Case Study_ Hepatic Lipidosis- Jade Jelinek

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Computer Science

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Apr 3, 2024

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1. What BCS would you assign Raisin now? What does this mean for Raisin? I would assign Raisin a BCS score meaning she is still obese, but is not as bad as ⅘ before likely due to her not eating. 2. What does it mean that Raisin is icteric? Describe the clinical appearance of icterus. Icteric means yellow, referring to jaundice. This is typically caused by an accumulation of bilirubin in the body. Icterus presents as yellowing of the skin, MM, eyes, and other areas not covered by fur. 3. What does the liver do with bilirubin? How is bilirubin typically excreted from the body? The liver is responsible for conjugating bilirubin and then it is excreted in the bile through feces and urine. 4. Describe the supplies needed for nasogastric intubation of the cat and the procedure to place this tube. ● 3-5 drops of tetracaine or proparacaine (also can use 1-2cc of 2% lidocaine) ● Sterile lubricant jelly ● Appropriately sized tube: a. 8-10 Fr polyurethane or medical grade silicone nasogastric tube (8 for cats and small dogs, 10 for larger dogs) ● 3-0 nylon suture material ● Needle drivers and scissors and/or 22-gauge needle ● Permanent marker ● 1-inch white tape 8. Empty 3cc syringe and a 3cc syringe with 1cc sterile water 3-5 drops of local anesthetic are applied down each nostril and allowed to sit for several minutes before repeating. A tube should then be measured down to the last rib and marked. It should then be lubricated liberally with sterile jelly. Using your dominant hand, introduce the tube into the ventromedial aspect of the nasal cavity through the selected nostril. Hold the head and neck in a neutral position as you advance the tube. As the tube passes through the oropharynx into the esophagus, the animal may or may not swallow. Massaging the throat may stimulate swallowing and encourage proper placement of the tube. Once the tube is advanced appropriately. Placement should then be insured by instilling saline. Once placement is confirmed it can then be sutured using a Chinese finger trap suture. (Rogers, 2020) 5. Identify two technician-driven interventions relating to the care of the nasogastric tube. Ensuring that an E-collar is in place to prevent them from pawing it out of place and regular assessment to ensure it is in place such as flushing warm water down and aspirating to see if you are getting anything back out.

6. What is Raisin’s Resting Energy Requirement? Develop a schedule for how many ml Raisin should be fed and how often she should be fed for the next five days using a Factor of 1.2. ● Calculate RER (kcal/day) as (weight (kg) x 30) +70. 11 lb/2.2= 5 kg (5 kg x 30) + 70 =220 kcal/day x 1.2= 264 kcal/day ● Choose diet (Jevity has 1.5kcal/ml) and total milliliters of diet per 24 hours. Food is 1 kcal/mL x 264 = 264 mL/day ● Calculate feeding plan-bolus feeding = diet ml/kcal/day divided by feeding/day=___ml every __hrs. 264 mL/day x (1 day/3 meals)= 88 mL 3 times per day or 88 mL/8 hours 7. Identify interventions that can be used to encourage Raisin to eat. You could try adding food toppers to make it more appealing, microwaving the food, or maybe talking with the veterinarian about an appetite stimulant if that doesn’t show improvement. 8. What does PEG stand for? Where does the tube enter the body? Which organ does the tube empty into? What do you need to be careful about when bandaging the tube? Why should the bandage be changed if it becomes soiled? PEG stands for percutaneous endoscopic gastrostomy. It is the placement of a feeding tube through the skin and the stomach wall. It goes directly into the stomach. You want to be careful not to pull the tube out when bandaging. It should be changed if it becomes soiled to decrease the risk of infection as the contents will contain a lot of bacteria. 9. How much should you feed Raisin at each feeding time? What should you do if she vomits after being fed? Describe how to care for the tube and the procedure for feeding using the PEG tube. Raisin should be fed in small amounts at each feeding time and should be monitored for reaction to the feed. If she does vomit, then the veterinarian should be notified and it may need to be given slower or that feed may be discontinued. Before feeding, aspirate with a syringe and if you're getting food back from last time, this means that she is not emptying correctly. To care for the tube you will check the insertion site for redness, swelling, and signs of infection, change the bandage every day, aspirate before you feed, make sure the end has a cap on it, and make sure that the outside of the tube is clean.

References Malone, E. (n.d.). Bilirubin . Vet Med Applied GI Physiology Supplemental Notes. https://open.lib.umn.edu/vetphysioapplied/chapter/bilirubin/ Rogers, J. (2020, March 5). Nasogastric tube - placement, Materials & Procedure . Ethos Veterinary Health. https://www.ethosvet.com/blog-post/nasogastric-tube-placement/ Veterinary Special Center. (n.d.). Peg-tube-feeding-maintenance. ... Vetspecialty.com. https://www.vetspecialty.com/wp-content/uploads/2023/06/PEG-Tube-Feeding- Maintenance.pdf

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