Nursing of Dogs and Cats I

What is the definition of nursing?

Scientific application of principles of care related to prevention of illness and care during illness

What are the 5 freedoms of animal welfare a veterinary nurse is obligated to?

1. Freedom from hunger/thirst

2. Freedom from discomfort

3. Freedom from pain, injury, disease

4. Freedom to express normal behavior

5. Freedom from fear and distress

What are the 4 steps of the nursing process?

1. Data collection → subjective + objective

2. Interpretation → triage (problem identification)

3. Plan implementation → DVM direction

4. Evaluate response → does the plan work for the individual patient?

What are the components of data collection (1st part to nursing process)?

1. Observation - may be a dynamic nature, have a baseline to compare to, monitor and check changes/trends

2. Technical skills - use your equipment → biologic sampling, diagnostic imaging, therapeutic adminstration

What are the components of data interpretation (2nd part of nursing process)?

1. Define problem - anything that interferes with well being

2. Problem identification - recognize abnormal → KNOW NORMAL, critical judgement → critical thinking and analysis, prioritize problem → triage

3. Verify problem - document everything including measurements, talk with your DVM

What is the components of plan (3rd part of the nursing process)?

1. Requires consultation - our opinion (vet nurse) and DVM opinion is important

2. Formulation of plan - based on data from signalment, history, PE, diagnostic testing

3. Implementation - DVM prescribes treatment,

What is the components of evaluation (4th part of the nursing process)?

1. Clinical response

   1. Dynamic* → will change quickly, response is different for every patient

   2. Patient has a unique response to each treatment

   3. Modify plan based on response

What are the required info needed for medical records?

1. All data obtained - subjective, objective

2. All interventions - procedures, biologic sampling, diagnostics

3. Legal documentation - signature

What is the format we use for medical records?

POVMR - patient oriented medical record

SOAP:

• S - Subjective

• O - Objective

• A - Assessment

• P - Plan

What are some components of animal interaction?

1. Animal interaction - personal touch/interaction

2. Observations

   1. Daily PE - degree is variable (ICU vs. boarding) → ICU = multiple times a day, boarding = once a day

   2. Minimal components → mental status, weight*, vitals, output (urination/defecation)

What are the components of a daily PE?

1. Mentation - how they act, alert/response status (BAR vs. QAR, lethargic?)

2. Weight*

3. Vitals

4. Output

What factors affect weight?

1. Hydration* - weight can change rapidly based on hydration

   1. Subjective measures to check hydration → MM status, skin turgor

2. Nutrition - intake (voluntary vs. forced)

Which factor affects weight the most?

Hydration

Ex: 1lb = 480ml, 2.2lbs = 1kg therefore 2.2×480ml = 1056ml or 1L

Meaning they can lose up to 1kg if they don’t drink enough water

When taking a temperature, where can you take it?

1. Rectal*

2. Otic - forehead/ear (ise correction factor)

3. Axillary - armpit (use correction factor)

4. Body

What is hypothermia?

Low body temperature

What are some causes for hypothermia?

1. Shock - lack of perfusion to organs/tissues

2. Anesthesia/post-op - drugs shut off temp. regulator

3. Environment

4. Disease:

   1. CRF - chronic renal failure

   2. Hypothyroidism

   3. CNS - central nervous system disease

What is the treatment for hypothermia?

1. Slow warming**

   1. Water blankets

   2. Water bottles - not really reliable

   3. Warm air

   4. Electric pads - use monitored pads

What is hyperthermia?

High body temperature

What are the causes of hyperthermia?

1. Reset thermoregulation → when you warm them up after hypothermia, you warm them up too much and they turn hyperthermia

2. Environment

3. Stress

4. Seizure

5. Excitement

What are the treatments to hyperthermia?

1. Cool water

2. Fans

3. Stop at 40C (104F) when cooling them down, their body will naturally cool down to normal limits → or else they go hypothermic

What do you avoid when treating hyperthermia?

1. Ice both → can lead to vasal constriction (constriction blood vessels)

2. Alcohol → evaporates quickly and doesn’t take a lot of heat with it

What are the components of heart rate/pulse when it comes to vitals?

1. Constant rate and rhythm

2. Coordinate with heart

   1. Pulse deficits → pulse and heartbeat don’t line up

   2. Arrhythmia → not consistent heart rate, sinus arrhythma - breath in = heart rate goes up

3. Perfusion indicator - blood circulation throughout body

What are some perfusion indicators?

1. 1. CRT

2. pink gums

Pulse pressure - systolic-diastolic

Quality:

1. Hypokinetic - weak

2. Normokinetic - normal

3. Hyperkinetic - strong

What are some components of respiration when it comes to vitals?

1. Rate - at rest, when they’re calm

2. Character

3. Auscultation

What are some ways to describe character of a dog’s breathing?

1. Eupnea - normal respiration

2. Dyspnea - abnormal shortness of breath/difficulty breathing

3. Phase - inspiration/exhalation

What are some things you hear when your auscultating the respiratory system?

1. Crackles = fluid

2. Wheezes = narrowed airways

3. Stertor = snoring/snort

4. Stridor = inspiratory wheeze

What are the types of output you see?

1. Urine

2. Fecal matter

3. Vomit

4. Regurgitation

When looking at urine, what are some things to look at?

1. It’s used as an indicator for → hydration, renal status, endocrine function

2. Amount - 1-2ml/kg

3. Specific gravity (USG) - measures urine density compared to water → weight per volume, solute → chemicals, sediment

What are some parts of looking at fecal output?

1. Frequency

2. Character - hard, dry, diarrhea, cow paste?

3. Elimination character - the way they poop

Dyschezia - painful defecation

Tenesmus - straining to defecate/urinate

What is another word for vomit and what is vomit?

Emesis

Vomiting is active gastric process - they use abdominal effort, stomach movement

What is regurgitation?

Backflow of food from esophagus or stomach (may not reach stomach)

• Has no abdominal effort

What is the difference between vomiting and regurgitation?

Vomit is active and uses abdominal effort

Regurgitation is passive and has no abdominal effort, kind of just happens

What are some secondary complications when it comes to cleanliness?

1. Scalding - urine/fecal matter stuck in fur, breaks down fur

2. Ulceration - destroyed epithelial layer

3. Infection - bacteria in an open wound

4. Myiasis - maggots → can create inflammation

What are the different types of trimmers?

1. Scissors/pliers

2. Guillotine (Resco)

3. Nail clipper

4. Grinders

How do you trim nails?

1. Avoid ‘quick’ by making serial cuts

How do you check the quick when cutting dark nails?

1. Look for the ‘pulp’ of the quick

   1. Check for the sole - flaky stuff

   2. Check for corium - just before ‘quick’ (looks like a circle)

When you cut the corium, what do you do?

1. Stop bleeding by using silver nitrate or styptic powder

Where are anal sacs located?

1. They are paired (2) at 4:00 and 8:00

2. Near mucocutaneous junction

What else is located near anal sacs?

1. The anal sphincter muscles - internal and external

What is the purpose of anal sacs?

1. Marking territory

2. Individual recognition

What are some complications when it comes to anal sacs?

1. Failure to empty → inspissated or drys out and cannot get out

2. Abscessation - infected by bacteria

   1. They rupture

How do you externally express anal sacs?

1. Cover opening* - with something like gauze

2. Apply pressure with fingers at 4:00-8:00, move in dorsomedial direction

3. It is incomplete emptying

How do you internally express anal sacs?

1. Use a gloved finger

2. Insert into rectum, make sure to use lube

3. Cover duct openings* - so it doesn’t spray at you

4. Apply pressure with fingers/thumb, squeeze in dorsomedial direction

What are some complications with anal sacs?

They can become abscessed or inflamed

How can you treat abscessed/inflamed anal sacs?

• Hot compress

• Drainage

• Internal medication

  • ductal catheterization

  • Flush with antiseptic/saline

  • Medications

What are some ear problems?

1. Otitis external

2. Otitis media

3. Hematoma

What is otitis externa?

Inflammation of the external ear canal

What is otitis media?

Inflammation of ear canal but it breaches deeper

What is a hematoma (ear-wise)?

Blood pools in the ear after injury

What are some predisposing factors to ear problems?

1. Pendulous pinna - floppy ears

2. Cerumen - excessive ear wax Ex: Cocker Spaniels

3. Hair - Poodles, etc.

4. Moisture - Sporting dogs produce more sweat/moisture

When cleaning ears, what are some things to be careful of?

1. Watch for pain

2. Check if the tympanic membrane is intact or non-intact with a speculum (otoscope)

What does it mean to maintain positive energy when it comes to feeding?

Caloric intake > metabolic need

What is Resting Energy Requirement for <2kgs?

70(weight in kg)^0.75 = kcal/day

What is Resting Energy Requirement for >2kg?

(30 x weight in kg) + 70 = kcal/day

What are some alteration factors in Metabolizable Energy Requirement?

1. Cage Rest - RER (resting energy requirement) x 1.1

2. Surgery, trauma, cancer, sepsis - RER x 1.2 - 1.5

3. Severe burn, head trauma, ventilator: RER x 1.7 - 2.0

What are the type of enteral routes when it comes to feeding?

1. Oral

2. Tubes

What is a type of parenteral route when it comes to feeding?

Intravenous (Jugular)

What are some nutrients you can give parenteral?

• Carbohyrates

• Fats

• Amino acids

• Electrolytes

• Vitamins

What are the requirements for parenteral feeding?

• 3 days minimum

• 24 hr monitoring

• Sterile mixture

What are some complications when it comes to parenteral feeding?

• Infection

• Sepsis