Supportive Feeding And Hydration Flashcards
What is inappetence?
A reduction in appetite
What is anorexia?
A complete lack of dietary intake
What are reasons for reduced appetite?
- illness
- nausea
- pain
- depression
- trauma
- concurrent medical conditions
What can a reduced appetite result in?
- reduced immune function
- poor healing
- affects drug metabolism
Factors to consider during supportive feeding?
- 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
The nurses role during supportive feeding?
- 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
Signs to look for during assessments?
- 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
What are the 3 types of supportive nutrition?
Total parenteral nutrition
Partial parenteral nutrition
Enteral nutrition
What is total parenteral nutrition?
- it is a nutritionally balanced solution
- delivered via a central line (intravenous)
- provides both nutrients and calories
What is partial parenteral nutrition?
- delivers part of patients nutrients and calories
- delivered via peripheral intravenous catheters
What is enteral nutrition?
- it is any feeding incorporating the gastrointestinal tract
What must be gathered before providing support?
- 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
What is Resting Energy Requirements (RER)?
It ensures the patient receives sufficient calories, calculations are performed based on their weight and decides the quantity they should be fed
What are the 2 RER calculation formulas?
RER(30xBW)+70=kcal/day (patients over 2kg)
RER 70(BW)^0.75=kcal/day (patients under 2kg)
What forms of encouragement can be used?
- 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
Factors to consider when syringe feeding?
- 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
What are the 6 tube feeding methods?
- naso-oesophageal/naso-gastric
- pharyngeal
- oesophagostomy
- stomach tube
- peg tube
- jejunostomy tube
Factors to consider when using nasal-oesophageal feeding tubes?
- 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
Factors to consider when using naso-gastric tubes?
- diet selection limited due to width of tubes
- can easily become blocked
- less invasive method
Steps to follow when placing an NG tube?
- 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
How to feed when using a NG tube?
- 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
How to properly remove NG tube?
- cut suture with blade
- gently pull tube out
Factors to consider when using oesophagostomy tubes?
- 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
Factors to consider when using gastronomy tubes?
- 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
Factors to consider when using jejunostomy tubes?
- 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
Factors to consider when using parenteral feeding?
- central vein is used
- used where gastrointestinal tract is not functioning
- specialist technique
- monitoring is essential
- is expensive
What information is required to effectively evaluate supportive feeding?
- 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
How to re-introduce food?
- 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
What are the different routes of water intake?
- diet
- drinking
- therapeutic medications
- metabolism
What are the different routes of water loss?
- urination
- faeces
- respiration
- sweating
- urinary infections
- renal damage
What are abnormal routes of water loss?
- vomiting
- diarrhoea
- panting excessively
- blood loss
What is the normal rate for fluid intake?
50mls/kg/24hr (1-2ml/kg/hr)
What is polydipsia?
- excessive drinking
- > 100ml/kg/24hr
- often an indicator of underlying condition
- can cause regurgitation, vomiting and nausea
What should be included in the patient assessment?
- 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
What are the 5 different levels for assessing hydration?
1%
5%
7%
10%
12%
Describe the signs of 1% hydration loss?
- slight loss in skin elasticity
- hair standing on end
Describe the signs of 5% hydration loss?
- tacky dry mucus membranes
- loss in skin elasticity
- increase in urine specific gravity (SG)
Describe the signs of 7% hydration loss?
- marked loss in skin elasticity
- increased urine specific gravity (SG)
- sunken eyes
- decreased urine output
- tachycardia
- slightly prolonged capillary refill time
Describe the signs of 10% hydration loss?
- skin tenting
- eyes sunken
- oliguria then Anura
- weak pulses
- prolonged capillary refill time
- signs of shock
- lethargy
Describe the signs of 12% hydration loss?
- depression
- collapse
- shock
- moribund
- death
Methods of measuring fluid loss?
- 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
How to monitor patient fluid in-take?
- 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
What are the 4 routes of fluid administration and when is each used?
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
Why is intravenous fluid therapy used?
- 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
Nurses role when caring for patients on IVFT?
- 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
Who calculates fluid requirements for patients?
- 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)
What are the 3 maintenance requirements?
Cat/Small Dog (1-10kg) - 60ml/kg/24hr
Medium Dog (11-25kg) - 50ml/kg/24hr
Large Dog (26-50kg) - 40ml/kg/24hr
How should hydration status be monitored?
- 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
