Small Animal Nursing II Exam 1 - Diagnostic Sampling & Therapeutic Technique, and Pain Management

• Patient condition and temperament

• Type of medication or fluid

• Urgency in administering the fluid or medication

• Cost

• Ease of administration

• What systemic or local effect is desired

The route of medication administration may depend upon

Aspiration pneumonia

Movement or hyperextension of the neck during oral medication administration may result in

Measure tube from tip of nose to 13th rib

How do you measure an orogastric tube?

Bending the distal end of the tube

What prevents backflow of fluid when removing an orogastric tube?

Transdermal (systemic and local effects)

Application of a medication through the skin

Aural

Application of drug into external ear canal

Medication must make contact with epithelium

What is the key to administering aural medication?

Intrarectal (local and systemic effects)

Medication is absorbed by the mucosa of the large intestine

• Insert tablet at least 5 cm into rectum with a gloved hand

• Short rubber feeding tube or urinary catheter can be inserted 8-10 cm into rectum

What is the procedure for administering intrarectal medication?

Intranasal

Application of medication into nasal cavity

• Feline infectious peritonitis (FIP)

• Feline viral rhinotracheitis-calici-panleukopenia (FVRCP)

• Bordetella bronchiseptica (most common)

Identify vaccines formulated for intranasal administration

Intranasal or intrarectal

Identify alternate routes used to administer Midazolam for treatment of seizures if there is no IV access

Intradermal (ID)

Administration of treatment into dermis

Used for allergy testing or to desensitize skin with local anesthetic

What is intradermal administration typically used for?

Subcutaneous (SC, SQ, Subq)

Identify the most common route for vaccine administration

Severely dehydrated or critically ill patients

SQ administration is NOT recommend in which type of patients?

• Dorsolateral region from neck to hips (avoid dorsal region of neck and back)

• Intrascapular region avoided for feline vaccinations

Where should SQ injections be given?

Right rear

The rabies vaccine is always given in the

Intramuscular (IM)

Administration of medication into muscle

• Lumbosacral musculature lateral to dorsal spinous processes

• Semimembranosus or semitendinosus muscles

• Deep lumbar injections in the third to fifth lumbar region for heartworm treatment

• Neck is never used for intramuscular injection

Where should IM injections be given?

Laterally to avoid sciatic nerve

Where should IM injections given in the thigh be directed?

• Used for immediate response

• When drug may be irritating to tissues

• When drug may not be absorbed by other routes

Identify indications for intravenous (IV) administration

Cephalic and lateral saphenous veins

Identify the most common areas used for IV administration in dogs

Cephalic and medial saphenous veins

Identify the most common areas used for IV administration in cats

Topical ophthalmic administration

Administration to ocular surface

Lay 3- to 5-mm strip of ointment on upper sclera or lower palpebral border

What is the procedure for administering ophthalmic ointment?

Butterfly catheter

Used for short-term IV access such as blood collection and administration of nonirritating medications

Over-the-needle IV catheter (OTN)

The most common type of catheter used, allowing long-term access of peripheral veins

Through-the-needle IV catheter

Catheter used primarily in the jugular vein

Multilumen IV catheter

Percutaneous catheter that allows simultaneous infusions at one site

72 hours

It is recommended not to leave a catheter in place longer than _____

• Thrombophlebitis

• Infection

• Leaking at insertion site by itself or during a flush

• Pain on injection

• Any portion of the catheter is exposed

Identify indications that an IV catheter needs to be removed or replaced

Every 4 hours PRN

How often should an IV catheter be inspected for patency?

Extravasation

Escape of medication from the blood vessel into the surrounding tissue

Trachea

Emergency drugs can be injected directly into the _____ via a tube because absorption is extremely rapid

Intraosseous (IO) administration

Used to deliver fluids, drugs, and blood products in bone marrow cavity

• Patients with sepsis

• Bones that are fractured or infected

• Skin over insertion site is not free of infection

• Bone cortex is punctured multiple times (can cause fracture)

Identify contraindications for intraosseous catheter administration

Tibia, femur, humerus, and occasionally iliac wing or ischium

Identify common sites for IO catheter placement

Intraperitoneal (IP)

Fluids are absorbed more rapidly than SQ, but more slowly than IV or IO

Administration of substances directly into abdominal cavity

SQ, IP, IM, IV, IO

List the routes of fluid administration in order of slowest to fastest

Testing clotting times (PT/PTT)

What is a coagulation profile used for?

It is best to get a clean stick where sample is collected on first attempt to minimize tissue fluid

What is important to keep in mind when drawing blood for a coagulation profile?

• Insert needle into the vessel as distally as possible

• If unsuccessful, reinsert more proximal to previous entry site

Describe the best practice for collecting blood from a peripheral vein

Reduces hemolysis

Why is it considered best practice to detach the needle from a syringe and remove the tube stopper before transferring blood?

Direct needle along longitudinal axis and insert bevel up

How should the needle be inserted when drawing blood from a cephalic vein?

At the thoracic inlet in the caudal direction

Where should you occlude the jugular vein for a blood draw?

Check for erythroparasites (heartworm) or monitor blood glucose

What is marginal ear venipuncture used for?

• Assess pulmonary function

• Assess patient's ability to ventilate and oxygenate

• Assess partial pressure of CO2 and O2

What is arterial blood sample collection used for?

• Dorsal metatarsal artery

• Femoral artery

• Sublingual artery

Identify the sites used to collect an arterial blood sample

• Excessive negative pressure

• Introduction of air

• Hematoma

• For best results, expel air from syringe, cap, and place in ice water bath

What precautions should be taken when withdrawing the needle from an arterial blood sample site?

• Continuous measurement of direct arterial blood pressure

• Collection of multiple arterial blood samples

Identify the uses of arterial catheter placement

Dorsal metatarsal

Identify the most ideal site for arterial catheter placement

• Less risk of hematoma or hemorrhage than femoral placement

• Catheter can be taped, not sutured

• Easier to maintain catheter position

Why is the dorsal metatarsal the most common site used for arterial catheter placement?

Contains environmental contaminants

Why is voided urine not acceptable for cultures?

False! This would be considered voided urine and would only be acceptable for routine analysis, not urine culture.

True or false: Bladder expression is considered a sterile method of collecting urine

Cystocentesis

Percutaneous aspiration of urine from bladder

• Obtain sterile urine samples for analysis or culture

• Minimizes iatrogenic urinary tract infections caused by catheterization

• Aids in localization of hematuria, pyuria, and bacteriuria

Identify indications for performing a cystocentesis

• Bladder not full enough

• Recent abdominal surgery or trauma

• Suspected bleeding disorders, pyometra, or bladder tumors

• Laceration of the bladder

Identify contraindications for cystocentesis

Lateral recumbency with the upper leg abducted

In what position should a dog be placed for urinary catheterization?

Lateral or dorsal recumbent with hind legs drawn cranially

In what position should a cat be placed for urinary catheterization?

• Retropulsion of urethral calculus into the bladder

• Urinary tract infection

• Trauma to the bladder or urethra

Identify risks associated with urinary catheterization

Thoracocentesis

A procedure in which a needle is inserted into the pleural space between the lungs and the chest wall

• Diagnose or treat pleural filling defects

• Removal of air or fluid

• Presentation of tachypnea and respiratory distress

• Absent breath sounds or muffled heart sounds on auscultation

Identify indications for thoracocentesis

Hypovolemia

Decreased blood volume

• Pneumothorax

• Lung laceration

• Laceration of blood vessel leading to hypovolemia

Identify complications associated with thoracocentesis

Abdominocentesis

A procedure in which a needle is inserted into the abdominal cavity

• Aspiration of fluid from the abdominal cavity

• Aids in diagnosing hemoabdomen, uroabdomen, peritonitis, or ascites

Identify the indications for performing an abdominocentesis

• Penetrating abdominal injury

• Suspected pyometra

Identify the contraindications for performing an abdominocentesis

Right, midabdominal region to avoid puncturing the spleen

Where should you direct your needle when performing an abdominocentesis?

• High incidence of false negatives

• Failure to obtain a sample

• Skin hemorrhage or protrusion of omentum

• Penetration of bowel or spleen

• Introduction of bacteria

Identify complications associated with abdominocentesis

• Monitoring vital signs

• Observing for pain

• Watching for abdominal distention

• Control of bleeding or bruising at site

What does post-abdominocentesis patient care entail?

Diagnostic peritoneal lavage (DPL)

Infusion of fluid into the abdomen, then retrieval of the fluid for analysis

Indications are the same as for abdominocentesis or if abdominocentesis is negative

Identify the indications for performing a diagnostic peritoneal lavage

Transtracheal wash

Collection of fluid from the lower respiratory tract for cytologic and microbiologic analysis

• Aid in the diagnosis of lower airway and lung disease

• Acute bronchopneumonia

• Identification of parasite eggs or larvae

• Identification of infectious agents

• Identification of neoplastic cells

• Patients in severe respiratory distress

Identify the indications for transtracheal wash

• Hemorrhage

• Pneumomediastinum or pneumothorax

• Subcutaneous emphysema around the trachea

• Acute dyspnea

• Iatrogenic infection

Identify complications associated with transtracheal wash

Arthrocentesis

Aspiration of fluid from a joint

Fine-needle aspirate (FNA)

A test performed to acquire sample for tissue cells from a mass

Aiding in deciphering between inflammation and hyperplasia

What is a fine-needle aspirate useful for?

5th vital sign

Pain can be considered the ____, and of equal importance with temperature, pulse, respiration, and blood pressure

• Anticipate and predict pain before it occurs

• Know that signs may not appear until severe pain

• Understand that pain tolerance varies widely

• Some animals hide pain (especially cats)

• Treat patients without requiring proof

• Tailor analgesic protocol to the individual

Identify examples of protocol that is conducive to sound pain management

• Species or breed

• Patient's individual behavior

• Particular surgery or illness

Identify factors to consider when diagnosing pain

• Increased heart rate

• Increased blood pressure

• Increased respiratory rate

• Vocalization

Identify physiologic signs of pain

Dysphoria

An emotional state characterized by anxiety, depression, or unease

Increased cortisol levels and cardiovascular stress

Identify physiologic changes secondary to pain

Nociception

Process of experiencing pain

Transduction, transmission, modulation, and perception

Identify the four steps of nociception

Transduction

The conversion of unpleasant stimuli into nerve signals at the point of injury

Tissue damage

A pain pathway begins at the site of

Nociceptors

Pain receptors are known as

Nociceptors are stimulated and nerves convert energy into electrical impulses once their threshold is exceeded

What happens during the transduction step of nociception?

Transmission

The sending of pain signs via nerve fibers to the spinal cord

A nerve impulse is generated and transmitted along peripheral nerves to the spinal cord

What happens during the transmission step of nociception?

Modulation

The process of amplifying or dampening incoming pain signals after arrival to the spinal cord

Perception

Occurs in the conscious brain and is the awareness that "I hurt"

Under anesthesia

In order to prevent true perception of pain, a patient has to be

Nociception occurs even during unconsciousness white patients under general anesthesia do not perceive they are in pain

Identify the difference between nociception and pain

• Local anesthetics

• Opioids

• NSAIDs

• Corticosteroids

Identify medications that can inhibit peripheral sensitization of nociceptors during transduction

Local anesthetics and alpha-2 agonists

Identify medications that can inhibit impulse conduction during transmission

• Local anesthetics

• Opioids

• Alpha-2 agonists

• Tricyclic antidepressants

• NSAIDs

• Anticonvulsants

Identify medications that can inhibit central sensitization during modulation