Provision of nutritional support

Provision of nutritional support

Carole Brown


All animals must receive a balanced diet to maintain optimum levels of health. When an animal is ill, it may not want to eat or may not be able to eat, leading to deficiencies of certain vital nutrients and energy. These deficiencies will seriously slow down the rate of recovery and impair the healing process. Failure to consider some method of nutritional support may compromise the patient’s chances of recovery.

When nursing the sick animal consideration must be given to certain factors which differ from those in the healthy animal:

1. Energy requirement – a healthy animal needs energy for basic metabolism and for exercise. A sick animal will use much less energy in exercise but disease and stress increase the normal energy requirements.

2. Type of food – sick animals often have a reduced desire to eat and thought must be given to palatability and how to tempt them to eat. If the animal does eat it may only eat small quantities, giving rise to the need to supply energy-dense food. In addition, the consistency must be considered in relation to the route of administration.

3. Route of administration: nutritional support can be given by the enteral route – making use of the gastrointestinal tract – or by the parenteral route – providing nutrients intravenously. In some cases a patient may not be able to use part of the gastrointestinal tract, e.g. the oral cavity, and steps must be taken to bypass it using some form of feeding tube.

This chapter considers all these factors and describes in detail the techniques involved in placing feeding tubes and the nursing care needed to maintain them.


(Administration of nutritional support using the gastrointestinal tract)

Procedure: Calculation of energy needs

1. Action: Calculate basic energy requirement (BER) for over 5 kg bodyweight.

    Formula: BER = (30 × kg bodyweight) + 70 kcal.

    For example, to find the BER for a 10 kg dog:



    Rationale: The energy required to meet the metabolic needs of patients is measured in kilocalories (kcal). The BER is based on the metabolic energy needs of a patient at rest, including processes such as respiration, circulation and kidney function. Age, bodyweight and composition, and activity may affect it.

2. Action: Calculate daily BER for 5 kg bodyweight and under.

    Formula: BER = (60 × kg bodyweight) + 70 kcal.

    For example, to find BER for a 3 kg cat:



    Rationale: Animals under 5 kg have a faster metabolic rate, so require more energy per kg bodyweight than do animals over 5 kg. This also applies to neonates, where the metabolic rate is greater than that of adults.

3. Action: Calculate illness energy requirement (IER) in relation to daily BER:



    Rationale: Illness and disease factors must be taken into account when artificially feeding patients. Stress and disease processes require an increase in energy to meet metabolic needs and counteract weight loss. The factors shown should be multiplied by the respiratory exchange ratio to give the kcal/day requirements.

Procedure: Calculation of food quantities to be administered

1. Action: Calculate quantity of kcal to be fed to a hospitalized 10 kg dog.

    For example, 10 kg dog requires 370 kcal/day at rest:



    Rationale: It is essential to ascertain the energy requirement in kcal before calculating the quantity of food in millilitres (ml).

2. Action: Calculate the quantity of food in ml to be fed to a 10 kg hospitalized dog. Food value 1.5 kcal/ml.

    For example, dog requires 444 kcal/day:



    Rationale: For artificial feeding it is important to choose a food that is energy-dense, i.e. a small volume contains a large number of kcal. This will reduce the volume given, providing easier and more efficient administration.

3. Action: Divide quantity in ml into equal feeds to be administered throughout the day:



    Rationale: Always divide the food quantity into equal workable amounts depending on the method of artificial feeding. Consider the time available for feeding and each patient’s needs. Avoid excessive quantities in single feeds to prevent discomfort, regurgitation or vomiting. Avoid small quantities that necessitate excessive handling and discomfort to the patient.

N.B.: Larger tubes, such as gastrostomy tubes, allow for larger quantities to be administered at each feed – calculations can be adjusted accordingly.

Procedure: Forced feeding – placing food in mouth

Food choice

Any proprietary, complete, balanced tinned food or energy-dense food; food of a high aroma is desirable.

1. Action: Select and prepare equipment – check expiry date of food; prewarm food; wash hands; wear gloves and apron; damp swabs, towel.

    Rationale: Ensure all equipment is selected and prepared prior to beginning the procedure to allow for efficient administration.

2. Action: Reassure patient and ask the assistant to restrain the patient, holding the head in a normal position.

    Rationale: Kind but firm handling will ensure the animal feels secure. Keeping the head in a normal position will reduce the risk of aspiration pneumonia.

3. Action: With gloved hands, take a small quantity of food. Open the patient’s mouth and place some food on the back of the tongue (Fig. 5.1).

    Rationale: Wear gloves to ensure hygiene is maintained. If the patient resents the procedure in any way, stop and offer reassurance before recommencing.

4. Action: Allow the patient to swallow and lick its lips, reassuring it throughout the procedure.

    Rationale: Encourage patient to swallow by externally massaging the ventral pharynx.

5. Action: Repeat until required amount of food has been administered.

    Rationale: If the patient becomes distressed before all of the food has been administered, stop the procedure and allow the patient to calm down fully before commencing again.

6. Action: Once all food has been administered, clean the patient’s mouth with damp swabs and dry the area.

    Rationale: The mouth must be free of any food debris to discourage bacterial growth.

7. Action: Record food administration and repeat at required intervals.

    Rationale: It is essential to keep accurate records of food administration to prevent any error.

8. Action: Dispose of equipment safely and appropriately.

    Rationale: This is essential to avoid contamination.

9. Action: Any food in tins must be covered and stored at 4–8°C between feeds.

    Rationale: Food must be stored according to the manufacturer’s instructions to avoid any loss of nutrients and subsequent deterioration of food quality.

Procedure: Forced feeding by syringe

Food choice

Food of high calorific value, liquid consistency or easy to liquidize and feed with a syringe, e.g. proprietary convalescent foods.

1. Action: Select and prepare equipment – calculate energy requirements and food quantity. Prewarmed food, catheter tip syringe, towel, assistant; wash hands, wear gloves and apron.

    Rationale: It is essential to select and prepare all equipment prior to beginning the procedure to ensure efficient administration.

2. Action: Measure correct volume of food into syringe.

    Rationale: Accurately measure volume required based on calculation of energy/kcal needed.

3. Action: Request assistance to hold patient.

    Rationale: Ensure patient feels safe.

4. Action: Support patient’s nose and mouth, keeping the head in a normal position.

    Rationale: Firm but effective handling will ensure food is delivered safely. Keeping the head in a normal position will reduce the risk of aspiration pneumonia.

5. Action: Introduce the syringe into the mouth between the upper and lower premolars above the surface of the tongue.

    Rationale: This area is the most suitable to aid administration and control food intake.

6. Action: Applying gentle pressure to the syringe, introduce approximately 10 ml of food into the mouth and allow patient to swallow. Stroke ventral aspect of pharynx to encourage swallowing.

    Rationale: Avoid giving food quickly or in one bolus as this may cause choking. Allow the patient to swallow and breathe between administrations.

7. Action: Continue with administration until the required volume has been delivered.

    Rationale: Only continue if patient is taking the food well and swallowing between administrations. If the patient gets distressed or fails to swallow, stop immediately.

8. Action: Clean and dry the patient’s mouth thoroughly and replace in kennel.

    Rationale: Always ensure mouth is free of any food debris and is dry, to discourage bacterial growth.

9. Action: Record food administered.

    Rationale: Accurate record keeping is essential to avoid error.

10. Action: Dispose of equipment safely and appropriately. Clean and disinfect surface areas.

    Rationale: It is essential to dispose of equipment correctly to avoid contamination.

Jan 8, 2017 | Posted by in NURSING & ANIMAL CARE | Comments Off on Provision of nutritional support

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