Chapter 21

1. Chapter 21 Small Animal Medical Nursing

2. Learning Objectives Describe general care of small animal patients, including bathing, grooming, ear cleaning, and nail trimming procedures Explain the special considerations in the care of recumbent, geriatric, and pediatric patients Describe the procedures for obtaining body temperature, blood pressure, pulse rate and character, and respiratory rate

3. Learning Objectives Differentiate between sensible and insensible fluid losses and explain methods used to determine patient hydration status and calculate fluid requirements for rehydration of patients List routes of administration of fluid therapy treatments and describe monitoring procedures used for fluid therapy patients

4. Learning Objectives Describe the indications for and procedures used in blood transfusion and oxygen therapies List the canine and feline blood groups and describe procedures for blood typing and cross-matching List and describe the five methods of physical therapy used in small animal practice

5. Learning Objectives Describe the indications for and procedures used in respiratory and topical therapies in small animal practice List and describe common diseases of dogs and cats and provide an overview of small animal vaccines and vaccination protocols Define zoonosis and identify common zoonotic conditions and methods of control of zoonotic diseases

6. Learning Objectives List common diseases of the eyes and describe methods of diagnosis and treatment List and describe common cardiac and endocrine disorders of dogs and cats and describe methods of diagnosis and treatment List and describe common urogenital and gastrointestinal disorders of dogs and cats and describe methods of diagnosis and treatment

7. Learning Objectives List and describe common orthopedic disorders encountered in small animal practice

8. General Care Veterinary technicians have professional and moral obligation to every patient to provide the following basic necessities: Clean, comfortable environment free from stress Fresh food and clean water at all times unless restricted Adequate exercise and grooming care Prompt and humane relief of suffering/pain Humane treatment of every patient

9. Grooming Important for several reasons Being clean and well-groomed enhances sense of well-being Clean animal less likely to develop severe dermatitis Grooming and medicated baths used to prevent or treat many dermatologic problems and control of ectoparasites Cleanliness of patient at discharge indicates overall quality of health care provided

10. Grooming Grooming and bathing equipment and supplies Care taken to prevent spread of infections, from one animal to another via grooming instruments Clipping or removing hair for medical reasons Important to obtain owner’s permission Particularly important in show animals Certain breeds are extremely slow regrowing hair

11. Bathing Basic technique for bathing Thoroughly wet coat with warm water Work a small amount of shampoo into a lather between hands Starting at head and working back to tail, work shampoo into coat Thorough rinse to prevent irritation of skin from residual shampoo Axillary and scrotal regions particularly vulnerable to residual irritation

12. Bathing Cage dryer Insecticide shampoos used only with approval of veterinarian Possibility of cumulative toxicity or drug interactions Insecticidal dips correctly diluted to avoid toxic reactions If immersion bath contraindicated, localized soiling may be handled with sponge bath

13. Exercise Moderate exercise is beneficial Contraindications include respiratory, cardiovascular, and musculoskeletal problems Moderate exercise consists of walking

14. Feeding Plays pivotal role in ensuring patient remains in positive energy balance Stock variety of foods, moist, semimoist, and dry, in variety of flavors Complete or partial anorexia—appropriate action to correct situation is important Contraindication—vomiting or suppressed appetite from ulcer or pancreatitis

15. Feeding Encourage patient to eat Substituting more palatable food or texture such as canned food Home-feeding regimen aids in selection of palatable diets Owner prepare food at home and bring it to hospital Personal attention at feeding time—talking and hand-feeding may work Cats particularly prone to anorexia—have lost taste for food

16. Feeding Force feeding Mix canned food with water to slurry consistency Administer with syringe Care taken to avoid giving too much at one time Allow for swallowing after each bolus to prevent choking and/or aspirating food into lungs High-calorie density supplements Help meet caloric needs Will not meet animal’s daily requirement by themselves

17. Feeding Gastric gavage Done in patients requiring force feedings Less stressful Enteral feeding used with increasing frequency and include placement of: Nasoesophageal tubes Esophagostomy tubes Gastrostomy tubes Jejunostomy tubes

18. Feeding Specially tailored diets are administered through enteral tubes Using complete diets ensures nutritional requirements are met

19. Feeding Total or partial parenteral nutrition (TPN/PPN) Consists of administering a sterile liquid containing a complete or partial nutritionally balanced diet Given IV through jugular catheter Aseptic technique is needed for every feeding Very labor intensive Introduces risk of sepsis to patient Chosen for most critically ill patients

20. Nail Trimming Excessive nail length results in: Altered gait—potential accentuation of lameness Likely to split or traumatically avulsed Become ingrown into footpads

21. Nail Trimming Common nail trimmers Resco Whites Cutting surface of nail trimmer is held parallel to palmar or plantar surface of footpads Nail is cut in this plane

22. Nail Trimming Cat nails are exposed by grasping paw between thumb and index finger Gently squeeze to extrude nail Once exposed, nails can be trimmed as described for dog Cats usually have clear nails Black nails often found on dogs are easy to cut too short

23. Nail Trimming Nails have a blood vessel and nerve running down the center of nail Called the “quick” The longer the nail, the further the quick extends out into claw The point where the quick takes on fleshy, shining appearance is the indicator to trim no further

24. Nail Trimming If nail is cut too short, it will bleed profusely; to stop bleeding, use: Silver nitrate sticks Styptic powder Flour or baking powder—for owners at home Educate owners on technique of nail trimming Especially with new puppies or kittens

25. Ear Cleaning External ear canal can accumulate: Cerumen, exudate, or cellular debris Sequela to otitis externa Initial and essential step in treatment of any external ear problem is complete and thorough cleaning of ear canal

26. Ear Cleaning Frequently necessary to sedate, tranquilize, or use general anesthetic to clean ears Ears are often painful Or patients strongly resisting ear cleanings Excess hair in ear canals Removed from some, left alone in others Depends on severity of ear infection Hemostat used to grab a small amount at a time

27. Ear Cleaning Otoscope is used to look into ear canal Cannula is gently inserted until visualization of tympanum is achieved Ceruminolytic agent is used when debris is waxy Tympanic membrane must be evaluated before using ceruminolytics and ear cleaners containing chlorhexidine Normal saline is used for initial cleaning until ear canal can be examined to assess tympanum

28. Ear Cleaning Cleaning procedure: Rubber bulb syringe, Luer-tipped catheter or syringe is used to deliver chosen cleaning solution into ear Gently massage ear to loosen wax and debris Cotton balls and cotton applicator sticks are used to gently wipe debris from external ear canal

29. Ear Cleaning Only remove debris visible in vertical canal Do not push debris into horizontal canal Examine with otoscope to evaluate completeness of ear cleaning

30. Ear Cleaning Cleaning with pulsating cleaners Warm water is added into reservoir tank of machine Add 5 ml of povidone or chlorhexidine solution Stream of water is applied to external ear canal in a rotating motion Water and debris is collected in irrigation basin or allowed to run into prep table

31. Ear Cleaning Once ear canal is clean Canal is carefully dried with clean cotton swabs and cotton balls Initial dose of otic medication is instilled into each canal

32. Ear Cleaning Ear swabs for parasite check or culture Done before cleaning to get best sample Use cotton swab to extract some of debris from each ear Mix with drop of mineral oil and roll swab on microscope slide Examine under microscope for Otodectes

33. Ear Cleaning Purulent debris in ear canal Requires a cytological evaluation Bacterial culture—using sterile swabs and culture medium Antibiotic sensitivity testing

34. Anal Sacs Sacs are paired structures, approximately 1 cm in diameter Reservoirs for secretions produced by anal glands Glands line walls and produce foul-smelling fluid Fluid varies from serous to pasty in consistency and color is brown to off-white

35. Anal Sacs Lie between internal and external anal sphincter muscles on either side of anal canal Sacs open into lateral margin of anus by single duct At approximately 4 and 8 o’clock positions of anus

36. Anal Sacs Clinical signs of impacted anal sacs Excessive licking of the perineum Scooting or dragging perineum on floor Abnormal carriage of the tail Vague indications of pain or discomfort in perineal region

37. Anal Sacs External expression technique Gloves and paper towels are required Fingers are placed over glands Gently squeeze and push up to milk fluid out of gland Paper towel is used to catch fluid to prevent soiling patient

38. Anal Sacs Internal expression technique Insert lubricated, gloved forefinger into rectum Immobilize sacs between forefinger and thumb Apply gentle pressure until secretions are forced through ducts If sac cannot be expressed with gentle pressure, reposition finger and thumb and reapply pressure Paper towels placed over anus to collect liquid and prevent soiling patient, environment, and technician

39. Bedding Keep patients clean by appropriate use of bedding Several types of bedding routinely used include Newspaper or other types of paper products Blankets, towels, and lamb’s wool Bedding material selected Disposable and economical Readily and effectively cleaned between uses Material is safe and nontoxic if ingested

40. Bedding Cats are easier to keep clean while hospitalized Litter is changed daily Pans either disposable or can be thoroughly cleaned and disinfected Non-surgical patients—clay or clay-like litter Surgical patients or patients with open wounds—shredded newspaper or litter made from newspaper

41. Recumbent Patient Decubital sores and urine scald Prevention and management important aspects for recumbent patients Urine and fecal scalding cause serious problems that complicate recovery Prevented by light application of protective compound such as Aquaphor or petrolatum Decubital sores source of sepsis, leading to death of patient

42. Decubital Sores Treatment is prevention Develop over bony prominences from continuous pressure and damage to overlying skin Various bedding advocated to reduce frequency and severity Bedding material should be either disposable or impermeable to moisture

43. Decubital Sores Potential problem with impermeable surfaces Urine and moisture remain in contact with skin exacerbating problem Skin must be kept as dry as possible Long-term management Straw provides adequate cushioning and urine drains through straw and away from patient

44. Decubital Sores Other measures to prevent decubital sores Frequent turning Intermittent use of slings Frequent baths keep skin clean Once decubital sores have developed Cleaned thoroughly with surgical scrub and completely dried Surgical debridement of necrotic tissue may be necessary

45. Decubital Sores Padding to prevent further pressure injury Sore itself needs to remain exposed to air to prevent retention of moisture Fashion a “donut” from foam rubber and to fix this to skin Difficult to maintain pads in proper location for long periods of time Topical antimicrobial agents used judiciously Many contain bases that form an occlusive dressing retaining moisture

46. Geriatric Nursing Present number of problems directly influencing nursing process Generally related to or resulting from degenerative diseases such as arthritis, and geriatric changes such as deafness and blindness Likely to react aggressively Gentle handling when lifting or moving Walk at slower pace to avoid pain Central nervous system disorders (e.g., brain tumor or cerebral infarction) may display as aggressive behavior

47. Geriatric Nursing Deafness frequently accompanies old age Easy to surprise or startle a deaf, older dog; may instinctively respond by biting Blindness can occur Cataracts, retinal degeneration, glaucoma, and other diseases Elderly dogs and cats Respond less to external stimuli Many are resistant to changes in daily routine Become stressed with hospitalization alone, resulting in rapid deterioration

48. Pediatric Nursing Hand-rearing orphaned puppies or kittens First step determine caloric requirements First week, 27 cal/kg/day Second week, 32-36 cal/kg/day Third week, 36-41 cal/kg/day Fourth week, 41-45 cal/kg/day Divide total daily requirement into 4 equal feedings Frequent feedings necessary to prevent Overdistention of stomach Emesis and aspiration pneumonia

49. Orphans Artificial milk replacers are available for puppies and kittens Calculate stomach capacity of puppies and kittens following this formula: Body weight in grams x 5% = capacity in milliliters

50. Orphans Gavage feeding via an orogastric tube Faster and easier than bottle feeding especially with multiple orphans Uses soft rubber feeding tube—8-16 Fr Hold tube up to orphan from tip of nose to eighth rib Mark tube with pen or tape at mouth Lubricate and advance tube down esophagus to mark on tube Use a syringe to inject warm (at least body temperature) milk replacer slowly