Final - Nutrition for Hospitalized Patients

Question 1

what are some reasons to wait to feed hospitalized patients?

Answer 1

1. underlying medical condition
2. complication with feeding
3. GI paresis/Ileus due to anesthesia, surgery, hypokalemia, GI disease or meds
4. dehydrated or shocked gut

Question 2

what should you feed a hospitalized patient?

Answer 2

1. highly digestible >95%
2. high moisture
3. small particle size
4. low-medium fat for dogs (20-30%) or medium-high fat for cats (30-50%)

Question 3

what is refeeding syndrome

Answer 3

feeding a starved animal too fast resulting in a rapid drop in K, Mg, and P

Question 4

K, Mg, P

Answer 4

K+ kills
Mg+2 malnourished
P pets

Question 5

how to prevent refeeding syndrome

Answer 5

1. correct electrolytes imbalances and hydrate before feeding
2. slowly introduce food (1/4-1/3 RER of current weight)
3. check K, Mg, P 12 hours post feed; if abnormal, decrease or discontinue feeding and correct electrolytes with fluids

Question 6

prolonged starvation/malnutrition (1-3wk) may require _____

Answer 6

additional supplements - thiamine (before feed), cobalamin, vitamin B complex

Question 7

conversion of crude protein and fat to g/1000 kcal

Answer 7

CP or CF from GA x 10,000
kg/kcal

Question 8

what are some risks for malnutrition

Answer 8

< RER for 5+ days
anorectic for 3+ days
nontraditional diet, unfamiliar brand, incomplete diet
GI signs
underlying disease
BCS < 4/9, >5% BW loss, > 2% BW loss/week
muscle loss
hypoalbuminemia (ascites/edema)
hair loss, dry flaky skin

Question 9

should you feed NPO (nothing by mouth)

Answer 9

NO, do feed by mouth = maintains gut barrier, reduces risk of bacterial translocation, shorter time to recovery and improved weight gain

Question 10

nasoesophageal tube (NE tube)
pros
cons

Answer 10

pros: minimal-no sedation, no special equipment
cons: discomfort, liquid diet, largely blind procedure which could result in perforated lung

Question 11

what tube must you verify its placement with rads or end-tidal CO monitor

Answer 11

NE tube

Question 12

esophageal tube (Etube)
pros
cons

Answer 12

pros: easy, brief anesthesia, more caloric dense diets - ideal for patients that have feeding-volume limitations
cons: tube obstruction, cellulitis at stroma site

Question 13

Percutaneous-guided gastrostomy tubes (PEG)
pros
cons

Answer 13

pros: good for laparotomy/endoscopy patients, long-term support, largest tube, deliver most diets after blending
cons: special equipment/ experience, mild cellulitis at site, peritonitis

Question 14

what should you consider when choosing a type of feeding tube

Answer 14

1. duration of nutritional support
2. need to circumvent segments of GI
3. clinician experience
4. patient’s anesthesia tolerance