Supportive Feeding And Hydration Flashcards

1
Q

What is inappetence?

A

A reduction in appetite

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2
Q

What is anorexia?

A

A complete lack of dietary intake

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3
Q

What are reasons for reduced appetite?

A
  • illness
  • nausea
  • pain
  • depression
  • trauma
  • concurrent medical conditions
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4
Q

What can a reduced appetite result in?

A
  • reduced immune function
  • poor healing
  • affects drug metabolism
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5
Q

Factors to consider during supportive feeding?

A
  • if patient has history of anorexia mist be included in nursing plan and highlighted by staff
  • critical patients require stabilisation before nutritional intervention
  • history of anorexia from 3+ days should be considered
  • supportive feeding should not be provided to unstable or recovering patients
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6
Q

The nurses role during supportive feeding?

A
  • ensure the patient receives their daily caloric requirements
  • select nutritionally balanced diet to allow RER consumptions in reasonable quantities
  • provide adequate nutrition factoring in disease process and dietary requirements
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7
Q

Signs to look for during assessments?

A
  • patients that have been unable or unwilling to eat for 3 days or more require assisted feeding
  • BCS3/5 or 5/9 ideal
  • recent weight loss more than 10% of body weight
  • is it severe cachexia or a paediatric patient
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8
Q

What are the 3 types of supportive nutrition?

A

Total parenteral nutrition

Partial parenteral nutrition

Enteral nutrition

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9
Q

What is total parenteral nutrition?

A
  • it is a nutritionally balanced solution
  • delivered via a central line (intravenous)
  • provides both nutrients and calories
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10
Q

What is partial parenteral nutrition?

A
  • delivers part of patients nutrients and calories
  • delivered via peripheral intravenous catheters
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11
Q

What is enteral nutrition?

A
  • it is any feeding incorporating the gastrointestinal tract
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12
Q

What must be gathered before providing support?

A
  • understand their normal feeding routine including brand, frequencies and treats
  • BCS and up to date weight
  • evaluate abilities including temperaments
  • actions to prevent or treat nausea
  • what diet the patient will be fed and the end goal weight
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13
Q

What is Resting Energy Requirements (RER)?

A

It ensures the patient receives sufficient calories, calculations are performed based on their weight and decides the quantity they should be fed

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14
Q

What are the 2 RER calculation formulas?

A

RER(30xBW)+70=kcal/day (patients over 2kg)

RER 70(BW)^0.75=kcal/day (patients under 2kg)

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15
Q

What forms of encouragement can be used?

A
  • normal diets and treats
  • change their feeding bowl
  • clean any discharge from their face
  • use warm or smelly foods
  • hand feeding
  • put food on lips or paws, little and often
  • drugs. Any be prescribed by the vet to stimulate appetite
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16
Q

Factors to consider when syringe feeding?

A
  • not likely to be successful in dogs or cats
  • only used on conscious patients
  • care to avoid aspiration
  • stressful
  • short term
  • slow administration behind teeth/at diastema and allow to swallow naturally
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17
Q

What are the 6 tube feeding methods?

A
  • naso-oesophageal/naso-gastric
  • pharyngeal
  • oesophagostomy
  • stomach tube
  • peg tube
  • jejunostomy tube
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18
Q

Factors to consider when using nasal-oesophageal feeding tubes?

A
  • stomach and intestine must be functioning for use
  • liquid food syringed into tube
  • flushed with water pre and post administration
  • placed via nares and ends in oesophagus
  • tube must be measured
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19
Q

Factors to consider when using naso-gastric tubes?

A
  • diet selection limited due to width of tubes
  • can easily become blocked
  • less invasive method
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20
Q

Steps to follow when placing an NG tube?

A
  • measure the tube
  • appropriate restraint
  • administer local anaesthetic drops to a red
  • lubricators tube
  • gentle pressure between nares can facilitate placement
  • one confident smooth motion
  • place until marker is reached
  • patient should swallow as inserted
  • secure tube
21
Q

How to feed when using a NG tube?

A
  • wear gloves, prep diet, flush, bring to body temp
  • check placement of tube
  • sterile swab top of tube pre and post use
  • monitor during for signs of discomfort and aspiration
  • flush tube with water prior and monitor the response
  • slowly administer selected diet (20-60 mins)
  • flush tube after to prevent blockage
22
Q

How to properly remove NG tube?

A
  • cut suture with blade
  • gently pull tube out
23
Q

Factors to consider when using oesophagostomy tubes?

A
  • for long term support
  • owners can be trained to use
  • width allows for easy administration and wider range of feeds to choose from
  • requires GA to allow placement
  • skilled procedure
  • placement must be checked radiographically
  • can lead to inflammation or stoma site infections
24
Q

Factors to consider when using gastronomy tubes?

A
  • used in patients with oral or oesophageal conditions
  • GA required for placement
  • long term feeding solution only
  • placed surgically during abdominal exploration or endoscopically via a flank approach
  • accurate patient monitoring is essential
25
Q

Factors to consider when using jejunostomy tubes?

A
  • food bypasses stomach and enters via small intestine
  • used in patients with upper GI conditions
  • must be in site for over 10 days
  • requires GA and takes skill and precision
  • placed endoscopically, surgically or nasojejunal
  • monitored closely for signs of abdominal pain
26
Q

Factors to consider when using parenteral feeding?

A
  • central vein is used
  • used where gastrointestinal tract is not functioning
  • specialist technique
  • monitoring is essential
  • is expensive
27
Q

What information is required to effectively evaluate supportive feeding?

A
  • food should be weighed and reweighed when removed to calculate how many grams have been eaten
  • tube feeding, mls given should be recorded
  • if patient is eating voluntarily but not eating full RER then kcal of total grams eaten has to be deducted from RER kcal requirement
  • monitor body weight , BCS and MCS
28
Q

How to re-introduce food?

A
  • feed little and often, introduce gradually (over 4 days)
  • feed slowly
  • warm food in sitting position or sternal recumbency
  • observe for signs of aspiration, discomfort or nausea
29
Q

What are the different routes of water intake?

A
  • diet
  • drinking
  • therapeutic medications
  • metabolism
30
Q

What are the different routes of water loss?

A
  • urination
  • faeces
  • respiration
  • sweating
  • urinary infections
  • renal damage
31
Q

What are abnormal routes of water loss?

A
  • vomiting
  • diarrhoea
  • panting excessively
  • blood loss
32
Q

What is the normal rate for fluid intake?

A

50mls/kg/24hr (1-2ml/kg/hr)

33
Q

What is polydipsia?

A
  • excessive drinking
  • > 100ml/kg/24hr
  • often an indicator of underlying condition
  • can cause regurgitation, vomiting and nausea
34
Q

What should be included in the patient assessment?

A
  • their normal drinking habits
  • their normal eating habits (quantity, wet or dry)
  • preferred bowl material
  • toileting habits
  • previous surgeries (neutered)
  • health conditions or medications
  • weight, age, mobility, activity levels
  • for cats must consider indoor/outdoors and water placement
35
Q

What are the 5 different levels for assessing hydration?

A

1%

5%

7%

10%

12%

36
Q

Describe the signs of 1% hydration loss?

A
  • slight loss in skin elasticity
  • hair standing on end
37
Q

Describe the signs of 5% hydration loss?

A
  • tacky dry mucus membranes
  • loss in skin elasticity
  • increase in urine specific gravity (SG)
38
Q

Describe the signs of 7% hydration loss?

A
  • marked loss in skin elasticity
  • increased urine specific gravity (SG)
  • sunken eyes
  • decreased urine output
  • tachycardia
  • slightly prolonged capillary refill time
39
Q

Describe the signs of 10% hydration loss?

A
  • skin tenting
  • eyes sunken
  • oliguria then Anura
  • weak pulses
  • prolonged capillary refill time
  • signs of shock
  • lethargy
40
Q

Describe the signs of 12% hydration loss?

A
  • depression
  • collapse
  • shock
  • moribund
  • death
41
Q

Methods of measuring fluid loss?

A
  • collect urine in kidney dish every time they urinate, then measure and check specific gravity
  • weigh bedding prior to placing in kennel, weigh if soiled
  • weigh patient regularly, affected by fluid gains/losses
  • weigh faecal output if using inco pads
  • weigh faecal catheter bag, if being used
  • weigh cat litter tray or use non-absorbent litter
42
Q

How to monitor patient fluid in-take?

A
  • measure the water prior to placing in kennel
  • measure again before disposing
  • calculate how much has been drunk
  • spills should also be noted, also note bowl raiser can be used for larger breeds
43
Q

What are the 4 routes of fluid administration and when is each used?

A

Oral = mild dehydration, short term illness, small patients or animals with feeding tubes

Subcutaneous = mild dehydration, patients not hospitalised

Intravenous = dehydration, anorexia, surgical procedures, IV drug administrations

Intraosseous = cardiovascular collapse, lack of IV access, avian patients, neonates or short term use

44
Q

Why is intravenous fluid therapy used?

A
  • helps supplement electrolytes
  • provides constant rate infusions of medications
  • supports patients through surgery, where blood loss is suspected
  • helps support organs such as kidneys
  • caution used in patients with cardiac disease
45
Q

Nurses role when caring for patients on IVFT?

A
  • check access site for swelling, bruising and pain
  • check line regularly for kinks, blockages and interference
  • check fluid running, and the volume of fluid to be administered
  • monitor clinical signs for hydration levels, use mucus membrane or specific gravity
  • monitor ongoing losses of vomiting or diarrhoea
  • check for signs of over hydration such as moist cough, dyspnoea, tachypnoea, lethargy, or increases urine output
46
Q

Who calculates fluid requirements for patients?

A
  • veterinary surgeon provides fluid rate for patient
  • veterinary surgeon prescribes fluid of choice
  • veterinary surgeon advises total amount to be administered over a period of time (12-24hours)
47
Q

What are the 3 maintenance requirements?

A

Cat/Small Dog (1-10kg) - 60ml/kg/24hr

Medium Dog (11-25kg) - 50ml/kg/24hr

Large Dog (26-50kg) - 40ml/kg/24hr

48
Q

How should hydration status be monitored?

A
  • should be frequently checked minimum every 12hrs
  • if on high rate of fluids or fluid bolos, hydration check every 2-5hrs depending on VS preference
  • VS informed, if patient eating and drinking improve means IVFT support can be reduced/removed
  • VS aware if patient stops eating or drinking as-well may want to provide supportive care/ increase rate
  • feedback concerns if showing concerns of over infusion or dehydration