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How to make a nutritional assessment

by
01 April 2016, at 1:00a.m.

VETERINARY NURSES SHOULD MEASURE AND RECORD THE WEIGHT OF EACH PATIENT every time they attend the surgery, VNs were told at VetsSouth 2016 in Exeter in February.

Nicola Ackerman, senior medical nurse at The Veterinary Hospital, Plymouth, told colleagues that only about 50% of UK practices routinely weighed all their clients’ pets.

The information provided by this simple procedure was invaluable when trying to plan an appropriate feeding regimen to aid the patient’s recovery from critical illness, she said.

Crucially, measurements recorded on the patient’s clinical records would provide a baseline to monitor the animal’s current health status and its response to treatment.

The same information would also help to guide that treatment since the recommended drug dose may change with differences in overall body mass and hydration status.

But taken on its own, bodyweight alone wouldn’t provide all the information needed for a nutritional assessment. Mrs Ackerman also recommended that body condition scoring should be carried out on each visit. This would, for example, help in detecting patients whose weight appears to be stable but have ascites or liver cysts that are growing in size and disguising the effects of the illness in reducing overall tissue mass. 

Estimates of muscle condition and hydration levels will also help in creating an accurate picture of the animal’s health status and resulting dietary needs. When assessing patients with chronic conditions such as renal disease or diabetes, “overcoat syndrome”, the presence of large fat deposits around the abdomen, can make it dif cult to detect any drop in muscle mass, she said.

All about individual needs

Mrs Ackerman emphasised that the food chosen and both the size and timing of the meals must take into account the individual needs of the patient.

Any calculations based on published nutritional advice or manufacturers’ recommendations may need to be amended according to the response of that particular animal. Its nutritional needs will also change over time and so clinical staff should reassess the animal at regular intervals.

In many cases, critically ill patients are likely to lose their appetite and so staff may have to consider ways to encourage the animal to eat or insert a tube to provide nasogastric or parenteral nutrition. In the latter group it was important to maintain a healthy gut by providing a small but continuous supply of fluid, nutrients and electrolyte to reduce the risk of bacteria crossing the gut wall, she said.

Nutritional support was also vital during the recovery phase. For most patients, the ideal would be to give the animal the same food that it receives at home.

“For cats, texture is just as important as flavour and so if you give it chunks of meat in gravy when it is used to getting chunks in jelly, then that will become a real stress factor for the animal,” she explained.

However, if on presentation, the owners say that they give the animal a diet of raw meat and bones then it may not be possible to offer the same. Mrs Ackerman noted that many university clinics now have a policy of only feeding processed food and some will even insist that patients normally given raw meat should be barrier nursed to avoid the risk of staff and patients becoming infected with salmonella and other food-borne pathogens.

Pets given raw food diets may also have to be starved for a longer period before surgery as such material is retained for longer in the stomach and may increase the risk of post-operative vomiting.

Post-treatment

Mrs Ackerman suggested that tinned pilchards in tomato sauce is a good option to encourage feline patients to start eating again after treatment. The sauce is rich in potassium, which can help to restore a normal appetite.

She also encouraged practices to allow the owners into the clinical area when the animal is recovering from surgical or medical treatment.

“They may be able to hand-feed the pet and their presence is certainly likely to make the animal less anxious. That will encourage the pet to eat which will help it get better more quickly.” 

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