Discharge Instructions and Client Education

Discharge Instructions

§Explain patient care to the owner

§Vet Tech often writes these

úYou’ve been doing post-op care and recovery

úYou have had more hands-on with the patient

§How painful are they?

§What’s the easiest way to pill them?

§Will they urinate while sling walking?

§Are they bothering their incision?

Discharge Instructions

§Tell them prior to surgery what to expect

úHave a cage ready

úTypical recovery period

§Tell them again when they schedule a pickup

§Tell them again at the pick up

§AND send written discharges home

All communications should be logged in record and a

copy of discharges must be in record as well

Discharge Instructions

§Common procedures may have a template

úCheck boxes

úAdd differences or specifics for the patient

úNeeds to include any medications or things sent

home

§More complex or special procedures need

more detail and take more time to write

úBe prepared, start the outline early

úBe precise

Beconcise

Discharge Instructions

§Have everything waiting to go when the owner arrives: Meds, ecollar etc, Bill, Discharges

§Make sure animal is ok and clean

§Take owner into a quiet room or area

úRemember patient confidentiality

úLeave the pet in their cage

 Will distract owner

 Will likely get too excited

 Owner needs to pay first

§Talk to the owner

úDon’t talk at them, or down to them

úDon’t read the paper to them

úDon’t mess up the animal’s name or their gender

Medications

§Name

§Strength

§How many

§Directions

úHow much

úHow often

úWhich route

úAny specific drug directions

 Empty stomach, not w/ cheese, wash hands, keep refrigerated etc.

§Why they are taking it

Potentialsideeffects

Medications

Carprofen 25mg #10: please give ½ tablet by mouth once daily for pain.  This will help with pain and inflammation from the surgery.  Potential side effects may include stomach upset, diarrhea, liver or kidney damage.

Clavamox 62.5mg/ml #15ml bottle: please give 1ml by mouth twice daily until finished.  This medication needs to be kept refrigerated and shaken before administering.  This is an antibiotics to help treat Fluffy’s skin infection.  Potential side effects include stomach upset, nausea, or diarrhea.

If you notice any of the above side effects please call us immediately and stop giving the medication.

Postanesthesia/sedation

§Should cover at least first 24 hours

§May need to confine, support walking or carry

§Isolate from other pets

úAvoid aggression

úRough housing before they are ready

§Walk on a leash

§Tell them when they can feed them again

úSpecial diet, amount or frequency

Postanesthesia/sedation

§May be sleepy all day

§May get sick on the way home from motion

§May not be hungry that night

§May not defecate for 2-3 days

úIleus from drugs

úNot eating for a bit

§Encourage the owner to call if they are concerned or animal isn’t normal by the next day

Postsurgical Instructions

§Incision

§Confinement

§Drains

§Bandage, Splint, Cast

§Feeding tube

Rechecks

Incision Care

Look at incision at least twice daily

Cold pack 2 days

Warm pack

Assure not licking or rubbing incision

Talk about what is healthy and what to look for

At the time of discharge the incision…

Has minimal bruising

Appears healthy

Has serosanguinous discharge

Swelling, increased discharge, foul odor, bruising, opening up, sutures/staples removed early (count)

Incision Care

If discharge

When should it stop

What does it look like now

When to call

If absorbable sutures

When can they bath

Do they need a recheck on the incision

Normally take 10-14 days

Older patients take longer

Cushings or diabetics take longer

Confinement

Be VERY specific

How confined

For how long

Days

Weeks

Months

Until their next recheck

Why we are confining them

Confinement

Cage rest – bed rest

Enough room to stand up, turn around and lay down

Outside briefly on a leash

Returned to cage confinement

Don’t leave water in cage if bandage is in place

House confinement

Can calmly walk around house when observed

No stairs, no rough housing

Outside on a leash for brief walks

Returned to cage when not directly supervised

Drains

I don’t send them home

Complications include infection, contaminating house, dislodging prematurely

Provide all cleaning supplies, gloves, detailed

instructions, extra bandage materials

Bandages, casts, splints

Must be confined indoors

Must protect when on

leash walks

Examine at least twice daily for

Wetness

Pee on outside

Strike through from inside

Dirty

Walking outside

Stepped in food

Licking it

Slippage

Too loose

Moving too much

Not doing it’s job

Can act like a fulcrum and

make it worse

Swollen extremity

Toes

Odor

Pain

Animal chewing at it

New lameness or worsening of lameness

Bandage, casts, splints

Dirty, wet, slips or any concern it needs to be changed NOW. Waiting 24 hours can make a small problem a HUGE one

When do you want them to come back if everything goes well

1 day

2 days

1 week

When in doubt, they should call

Feeding Tube

How long it will be in place

How to clean it

How to feed through it

If the animal will have any food or medications by mouth as well as tube

Complications to look for

Feeding Tube

Clean skin/tube area 1-2 times daily

Fresh bandage daily at skin

May use dilute antiseptic around tube for

cleaning

May opt for clean damp cloth for gentle

cleaning

Tube should be bandaged to avoid dragging it or stepping on it or chewing it

Feeding Tube

Make sure tube is in place

Hasn’t been chewed off

Hasn’t migrated in or out

Mark with sharpie, or measure total length

Feeding with a tube

Flush with water before and after each feeding

If clogged

Put fizzing Coke in for 5-10 minutes

The try to flush water again

Repeat if needed

Then call if still clogged

Feed exact amount vet calculated

If increasing amount, make a calendar or list with

dates

Typically offer food ad lib and once animal eats enough the tube feedings stop

Medicating with a tube

Flush before and after with water

Liquid medications easy

Can crush most pills too

Avoid chunks

Crush immediately before giving thru tube

Too Much

Either fluid, food or both

Large, swollen belly

Pain when rub abdomen

Won’t lie down

Rolls on back

Needs to be a gradual increase in feedings

Split up meals (often 6-8 meals a day at first)

Increase to full calories over 3 days

Eventually less frequent meals

Appetite Stimulants

Low dose valium

Used IV usually in hospital

Cyproheptadine

Antihistamine

Steroids

Mirtazipine

Antidepressant

Only a temporary solution

Dental Extraction

Soft food for days to a week

Canned food

Wet their normal dry diet before feeding

No chew toys, rawhides etc

Can’t chew on their own feet either

May see faint blood in water bowl initially

Should decrease in amount and freq

Long-term bleeding is a problem

Rubbing or pawing at face indicates pain

Not wanting to eat indicates pain

Dog for a couple days ok

Fat cat for more than 2 days is NOT GOOD

Foul odor indicates infection

Mouth heals fast – 7 days

Gastrointestinal Surgery

Earlier the better

May go home on small meals or bland diet

Need to be confined and incision care 10-14 days

Watch for peritonitis

Depression, lethargy, nausea, vomiting

Swollen painful abdomen, increased bruising, fever

2-3 days postop

7-10 days postop if antibiotics are used

Perianal Surgery

Tumors, anal sacs, wounds

Meds for pain and inflammation

May give antibiotics if sutures are back there

May have high fiber diet to soften stools

Laxatives (lactulose)

Fish oils

Don’t want diarrhea

Watch for straining, vocalizing when defecating or

posturing a lot without pooping

Pain

Stricture

If defecates without control (no sphincter pinch) = (

Cystotomy

Allow frequent potty trips

Avoid bladder distention

Bladder is inflamed so animal feels urge often

Confinement to protect abdominal incision

Normal incision care

May get special diet, meds, antibiotics

Monitor for straining to urinate or trouble getting a

good stream

Blood in urine is normal up to 36 hours

Should decrease in amount over time

Easier to see if pee on white paper towel

If cannot urinate its an EMERGENCY

More than 24 hours is a really big deal

Onychectomy

No clay, clumping litter (dust, dirt = infection)

Shredded paper towels, Yesterday’s News etc

Crate confined (not an entire bathroom)

Check toes for swelling, discharge, worsening or appearance of lameness

Bleeding should be reported asap

Cat needs to be indoors for rest of life

Orthopedic Surgery

Confinement

What type, how long, why

Leash walked, sling walked

How often, how long

Bandage or incision care instructions

Exfix instructions for cleaning and bandage

Pain medications

Calorie restrictions during cage confinement

Potential complications

Implant failure, infection, not healing, lameness etc.

Fractures will take longer to heal or may not

heal at all if patients are over active

Can heal despite infection if on antibiotics

Must have blood supply and stability to heal

Aural Hematoma/TECA

§Bandage care

úLabel ears in case owner or emergency vet has to remove

§Changing bandage

§Ecollar

§Medications

§Rechecks

§Eye drops for TECA if needed

C Section

Keep separate until everyone is awake

Avoid crushing

Watch for aggression towards babies

Discharge from hospital asap

Best place to get sick

Weigh newborns once daily

If not gaining give extra private time to nurse

Still not gaining supplement

Incision care – very important

Vaginal discharge is normal

Red – brown

Few days

No foul odor

Normal loose stools

Feed high calorie food, she should be pretty hungry

Watch for red, swollen or painful nipples

Pain Medications

Multimodal approach best

Preemptive analgesic best

Start NSAID before surgery

Not if GI upset

Not if bleeding disorder

Not if dehydrate

Don’t switch NSAIDs without a ‘wash out’ period

NEVER with steroids

Fentanyl patches have high abuse potential

May dislodge and not work

Once off, cannot be replaced

If punctured they’re useless

Butorphanol is weak sedative and only pain control for less than 45 minutes

Tramadol is synthetic opiod

Not currently controlled

Cheap

Easy

Works well

So how painful are they?

Scratch

Skin incision

Muscle manipulation or Spay

Dental extraction

Joint surgery

Fracture

1 being low potential for pain, 6 being a big deal

What the owner hears

Three things

Discharges should have the details

Repeat, repeat, repeat the three biggest

things

Always make it clear when they need to come back

Come back early if problems

Potential complications

How to get a hold of someone, especially at night or weekends