SA 4 - Tesse

Question 1

What are the clinical signs of protein energy malnutrition (PEM)

Answer 1

Weight loss, muscle wasting, pallor, chronic infections, poor hair coat

Question 2

T/f: specific nutritional deficiencies are common in north american cats and dogs

Answer 2

false

Question 3

what is the pathognomonic clinical signs of taurine deficiency in cats

Answer 3

dilated cardiomyopathy, central retinal degeneration

Question 4

what is the pathognomonic clinical sign of vit K deficiency

Answer 4

coagulopathy

Question 5

what is the pathognomonic clinical sign of thiamine deficiency in cats

Answer 5

brain stem necrosis leading to neurologic signs

Question 6

Are there hematologic abnormalities that can be found on a nutritional assessment?

Answer 6

yes -> anemia and lymphopenia (PEM), regenerative to microcytic nonregenerative (iron deficiency), microcytic hypochromic anemia (copper deficiency), macrocytic hypochromic (folate deficiency), megaloblastic anemia (B12 deficiency)

Question 7

Match the deficiency with the anemia:
1. copper
2. iron
3. B12
4. Folate

a. regenerative to microcytic nonregenerative
b. megaloblastic
c. macrocytic hypochromic
d. microcytic hypochromic

Answer 7

1 - d
2 - a
3 - b
4 - c

Question 8

T/f biochemical abnormalities in nutritional assessments are often pathognomonic and super specific to the disease

Answer 8

FALSE. highly insensitive and nonspecific

Question 9

what are some biochemical abnormalities that can be seen with obesity

Answer 9

hyperglycemia and glucose intolerance
hyperlipidemia

Question 10

what are some biochemical abnormalities that can be seen with PEM

Answer 10

creatinine, albumin, BUN changes

Question 11

What should you do with a nutritional assessment done on a healthy animal

Answer 11

make clear and specific recommendations (complete and balanced, ID food by brand name flavor and form, provide several choices, give exact amlount to be fed and frequency). These should be written and updated in the medical record

Question 12

what should you do with a nutritional assessment done on a sick animal

Answer 12

pretty much the same as the healthy animal, except consider specialized or prescription diets, initiate assisted feeding early, and while complete and balanced rations are preferred, they are not always indicated for certain diseases (ie you want a low protein diet for CKD, even if it isnt balanced)

Question 13

What are some measures you should monitor for response to a diet during a nutritional assessment

Answer 13

palatability
signs of dietary intolerance
assessment of BCS and weight
follow underlying disease of sick patients

Question 14

What type of animal do nutritional deficiencies most commonlyl occur in

Answer 14

sick ones

Question 15

What is Protein Energy Malnutrition (PEM)

Answer 15

a deficiency of protein and calories that is common in hospitalized patients

Question 16

what are the well documented affects of PEM

Answer 16

anemia, hypoproteinemia, delayed wound healing, decreased immune function, GI, resp, cardio compromise, death

Question 17

T/F healthy canids are well adapted to survive food deprivation

Answer 17

true

Question 18

what are the two primary groups of starvation adaptation in canids

Answer 18

acute (maintain blood glucose concentration via hepatic glycogen and amino acids)

chronic (fat derived fuels preserve lean body mass)

Question 19

lean body mass =

Answer 19

FUNCTION

Question 20

what disease compromises adaptation to starvation

Answer 20

PEM

Question 21

what type of starvation adaptation is blocked in patients with PEM

Answer 21

chronic (switch to fat derived fuels is blocked)

Question 22

PEM lease to a relative _____ in metabolic rate, and an altered _____ milieu

Answer 22

increase, hormonal

Question 23

what change in fuel utilization of preferences occurs in PEM patients

Answer 23

glucose&raquo_space;» fats

Question 24

why are amino acids and glucose so often deficient during illness?

Answer 24

there is a high demand for protein and energy in illness for protein synthesis (think of how many acute phase proteins, WBCs, immunoglobulins, clotting factors, etc are required for illness and wound healing). Adipose stores cannot meet the energy or synthetic substrate needs of illness, so lean body mass is rapidly catabolized

Question 25

which species may be predisposed to protein energy malnutrition

Answer 25

cats, because they conserve their lean body mass less efficiently and have a high basal protein requirement

Question 26

what is the common history for a PEM patient

Answer 26

critically ill (surgery, infection, cancer, thermal burns) decreased food intake

Question 27

what are common PE findings for PEM

Answer 27

body weight and BCS may be unchanged nonspecific symptoms (muscle wasting pallor, poor coat, hepato/splenomegaly, chronic infection, peripheral edema, lymphadenopathy)

Question 28

what are common laboratory testing findings for PEM

Answer 28

normocytic/normochromic nonregenerative anemia and lymphpenia

Question 29

what are common serum biochemistry parameters in PEM

Answer 29

decreased creatinine (from muscle wasting) hypoalbuminemia

Question 30

what is common during critical illness

Answer 30

PEM

Question 31

what are the steps of initiation of nutritional support in critically ill patients

Answer 31

1: determine fluid requirement 2: determine energy requirement 3. select calorie sources 4. micronutrient requirements 5. select route of administration

Question 32

what is the daily fluid requirement in an average animal

Answer 32

~60 mL/kg

Question 33

how can you supply fluids to an animal

Answer 33

voluntary intake, tube, or parenteral solution

Question 34

what energy requirement parameter should be used during initiation of nutritional support of critically ill patients

Answer 34

resting energy requirement (RER)

Question 35

what does RER do

Answer 35

maintains basal metabolic rate, maintains body temperature in thermoneutral environment, allows recovery from activity, no increment for food consumption

Question 36

What are the two equations for RER

Answer 36

RER = 30(BW in kg) + 70 for animals over 2 kg and under 45 kg RER = 70(BW in kg) ^3/4 for all animals

Question 37

what are some factors that effect optimal distribution of calories

Answer 37

species, palatability, digestibility, cost and availability, ease of use, specific disease process

Question 38

what is the optimal protein intake variable in dogs

Answer 38

25 -45% of calories

Question 39

what is the optimal protein intake variable in cats

Answer 39

30 -50 % of calories

Question 40

T/F critical care diets are often high in fats

Answer 40

true

Question 41

optimal fat intake of fat in dgs

Answer 41

20-60 % of calories

Question 42

optimal fat intake in cats

Answer 42

35-50% of calories

Question 43

T/f carbohydrates are not required by dogs or cats

Answer 43

true

Question 44

why does optimal intake of carbs vary in critically ill patients

Answer 44

they may not be used efficiently during illness, but can be an alternative calorie source for some patients with protein or fat restrictions

Question 45

what should you consider first when selecting a ration for a critically ill patient

Answer 45

optimal caloric distribution

Question 46

how can you best meet the micronutrient requirements for patients with critical illness

Answer 46

via commercial diets, with supplementation only if specifically indicated

Question 47

what nutrients are important for immune response

Answer 47

protein, zinc, iron, vit A, arginine

Question 48

what are the three possible routes for nutritional support

Answer 48

voluntary intake enteral (tube) feeding parenteral (intravenous) feeding

Question 49

which route of administration is best if nutrient requirements are met

Answer 49

voluntary intake

Question 50

what are some steps to maximize voluntary food intake

Answer 50

hand feed small frequent meals offer highly palatable and aromatic foods warm food prior to serving use calorie/nutrient dense commercial rations pharmacologic appetite stimulation

Question 51

what are some examples of pharmacologic appetite stimulation that can be used to maximize voluntary intake

Answer 51

antidepressants (mirtazapine, diazepam) cyproheptadine (periactin)

Question 52

what are advantages of enteral feeding

Answer 52

more physiologic prevents villous atrophy prvents bacterial translocation less complex fewer complications cheaper

Question 53

what are disadvantages of enteral feeding

Answer 53

long periods of transition contraindicated if GI tract non-functional

Question 54

what are the various types of feeding tubes

Answer 54

nasoesophageal pharyngostomy esophagostomy gastrostomy jejunostomy

Question 55

How do you choose which type of feeding tube to use?

Answer 55

- anatomic site of GI dysfunction - expected duration of nutritional support - patient conformation and concurrent diseases - type of ration intended to be fed - clinical status of the patient

Question 56

okay... so what do we put in the feeding tubes?

Answer 56

-blenderized commercial pet food - commerical paste-type formulations specifically designed for tube feeding - commercial veterinary liquid formulations (for nasoesophageal and jejunostomy tubes only)

Question 57

what are the general differences between critical care/tube feeding rations and normal diets?

Answer 57

CC/feeding tube rations will have much higher % protein kcals and %fat kcals, much lower %carb kcals, and slightly higher caloric density

Question 58

which type of tube feeding requires CRI

Answer 58

jejunostomy

Question 59

what is the ultimate goal of enteral feeding delivery

Answer 59

initial bolus feeding every 2 hours, to delivery of requirements in 4 to 6 daily feedings

Question 60

what are the pros of parenteral feeding

Answer 60

bypasses GI tract allows complete bowel rest decreased risk of aspiration may not require anaesthesia decreased risk of bleeding

Question 61

what are the cons of parenteral feeding

Answer 61

villous atrophy bacterial translocation increased complications (sepsis. hyperglycemia, hyperlipidemia) requires specialized equipment and products increased level of care more expensive

Question 62

T/F you should discontinue nutritional support after removing your feeding tube/catheter

Answer 62

FALSE. you should do it before removing the route of admin, and compare the patient's food intake and make sure they still meet the requirements on their own

Question 63

what type of diet should you transition to after discontinuing nutritional support in critical care patients

Answer 63

highly digestible, low residue rations via small and frequent feedings for days to 1-2 weeks