Physical Diagnosis (Small Animal 2nd Year)- SOAP and Injections

Subjective, Objective, Assessment, Plan

what does SOAP stand for?

discharge are more formal and problem-oriented medical record

what is the diff. between a SOAP and medical record/discharge?

medical record

are SOAPs or medical records/discharges emailed to the owner directly to serve as client education?

subjective

what section of a SOAP does this info belong?:

-signalment, complaint, history, mentation

subjective

what section of a SOAP does this info belong?:

-feelings, thoughts, "unmeasurable"

info that you CANNOT put a number or rigid descriptor on

what type of information is in the subjective?

info that you CAN put a number or rigid descriptor on

what type of info is in the objective?

objective

what section of a SOAP do most of your physical findings go?

objective

what section of a SOAP does TPR, BCS, pain score, and hydration status go?

data

S/O part of a SOAP is the ______ collection

S and O

what sections of a SOAP are often combined?

the subjective and objective data

what is the assessment portion of a SOAP an analysis of?

assessment

problems and differential diagnosis for each problem go in which section?

D- degenerative, developmental

A- allergic, anomalous, auto-immune

M- metabolic, mechanical, mental

N- neoplasia, nutritional

I- inflammation, infectious, immune-mediated, iatrogenic, ischemic, idiopathic

T- trauma, toxin

what does DAMNIT stand for?

Plan

diagnostics and treatments for each problem or differential go into which part of a SOAP?

client communication

what is equally important to diagnostics and treatments in the Plan portion in a SOAP?

-oral

-sublingual

-feeding tube

-rectal

-topical

-ophthalmic

-intranasal

-intratracheal

what are the diff. routes of administration (not with syringe)?

-intradermal

-SQ

-IM

-IV

-intraosseus

-intraperitoneal

-intracardiac

what are the diff. routes of administration (w/syringe or through skin)?

given via GI tract

what does enteral mean?

not given via GI tract

what does parental mean?

-1/3 of a slice rolled and empty

-1/3 of a slice rolled and with meds

-1/3 of a slice rolled and empty

what is the 1, 2, 3 rule?

-"get over the hump" (the tongue)

-"lick their nose"

what are the two things to remember with administering oral meds in dogs?

right hand

when pilling a dog, which hand should you put the pill in?

close their mouth and blow on their nose to encourage swallowing

what is a trick you can do to ensure that the dog will swallow a pill/liquid meds after pilling them/giving oral meds?

teeth and cheek

liquid medications can be administered in a pouch located between the ______ and ______

pilling device

_________ can be used to place a pill or capsule over the base of the tongue, to avoid you having to place your finger's in a cat's mouth

at least 4 ml of water, tuna juice or some food or coat with butter

for cats, to avoid pills sticking in the esophagus, follow with what?

from the side of the mouth, behind the canine teeth

with liquid oral meds in cats, it is best to insert the syringe from where, rather than the front?

1/2 ml

how many mls can adult cats swallow at a time?

-local blocks

-allergy testing

what are intradermal injections used for?

25-27 gauge needle

what gauge needle should you use for intradermal inj.?

1. tense skin

2. insert

3. inject

steps to doing an intradermal inj.?

bleb

you should feel resistance when doing an intradermal injection and should get a "_____"

1. good restraint/distraction

2. bevel UP

3. smaller the number, bigger the lumen (gauges)

4. match gauge to patient and drug

5. aseptic technique

what are the 5 things to know about injections?

SQ

what is the most common route of inj.?

larger volume, less painful, less restraint

why is SQ the most common route of inj.?

18-25 gauge

what gauge needle should you use for SQ inj.?

base of skin tent

For a SQ inj., insert the needle at ________ and aspirate

blood, negative

for a SQ inj. only inject if there is no ______ and ______ pressure

IM- 90

SQ- 45

IV- 25

intradermal- 15

what are the angles of injections for IM, SQ, IV, and intradermal?

right pelvic limb SQ

where to inject rabies vax for dogs?

right thoracic limb SQ

where to inject DAPP vax for dogs?

left thoracic OR pelvic limb SQ

where to inject lepto vax for dogs?

left thoracic OR pelvic limb SQ

where to inject lyme/influenza vax for dogs?

right pelvic limb SQ

where to inject rabies vax for cats?

right thoracic limb SQ

where to inject FVRCP vax for cats?

left pelvic limb SQ

where to inject FELV vax for cats?

distal to elbow and stifle due to concern of fibrosarcoma

for cats, what is the concerns with vax. injections?

-sedation

-pain meds

-melarsomine

IM injections are commonly used for what?

20-22 gauge

what gauge is typically used for IM inj.?

smaller, painful

IM injections are used for _______ volumes and more _______

-hamstring

-epaxial

-quadriceps

-triceps

what are the four most common sites for IM injections?

1. perpendicular to muscle

2. aspirate

3. inject

steps to given IM injection?

-Easy to locate

-Can handle larger volumes

-Less chance of complications

what are the 3 advantages of epaxial IM inj.?

-more painful

-slower onset

what are the 2 disadvantages of epaxial IM inj.?

1. find last rib and follow up to spine

2. count back 3-5 dorsal spinous processes

3. come 1-3 cm off midline and palpate muscle

4. insert needle perpendicular to the skin

5. aspirate, then inject

steps to doing an epaxial IM injection?

-safest for personnel

-less painful

-faster onset

what are the 3 advantages of an IM hamstring inj.?

watch out for sciatic nerve!

major disadvantage of an IM hamstring inj.?

caudally

for an IM injection in the hamstring, angle the needle ________

-most rapid onset

-allows for prolonged admin.

what are the 2 advantages for an IV inj.?

takes most skill

disadvantage of IV inj.?

cephalic, lateral saphenous, jugular

three common sites for IV inj.?

occlude, 23-25 degree angle, insert, aspirate, release, inject, withdraw, pressure

steps to do IV injection?