Small Animal Nursing I Lab 6 - Veterinary Nursing and Common Diseases

Nursing care

What is the most significant role of the veterinary technician?

1. Freedom from hunger and thirst

2. Freedom from discomfort

3. Freedom pain, injury, or disease

4. Freedom to express normal behavior

5. Freedom from fear and distress

What are the core freedoms of animal welfare that nursing care supports?

By providing access to fresh water and a diet that maintains health

How does nursing care support an animal's freedom from hunger and thirst?

By providing an appropriate shelter and comfortable resting area

How does nursing care support an animal's freedom from discomfort?

By prevention of pain, disease, and injury, or rapid diagnosis of disease

How does nursing care support an animal's freedom from pain, injury, and disease?

By providing sufficient space, facilities, and company of the animal's species

How does nursing care support an animal's freedom to normal behavior?

By ensuring conditions and treatment that prevent suffering

How does nursing care support an animal's freedom from fear and distress?

A structured discipline that ensures consistently excellent care to all patients

What is the veterinary technician practice model?

• Communicate information about changes in patient status to the healthcare team and client

• Work closely with the veterinarians to ensure patient needs are quickly addressed

How can technicians ensure that the veterinary technician practice model is being utilized?

Assessment

What is step 1 of the veterinary technician practice model?

• Gather or review patient history in the patient record

• Review medical records for past historical information

• Perform a physical examination

• Review lab results and diagnostic, surgical, and medical reports

• Convey this information during rounds

What does step 1 (assessment) of the veterinary technician practice model entail?

SBAR (situation, background, assessment, and recommendation) method

What method of conveying information does the Navy use that is comparable to "rounds" in a veterinary hospital?

Planning

What is step 2 of the veterinary technician practice model?

Based on the assessment, make a clinical judgment regarding the physiologic and psychological needs of the patient (technician evaluation)

What does step 2 (planning) of the veterinary technician practice model entail?

A clinical judgment regarding the physiologic and psychological needs of the patient based on the critical thinking and analysis of gathered data.

Technician evaluations often refer to deficiencies in the five freedoms, compared with the "body systems" approach that veterinarians use to diagnose a medical condition.

What is a technician evaluation?

For a patient with tachypnea, cyanosis, dyspnea, and low pulse oximetry, the data would be given a technician evaluation of hypoxia.

Hypoxia - low levels of oxygen in the body tissues

What is an example of a technician evaluation?

1. Identification of actual problems

2. Risk of future problems

3. The level of client knowledge and/or coping abilities that may or may not impair the at-home care of the pet

What do the categories of a technician evaluation include?

Implementation

What is step 3 of the veterinary technician practice model?

Once technician evaluations are identified and prioritized, each should have a desired outcome.

Each evaluation should be followed by one or more interventions.

What does step 3 (implementation) of the veterinary technician practice model entail?

A patient with hypoxia should be given adequate oxygenation which would be evidenced by the resolution of dyspnea, tachypnea, and return of mucous membranes to a normal color, and normal pulse oximetry

What is an example of implementation within the veterinary practice model?

Evaluation

What is step 4 of the veterinary technician practice model?

• Nursing care is revised based on patient response to interventions and new technician evaluations are identified based on changes in patient status

• Reevaluation is crucial after intervention

• Additional data (lab work, imaging) are required to fully assess the patient's response to nursing interventions and to prescribed treatment

What does step 4 (evaluation) of the veterinary technician practice model entail?

It focuses on a patient-centered approach and evaluates each patient's response to therapy, instead of a "one size fits all" approach

Why is it crucial to reevaluate a patient after intervention?

Etiology

The study of the cause of disease

Idiopathic

A disease that has an unknown cause

Pathogenesis

*The foundation of patient evaluation requires a basic grasp of the pathogenesis of common small animal medical disease

The manner in which a disease develops (acute versus chronic)

Lesions

The damage or abnormal changes associated with the development of disease

Clinical signs

The symptoms of a disease that emerge as lesions develop

Inflammation, irritation, and obstruction or restriction of the airway

What does respiratory disease often lead to?

Inflammation or irritation of the nasal mucosa

What causes nasal discharge?

Serous

Clear liquid nasal discharge

Mucoid

Opaque and sticky nasal discharge

Mucopurulent

Green-yellow and mucoid nasal discharge

Hemorrhagic

Bloody nasal discharge

Inflammation of the nasal epithelium

Vasodilation, leakage of fluid from these vessels into surrounding tissues, and increased production of mucus lead to narrowing of the nasal and sinus passages, causing obstruction

What causes nasal and sinus congestion?

• Sneezing

• Facial swelling

• Stertor or stridor

• Cough

• Pleural effusion

• Dyspnea

• Hypoxia

• Hypoxemia

What are notable signs of respiratory disease?

Anorexia particulary in cats

What can a diminished sense of smell cause?

Inhalation of foreign material

In dogs, sneezing is often associated with

Viral infection of the upper respiratory tract

In cats, sneezing is often associated with

Stertor

A loud snoring or snorting sound caused by obstruction of the pharynx or larynx

Stridor

A high-pitched inspiratory wheeze caused by obstruction of the pharynx or larynx

Irritation or inflammation of the pharynx, larynx, trachea, bronchi, or pleura

What causes a cough?

Hemoptysis (can be associated with heart worm disease or CHF)

The coughing up of blood

The accumulation of excessive fluid within the thoracic cavity that compress the lungs

*Causes include fluid overload, infection, lymphatic obstruction, coagulopathies, and trauma

What is pleural effusion?

• Respiratory distress with increased inspiratory effort

• Lung sounds are decreased

• Heart sounds are muffled

*Confirmed via thoracocentesis (after auscultation or u/a), radiography, or ultrasonography

How might a patient with pleural effusion present?

Dyspnea

Increased respiratory rate or effort, often with an abdominal component to the breath

Orthopnea

Ability to breathe only in an upright position

• Interruption of normal airflow (obstruction)

• Inadequate lung inflation (pleural effusion, pneumothorax)

• Alveolar gas exchange (pneumonia)

What can cause dyspnea?

Patients exhibit increased inspiratory effort and take slow, deep breaths

What type of breathing is often associated with upper airway disease?

Patients exhibit increased expiratory effort and have shallow, rapid breaths

What type of breathing is often associated with lower airway disease?

Hypoxia

Deficient oxygenation of tissues

• Reduced blood flow (e.g., CHF)

• Decreased oxygen-carrying capacity (e.g., anemia)

• Hypoventilation (e.g., pleural effusion)

• Ventilation-perfusion mismatch (when part of your lung receives oxygen without blood flow or blood flow without oxygen)

What can cause hypoxia?

An estimate of the amount of O2 in hemoglobin which provides information about tissue oxygenation and oxygen delivery

What is pulse oximetry and what does it measure?

Tachypnea, tachycardia, cyanosis or pallor, and dyspnea

What are the signs of hypoxia?

Hypoxemia

A decrease in the partial pressure of oxygen in arterial blood as measured by arterial blood gas analysis

Bronchial disease

What may wheezing lung sounds be indicative of?

Pleural or pulmonary disease

What may crackling or popping lung sounds be indicative of?

Thoracic mass, effusion, or diaphragmatic hernia

What may absent or muffled lung sounds be indicative of?

• Airway humidification/hydration

• Emergency treatment of dyspnea (e.g intubation)

• Oxygen therapy

• Decreasing stress with minimal handling, sedation, a quiet environment

• Coupage (controlled striking of the thorax) and positioning strategies

• Thoracocentesis (using a needle and syringe to remove fluid from the thorax)

• Medication (bronchodilators, antibiotics, antifungals, expectorants, and anti-

inflammatories)

What are examples of therapeutic approaches to patients with respiratory disease?

1. Myocardium (thickening of the heart muscle)

2. Valves (narrowing or malfunction of the aortic, mitral, pulmonic, and tricuspid)

3. Conductive tissue (SA, AV, Bundle of His)

4. Pericardium can fill with fluid or blood

5. Flow of blood

Heart disease is a pathologic abnormality that affects the _____

Causes thickening of the heart muscle

How does heart disease effect the myocardium?

Causes narrowing or malfunction of the aortic, mitral, pulmonic, and tricuspid

How does heart disease effect the heart valves?

Pericardium (the sheath covering the heart) can fill with fluid or blood

How does heart disease effect the pericardium?

80%

Myocardial disease is present in what percent of cats?

75%

Valvular disease is present in what percent of dogs?

• Annual physical examinations

• Screening echocardiography for predisposed breeds

• Many patients are asymptomatic or owners miss subtle signs (early tachypnea, exercise intolerance, lethargy, or tachypnea)

Early detection of heart disease is reliant on _____

• Tachycardia to bradycardia

• A weak, bounding, or asynchronous femoral pulse

• Heart murmur

• Arrhythmias

On physical examination, a patient with heart disease typically exhibits _____

Auscultable turbulence associated with the movement of blood

through narrow, altered cardiac valves or shunts between heart chambers

What is a heart murmur?

Irregular heart rhythm (pulse deficits are commonly present in harmful

rhythms)

What is an arrhythmia?

Tachypnea (Owners should monitor respiratory rate at home)

What is one of the earliest signs of heart failure that owners should be aware of?

Hypoxia

Inadequate tissue perfusion in prolonged heart disease

• Tachypnea

• Syncope (fainting)

• Weakness

• Prolonged CRT/pale mucous membranes

• Exercise intolerance (dogs)

• Anorexia, depression, and weight loss (cats)

What are the clinical signs of hypoxia?

• ACE inhibitors

• Beta blockers

• Positive inotropes

• Calcium channel blockers

• Antihypertensives

• Antiarrhythmic drugs

• Low-sodium diets

• Stress reduction

• Exercise restrictions

What may treatment for heart failure include?

• Reduce afterload (the pressure of blood as it is pumped into vessels)

• Improve cardiac muscle contractility

• Treat volume overload (diuretics)

• Prevent blood clots in cats

Patients diagnosed with heart failure are often treated with medications to _____

When decreased cardiac output causes poor return of blood to the

heart leading to fluid overload in tissues and impaired pulmonary gas

exchange

What is congestive heart failure?

Decreased cardiac output and tissue hypoxia

What causes poor venous return and fluid overload?

• Fluid backing up into the lungs (pulmonary edema)

• In cats, fluid into pleural space (pleural effusion)

Left-sided congestive heart failure is associated with

• Dyspnea or tachypnea

• Cyanosis

• Crackles, wheezes, and decreased lung sounds on asucultation

• Coughing in dogs

What are the clinical signs of left-sided congestive heart failure?

Venous congestion occurring in the abdominal and thoracic cavities

Right-sided congestive heart failure is associated with

• Edema

• Jugular distention

• Abdominal distention caused by ascites, hepatomegaly, and pleural and pericardial effusions

What are the clinical signs of right-sided congestive heart failure?

Myocardium

The heart muscle

Cardiomyopathy

Disease of the heart muscle

Hypertrophic cardiomyopathy (HCM)

The most common form of feline cardiomyopathy

Hypertrophic cardiomyopathy (HCM)

Characterized by increased thickness of the left ventricle wall and a small ventricular lumen

Feline arterial thromboembolism

*Cats with hypertrophic cardiomyopathy are at risk

A condition in which blood clots form in the cat's heart and lodge in the arterial vasculature, disrupting blood supply to the hind limbs

Feline arterial thromboembolism

Cats with hypertrophic cardiomyopathy are at risk for what condition?

• Hindlimb paresis or paralysis

• Severe pain

• Cyanotic toe pads

• Absent or poor femoral pulses,

• Coolness of the affected limb

What are clinical signs of feline arterial thromboembolism?

Dilated cardiomyopathy (DCM)

The most common canine cardiomyopathy

Dilated cardiomyopathy (DCM)

*Primarily affects the left side of the heart

Characterized by extreme atrial and ventricular dilation with decreased contractility

Degenerative atrioventricular valve disease (primarily affects dogs)

A condition that affects the mitral or tricuspid valve leaflets or cusps and is characterized by thickening of the tissue

100.0-102.2 °F

What is a normal temperature for adult dogs and cats?

140-220 bpm

What is a normal heart rate for adult cats?

60-160 bpm

What is a normal heart rate for adult dogs?

16-32 breaths/minute

What is a normal respiratory rate for adult dogs?

20-42 breaths/minute

What is a normal respiratory rate for adult cats?

130-160 mmHg

What is a normal systolic blood pressure in adult dogs?

120-160 mmHg

What is a normal systolic blood pressure in adult cats?

Above 95%

What is normal oxygen saturation for adult cats and dogs?

15-25 mmHg

What is normal intraocular pressure for adult cats and dogs?

Inadequate blood volume or low hemoglobin concentration (anemia)

What may pale pink or white mucous membranes indicate?