Nutrition

Front 1

Critical Care Nutrition

Back 1

Trauma, disease, stress (etc.) increases in energy requirements;

Malnutrition leads to a decrease energy stores which can effect wound healing, gastrointestinal function and other body systems;

Any patient that has not eaten in the last three days or NPO for more than 3 days is a candidate for malnutrition

Front 2

Enteral Feeding Methods

Back 2

Encouraging;

Appetite stimulants;

"Force" feeding by syringe;

Nasogastric/nasoesophageal intubation;

Esophagostomy tube feeding;

Gastrostomy tube feeding;

Enterostomy tube feeding;

Front 3

Determine Food Types for Feeding Enteral Route

Back 3

Can choose:

Liquid or modular products;

Blended pet foods;

Do not use Liquid Milk replacer for adult patients;

Human baby food not recommended as a source of nutrition as it does not meet complete nutrient requirements

Front 4

Enteral Feeding

Back 4

Food may need to be strained;

Food at room temperature;

Each meal followed by water flush to keep tube from clogging;

Can provide liquid medication this way;

Have feeding plan, record all meals, time given and water intake

Front 5

Monitoring Feeding

Back 5

Monitor:

Food and water intake (essential);

Body weight daily and BCS;

Evaluate and clean tube placement site daily;

Feed meal slowly over a 5-15 minute time period

Front 6

Syringe Feeding

Back 6

Patients are fed a liquid or moist homogenized food;

Dogs- fed between molar teeth and cheek;

Cats- fed between the four canine teeth;

Used when an animal chooses not to eat on its own;

If animal chooses not to swallow voluntarily, syringe feeding should be discontinued as pulmonary aspiration could occur

Front 7

Nasoesophageal

Back 7

For short term feeding (usually no more than 3-5 days, although has been used up to 2 weeks);

Contraindicated in animals that are vomiting, comatose or lack a gag reflex;

Oral cavity is bypassed and swallowing;

Front 8

Placing a Nasoesophageal Tube

Back 8

8 Fr for most dogs and 5 Fr for most cats; Measure tube from tip of nose to the last rib;

Mark with a permanent marker;

Place a few drops of local anesthetic (Alcaine) in the animals nose before beginning;

Lubricate tube with sterile water soluble lube;

Slowly insert tube into the nostril and direct medially and ventrally- continue passing until you reach the mark;

Once the tube is in place, test with 3-5 mL of sterile saline to ensure the tube is in the esophagul and not in the lungs;

If animal shows signs of distress or coughing the tube placement is incorrect- if in doubt, remove and replace, or radiograph;

Once in the correct place, the tube is generally held in place with sutures or tissue glue;

The tube is secured just lateral to the nares and then is extended along the dorsal nasal midline and also secured;

Radiograph taken to ensure proper placement;

The animal should also have an E-collar to prevent self removal of the tube

Front 9

Esophagostomy

Back 9

Enters the esophagus through the skin of the neck, bypasses mouth and pharynx, does not go into the stomach;

Anesthesia is required

Front 10

Gastrostomy Tube

Back 10

By pass proximal GI tract;

Surgical production of an artificial opening between the stomach and the abdominal wall

Front 11

Percutaneous Endoscopic Grastonomy Tubes

Back 11

AKA PEG tubes;

Placed directly in the stomach of the animal with the guidance of an endoscope;

Useful in treating cats with Hepatic Lipidosis to ensure they eat until recovery;

Animals are able to go home and be fed by owner;

Animals can still eat food by mouth, if they choose;

Animals should be eating their DER by mouth before the PEG tube is removed;

Front 12

Placing a PEG Tube

Back 12

Animal needs to be anesthetized;

Placed in right lateral position and are 4-6" caudal to the last left rib is prepared for surgery;

Endoscope is passed through the needle and is picked up by retrieval forceps and is removed through the animals mouth;

Once the suture has been externalized, it is attached to the end of the tube and is pulled through the esophagus, into the stomach and out of the body;

The tube is not usually sutured or glued however is held in place by the rubber flange;

Need to remain in place for at least 5-7 days;

Removal of the tube is usually performed by traction (tugging hard)

Front 13

Enterostomy

Back 13

Surgical production of an artificial opening between the small intestine and the abdominal wall

Front 14

Complications of Enteral Nutritional Support

Back 14

GI- V/D;

Mechanical- Tube migration, premature removal or obstruction;

Patient discomfort- restlessness, salivation, abdominal bloating, coughing;

Respiratory- aspiration pneumonia;

Clogged tube;

Stress associated with restraint;

Infection around tube placement sites;

Cellulitis

Front 15

Illness Factors

Back 15

Cage rest: 1.1;

Surgery, trauma, cancer, sepsis: 1.2-1.5;

Severe burns, head trauma, ventilator patients: 1.7-2.0;

*whats fed in hospitalized may not be wanted to be eaten at home*

Calculation is RER x Illness factor

Front 16

Parenteral Nutrition

Back 16

Given if an animal is very ill, it is possible to give them the nutrients they need intravenously (TPN- Total Parenteral Nutrition);

This involves adding dextrose, lipid emulsion, amino acids with electrolytes, potassium, vitamine B complex, and trace elements to their bag of fluids;

This can also be done partially as a supplement aka Partial Parenterla Nutrition (PPN);

Recommended to provide enteral nutrition at the same time as parenteral to provide nutrients to the gut to prevent further deterioration and promoting intestinal growth

Front 17

Indications of Parenteral Nutrition

Back 17

Animals that have uncontrolled vomiting and unable to digest and absorb nutrients via the GI tract;

Ex: IBD, peritonitis, pancreatitis, during intestinal surgery recovery;

Front 18

Administration of PN

Back 18

Can be either:

Central;

Peripheral;

Intraosseous;

Intraperitoneal;

*Generally central IV catheter is placed as this method reduces infection and phebitis*