Clinical Nutrition Flashcards
What are six basic classes of nutrients in a balanced diet?
Protein Fat Carbohydrates Minerals Vitamins Water
Describe vitamins and their importance.
Organic compounds A, D, E, K + B and C Energy metabolism Biochemical reactions Deficiency syndromes
What are the macrominerals?
Calcium Phosphorous Magnesium Sodium Potassium Chloride Sulphur
What are the microminerals?
Iron Copper Zinc Manganese Iodine Selenium
Describe protein.
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
What is the function of protein?
Regulation of metabolism
Cells and muscle fibre structure
Tissue growth and repair
Energy source
What can occur if protein is in excess in the diet?
Liver/kidney problems
Care in ageing animals
Increase for young
What can occur from a protein deficiency?
Poor growth, muscle and weight loss Dull hair Reduced immunity Oedema (hypoalbuminaemia) Death
What is the function of fat in the diet?
Provide energy Aid absorption of fat-soluble vitamins Enhance palatability Source of essential fatty acids - linoleic/linolenic/arachidonic acids DHA - neural development
What can occur from inadequate fat intake?
Energy deficiency
Essential fatty acids deficiency - impaired reproduction/wound healing, dry coat, flaky skin, eczema
What are the 3 main groups of carbohydrate?
Monosaccharides - glucose/fructose
Disaccharides - maltose/lactose/sucrose
Polysaccharides - starch/glycogen/fibre (complex carbs)
What is the function of carbohydrates?
Energy - may be converted to fat
Metabolic requirement for glucose (precursors - amino acids/glycerol)
Enzymes required for disaccharides (lactase, sucrase)
Describe dietary fibre.
Indigestible polysaccharides (cellulose/lignin/pectin) Mainly constitute of plant cell walls Relatively indigestible in the intestines of dogs/cats
What is the function of dietary fibre?
Add bulk to the faeces
Prevent constipation and diarrhoea
Role in correction of obesity
Role in regulating blood glucose levels in diabetics
What are the possible consequences of obesity?
Hepatic lipidosis Joint disease Diabetes mellitus Skin disease Cardiorespiratory disease Surgical implications Feline Lower Urinary Tract disease (FLUTD) - males
How can we implement weight loss and what is a safe amount of loss?
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
What are the benefits of obesity diets?
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)
Why might L-carnitine be supplemented in obesity diets?
Non-essential amino acid
Helps encourage use of fat for energy and reduce fat storage
Helps reduce the risk of hepatic lipidosis in cats
What does a GI diet contain?
Highly digestible proteins and starch Prebiotics (MOS / FOS) Omega 3 essential fatty acids (EPA / DHA) Fibre - psyllium High/low fat
What does a hypoallergenic diet contain?
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)
Describe a convalescent diet.
30-50% total energy provision via protein sources
Available forms = liquid/powdered/solid wet
Define Resting Energy Requirement (RER).
Includes energy expended for recovery from physical activity and feeding
(Hospitalised patients)
Define Maintenance Energy Requirement (MER).
Energy required by moderately active animal
Not included = energy for growth, lactation or work
Need to consider life-stage factors
How do we calculate energy requirement for a hospitalised patient?
Use RER
RER = 70 x bodyweight (kg) ^0.75
Or RER = 30 x bodyweight (kg) + 70
How do we calculate the energy requirement for a healthy animal?
Use MER
RER x appropriate life-stage factor
What breeds are predisposed to pancreatitis?
Terriers
Miniature Poodles
Miniature Schnauzers
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
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
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
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
What is required in a diet for hyperthyroid patients?
Dietary iodine required for production of thyroid hormone
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
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
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
What are the three types of feeding tube?
Naso-oesophageal
Oesophageal
Percutaneous Endoscopic Gastrotomy (PEG) tube
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
How long can we use an NO feeding tube?
Up to 7 days.
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
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
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
What are we checking an O-tube stoma site for?
Swelling, discharge, redness, pain
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
How long can an O-tube be in place?
Weeks to months (can be managed by owner at home)
What are the contraindications for an O-tube?
Persistent vomiting
Reduced/impaired gastric flow
Comatose/recumbent/dysphoric patients (aspiration risk)
Oesophageal disease
What complications can occur with an O-tube?
Infection
Loss of negative pressure (tube displacement)
Suture failure
Blockage (less risk than NO tube)
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
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)
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)
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
