FEEDING INPATIENTS, PARTICULARLY THOSE WHICH ARE ANOREXIC or have a low body condition score, or those in for the long term, is an area where one can really put the “nurse” into nursing skills. Although inpatient feeding is primarily the nurses’ responsibility, full support for the entire process from the whole team would be very best practice.
A positive patient outcome is more likely when nutritional requirements are properly paid attention to (Brunetto et al, 2010), starting by taking an accurate history on admittance – not the vague “been off food for a few days” – to ensuring the correct diet is given and maximising the chances of them actually eating said diet. Ultimately, receiving enough calories really does affect the outcome (Remillard et al, 2001).
Assuming the correct diet and calorie plan have been recommended, there are many tricks for getting them to eat, so let’s take a closer look.
First off, don’t set yourself up to fail! Find out on admission your patients’ favourite foods, including format. We often assume that ill animals prefer wet food, but this is not always the case and as for human foods, now is not the time to lecture on inappropriate feeding!
Many years ago, my dog had a laminectomy. Two days after the surgery, a nurse phoned me in despair, asking what I thought he would eat, as they had tried many commercial preparations plus foods such as chicken, ham, cod and tuna.
I sheepishly admitted that he loved cooked spaghetti – not ideal, I realise, but it kick-started his appetite and they were then able to feed him something far more appropriate. If they had asked me on admittance, I would have told them this and he might have started eating much sooner. Remembering how fastidious cats are, gently cleaning their faces of dried blood or mucous helps them feel better and may help them smell food more easily.
Physical aspects of food
For pets with facial trauma, ideally place a feeding tube to ensure ideal calorie intake but if this isn’t done, ensure the patient has adequate pain relief and consider the physical aspect of the food – roll soft food into bitesized balls, feed from a raised bowl, warm food to enhance the aroma and if feeding human food, such as tuna or pilchards, ensure you use the juices too to improve palatability.
Cats tend to like privacy, so providing a box or covering the kennel is one solution, but ideally feed the patient in a different location to where procedures take place.
Giving drugs, injections, taking blood, grooming and so forth, in the place where you also expect them to eat, might not be ideal and may just cause enough stress to quash any appetite.
It also goes without saying that for cats, litter trays should be well away from the feeding station and water should be as far away from food as possible (Ellis et al, 2013). This can be tricky in a small kennel, so if the patient is to be residing for more than a day and you have the space available, a larger dog-type kennel would be preferential.
Nausea must be controlled with antiemetics as feeding a critically ill patient is vital to reduce further complications (Hackett, 2011), and must have time to take effect. Also, while it is tempting to offer a smorgasbord of everything in order to find out what the animal might eat, this is very unappealing to a patient who feels sick.
The rule is simple: offer a small amount of one food, leave it for no longer than 20 minutes and remove any which is uneaten.
Dehydration
It is possible that patients having many procedures during work-up may become mildly dehydrated, potentially resulting in headaches – in this instance, feeding from a raised bowl, or hand feeding, may be beneficial. Consider offering a palatable rehydration solution instead of water in these cases.
Finally, consider the general environment where the patient is expected to eat, from the patient’s point of view. Is there a noisy dog or is someone vacuuming? Is the radio too loud for their heightened sense of hearing? Interestingly, Bowman et al (2015) found that classical music played in the kennel area reduced stress in dogs.
Deal with distractions
While you are attempting to handfeed at one end of the kennels, are your colleagues wrestling a dog into a muzzle at the other end? Is someone wearing strong perfume or are people arguing or mucking around? This might seem a bit silly, but it’s easy to forget how sensitive dogs and cats are to sounds and smells and tensions, and stress in turn tends to affect appetite (Schwartz, 2002; Sherman and Mills, 2008).
So to summarise, a bit of forward- planning and TLC can go a long way to ensuring a positive experience and reducing the risk of nutrition-related complications in patients.
References
Bowman, A., Scottish Spca, Dowell, F. J., Evans, N. P. (2015) “Four Seasons” in an animal rescue centre; classical music reduces environmental stress in kennelled dogs. Physiol Behav 1 (143): 70-82. doi: 10.1016/j.phys beh.2015.02.035. Epub 2015 Feb 21.
Ellis, S. L. H. et al (2013) AAFP and ISFM Feline Environmental Needs Guidelines. Journal of Feline Medicine and Surgery 15: 219- 230.
Brunetto, M. A., Gomes, M. O. S., Andrew, M. R. (2010) Effects of nutritional support on hospital outcome in dogs and cats. J Vet Emer & Crit Care 20 (2): 224-231.
Hackett, T. B. (2011) Gastrointestinal complications of critical illness in small animals. Vet Clin North Am Small Anim Pract 41 (4): 759-766, vi. doi: 10.1016/j. cvsm.2011.05.013.
Remillard, R. L. et al (2001) An investigation of the relationship between caloric intake and outcome in hospitalized dogs. Vet Thera 2 (4): 301-310.
Schwartz, S. (2002) Separation anxiety syndrome in cats: 136 cases (1991- 2000). J Am Vet Med Assoc 220 (7): 1,028-1,033.
Sherman, B. L., Mills, D. S. (2008) Canine anxieties and phobias: an update on separation anxiety and noise aversions. Vet Clin North Am Small Anim Pract 38 (5): 1,081-1,106, vii. doi: 10.1016/j.cvsm.2008.04.012.
