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Applied Clinical Veterinary Nursing > Nutrition > Flashcards

Nutrition Flashcards

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1
Q

what are the 2 classes of dietary sensitivities?

A

immunologically mediated

non-immunologically mediated

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2
Q

what are the 2 classes of non-immunologically mediated dietary sensitivities?

A

repeatable

non-repeatable

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3
Q

what is an example of a non-immunologically mediated, repeatable dietary sensitivity?

A

food intolerance

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4
Q

what is an example of a non-immunologically mediated, non-repeatable dietary sensitivity?

A

dietary indescretion (gluttony)

intoxication

contamination (poisoning)

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5
Q

what is an immunologically mediated dietary sensitivity also known as?

A

food allergy (hypersensitivity)

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6
Q

can you have a non-immunologically mediated food allergy?

A

no

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7
Q

can food allergies be proven?

A

often suspected but rarely proven

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8
Q

what is a food allergy?

A

an immunologically mediated, adverse food reaction to a dietary component

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9
Q

what type of molecule usually triggers adverse food reactions?

A

proteins

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10
Q

why aren’t AFRs more common than you’d expect for an organ so exposed to foreign antigens?

A

defence mechanisms are in place to reduce likelihood of an AFR

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11
Q

explain the concept of ‘oral tolerance’

A

a complex series of signalling and processing events resulting in tolerance of foreign antigens

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12
Q

what happens when ‘oral tolerance’ fails?

A

adverse food reaction occurs

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13
Q

broadly, why does an adverse food reaction occur?

A

failure of ‘oral tolerance’ - a response is triggered

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14
Q

which body systems usually display the clinical signs of an AFR?

A

dermatological and/or gastrointestinal systems

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15
Q

what do adverse food reactions commonly manifest as?

A

delayed hypersensitivity (type 4)

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16
Q

what are the most common food allergens in dogs?

A

beef
dairy products
wheat

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17
Q

what are the most common food allergens in cats?

A

beef
dairy products
fish

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18
Q

which allergen causes canine epileptoid cramping syndrome?

A

wheat

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19
Q

what are the common cutaneous signs of a food allergy?

A

pruritus/erythema

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20
Q

what are cutaneous signs of a food allergy often identified as?

A

atopy and flea allergy

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21
Q

what is atopy?

A

skin reaction due to external factors e.g mites/fleas

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22
Q

can cutaneous signs present without GI signs?

A

often

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23
Q

what are the GI signs of a food allergy?

A

vomiting, diarrhoea

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24
Q

why can it be difficult to diagnose a food allergy from GI signs alone?

A

non-specific - need to differentiate from other causes

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25
Q

what is the systemic sign of a food allergy?

A

signs associated with anaphylaxis

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26
Q

what is the common clinical presentation of a patient with a food allergy?

A

younger pets (any age possible)

large intestinal pattern diarrhoea

other causes of clinical signs have been excluded where appropriate

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27
Q

after what age do we become less suspicious of a food allergy over other causes?

A

after age 10

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28
Q

what are the main stages of diagnosis/management of a food allergy?

A

exclusion/limitation

challenge and rescue

provocation and rescue

maintenance

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29
Q

what is involved in the exclusion/limitation stage?

A

consumption of prescribed foods and water only

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30
Q

what is involved in the challenge and rescue stage?

A

re-introduction of normal diet

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31
Q

what is involved in the provocation and rescue stage?

A

addition of 1 new food type at a time and monitoring symptoms

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32
Q

what is involved in the maintenance stage?

A

maintenance on food which aids symptoms

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33
Q

should blood tests be performed for suspected food allergies?

A

blood testing for GI manifestations of food allergies/sensitivities has no clinical utility

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34
Q

how long before we would expect to see an improvement in cutaneous signs?

A

up to 10 weeks

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35
Q

how long before we would expect to see full resolution of GI signs?

A

~6 weeks

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36
Q

what are chronic inflammatory enteropathies?

A

group of diseases with chronic (gastro-)intestinal inflammation

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37
Q

what are the symptoms of a CIE?

A

any of - vomiting, diarrhoea, dysorexia, weight loss

~3 weeks duration

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38
Q

what is dysorexia?

A

abnormal appetite

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39
Q

what must occur before diagnosis of CIE?

A

exclusion of other causes of clinical (GI) signs/inflammation first

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40
Q

what extra-GI diseases might cause similar symptoms to CIE?

A

exocrine pancreatic insufficiency

local abdominal inflammation - pancreatic/hepatic/renal

metabolic causes

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41
Q

which metabolic dysfuctions should be ruled out before CIE diagnosis?

A

portosystemic shunts

hypoadrenocorticism (addisons)

hyperthyroidism

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42
Q

which tests can we use to rule out other causes before CIE diagnosis?

A

lab tests - faecal analysis, bloods

imaging - AUS

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43
Q

what are the possible causes of CIE?

A

food responsive disease

antibiotic responsive disease

idiopathic disease

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44
Q

how can we confirm food-responsive CIE?

A

diet trial

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45
Q

how can we confirm antibiotic-responsive CIE?

A

only considered in certain breeds e.g. GSD

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46
Q

how can we confirm idiopathic CIE?

A

endoscopy to diagnose/confirm and exclude other microscopic/structural disease

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47
Q

how does idiopathic CIE usually occur?

A

usually immune-mediated

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48
Q

what were idiopathic CIEs originally referred to as?

A

inflammatory bowel disease

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49
Q

what causes the symptoms of idiopathic CIEs?

A

loss of tolerance to the mucosal flora in the intestinal tract

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50
Q

what type of disorder is an idiopathic CIE?

A

immunological

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51
Q

what can we see on endoscopic biopsy which confirms idiopathic CIE?

A

inflammation - various types

architectural changes - villi atrophy

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52
Q

what are the route options for intestinal biopsy?

A

laparotomy or endoscopy

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53
Q

what are the advantages of taking biopsies via laparotomy?

A

enables multiple full-thickness biopsies

enables full exploration of other organs

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54
Q

what are the disadvantages of taking biopsies via laparotomy?

A

surgical risk of dehiscence (~10%)

risk of peritonitis, sepsis

55
Q

what are the advantages of taking biopsies endoscopically?

A

minimally invasive, small mucosal biopsies

56
Q

what are the disadvantages of taking biopsies endoscopically?

A

may not reflect jejunal disease (can’t access via endoscope)

57
Q

what are the consequences/complications of CIEs?

A

dehydration

protein malabsorption (protein losing enteropathy)

hypocobalaminaemia

GI haemorrhage +/- anaemia

GI perforation (rare)

58
Q

what can protein losing enteropathy result in?

A

hypoalbuminaemia

59
Q

what are the clinical signs f hypoalbuminaemia?

A

effusions - pleural and peritoneal

oedema

thromboembolitic events

60
Q

what can GI perforation lead to?

A

septic peritonitis - life-threatening

61
Q

what are the types of supportive/standard therapies for CIEs?

A

fluid balance

nutritional management

anti-emetics/appetite stimulants as required

immunosuppression

62
Q

what might nutritional management of CIEs look like?

A

dietary modification, exclusion diet

tube feeding initially in severely affected patients, considering dietary suitability

63
Q

what is typically used for immunosuppression in idiopathic CIE patients?

A

prednisolone - minimum effective dose

64
Q

what other drugs might be given as part of management of idiopathic CIEs?

A

fenbendazole

metronidazole

vitamin B12

anti-platelet drugs

65
Q

what are the general principles for dietary trials?

A

feed exclusively with water min 3-10 weeks

don’t confuse with ‘sensitive’ GI diets

66
Q

why might other disease response to dietary trials?

A

started feeding highly digestible, high quality diet may result in resolution of other symtoms

67
Q

what are the main options of food intolerance/sensitivity trials?

A

novel protein/carbohydrate

hydrolysed protein

68
Q

can homemade diets be used for food intolerance/sensitivity trials?

A

most are not fit for purpose

69
Q

what are our main nursing considerations for patients with food sensitivities/intolerances?

A

hydration status

management of inappetence/nausea

nutrition/malnutrition status

abdo discomfort

hypoproteinaemia

diarrhoea/faecal scold - patient hygiene

70
Q

how can we monitor patient nutrition while hospitalised?

A

record food intake - hospital charts

monitor body condition/weight, consider effect of fluid balance

71
Q

when should we consider nutritional support for hospitalised patients?

A

<80% RER voluntary intake (over 2-3 days)

> 10% BW loss (after fluid balance)

> 3 days hyporexia

severe underlying disease e.g. trauma, sepsis, severe burns

72
Q

how much BW change is possible day to day due to weight loss?

A

only 1% per day - rest is fluid balance

73
Q

how else can we manipulate the diet/feeding to help patients with food sensitivities/intolerances?

A

feeding frequency/posture - consider raised feeding

low fat

supplemented fibre in large bowel/colonic disease

74
Q

why might a low fat diet be advantageous for these patients?

A

facilitates gastric emptying

good for reflux/regurgitation

75
Q

why might patients with sensitivities/intolerances experience abdominal discomfort?

A

GI pain - dilation, ulceration

reflux pain

76
Q

which medications might be given to help patients with GI pain?

A

omeprazole
sucralfate

77
Q

how can we help patients with reflux pain?

A

manage oesophagitis

postural feeding

78
Q

why should opioids be avoided in patients with CIEs?

A

they slow peristalsis - may exacerbate/cause ileus

79
Q

how can we help avoid diarrhoea scalding?

A

keep behind as clean and dry as possible

topical barriers e.g. cavilon spray

avoid patient grooming

tail bandages

absorbent bedding (not vetbed-scratchy)

80
Q

what are the monitoring considerations for patients with food sensitivities/intolerances?

A

weight and appetite

demeanour

vomiting/diarrhoea - record nature and quantity

hydration/volaemic status

HR/RR

comfort levels

blood/electrolytes

81
Q

why is clinical nutrition important?

A

vital for good patient management

reduces morbidity and mortality rates

reduces length of hospitalisation and complications

82
Q

how would you assess for malnutrition in a patient?

A

muscle condition
body condition score
unexplained weight loss >10% BW
poor coat condition

83
Q

what are the risk factors for malnutrition?

A

severe underlying disease

large protein loss

burns

head trauma

84
Q

what happens during simple starvation?

A

normal metabolic adaptations-

utilisation of glycogen stores

conservation of protein

fat usage increased

85
Q

what happens in the body during stress starvation?

A

hypermetabolism

breakdown of protein/muscle wastage - catabolism

less time to state of malnutrition

cachexia

86
Q

what is cachexia?

A

muscle loss in the presence of disease

87
Q

what does stress starvation ultimately result in?

A

poorer prognosis for recovery, particularly if not managed quickly

88
Q

what should be managed first with malnutrition, before short-term aims are addressed?

A

address hydration, electrolytes and acid-base balance, manage pain

89
Q

why is it important to manage pain when providing supportive clinical nutrition?

A

pain slows gut motility

90
Q

what are the short-term aims of supportive clinical nutrition?

A

provide for any ongoing nutritional requirements

prevent/correct ant nutritional deficiencies/imbalances

minimise metabolic derangements

prevent further catabolism of lean body mass

91
Q

what should long-term nutritional aims for supportive clinical nutrition include?

A

restoration of optimal body condition

provision of required nutrients to the animal within its own environment

92
Q

what are the 4 main type of assisted enteral feeding tubes?

A

naso-oesophageal/gastric - short term

oesophagostomy

gastrostomy

jejunostomy

93
Q

how long should an NO/gastric tube be in place?

A

no longer than 5-7 days

94
Q

can an RVN place an NO/gastric feeding tube?

A

yes (under instruction)

95
Q

what factors influence choice of assisted enteral feeding technique?

A

patient - tolerance, anaesthesia risk, duration required

technical - clinician experience, risk of complications, type of diet

owner - cost, ability to use at home if required

96
Q

what is re-feeding syndrome?

A

complex metabolic derangements that occur when enteral/parenteral nutrition is fed to severely malnourished patients, or those following a period of prolonged starvation

97
Q

why is it important to consider re-feeding syndrome?

A

patient needs time to adjust to food again - changing from catabolic to anabolic state

potentially fatal complication

98
Q

what metabolic changes occur due to sudden increased insulin?

A

severe hypophosphataemia

hypokalaemia

hyponatraemia

hyperglycaemia

hypocalcaemia

99
Q

what are the clinical signs of re-feeding syndrome?

A

cardiac failure

respiratory failure

neurological dysfunction

peripheral oedema

haemolytic anaemia

100
Q

why do clinical signs associated with re-feeding syndrome occur?

A

due to metabolic derangements

101
Q

how can we minimise risk of re-feeding syndrome?

A

only commence feeding once patient is haemodynamically stable (fix fluid/electrolyte defects)

risk assessment regarding malnutrition

gradual introduction - micro-enteral nutrition

tube feed until patient voluntarily eating >85% of calculated energy requirements daily

102
Q

what is micro-enteral nutrition?

A

delivery of small amounts of water/electrolytes/readily absorbed nutrients directly into the GI tract

using oral rehydration fluid (oralade/lectade)

103
Q

how long should it take to get to feeding full RER if patient has been anorexic <3 days?

A

3 days

day 1 = 1/3rd RER
day 2 = 2/3rds RER
day 3 = full RER

104
Q

how long should it take to get to feeding full RER if patient has been anorexic >3 days?

A

5 days

day 1 = 1/4 RER
day 2 = 1/2rd RER
day 3 = 2/3rds RER
day 4 = 3/4 RER
day 5 = RER

105
Q

what is parenteral nutrition?

A

provision of nutrition via the IV route when enteral nutrition is not possible

106
Q

why is parenteral nutrition rarely used?

A

it is a highly skilled practice with multiple possible complications

human evidence shows may worsen outcomes if not managed appropriately

only suitable for selected patients

107
Q

what is the first line of nutritional support?

A

supported enteral nutrition

108
Q

what are the solution components for TPN?

A

lipid
amino acids
carbohydrate (dextrose or glycerol)

109
Q

how should TPN lines be managed?

A

peripheral lines must only deliver the PN solution

monitor twice daily for phlebitis/infection at cannula site

manage PN mixtures to avoid separation of solution

110
Q

what complications should be monitored for during TPN?

A

metabolic complications (most common)

mechanical e.g. occlusion of dislodgement, patient interference

septic - maintain aseptic techniques

111
Q

what grams/ratios should be in TPN mixture?

A

calculate for RER

dogs: 4-5g protein per 100kcal then 50:50 lipid:dextrose

cats: 6g protein per 100kcal then 50:50 lipid:dextrose

112
Q

which conditions have decreased requirements for TPN?

A

hepatic/renal failure

113
Q

which conditions have increased requirements for TPN?

A

protein-losing conditions
sepsis, buns, head trauma

114
Q

what preventative measures should be put in place to avoid complications during TPN?

A

experienced personnel involved with all aspects of the process

clear protocols and procedures in place for staff to follow

aseptic techniques

prevent patient interference

regular monitoring and recording

115
Q

why might owner choose raw/vegetarian/vegan diets for their pets?

A

personal opinions/beliefs
‘cheaper’
social media influence
allergies/sensitivities
closer to ‘natural’ diet of wolf
more natural, less processed
looks more appealing
human-animal bond
mistrust of food companies

116
Q

what does BARF stand for?

A

bone and raw food/biologically-appropriate raw food

117
Q

why is raw feeding found to be growing in popularity in the UK?

A

perceived to be ‘healthier’

avoids ‘problematic’ ingredients

health benefit claims

value of time spent preparing food

distrust of pet food industry and ‘processed’ foods

118
Q

why is a ‘wild diet’ not appropriate for domestic dogs?

A

domestic dog is genetically altered from wild counterparts

have increased capacity for starch digestion

greater longevity

119
Q

what are the risks of feeding a RAW diet?

A

imprecise nutritional measurements

risk of GI perforation, bone impaction in GI tract

low vitamin and mineral content

microbiological infection

issues with sources - e.g. gullet tissue hyperthyroidism

120
Q

what are the microbiological infection risks involved in raw feeding?

A

salmonella commonly investigated

listeria, toxoplasma, crypto, mycobacterium bovis

toxicara larvae - humans are paratenic hosts

121
Q

does the WSAVA recommend raw feeding?

A

currently no properly documented evidence of health benefits for raw feeding, but there are well-documented risks

recommends against

122
Q

does the BSAVA recommend raw feeding?

A

claims important to consider pros and cons

says raw diets can be safely fed provided assurance of nutritional adequacy is confirmed and sufficiently high levels of hygiene are met

123
Q

what is the Raw Feeding Veterinary Society’s stance on raw feeding?

A

claims health benefits have been researched and documented

outdated studies on microbiological risks

lack of evidence to support risk of ingested bones

refutes claim of nutritional inadequacy

124
Q

what does RMBD stand for?

A

raw meaty bone diet

125
Q

what are the key considerations for discussions with owners wanting to feed alternative diets?

A

why do they want to feed an alternative diet? - dispel misconceptions, understand their perspective

discuss importance of risk management with them

126
Q

how can we discuss risk management for raw diets with owners?

A

individual assessment of patient

assessment of home environment/children/immunocompromised

appropriate sourcing/preparation

monitoring

127
Q

what advice can we give owners about source selection for raw feeding?

A

irradiated diets to remove some pathogens

not ground meat - more risk of surface bacteria, more processing

cook food prior to consumption

scrupulous hygiene

regular antithelmintic therapy

home freezing not effective against bacteria

128
Q

what temperature is sufficient to kill bacteria in raw food?

A

74 C

129
Q

why are vegetarian diets not usually appropriate for domestic animals?

A

cats and dogs have increased protein requirements compared to people

limited essential amino acids in vegetable protein

essential feline dietary nutrients - generally have animal source

130
Q

why are commercially available vegetarian/vegan diet still inappropriate?

A

vast majority nutritionally inadequate

tend to have decreased palatability, digestibility and biological value

131
Q

how can we consider the clients perspective in conversations around raw feeding?

A

inappropriate to simply dismiss clients wishes - need to ensure supportive conversation

educate owner of risks and how to manage - individual tailoring with professional advice

132
Q

what general considerations should we have during conversations around alternative diets?

A

consult with professional peers in practice

consider practice position

individualised advice and support for owners - show empathy, respect, without judgement

make sure always taking an evidence-based approach

133
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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