References
Awareness, perceptions and practices of UK veterinary nurses on managing the risk of malnutrition in hospitalised cats and dogs
Abstract
Aims:
There is minimal research surrounding malnutrition in hospitalised cats and dogs. This study investigated current attitudes, knowledge, practices and barriers for veterinary nurses when managing patients at risk of malnutrition.
Methods:
A 28-question online survey was distributed to UK veterinary nurses. The quantitative data underwent both descriptive and inferential analysis, while the qualitative data was analysed using latent thematic analysis. The sample totaled 56 registered veterinary nurses and 23 student veterinary nurses.
Results:
Respondents were less confident identifying cats at risk of malnutrition (median 7.0/10.0) compared to dogs (median 8.0/10.0). Respondents were less satisfied that malnutrition is addressed effectively in cats (median 6.0/10.0) compared to dogs (median 7.0/10.0). Satisfaction that malnutrition is addressed in a timely manner was 6.0/10.0 (median), mostly due to delayed feeding tube placement (n=23, 29%). Few respondents use a muscle condition score (n=18, 23%) and even fewer (2.5%, n=2) listed muscle loss as a risk factor. Barriers included a lack of protocols (n=53, 67%).
Conclusions:
Malnutrition is addressed less effectively, and assessed less confidently, in cats. Moreover, malnutrition is not addressed in a timely manner due to slow and inconsistent interventions. Therefore, education, increased awareness and protocols may aid in addressing malnutrition.
Nutrition is important for animals recovering from illness (Corbee and Kerkhoven, 2014). According to the International Society of Feline Medicine (ISFM) consensus guidelines, inappetence is the third most common reason a cat is presented in practice (Taylor et al, 2022). Similarly, one study found 84% of hospitalised dogs consumed less than 25% of their resting energy requirement (RER) (Molina et al, 2018).
Malnutrition is defined as poor nutritional status due to insufficient, unbalanced or excess nutrients and can increase morbidity and mortality in critically ill patients (Chan, 2015). One study found vomiting, older age and longer hospitalisation are risk factors for malnutrition with a link between insufficient calorific intake and death (Molina et al, 2018). A patient is at a low risk of malnutrition when calorific intake is less than 80% RER for 3 days. Moderate risk factors include: a calorific intake of less than 80% RER for 3–5 days, weight loss, illness of 2–3 days, hypoalbuminaemia and mild muscle loss. High risk factors include: a calorific intake of less than 80% RER for more than 5 days, severe vomiting or diarrhoea, a body condition score (BCS) of less than four out of nine, moderate or severe muscle loss, and illness exceeding a duration of 3 days (Perea, 2012; Taylor et al, 2022). Significant weight loss is defined as a loss of 5% within 5 days or 10% gradual loss, without fluid deficits (Fabretti et al, 2020). Other risk factors include anorexia of more than 5 days, sepsis, and wounds and burns which cause protein loss (Chan and Freeman, 2006). A stable patient with two or more high-risk factors should receive prompt nutritional intervention (Perea, 2012; Taylor et al, 2022). Moreover, during illness, stress starvation may occur, which is the catabolism of lean body mass as a result of an inadequate calorific intake. This negatively influences immune function, wound healing and muscle strength (Chan, 2020). Overall, the effects of malnutrition during hospitalisation include longer hospitalisation and elevated risk of sepsis (Chan, 2015).
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