibre - psyllium
High/low fat
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20
Q

What does a hypoallergenic diet contain?

A 
Hydrolysed protein/novel protein e.g. duck
Complex of B vitamins and amino acids plus zinc and linoleic acid = support skin barrier effect of skin
Omega 3 essential fatty acids = EPA and DHA
Beet pulp (intestinal transit), FOS, MOS and zeolite (intestinal environment)
21
Q

Describe a convalescent diet.

A

30-50% total energy provision via protein sources

Available forms = liquid/powdered/solid wet

22
Q

Define Resting Energy Requirement (RER).

A

Includes energy expended for recovery from physical activity and feeding
(Hospitalised patients)

23
Q

Define Maintenance Energy Requirement (MER).

A

Energy required by moderately active animal
Not included = energy for growth, lactation or work
Need to consider life-stage factors

24
Q

How do we calculate energy requirement for a hospitalised patient?

A

Use RER
RER = 70 x bodyweight (kg) ^0.75
Or RER = 30 x bodyweight (kg) + 70

25
How do we calculate the energy requirement for a healthy animal?
Use MER | RER x appropriate life-stage factor
26
What breeds are predisposed to pancreatitis?
Terriers Miniature Poodles Miniature Schnauzers
27
How can we provide enteral feeding for pancreatitis patients?
Avoid high fat diet due to concurrent hyperlipidaemia Prepyloric feeding well-tolerated in acute pancreatitis - nasogastric (last rib), naso-oesophageal (10th rib), no need for GA Limitations = lumen size (restricts diet choice) - consider RER calculation, choose commercial diet with veterinary surgeon
28
Describe nutrition for arthritis patients.
Weight management Omega 3 fatty acids (EPA/DHA) - reduce inflammation Green lipped mussel - omega 3 fatty acids Glucosamine (chondroitin sulfate) - cartilage formation/repair, reduce inflammation, slow cartilage degradation
29
What are our dietary aims in diabetes mellitus patients?
Support in achieving/maintaining normal serum glucose levels Decrease postprandial glucose peaks Achieve normal metabolism of carbs, fat and proteins Normalise bodyweight
30
Describe an ideal diet for diabetes mellitus patients.
Protein Low fat - high fat increases insulin resistance Soluble carbohydrate Insoluble carbohydrate (fibre!) - important factor in management
31
What is required in a diet for hyperthyroid patients?
Dietary iodine required for production of thyroid hormone
32
Describe the ideal diet for cardiac disease.
Taurine - especially for cats L-carnitine synthesised from lysine and methionine - myocardial energy production Arginine - normal vascular tone Omega 3 fatty acids - reduces muscle loss, antiarrhythmic effects
33
What nursing interventions can we attempt to encourage spontaneous eating?
``` Avoid food buffets in kennel Avoid prescription diets Try different textured foods e.g. dry/wet Antiemetic medications / appetite stimulants / analgesia / pro-kinetics TLC - grooming, playing, cuddling Offer food away from kennel Usual diet / favourite treats Warmed foods e.g. fresh chicken/fish ```
34
When do we place a feeding tube?
Patient has been anorexic for 48hrs or more If vet anticipates patient to be anorexic after surgical procedure If there is trauma to mouth/head/neck To admin oral rehydration/medications
35
What are the three types of feeding tube?
Naso-oesophageal Oesophageal Percutaneous Endoscopic Gastrotomy (PEG) tube
36
How do we administer a naso-oesophageal (NO) tube feed?
Calculate required amount of food Wear non-sterile gloves Draw up required amount of food into appropriate syringe(s) Pre-warm food within syringes in a warm water bath Check for negative pressure Admin 10mls water as pre-flush Admin feed slowly (over 10-15mins) Watch for signs of nausea/regurgitation - if present, slow down/try again in half an hour Admin 10mls water as flush
37
How long can we use an NO feeding tube?
Up to 7 days.
38
What are the contraindications for NO tube use?
``` Cat flu, congestion Rhinitis / epistaxis / head trauma Oesophageal disease Marked regurgitation Persistent vomiting Impaired gastric flow Patients who are comatose / have limited gag reflex / risk of aspiration If nutritional support needed for longer than 7 days ```
39
What complications can occur with an NO feeding tube?
Patients removing their own tube Not getting negative pressure before a feed (tube displacement) Infection Reluctance to eat due to irritation from tube Aspiration Large dogs requiring large feeds (small lumen) Blockage
40
What nursing care can we provide for oesophageal tube patients?
Check stoma site twice daily, clean with 1:10 iodine Tempt with food before every feed No neck collars / slip leads Admin medications through tube when possible
41
What are we checking an O-tube stoma site for?
Swelling, discharge, redness, pain
42
How do we carry out O-tube feeding?
``` Wear non-sterile gloves Pre-warm food within syringes in a warm water bath Check for negative pressure Admin 10mls water as pre-flush Admin food slowly (over 10-15mins) Flush again with 10mls water, watching for signs of regurgitation/reflux/nausea Admin any meds Admin 10mls water as flush ```
43
How long can an O-tube be in place?
Weeks to months (can be managed by owner at home)
44
What are the contraindications for an O-tube?
Persistent vomiting Reduced/impaired gastric flow Comatose/recumbent/dysphoric patients (aspiration risk) Oesophageal disease
45
What complications can occur with an O-tube?
Infection Loss of negative pressure (tube displacement) Suture failure Blockage (less risk than NO tube)
46
How do we carry out a PEG tube feeding?
Wait 24hrs after placement Wear non-sterile gloves Pre-warm feed within syringes in a warm water bath Aspirate stomach contents until you get negative pressure Measure volume and then replace it through the PEG tube Adjust feed as necessary, and admin very slowly (over 20-25 mins) Admin any meds Flush with 10mls water
47
What nursing considerations should we have for PEG tube patients?
Try to administer oral meds through tube when possible Check stoma site twice daily (as with O-tube) Stockinette instead of wrap dressing Tempt with food before every meal (if appropriate)
48
How long can a PEG tube be in place?
Cannot remove for at least 7 days | Can be in place for months (managed by owner at home)
49
How much of the patient's RER do we deliver each day after tube placement?
24hrs after tube placement = 1/3rd RER 48hrs after tube placement = 2/3rds RER 72hrs after tube placement = 3/3rds RER

Veterinary Nursing (65 decks)

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