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Essential Veterinary Patient Care Yr1 > Nutritional support > Flashcards

Nutritional support Flashcards

1
Q

List the 5 reasons for utilising feeding plans.

A

To:
1. Deliver daily calorie requirement (DER + RER)
2. Improve recovery time
3. Ensure a nutritionally balanced diet to maintain optimuum bodily functions
4. Prevent or correct nuritional imbalances
5. Prevent the body from catabolizing lean body mass

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2
Q

7..

What information do you need in order to create a feeding plan?

A

What the:
* Normal feeding habits are (how often, amount etc, amount)
* Feeding routine is
* What diet is being provided
* Known allergies are
* BCS
* MCS
* VS diet diagnosis of type of diet + approval

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3
Q

What are the 5 steps to creating a feeding plan?

A
  1. Ascertain what the normal feeding habits are; including routine + diet
  2. Find out from the owner any known allergies or medically relevant reasons to why their diet is being given
  3. Discuss with VS in charge, what diet should be offered - relevant to clinical condition
  4. Share BCS + MCS with VS - as they are subjective
  5. Record on patient’s client record + hospitilisation sheet the diet that must be fed + a list. of alternative foods that could be fed - if unavaliable

4 - Note, that there may be clinically relevant reasons for a high or low BCS or MCS score, which may alter the DCR (Daily Calorie Requirement)

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4
Q

What is the BCS for rabbits called?

A

Rabbit Size-0-Meter

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5
Q

What is the minimum and maximum score range on the Rabbit Size-0-Meter?

A
  • Minimum = 1
    (Underweight)
  • Maximum = 5
    (overweight)
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6
Q

What is the ideal score on the Rabbit Size-0-Meter?

RS0M = Rabbit Size-0-Meter

A

3

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7
Q

What percentage under ideal body weight is a rabbit, with a score of 1, on the RS0M?

BW = Body Weight

A

> 20% below ideal BW

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8
Q

What percentage under ideal body weight is a rabbit, with a score of 2, on the RS0M?

A

10 - 20% below ideal BW

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9
Q

What percentage over ideal body weight is a rabbit, with a score of 4, on the RS0M?

A

10 - 15% over ideal BW

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10
Q

What percentage over ideal body weight is a rabbit, with a score of 5, on the RS0M?

A

> 15% over ideal BW

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11
Q

What 6 areas/landmarks are assessed when using the RS0M?

A
  1. Hip bones
  2. Ribs
  3. Spine
  4. Fat cover
  5. Muscle mass
  6. Rump curvature
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12
Q

What are the identifying characteristics of a score of 1, on the RS0M?

A
  • Hip bones, ribs + spine = sharp to touch
  • No fat cover
  • Loss of muscle
  • Obvious curves of the rump
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13
Q

What are the identifying characteristics of a score of 2, on the RS0M?

A
  • Hip bones, ribs + spine = easily palpable
  • Very little fat cover
  • Loss of muscle
  • Flat rump
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14
Q

What are the identifying characteristics of a score of 3, on the RS0M?

A
  • Hip bones + spine = easily palpable, not sharp + feels rounded
  • Ribs feel like a pocket of pens
  • No abdominal bulge
  • Flat rump
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15
Q

What are the identifying characteristics of a score of 4, on the RS0M?

A
  • Hip bones, ribs + spine = requires pressure to palpate
  • Some fat layers
  • Rounded rump
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16
Q

What are the identifying characteristics of a score of 5, on the RS0M?

A
  • Hip bones, ribs + spine = can’t be felt
  • Tummy sags
  • Obvious fat padding
  • Ruump bulges out
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17
Q

What does the MCS focus on?

A

Muscle mass

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18
Q

Can an obese patient have a low MCS?

A

Yes, this does not mean they’re healthy though

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19
Q

Does a healthy BCS mean the patient will have a healthy MCS?

A

No

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20
Q

Think of whether they are fast or slow..

What are the most common 2 types of conditions that tend to present with muscle loss?

A

Acute disease + Chronic disease

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21
Q

What is the difference between Sarcopenia + Cachexia?

A

Sarcopenia defined as the loss of muscle mass and function associated with aging. (Unrelated to disease)

Cachexia defined as weight loss due to an underlying illness, are muscle wasting disorders. (Associated to disease + morbidity)

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22
Q

Name a few causes of cachexia, in relation to chronic disease

A
  • Congestive heart faliure (CHF)
  • Cancer
  • Respiratory disease
  • Kidney disease
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23
Q

How often should patient MCS be performed?
And why?

A

Every time the patient is seen, to assess how stable their condition is

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24
Q

Name 6 potential aspects that muscle loss affects.

A
  1. Joint health
  2. Tissue health
  3. Fitness
  4. Function
  5. Immune health
  6. Wound healing
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25
Q

What association provides the feeding guide that is used in hospitlised patient’s, for dogs and cats?

A

World Small Animal Veterinary Association (WSAVA)

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26
Q

What is the Resting Energy Requirement (RER) formula?

A

RER = BW (kg) x 30 + 70

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27
Q

What does the RER formula work out?

A

The calories required in a 24hr period, to maintain bodily functions, when the animal is resting

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28
Q

Work out the RER for a 25kg Border Collie

A

RER = BW (kg) x 30 + 70
RER = 25kg x 30 + 70
= 820 kcals p/24hrs

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29
Q

Work out the RER for a 5kg DSH

DSH = Domestic Short Hair

A

RER = BW (kg) x 30 + 70
RER = 5kg x 30 + 70
= 220 kcals p/24hrs

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30
Q

Work out the RER for a 2kg Tea-cup Yorkie

A

RER = BW (kg) x 30 + 70
RER = 2kg x 30 + 70
= 130 kcals p/24hrs

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31
Q

What does DER stand for?

A

Daily
Energy
Requirements

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32
Q

State a few factors that affect RER

A
  • Age - growing patients require greater calories
  • Working animals (Spingers, collies etc) require more kcals for their high-active lifestyle
  • Pregnant or lactating patientes
  • Neonates
  • Immunocompromised patients
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33
Q

What is the Growth DER for Canines, under 4 months old?

A

RER x 3

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34
Q

What is the Growth DER for Canines, over 4 months old?

A

RER x 2

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35
Q

What is the Growth DER for Kittens?

A

RER x 2.5

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36
Q

What is the Maintainance DER for Adult Neutered Canine?

A

RER x 1.6

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37
Q

What is the Maintainance DER for Adult Neutered Feline?

A

RER x 1.2

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38
Q

What is the Maintainance DER for Adult Intact Canine?

A

RER x 1.8

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39
Q

What is the Maintainance DER for Adult Intact Feline?

A

RER x 1.4

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40
Q

What is the Maintainance DER for Adult Obese Canine?

A

RER x 1.4

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41
Q

What is the Maintainance DER for Adult Obese Feline?

A

RER x 1

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42
Q

What is the Maintainance DER for Adult Canine during weight loss?

A

RER x 1

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43
Q

What is the Maintainance DER for Adult Feline during weight loss?

A

RER x 0.8

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44
Q

What is the Maintainance DER for a Light-work working Adult Canine?

A

RER x 2

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45
Q

What is the Maintainance DER for a Heavy-work working Adult Canine?

A

RER x 4-8

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46
Q

Work out the RER for a 2m old Terrier Cross breed, weighing 2.5kg

A
  1. RER = BW (kg) x 30 + 70
    = RER = 2.5kg x 30 + 70
    = 145 kcals p/24hr

2.DER = 2m = In ‘Up to 4m old’ bracket = DER x 3
= RER x 3
= 145 x 3
= 435 kcals p/24hr

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47
Q

Work out the RER for a 1 yr old Cocker Spaniel, weighing 9kg

A
  1. RER = BW (kg) x 30 + 70
    = RER = 9kg x 30 + 70
    = 340 kcals p/24hr

2.DER = 1 yr = In ‘Medium/Heavy work’ bracket = DER x 4
= RER x 4
= 340 x 4
= 1360 kcals p/24hr

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48
Q

What are the 10 pieces of information you must ascertain to calculate how many grams p/24hr can be given to the patient?

A
  1. Patient history
  2. Diet
  3. Normal feeing habits
  4. Relevant medical + surgical conditions
  5. BCS
  6. MCS
  7. Weight
  8. Discussed with VS in charge, what diet diagnosis, RER calculations
  9. Calculate kcal p/24hrs
  10. Calculate grams p/24hrs
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49
Q

How do you work out how many grams the patient requires to be fed per day?

A

By finding out what the kcal/g of the selected diet is + divide it by the kcals p/24hrs

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50
Q

How to work out the kcal per gram of dry food.
Using the example below.

Dry food tin = 3756kcals per kg = 376kcals per 100g

A

Convert Kg > g.

= 3756kcal p/g (divided by) 100
= 3.76 kcal p/gram

Because there is 1000g in a kg

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51
Q

How to work out the kcal per gram of wet food.
Using the example below.

Wet food can = 286kcals per 354 g can

A

Start by converting Kg > g.

= kcals p/gram (divided by) amount in the can
= 286kcal p/g (divided by) 354g
= 0.8 kcal p/gram

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52
Q

How do you work out how many grams a day the patient needs from that tin of wet or dry food?

A

RER (divided by) kcals p/gram
= g p/24hrs (divided by) meals to be given per day
= g per feed

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53
Q

Work out how many grams a day does a 25kg border collie, on a selected diet of dry Hills z/d, with 3.6kcals per gram

Hills z/d = z/d = diet name

A

Work out RER
RER = BW (kg) x 30 + 70
= RER = 25kg x 30 + 70
= 820kcals p/24hrs

**Ascertain how many kcals in p/g of diet **
= Diet kcals p/g = 3.6kcal

Work out how many kcals p/24hrs
RER (Divided by) kcals p/g = diet kcals p/24hrs
= 830kcals p/g (divided by) 3.6 kcals p/gram
= 227.8g p/24hrs

**Meals required per day = usually 4 **but can be 6 (in paediatric patients)

Find kcals p/g p/24hrs (divided by) meals required per day = g per meal

= 227.8g p/24hrs (divided by) 4 meals
= 228.56.95g per feed

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54
Q
A
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55
Q

What is Refeeding Syndrome?

A

A fatal condition, when the body prevents protein and muscle breakdown during period of starvation/anorexia/severe malnutrition, the body adapts by altering it’s metabolism

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56
Q

When is refeeding syndrome a high risk when providing nutrionally support to newly hospitilised patients who haven’t eaten in a while?

(Malnourishment)

A

When they first become hospitilised and nutritional support is provided, as it is following a period of starvation for the weak body

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57
Q

What should you look for in the patient’s history, that could increase the risk of refeeding syndrome?

A

A hx of anorexia

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58
Q

What percentage of body mass loss will increase the risk of refeeding syndrome?

A

> than 50% body mass loss

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59
Q

What would a sudden electrolyte shift, caused by a sudden surge in Insulin lead to?

A
  • Hypokalemia
  • Hypomagnesemia
  • Hypophosphatemia
  • Death

(Kalemia = Potassium)

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60
Q

State as many reasons for nutrional support as you can

A
  • Hypothermia
  • Vomiting
  • Nausea
  • Pain
  • Foreign body
  • Disease
  • Viruses
  • Pyrexia
  • Age/geratric
  • Recovering anaesthesia
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61
Q

What 3 types of nursing feeding methods can cause food aversion?

A
  1. Syringe feeding
  2. Tube feeding
  3. Parental feeding
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62
Q

What the difference between Inappetence and Anorexia?

A

Inappetence is a reduction in appetite,

Whereas,

Anorexia is a complete lack of dietray intake.

Note: Remember that clients will see Inappetance as ‘being picky’

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63
Q

True or False.

If a patient has a history of anorexia, this does not need to be included into the nursing plan, as it is not currently medically relevant.

A

False, this should always be including into the patient’s nursing plan
+
Must be brought to the VS’s attention

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64
Q

What can abdominal distension be a sign of in patient with problematic GI movements?

65
Q

Define Ileus

A

The absence of propulsive aboral movement of the gastrointestinal tract contents (Intestines)

66
Q

What is meant by ‘propulsive aboral movement’ ?

A

Normal muscle contractions along the gastrointestinal tract, i.e. peristalsis

67
Q

What can an absence of propulsive aboral movements in the GI tract cause?

A

Intestinal impaction

68
Q

Name 2 potential causes of Ileus

A
  1. Enteritis
  2. Hypocalcaemia

Enteritis = Inflammation of the SI

69
Q

What may critically ill patients often require prior to nutirional interventions?

A

Stabilisation!

70
Q

What potential methods could be required to stabilise a patient prior to nutritionally interventions, in critically ill patients?

A
  • Assessment + stabilisation of vital signs
  • IVFT
  • Oxygen therapy - if hypodynamically stable, otherwise the patient can go into hypovalemic shock, due to reduced blood flow to the GI tract
  • GA or Anaesthesia
71
Q

For non-critical patients, who have a history of anorexia, how many days do they need to be anorexic in order to be considered for nutritional support?

72
Q

What can poor perfusion of blood to the GI tact, leading to a decrease in nutrient absorption + digestion, lead to?

73
Q

True or False.

Ileus can increase the risk of regurgitation + vomiting.

74
Q

What 2 potential recurrent conditions can also be considered to increase the risk of regurgitation + vomiting in patients?

A
  1. Pancreatitis
    (due to naseua , pain + inflammation)
  2. Osteoarthritis
    (due to inflammation of GI tract bv’s)

Pancreas = produced digestive enzymes

75
Q

What 3 factors should you ensure, within the nursing role, to provide nutrition to patients?

A
  1. Patient’s recieve their Daily Energy Requirements (DER)
  2. Select a nutriontionally balanced diet, to meet Resting Energy Requirements (RER)
  3. Provide adequate nutrition, factoring in disease + dietary requirements
76
Q

What 5 affects can providing appropriate nutrition have for patients?

A
  1. Improved recovery times
  2. Ensure appropriate wound healing
  3. Maintain muscle + body mass
  4. Reduce risk of infection
  5. Maintain immune system
77
Q

Whe exactly should you count how long a patient may have been anorexic for, when asking a client?

A

Start from when the patient stopped eating - exactly (at home)

78
Q

True or False.
If the patient is already malnourished, nutritional support should not be instiuted until they are hemodynamically stable.

79
Q

What is meant by hemodynamically stable?

A
  • Stable heart
  • Good circulation
  • Good blood pressure
80
Q

What nursing nutritional support should be offered to a patient that has been anorexic for 1- 2 days.

A
  • No nutritional support required just yet
  • Write down feeding orders
  • Monitor food intake
  • Monitor clinical condition - daily
81
Q

What nursing nutritional support should be offered to a patient that has been anorexic for 3 - 4 days.

A
  • Nutritional support liekly needed, if recovery is not imminent
  • Consider feeding tube placement - requiring anaesthesia
82
Q

What nursing nutritional support should be offered to a patient that has been anorexic for 5 days.

A
  • Nutritional support required
  • Place feeding tube
    or
  • Initiate parental nutrition
83
Q

Give 5 major reasons for implementing nutritional support to patients

A
  1. Anorexia
    (Has multiple causes; pain, depression, nausea or ileus)
  2. Inappetence
  3. Patients with a high, constant, catabolic state (like burn patients, as it takes a lot of energy + calories to heal)
  4. Inability to eat
    (Oral surgery, trauma to the jaw, skull fracture = feeding tube)
  5. Clinical conditions effecting:
    = Entire GI tract
    = Upper GI tract
    = Lower GI tract
84
Q

What are the 3 main types of supportive nutrition that can be afforded to patients?

A
  1. Total Parenteral nutrition
  2. Partial Partenteral nutrition
  3. Enteral nutrition
91
Q

Name an example of an eneteral feed that can be used in the VP

A

Royal Canin recovery liquid

92
Q

What is meant by ‘Prandially’?

A

Relating to a meal

93
Q

What are the 2 disadvantages of using Nasogastric + Nasosophageal feeding tubes?

A
  1. Requires a liquid diet
  2. Can only be used until 5 days
94
Q

What are the advantages of using Nasogastric + Nasosophageal feeding tubes?

A

They are relatively easy to place

95
Q

What are the 2 advantages of using Esophagostomy feeding tube?

A
  1. Not technically difficult to place
  2. Can use canned critical care diet or slurry/blended canned diet
96
Q

What are the disadvantage of using Esophagostomy feeding tube?

A

Requires general anaesthesia for placement

97
Q

What are the 3 advantages of using Gastrostomy feeding tube?

A
  1. Larger - allowing a thicker diet/blend
  2. Easier for clients to manage
  3. Long-lasting
98
Q

What are the 2 advantages of using Jejunostomy feeding tube?

A
  1. Enable more distal feeding
  2. Bypasses the pancreas - which is benefical for patients with pancreatitis
99
Q

What are the 2 disadvantages of using Gastrostomy + Jejunostomy feeding tubes?

A
  1. Requires surgical placement
    (Or endoscopic placement for gastrostomy tubes)
  2. Can lead to complications, if removed too early
100
Q

What are the 4 types of feeding tubes?

A
  1. Naso-oesophageal
  2. Oesophagostomy
  3. Gastrostomy
  4. Jejunostomy
101
Q

Name the 4 patient factors which will impact the choice of feeding tubes

A
  1. Duration of intended intervention
  2. Underlying disease (Including treatment + prognosis)
  3. Necessity + saftey of anaesthesia
  4. Tolerance of the tube
102
Q

Name the 4 technical factors which will impact the choice of feeding tubes

A
  1. Clinician’s experience
  2. Risk of complications
  3. Invasiveness
  4. Type of diet to be used
103
Q

Are Naso-oesophageal + Nasogastric tubes for short or long-term placement?

104
Q

What part of the GI tract must be working in order to provide short term nutirition with a Naso-oesophageal + Nasogastric tubes?

A

Upper GI tract

105
Q

Where is the location of the placement of the naso-oesophageal tube?

A

Distal oesophagus via the nose

106
Q

How long can you keep a naso-oesophageal tube in for?

107
Q

True or False.

Naso-oesophageal tubes can be managed by clients, at home.

108
Q

Name the contradications to why a naso-oesophageal tube cannot be used

A
  • Trauma to the head, neck, nasal cavity + oesophagus
  • Comatose or recumbent patients
  • Can’t be used long-term
  • Cannot be in patients that are;
    = Vomiting
    =Abnormal gag-reflex
    = Functional or mechanical GI obstruction
109
Q

Are Oesophagostomy tubes for short or long-term placement?

A

Short + long term (months)

110
Q

Why might Oesophagostomy tubes be used for short or long term used?

A

Trauma, injury or disease involving mouth + pharynx

111
Q

Where is the location of the placement of the oesophagostomy tube?

A

Distal oesophagus via surgical placement into the cranial oesophagus, through the skin

112
Q

How long can you keep a oesophagostomy tube in for?

A

Days > months

113
Q

Name the contradications to why a oesophagostomy tube cannot be used

A
  • Oesophageal disorders
  • Vomiting
  • Comatosed patients
  • Recumbent patients
  • Following oesophageal surgery
114
Q

What is another name for Gastrostomy tubes?

A

PEG tubes
(Percutaneous Endoscopic Gastrostomy)

115
Q

Why might PEG tubes be used for short or long term used?

A

Injuries or surgery to the:
* Oral cavity
* Larynx
* Pharynx
* Oesophagus

116
Q

Where is the location of the placement of the Gastrostomy tube?

A

The stomach via surgical:
* Laparotomy
* Endoscopically through the ventrolateral abdominal wall (left)

117
Q

How long can you keep a PEG tube in for?

A

Mid - Long term

(Months > Years)

118
Q

Name the contradications to why a gastrostomy tube cannot be used

A
  • Primary gastric disease
  • Ulceration
  • Neoplasia
  • Intractable vomiting
  • Peritonitis
119
Q

What 4 tubes can be managed at home, with clients?
+
What tube can’t?

A
  1. Naso-oesophageal
  2. Nasogastric
  3. Oesophagostomy
  4. Gastrostomy
    +
    The Enterostomy tube, otherwise known as Duodenostomy or Jejunostomy tubes, cannot be maintained at home
120
Q

Are Enterostomy tubes for short or long-term placement?

121
Q

What tube can be used to bypass the part of the stomach or GI tract?

A

Enterostomy tube

122
Q

Where is the location of the placement of the enterostomy tube?

A

The SI via surgical laparotomy, through the abdominal wall
or
Endoscopically via gastric tube + through the pylorus

123
Q

How long may enterostomy tubes be kept in place for?

A

Long term, weeks > months

..But the term is limited due to the requirement of hospitilisation

124
Q

Name the contradications to why a enterostomy tube cannot be used

A
  • Patient must be stable for anaesthesia + surgery
  • Dysfunction of the SI
125
Q

What is the RER calculation for an entire adult dog?

126
Q

What is the RER calculation for an entire adult cat?

A

1.4 - 1.6 x RER

127
Q

What is the RER calculation for an neutered adult dog?

128
Q

What is the RER calculation for an neutered adult cat?

A

1.2 - 1.4 x RER

129
Q

What is the RER calculation for an obese-prone adult dog?

130
Q

What is the RER calculation for an obese-prone adult cat?

A

0.8 - 1 x RER

131
Q

What is the RER calculation for an light exercise adult dog?

132
Q

What is the RER calculation for an heavy exercise adult dog?

A

4 - 8 x RER

133
Q

What is the RER calculation for a senior dog?

134
Q

What is the RER calculation for a senior cat?

A

1.1 - 1.4 x RER

135
Q

What is the RER calculation for a 4 m/o dog?

136
Q

What is the RER calculation for a growing cat?

137
Q

What is the RER calculation for a early pregnant bitch?

138
Q

What is the RER calculation for a late pregnant bitch?

139
Q

What is the RER calculation for a lactating bitch?

A

1.9 x RER
(+ 25% p/puppy)

140
Q

What is the RER calculation for a early pregnant queen?

141
Q

What is the RER calculation for a queen, during parturition?

142
Q

What is the RER calculation for a lactating queen?

A

2 - 6 x RER

144
Q

How often should a Finch be fed?

145
Q

How often should a Budgie, Lovebird, Cockatiel or small Conure be fed?

146
Q

How often should a Amazon be fed?

147
Q

How often should a large Cockatoo or Macaw be fed?

A

Q8 - 12 hrs

148
Q

When gavage feeding birds, how should you position the bird, when handling?

A

Gently extend the neck to ensure the esophagus is straightened, to guide the food into the crop

149
Q

Aside from gavage tubes, what type of feeding needles are easiest to use when feeding psittacine birds?

A

Curved stainless steel ball-tipped feeding needles

150
Q

What gauge of feeding needle should you use for a Finch?

151
Q

What size gauge of feeding needle should you use for a Canary?

A

Size 16 - 18

152
Q

What size gauge of feeding needle should you use for a Bugerigar parakeet?

A

Size 14 - 16

153
Q

What size gauge of feeding needle should you use for a Lovebird?

A

Size 12 - 14

154
Q

What size gauge of feeding needle should you use for a small Conure or Cockatiel?

A

Size 12 - 14

155
Q

What size gauge of feeding needle should you use for a large Conure?

A

Size 10 - 12

156
Q

What size gauge of feeding needle should you use for a Amazon Parrot or small Cockatoo?

A

Size 8 - 10

157
Q

What size gauge of feeding needle should you use for a large Cockatoo or Macaw?

A

Size 8 - 10

Essential Veterinary Patient Care Yr1 (12 decks)

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