C&N Small animal medical nursing

what are the 5 freedoms

1. Freedom from hunger and thirst
2. Freedom from discomfort
3. Freedom from pain, injury, and disease
4. Freedom to express normal behavior
5. Freedom from fear and distress

Subjective & objective data, BCS & Pain scores are gray areas, Includes medical history, medical record, PE, lab reports, etc, "Rounds"

Assessment (S & O of SOAP)

Technician Evaluations, Clinical judgement regarding the needs of the patient, Based on the technician's independent critical thinking, Evaluations listed in order of importance & assigned numbers, Should include owner's knowledge & ability to provide care, Often deal with deficiencies in the 5 freedoms

Planning (A of SOAP)

Interventions or actions to achieve desired outcomes, Based on technician evaluations

Implementation (P of SOAP)

Continuously revised patient care plan, Most crucial step of the vet tech practice model, Assess the patient, determine if goals were met, make adjustments, Additional or new data

Evaluation (back to S & O of SOAP)

Pathogenic organisms invade & colonize within tissues/fluids, Includes bacteria, viruses, fungi, & rickettsia, Transmissible or Non tranmissible, Direct or indirect transmission, Indirect requires fomite or vector

Infectious Diseases

Infectious diseases that are transmissible from animals to humans, Reverse zoonoses, Humans to animals

Zoonoses

Etiology

cause of disease

Pathogenesis

how a disease develops

lesions

changes in the body

Clinical signs

outward appearance or symptom that is not normal

Inflammation, infection, obstruction, or restriction of the airway

Respiratory Diseases

-Serous, mucoid, mucopurulent, or hemorrhagic
-Unilateral or bilateral
-Duration & progression

Nasal Discharge

Foreign body- dogs

Sneezing

Contagious- cats

Sneezing

-Teeth, foreign bodies, neoplasia
-FUNGAL infection

Facial Swelling

loud snoring/snorting

Stertor

high pitched wheeze on inspiration

Stridor

-Forceful expulsion of air from the lungs
-Productive or Nonproductive
-Hemoptysis is coughing up blood
-Can be heart related

Cough

Hemoptysis

coughing up blood

-Excessive fluid within the thoracic cavity
-Compression of the lungs & inadequate lung expansion

Pleural Effusion

Dyspnea

Increased respiratory rate or effort

Orthopnea

ability to breathe only in an upright position

-Dogs: neck extended & elbows abducted
-Cats: sternal

dyspnea

slow, deep breaths with increased inspiratory effort

upper airway

shallow, rapid breaths with increased expiratory effort

lower airway

Hypoxia/Hypoxemia

Deficient oxygenation of tissues
-Measured with pulse oximetry
-tachypnea, tachycardia, cyanosis, dyspnea

Decreased in partial pressure of oxygen in arterial blood
-Measured by arterial blood gases

Hypoxia/Hypoxemia

Abnormality of the myocardium, valves, pericardium, or rhythm

Heart Disease

______ disease is most common in cats

myocardial

_______ disease is most common in dogs

valvular

Compensatory mechanisms

asymptomatic patients

Compensatory mechanisms fail Inadequate tissue perfusion (hypoxia)
S/S in Dogs: tachypnea, exercise intolerance, syncope, prolonged CRT, cough
S/S: in Cats: anorexia, depression, weight loss

Heart Failure

Venous congestion in the abdominal & thoracic cavities
-Edema, jugular distension, ascites, pleural & pericardial effusions

Right Sided CHF

Venous congestion in the pulmonary vasculature
-Pulmonary edema, pleural effusion, dyspnea, tachypnea, coughing -Abnormal respiratory sounds

Left Sided CHF

Most common form of cardiomyopathy in cats
-Increased thickness of the left ventricular wall
-Most common complication: feline arterial thromboembolism
-Hind limb paresis/paralysis, severe pain, altered femoral pulses

Hypertrophic Cardiomyopathy

Most common form of cardiomyopathy in dogs
-Extreme atrial & ventricular dilatation with decreased contractility

Dilated Cardiomyopathy

Thickening of the valve leaflets
mitral valve is the most commonly affected

Degenerative Atrioventricular Valve Disease

Dirofilaria immitis, Clinical signs based on worm burden & longevity of the adult worm, Dogs: large number of worms that live a long time, Pulmonary arteries, right ventricle, caudal vena cava, Cats: small number of worms that only live 2-3 years Pulmonary arteries, Key to treatment is PREVENTION, Patients are at risk of pulmonary thromboembolism

Heartworm Disease

Greater than 150mm Hg
Primary (idiopathic) or secondary --Secondary hypertension is the most common
-CKD, hyperthyroidism, HAC, DM Most are asymptomatic
-Routine screening of cats > 10 yrs
-Fundic exams
-Blindness is often the presenting complaint

Systemic Hypertension

-PASSIVE expulsion of material from the mouth, pharynx, or esophagus
-NO nausea or abdominal contraction
-Usually undigested food or water

Regurgitation

-ACTIVE expulsion of contents from the stomach & duodenum
-Nausea & retching
-Lip smacking, hypersalivation
-Amount, content, duration, & frequency

Vomiting

-Frequent passage of loose, unformed, watery stool
-Amount, content, duration, & frequency

Diarrhea

-Infrequent & difficult passage of hard stool
-When was last normal bowel movement
-GI, musculoskeletal, environment causes

Constipation

Vomiting fresh or digested blood

Hematemesis

-Presence of blood in feces
-Colon or rectum (anal glands)

Hematochezia

-Presence of digested blood in feces
-Black, tarry color
-Upper GI bleeding

Melena

-Painful straining at urination or defecation
-Lower GI disease

Tenesmus

_____is prematurely activated within the pancreas NOT the duodenum

trypsin

-Fever, vomiting, diarrhea, abdominal pain, anorexia
-IV fluids, analgesics, antiemetics, ultra low fat diet

Acute Pancreatitis- Dogs

-Anorexia, lethargy, weight loss
-Can lead to EPI
-Novel protein or hypoallergenic diet

Chronic Pancreatitis- Cats

-Lack of production & secretion of pancreatic digestive enzymes
-Maldigestion & malabsorption of nutrients
-Pancreatic acinar atrophy in dogs
-Chronic pancreatitis in cats

Exocrine Pancreatic Insufficiency

-Signs & symptoms depend on location, severity, & chronicity of disease
-Lab work & imaging very helpful

Hepatobiliary System

-Severe disease resulting from hyperammonemia
-lactulose, small frequent meals, restricted protein

Hepatic encephalopathy

-Accumulation of lipids in > 80% of hepatocytes
-Derangement of lipid metabolism associated with prolonged anorexia
-Obese cats
-Secondary to stress or concurrent disease

Feline Hepatic Lipidosis

-Inflammation of the liver parenchyma
-Chronic hepatitis is longer than 4-6 months
-Suspected autoimmune disease
-Signs not evident until 75% of liver mass is lost
S/S: vomiting, diarrhea, anorexia, weight loss, PU/PD
Dx: PE, serum chemistry, liver biopsy

Canine Chronic Hepatitis

-Inflammation of the bile ducts
-Acute cholangitis is from ascending infection from the small intestine
S/S Acute Cholangitis: fever, vomiting, icterus, abdominal pain
S/S Chronic Cholangitis: anorexia, weight loss, lethargy, weight loss
Dx: PE, blood work, imaging, liver biopsy
Tx: IV fluids, antibiotics, ursodiol (bile acids), nutrition

Feline Cholangitis/Cholangiohepatitis

Vascular abnormalities that connect the portal & systemic circulation

Portosystemic Shunt

-Congenital
-Connect portal vein to the vena cava
-Surgical ligation of shunt is treatment of choice

Extrahepatic Shunts

-Congenital or acquired
-Small shunts within the hepatic parenchyma
-Medical management

Intrahepatic Shunts

-Irreversible, progressive loss of renal tissue
-Impairment of fluid homeostasis & electrolyte balance

Chronic Kidney Disease

elevated BUN & creatinine

Azotemia

buildup of toxins in the bloodstream

Uremia

reflects hydration status & kidney function

USG

Creatinine level
Dog<1.4 mg/dL
Cat<1.6 mg/dL

Stage I - normal

Creatinine level
1.4-2.8 mg/dL
PU/PD

Stage 2 - 33% function

creatinine level
2.9-5.0 mg/dL
Vomiting, anorexia, dehydration

Stage 3 - 25% function

Creatinine level
>5.0 mg/dL
Muscle wasting, oral ulcerations

Stage 4 - less than 10% function

___is a pathologic stone in the urinary tract

Urolith

-Depends on pH, concentration, & saturation of urine
-Classified on the predominant mineral components
-Struvite, calcium oxalate, urate
-High recurrence rate, prevention is key

Urolithiasis

S/S: stranguria, pollakiuria, hematuria, staying in litter box
-pain, anorexia, vomiting, depression with obstruction
Tx: surgical removal, lithotripsy, medical dissolution
Prevention: specific diets to modify urine pH

Urolithiasis

-E. coli
-Female dogs
-Secondary complication of DM, CKD, & HAC
S/S: hematuria, pollakuria, inappropriate urination
Dx: microscopic exam of urine & positive urine culture
Tx: antibiotics & reculture

Bacterial Cystitis

Collection of signs indicated bladder & urethra inflammation
-Stranguria, dysuria, hematuria, pollakuria, inappropriate urination
-Male cats
-Obstructive or non obstructive (feline idiopathic cystitis)
S/S Obstructive: pain, vomiting, anuria, altered mentation
S/S FIC: inappropriate urination
Tx Obstructive: catheterization, surgery
Tx FIC: self limiting in 3-5 days

Feline Lower Urinary Tract Disease

Benign thyroid adenoma that increases metabolic rate
S/S: weight loss, polyphagia, PU/PD, tachycardia, hypertension
Sequela: hypertrophic cardiomyopathy, systemic hypertension, CKD
Dx: elevated T4 levels

Hyperthyroidism

methimazole
-frequent monitoring of T4 levels, resolution of clinical signs

PalliativeTx

radioactive iodine, thyroidectomy
Radioactive iodine is treatment of choice
-Patients must have healthy renal function
-Single subQ injection

Curative Tx:

Immune mediated destruction & idiopathic atrophy of the gland
-Subsequent decrease in metabolic rate
S/S: weight gain, exercise intolerance, lethargy, altered mentation
PE Findings: hypothermia, bradycardia, truncal alopecia, seborrhea
Dx: low T4 & low free T4
Tx: oral T4 replacement therapy

Hypothyroidism

Insufficient production of insulin by pancreatic beta cells
-dogs

Type I: Insulin dependent

Type II: Non insulin dependent

cats

S/S: PU, PD, polyphagia, cataracts (dogs), plantigrade stance (cats)
Dx: hyperglycemia with concurrent glucosuria
Tx: subQ insulin, high fiber diet (dogs), high protein, low carb diet (cats)

Diabetes Mellitus

-Alternative pathway for carbs results in ketone production
-Ketonuria is the hallmark finding of DKA
-Often depressed, vomiting, anorexic, or comatose
-Treat aggressively with fluids & insulin

Diabetic Ketoacidosis

Elevated levels of cortisol produced by the adrenal cortex
-Functional pituitary tumor or adrenal tumor

Hyperadrenocorticism

S/S: polyphagia, weight gain, PU/PD, pot belly appearance
-Secondary skin & urinary infections
Dx: ACTH stim test, LDDST, endogenous ACTH levels
Tx: mitotane, trilostane, surgical removal of the adrenal tumor

Hyperadrenocorticism

-Mitotane destroys adrenal cortex tissue
-Trilostane inhibits cortisone synthesis
-Replacement therapy is needed if adrenal gland is removed

Hyperadrenocorticism

-Adrenal gland atrophy or destruction
-Inadequate secretion of aldosterone & cortisol
-Aldosterone is a life essential mineralocorticoid
-Controls electrolyte balance especially sodium & potassium
-Cortisol is a glucocorticoid

Hypoadrenocorticism

S/S: anorexia, vomiting, PU/PD, weakness, bradycardia, weight loss
-Exasperated by periods of stress (boarding, travel, etc.)
Lab Findings: anemia, hyperkalemia, hyponatremia, hypoglycemia, azotemia
Dx: ACTH stim (low cortisol before & after)
Tx: mineralocorticoid supplementation

Hypoadrenocorticism

Most common cause of hemolytic anemia in dogs

Immune Mediated Disease- IMHA

Primary IMHA occurs in ______

dogs

Secondary IMHA occurs in ____secondary to hemoparasites

cats

S/S: lethargy, pale MM, icterus, tachycardia, fever
Dx: positive Coombs test & autoagglutination
Tx: IV fluids, blood transfusions, immunosuppressive therapy, tx underlying disease

Immune Mediated Disease- IMHA

-Thromboembolism is common & can be fatal
-Treat with anticoagulants

Immune Mediated Disease- IMHA

Disorder of neuromuscular transmission
-Generalized muscle weakness that worsens with exercise
-Megaesophagus & regurgitation are common

Immune Mediated Disease-Myasthenia Gravis

Dogs > cats
-Autoantibodies attack acetylcholine receptors
Tx: anticholinesterase inhibitors & immunosuppressive drugs

Immune Mediated Disease-Myasthenia Gravis