Exam 1 - Nutrition & Feeding Tubes in Small Animals Flashcards
what are some indications of doing a nutritional assessment of small animal patients?
all patients with inadequate voluntary food intake
patients with gi signs
patients with weight loss
all hospitalized/critically ill patients
high index of suspicion
if your patient has a normal BCS/muscle mass & a preserved appetite, does your patient need assisted feeding?
no assistance required
if your patient has a low BCS and/or muscle mass & a preserved appetite, does your patient need assisted feeding?
evaluate the sufficiency of voluntary intake (RER calculation)
if your patient has a low BCS and/or muscle mass & an absent appetite, does your patient need assisted feeding?
requires assisted feeding
how is RER calculated for animals 2-30kgs? what is the other equation that can be used?
RER = (30 x current body weight in kg) + 70
RER = 70 x (current body weight in kg)^0.75
why are illness factors not recommended anymore when calculating RER?
avoided to prevent overfeeding
how is the increase in energy-needs associated with disease processes counterbalanced?
the decreased physical activity experienced by hospitalized/ill patients is the counterbalance
what are some examples of routes of enteral nutrition support?
nasogastric/nasoesophageal tubes
esophagostomy tubes
gastrostomy/jejunostomy tubes & forced feeding (not recommended)
why is enteral nutritional support so important for critical patients?
the gut receives the majority of its nutrients via the enteral route - not hematogenous
need to feed your patient’s enterocytes
what questions should be asked when deciding if enteral nutritional support is indicated?
- is the gi tract functional
- does the patient have an intact gag reflex
if both answers are yes - proceed with enteral nutrition which is always preferred over parenteral
if you need enteral nutritional support longer than 5-7 days, what route are you considering?
esophagostomy tube
if you need enteral nutritional support, but your patient can’t tolerate general anesthesia & a surgical procedure, what route should you consider?
NE/NG tube
what are the benefits of using an NG/NE tube?
cheap, non-invasive procedure, no need in anesthesia, & easy procedure
what are the limitations of using an NG/NE tube?
can’t be used at home, only can do a liquid diet, can’t use in animals with nasopharyngeal disease, & only is for temporary use
what are the benefits of using an esophagostomy tube?
can be used by the owner, cost-effective, can be used for several months, well tolerated, & blenderized food can be given
what are the limitations of using an esophagostomy tube?
requires general anesthesia, requires surgical incision, can’t be used in animals with esophageal disease or pyloric obstruction
what is the proper placement of an NG tube? NE tube?
NG - in the stomach
NE - distal tip of the feeding tube should be placed between the carina and diaphragm for an NE tube
how do you confirm the placement of your NG/NE tube?
rads -
NG - in the stomach
NE - distal tip of the feeding tube should be placed between the carina and diaphragm for an NE tube
once placed, aspirate the tube with a syringe, looking for stomach contents or gas from stomach, or confirmation of negative pressure
T/F: a patient should be hemodynamically stable prior to initiating assisted feeding
true
how much food do you give when starting assisted feeding?
on day 1, start with 1/3 of RER split across 4-6 meals
day 2, feed 2/3 of RER
day 3, feed full RER
what should you monitor your patient for when using assisted feeding?
monitor for vomiting, regurgitation, gastric distension, & ileus
if your patient has pancreatitis, what type of diet should you give?
low fat
if your patient has hepatic encephalopathy, what type of diet should be given?
protein-restricted diet only if signs are present
if your patient has acute gastroenteritis, what type of diet should be given?
highly digestible diet
how do you treat dysmotility & ileus encountered during enteral nutrition?
temporarily discontinue or slow down nutrition if not tolerated, but remember that the best pro-kinetic agent is food in the stomach
prevent gastric overdistension - empty the stomach through the NG tube
antiemetics - maropitant, ondansetron, & metoclopramide
prokinetics - cisapride, metoclopramide, & erythromycin
what animals are at risk of developing refeeding syndrome?
animals that are severely malnourished or have experienced prolonged starvation
due to intracellular depletion of electrolytes
what is the pathogenesis of refeeding syndrome?
too much food given to a severely malnourished patient
increased insulin production - leads to insulin-driven glucose, PO4-, K+, & Mg2+ uptake
leads to severe hypophosphatemia, hypomagnesemia, & hypokalemia
hemolytic anemia, cardiac failure, neurological dysfunction, & respiratory failure causing death
what are the general guidelines for preventing refeeding syndrome?
identify at risk patients
correct fluid & electrolyte imbalances first
administer nutrition gradually & increase incrementally
frequently monitor electrolytes every 4-8 hours (especially during the 1st 48 hours - K, Mg, PO4, Ca, glucose, PCV,TS)
supplement electrolytes & thiamine as needed
discontinue or slow down nutrition should complications arise
what common complication is seen in NG tubes in cats?
removal of the feeding tube secondary to sneezing, coughing, or vomiting despite continuous use of e-collars
what size NG tube is indicated for dogs & cats?
dogs - 6-8 french
cats - 3.5-5
what are common complications seen with NG tubes? how are these avoided?
epistaxis, rhinitis, & tracheal intubation with secondary pneumonia
place an e collar on the patient
what is the most common complication seen with esophagostomy tubes?
skin infection at the site of placement
what size tube is commonly used for esophagostomy placement?
12-14 french
what is the proper placement of an esophagostomy tube? how is this confirmed?
extends to the 7th or 8th intercostal space - distal esophagus but not past the LES
rads are used to confirm correct placement of the tube in the mid to distal esophagus
the tip of the tube should not pass beyond the lower esophageal sphincter as this can cause irritation and predispose the patient to gastric reflux
what are the clinical manifestations seen with abnormalities caused by refeeding syndrome?
peripheral edema, hemolytic anemia, cardiac failure, neurological dysfunction, & respiratory failure
why does refeeding syndrome occur?
total body reserves of sodium, potassium, phosphorous, and magnesium are depleted in starvation while serum levels are maintained
natriuresis during anorexia can lead to volume depletion
typically, the body uses protein and fat for energy during starvation - during re-feeding, the body isn’t equipped for the carbohydrates that are present in the diet, tube feeding mixture, or parenteral nutrition that we commonly use
when malnutrition is reversed, there is a significant shift back to the use of carbohydrates, rather than fat reserves, resulting in a significant insulin release
this increases the uptake of glucose, potassium, phosphorous and magnesium - naturiesis stops and edema can develop
Increases in HR, BP and cardiac output can lead to volume overload and pulmonary edema, even in animals with no previous history of heart disease
