Veterinary Case Study Escape

Veterinary Clinic Escape

Click here first

Next

Skippy

You are an assistant in a busy veterinary hospital. You arrive for your shift and escort the first client/patient into an exam room. Skippy's owner has brought him to your veterinary clinic because he is straining in the litterbox. You will succeed when the patient is discharged from the hospital. -get moving! ⏱

Start

Case Study...

Case Study...

Alright, he is not feeling well. Let's get a full assessment started by taking a history. Choose a question.

How long has your cat had this problem?

Why do you think Skippy is having trouble urinating?

Is your cat having trouble urinating?

Next

Other good questions: How long ago did you notice a change in Skippy? What do you feed Skippy? How is his appetite? Any vomiting or diarrhea? General lifestyle questions What is he doing in the litterbox?

Client responses

Client responses

Client responses

Next

The exam

Dr. Smith examines Skippy. Click on the buttons to see his findings. Click on the crystal ball when you are done.

FILL IN THE BLANKS

hydrated

Tacky mucus membranes indicates that the patient is likely ____________

dehydrated

dehydrated

has poor O2

hearing

seeing

feeling

Palpation in this context means that the Dr. is ___________ the patient.

feeling

What is most likely to be the patient's problem/condition? _______________________

UTI

urinary blockage

urinary blockage

urethral tumor

Next

After the exam, Dr. Smith determines that Skippy has a urinary blockage. He sedates Skippy and administers analgesics. Then he passes a urinary catheter, clearing the urethral blockage.

Next

orders

Dr. Smith wants to get bloodwork while the patient is anesthetized. A CBC and Chemistry Panel are ordered. What information will each test provide?

Next Page

Next

Next

Figure 2. (A) Right lateral radiograph from a 15-year-old castrated domestic shorthair cat presenting with a 3-day history of periuria and 1-day history of stranguria. Radiographs show a urethral stone (white arrow) and bladder distention (black arrows) consistent with urethral obstruction. Click on the blue arrow button for more info.

Blood Tests

Solution

Drag each component to the correct test box. When you are finished check your answers by clicking on the solution button.

Enzymes

CBC

Chem Panel

Hormones

Lipids

Proteins

RBC

WBC

Question 1/3

Question 1/2

Question 2/3

Question 3/3

The results are in. Click below to learn more. Using your notepad, make a note of any values outside the reference range.

CBC

Chemistry Panel

Urinalysis

Next

FILL IN THE BLANKS

Proteins

The CBC can provide information about _________ ,

WBC

WBC

glucose

an infection

which can indicate ______________.

sing

diabetes

anemia

an infection

Did you know that images are a support to add info?

Option 1

Option 2

Option 3

Did you know that images are a support to add info?

Option 1

Option 2

Option 3

Did you know that images are a support to add info?

Option 1

Option 2

Option 3

Well done!

An increase in both BUN and creatinine is a condition known as azotemia. The presence of azotemia is indicative of dehydration, renal dysfunction, or blockage. Veterinarians determine the cause with the patient’s history and physical exam findings. In Skippy’s case, his inability to void his bladder caused the azotemia.

Did you know that images are a support to add info?

Option 1

Option 2

Option 3

Did you know that images are a support to add info?

Option 1

Option 2

Option 3

Did you know that images are a support to add info?

Option 1

Option 2

Option 3

Urinalysis results

• When the quantity of crystals progresses to the point that a plug is formed in the urethra the cat becomes obstructed.
• In many cats the plug that forms is made up of struvite crystals.
• There will be repeated trips to the litter pan with straining, and crying in pain upon attempting to urinate. These symptoms can be confused with constipation. Sometimes a few drops of bloody urine are produced, although many cats cannot urinate at all.
• As the problem progresses these cats can start vomiting, become depressed and dehydrated, and stop eating. After several more hours the kidneys are unable to function and dangerously high levels of phosphorous and potassium build up in the blood stream. If not corrected, the affected cat will die from a buildup of toxins or cardiac arrest due to the high potassium.

A Great result

Good news! Skippy has responded well to his treatment. All of you hard work and TLC has paid off. Skippy is ready to go home.

Vital Signs

Temperature: 98.6⁰F Pulse: 180 bpm Respiration: 60 bpm CRT: <2 sec. Weight: 11#, BCS 6/9

• Skippy is the only cat in the household
• he stays indoors
• he is up to date on vaccines

CBC

RBC WBC

Chem Panel

Enzymes Hormones Lipids Proteins

Watch this video to see how a male cat is unblocked using a urinary catheter.

Skippy

MN Siamese DOB: 01/01/2015 Wt: 10 lb. Up to date on all vaccines

Next

• very small urine clumps in litterbox
• vocalizing while squatting in litterbox
• frequently licking his genital region

Which components are outside of the reference/normal range?

Which components are outside of the reference/normal range?

• Does your cat produce urine when it goes to the litter box?
• Does your cat howl, meow, or cry out in pain when posturing to urinate?
• How many times a day does your cat go to the litter box?
• How often do you clean the litter box?
• Is your cat showing any behaviors to lead you to believe your cat is in pain? (This should lead to further questions regarding hiding behaviors, abnormal aggression, seclusion from others in the household, or hunched posture.)
• Have you seen your cat vomit or found vomitus in the household? If yes, how many times, and what did it look like?
• How many other cats do you have in the household?
• How many litter boxes do you have?
• When was the last time you saw your cat defecate?

Taking a history...

Watch this video for some tips on client communication.

Types of buttons

Navigation:

All of the above buttons will give you more information. Be sure to explore all of them.

• When answering a multiple choice question, be sure to hit send after your selection(s).
• If a window opens you can close it by clicking anywhere or the x button in the upper right corner.

Not the best choice. You should always use the pet's name.

BUN and Creatinine

Diagnostic significance

Blood urea nitrogen (BUN) and creatinine can be used to evaluate kidney function. Elevated levels of these compounds can indicate kidney dysfunction. Urine should be obtained at the same time that the blood sample is analyzed. This data together is used to get a complete picture of the patient's health.

Not the best choice. This is a closed end question. The owner can simply answer yes or no, not giving us enough information. Also, you should always use the pet's name.

• Does your cat produce urine when it goes to the litter box?
• Does your cat howl, meow, or cry out in pain when posturing to urinate?
• How many times a day does your cat go to the litter box?
• How often do you clean the litter box?
• Is your cat showing any behaviors to lead you to believe your cat is in pain? (This should lead to further questions regarding hiding behaviors, abnormal aggression, seclusion from others in the household, or hunched posture.)
• Have you seen your cat vomit or found vomitus in the household? If yes, how many times, and what did it look like?
• How many other cats do you have in the household?
• How many litter boxes do you have?
• When was the last time you saw your cat defecate?

Correct! This open ended question is the ideal choice. The client will need to describe what they have observed. A good follow up question would be to ask how long they have observed this behavior?

• symptoms began 24 hrs ago

• vomiting
• lethargic
• not eating

The severity of the situation will determine the next course of action:

• If the patient is in severe distress (e.g., is painful, is in respiratory distress, has abnormal mentation), moving the patient from the examination room into the treatment room, notifying the rest of the team, and starting interventions immediately would be appropriate.
• If the patient is in an emergent situation and unstable based on physical examination and vitals obtained, treating the most life-threatening condition first would be appropriate.
• If red flags are raised based on patient history and physical examination findings but the patient is not in immediate distress, leaving the patient in the examination room while you alert the veterinarian could be the appropriate course of action.