Nutritional Support & Assistd Feeding

Dogs which may require nutritional support due to lacking an ___ or the ___ to eat

appetite, ability

Reasons a lack of appetite could be caused ___, ___, ___, ___/___,___

diabetes, IBD, CKD, fear/anxiety/pain

Insufficient Nutrient Intake can cause impaired ___, decreased ___ to infection, inability to withstand ___, ___ and effect of ___, decreased ___ strength, muscular ___, organ ___, or ___

immunity, resistance, shock, surgery, drugs, wound, weakness, failure, death

The goal of supportive feeding is to meet the patient’s ___ needs and prevent further ___

nutritional, deterioration

Guidelines regarding nutrition and when to intervene: 1-2 days of anorexia ___ order should be made and ___ food intake and clinical condition. 3-4 days of anorexia a nutritional support is likely needed if ___ isn’t imminent. 5 days of anorexia nutrition support is required, usually with a feeding ___ or ___ nutrition

feeding, monitor, recovery, tube, parenteral

Reasons to consider nutritional support:

• loss or anticipated loss more that ___ of body weight

• anorexia longer than ___

• conditions which stop eating for _-__

• any ___

• ___

• Severe ___ ___ diseases like cancer, IBD, liver failure

• increased ___ ___ loss through D+, V+, draining wounds, burns

10%, 3 d, 2-3 d, trauma, surgery, systemic infiltrative, nutrient loss

The goal of nutritional support is to meet ___ although it may take __-_. If possible ___ oral feeding or ___ feeding. If not unable ___ techniques may be required

RER, 2-3 d, voluntary, coax, assisted

The safest and most natural route of feeding is ___

GI

In order for voluntary oral intake to be effective is ___ of their RER must be consumed

85%

Some appetite stimulants which may assist with voluntary oral intake: ___, ___, ___ but it isn’t suitable for long-term

prednisolone, mirtazepine, cerenia

Force feeding or syringe is a ___ assist enteral feeding. It is very ___, has the risk of ___, cause food ___, pose a ___ hazard, and it is hard to calculate accurate ___ consumed

common, stressful, aspiration, aversion, chocking, volume

Tube feeding is if ___ or ___ to eat voluntarily, but only ___ or ___ can be fed.

unwilling, unable, liquid, gruel

When feeding with a tube, it can become ___ and needs to be flushed with water frequently

clogged

When administering medications to a patient that has a tube ___ med are preferred or pills can be ___ and placed in water to ___ before administration

liquid, ground, dissolve

Parenteral nutrition administration is used when eneral isn’t an option like with ___ failure, could ___ a disease, uncontrollable ___, or ___, poor anesthetic ___ for enteral feeding tube placement, or ___ ___ is a concern

gut, exacerbate, V+, D+, candidate, aspiration pneumonia

Types of nutrition used for parenteral nutrition: ___ ___ ___or ___ ___ ___

Total parenteral nutrition, partial parenteral nutrition

A ___ ___ ___ can be used for parenteral nutrition to prevent phlebitis

central venous catherter

When giving parenteral nutrition fluid levels need to ___ to prevent overload

adjusted

Disadvantages of parenteral nutrition: A dedicated ___ ___ ___ is required for TPN and can ___ be used for TPN, and must be properly and ___ prepared, and should be ___ monitored. ___ period is needed to return back to enteral feeding

central venous catherter, only, aseptically, intensively, transition

When transitioning from parenteral back to enteral either ___ or ___ diets are reccommended

pediactric, geriatric

When starting supportive nutrition start ___, and the food intake should gradually increase over _-_ days.

slow, 2-3

When starting nutrition support if showing ___, ___, ___ or the patient becomes ___ reassess the plan. ___ pumps can also be used to give a certain amount of food, and they should be constantly ___

vomiting, discomfort, nausea, distressed, syringe, monitored

When transitioning back to oral diet it may while the patient is ___, ranging from _-__. Go slow with the ___

hospitalized, 2-6 wks, transitioning

When discharging an animal that has been on nutritional support inform the owner that feeding from now on will not ___ the disease but help ___ it

cure, manage

There are two types of tubes which go through the nose: ___ and ___

nasogastric, nasoesophageal

A nasoesophageal tube goes from the nares to the ___ ___

distal esophagus

A nasogastric tube goes from the nares to the ___

stomach

between a nasogastric and nasoesophageal tube a ___ is more common

nasogastric

Nasogastric tube are useful for ___-___ feeding less than ___

short-term, 10 d

Nasogastric tubes are used in P with functional ___, ___ and ___

esophagus, stomach, intestines

nasogastric tubes are contraindicated in patients that are ___, ___ or lack a ___ reflex

vomitting, comatose, gag

Nasogastric tubes can be placed without ___, and no specialized ___ is required. The tube can be ___ to the patient, and only ___ ___ diets can be given via tube

anesthesia, equipment, equipment, liquid enteral

When placing a esophagotomy tube it requires ___ but not ___ depth just enough to place a ___ gag

anesthesia, surgical, mouth

The esophagoostomy tube gives the ability to ___ patients with the tube and the owner can continue ___

discharge, care

Complications which can come with esophagostomy tubes:

• tube ___ due to vomiting or removal by patient

• skin ___ around exit site

• ___ off the tube end after vomitng

displacement, infection, biting

The DVM makes incision on the ___ side of the neck to pass a tube through, and feeding can be administered ___after placement

left, immediately

When plaing a gastrotomy tube it can be placed ___, ___, or ___. However, all gastrotromy require general ___

endoscopically, blindly, surgically, anesthesia

After placing a gastrotomy tube there is a minimum waiting time of ___ so a ___ can form before feeding should occur

12 hrs, stoma

Gastrotomy tubes can be left ___-___ from ___-___

long-term, 1-6 mth

When a gastrotomy tube is used, have causion for ___ ___, ___, ___ ___ or ___ by the patient

aspiration pneumonia, vomiting, tube migration, removal

Although jejunostomy tubes are uncommon they can be indicated when the upper ___ should be rested or ___ stimulation should be decreased

GI, pancreatic

jejunostomy tubes are placed ___ or threaded through a ___ tube

surgically, gastrotomy

When using a jejunostomy tube its best to CRI using a ___ pump to avoid ___ the patient

syringe, overfeeding

Complications that come with a jejunostomy tube: ___, ___, ___ ___ out of the jejunum, ___ of GI contents

vomiting, diarrhea, retrograe movements, leakage

For enteral feeding the type of diets can vary including: ___, ___, ___ and ___ foods and not every food can be used with every tube. The ___ the diet the less chance of the tube clogging occurs

canned,

When using canned diets for tuber feeding blend ___ can to ___ can of water

1,1

When using dry food to tube feed: add the food to a blender until ___ then add ___ then ___ again, and allow the ___ to soak up water

po

Mechanical complications with tubes:

• both tube obstructions and premature removal called ___

• avoid obstructions by not letting ___ sit in tubes and ___ after feedings

• Rinse between ___ to avoid reactions between each other, and also between ___ and ___

• When clogged flush with ___ water if unsuccessful use a ___ drink

• prevent premature removal, with an _-___ and ___

dislodgement, food, rinsing, medications, medication, food, warm, carbonated, e-collar, wraps

for a jejunostomy tube leave it in for ___-___ to form a stoma 

7-10 d

Complications with the GI with tubes

• it can be administered too ___, too ___, or at the wrong ___

• liquid enteral diets are likely to cause ___ stool but not diarrhea

•  ___ can cause diarrhea

• if a patient has diarrhea canned ___ or ___ can help

quickly, much, temperature, soft, medications, pumpkin, yogurt

Metabolic complications

•  ___ syndrome

• result of the patient’s inability to ___ certain nutrients

refeeding, assimilate

Infectious complications with tube feeding

•  ___ of enterally fed formula

•  ___ ___, can seen with esophagostomy, gastronomy, jejunostomy tubes

•  ___ ___ which can be caused by dislodging of a gastrotomy or jejunotomy tube

•  ___ ___, seen in patients who’ve had pneumonia, impaired mental status, neurological injuries, reduced or absent cough, or gag reflexes and those on mechanical ventilation

contamination, peristomal cellulitis, septic peritonitis, aspiration pneumonia

Contamination of enterally fed formulas by following ___ rules in prep and storage, ___ food should be prepared daily, ___ diets can be refrigerated for 48 hrs,

hygiene, blended, commericial

Peristomal cellulitis can be avoided by ensuring the tube isn’t ___ too tightly to the body wall

secured

Septic peritonitis can be prevented by ensuring a ___ has formed before tube removal

stoma