patient care 1

Patient care 1

By Bethany shorter

Evidence based nursing ...

What does evidence based nursing mean?

• Evidence based (nursing/veterinary medicine) is defined as a combination of what we already know, what the best-avaliable evidence is, patient circumstances & owners values in order to make decisions about the care which we give our patients (RCVS knowledge, 2016)

Why do we learn EBN/ EBVM?

• Similar to in human medicine it helps improve nursing efficiency, reduces patient mortality(death), reduces patient morbidity(illness), impored patient well being & satisfaction, Development of profession as a whole, increased job satasfaction.

Their are 5 A's of EBN:

• Ask- define a clinical question
• Aquire- find the best avaliable reference
• Appraise- assess the quality & relevance of the evidence found
• Apply- implement the evidence into clinical practice
• Assess- evaluate the impact of the change

Manual handling operations regulations 1992 ...

involves any activtiy that requires the use of force exerted by a person to

• Lift an object
• Lower an object
• Push an onject
• Pull an object
• Carry an object
• Move an object
• Hold/support an object

• The act expands on the general provisions of the H&S at work act
• Specify that all manual handling activities should be avoided when practical to do so
• Measures & controls should be in place where possible
• What aids could be used?

Numerical guidlines for lifting & lowering loads

Lifting & lowering loads (points to note:)

• Your ability to lift may increase with technique training
• Your ability to lift may reduce due to ill health &/or enviromental conditions
• Risk of injury increases as weight of load increases
• Risk of injury increases with incorrect handling

Twisting, reaching (increases stress on the lower back), repetitive task, not bending your knees)

In a veterinary practice manual handling involves...

• Animals
• Equipment
• Drugs
• Fluids
• Feed
• Bedding
• Gas cylinders

Lifting technique

• plan the lift- seek help if required, wear PPE, assess area
• Place feet apart or one slightly in front of the other to give a stable base
• Slide object closer to you if necessary
• Bend your knees & not your back
• Keep your back straight (lift head up)
• Keep your shoulders level & facing same direction as hips
• Grip the load with your palms, not just your fingers
• Keep arms close to the body to aid support

Moving the load 2 people

• Previous principles apply
• communication
• move feet slowly
• co-ordinate the lift

with your partner

Gas cylinders

• possibly the most dangerous of routine manual handling tasks
• Heavy & awkward
• Requires special care & equipment to handle/ secure
• Use a purpose designed trolley
• Never lift by its valve/ protection cap
• Tilt the body & rotate the cylinder to place in the trolley
• The trolley should have securing bars
• When stored they must always be secured to a well in a upright position
• Consider PPE

Moving the load one person

• Keep the load as close to your body as possible
• Keep the heaviest side closest to your chest
• When pushing/ pulling use your body weight to move the loas, can let the momentum of the load do the work
• When pulling, keep your back straight, arms close to your body centre line
• Avoid twisting

Risk assessments:

We are going to use a risk assessment to assess an area of practice Can also be used to assess individual staff members, shift patterns, individual pieces of equipment & more Five steps:

• Identidy the hazard
• Decide who may be harmed & how they may be harmed
• Look at how likely it is that the harm will occur & how it could be prevented
• Record the findings & inform staff
• Review regularly & update if anything changes

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• Potential hazards- name the hazard in the area
• Who is at risk?- just a specific team/ client/ everyone
• Existing control measures- what is already in place in the practice to minimise this risk?
• Risk rating- A calculated number indicating whether action is needed
• Preventative measures- is there any additional actions that needs to be put in place to lower the risk rating?
• Responsibilities- who is responsible from the new preventative measures? date of review

Health & safety in a veterinary setting...

Relevant health & safety legislation-

• Health & safety at work act 1974
• RIDDOR 2013
• COSHH 2002
• Enviromental protection act 1990
• Hazardous waste regulations 2005
• Ionising radiation regulations 2017
• Manual handling operations regulations 1992
• Fire precautions act 1971- the regulatoty reform (fire safety) order 2005 & the fire safety (scotland) regulations 2006
• Health & safety first aid regulations 2013
• Electricity at work regulations 1989

Aims of health & safety

• to ensure we live in a safe enviroment
• To ensure we live in an enviroment that maintains our health & does not deteriorite it

In reference to a veterinary practice

• Provide a safe area for clients to recieve a service
• To provide a safe working eviroment for staff
• To provide a safe working enviroment for the patients

What are the costs/ consequences of not considering H&S in practice?

• Human?
• Economics?

How health & safety is applied in a veterinary setting

• Health & safety in monitored by the health & safety executive (HSE)- & as part of the RCVS practice standards scheme (voluntary)

H&S legislation-

• identify potential hazards/ risk assessments
• Safety signs/ signals
• Preventative/ control measures
• Polices
• Training & responsibilities
• First aid & welfare facilities
• Reporting & recording

Legal requirements for employers-

• All employers, whatever the size of the buisness:
• Must provide toilets, washing facilities, drinking water, suitable lighting & temperatures, training, equipment, safety uniform (including free PPE)
• Must provide free health & safety training
• Must report major injuries & fatalities to the incident displayed or as an electronic copy
• Must provide first aid facilites
• Must decide what can cause harm in the workplace & implement precautions to stop or reduce the risk of the harm occurring
• Must consult with employees on all elements of health & safety

Near miss reporting:

• What is a near miss? an incident or unplanned event that did not result in injury, illness or damage- but had the potential to do so, also known as ' a narrow escape'
• Why should these be reported?

• How should these be reported?

Responsibilities of employers-

• To take reasonable care of health & safety of themselves & others, whilst in the work place
• Respect safety rules & report potential hazards to supervisors
• Co-operate with the employer to enable any duty or requirement under the act to be performed or complied with
• Not interfere with anything provided in the interests of health, safety & welfare
• Keep tetanus booster & other relevant vaccinations UTD

-----RIDDOR 2013-----

-----COSHH 2002-----

The reporting of injuries, diseases & dangerous, occurances regulations

• All accidents that occur in the work place must be recorded in a HSE approved accident book
• Serious events must also be reported directly to the HSE
• Catagories (7 in total)
• Deaths
• Specified injuries or fatal accidents
• Any accident or illness resulting in absene from work for more than days ( because of an incident at work)
• Dangerous occurences & near misses
• Accidents to members of public if resulted in any hospital treatment- must be fault of practice
• Any diagnosed disease directly caused/ made worse by place of work
• Gas incidents

The control of substances hazardous to healh regulations

• Covers management of risks associated with hazardous substances
• Includes information on all pharmaceutical products & chemicals used in veterinary practice
• Includes assessments & safety precautions

-----Hazardous waste regulations 2005-----

Clinical waste:

• Safe handling & disposal of clincal waste
• Waste must be stored in the correct waste receptable

What considerations should there be for the clinical waste storage areas?

• All vet practices producing 200kg of clincal waste must be registered with enviromental agency website. Must have a waste contractor
• (licensed disposal company) & keep appropriate records
• Veterinary practice clincal waste is divided into groups- hazardous & non-hazardous waste

Clinical waste: Non-hazardous

Clinical waste: hazardous

The Regulatory Reform (fire safety), order 2005 Scotland Regulations 2006)

Ionising Radiations Regulations 2017

• Radiation is dangerous
• Everyone involved with radiation must be protected from it's dangers
• All practices should have their own written local radiation rules & a system of work- displayed
• Who should not be taking part in radiography within veterinary practice?

Typical fire hazards in veterinary practice including:

• Oxygen cylinders
• Pressurized air cylinders
• Volitle liquids
• Naked flames such as bunsoen burners
• Dryers
• Cooking equipment
• Electrical equipment

Main principles:

• A definite clinical justification for the use of the procedure
• Minimal exposure
• Controlled area with warning signs
• Personal monitoring
• An appointed Radiation Protection Supervisor (RPS) & an Radiation Protection Advisor (RPA)
• PPE requirements?

Fire Action

• Basic Training to understand risks
• Action in event on a fire
• Raise the alarm
• Appropriate extingusher use
• Hose points
• Action regarding exit routes/ assembly points
• instructions during surgery

Further details on fire safety can be found at www.fire.gov.uk

Risks & Hazards Within Veterinary Practice

Pregnancy

• Developing foetuses are susceptible to the harmful effects of radiation
• Pregnant women are more susceptible to injuries caused by lifting
• Manual handling
• Some drugs can be potentially harmful to developing foetuses
• Anaesthetic agents can cause miscarriages
• Zoonotic disease e.g. Toxoplasma gondii, salmonella

Ill health & RisksPre-existing conditions may be made worse by:

• Animal hair
• Aerosols/ Disinfections
• Upsetting situations
• Inappropriate handling can seriously worsen their condition
• Ideally, they should not be lifting anything
• Exposure to zoonotic infections etc

Risk- The likelihood of causing harmHazard- Something that has the potential to cause harm

Identify Special Risks Animals:

• Unable to observe or manage a risk themselves
• Risks to humans through handling

Clients:

• Entering a harxardous enviroment
• Equipment in consulting rooms
• Restraint of animals (risk of attack)
• Drug
• Able to observe potential risks possibly not able to manage them
• Risk to staff- burglary, (money or drugs)

Staff

Age- children

• Animal inflicted injuries
• Handling equipment. insruments, drugs
• More susceptiable to harmful effects of radiation
• Often less experienced in handling animals
• Are less physically able to lift
• May not be aware of the necessity of adhering to practice procedures &legislation

Age- elderly Often more susceptible to lifting injuries Often more susceptible to infevtioin

Admission

Communication

Reasons for admission

• Return from refferal/ overnight care
• Boarding
• Surgical treatment
• Medical treatment
• Diagnostic investigations
• Monitoing

Initial steps

• Allocate a suitable time slot an area- be efficient
• Practice details must be correct on the form
• Ensure date on the consent form is for the day the form is being signed
• Reason for admission must be detailed clearly and in full

Abbreviations shouldnt be used on the form e.g. General anaethesia not GA as could mean anything

• Check the reason for admission with owner- surgical treatment/ medical treatment/ boarding?
• Discuss risks of the procedures, use of off-license medications
• Estimate for procedure must be noted and confirmed with owner

References in both VS and VN code of professional coduct Your responsibilites to clients

• Ensure that clear written information is provided about the practice
• Ensure the client is kept infored of patient process
• Ensure that the client is made aware of any procedures to be performed
• Facilitate communication between the veterinary surgeon & the clint to assist the clients understanding of any issues relating to their animals treatment
• Recognise situations where the client should speakto the veterinary surgeon in charge of the case
• Support and reassure

Reasons for admission

• Pre-anaesthetic blood test
• fluid
• teeth rasped
• Anal glands
• Trim hooves
• Clip nails
• Clean ears
• Apply flea/worm tx
• Clip matts

Financial estimates

• Estimaes must be given for treatmen to be carried out (record any quoted prices)
• Owners should be updated as necessary (do not underestimate how quickly bills escalate)

Admission

Relevant history

• Anything chnaged since last seen by vet?
• Locations of any lumps
• Female neutering- any chance of pregnancy?
• Last season if entire
• Current medication & health conditions
• Recent health- e.g. any recent V+ or D+
• Vaccination history
• Preventative healthcare history (e.g. flea/worm tx)
• Any allergies?
• Equine- farrier details, check passport
• Any other concerns?

Confirming clients/ animals detailsConfirm client details:

• Name, address and correct telephone number (including one for that day)
• Are they the owner or an agent

Confirm animal details:

• Name, species, breed, sex, neutering status, age, updated bodyweight
• Check if the patient is insured with whom
• If multiple animals- do not assume you know which patient is which
• Check microchips, ID discs on collars, equine passports (including section 9), freeze mark

Check normal feeding regime

• Check when the patient was last fed & given water
• Normal diet

Relevant history

• Overall body condition
• signs of infectious disease (e.g. ringworm/ strangles)
• Vital signs (TPR)
• Signs od ectoparasites
• If surgery- signs of pyoderma/ skin irritation
• WEight
• Evaluate & discuss temperament

Check normal routine

• Usual bedding for horses/ exotics: Shavings, straw, paper?
• Preferred cat litter
• Toileting places for dogs- e.g. grass only? special commands?
• Check when the patient last toileted

Admission

Consent

• All patinets must have a consent form- this is a legal document
• Principles of obtaining valid consent to treatment

(Written/ informed/ insurance/ form design/ competent adult)

Temperature considerations

• Always need to discuss this before the patient is stabled/ kennelled
• Equine considerations

(good to clip / good to lunge / good to tie-up

• Small animal considerations

(Usually muzzled/ been away from owner before/ good with other cats and dogs/ if more than one kennelled together or apart)

Informed consent Re-cap

• Informed consent can only be given by a client who has had the opportunity to consider the options for treatment & had the significance & risks explained to them
• Ensure the owner understands everything- do not assume
• To ensure informed consent clients should be made aware if someone other than the VS may be performing a task
• Obtaining consent is a process, the culmination of which is generally a signature, but it is what goes before that enables the consent to be given
• Obtaining consent is the responsibility of the VS but it can be delegated to other competent staff

To finish

• Label possessions

(create ID tags for dog collor, cat basket, rugs, etc. Discuss any payment policies Gain client consent Advise on time to phone (& has correct contact details for the practice) or time to collect Note down the vet/ nurse involved with the admit

Following admission

• Owners will often wish to unload (equine) & see their pet settled in a hospital stable/ stall/ kennel themselves, & this may be preferable in some cases. However, check the practice policy with regard to owners entering other clinic areas
• Tick off or record arrivals
• Liaise with VS
• Extra requests

• Complete inpatient cards/charts, other areas of hospital/ computer ect
• Equine door cards- remember public may see

Steps of discharging

Step 2

• Check the clients record- ensure the billing is up to date

Ensure discharge form is ready/ correctExtra forms- bandage care forms, referral forms

• Ensure patient belongings are collected & ready for discharge
• Check the correct strength & amount of meication has been prepared for discharge
• Food/ buster collars & bandage bag ready to go home with

Explaining procedures

• State the procedure undergone

(e.g. Routine spay under general anaethetic) (e.g. Emergency colic surgery to corect a 360 degree colon torsion under general anaethetic

• Confirm any extra procedures performed
• Any medication given
• How patient is recovering

Transportation- horses

• Not all owners have their own transport
• May need to make arrangements to hire transport
• Transport type- mare/foal, post op fracture
• Any requirement for sedation
• Previous travel experience

Step 1

• Confirm with the vet if the patient is ready to leave
• Establish ho will be discharging the patient
• Ensure the correct patient
• Ensure patient is clean and tiy (brushed) with all IV catheters removed
• Check all wounds (including oral wounds)
• Check bandages are clean, secure and dry

Step 4

• Book folloe up appointment if necessary
• Ensure client has all practice contact details including OOH (Out Of Hours) provision in case of problems
• Client to settle account
• Only then bring the patient through or take owner out to yard to collect their horse

Step 3

• Take client to consult/ quiet room to ensure privacy
• Explain procedure & any aftercare to the client- it is a good idea to go through the invoice at this point
• Use written information such as discharge forms & drug charts to ensure understanding
• Confirm clients understanding
• Ensure that all questions that the client has are answered

General aftercare

• General monitoring of patient
• First day/ evening requirements once home for same day routine ops (keep warm/ diet)
• Explaining ongoing medications

Explain when each medication should be started Ensure they happy & capable of administering Explain any necessary precautions e.g. PPE (gloves), contra-indications for pregnant women

• Need for clearly written dispensing label
• Wound management

Explain what to expect & look for visually Explain importance of preventing patient interference Bandage care (& how/when to change/ remove if relevant)

• Return to exercise/ physiotherapy requirements

Ensure owner is capable of adhering to this plan

Payment

• What is your practice policy?
• Break down of costs should be available (itemised bill)
• Method od payements

(cash- check it, Cheques- signature must be the same as guarantee card, Debit & Credit cards, Standing order- fixed amount transferred by client, Direct debit- amount paid can be altered by the veterinary practice

• Process payment - record
• Provide Recipts

(Date, nurses name, amount recieved, practice details, owners name

General aftercare Useful for convalescing patient:

• Improve range of movement in joints/ soft tissue during & after immobolisation
• Maintain muscle tone
• Improve muscle strength
• Rehabilitate normal gait pattern
• Controlled exercise program to regular full performance

Summary discharging patients

• Ensuring the patient is ready
• Planning
• Home circumstances
• Transportation
• Information to owner/ owner capability/ owners check

• Routine changes /exercises/ physiotherapy
• Drug administration
• Diet

• Wound aftercare- usually no longer than 3"

Bitch- Underside of abdomenMale- Between base of penis & scrotum Check at least twice daily for signs of swelling, discharge, redness, discomfort (weeping can be gently bathed) Avoid interference

• General demeanor

Check gums, rasps, pain, weakness, alertness

• Follow-up appointments

Recheck 2-3 days post surgery Recheck again 10-14 days (& remove stitches if necessary)

Post-op care Neutered-Dog

• Bitch spay- removal of the womb & ovaries
• Castration- removal of testicles
• Diet

Note if already been offered food Adise reduced portion that evening, little & often water (Increased risk of vomiting) Monitoring appetite

• Medications- usuallt NSAIDs only for 3-5 days
• Exercise

Keep quiet, warm & on lead in garden first night 10-14 days post op lead only 15-20 mins walk Bitch- avoid stairs, furniture, jumping into cars Bowel movements may be reduced for 24-36hrs post op

• Monitor

• Wound aftercare

Queen- underside/ left side of abdomen Male- x2 directly over testicles Male cats may appear as if they still have testicles Often skin glue is used instead of sultures Avoid interference- ma need to assist with grooming

• General demeanour

Check gums, resps, pain, weakness, alertness

• Follow-up appointments

Recheck 2-3 days post surgery Recheck again 10-14 days (usually females only)

Post-op care Neutered-Cats

• Similar procedure/ aftercare to dogs
• Diet

Note if already been offered some foodAdvise reduced portions that evening, little & often water Monitor appetite

• Medications- usually remale only- NSAIDs only for 3-5days
• Exercise

Restricted, warm indoors with litter tray Avoid stairs & furniure Ensure access to water

Post-op care- Dental

Post-op care- Rabbits & Rodents

• Diet

Often small amounts of soft food first evening May need to continue soft food for around 14 days (depending on extractions) Monitor closely for any difficulty

• Medications

Analgesia +/- ABs More than one so ensure communication efficient

• Exercise

Resume as normal following day

• Wound Aftercare

Some blood tinged saliva is to be expected initially Monitor for halitosis Avoid brushing for 7 days post surgery Thereafter for good hygiene, brush 3x per week with enzymatic pet toothpaste Demonstation if required

• Keep warm & quiet for the evening
• Keep other pets away if pestering & reduce handling for first 12 hours
• Eating is vital, may have been offered some

Recovery food may be a consideration Expect normality after a few days Remeber caecotrophs for rabbits if wearing a collar Shallow feed bowls

• Wound aftercare

Bedding- shredded paper or towels to prevent catching on any sutures May need to assist with grooming Check for urine scalding

• Medications

Owners may be less confident than with dogs/ cats Consider demonstrations

• Feeding

Re-introduce hard feed after 30 days Examine manure for characteristics Fibre diet- slow re-introduction Monitor appetite

• Exercise

First 30 days- box rest with 10 mins hand walking to grass 3-4 times daily At 50-60 days- round pen or small paddock exercise if incision healing well, increase hand walking At 60-90 days- gradually return to normal activity providing no complications

• Monitoring

Temperature should be taken for 14 days post surgery heart rate, respiratory rate

• Surgical wounds

Swelling, discharge, discomfort Follow up appointment Staples (if ay) removed at 10-14 days Check at 30,60 & 90 days

General home care- horses

Post-op colic care-

Nurses can play crucial role in client support & guidance. Factors to consider:

• Owners worry about extended period of box rest
• Diet

Type of patient competition horse, brood mare etc. Ad lib forage Use of forage based diet Use of pro & pre-biotics Feed little & often regime

• Alleviating boredom- preventing stable vices
• Swelling in distal limbs
• Grooming- good for muscle tone/ general well-being
• Walking out in hand
• Bedding thickness

Clinical examination

Post-op care- Horse castration

Patient assessment

• On admission, a full routine health check should be performed
• Thereafter a check should be carried out at least once daily throughout the period of hospitalisation

• Exercise

Restrict first 24hrsStart exercise 24hrs post surgery to help reduce swelling & facilitate drainage, lunge 15mins 1-2x daily at trot Stiffness should ease

• Monitoring

Apply fly spray, summer fly cream around area Terramycin spray Wound should heal 2-14 dats and contract Watch for swlling of the scrotum& contract May swell through days 2-5 but should reside day 5 Some dripping from site is to be expected for first few hours, should be no streaming First few days a small amount of clear, red tinged fluid ok, yelloe or pus coloured is not Any tissue hanging out of the site also not ok- emergency

SOAP framework

• Subjective

Personal assessment of immeasurable observations (demeanour, behaviour, posture, degree of lameness etc.)

• Objective

Facture assessment of measureable observations (TPR, MM, BP Ect.)

• Assessment

Comparison exercise to assess the progress of the patient (may include noth subjective & objective observations)

• Plan

How to treat the patient (nursing) (May include specific treatment protocol e.g. medications or physical interventions or observation protocol e.g. frequency of TPR monitoring

Respiration

Clinical examination

Starting with respiration, pulse and heart rate

Points to considerBefore going ahead with your assessment, consider the following:

• Patients are individuals
• Temperature can effect findings
• Restraints
• Condition
• Barrier nursing
• Enviroment (white coat syndrome)
• Age (young vs old)
• Record chart

Respiratory rates: normal values

• Dogs- 10-30
• Cats- 20-30

• Horses- 8-20
• Rabbits- 30-60

Terminology

• Bradypnoea/ tachypnoea
• Apnoea
• Dyspnoea
• Paradoxical

You can use:

• stethescopes
• Observation
• Palpation

Observe or place your hand over your dog’s chest to count the number of times the chest rises (inhales) and falls (exhales). Each rise/fall combination counts as one breath.

Normal lung sounds consist of sounds made from breathing in (inspiration) and breathing out (expiration). We do not get breathing or respiratory rates from listening to the lungs but rather from looking at the movement of an animals flank moving up and down when they are breathing and counting the number of breaths. We listen to the lungs to try and find normal lung sounds or any abnormal lung sounds. Normal lung sounds can often sound like a breeze moving through the air but they are typically not very loud, and sometimes we don't hear them very well when listening to an animals lungs during a physical exam. It is important to know what normal lung sounds sound like so we can tell when there is an abnormal sound. Abnormal sounds like wheezes, which sound like someone stepping on crunchy snow, or crackles, which sound like popcorn popping, alert us and tell us that there is something abnormal happening with the lungs. In the video you can listen to an example of normal lung sounds!

Head to toe examination

• Observe the patient from a distance
• Overall coat condition
• General condition
• Physical examination

• Posture

• Musculature

• Skull surfaces

• Moist nares

• Patent airways/ signs of dyspnoea

• Presence/ absence of nasal discharge

• Epistaxis

• Sneezing

Head

Heart & heart rate

Pulse rate & quality

• Restrain the patient if necessary
• Place fingers over the chosen artery
• Using a watch with a second hand, count the pulse for a minute
• Record the rate, presence of pulse deficit, & pulse quality

You can use:

• stethescopes

(presence of murmur?)

• Manual Palpation

The heart beat can be felt most easily on the left side of the ventral chest allowing assessment of the rate, strength/quality

• ECG (electrocardiogram)
• Ultrasound

Pulse rate & quality Blood pumped into the aorta during ventricular contraction creates a wave that travels from the heart to the peripheral arteries. The wave is known as a pulse The pulse can be palpated by placing the index & middle fingers on a part of the body where an artery crosses bone

• Teeth/ signs of dental disease

• Tongue
• Breath

Uraemia associated with kidney disease = ammoniaDiabetes mellitus= pear drops Jaw missalignment Congenital deformities (e.g. cleft lip/ palate)

Terminology

• Bradycardia
• Tachycardia

• Horses- 30-40
• Rabbits- 130-325

Heart/ pulse rate

• Dogs- 60-180
• Cats- 110- 180

Mucous Membrane Colours

Pale- Indicative of poor perfusion: may be indicative of shock, circulatory collapse, haemorrhage, anaemia or severe vasoconstriction

Bright/ brick red (congestion)- Over oxygenation of tissue (vasodilation), may be seen post exercise, or be indicative of sepsis, fever, congestion, causes of entensive tissue damage or excitement

Can be observed in mutiple places including gums/ cheeks Should be moist and pink colour Idicator of adequate blood flow and therefore oxygenation of tissues CRT- Press on gums gently (which should make them go white) realise and it should take below 2 seconds for the colour to return in a health animal

Blue/ puple (cyanosis)- indicates severe hypoxoemia, could be cause by respiratory difficulty & requires immediate action

Yellow (licterus/ jaundice)- may be indic-ative of or an increase in RBC destruction & circulating bilirubin, or by neonatal liver disease/ bile flow obstruction, isoerythrolysis in equine neonates

Orange- may be seen after adminiatration of sythetic haemoglobin products

Chocolate brown- may be seen in dogs & cats & is indicative or paracetemol poisoning

Peterchiae

• small pinpoint haemorrhages seen in patients with clotting disorders, often those poisoned with rodenticides (warfarin)

Cherry red- may be indicative of cabon monoxide poisoning

• Ocular discharge
• Conjunctivitis
• Foreign body
• Nystagmus
• Pupil size

(Unequal pupil size)

• Pupillary light reflex

Eyes

Things to check for:

• Biepharospasm- squinting
• Abnormal bulging or unequal size

Glaucoma or oedema of the conjunctiva (chemosis)

• Suken eyes
• Exophthalmos/ proptosis- abnormal protrusion of the eyeballs
• Prolapse
• Entropion- inversion of eyelids
• Ectropion- eversion of eyelids
• Nictitating membrane visible?
• Cornea

(ulcers, opaque, scratching, jaundiced or increased vascularity?

Anisocoria= unequal pupil size Seeral different causes, corneal ulcers, disease or injury to the brain or nerves running to effected eye, increased pressure in eye, retinal disease etc.

Ophthalmoscope

Nystagmus= involuntary, rhythmic movement of the eyeballCauses- Stroke, dehydration, hypothyroidism, exposure to toxins etc.

Exophthalmos= eyes bulging out infr- ont. Causes- Haemorraging behind eyes, cancerous tissues behind eyes, infections, absesses, inflammation of muscles behind eyes ect.

Entropion= eyelid folds inwards in on itselfCauses- inflammation, aging, injuries to the eyes, dry eyes ect.

Nicitating= 3rd eyelid that protects the eye from dryness & damage inflammation of this= horner's syndrome Causes- gastrointestinal parasites, especially tapeworms, foreign body, inflammation of eyes

• Check pinnae for inflammation & wounds
• Ear canal

(Foreign bodies, ear mites, signs of infections Signs of infections

• Itchy ear
• Heat & swelling
• Smelly ear
• Pain around ear (avoiding/ shy around it)
• Head shaking/ face rubbing
• Fatige
• Depression

Ears

Lymph Nodes

Will be enlarged in the event of neoplasia/ infections

Skin & coat

Hives=

Causes- Allergies (pollon. dust, bites, medication ect.) Itchy & uncomfortable but not severe

Things to look for:

• Check for a skin tents
• Ectoparasites
• Wounds- open or closed
• Hives (urticaria)
• Hair loss (alopecia)
• Skin conditions such as dryness, scaliness, greasiness, pyoderma, eczema, allegies, fungal & hot spots
• Body condition scoring

Alopecia=

Causes- Fleas, mites, lice, skin allergies, ringworm, hormone diseases such as hypothyroidism & cushings, overgrooming, stress,

Ectoparasites =

Causes- Fleas, mites, lice, ticks ect.Signs- increased itching, readness of skin, alopecia, crusty/flaky skin, scabs, dermatitis

Skin tents- Hydration test =

Causes- Dehydration Using your thumb & forefinger pinch the skin on the back of neck/ head skin should spring back if hydrated or stay up if not

Forelimbs

Atrophy=

Degeneration & breakdown of muscle & tissue in the limb Causes- damage to muscle fibres, old age, disease causing weight loss, injury resulting in box rest, malnorishment Common in diabetic, renal failure

Things to look for:

• Weight bearing/ lameness
• ROM
• Atrophy
• Wounds
• Crepitus
• Fractures
• Discomfort, heat or swelling
• Toes/pads, claws, hooves (check for tenderness, wounds, Foreign bodies)

Lameness=

Causes- Pain, injury, lamanitis, tendon damage, fractures, soft tissue damage(strain, sprain) osteoarthritis, hip dysplasia

Crepitus=

Noise when a join moves- usually accompanied by pain & swelling caused by friction beween articulating surfaces in a joint or when a tendon or ligament snap back after stretching over bony structures

ROM= Range of movement=

Causes of restricted ROM - inflammation of soft tissues, muscle stiffness, pain, joint dislocation, fractures, osteoarthritis,

Thorax

Abdomen

Things to check-

• visually for detension
• Gently palpate the abdomen using light pressure & he end of your finger not finger tips (looking for tenderness, pain, swelling)
• Auscultate (listen to gut sounds) using stethoscope
• The kidneys, bladder, spleen & small intestines may be felt in smaller patients, but is often difficult to locate these structures in tense or obese patients

Things to check-

• Heart rae (if not already done)
• Gently feel ribs & thoracic vertebra for any signs of swelling
• Respiratory rate (if not already done)
• Lung sounds

(crackles & rales as auscultation of the chest suggest pulmonary oederma pneumonia & bronchitis

• Coughing

Pulse rate & quality

• Contagious
• Distingush type-

(dry & hacking or moist & productive)

• When did it develop?
• cough causes-Tonsilitis, kennel cough, heartworms, infections, bacteria ect.

Heart/ pulse rate

• Dogs- 60-180
• Cats- 110- 180

• Horses- 30-40
• Rabbits- 130-325

Pelvis, hindgut, Tail & Anus

Things to look for:

• Pelvis & hindlimb should be examined in the same way as the forelimbs
• Femoral pulse can be assessed(medial aspect of the proximal femur)
• Ensure tail can move voluntarily, check coccygeal vertebrae
• The anus should be checked for signs of soiling, trauma or discharge
• Anal lands may become infected &/or impacted
• Rectal temperature

Taking a rectal temperature-

• Collect & prepare all required equipment
• Correctly restrain the patient
• Shake down the thermometre (if using a mercury thermometer) & check the reading
• Apply lubricant to the theromeer tip
• Insert into the rectum for the correct length of time (1 minute for mercury, until the timer bleeps for digital)
• Remove, wipe with cotton wool & read
• Wipe clean with antiseptic solution
• Write the reading down

Normal rectal temp values-

• Dogs- 38.3-38..7
• Cats-38-38.5
• Horses- 37.9-38.5
• Rabbits- 38.5-40

Terminology-

• Hypothermia
• Hyperthermia
• Pyrexia

Reproductive organs males-

Reproductive organs females-

Things to look for:

• Swelling of the vulva or vulval discharge in bitches

(blood red pro-oestrus) (straw coloured oestrus) (Dark green/ brown parturition is imminent) (Black death & decomposition of foetuses) (puruient green or pale coffee-coloured open pyometra)

• Breeding mares may have undergone caslicks surgery
• The teats should also be checked for lactation &/or mastitis

Things to look for:

• Penis & testicles should be checked for signs of trauma or abnormal swelling
• Entire dogs should have two descended testes within the scrotum
• Entire dogs & cats should also have two palpable testicles
• Geldings- check sheath (growths, maggots, swelling, irritation, injury, etc.

Caslick surgery can be a very effective way to prevent fecal contamination in mares. It is especially useful in mares that are used for breeding or that have a history of reproductive problems.

This procedure is commonly used in mares that have poor conformation of the vulva or a vaginal defect that prevents them from keeping their vulva closed.

Weight assessment -

Physiological changes -

Summary of main observations - objective

• Weight can be assessed by feeling along the flanks of the animal to determine whether the ribs can be felt easily (ideal), protrude or cannot be felt (unideal)
• Normal weight for breeds/ species can be used as a guide to ideal weight, but as always there are individual variances
• Body/ muscle condition score

As well as conducting a physical examination the following should also be monitored:

• Appetite changes
• Thirst changes
• Urination patterns
• Defecation patterns

• Vomiting
• Signs of pain
• Stress & behavioural changes

• Heart rate
• Pulse rate & presence of a pulse deficit
• Checking capillary refill time (CRT)
• Obtaining a rectal temperature
• Respiratory rate
• Others
• Urine output & faecal output
• Water & food consumption
• Presence of vomiting & diarrhoea

Summary of main observations - subjective

• Subjective observation does not provide a numerical result (difficult to reliably compare recordings between staff)
• Subjective observationis useful because it allows for change, improvement, & deterioration to be identified
• Allows for patients to be observed from a distance (less likely to cause stress & anxiety & therefore increasing objective parameters)
• Heart sounds & pulse quality
• Mucus membrane (MM) colour
• Lung sounds
• Pain, signs of lameness, behaviour

Analysing & recording data -

Once you have collected data on vital signs what should you do with it?

• Written format
• Graphical/ visual format to enable trends, peaks & troughs to be observed

Record this on the clincal history & the hospital sheet

Rabbits -

First Aid

Emergency telephone call -

Who may carry out first aid?

• Anyone providing they are trying to reach the aims of first aid

What are the aims of first aid?

• Preserve life
• Prevent suffering
• Prevent deterioration
• Promote recovery

What are the first rules

• Airways
• Breathing
• Circulation
• Disability
• Danger/ Safety (safety comes first)

(assess area/ assess your safety/ assess animals safety)

• Calling for help

The nurse may be the first point of contact esp, if Out of Hours Listen to owner

• Listen & be patient
• Ask for client details
• Ask for animasl details
• Breif history
• Record information

Advise owner

• Stay calm
• Advise on any care required by owner (dependant on situations)
• If coming in- adise how to the patient safely
• Ensure understanding
• Ask for ETA/ advise on your ETA

Inform team & prepare for arrival

Triage -

• French word for 'to sort' (Breton, 2011)
• To organise the patients tha need to be seen immediately from the patients that can wait, we assess the three major body systems: Respiratory, Cardiovascular & Neurological
• Triage in emergency practice occurs over the phone, on arrival, & also in hospitilasied patients
• The aium of triage is to provide a rapid assessment of the patient based on their physical parameters, to guarantee the life threatening signs are identified early, to ensure the best treatment & outcome

Breif history

Preparation

Primary survey

S= Safety (depending on patient condition) A= Airways B= Breathing (neurological concerns)

Current signs

• Able to breathe easily? Any noise? Open mouth (in cats)?
• Any haemorrhages?
• Acting normally? Able to respond to name? Able to walk normally?

Onset of signs

• Did anything happen to cause these signs?
• E.g. trauma or known/ suspected toxin ingestion?

Gradual progession or rapid deterioration? Current medical conditions?

• Current medication- has it been given?

C= Circulation D= Disability

Primary survey- Airways & Breathing

• Number of staff required- who?
• Suitable kennel/ stable &/or location within the practice
• Equipment
• Consumables
• Restraint/ handling/ transport equipment
• Paperwork

Is the patient breaching?

• Chest movements
• Nose/ mouth movements

Is there a patent airway? Are there any abnormal chest sounds? Is the breathing laboured? Is the breathing shallow?

Is the animal concious Consider- patient positioning, oxygen, suction, intubation/ tracheostomy & IPPV, thoracocentesis

Thoracocentesis

Haemorrhage- control methods

Invasive medical procedure to remove fluid or air from the pleural space for diagnosis or therapeutic purposes

Primary survey- Circulation

Overall assessment of circulatory system

• Mucous membrane colour
• CRT
• Heart rate & rhythm
• Pulse quality/ Pulse deficit
• Temperature

Establish if evidence of shock Is there any obvious haemorrhage? Consider- defibilation, haemorrhage control, IV access & emergency IVFT

Indirect pressure- Arteries used:

• Brachial artery- medial, distal humerus- pressure will reduce blood flow to the lower forelimb
• Femoral artery- medial aspect of the femur- pressure will affect the blood flow to the lower hind limb
• Coccygeal artery- found on the venteral aspect of the tail

Shock- A state resulting from inadequate blood (& oxygen) perfusion to tissues

Hypovolaemic shock

• Most common
• Reduced circulating blood volume
• Haemorrhage, loss of tissue fluid e.g. severe V+ & D+
• Body responds through vasoconstriction

Obstructive shock

• Caused by something (within or outside of circulation) Preventing return of blood to the heart)

Clinical signs

• Pale/ dry mucus membranes (bright red in distributive shock)
• Slow CRT (fast in distributive shock)
• Weak/ rapid pulse
• Cold extremities
• Increased heart rate
• Rapid, shallow respiration
• Poor skin turgor
• Decreased urine output
• Reduced level of conciousness
• Collapse

Distributive shock

• Inflammatory mediators cause blood vessels to dilate
• Subtypes:
• Neurogenic shock
• Anaphylactic shock- allergic reaction
• Endotoxic/ septic shock- reaction to toxins

Treatments

• Treating the cause of shock - e.g. control haemorrhage
• Keep warm & comfortable
• IV fluid therapy
• Observations of TPR/ CRT/ MMs/ Pupilary reflex/ Palpebral reflex/ Conciousness
• TLC

• Convulsions

Cardiogenic shock

• Impaired heart function
• Hypotension

Primary survey- Neurological

Secondary survey- Neurological

Normal mentation?

• If not , is it lethargic or collapsed? Are they responsive?

Seizures?

• If actively seizuring on triage the patient needs immediate treatment

Assess eye positioning, pupil size & reaction to light, & head position Can the patient walk? is the gait normal?

• Not necessarily a life threatening emergency that requires immediate attention, but will need prioritising over more routine cases

Secondary survey refers to the detailed physical examination performed after the primary survey, & should only be performed once the patient has been adequately stabilised History

• Record in a concise format
• Chronology of daily progression since onset of signs
• Background information including past medical problems, toxicities, medications, drug & food sensitivites, blood transfusions, travel history, the date of last vaccinations, & other preventive care

Physical examinations

• Full head-to-toe examination
• Specilist neurological & orhopaedic examination may be warranted

Diagnostics

• Minimum database- blood & urine tests +/- coagulation tests
• Diagnostic imaging

Specific First Aid / Emergencies

Wounds Burns & scolds Poisons

• Insect stings/ toxins/ etc.

Epilepsy / seizures Fractures & luxations Choke

Sensory organ damage Major organ damage Unconasciousness / collapse

Considerations

• Size
• Depth (partial or full thickness)
• Danger to yourselves
• Poisoning of patient
• Infection & hypothermia

Wounds

Burns & scalds

Treatment

• To practice ASAP
• Cool the area with cool running water
• Warm the patient
• Dress the wound (non-adherent dressing)
• Replace fluid loss
• Analgesia
• Treat for shock

Open or closed wounds?

• Open- any wound that has broken skin surface
• Closed- internal wounds

May or may not be appropriatee to ask owner to apply pressure Bring down ASAP for assessment- owners may over/ under exaggerate How are we going to treat open wounds?

• Haemorrage control- assess for shock
• Remove FBs
• Clip & clean
• Dress & re-dress
• Surgery?

How are we going to treat closed wounds?

• Cold compression
• Drain?
• Dressing?
• Surgery?

Whats the difference?

• Burn- dry heat
• Scold- moist heat

Possible causes of a burn? Possible causes of scolds?

Insect stings

Generally not severe depending on site Can result in allergic reaction (anti-histamines & IVFT treatment)

• Bee stings (Acid) bathe the area in dilute bicarbonate soda)
• Wasp/ hornet sting (Alkaline) Bathe the area in dilute vinagar

Oral route or via skin (cutaneous route)

• Vemon (european addders)
• Antifreeze (ethylene glycol)
• Pesticides (slug & rat bait)
• Fungicies (garden sprays)
• Insecticides (garden sprays & permethrin flea treatment given to cats)
• Household chemicals (bleach, white spirit)
• Inhalants (carbon monoxide, smoke)
• Plants (lillies, daffodils, rhododendron, ragwort)
• Medicines (asprins, paracetamol)
• Foods (mould, chocolate, raisins, grapes, mushrooms, onions, garlic)

What is the poison?

• Ask client to bring packaging/ samples

When was that animal in contact with the poison OR Did it definitely eat the poison

What species, breed, age is the animal? What symptoms is the animal exhibiting?

Treatment of poisoning

• To practice ASAP
• Prevent further exposure
• Identify poison
• Contact the veterinary poisons information service
• Administer antidote
• Prevent GI absorption (induring vomiting, gastric lavage, saline purge, activiated charcoal, IVFT) (Do not induce vomiting if corrosive substance, patient is unconcious/ convulsing or if ingested more than 4 hours ago).
• Wash coat & wound care if applicable (liquid oily compounds (e.g. petrol)-dilute washing up liquid, vegtable oil / liquid paraffin) (non- oily compounds (e.g. disinfectants - warm water) Solid oily compounds (e.g. tar- clip fur, vegtable oil/ butter/ liquid paraffin)

Poisons

Epilepsy & seizures

Dislocations

• Patella luxation in small/ toy dogs usually congential & "pop back" into place- usually non painful
• Hip dislocation may occur fairly easily & recurrently in dogs with hip displasia
• Major force required to dislocate a "normal" joint e.g. RTA/ fall
• Hip dislocation often associated with Pelvis
• Dislocations may be reduced (put back into place) under GA

Epilepsy= a condition that causes waves of disorganised electrical activity within the brain resulting infrequent seizures (often idopathic) Clincal signs: (different signs for 3 phases)

• Pre-ictal phase- hyperexcited or anxious
• Ictal phase- recumbent seizing phone (concens- if above 5min status epilepticus)
• Post-ictal phase- Dazed, unsteady, lethargic, aggressive?

Telephone advise

• Do not touch the patient
• Minimise people in the room but do not leave the patient alone
• Remove objects that could injure the animal
• Reduce light & noise levels
• Allow to rest once subsided
• Advise owners to make notes
• Bring to vets as soon as is safe to do so

Treatment

• Anti-convulsant drugs (rectal & IV)
• IVFT
• Bloods to identify cause

Fractures

Clinical signs:

• Pain
• Swelling
• Deformity
• Loss of function
• Crepitus
• Unnatural mobility

Treatment:

• Care!
• Provide support (e.g. Robert jones bandage or splint)
• Control any haemorrhage- assess for shock
• Restrict movement/ cage rest
• Spinial injuries- keep flat/ moved as little as possible
• Analgesia
• Surgical correction

Main types:

• Simple/ transverse
• Oblique
• Spiral
• Comminuted
• Greenstick

Subtypes:

• Displaced
• Complicated
• Compound

Sensory organs- eyes

Eyeball injuries:

• Cornea injuries: Penetrating wounds e.g. scratches & non-penetrating wounds e.g. ulcers
• Direct trauma to the eyeball
• Fractures to the skull
• Prolapse of the eyeball

Clincal signs:

• Conjunctivitis
• Epiphora (increased tear production)
• Photophobia (Abnormal intolerence to visual perception of light)
• Blepharospasm (spasm of the eyelid causing involuntary blinking & twitching that can become itchy & painful due to external irritation

Eyelid injuries

• Foreign bodies e.g. grass seeds
• Wounds
• An inflammation reaction

Treatment of eye prolapse:

• A prolapsed eye should be replaced ASAP (only by a VS) Keep lubricated & prevent self trauma
• Flush with saline to clean
• Sterile gauze/ swab taped over area
• Elizabethan collar or similar placed
• Dark, warm area
• Monitor closely

Sensory organs- Nose

Sensory organs- ears

Part of respiratory system Can cause dyspnoea / epistaxis / nastal discharge Potential causes

• Direct trauma
• Foreign body
• Infection
• Tumours

Usually damage to pinna or foreign body in ear canal

Treatment

• Cold compresses to alleviate haemorrhage
• Quiet area
• Observations
• Avoid muzzling

Treatment:

• Stop Hemorrhage
• Reduce pain
• Remove foreign body
• Surgery?

Clincal signs:

• Haemorrhage
• Shaking of the head
• Self trauma
• Swelling

Sensory organs- Mouth

Potential causes

• Foreign bodies- e.g. fish hooks, sticks
• Fractures (e.g.mandibular symphysis)
• Insect stings

Commonly injured as patients us mouth for investigating

Clinical signs

• Pain & swelling
• Pawing/ rubbing at face
• Salivation/ drooling
• Dysphagia
• Presence of Foreign body

Treatment

• Treat for insect sting
• Remove foreign bodies if present
• Investigation
• Surgery
• Feeding tube?

Choke

• Sedation may be needed to relieve anxiety
• Care with placing hands to mouth
• Extend head & neck (in sternal recumbency if possible)
• Initiate oxygen therapy (urinary catheter around foreign body) (tracheostomy)

Removal of foreign body depends on type

• Suction
• Heimilich manoeuvre
• Coupage
• Ball- lay in dorsal recumbency & massage underneath object
• Surgery/ endoscopy

Coupage is performed by striking the chest gently but firmly with cupped hands. This action helps loosen secretions trapped win the lower airways, allowing them to be more effectively cleared by coughing.

Injuries to major organs- stomach

Gastrointestinal obstruction/ stasis

• Radiographs usually diagnostic
• Obstruction can result in gastric rupture- esp, in animals unable to vomit

Gastric dilation & volvulus (GDV)

• Usually in deep chested breeds
• Cause not always known
• Usually after ingesting large amounts of dry food quickly, followed by exercise
• Gas fills stomach, twists, pushes on caudal vena cava & diaphragm -> obstructive shock

Clinical signs:

• Anorexia
• Signs of discomfort & restlessness
• Collapse
• Shock
• Reduced gut sounds
• Lack of faeces/ Diarrhoea
• Vomiting

Clinical signs:

• Distension of the stomach
• Signs of discomfort & restlessness
• Unproductive retching
• Dyspnoea
• Collapse
• Shock

Treatment:

• Genuine emergency
• IVFT
• Relieve pressure ASAP
• GA & surgical correction (gastropexy)

Treatment:

• Genuine emergency
• Monitor blood glucose
• Assisted feedings
• Treat for shock- IVFT
• Analgesia & prokinetics
• Remve obstruction if present/ possible

Injuries to major organs- spleen

Injuries to major organs- Kidneys

Blood filled organ- damage can lead to perfuse haemorrhage & death

Large blood supply- trauma can lead to extensive haemorrhaging & even death

Clinical signs:

• Posture 'hang dog'
• Haematuria (blood in urine)
• Oliguria (low urine output)

Potential causes:

• Trauma
• Tumours
• Torsion

Clinical signs:

• Sudden collapse
• Tachypnoea
• Place MMs & weak pulse
• If torsion then will be swollen, hard & extremely painful

Potential causes:

• Nethroliths (kidney stones)
• Blunt force trauma

Treatment:

• Warm, dark kennel
• Quiet
• Treat for shock (IVFT)
• Veterinary surgeon to diagnose extent of damage

Treatment:

• If ruptured- PTS
• If not ruptured- treat as for shock
• Blood transfusion or IVFT
• Surgery (Splenectomy)

Injuries to major organs-Bladder

Injuries to major organs- Diaphragm

• More common in cats & dogs, usually result of an RTA
• Abdominal organs move into thoracic cavity

Potential causes:

• Uroliths
• Rupture
• Bruising
• Displacement

Clinical signs:

• Anuria / dysuria- true emergency
• Haematuria
• Oliguria

Treatment:

• Keep warm & quiet
• Oxygen supplementation
• Monitor pulse & respiration
• Radiographs & surgery

Clinical signs:

• None
• Varying degrees of dyspnoea
• Posure- sitting upright (orthopneic position)

Treatment:

• Close monitoring of urine production
• Urine sample analysis
• Possible requirement to remove urethral blockage
• Imaging of bladder & kidneys
• Surgery

Injuries to major organs-Pyometra

Injuries to major organs-Heart

Pyometra= puss filled uterus Clinical signs +ultrasound are usually diagnostics Causes:

• Repeated cycles with no pregnancy causes cysts
• Opening of cervix during oestrus causes bacteria to enter
• Low WBC's within uterus during oestrus

May be open or closed

• Closed- true emergency (rupture more likely)

Heart failure Heart is unable to pup blood around body resulting in signs of cardiogenic shock Left sided heart failure- fluid accumulates within chest (pulmonary oedema/ pleural effusion) Right sided heart failure- fluid accumulates within rest of body esp. abdomen (ascites)

Clinical signs:

• V+ & D+
• Anorexia
• Uncomfortable abdomen
• Pyrexia
• Open- purulent discharge from vagina
• Collapse (septic shock)

Treatment:

• Diuretics
• Thoracocentesis
• Oxygen therapy
• Low stress handling
• Keep warm

Clinical signs: Signs of cardiogenic shock e.g.

• Dyspnoea
• Pale/ cyanotic MM
• Weak pulses

Treatment:

• Treat shock if present
• IVFT
• IV antibiotics
• Ovariohysterectomy (medical treatment often successful)

Unconsiousness & collapse

Neutering Advise

Dog spay

Dog Castrate

Cat Neutering

Advantages:

• Reduced risk of mammary tumours
• Prevention of pyometria
• Behaviour
• Prevention of unwanted litters of puppies

Advantages:

• Prevention of testicular tumours
• Decreased risk of prostate benign masses
• Behaviour
• Scent marking

Advantages:

• Control of the unwanted cat population
• Prevention of reproductive tumours
• Behaviour (especially males)
• Less injuries & less likely to involved in an RTA (Smith,2011)

Disadvantages:

• Increased risk of prostate malignant tumours
• Weight gain

• Behaviour
• Delayed growth plate closure (early neutering)
• Abnormal delevlopment

Disadvantages:

• Incontinence in old age
• Weight gain
• Coat changes
• Behaviour
• Delayed growth plate closure (early neutering)
• Abnormal delevlopment

Disadvantages:

• Weight gain
• Male cats more likely to suffer with a "blocked bladder" urethral obstruction
• Increased risk of growth plate fractures (if neutered early)

Neutering Advise

Normally a standing procedure horses under 4 years of age:

• Consider when it may be necessary to castrate a horse under general anaesthetic
• Https://www.youtube.com/watch?v=9pvDXu9wumE (Male castration)

For cryptorchid horses (normally called 'rig' in horses) laparoscopic techniques can be used to remove the abdominal tactical

Horse castrations

Horse ovarectomy:

• Mares are not routinely neutered
• An overiectomy can be performed for mares that are exhibiting aggressive behaviours
• Normally standing laparoscopy surgery

Neuromas:

• Thickening of nerve tissues
• Consequence from cushing/ servering testicular nerves during castration
• Inguinal pain, hind limb lameness, back pain & behavioural problems

Https://www.youtube.com/watch?v=NttfZwYQxow (Bitch laperoscopy)

Advantages:

• REduced amount of pain after the operation- The surgical wounds are much smaller with keyhole surgery 0.5to 1cm compared to 6-15cm
• Your pet will return to her noral level of exercise faster- normally rest for 10-14 days but after ;aparoscopic sugery only 5 days rest is required on adverage
• A significant reduced risk of complications- such as bleeding from the surgical site this is due to the surgeons having better visualisation of the ovaries & using advanced equipment to seal the vessels

Obesity:

• Relationship is not fully understood
• Owner compliance in monitoring food intake, exercise & weight gain will be the main limiting factor

No change in learnt stallion-like behaviour:

• Implant off-license

First aid kit contents

Crash box contents

Intravenous Acess & drugs

• Endotracheal tubes of various sizes (with tube tie for SA & intubeaze for cats)
• SA- laryngoscope ith various sizes of blades
• Ambu bag (if possible, ensure access to oxygen & breathing circuits are available nearby)
• Suction unit with attachment

• Syringes, & needles of different sizes
• Equipment for IV placement (clippers, various IV cannulas, skin prep, tape, IVFT connectors)
• Bandage scissors & materials
• CPR drugs & saline flush
• CPR drug dose charts & algorithum sheets

Asystole (heart not contracting- no heart beat)

• Atrophine- to increase heart rate
• Adrenaline & vasopressin- causes vasoconstriction-> increases blood pressure
• Atipamezole, naloxorie etc. - reversal agents

Fibrillating heart

• Lidocaine (anti dysarrhythmic drug) (PLus defib/ precordial thumb)

• Defibrillator with gel
• Tracheotomy/ thoracostomy kit

Cardiac Massage

Artificial Respiration

• If respiratory movements are absent, the paient must be supplied oxygen immediately
• Ideally, the patient should be intubated & IPPV given

endotracheal tube intubation in dog- Youtube Orotracheal intubation in the horse- Youtube Alternatively, give mouth-to-mouth resucition

1. Place patient on their side & extend the neck
2. Pull the tounge forward
3. Take hold of the nose & hold one hand under jaw to seal mouth
4. Blow into the nose, removing mouth before you inhale again
5. Be gentle to note overinflate the lungs, especially in smaller patients

Start ASAP if no heart beat

1. Place patient in lateral recumbency (if not already)
2. Extend neck & forelimbs forwards
3. Smaller patients (small mammals & cats) PLace your hand ventrally around on the other side of the chest wall just behind the elbows & apply even pressure squeezing the thumb & fingers together 120times per minute
4. Medium patients (dogs & foals) Use heel of the hand, other hand on top, interlock fingers, & lock elbows 100-120 times per minutes
5. Large patients (adult horses) 80 times per minute knees used to compress ventral thorax
6. Aim for compression of a 1/3 of chest width
7. Stop massaging the heart at regular intervals (every 2 mins) & observe whether or not heart has started to beat on its own again

Wound classifications

Incision Wounds

• Wound= An injury which there is a forcible break in the continuity of the soft tissue
• Wounds are classified into groups based on their cause & the resulting type of damage
• Classifications are useful as each wound type comes with varying treatments, complication, & healing success

• Causes: sharp objects Knife/scalpel, glass, tin etc.
• Clean edges with little damage to surrounding areas
• High chance of haemorrhage

Puncture Wounds

• Causes: Nail, thorn, fish hooks, teeth
• Small external wound with potential to be deep & effecting underlying structures
• Usually high infection risk due to cause!

Laceration Wounds

Avulsion/ degloving Wounds

• Causes: Dog fight, RTA, barbed wire
• Large irregular wound with damage to skin & superficial tissues
• May bleed less than incised wound
• Often contaminated/ foreign material present

• Focible seperation of tissue from its attachment
• Degloving- extensive removal of tissue
• Causes- RTA/ fences
• Usually highly contaminated due to cause & extensive skin damage

Contusions

Abrasion/ graze/erosion Wounds

• Causes- blunt forced trauma results in blood vessel rupture
• Yellow bruises caused by bilirubin- sign of healing
• Difficult to detect in horses!!!

• Causes: Friction causes epidermis to be removed to expose the dermis underneath
• Painful but usually superficial damage only

Haemotoma

Crush Injury

• Causes: Blunt force trauma or excessive head shaking
• Similar to bruise formation but more severe/ extensive
• Blood should eventually clot, contract & scar over time- but very painful!!!

• Crushing of internal structures due to fallen object/ RTA
• More common in smaller patients
• May cause both open & closed wounds

Complicated

Burns & scolds

• Complicated wounds are any wound that cannot be closed primarily without complex surgical manipulation.

Wound status

Wound Management steps

Appearence of wound

Patient temperment

Clean

• No break in sterility- surgically prepared & no contaminated body systems entered most surgical wounds

Clean-contaminated

• Surgery into a contaminated area but no obvious spillage into non-contaminated area

Contaminated

• Surgery into a contaminated area with spillage of contents into non-contaminate area OR open wound with no obvious infection

Dirty

• Wounds with discharge/ infection already present

• Control haemorrhage
• Suspectedinfection? swab / joint fluid sample taken for culture & sensitivity
• Decontaminate the wound
• Debridement of necrotic/ devitalised tissue
• Consider methods of wound closure
• Consider factors that may delay wound healing
• Apply dressing if appropriate
• Monitor progress

Presence of haemorrhage

Wound status

Animal condition

Position of wound

Infected?

Considerations

Size & shape at wound

Role of VN in wound healing

• TLC
• Comfort obs
• Bandage obs
• Repeat dressing changes
• Grooming
• Feed
• Puzzles/ games
• Out of cage/ stable time
• Client information

Decomtamination

Wound closure

Healing can be achieved inone of three ways (n.b.full restoration of anatomy is seldom(rarely) ever achieved)

• Primary or first intention healing)

Immediate closure of wound via surgery Clean, non-infected wounds

• Secondary or second intention healing

Allowing wound to heal by itself over time- increased scarring Infected/ large wounds

• Delayed primary or third intention healing

Allowing the wound to heal by itself for a period, then surgical closure later Contaminated wound

• Sterile water-soluble jelly in wound
• Clip & clean around the edges of the wound (allows assessment of wound)
• Lavage & gently clean wound (sterile saline, waer, povidone-iodine (0.1-1%), Chlorhexidine(0.05-1%))
• Usea 30ml syringe & 19G needle creates pressure of 8psi

Debridement

• Removal of foreign matter, necrotic/ non-viable or contaminated tissue

• Two ways of achieving this:

1) Surgical debriment Using a scalpel/ scissors to cut away necrotic tissue. Useful if wound is relatively fleshy & not infected 2)Debridement dressings Useful in initial stages of infected wounds

Factors that delay wound healing

• Movement
• Infection
• Tension
• Interference of blood supply
• Nutrition

• Persistent irritation & self trauma
• Tumour cells invading wound
• Presence of foreign materials
• Immune conpromised
• Steroids (antiinflammatories)

4 Stages of Wound Healing

Heamostasis Phase

• Blood vessels constrict to restrict blood flow
• Platelets plug formed in break of vessel wall
• Happens immediately- takes about 60 seconds
• To keep blood in vessel & reduce contamination

Imflammatory Phase

• Healing & repair cells move to site of injury (causing swelling)fluid coming

• Damaged cells & pathogens/bacteria removed
• Happens immediately- last about 2-5 days

Proliferative Phase or Granulation phase

• Wound is rebuilt with new granulation tissue
• Contraction of wound margins
• Epithelialisation
• Happens about 3-7days after injury

Remodeling Phase

• Wound fully closed
• Scar tissue formed- new tissue gains strength & flexability
• Happens about 5-7 days after injury- last up to 2yrs
• At least 9-12 months before strength regained

Bandaging

Golden rules of bandaging

• SA- always trim claws prior to bandage application
• Equine pick hooves out & brush clean
• Ensure feet are dry in both

• Horses lower limbs- bandage clockwise on right leg & anti-clockwise on left leg
• SA lower limbs- always include foot
• Always bandage distal to proximal
• Wrap in a spiral pattern overlapping by50%
• Ensure there is firm, even pressure- not too tight

DO NOT STICK TAPE TO FUR- PAINFUL TO REMOVE

Reasons for bandaging

• Holding dressings (which cover wounds) in place on any area of the patient
• Protect wound against contamination, patient interference/ further trauma & infections
• Pressure to minimise haemorrhage, swelling & oedema
• Support area & reduce movement of skin edges (which can result in wound breakdown)
• To absorb exudates/ discharge

Golden rules of bandaging

• Wash hands & wear gloves
• Consider nature/ position of wound when choosing material
• Collect & unwrap all material in advance
• Consider patient temperament (for placement & changes)

Always have an assistant to restrain patient Talk to your patient Prevent potential interference Ensure bandage is neat- this is all the owners will see!!!

Bandaging Layers

Passive Dressings

Primary Layer (Dressing)

Adherent

• Dry to Dry

Dry swabs directly applied to wound, debris & necrotic tissue adheres to swabs, and are pulled away when the dressing is changedEffective, cheap, but painful & can cause trauma

• Wet to Dry

As above but soaking with sterile saline, dressing dried out & when removed, takes exudate & debris, used to remove exudates & debris Still effective & cheap, but less traumatic

Bandages should consist of 3 layers

• Primary (Dressing)

• Secondary

• Tertiary

Needs to be

• Non-toxic
• Non irritant
• Non allergenic
• Absorbent
• Sterile
• Cost effective
• Allow gaseous exchange / vapour permable
• Provide thermal insulation
• Maintain a moist enviroment
• Promote wound healing (by passive or active methods)

Non-Adherent

• Perforated film dressing

Provides a barrier to protect the wound & keep it moist Trade names: Melolin or Rondopad

• Absorbing form dress

Absorbent dressing that supplies padding for protection Trade names: Allevyn or Renofoam

Primary Layer (Dressing)

• Alginates (E.g. Algisite)

Derived from seaweed, soft wovern dressing, reacting with sodium ions to form a moist, fluid holding gel

• Poultice

Used in equine Draws out fluid from wounds

• Others: Stardard dressings impregnated with: Silver, charcoal, honey, aloe vera, collagen etc.

Active Dressings

Unlike passive dressings, these contain active ingredients that promote wound healing

• Hydrocolloids (E.g. Blister plasters, Replicare)

Rehydrate & debride necrotic woundsStimulates granulation tissue

• Hydrogels (E.g. Intra-site, Flexigel)

Interactive: sheet or gel Rehydrates necrotic tissue, absorbs exudate, reduce oedema

Secondary Layer

Conforming layerStretchy layer designed to hold/ stabilise & compress the padding layer

• Standard conforming bandage: (trade name: knit-fix / knit firm / co-firm
• White open weave bandage (WOW)
• Crepe bandage
• Tubular bandage

Needs to

• Hold the primary layer in place
• Padding provides comfort & support
• Absorb exudates in case of strike-through
• Provide an even pressure
• Two layers to the recondary layers (Padding & conforming)

Wow

Crepe

Padding layerDesigned for varying levels of exudate & support:

• Softban: soft, natural (but thin) padding
• Foam rolls: Thicker supportive padding
• Cotton wool: heavy supportive padding
• Gamgee: Large animal cotton wadding (exudate ++)

Knit-fix

Tubular

Splints

Tertiary Layer

Needs to

• Protect the primary & secondary layer from soiling/ interference
• Holds primary & secondary layers in place

Usually elastic cohensive or adhesive Adhesive: Zinc oxide tape Adhesive: Elastoplast/ E-band Cohesive: Vet- wrap NB: Do not stick adhesive bandages to skin or fur or let the tertiary layer extend over that of the secondary layer

Often aapted from household objects such as broom handles, lolly sticks & drain pipesThis is only for first aid measure!!!

• There are also commercially made splints

These are for veterinary use- can cause problems if not fitted correctly Splint types

• Gutter splint
• Monkey splint
• Kinsey splint

Patient interference

Preventing interference

Needs to

• Check tightness, frequently, allow for swelling
• Guards e.g. Buster collars
• Do not allow bandage to touch ground
• Client education
• Adequate analgesia
• Suitable redressing times

Why?

1. Discomfort: Bandages can be tight and uncomfortable, causing the animal to try and remove them. Additionally, wounds can be itchy or painful, causing the animal to scratch or bite at the affected area.
2. Anxiety: Being in an unfamiliar environment, such as a veterinary clinic, can cause animals to feel anxious or stressed. This anxiety may cause the animal to try and remove their bandages or lick at their wounds.
3. Boredom: If an animal is kept in a confined space for a long period of time, they may become bored and restless. This restlessness can lead to the animal trying to remove their bandages or pick at their wounds out of boredom.
4. Instinct: Some animals may have an instinctual drive to lick or bite at their wounds as a way of cleaning them or promoting healing. However, this can actually make the wound worse and slow down the healing process.

Monitoring bandages

Monitor & remove bandage if...

• Chewing at the dresssing
• Foul smell
• Soiling or wetting
• Strike through
• Swelling above / below the dressing
• Sippage of the dressing

Poorly managed dressing, for any of these reasons can lead to very serious damage to the patient, even death

Alternative treatment: Larval therapy

Casts

• A specialised wound dressing technique
• A useful way to control movement during therapy
• Commonly used for wounds to the hoof capsule, heel bulb, tendons, cannon, fetlock & pastern areas in a horse
• May be used for fracture healing in small animal patients
• REstriction of space appears to allow wounds to heal without the formation of exuberant granulation tissue (proud flesh)
• Management involves careful monitoring to ensure tha complications are avoided

Maggot debridement therapy

• Live sterile maggots
• Microbiologically tested
• Chronic non-healing wounds
• Secrete a mixture of digestive enzymes
• Dead tissue is broken down
• Maggots ingest bacteria & debris (free range or bio bag)
• Can be irriating for animals
• Contrindications

Why

• To check its not too loose & going to fall off
• To check the wound is healing properly & monitor for signs of infection
• To check its not too tight & causing blood flow restriction

Cast checks

• Cracks & creases
• Check inside of top of cast
• Patient comfort
• Swelling above cast
• Patient behaviour
• Temperature

Top Equine emergencies

Lameness

Foot absescss

Synovial infection

Common Causes:

• Lameness
• Heat
• Strong pulse

Classified as any horse that is non weight-bearing Requires further investigation

• Lameness
• ++Temperature
• ++ swelling around joint/ sheath
• wound visible?

Treatment: Emergency procedure

Treatments:

• Vet/ farrier
• Hot tub
• Poultice
• Dressing

Common Causes:

• Foot abscess
• Synovial infection
• Tendon/ ligament injury
• Fracture
• Lymphangitis

Investigation can include:

• Xrays
• Ultrasound
• Synoviocentesis
• Surgury

Wildlife first aid/ nursing:

Ethics & finances

Admission & consent

• Barnes and Farnworth (2017) found 85.6% of 169 RCVS accredited practices agreed that the public expect veterinary practices to treat injured wildlife free of charge. • However, there are no UK organisations that accept sole responsibility for wildlife health. • The Code of Professional Conduct for Veterinary Surgeons states… • A Veterinary Surgeon cannot unreasonably refuse to provide first aid and pain relief to any animal of a species treated by the practice during normal working hours (RCVS 2012b). • They must provide the same level of care for all other species until a more appropriate centre can accept responsibility. • Initial emergency treatment should be provided free of charge during practice hours (RSPCA, 2016). • The RSPCA offer reimbursement for initial emergency treatment (or euthanasia) for animals over 1 kg which excludes many species presented in practice and only applies if the rescuer contacts the charity initially (and obtains an incident number). • If finances are not available to care for the wildlife casualty properly, then euthanasia should be the preferred option rather than poor care (Mullineaux, 2017).

• RCVS Code of Professional Conduct, Supporting Guidance on 11. Communication and Consent – Wildlife

• Consent is not required by the finder to give any treatment to a wild animal, including euthanisation

• The Wildlife and Countryside Act 1981

• The only exception for a wild animal to be taken from the wild is if its disabled & you are taking it for the purpose of tending to it & releasing it when it is no longer disabled

• BVZS Good Practice Guidelines for Wildlife Centres (2016)

• Good idea for the finger to sign and relinquish the animal into your care & to also give their consent for their personal information to be held & transferred to a wildlife rescue centre or rehabilitator

Personal into to gather

• Name, address & phone number of the rescuer
• The reason why the animal was rescued
• Any first aid already administered
• Any food & water offered
• The exact location where the animal was found

Wildlife first aid/ nursing:

1) Initial Examination/ Triage

List of commonly seen wildlife casulties:

• A full standard clinical examination should be carried out, as would be the case for any other patient
• Particular note should be taken of:
• Body condition, behaviour, hearing, vision, (Jaw, beak, limbs/ wings, feathering in birds)

• Grey squirrels
• Bats
• Foxs
• Deer
• Badgers
• Wild snakes
• Otters
• Seals
• Red squirrels

In order of prevalence:

• Garden birds
• Hedgehogs
• Birds of prey
• Wild rabbits
• Seabirds(e.g. seagulls)
• Waterfowls (e.g. swans)
• Game birds (e.g. pheasants)

Handling- Safety of handler

• As humans are predator to the wildlife, how we handle these patients must be quick & efficient

• Wildlife are clearly not domesticated (& have anatomy that acts as a level of defence e.g. breaks, teeth, spines) therefore it is essential that practices encourage & provide the use of personal protective equipment when dealing with wildlife casualities
• Most birds can be handled easily concious, using a towel as appropriate, to allow full clinical examination
• Anaesthesia is often needed to fully examine mammalian casualities

Wildlife rehab steps:

1. Initial examination, 'triage' & first aid
2. Diagnosis & ongoing treatment
3. Rehabilitation
4. Release

Handling- Safety of animal

Handling- Zoonotic diseases

• Any handling & interaction with wildlife is stressful & can, in some circumstances, lead to further exhaustion (e.g. respiratory distress, capture myopathy)
• Capture myopathy

1. Commonly seen in deer but any species can suffer with it
2. Causes hypothermia, ataxic, muscle weakness, renal & cardiac complications

• Complications can be reduced by:

1. Efficient handling & returning to enclosure
2. Cool enviroments when handled
3. Active efforts to reduce stimulus in the area e.g. noise

Avoid imprinting- any individuals which have become tame or confident around human activity are less likely to be able to be released & may need a captive enviroment for constant survival. Ethics of this should be considered.

• Another consideration is that wildlife can also act as resevoirs of zoonotic diseases, such as:
• Avian influenza, campylobacter, salmonellosis, chlamydia, leptospirosis, rabies, ringworm, toxoplasma gondii, tuberculosis
• We also need to consider the risks of disease transmission to domestic species within the practice (Mullineaux, 2014)

Bats should always be handled using appropriate gloves because of potential rabies virus risks

Common buzzard- showing signs of respiratory distress commonly seen when in captivity

Hedgehogs are commonly infected with ringworm, a common zoonosis- gloves should be worn.

Euthanasia

Determining suitability for release

The following are common reasons for wildlife euthanasia:

• Lack of finances that would impact on patient welfare
• Animals listed under Schedule 9 of the WCA 1981

Unsuitability for future release:

• Unconcious or comatose animal
• Behavioural abnormalities
• Damage to jaw or beak likely to interfere with feeding & grooming
• Permanent or long-term reduction/ loss of hearing &/or vision
• Loss, or permanent loss of function, of a limb or wing (including fractures)
• Permanent feather damage or loss of waterproofing in birds
• Fracture of the pelvis with narrowing of pelvic canal
• Loss of reproductive function

• Returning an unfit casualty consitutes as 'abandonment' which is regarded as an offence under legislation
• Regarding non-indigenous animals of the UK, animals listed under Schedule 9 of the wildlife & countryside act (WCA) 1981 can only be kept in captivity for rehabilitation with an appropriate license, however immediate veterinary care is permitted.
• These species cannot be deliberately released but some can in certain areas with a license.

Invasive species

• Grey squirrel
• Muntjac deer
• Canadian geese
• Raccon
• Ringed-neck parakeets
• Ruddy ducks
• Etc.

2) Diagnosis

Diagnostic Testings

• Animals usually present for one of three reasons:
• Acute trauma

1. Bites from domestic animals
2. Wounds from fights/ gun pellets
3. Fedglings fallen from nest +/- been attacked
4. Legs stuck in traps/ amputated

• Disease

1. Infectious disease (e.g. leptospirosis)
2. Parasite infection
3. Poisoning (e.g. rat bait)

• Ababdoned (on seemingly abandoned) as neonates/ juveniles)

• When considering further diagnosis, consider the cost-benefits
• Often a good clinical examination is all that is required to make a triage decision
• Remember in house blood machines will not usually be suitable for wildlife haematology & biochemistry will only be of value if reference ranges are available
• faecal analysis for parasites
• Survey radiographs can be beneficial for a triage assessment of extent of injuries

3) Rehabilitation- Treatment

• The principles of first aid are no different for wildlife casualities than for other species and should include (as appropriate):
• Fluid therapy, analgesia, bandaging & wound care, appropriate accomidation, provision of an appropriate ambient temperature, nutrition.

Fluid therapy

• Crystalloid fluids such as hartmann's solution can be used in all species
• Shock rates, of typically 10-20ml/kg as a bolus repeated as necessary, should be followed by maintenance fluids (at minimum)
• The wings or medial metatarsal vein can be used in bids & superficial veins are easily accessible in the larger mammals, allowing intravenous fluid therapy
• Alternatively, fluids can be given under the skin (subcutaneously)
• Birds can be easily crop tubed (gavaged) using oral rehydration fluids

3) Rehabilitation- Treatment Continued

Analgesia

• Medicines given to other species can be used off-licence where needed:
• Generally vets should avoid the use of corticosteroids & only use antibiotics where there is clear clincal need. The use of these drugs in wildlife can be especially counterproductive

Bandaging & wound care

• The principles of bandaging & wound care are the same for wildlife as for domestic species
• As well as being useful to stop haemorrhage, bandaging is essential first aid for wing trauma in birds

Accommodation

• Appropriate bedding

1. Provides somewhere to hide, warmth, support & absorbency
2. Should be cheap, easily disposed of, or easily cleaned, & should not cause any digestive or mechanical problems

• Remember birds may need to be on water, perches or suitable aviary floors

1. Recumbent birds require adequate padding to prevent the development of keel sores

• Cover the fronts of kennels with blankets to provide extra privacy
• Hides can also provide a place for the individual to go where they are unable to see humans

• Careful attention should be given to the housing of wild animals in a veterinary practice
• Consider the place the species play in the ecosystem & segrate predator & prey species (this may need to be isolated)
• Passing human(& animals) traffic & noise should be kept to a minimum
• There should be easy access to the accommodation
• Suitable kennels are ones that are insulated, secure, not easily damaged, & easy to clean (Wild animals, especially the larger ones, will damage unsuitable kennels)
• Mammals that are clearly still dependent (or un-feathered birds) should be placed in an incubator at 28-30'C

4) Release

Nutrition

• Remember, releasing an unfit animal is abandonment
• Move to a more suitable facility once first aid is completed
• Information fromthe finder regarding location is important

1. The wildlife casualty would have an established territory & be familiar with food sources, so if released in a unknown enviroment, the animal would be vulnerable whilst finding new resources)

Some wildlife casualties usually have very high metabolic rates. Once dehydration & hypovolaemia have been corrected 'energy' must be provided, most easily as 'food'. Identification of both species & age is key to providing the correct level of care & correct type of nutrition.

Neonates:

• An oral rehydration solution is the preffered first oral feed, followed by a puppy ilk replacer in the short-term
• It will be necessary to stimulate urination & defecation in young mammals

Adults:

• Mashed cat & dog food can be used for carnivorous, insectivorous & omnivorous birds & mammals

1. Commercial 'liquid' diets are available (e.g. critical care formula, Emeraid products, Hills a/d

• Reliably sourced dead day old chicks are suitable for birds of prey, badgers & foxes
• Small fish (sprats) are suitable for seabirds & waders
• It is useful to stock a variety of seeds for granivorous birds & bird pellets for gamebirds, waterfowl.

The nursing process

Nursing care- the profession or practice of providing care for the suck & infirm

1) assessment

• Data collection
• To assess individuality of the patient
• Subjective & objective observations
• Questionaire with clients
• Information from team members

2) Nursing diagnosis

• Not concerned with making judgements about the disease (this is confined to the veterinarian)
• Identify actual & potential problems
• Identify priorities amongst problems

3) Planning

The information gained during the assessment stage can be used to set goals & formulate a plan to reach those goals

• A goal & nursing intervention(s) have to be set for each actual & potential problem
• A distinction should be made between short & long term goals

They should be

• Specific
• Realistic
• Measurable

• Aims
• To solve actual problems identified
• To prevent any potential problems identified becoming actual problems
• To prevent the problem treated reoccuring
• To helpthe patient be as comfortable as possible even if death is inevitable
• To help the patient & client cope with those problems that cannot be solved

• Time orientated
• Action orientated

Orem's Model

4) Implementation/ intervention

Published in- 1971 updated between 1980-2001One of the first nursing care models used in humans by nursesStates nurse/ practitioner should only become involved when the patients ability to achive the 8 needs is compromised other wise its the persons &/or family members responsibilty

• 'Doing stage'
• It is important that nurses make it clear what decision has been made
• Any information should be clearly recorded on the care plan
• Treatment administered should always be initialised

5) Evaluation

• This is a vital part of the nursing process
• From evaluating the planning & nursing interventions it can be seen whether the patient &/or client has benefited
• Questions to be asked if you have not achieved your aims for the patient
• Was the goal partly achieved?
• Has the problem improved at all?
• Has the problem worsened?
• Was the goal appropriate?
• Do we need interventions from other team members?

8 universal self care needs

• Sufficient intake of air
• Sufficient intake of water
• Sufficient intake of food
• Satisfactory elimative functions (faeces & urine)
• Activity balanced with rest
• Balance between solitude & social interaction
• Prevention of hazards to human life, human functioning & human well-being
• Promotion of human function & development within social group & the desire to be 'normal' ( animals dont have desire to be normal)

Most care plans are basic on these 8 key factors

1 main problem in animals is they cant make decisions on their own care

Implementing nursing care plans (NCP)

Advantages

• Nursing care plans/ models provide a framework in which to follow the nursing process
• Provide consistency in care given
• Less conflict between nurses on care required
• Incorporates care given by other team members
• Gives direction & guides decision making

Orem see's the nursing plan as fluid & a continous flowing process to continually assess any new arriving potential & actual problems arise

2) Lifestage

• Adulthood
• Senior citizen/ OAP (geriatric)

Roper, Logan & tierney Model (RLT)

Time from birth to death:

• Baby/ toddler
• Adolescence

Requires prior knowledge & understanding of life stages for each specieswill vary for each individual- some make it to old age, some sadly do not

little more indepth than orems

3) Dependence/ independence continnum

Acknowledges there are times when a patient will vary in their ability to carry out AOL's Identify reasons the patient cannot carry out activity Level of competency plotted on a continuum Promps implementation of effectivive nursing care to allow the patient to carry out each activity Total dependence Total independence

RPL- five parts

• Activities of living (AOL) x12
• The patient lifespan
• Dependence- independence continuum
• Factors affecting AOL x5
• Individuality in living

4) Factors influencing the activities of living

• Politico- economic

• Sociocultural
• Enviromental

• Biological
• Psychlogical

1) Activities of the living x12

• Maintaining a safe enviroment
• Communicating
• Breathing
• Eating & drinking
• Eliminating
• Personal dressing & cleansing (grooming
• Controlling body temperature
• Mobilising
• Working & playing

Biological if they cant eliminate on their own Physicological if they cant sleep Enviromental- hospital setting, brigt light, other animals, noises ect Politico- not every country has the same treatments available

• Expressing sexuality
• Sleeping
• Dying

5) Individuality in living

• How patients carry out AOL's differently

Things that may appear abnormal but is normal for that animal

The ability model (orpet & jeffery 2007)

The work of roper, logan, tierney & orem influenced this model

• Ability assessment chart- TEN ABILITIES
• Gather information about animals usual routine from owner
• Identifies actual & potential problems (never forgetting influential factors
• Ientifies a long term goal
• Use each actual & potential problem to identify a short term goal & plan to reach it
• Only veterinary specific nursing plan!!

Andrea jeffery

Hilary orpet

Is the animal able to...

• Eat an adequate amount
• Drink an adequate amount
• Urinate normally
• Defecate normally
• Breathe normally
• Maintain body temperrature
• Groom itself
• Mobilise adequately
• Sleep/ rest
• Express normal behaviour (interact normlly)

Other influencing factors

• there are other factors that need to be taken into account as they may affect the care provided:
• Cultural differences
• Owner compliance
• Financial implications
• Life stage

Pain

Signs of pain:

Veterinary patients cannot verbilise, or self report on the ammount of pain they are experiencing It is importan to recognise sign of pain in patient

Facial expressions

• Such as in rabits, mice, rats & whorses where 'grimance scales' have been delevloped & tested in reasearch.

Posture/ body activity

• Abdominal pain (colic)

Flank watching, lip curling, stretching as if to urinate, inappetence, teeth grindding, sweating, lying down & getting up, grunting/ groaning

• Limb pain (lameness)

Obvious lameness, inability to weight bear, weight shifting, persistent resting of limbs, standing abnormally

• From the ethical perspective
• There are no positive effects for the patient
• Essential parts of patient care
• Impedes recovery
• Painful mouth may prevent an animal from eating
• Painful chest may interfere with normal respiration
• Painful abdomen may reduce the likihood of passing urine &/or faeces

VocalisationAnimals normal behaviour is import here. what is the nature of the changesBehaviour Excessive sleep, withdrawl or irritability is generally believed to be indicative of chronic pain states, but if the patient suddenly awakens or vocalises it can be interpreted as an indicator of acute pain Physiological indicators Heart rate increase, blood pressure increase, oxygen saturatkon decrease & breathing patterns (rapid, shallow or irregular) variations are all often attributed to the pain response Biological markers Stress hormones such as cortisol & adrenaline can be measured in serum or saliva saples

Although we want to remove all the animal pain it may not be ethical to do so, for instance if an animal with a fracture you want them to stay still & not apply pressure if you make them feel toocomfortable they are going to want to get up & move around which could potentially cause more damage (want to find balance) Prey animals such ashorses, rabbits, hamsters mask pain as in the wild the predator pics off the weakest link

Pain scores

Resolution of pain

Pain scoring systems can be utilised to quantify pain: putting a number on the level of pain This helps determine :

• Whether pain exists
• Whether analgesia is sufficient
• In order to monitor patient progress in terms of pain management

Cats & dogs

• The colorado state university feline/ canine acute pain scale (CSU_FAPS or CSU_CAPS)
• Glasgow composite measure pain scale (CMPS_Feline/ Canine)

Rabbits & rodents

• Rabbit grimance scale (RbtGS) ect

Horse

• Horse grimance scale (HGS)
• The Colorado state university equine comfort assessment scale

• Inform vet
• Accurately administer pain relief under the vets supervision if directed to
• Record dose given, drug name, time given on hospilitalisation chart/ nursing care plan
• Continue to closely monitor the patient

Bowel function management

Aperients

Defecation

Appearance varies considerably between different species, know what is normalDaily monitoring of faecal output should be monitored & recorded to include:Amount Consistency

Definition: A Medicine or food that acts as a mild laxative' Examples: Laxapet- excellent for constipation Lactulose- constipation, liver failure as binds ammonia Katalax- often used for cats for furball treatment (stomach tube) Liquid paraffin- gastrointestinal lubricant often used to treat colic Klean-prep- used before a patient has abdominal surgery Docusol- used to empty large intestine for disgnostic/ constipation

Presence of parasites

Frequency & ease Colour

Defecation Terminology

• Tenesmus- painful, ineffectual straining
• Consitpation- a condition with hardened faeces & difficulty emptying the bowels
• Diarrhoea- rapid expulsion of soft non-formed material from the rectum
• Melaena- production of dark, tarry faeces +/- mucus. Evidence of the blood loss in the upper gastrointestinal tract
• Haematochezia- fresh red blood in the faeces

Aperients often used for: Often given on a regular basis to long haired cats to prevent hairballs Can be used post-enema May be sued pre-surgery to help flush GI tract e.g. diagnostics, colonscopy when need to be clear view Used post sugery to prevent straining Lactalose has another benefit of binding ammonia- so used in patients with liver failure are needs to be take to avoid diarrhoea

Diarrhoea

May not always be any other clinical signs of illnessBarrier nursing- zoonotic?

• Always assume infectious until otherwise known

Check for soiling- barrier creams & clean bedding Antispasmodic agents may be given for abdominal pain Fluid loss hrough diarrhoea can result in electrolytes imbalances

Other treatments used for constipation: Exercise Nasogastric tubes Intravenous fluids if due to dehydration

• Monitor hydration status

Bowel function management (enemas)

Enemas Definition: 'A liquid substance/ preparation placed into the rectum & colon of a patient to stimulate evacuation of faecal materialNot intended to flush colon Ideal is to ditend the rectum & colon Aim is to initiate expulsion reflexes

Therapeutic purposes

Reasons for giving an enema Constipation/ impaction Diagnostic or surgical procedures

Amounts: Warm water 36-37degrees Cats & small dogs- 20ml/kg Medium/large dogs/ foals- at least 1L (double if over 30kg) Adult horses, too large, aperients more common Proprietary agent (Micralax):as directed Contrast medium: as directed- one off

Method

Prepare equipment, warm water to body temperature 36-37*cWear PPEPatient should be handled & restrained appropriately (standing or lateral recumbency Lubricate tip of applicator Insert nozzle of applicator into the anus, rotate & advance into the rectum Introduce the chosen solution Digitallly remove any faeces if necessary SA-if conscious, supply litter trays/ take patient outside to defecate Monitor amount & appearance of any faeces passed

Used if x-raying

+/- general anaesthesia/ sedation

Rotating helps get into rectum

Higginson's syringe

Enema bucket

bucket of soapy water

PPE

Measuring jug

Sedation

Infectious agents

Bacteria Replication

Binary fission

Infection classificationsSystemic infections

• Widespread throughout the body

Exogenous infection

• Caused by organisms not normally in the body that have entered from enviroment

Nosocomical infection

• Acquired in hospital

Latrogenic infection

• Resulting from the acction of the vet

Conjuguation

Why is this important? Infection control will prevent the incidence of infection in veterinary practice In order to unerstand why & how we must utilise infectioncontrol in veterinary practice we need to know what actually causes infectious disease

DefinitionsInfectious agents are organisms that are capable of producing an infectious disease An infectiousmicro-organism is known as a pathogen A parasite is an eukaryotic organism that lives on or in a host organism & gets its food from or at the expense of its host

Capsule (the slime layer)

• Acts as a barrier from the enviroment, assit in sticking to surfaces, prevent host's WBC's getting too close enough to engulf them

Cell wall- n.b. most bacteria have a cell wall

• Maintains the cell shape so that it doesnt burst

Cell (plasma) membrane

• Lies just within the cell wall & is selectively permeable to control passage of substances into & out of the cell

Cytoplasm

• Thick fluid inside the cell membrane containing dissolved substances such as nutrients, waste products & enzymes

Bacteria

Two attached on the outside of the cell...Pili

• Numerous straight hair-like appendages which have nothing to do with movement (allow attatchment to cell linings, or transfer genetic material from one bacteria cell to another)

Flagella

• One or more thread like structures that create movement by rotating in a corkscrew fashion

Within the cytoplasm we have...Chromosome

• Single chromosome (extensively coiled molecule of DNA) which contains the hereditary information of the cell & helps the cell function

Plasmids

• A small'extra' piece of DNA which can replicate independently from the chromosome, they include extra learned information.

Ribosome

• Where RNA is made into proteins

Bacteria

Spore formation

Toxigenicity

Gram stain

• Toxins are poisonous substances that have a damaging effect on the calls of a host
• Exotoxins

• Toxins are released into surrounding enviroment (e.g. circulatory system or food)
• Can be destroyed by some chemicals & heat
• Toxoids will stimulate the production of antitoxins
• Endotoxins
• Part of the cell wall of certain bacteria released when the cells die & disintegrate
• Responsible for non-specific reactions in the body such as fever
• Can cause endotoxic shock

Gram stain, is a method of staining used to classify bacterial species into two large groups: gram-positive bacteria and gram-negative bacteria. Identification of certain types of very small bacteria is difficult & specialist:

• Chlamydia

• Mycoplasma (no true cell wall)

• Sometimes species of bacteria produce spores/ endospores
• The chromosome in the bacterial cell replicates, a septum forms & a forespore is produced. A spore coat in formed around the forespore, then it is released by repture of the parent cell
• Enables survival during unfavourible conditions
• Most common in Bacillus (& more specifically clostridium) species)
• Often found in soil
• Extremely resistant - can survive years
• Sterilisation process is required to destroy spores

• Rickettsia

Optimal conditions

Bacteria

Mucopurulent exudate draining from vulva

In order to survive & replicate bacteria must have:

• Water
• Essential nutrients
• Correct PH- usually about ph7.4
• Correct temperature- optimum is body temp
• Corect gaseous enviroment- bacteria can be classified according to their gaseous enviroment
• Obligate or strict aerobes- must have oxygen for growth
• Obligate anaerobes- will only grow in the absence of oxygen
• Facultive anaerobes- may grow with or without oxgen
• Micoaerophiles- will only grow if the percentage of oxygen is lower than that of atmospheric air

The urine body containing mucopurulent exudates

Straw-coloured fluid within the cranial vagina

Bacilli examples

• Contagious Equine metritis (CEM) -taylorella equigentails (-ve)
• Tetanus- clostridium tetani (+ve)
• Anthrax- bacilus anthracis (+ve)
• Botulism- clostridium botulinum (+ve)
• Salmonellosis- salmonella spp (-ve)
• E coli- Escherichia coli (-ve)
• Pseudomonus (-ve)
• Kennel cough- bordetella bronchiseptica

Vibrios

• Campylobacter- campylobacter spp (-ve)

Top of tail sticks out, worried expression, rigid ears

Muscle spasm, stiff gait

Prolapsed of third eyelid which may cover half the eye & flared nostrils

Viruses

Spirals examples

Spirilla Spirochaetes

• Leptospirosis- leptospira spp (-ve)
• Lymes disease- borrelia burgdorferi (-ve)

Obligate intracellular parasites

• Must invade a host in order to replicate & survive
• Virus particle (virion) is composed of two parts;
• Nucleic acid- either DNA or RNA
• Caspid- the protein coat

Cocci examples

• Summer pneumonia- Rhodococcus equi (+ve)

Diplococcui

• Meningitis- neisseria meningitidis/ meningococcus (-ve)

Streptococci

• Pneumonia- streptococcus pneumoniae/ pneumoccus (+ve)
• strangles- streptococcus equi (+ve)
• Streptococcus intermedius (+ve)

Staphylococci

• Skin disease/ pyoderma
• MRSA- methicillin resistant staphylococcus aureus (+ve)
• Staphylococcus spp (+ve)

Cocci examples

The virus particle

MRSA

Strangles

Virus examples

• Rabies (RNA)- enveloped
• Parvovirus (DNA)- non enveloped
• Equine herpes virus (DNA)- enveloped
• Distemper (RNA)- enveloped
• Influenza (RNA)- enveloped
• Rotavirus (RNA)- non-enveloped
• Feline herpes virus (DNA)- enveloped
• Feline leukaemia (RNA)- enveloped
• Myxomatosis- (DNA)- enveloped

Viruses

Incubation

• Once a host cell has been infected, here is a lag time before symptoms are seen
• The incubation period
• Clinical signs are seen once a large number of particles infect a large number of cells

Rabies

ReplicationVirion must find a suitable Receptor cell

Parvovirus

Equine herpes virus

Examples

• Candida albicans (thrush) found in the intestinal tract in healthy animals & elsewhere in unhealthy animals

• Malassezia pacydermatis may be found on normal skin, but can cause skin disease in the dog & sometimes the cat

Protozoa

• the lowest form of animal life
• Unicellular organisms

reproduce via binary fission

Examples

• Coccidia (produce oocysts)
• Isospora
• Eimeria
• Cryptosporidium parvum
• Sarcocystis
• Toxoplasma gondii
• Neospora caninum
• Hammondia

• Giardia spp
• Others
• Babesia

• Leishmania

Moulds

Examples

• Dermatophytes (ringworm)
• Microsporum canis (dogs & cats)
• Trichophyton mentagrophytes (dogs, cats,rabbits, guinea pigs)
• Trichophyton equinium (horses)

Aspergillius fumingatus (dogs, horses, birds)

• Multicellular
• Have filaments called hypha(e)
• Some moulds have walls/ septa in between cells
• Others have no septa & exist as a long cell with many neclei within it
• Reproduce to produce spores

Fungi

• Grow aerobically
• Pathogenic fungi are classed into 2 types:
• Yeasts

• Moulds

Yeasts

• Unicellular
• Larger than bacteria cells
• Reproduce asexually via budding

Prions

Ectoparasites

• Small protein particles
• Cause infectioin within the CNS, leading to death
• Long incubation period (from 2mths to 20yrs)
• Affected animals exhibit nervous signs & incoordination
• Diagnosis nomally via brain tissue at PM
• Research is aimed at being able to make a diagnosis in the live animal
• Do not seem to affect horses, dogs or rabbits

• Ectopaarasites are parasites that live on the outer surface of the body

Small animal ectoparasites include:

• Fleas
• Flies
• Lice

Equine ectoparasites include:

• Mites
• Lice
• Others e.g. flies, midges

• Mites
• Ticks

Examples

• Spongiform encephalopathy in sheep (Scrapie)
• Bovine spongiform encephalopathy (BSE)
• Feline spongiform encephalopathy (FSE)

Endoparasites

• Endoparasites are parasites that live within the body of a host

Equine endoparasites include:

• Nematodes
• Cestodes
• Trematodes
• Bots

Small animals endoparasites include:

• Nematodes
• Cestodes

Intravenous fluid therapy

Intravenous fluid therapy