Nutritional assessment of the inpatient Flashcards
Nutritional support
Entreal - via the digestive system
Parenteral - outside of the digestive system (intravenous)
Enteral
Generally preferred
physiologically normal for the patient (will make a faster recovery)
Prevents enterocyte atrophy and supports gastrointestinal function
prevents bacterial translocation
less expensive and less complications
Parenteral
specialist training and equipment required
carries high risk of bacteraemia if strict asepsis not adhered to
Often infused via a central line (jugular)
if peristalsis ceases, can lead to bacterial translocation
Feeding tubes
type of enteral support. Although they have a lower risk profile than parenteral feeding they do come with their own risks
risks of pathogen entry at surgical site
compounded by food contamination around the site - must be kept as clean as possible
misplacement
equation for feeding tubes
(BWx30) + 70
rer is used instead of MER as the patient is at rest
common types of feeding tube
Nasogastric feeding tube
Oesophagostomy feeding tube
gastrostomy feeding tube
jejunostomy feeding tube
parenteral nutrition
the administration of nutrition via a parenteral route. in practice this means via the iv route
last option as it bypasses the digestive system.
bag is tailor made to each patient under strict surgical conditions.
A central line is inserted aseptically and the fluid is administered via specific fluid pumps. Very careful observation is needed of both the insertion site and the patient in general.
indications of parenteral nutrition
Used in cases when key parts of the digestive tract are compromised
Complications in parenteral nutrition
introduction of bacteria straight into systemic circulation - leading to bacteraemia, overfeeding, metabolic complications. Care needed not to volume overload patient ( when on seperate fluid therapy)
Nutritional assessment of the inpatient
clinical history
clinical exam
Lab tests
why do we starve cats/dogs/ferrets prior to any sedation or general anaesthetic
reduces the risk of aspiration pneumonia
but it can make some of our older, younger or compromised patients more predisposed to hypoglycaemia
why do you think the affects of chemical restraint might have on the digestive system?
They can drastically reduce gastrointestinal motility
what do you think the affects of simply being in a stressful environment have on the body
release fight or flight sypathetic hormones
adrenalin, cortisol
these can also slow Gi motility (peristalsis)
post surgical nutritional considerations
patients should eat asap after surgery
60-70% immune function in cat and dogs come from the intestines
should ideally be highly palatable and easily digestible
moderate high in good quality fat, high biological, taurine and arginine
Post surgical nutritional considerations
arginine is essential for the conversion of ammonia into urea
taurine known to aid the immune response
glutamine aids in gluconeogenesis and helps prevent bacterial translocation by supporting enterocyte function
Gastroenteritis
refers to inflammation of both the stomach and intestines the most common cause being vomiting and diarrhoea respectively, this condition is a symptom rather than a cause.
Gastroenteritis
a dietary indiscretion or bacterial infection
considerations
-treat dehydration along with electrolyte loss
- energy dense and easy to digest
- withholding food for 12-24 hours intractable vomiting recommended
followed by feeding 25-30% of their RER on the first day across 6 feeds
Refeeding syndrome
before feeding any animal for the first time we should
assess the patients electrolyte levels
place them on intravenous fluids if needed
feed them a 1/3rd of their RER in the 1st feed 2/3rds 2nd feed
refeeding sydrome
- starved patients have low levels of electrolytes
- when a high carbohydrate diet is fed this causes a huge release in insulin
- insulin takes glucose to the cells
- however, it also pushes electrolytes like potassium and calcium into the cells
this can lead to sudden death
gastric dilation volvulus
the stomach becomes full of air, dilates and then twists causing profound cardiovascular compromise
- large, deep chested breed predisposed
advice to clients
- never exercise predisposed breeds after eating
