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Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
Nutrition for Non Critical Hospitalized Patient
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Nutrition for Non Critical Hospitalized Patient

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  • Important part of patient care that is often overlooked
    Not always on tx sheet
    Antibiotics have what, when, how much, route – nutrition should too
    Fasting for surgery
    How about vomiting/ Diarrhea? - sometimes contraindicated
    Dr decision but we should understand the importance of nutrition and make suggestions
  • Even a patient that is well nourished at admission can rapidly become nutritionally depleted during hospitalization.
    already malnourished at admission and that require prolonged hospitalization are at risk for increased morbidity and mortality due to poor nutritional status.
    be proactive to ensure that nutritional support of hospitalized patients is not overlooked.
  • How much to feed?
    How much do you think should be fed?
    How do you determine how much your patient should eat?
  • What does Dr want them to eat?
    Not want them to eat?
    What other foods can we try?
    What should we NOT try?
  • How long should we let patients go without eating?
    What can we do to get our patients to eat?
  • Will they eat if hand fed?
  • What about syringe feeding?
  • Is an antidepressant – can cause sedation, hyperactivity, vocalization
    Careful with renal or hepatic disease
    Other meds sometimes used diazepam and cyproheptadine
  • Drooling often indicates nausea
    Try cold food, it masks the smell. Some nauseous pets don’t like smelly foods
  • Nauseous
    Leaving food with patients
  • Recent history of involuntary weight gain or loss?
    History of nausea, vomiting, or diarrhea?
    Changes in the pet's appetite, urination, or defecation?
    Difficulty chewing or swallowing?
    Any allergies?
    Any recent change in the pet's diet?
    How many people?
    Who is primarily responsible for feeding?
    Other pets in the household?
    What kind of food?
    How much food ?
    Treats – commercial, dental, table food, used to administer meds?
    Supplements?
    Garbage, obtain food from outside sources (e.g. neighbors), or hunt prey?
  • Fast – 8-24 hrs, then small frequent meals highly digestible low fat food
    Fasting, even for this period of time, decreases the length of the intestinal villi
    increases the risk of bacterial translocation
    reduces activity of intestinal disaccharide enzymes
    bowel does not necessarily “rest” when empty
    during fasting, dogs experience migrating motility complexes or “housekeeping waves”; cats experience a similar motility pattern.
    During inflammation, normal motility is likely decreased and ileus and delayed gastric emptying are present.
    Feeding may help maintain the activity of small intestinal digestive enzymes and help preserve normal villi morphology
    food in the intestine also decreases the risk of bacterial translocation.
    Feeding small amounts may improve intestinal motility and gastric emptying
    In some cases of diarrhea, feeding worsens clinical signs; therefore, patients should be treated individually and feeding stopped if diarrhea appears to worsen.
  • When intractable vomiting is present, oral intake of food should generally be avoided, but for as short a time as possible.
    In dogs infected with parvovirus, early enteral feeding results in faster resolution of vomiting and diarrhea than does withholding food
    Similar to feeding during diarrhea, feeding small amounts may improve gastric emptying and a return to normal motility
    Highly digestible foods with a low to moderate fat content should be considered because high-fat diets may slow gastric emptying and promote vomiting in some patients. Parenteral fluids and electrolytes should be provided as needed
    antie-metics should be used if the presence of a GI foreign body has been ruled out.
    anorexic patients or those that have not been offered food for a period of time introduced slowly, starting 10 or 15% of the RER divided into four or 5 feedings per day.
    If the feedings are well-tolerated, then the amount can gradually be increased by 20 to 25% the following day and so on until the full caloric requirement is meet
  • It is important to introduce food slowly in anorectic patients to prevent refeeding syndrome.
    first described in people with the liberation of Holocaust survivors during World War II.
    It was found that, after prolonged periods of anorexia, aggressive overfeeding leads to severe metabolic imbalances, which in some cases could be fatal
    For example, as phosphorus and potassium shift back into the intracellular space, severely decreased serum phosphorus concentration can lead to hemolytic anemia. Typically, this is a concern once phosphorus concentration drops below 2 mg/dl and, at this point. Potassium concentration should be monitored closely and supplemented as well. Ideally, phosphorus and potassium concentrations should be monitored daily in these patients for the first few days of feeding. It is also important to remember that liquid diets are 75% water, so reducing the patients IV fluid rate may be indicated as feedings increase.
  • Many formulas – weight loss, weight gain, active, growth, repro
    Top formula more accurate especially for very small and very large pets
    Use what is most comfortable for you
  • Smart phone calculator
    Turn sideways
    (body weight in kg) ¾ x 70 = RER
  • The difference is only 0.4 kcal/kg
  • The difference in this example is 4.59 kcal/ kg
  • The diference in this example is 16.8 kcal/kg
  • Or RER = 662 using the other formula, she need to eat 1.79 cans 
  • These are a few of the foods we commonly
    You could easily make your own chart
    Available online, product guides, call
  • feeding Q4 = ¼ can per feeding
  • Feeding Q12 = 1.5 cups per feeding
  • Q4 = 1/3 can per feeding
  • What can techs do?
    Talk to the doctor!
    Ask for drugs. Pepsid, ondansatron, cerenia
    mitazapine
    Calculate RMR
    Suggest a NE or NG tube
    Document in nursing notes and when rounding!
  • Plate vs. bowl
    Plastic vs. metal
    Warm vs. cold
    Beef or chicken
  • Ate canned not dry
    Ate chicken not beef
  • Maybe hand feeding works
  • Or maybe not!
  • Meat baby food
    No onion
    Short term to get them started
  • Short term to get them started
  • Dogs sometimes will eat canned cat food even when they won’t eat canned dog food
  • What should we not try?
    Not feeding rx foods in hospital
  • Some might eat off a tongue depressor or spoon
  • Or out of your hand but will it be enough?
    If allowable offer a variety of treats
    In cage
    Out of cage
  • Try feed dogs outside
    NOT cats!
  • Some patients like to be left alone to eat
    Some want company
  • I hate syringe feeding
    Patients hate it
  • Difficult to feed enough to get RER
  • Especially if nauseas don’t keep food with them
    Don’t syringe feed
    Talk to Dr – ask for meds
  • I hate to see this
    If your nauseas do you like smelling food all the time?
  • Our challenge is to find what works!
  • Document in nursing notes
    If Rex tries to take your hand off when you reach for his bowl – I bet you write it down
    How about what he ate?
    How much?
    Where?
    If not eating what have you tried?
    Have you asked the owner to bring food? Or treats?
  • Patient that hasn’t eaten for 3 days or more
    At least 75 % of RER
    consider a NE or NG tube!
    Can be used for bolus or CRI feedings
    Flush with water Q 4 hours
  • NE tube - Ideally to 7th to 9th intercostal space
  • NG tube
  • Curving downward into stomach
  • 1 kcal/ml
    8ounce can = 237 ml
    Refrigerate once opened – discard after 48 hours
  • Do not set up more than 6 hours of liquid diet
    Replace entire set up every 24 hours
  • Often start with water CRI via feeding tube
    BE CAREFULE – MARK THE LINE!
  • Any patient not eating for 3 days, including time at home prior to being admitted, needs feeding tube or PPN
  • Transcript

    • 1. Nutrition for the Non-Critical Hospitalized Patient Ed Carlson, CVT
    • 2. I’d like to talk to you about I’d like to talk to you about……. diarrhea
    • 3. Resting Energy Requirement 70 x (body weight in kg) ¾ = RER OR 30 x (body weight in kg) + 70 = RER
    • 4. Sandy weighs 44 pounds, 20.0 kg. 70 x (body weight in kg)¾ = RER 70 x (20kg)¾ = 662 kcal/day Or 30 x (body weight in kg) + 70 = RER 30 x 20kg = 600 + 70 = 670 kcal/day
    • 5. King weighs 100 pounds, 45.5 kg. 70 x (body weight in kg)¾ = RER 70 x (45.5kg)¾ = 1226 kcal/day Or 30 x (body weight in kg) + 70 = RER 30 x 45kg = 1365 + 70 = 1435 kcal/day
    • 6. Tiny weighs 3 pounds, 1.36 kg. 70 x (body weight in kg)¾ = RER 70 x (1.36kg)¾ = 88.1 kcal/day Or 30 x (body weight in kg) + 70 = RER 30 x 1.36kg = 40.8 + 70 = 111 kcal/day
    • 7. One 13 oz. can of Hill's® Prescription Diet® i/d® Canine Gastrointestinal Health contains 369 kcal. We determined Sandy’s RER is 670 kcal. Sandy needs to eat 1.8 cans per day to meet her RER (670 divided by 369 = 1.8)
    • 8. Max - beagle mix RER = 670 kcal per day How much canned Iams chicken should he be fed per day? 427.5 kcal/can
    • 9. Rex - lab RER = 1137 kcal / day How much Iams Mini Chunks should he be fed per day? 379 kcal/cup
    • 10. Fluffy – DSH RER = 205 per day How many 3 oz. cans of Iams should she eat per day? 3 oz. can – 97 kcal
    • 11. Veterinary Technicians = Patient Advocates!
    • 12. X
    • 13. Document! Be specific!
    • 14. The truth about feeding tubes
    • 15. Nasoesophageal Tube
    • 16. Nasogastric Tube
    • 17. Nasogastric Tube
    • 18. Be a nutritional advocate for your patients!
    • 19. Questions?

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