VETN 127B- Nursing Dogs and Cats I

Nursing Definition

scientific application of principles of care related to prevention of illness and care during illness.

1st freedom of animal welfare

1.freedom from hunger/thirst: food, H2O when appropiate

2nd freedom of animal welfare

2.freedom from Discomfort: clean, comfortable, stress free

3rd freedom of animal welfare

3. freedom from pain, injury, disease: relief of suffering. rapid diagnosis and treatment.

4th freedom of animal welfare

4.freedom to express normal behavior: proper exercise, grooming. proper social interaction

5th freedom of animal welfare

5.freedom from fear and distress: humane treatment

problems defintion

require diagnosis and therapy. that interfere with the patients

Problem Solving

data collection- all information. database. subjective and objective goes with history.

interpretation

problem identification. Putting all information together. Triage problems: to sort problems worst to least:bleeding vs. ear infection. Future problem risk. determine client abilities: can clients be able to deal with these problems. 

Plan implementation

always DVM direction. Many interventions.

evaluate response

individual patient: making sure each treatment is working for EACH patient. New plan development: if plan isn’t working come up with a new one, always approved by dvm first.

observation

best way to collect data. interpret “inspect” everything. 

baseline

have initial physical of patient . upon initial presentation. sometimes lab tests.

serial monitoring

 clinical situation dependent. reliable schedule. must monitor depending on situation. Bad situation-monitor patient all day. 

technical skills-equipment usage

stethoscope, thermometer, pleximeter. biological sampling, diagnostic imaging, and therapeutic administration: can’t do without DVM approval.

Ascult

listen indirectly or directly

Defining the problem

well-being interference-patient not doing well. requires diagnosis. requires treatment.

Problem identification

recognize abnormal. Means you must know the normal! 

clinical judgement

critical thinking. analysis-interpret and analyze the data

Verify Problem

document- must document everything. If it’s not documented then it didn’t happen. especially measurements. Consult with DVM to make sure you documented correctly. 

The plan requires?

requires consultation. vet nurse evaluation and dvm. getting all information like history and physical. Only DVM can prescribe a plan.

formulation -data obtained

signalment, history, physical, and diagnostic testing.

implementation

DVM prescribes. Medical vs. Surgical. Us nurses carry out dvm orders and treatment plans. Only dvm’s can do surgeries.

Communication- Rounds

good communication with other staff is very important. Doing rounds is when 1st shift tells 2nd shift everything that is going on before they switch and 1st’s leave.

patient uniqueness

individual response. what you do can cause rapid or slow changes. It’s different for everyone.

plan modifications

Must know why you need to modify. Means you need additional data(information) which may require more diagnostics. May need to then maintain or modify therapy. can be drugs and treatment.

POMR

problem oriented medical record. 

Medical Records

record everything. all data obtained. subjective/objective. And all interventions: procedures, biological sampling, diagnostics. They are LEGAL documents. always sign. If you didn’t write it down it didn’t happen.

Format, SOAP

Subjective: why they are here, whats changed. Objective:physical exam. Assessment. Plan: only DVM can create.

Observations

daily physicals! degree variable: boarding vs. ICU patients. Minimal components: mental status-subjective(opinion) Weight, Vitals, Output

Mentation

subjective. BAR. alert status, response status

Weight factors

hydration. water weight they will loose quickly. 1lb=480 milliliters 2.2lbs=1 kilogram. example: lost 1kg in 1 day then lost about 1 liter of fluids. skin turgor: resilience of skim “firm” or “soft” 

Nutrition intake-weight

can affect weight but will take a lot longer than water.

Temperature locations

Rectal-most common. Otic-ear:correction factor. Axillary-armpit:correction factor

different types of themometers

glass/mercury. electronic. Infrared-with red light. 

Hypothermia

low temp.

causes of hypothermia

Shock:heart isn’t perfusing enough. Anesthesia/post-op. Environment. Disease: hypothyroid, chronic renal failure(CRF), CNS

Treatment for hypothermia

slow warming. creating a tunnel of heat. Hot pad under and above patient. stop @ -37.7(100F) so they don’t get too hot.

Hyperthermia

High temp

Causes for Hyperthermia

reset thermoregulation. Fever(pyrexia). tumors. environment-stress. seizures-muscles constantly contracting. excitement. 

treatment for hyperthermia

cool H2O, get them wet. then put a fan on them. when water evaporates it takes a lot of heat with it. avoid ice baths and alcohol.

heart rate/pulse

rate and rhythm. coordinate with heart. The heart rate or pulse is the number of heartbeats per minute, reflecting the rhythm and coordination of the heart's contractions.

synis rhythm

constant steady beat. same cadence

Arrhythmia

not a constant rhythm. can beat too fast or too slow.

perfusion indictor/quality

pulse pressure. systolic-diastolic: far apart strong pulse. quality: hypokineitc- strong. Nomokinectic-normal Hyperkinectic-weak

sinus arrhythmia

inhales heart will speed up and exhales heart rate will slow down. 

Respiration rate

eupnea-normal breathing. Dyspnea-abnormal inspiration or expiration. crackles-fluids. wheezes-narrowed airways. Stertor-snoring/snort. Stridor-inspiratory wheeze, struggling inhaling.

Urine output indicator

hydration, renal status(kidneys) endocrine function-normal or abnormal. 

amount urine should be produced

1-2mls/kg/hr. 10kg dog should produce 10-20mls every hour.

Specific gravity urine

urine density. compare to distilled water. solute-chemicals: whats desolved in water. Sediment: let sit, what settles to the bottom. urine should be more dense. use refractometer to measure density.

gastrointestinal output

feces. 

elimination character -feces

Dyschezia-painful defication. Tenesumus- straining to have a bowel movement. Hard to tell if it’s from urinating or popping.

Vomiting

Emesis. active gastric process. just cause it comes out of mouth doesn’t mean its vomit.

Regurgitation

back flow. may not have reached the stomach. could be just from the asophagus. 

Cleanliness Complications

Scalding ( from urine or feces). Skin ulcerations. infection. Myiasis-fly maggots on skill, will only eat dead tissue smells horrible.

comfort indication

don’t technically know. we can’t speak to them so we anthropomorphize with them. The more comfortable they are the faster they recover. It’s an indication of care. 

Bathing

removes debris. regular baths unless prescribed by dvm. which can be dermatology or parasitology prescribed.

precautions when bathing

eyes- sterile ointment, just like us soap will burn there eyes. Ears- cotton plug just don’t forget to remove it after. Throughly rinse- do it once and then again to make sure you get it all. Drying- start with towel then can use fan just be careful of hyperthermia.

Trimming/shaving

always ask the owners permission. explain the reason-could be for catheter or just grooming. 

trimming/shaving Equipment

always disinfect so you don’t spread diseases. To prevent trauma adjust blades properly, clipper burn is from pulling the skin into the blade not the clippers getting to hot.

Indications for trimming/shaving

surgery. skin trauma. diease-ringworm. hair matting. cleaning

nail trimming indications

excessive length. traumatic avulsion. Pad invasion-digging into paw pads. altered gate(walk). inflicting wounds like scratching others. damaging property. 

trimmer types

scissor/pliers-size variable based on nail. Guillotine-sharp, proper grip like pistol hold. Human nail clippers for small animals. Grinders- caution creates heat.

nail trimming length

digital pad must be able to touch the ground. palmar/planar surface. Sometimes you must cut the quick if it’s grown too long past the pad and it will bleed. Avoiding quick: easy with clear nails, with dark nails start distally and very small pieces at a time. the material will change.

Corium

quick on nails

Cutting Corium

create hemorrhage. use silver nitrate which will burn or styptic powder. “quick stop”

Anal Sacs

location 4-8 o’clock. ductal opening near mucocutaneous junction. anal sphincter muscles are internal and external.

Purpose of anal sacs

marking territory. why dogs smell each others butts. they secret onto fecal too. 

Complications of anal sacs

failure to empty -inspissated, may be to dry like toothpaste. Or gets infected and creates a abscess and sometimes ruptures which is ideal.

Expressing anal sacs

external-cover opening with digital pressure at 4-8. push dorsomedial, toward the center. internal- gloves. lube rectal insertion, cover duct opening, finger/thumb pressure dorsomedial. ONLY can fully empty internally . 

anal sac abscess

hot compress to increase temp of local tissue to increase blood flow , loosens up liquid. Drainage. +/- antibiotics- most don’t need. Internal medication- ductal cath. flush it with mild antiseptic or saline or medication.

Ear problems

otitis externa( external ear infection) many causes. Otitis media(in the ear) Hematoma- cartilage fractured and bleeds.

predisposing factors of ears

pendulous pinna(low hanging ears) Cerumen(ear wax) especially in cocker spaniels. Hair(holds moisture) Moisture(sporting dogs)

Ears cleaning (cautions and why)

caution can be painful. Don’t go to deep can cause damage to tympanic membrane. biological samples- cytology or bacteriology. Hair removal- digital or with forceps. Debris with cotton swabs, flushing. only go has far has you can see. 

ear flushing

solutions -saline, ceruminolytic(breaks up cerumin) astringent, antiseptic. “slosh and shake” message cotton balls. Deep cleaning only under anesthesia with only dvm. painful may even move there head even in a anesthesia plane. otoscope used.

Feeding maintains and complications

maintain positive energy. Caloric intake> metabolic need. Complications-hospitalization (stress) may not eat! or disease: increases requirements and loss of ability like sometimes if jaw is broken they can’t eat. diet changes

feeding requirements 

resting energy requirement: <2kg (weight kg) 0.75=kcal/day

>2kg (30 x weight kg) + 70=kcal/day. Metabolizable energy requirement: cage rest RER x 1:1 surgery,trauma,cancer,sepsis RER x 1:2-1:5. severe burn, head trauma, ventilator RER x 1.7-2.0 

Routes of feeding 

enteral -oral (voluntary, coaxed, forced) Tubes: orogastric(mouth) Nasogastric(nose) Pharyngostomy( hold in pharygx) Esophagostomy (hole is esophagos) Gastrostomy (through side of body) Enterostomy( by pass stomach wall into intestines). 

Parenteral (PN) (TNP)

intravenous(jugluar) must have all ingredients -buy made bags. Requires for at least 3 days. constant 24hr monitoring. sterile mixture. Complications- infection and sepsis(infection in blood stream)