Principles of veterinary nursing

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What is the RVNs role in assessment and observation?

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What is the RVNs role in assessment and observation?

Practical skills and knowledge.

The ability to recognise normality and abnormality.

Get to know your patients.

Record and report all observations to the veterinary surgeon.

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What are the key points to consider?

Patients have likes and dislikes, fears and phobias.

They will often react differently to how they normally are at home.

The hospital environment may have an impact on their behaviour.

Familiarise yourself with the patient as an individual.

Consider stress reduction techniques.

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What are the different stress reduction techniques?

Pheromones (pet remedy).

Covering the kennels with blankets and allowing places to hide.

Radios in the kennel and cattery to play music (classical).

Make sure that they can’t see each other (can help or can make it worse).

Keep different species separate (predator vs prey species).

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What is the importance of handling and restraint?

Adequate restraint necessary during all examinations not only to protect the patient but also the handler and/or examiner.

Handler must be calm, confident and provide reassurance to the patient.

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What is the clinical examination?

When do we carry out a full examination?

  • During the initial admission of the patient.

  • Intermittently throughout the hospitalisation.

Prior to the examination, assess demeanour, temperament, body language and overall condition.

Remember to talk in a reassuring manner and fuss/stroke the patient where appropriate (if safe to do so).

Methodical approach starting with the head and progressing to the tail.

  • This will ensure nothing is missed during the examination.

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What is TPR?

Temperature, Pulse, Respiration.

TPR should be monitored routinely in all hospitalised patients.

  • Catch any early signs of ill health or disease.

  • Information of how they are doing (are they getting better or worse, how are they responding to treatment).

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How can we measure temperature?

Many types of thermometer available to measure body temperature.

  • Digital thermometer

  • Mercury thermometer

Most commonly used route is the rectum.

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What are the characteristics of a digital thermometer?

Are much quicker in obtaining the patient temperature.

They are also safer as they do not contain mercury.

It is much harder to ‘accidentally’ lose a digital thermometer in the rectum of the patient as the length of the thermometer widens at the hand piece section.

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What are the characteristics of a mercury thermometer?

Mercury is hazardous if the glass is dropped and smashed.

Need to be shaken down prior to use to ensure the mercury is within the bulb.

Shape is completely linear.

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Why is the rectum the most commonly used route for checking temperature?

Easy to access (most of the time).

Measures core body temperature = more accurate.

Often tolerated well by most patients.

Relatively easy for the operator to perform.

Using a rectal thermometer will provide you with a relatively accurate body temperature when compared to other methods such as aural and subdermal temperature monitoring.

When using a rectal thermometer, the thermometer should always be held by the operator and never left to sit in the rectum as it may be lost and become a foreign body.

The tip of the thermometer sat within the rectum should be gently pressed against the rectal wall in order to obtain an accurate body temperature.

If this is not performed, the thermometer may measure the temperature of faeces present in the rectum, which often reads at a slightly lower temperature compared to the patients core body temperature.

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What are the additional routes used to measure temperature?

Aural (ear):

  • Are useful in patients under general anaesthesia especially if the rectal route is inaccessible (for example; during rectal surgery or where the patient is under a surgical drape).

  • They are also useful for patients who dislike having their rectal temperature taken.

Subdermal (under the skin - microchip):

  • Often built into the patients microchip

As the aural and sub-dermal routes are quite superficial, they are not as accurate as rectal and oesophageal temperature monitoring.

Oesophageal temperature probe:

  • Under general anaesthesia only

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What is hyperthermia?

An increase in body temperature due to a failure of the bodies cooling mechanisms.

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What is pyrexia?

An elevated body temperature due to fever in response to an infection or inflammatory process = this is a protective mechanism.

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What is hypothermia?

A decrease in body temperature.

Neonates:

  • Have a high ration of surface area to body weight.

  • Less subcutaneous fat and they move around much less than adult animals which may leave them at risk of hypothermia.

Severe disease or shock.

Sedation and anaesthesia:

  • Especially if their skin is allowed to touch a cold surgical table during their procedure.

  • They are also unable to shiver due to depression of the CNS (an effect of anaesthetic drugs).

  • The inhalation of cold anaesthetic gases and oxygen may also leave the patient at risk.

Overexposure to a cold environment:

  • Most fit and healthy patients should be able to cope with being in a cold environment or winter weather. However, young, geriatric and ill patients may be unable to cope leaving them at risk of hypothermia.

Additional causes include:

  • Unconsciousness and coma impending parturition.

  • Inaccuracies in temperature recording (human error)

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What is diaphasic?

Fluctuating temperature.

A symptom of Canine distemper virus (CDV).

A fluctuating temperature can be difficult to manage and keep the patient comfortable.

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Where are the major pulses located?

Pulse waves are located where an artery runs close to peripheral tissue.

The major pulses are:

  • Carpal pulse

  • Lingual pulse

  • Coccygeal pulse

  • Femoral pulse

    • Dorsal metatarsal pulse

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What are the different characteristics of a pulse?

Pulse quality = strength and speed.

In the normal healthy patient, their pulse should increase in inspiration and decrease on expiration.

This is known as ‘sinus arrhythmia'.

Weak pulse = hypovolaemia or cardiac disease.

Hyperdynamic pulse (strong and jerky) = compensatory mechanisms for hypovolaemia or cardiac abnormalities.

Pulse deficit = pulse rate that does not correspond to the heart rate.

  • If this is detected, electrocardiography (ECG) should be performed.

  • To assess for pulse deficit, a stethoscope shoul be used to listen to the heart rate at the same time as palpating the pulse.

  • The heart should beat at the same time as the pulse and if this does not occur = pulse deficit.

Tachycardia.

Bradycardia

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What are the common causes of tachycardia?

Stress.

Pain

Pyrexia

Exercise

Excitement

Disease process

Hypovolaemia

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What are the common causes of bradycardia?

Unconsciousness

Sleep

Drug induced

Extremely fit

Cardiac arrhythmias

Hypothermia

Hibernation

Anaesthesia

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What is respiration?

Natural movement of the thorax = expansion on inspiration and contraction on expiration.

One breath consists of one inhalation and one exhalation so count either when the chest moves in or when the chest moves out (not both).

Respiratory rate, effort and noise should be observed and recorded.

Tachypnoea.

Bradypnoea.

Dyspnoea.

Cheyne-Stokes respiration.

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When is the best time to assess respiration rate?

In a calm state prior to handling the patient (for an accurate value).

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What are the common causes of tachypnoea?

Excitement.

Pain.

Exercise.

Pyrexia or hypothermia.

Stress.

Fear.

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What are the common causes of bradypnoea?

Sleep/hibernation.

Relaxed patients.

Brain and neck trauma.

Hypothermia.

Anaesthesia.

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What are the common causes of dyspnoea?

Obstruction of the airway.

Respiratory tract disease.

Lung pathology.

Trauma of the thorax.

Increases pressure on the diaphragm (from abdominal organs).

The benefits of a clinical examination and treatment of a patient in respiratory distress must be weighed against the deleterious effects of performing this.

Less is often more when dealing with dyspnoetic patients.

Excessive handling, restraint and stress can cause further respiratory compromise potentially leading to death of the patient.

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What are the common clinical signs of dyspnoea?

Cyanotic mucous membranes.

Abducted elbows.

Paradoxical abdominal movements.

Hypersalivation.

Open mouth breathing.

Extended neck.

Dilated pupils

Collapse.

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What are the common characteristics of mucous membranes?

The colour and hydration of the mucous membranes are a very good indicator of general health.

Can also be an indicatory of an emergency.

Normal = salmon pink colour and moist.

Moist mucous membranes indicate good hydration (in addition to other clinical findings).

If the mucous membranes are ‘tacky’ this may indicate dehydration.

Pale (pale pink to white) = poor perfusion

Cyanotic (blue-tinged/purple) = insufficient ocygen transport/volume resulting in hypoxia.

Icterus/jaundice (yellow) = increased concentration of bilirubin.

Petechia (small pinpoint red/purple haemorrhages) = clotting disorders.

Congested (brick red).

Cherry red = carbon monoxide poisoning.

Chocolate brown = acetaminophen poisoning.

If unable to assess the mucous membranes within the oral cavity, other areas can be assessed:

  • Prepuce

  • Conjunctiva

  • Sclera of the eye

  • Sometimes the skin

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What are the common causes of pale mucous membranes?

Haemorrhage

Shock

Anaemia

Severe vasoconstriction

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What are the common causes of cyanotic mucous membranes?

Respiratory obstruction.

Dyspnoea.

Patient with cynaotic mucous membranes should be assessed immediately and treated as an emergency.

The Chow Chow dog breed has naturally blue mucous membranes (oral) and tongue which can be misleading.

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What are the common causes of icterus/jaundice mucous membranes?

Liver disease

Bile flow obstruction

Erythrocyte destruction

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What are the common causes of petechia mucous membranes?

Von Willebrand’s disease

Poisoning (anticoagulant rodenticides).

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What is CRT?

Capilllary Refill Time.

CRT is a good indicator of circulation.

Apply pressure on the gum with a clean thumb or finger then release.

Normal colour return in
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What is hypovolaemia?

A state of low extracellular fluid volume, generally secondary to combined sodium and water loss.

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What is hypotension?

Low blood pressure.

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Why is appetite an important factor?

Nutrition is one of the most commonly overlooked factors.

Appetite and bodyweight can change rapidly during hospitalisation.

Calculate nutritional requirements and monitor and record body weight daily.

Reduced appetite = inappetance.

Complete loss of appetite and not eating = anorexia.

These are often the first signs observed if an animal is unwell.

Pica.

Coprophagia.

Polyphagia.

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What are the common causes of a change in appetite?

Oral ulceration.

Oral pain.

Dysphagia.

Nasal congestion/loss of smell.

Nausea.

Anxiety or fear.

Pyrexia.

Infectious disease.

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What is pica?

Craving of unnatural foodstuffs (dietary imbalance or behavioural).

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What is coprophagia?

Eating faeces.

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What is polyphagia?

Increased appetite.

Common in unstable diabetes mellitus, hyperthyroidism and patients receiving corticosteroid therapy.

Some animals are just greedy.

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Why is elimination an important factor?

Normal urine production = 1-2 l/kg/hour (this will decrease slightly overnight).

Oliguria - reduced urine output (<0.5ml/kg/hour may require investigation and/or IVFT).

  • May occur as a result of dehydration, hypovolaemia and acute renal failure.

Anuria - inability to pass urine.

  • May be caused by urinary tract trauma, acute renal failure, ruptured urinary bladder or urinary obstruction (stones or calculi).

  • Anuria can lead to further metabolic abnormalities, especially hyperkalaemia.

  • Potassium is excreted via the urinary system and if this is not possible (in cases of anuria) hyperkalaemia will occur leading to further life-threatening cardiac problems.

In normal healthy patients, urine should be passed freely without dysuria.

Polyura - increased urine production.

Polydipsia - increased thirst.

Normal water intake = 50ml/kg/24 hours.

When both of these signs are presented together it is often referred to as PUPD.

Haematuria.

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What is hyperkalaemia?

High concentration of potassium in the blood.

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Why is water intake levels important?

Water intake volumes will vary across species and the diet that they are fed.

Animals who are fed a wet diet often gain some of their daily water requirement from their food whereas animals fed a dry food are often seen drinking from a bowl of water much more frequently (due to the dry food containing very little water).

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What is PUPD?

Polyuria / Polydipsia.

PUPD may be caused by nephritis (inflammation of the kidney), diabetes mellitus, diabetes insipidus, pyometra (bacterial infection of the uterus), hyperadrenocoricism (Cushing’s disease) and many more reasons.

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What is haematuria?

Blood in urine.

Causes include cystitis, neoplasia, trauma and infection.

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What factors should be observed and recorded when monitoring urination?

Signs of pain or straining when passing urine.

Odour.

Colour.

Consistency.

Turbidity (cloudiness).

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What is retching?

Passive backflow movement of food and/or liquid from the oesophagus.

Retching often occurs without any warning from the patient.

Active retching and abdominal contractions are often observed with vomiting.

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What is vomiting?

Active forceful evacuation of stomach contents.

Stercoraceous - vomit containing faeces.

Haematemesis - vomit containing blood.

Bilious - vomit containing bile.

Cyclic - reccuring acts of vomiting.

Regardless of what the vomit contains and how it occurs, the volume and frequency, appearance, odour and patient behaviour (pre and post) should be recorded.

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What is constipation?

Difficulty in emptying the bowels (may lead to tenesmus).

Causes include:

  • Ingestion of foreign bodies

  • Tumours of the rectum or colon

  • Environmental factors (soiled litter trays, lack of facilities, confinement)

  • Enlargement of the prostate gland

  • Lack of excersie

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What is diarrhoea?

Increase in liquidity of faeces, often passed more frequently.

Causes include:

  • Irritation of the intestinal mucosa

  • Dietary

  • Inflammation

  • Bacterial

  • Viral

  • Endoparasites

  • Tumours of the intestine

  • Intussuception (the invagination of one part of the intestine into another)

    • Ingestion of placenta post parturition in bitches

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When monitoring faecal elimination what factors should be observed and recorded?

Volume

Colour

Consistency

Odour

Presence of blood or parasitic worms

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What are the different type of discharges?

Nasal

Aural

Ocular

Vaginal

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Why is the monitoration of coughing important?

The cough reflex is initiated by sensitivity of the respiratory mucosa in an attempt to clear the respiratory passages.

Various causes include:

  • Infectious (kennel cough, canine distemper virus)

  • Congestive heart failure

  • Endoparasites (lungworm)

  • Inflammation

  • Respiratory tract trauma

  • Laryngeal paralysis

  • Inhalation of irritants

Patients presented with coughing should be assessed to ensure that it is not of an infectious origin.

These patients would require isolation and barrier nursing.

Care should be taken when having to restrain a coughing patient as restraint may further aggravate the problem.

Patients receiving IVFT must also be monitored closely to prevent fluid overload.

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What is the importance of anatomical planes and directions?

Use of a day to day basis.

Identify wounds.

Clip sites.

Anatomical landmarks.

Injection sites.

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What is the cranium?

Skull - anatomical landmarks to utilise when nursing. Good for body scoring cachexia - muscle wastage around the skull. Makes these landmarks more obvious/palpable.

Mandibular symphysis - joint non-mobile. Important in dentals specifically cat dentals. If vet struggling to remove tooth risk of fracturing the joint. Have to wire the jaw.

Mandibular Ramus - body condition score poor the face will look quite draw in here.

Angle of jaw - forms the jaw we can see on the outside.

Occipital crest - very prominent in poor body condition score.

Orbit - where the eye sits.

Zygomatic arch - very fragile forms eye socket, cheek bone, common for fracture post RTA.

Foramen - entry into the bones foramina. Allow something to pass through. In this case nerves. Also have a foramen at the back of the skull in occipital bone (foramen magnum) allows the spinal cord enter.

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What is the forellimb - shoulder.

Shoulder joint.

These landmarks can be palpated as they are bony prominences.

The points where bone attaches to bone.

Scapula joins the humerus.

Can be difficult to feel on a patient due to heavy muscle coverage.

Can feel assess where to clip for surgery etc.

Joints can be difficult to feel.

More obvious in patients with poor body condition.

Acromion - distal aspect of the spine of scapula.

Supraspinatus and Infraspinatus either side of the spine of scapula - attach to greater tubercule.

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What is the forelimb - elbow?

Elbow joint.

Olecranon is the point of the elbow.

Important area to consider in relation to arthritis.

Humerus joins radius and ulna.

Arthritis - articular surfaces break down - bone on bone contact.

Blood sampling lifting elbow to take blood/place IV for patient.

Could be painful especially in older patients.

Olecranon is the point of the elbow. Where hand would go to present forelimb.

Humerus sits onto radius and ulna. Humeral condyles - ridges sit onto the radius and ulna - can be painful when arthritis occurs.

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What is the pelvis?

Acetabulum - socket of the hip joint.

Sacral vertebrae sit in the dorsal aspect of the pelvis.

Caudal view and lateral view.

Sacral vertebrae sit between the wings of the ileum - gap - sacral vertebrae are fused like a jigsaw piece sit in there.

Ischium seat bone in dogs - point below the tail.

Again in a dog with BCS these areas will be very prominent.

Pubis forms central part of the pelvis. Central joint - pubic synthesis - does not allow for much movement.

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What is the hindlimb - stifle and hock?

Tibial tuberosity is the point of insertion for the Quadriceps Femoris muscle.

Calcaneus is the point of the hock and insertion point for the Achilles tendon.

Two joints here - knee joint or stifle - femur and tibia and fibula joint.

Hock joint - or tarsus - tib/fib and tarsal bones joint.

Calcaenus is the largest tarsal bone.

Patella - patella jumps out of the trochlear grove in the femur and is very painful.

Adapt a distinctive gate.

Tends to happen in smaller breeds.

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What are the common injection sites?

Subcutaneous.

Intramuscular.

Intravenous.

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What is the subcutaneous injection site?

Administration into the subcutaneous tissue e.g. scruff.

Under the skin.

Often use the scruff as there is a lot of loose skin but can be administered anywhere that there is loose skin.

Tend to tolerate this well as less nerve fibres in the scruff.

Quite a large volume can be injected here.

Use a 45 degree angle.

Administer a microchip like this.

First one to practice quite straight forward.

Clients can give a subcut injection if taught how to tends to be for diabetic patients so they can administer insulin regularly.

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What is the intramuscular injection site?

Administration into the muscle.

Can be painful - depends on the drug administered so need someone to hold the patient.

Quadriceps, lumbar muscles and trapezius - avoid injecting into vertebrae.

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What is the intravenous injection and blood sampling site?

Administration into the vein.

Gives drugs into the vein or take blood from the vein.

Can be painful and requires assistance.

Common IV injection sites:

  • Cephalic vein

  • Lateral saphenous vein

  • Jugular vein (central line required)

  • Marginal ear vein

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What is the cephalic vein?

Most common for placement of IV.

Can take bloods.

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What is the lateral saphenous vein?

Superficial vein.

Hindlimb.

Can be used to place IV catheters and take bloods.

Can occlude more easily due to location.

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What is the jugular vein?

Either side of the neck.

Mainly used for taking bloods.

Central line - longer catheter that goes along the jugular vein into the vena cava.

Get a smooth sample.

When administering injections and obtaining blood samples, the correct patient restraint and skin preparation must be carried out.

PPE must also be worn.

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What is the marginal ear vein?

Margin of the ear.

Mainly used in rabbits.

Can use in dogs e.g. basset hound, daschund.

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What are the important points for injection technique?

Wash hands before and after (WHO method).

Wear PPE.

Correct patient restraint and preparation.

Always draw back on plunger when administering medication.

Never recap your needle.

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Where is the femoral pulse located?

Proximal medial surface of the femur.

Tends to be the easiest to feel as it has a large artery.

Don’t use thumb to feel for pulses - will feel you own pulse in your thumb.

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Where is the carpal pulse located?

Caudal surface of the carpus.

Feeling caudal surface of the dogs leg.

Usually by the digital pad of the dog.

Fur can impair feeling.

Carpal pulse is less strong than femoral pulse - further from the heart the weaker the pulse.

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Where is the coccygeal pulse located?

Proximal ventral surface of the tail.

Don’t generally use this pulse in a conscious animal as they can be defensive.

Use under anaesthesia.

Can use for blood pressure monitoring.

Gloves should be worn.

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Where is the lingual pulse located?

Ventral surface of the tongue.

Only use under GA can often see this pulsing when patient is anaesthetised.

Gloves should be worn.

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Where is the dorsal metatarsal pulse located?

Dorsal surface of the metatarsals.

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What are lymph nodes?

Lots of different lymph nodes in all different sizes.

Some inside the body unable to palpate, those closer to the body can sometimes be palpated.

Superficial ones looked at to palpate on clinical exam.

Lymph nodes are part of the lymphatic system - bean shaped.

  • Filter lymph to identify foreign items (virus, bacteria) in body to initiate immune response.

  • Lymphocytes essential for this.

When an infection occurs, lymph nodes become palpable.

Paired.

The submandibular, prescapular and popliteal lymph nodes can often be palpated as they are superfiical.

The other lymph nodes may be palpated in underweight animals or when the nodes are enlarged (in cases of infection and/or inflammation).

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What are the common lymph nodes?

Submandibular.

Axillary.

Inguinal.

Prescapular.

Popliteal.

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Where is the submandibular lymph node located?

At the angle of the mandible.

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Where is the axillary lymph node located?

In the axilla (armpit).

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Where is the inguinal lymph nodes located?

Ventral abdomen (in the inguinal/groin region).

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Where are the prescapular lymph nodes located?

Cranial to the scapular.

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Where are the popliteal lymph nodes located?

Caudal, proximal hind limb.

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What is the definition of nursing?

A profession concerned with the provision of services essential to the maintenance and restoration of health by attending the needs of sick persons/animals.

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What does the RCVS outline a veterinary nurse as?

Veterinary nursing is the supportive care of animals receiving treatment within a veterinary practice.

A veterinary nurse works as a member of the veterinary team, providing expert nursing care for sick animals.

Veterinary nurses also play a significant role in educating owners on maintaining the health of their pets.

They carry out technical work and are skilled in undertaking a range of diagnostic tests, medical treatments and minor surgical procedures, under veterinary direction.

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What does the BVNA outline veterinary nurses as?

Veterinary nurses (VNs) work alongside veterinary surgeons in order to provide a high standard of care for animals.

Veterinary nurses normally work within a veterinary surgery or veterinary hospital and are involved in a wide range of care and treatment.

VNs provide skilled supportive care for sick animals as well as undertaking minor surgery, monitoring during anaesthesia, medical treatments and diagnostic tests under veterinary supervision.

VNs also play an important role in the education of owners on good standards of animal care.

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What is the metaparadiagram of nursing?

Consists of four concepts:

  • Person - this refers to the sick individual not as a patient but as subject a person in the full sense of the word.

    • his person is unique and autonomous, and should be treated as such.

  • Health - referred to not just in a clinical sense but as negotiated and contextual.

  • Environment -

    • Gives the full context of health care positive or negative.

    • All things which may impact on a patients recovery.

    • Social, cultural, religious beliefs and general attitudes.

  • Nursing -

    • Nursing can be translated into caring.

    • Refers to hands on medical treatment from a nurse to a patient.

    • A paradiagram of compassion, the reason why nurses become nurses: to help and ease suffering.

    • An ethical and emotional paradiagram which is at the core of the nursing as a profession.

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What is the nursing process?

  1. Assessment

  2. Planning

  3. Implementation

  4. Evaluation

Nursing diagnosis will happen between the assessment and planning stages.

The RVN will decide on the most appropriate interventions for the patient based on the actual and potential problems identified during assessment.

RVNs following the nursing process take a systemic and organised approach to the delivery of care.

The end result = the delivery of holistic nursing care.

The nursing process is significant in addressing the individual needs of our patients rather than making assumptions on the care required on the basis of diagnosis.

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What is hollistic nursing?

Nursing the ‘whole patient’ rather than just their disease or injury.

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What is caring for patients?

Caring for a patient involves any action or intervention that will improve the health and welfare for that individual.

In a broad sense there are two models which define how care can be given to a patient.

These are known as:

  • The medical model.

  • The nursing model.

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What is the medical model?

Views the patient as a set of complex anatomical parts and physiological systems that are functioning incorrectly.

A disease orientated view of a patient, most commonly used with VS.

If RVNs use the medical model this simply encourages them to carry out tasks solely on the instruction of the VS.

RVNs therefore tend to use the nursing process and nursing models to enable us to provide holistic care.

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What are the stages of the nursing process?

Stage one = assessment.

Stage two = planning.

Stage three = implementation.

Stage four = evaluation.

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What is involved in stage one of the nursing process?

The assessment stage will evidently establish the needs of the patient.

The following actions must be carried out:

  • Collection and recording of patient information.

    • This may occur during the admit appointment or during a shift change over

      • Objective - clinical examination

      • Subjective - feelings from the owner

      • Current and previous nursing records

      • RSPCA officers, police officers, external personnel

  • Reviewing of the collected information.

  • Identifying actual and potential nursing problems (including priorities).

Wrong information = wrong action and nursing care.

Assessment methods include client questionnaires at admission, RVN observation of the patient (physical and visual), discussions with the VS and other staff members and reviewing personal knowledge on previous cases.

Questions should be mostly open (rather than closed) to gather as much information as possible from the owner. If simple closed questions are asked, very little information will be obtained as it will be mostly yes or no or one word answers. Some closed questions however are necessary.

Useful to have some form of checklist or crib sheet to guide the information collection process.

Many nursing models have this framework built in.

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What is involved in stage two of the nursing process?

The aims of planning are to:

  • Solve actual problems and prevent recurrence.

  • Prevent potential problems from becoming actual problems.

  • Help the terminal patient to be as comfortable as possible in addition to supporting the client.

Plans should be written clearly to enable all staff to understand and to prevent a breakdown in communication.

Setting goals:

  • A goal must be set for each problem that has been identified during the assessment stage.

  • Problems must be prioritised and short or long term goals set.

All staff members must adhere to the plans to ensure uniform care and prevent a break in continuity.

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What is involved in stage three of the nursing process?

The RVN will now begin to do their traditional role in undertaking nursing care following the plan that has been created.

During planning and implementation, you must justify the intervention and make it clear that decision-making has taken place rather than simply carrying out a task ‘just because that is how it has always been done’.

Nursing care must be recorded either on the patients care plan, hospital sheet or computer record.

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What is involved in stage four of the nursing process?

A final important ‘reflective’ stage but often overlooked.

The outcomes and nursing care must be appraised to assess whether goals have been reached.

Goals reached = nursing care is appropriate and we can continue or stop if required.

Slow progress or patient has deteriorated = the entire plan should be altered accordingly to meet the needs of the patient.

This why nursing plans are often referred to as ‘living documents’ as they are constantly changed and updated in line with the patients requirements, improvement or deterioration.

Ongoing evaluation = formative evaluation - this is carried out when the patient required continued nursing care in hospital.

Summative evaluation takes place after a nurse is no longer involved in the care of that animal usually after they have been discharged.

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92

What is the guidance from the RCVS Code of Professional Conduction for Veterinary Nurses regarding nursing and the nursing process?

1.6 Veterinary nurses must communicate with veterinary surgeons and each other to ensure the health and welfare of the animal or group of animals.

2.5 Veterinary nurses must keep clear, accurate and detailed clinical nursing and client records.

4.1 Veterinary nurses must work together and with others in the veterinary team and business, to co-ordinate the care of animals and the delivery of services.

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93

What are nursing care plan models?

Integrate the nursing process into a nursing model/framework to fill in the gaps.

  • ‘Nursing models provide the nurse with key pointers regarding patients assessment, care planning, the type of interventions that are appropriate and finally, evaluation’.

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94

What should you consider before administering any medication?

Pharmacological properties of the medicine.

  • What the drug is, how it works, how quickly it takes effect, effectiveness, how long it lasts for.

  • Both VN and VS need to be aware as dispensing drugs.

  • Idea of how the patient should respond to the medication.

Rate of absorption.

  • Fast absorption results in the drug taking effect faster.

The individual patient as a species and their size.

  • The type of medication may be different depending on the patient e.g. tablets or oral liquids.

Convenience for the administrator - temperament of the patient.

  • Owner may not be able to tablet own patient so a liquid oral med may be better.

  • For aggressive patients injection may be safer than a tablet.

Licensing.

  • VNs need to be aware.

The role of the nurse is to administer medicines to the patient on the order of the VS.

The nurse must follow the sic rights to ensure they will efficiently, effectively and safely medicate a patient.

Wash hands.

Wear PPE.

Always wear gloves, some drugs may require other PPE.

Remember cross contamination and how we need to prevent this.

Protecting ourselves and out patients.

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95

What are the six rights a VN must follow when administering medication?

Right patient.

  • Patient details correct on any hospitalisation records kept on the front of the animals kennel or on their computer records.

  • Colour coded paper collars with the patients name.

  • Microchip details (check they match patient records).

  • Kennel number associated to certain patient.

Right medicine.

  • Double check that the medication you are picking up or drawing up is the correct medication, is labelled correctly and is recorded on the hospitalisation records.

  • Any concerns about the medication, discuss this with the VS before administering any medication.

Right dose.

  • Any drug calculations should be double checked by another clinical member of the team.

  • Helpful for members of staff that are new to drug calculations, however, anyone can make a mistake so all calculations should be checked over. If you ever doubt that the calculation is incorrect repeat it and see if you get the same answer and get a VS or RVN to check.

  • If there are any discrepancies discuss this with the prescribing VS before administering any medication.

Right route.

  • As VNs you should have a good understanding of the different routes of administration of medications and which drugs can be administered via which routes.

  • This is also understanding that some medications can cause harm if given via the wrong route.

Right time and frequency.

  • Drugs need to be given at the correct time and frequency.

  • This can be an issue when meds need to be given at a certain time. If this drug is missed the pain relief will wear off and the patient could become painful. The effect of other drugs will also be less beneficial if not used at the correct time, so it is important to try to give medications at the correct time.

Right documentation.

  • RCVS Code of Professional Conduct for Veterinary Nurses, 2.5 - Veterinary nurses must keep clear, accurate and detailed clinical nursing and client records.

  • Every medication that is given to a patient should be clearly documented on the clinical records including the drug name, dose and time given with initials of the nurse that administered the drug.

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96

What are the different routes of medication administration?

Parenteral administration.

Enteral administration.

Topical administration.

Inhalational administration.

Rectal administration.

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97

What is the parenteral route of medicine administration?

Any route other than the oral route. Generally injectable routes.

  • Subcutaneous

  • Intramuscular

  • Intravenous

These are the most common routes on injection, however there are a number of other routes.

  • Intraperitoneal - administration into the peritoneum

  • Intradermal - administration into the dermis (of the skin)

  • Intra-articular - administration into the joint cavity.

  • Intra-arterial - administration into the artery

  • Intrapleural - administration into the pleural space

  • Intratracheal - administration into the trachea

  • Intrathecal - administration into the subarachnoid space

  • Intraosseous - administration into the bone

  • Intracardiac - administration into the heart

    • Epidural - administration into the vertebral canal (outside the dura mater)

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98

What is the subcutaneous route of medicine administration?

Administer into areas of loose skin - usually into scruff.

45 degree angle.

Bevel facing upwards.

Injection below the skin.

Advantages:

  • Can be administered in areas of loose skin

  • Larger volumes can be administered

  • Generally pain free (medicine dependent)

Disadvantages:

  • Absorption is generally slow.

  • Possible damage to small blood vessels.

  • Some medicines may cause pain when administered.

  • Owner cannot administer unless they are correctly trained

    • Local reactions may occur (inflammation and/or irritation).

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99

What is the intramuscular route of medicine administration?

Administer into the muscle - paralumbar, quadriceps.

90 degree angle.

Avoid sciatic nerve if using quadriceps.

Can use trapezius, hamstring group, triceps - rare.

Advantages:

  • Absorption quite quick - 20 to 30 minutes

  • More convenient in less cooperative patients

  • Medicines in a suspension can be administered

Disadvantages:

  • Often painful especially when using certain medicines.

  • Small volumes only.

  • Local reactions may occur.

    • Accidental intravenous administration may occur.

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100

What is the intravenous route of medicine administration?

Administer into a vein - main veins used are the cephalic, lateral saphenous, marginal ear vein and the jugular.

25 degree angle.

Bevel facing upwards.

Advantages:

  • 100% bioavailability - the amount of drug that enters the circulation unchanged.

  • Rapid onset of action.

  • Irritant medicines can be administered, for example cancer chemotherapy.

  • Less painful than intramuscular administration.

  • Some medicines can be administered IVFT.

Disadvantages:

  • Strict aseptic technique

  • Maintenance intravenous catheters required (if in place)

  • Skilled technique

  • Slow administration required to prevent cardiac and neurological problems

  • Potential complications if extravascular administration occurs

  • Medicine must be in a solution

    • May be painful and stressful

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