18. 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
19. 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
20. 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
21. 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)
22.
23. Max - beagle mix
RER = 670 kcal per day
How much canned Iams chicken
should he be fed per day?
427.5 kcal/can
24. Rex - lab
RER = 1137 kcal / day
How much Iams Mini Chunks
should he be fed per day?
379 kcal/cup
25. Fluffy – DSH
RER = 205 per day
How many 3 oz. cans of Iams
should she eat per day?
3 oz. can – 97 kcal
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
