advanced vet patient care 🫀 Flashcards

Question

what is exudate

Answer 1

exudate consists of wound fluid plus liquified necrotic tissue created by WBC's via the autolytic debridement and oedema caused by inflammation. exudate levels are proportionate to the amount of contamination, infection and tissue damage in a wound and should subside as the wound transitions from the inflammatory/ debridement phase to the repair stage. good bandaging and antibiotics will help wound healing

Answer 2

its normal

Answer 3

its infected

Answer 4

provide a functional and cosmetic repair, relief of pain and distress to the animal, economic and time efficient procedures and prompt decision making in the event of signs of delayed healing

Answer 5

- assess the whole px initially and stabilise - time since injury - what caused the wound - degree of contamination - degree of trauma at the site - necrosis - concurrent disease/medication - is treatment / cost a viable option for the px? - euthanasia

Answer 6

PRIMARY CLOSURE - healing by first intention - this is the immediate closure of a wound after injury. this process can be used to close clean or clean-contaminated wounds with surgery - classification- clean - management- immediate closure no tension

Answer 7

DELAYED PRIMARY CLOSURE - this type of closure occurs 2-5days after injury, before granulation tissue is formed. this process can be used to close clean-contaminated or contaminated wounds. - classification- clean-contaminated or contaminated. questionable tissue viability - management- lavage + debridement until healthy. appropriate dressing, closure after 2-3 days

Answer 8

SECONDARY CLOSURE - this type of closure occurs at least 5 days after injury and after healthy granulation tissue has formed. this process can be used to close contaminated or dirty wounds. - classification- contaminated or dirty - management- lavage + debridement , appropriate dressing, closure after 5-7 days, granulation bed has begun to form

Answer 9

HEALING BY SECONDARY INTENTION - this type of closure occurs when a wound heals on its own by forming granulation tissue, epitheliasing and contracting. - second intention is not selected for areas such as a limb on which the wound involves 2/3 or more of the limb because the risk that wound contraction will cause decreased mobility and or a tourniquet effect. - classification- unsuitable for surgical closure. extensive contamination and devitalisation - management- open wound management. lavage and debridement. appropriate dressing. allowed to heal.

Answer 10

1. contaminated wounds should never be closed primarily. if in doubt treat as infected. 2. don't manage an open wound for an excessive period. 3. if trauma caused the wound, let wound declare itself to give it time to disclose what tissue is viable or not.

Answer 11

1. wear gloves 2. ensure adequate analgesia is provided and had time to take effect 3. GA usually required 4. keep covered with sterile, non-lining dressing prior to prep 5. swab wound bed for culture and sensitivity 6. insert sterile water soluble jelly into wound 7. clip around wound- total injury should be visible, clip passed unviable tissue and provide a 2cm margin 8. debridement

Answer 12

helps to remove debris, reducing contamination and significantly reduces infection risk

Answer 13

20ml syringe

Answer 14

19G needle

Answer 15

debridement prepares the wound bed by removing debris, contamination and necrotic tissue remaining after lavage. Debriding will reduce the risk of infection and promote healing

Answer 16

the number of microorganisms that the wound is contaminated with

Answer 17

forms when multispecies bacterial communities organise onto a wound surface and form an extracellular matrix of polysaccharides, proteins and nucleic acids to provide protection and ensure survival.

Answer 18

prolonged inflammation and healing delay

Answer 19

autolytic mechanical surgical

Answer 20

Use of primary layer applications such as alginates, hydrocolloids, hydrogels, honey, or sugar. This form of debridement is the most selective because it spares healthy cells and intact matrix molecules while removing damaged cells and matrix with microscopic precision.

Answer 21

Physical removal of tissue adhered to a dried-on dressing; nonselective and, thus, the least desirable form of debridement. Also, very painful so requires anaesthetic and analgesia.

Answer 22

Gold standard technique. Tissue removed by surgeon according to characteristics, such as color, texture, vascular supply, and temperature; selective on a macroscopic level.

Answer 23

sterile environment and are applied to the wound bed. Maggots may be applied with custom pre-constructed dressings or Individually created dressing to keep the maggots securely In the wound bed.

Answer 24

Using a soft purpose made scrubbing brush such as Debrisoft

Answer 25

Acemannan: Derived from aloevera and used on burns, dermal ulcers, lacerations, and radiation therapy wounds.11

Answer 26

Derived from kelp and used in the inflammatory and repair stages. Absorb fluid from the wound, convert to a gel, and thus should not be used on dry wounds.

Answer 27

Derived from living tissue and used in the inflammatory and repair stages. Provide a matrix for cell migration.

Answer 28

Living organisms such as leeches or maggots. Leeches decrease edema and venous congestion. Maggots debride necrotic tissue, and their secretions provide antimicrobial benefits.

Answer 29

Nonpasteurized honey (e.g., Manuka) provides antibacterial benefits, reduces edema, hastens sloughing of devitalized tissue, and promotes granulation tissue formation.

Answer 30

Composed of hydrophilic polymers. Used during the repair stage on low-exudate to medium-exudate wounds. As exudate from the wound is absorbed, the hydrocolloid liquefies to form a gel. These dressings are usually used in wounds that require additional moisture and natural debridement. Hydrocolloids actively stimulate wound healing and encourage debridement as they degrade on interaction with wound exudate. They are best used in dry to semi-dry wounds, requiring maintenance in an optimal moist environment. Dressings are left in place for several days and provide a near-ideal wound healing environment.

Answer 31

Hydrogels are used in wounds thought to be at risk of drying out. The main role of hydrogels is as a fluid donator for dry wounds. Hydrogels can both donate and trap water; therefore, they are useful for absorbing wound exudate, as well as hydrating and debriding necrotic material within the wound. A secondary dressing is required for hydrogels to work efficiently – this should ideally be a foam dressing with a semi-permeable film backing to maintain humidity and a moist wound environment.

Answer 32

Reduces edema and bacterial proliferation and promotes granulation tissue formation.1 Application should be at least 1 cm thick

Answer 33

sutures surgical staples surgical reconstruction- skin flaps or skin grafts surgical drains - active or passive

Answer 34

covering the wound with an appropriate dressing and bandage; it does not mean the wound is left open to the environment.

Answer 35

to work synergistically with the cells, providing the best environment possible to support the body’s wound healing process.

Answer 36

Healing is progressing well Reconstructive surgery is not needed to prevent contracture or scarring that might inhibit mobility or be cosmetically unacceptable The patient tolerates bandaging.

Answer 37

maceration- excessive production of exudate spilling onto adjacent healthy skin increasing susceptibility to infection excoriation- contact with toxins from the wound causing damage to top layers of skin

Answer 38

-Check underlying cause -Re-evaluate the best dressing for appropriate absorbency -Change the dressings more frequently -Protect peri-wound tissue with barrier cream -Ensure thorough cleaning at bandage changes

Answer 39

Granulation tissue is built by fibroblasts, which secrete new extracellular matrix molecules (eg, collagen, elastin) and endothelial cells, which build new blood vessels

Answer 40

bright red and moist. it has a slightly uneven appearance.

Answer 41

Process when Epithelial cells on the skin edge migrate onto the granulation tissue, which provides the oxygen, moisture, and surface required for epithelial cells to proliferate, cross the wound, and create a new epidermis.

Answer 42

1mm/ 10 days - 10cm wound takes 500days to completely epithelialise.

Answer 43

medium exudate as low exudate still has absorbency and excess exudate allows the dressing to become fully saturated which will lead to maceration of the surrounding healthy tissues

Answer 44

-Effective wound assessment -Good knowledge of stages of wound healing and how dressings create optimal wound environment -Location of the wound site -Consideration of the cost of dressings

Answer 45

These foams are highly absorbent and act by drawing excess exudate away from the wound, maintaining some moisture through humidity, which keeps the wound moist. They are commonly applied on top of other products – for example, hydrogels or honey. Foam dressings are now available with antimicrobial properties.

Answer 46

PHMB is as an antimicrobial agent exhibiting broad spectrum activity against bacteria and fungi. This PHMB within the dressing attacks bacteria in wound exudate as it is absorbed. This type of foam dressing is effective against Staphylococci (including MRSA), Pseudomonas, Proteus etc.

Answer 47

A relative newcomer to the veterinary dressings market, this is a gauze dressing saturated in a 20 per cent hypertonic saline solution. This dressing promotes biological cleaning and the autolytic debridement process in non-infected and highly exuding wounds.

Answer 48

Wounds that produce vast quantities of exudate can be very difficult to manage. New dressings have been designed to cope with very high volumes of exudate by incorporating polyacrylate crystals into the dressings in combination with hi-tech silicone adhesives to make them very “wearable”.

Answer 49

Silver and its salts have antiseptic and antibacterial properties. The silver in the dressings ionises to release active silver ions into the wound. The dressings require activation prior to use, by moistening with water for 10 seconds. Effective against Pseudomonas species, MRSA, E coli and common yeasts and fungi, including Candida.

Answer 50

-Use of low level laser waves to enhance wound healing and reduce/prevent infection -Increases blood flow and oxygenation -Reduces inflammation and pain -Speeds up wound healing

Answer 51

Use of negative pressure to encourage epithelialisation and contraction of the wound through the use of a vacuum pump sealed within a plastic dressing

Answer 52

1. devitalised tissue 2. exuding wounds 3. infection

Answer 53

-Provide optimum conditions for growth of bacteria -Delays the inflammatory phase -Reduces the viability of the wound bed -Many causes; localised to wound vs systemic issues Requires debridement

Answer 54

Development – contamination, colonisation, critical colonisation, infection -Signs – erythema, pain, oedema, localised heat -Biofilm – protective coating produced by bacteria. Causes folding in of skin edges -Causes damage or deterioration of the wound delaying healing, may cause systemic illness. Care AMR infection -Check wound is properly debrided and cleaned, exudate level is managed, antimicrobial dressings (consider removal of debris and endotoxins from wound bed), systemic antimicrobials where indicated (culture & sensitivity)

Answer 55

Environment: Dedicated/Isolated room. Incontinence pads & ventilation PPE: Gown, gloves, face mask Vet & Nurse discuss options & plan. Vet would carry out any debridement required. Aseptic Technique Swab wound for culture & sensitivity to allow approp antibiotic treatment Lavage Solution: PHMB breaks down biofilm. If unavailable active 8-12psi – bag of fluids/giving set/3 wat tap/20ml syringe/18-20G needle. (Wound irrigation systems are now available) debridement & isotonic solution Amount lavage 100ml/cm2 Dressings: Antimicrobial e.g. PHMB, silver or honey. Good control of exudate Redress according to exudate volume -2-3 days maximum Waste – Non-hazardous non-infectious Vs Hazardous Infectious

Answer 56

1. Remove exudate and fluid from surgical sites especially where the surgery has caused dead space 2. Allow monitoring of the surgical site ie abdominal surgeries- monitor free fluid composition and amount and replace loses 3. Aid wound healing and reduce the risk of dehiscence

Answer 57

-Use capillary flow -Gravity -Penrose drains -Made of rubber latex -Wider= more effective drainage -Increased risk of infection of both the site and surrounding areas -Can cause irritation of the skin when in place of from fluid Sometimes the end is covered in absorbent material to absorb exudate -Cheap and often used in GP or for minor infected wounds such as bite wounds

Answer 58

-Closed System, collects fluid into a reservoir -Apply an artificial pressure gradient to pull fluid or gas from a wound or body cavity -Less risk of ascending infection -Higher efficacy -Can be positioned in any position as not relying on gravity -More expensive -Continuous or Intermittent Negative Pressure

Answer 59

Active suction drains Fenestrated drain attached to tubing that is then attached to a grenade Air is removed from the grenade to create the negative pressure When full or if there is an issue with the drain positive pressure will be present Reduce dead space, remove air and fluid Used for abdominal surgeries or larger wounds such as STS removal Stay in until become non productive usually 3-5 days

Answer 60

Same as Jackson pratt Not used as to empty they have to be disconnected from the close circuit tubing unlike Jackson Pratt drains that have a separate area for emptying

Answer 61

Completely closed active suction drains Same as above the drain has fenestrated holes Tubing to the reservoir bottle This bottle is already primed as a vacuum DO NOT REMOVE THE CLAMP A seal must be formed usually 4-6hrs post surgery then the clamp can be released allowing the drain to function The reservoir has numbers to allow for recording volumes They are bulky and not well tolerated in smaller species Can be secured using surgical vests or cardio- vests

Answer 62

2-4ml/kg/24hrs

Answer 63

when the fluid production is less than 2ml/kg/24hrs

Answer 64

-Barrier nurse -Excellent hygiene -Minimum PPE of gloves -Passive- Clean regularly to prevent irritation and infection, ensure environment clean -Active- Empty when +ve pressure, DO NOT EMPTY Q4hrs just because the hospital sheet says drain, check if +ve pressure, empty if –ve pressure, check connections and mark on –ve pressure no requirement to drain -If reservoir/canister is full, they must be replaced not emptied and reused -Every time they are emptied, fluid/air volume must be recorded if concerned check sample -Prevent patient interference

Answer 65

- tubular elastic net dressing size 10 -pet suit

Answer 66

Where complete upper airway obstruction has occured

Answer 67

- they provide Airway protection - Airway patency - Mechanical ventilation - If unable to intubate ie UAO - Laryngeal paralysis sometimes requires a longer term trach stoma

Answer 68

The net result of lung exposure to fluid, solid matter and bacteria can be minor, with a temporary physical reduction of the number of alveoli available for gas exchange while the immune system removes the problem. Alternatively, such exposure may lead to local or widespread pulmonary inflammation or infection – termed aspiration pneumonia, acute lung injury or acute respiratory distress syndrome. This complication has serious implications

Answer 69

If the tracheostomy tube is too small, or partially or fully obstructed, the patient will still breathe with increased respiratory effort. The resulting negative intrathoracic pressure during inspiration will continue to predispose the animal to gastro-oesophageal reflux and, if the patient’s head moves below the level of the oesophagus, regurgitation may occur. This phenomenon is a risk in tracheostomy patients, as regurgitation does not involve a coordinated sequence of events causing the pharynx and larynx to protect the airway (as occurs during vomiting). Inhalation of fluid is therefore more likely, and the decreased effectiveness of the cough reflex and mucociliary escalator means the lungs are at greater risk of exposure to fluid, food and bacteria.

Answer 70

Wound exudate from the tracheostomy site flows down the trachea, thus increasing lung exposure to fluid and bacteria.

Answer 71

More particulate matter is introduced to the respiratory tract;

Answer 72

Pressure can no longer build up behind a closed glottis, so fluid or solid matter within the airway can no longer be ejected effectively and will accumulate within the airway or flow (under gravity) to the lungs;

Answer 73

This causes inflammation of the respiratory epithelium, leading to increased mucus production, which, in turn, dries, causing thicker secretions or solid plugs. The mucociliary escalator no longer functions normally as the cilia are affected by the adverse conditions, particularly in the region of the tip of the tracheostomy tube;

Answer 74

immediately.

Answer 75

Humidification filters that can be attached to the end of the tube are one of the simplest ways to humidify inspired air for these patients. These are disposable. If the filters are unavailable, there are several alternative techniques which can be employed to provide humidification. One of these is the instillation of sterile isotonic saline (Burkitt Creedon and Davis, 2012). In order to provide proper humidification, 0.5–3 mls of sterile isotonic saline should be instilled into the tracheostomy tube hourly. Prior to instillation, the outside areas of the tracheostomy tube should be cleaned with chlorhexidine solution and sterile gauze. After cleaning and drawing up the sterile saline into a sterile syringe, the needle must be removed quickly and saline should be squirted into the tube without touching the sides. Nebulisation is another alternative method. Nebulising sterile saline for 10–15 minutes every 4–6 hours

Answer 76

Good wound care is vital for all tracheostomy tube placements, as these sites become prime locations for bacterial growth. Hands should be washed and gloves worn prior to handling the tracheostomy tube or area surrounding it. Sterile gloves should be used when cleaning the wound. The area should be cleaned around the incision and under the tube with chlorhexidine solution-soaked sterile gauze. Chlorhexidine solution should be diluted to 0.05% concentration for cleaning the wound (Burkitt Creedon and Davis, 2012). The gauze must not be dripping as the solution should not be allowed to get inside the incision. The nurse can begin working at the wound edges and work outward, away from the incision. No ointments should be used in the incision and wound area. Sterile cotton-tipped applicators may also be used instead of sterile gauze squares. Dry gauze pads can be placed around the tracheostomy tube after cleaning to aid in the absorption of exudate. The gauze pads should not be cut as the small fi bres that will be loosened by the cutting action could be inhaled by the patient. Instead, the gauze should be simply folded as needed to fi t around the tube. The tube ties should be checked each time the wound is cleaned, to ensure the tube is secure, and should be changed whenever they become soiled.

Answer 77

Suctioning Patients with tracheostomy tubes produce various amounts of secretions. Regular suctioning is required but must be done very carefully as complications can occur. The patient should be pre-oxygenated for several minutes prior to suctioning. Aseptic technique must be followed (Fudge, 2009). A sterile, soft, long catheter that is pliable with fenestrations should be used. Silicone catheters are often preferred, but even a red rubber catheter may be used. The suction unit should not be turned on until the catheter is in place. Suction should be intermittent and light while moving the catheter in a circular motion to withdraw it. This process should take less than 15 seconds. Oxygen should be supplied and the patient given a break before repeating the process. Suctioning should be discontinued if there is a vagal response, cough, gag reflex, or any other adverse effects (Figure 5). This procedure should be practiced in advance of performing it (Figure 6). Veterinary nurses should use an alcohol based hand solution or disinfectant scrub to cleans hands and fingernails prior to the procedure. Ideally gloves should be worn in addition to proper hand sanitisation protocols.

Answer 78

The inner cannula of the tracheostomy tube should be removed every 4–6 hours at minimum and replaced with a new sterile inner cannula. The original cannula can then be cleaned and soaked in a chlorhexidine solution to be used for the next exchange. Additional saline may be infused into the outer lumen if copious secretions are noted. If single-lumen tubes are used, the entire tube requires replacement. Care should be taken not to do this too often as it will irritate the wound. Therefore, tubes with inner cannulas are preferred to single-lumen tubes. Coupage and changing the posture of the patient may also facilitate removal of respiratory secretions, especially if done immediately after nebulisation. While care of a patient with a tracheostomy tube is intensive and involved, when the outcome is a healthy patient returning home, this in itself is a reward. Veterinary nurses must remember to start care immediately once a tube has been placed, and to always be on the watch for complications such as dislodgment, obstruction, or occlusion of the tube. They must also be diligent about preventing secretions from building up and blocking the tube, providing aseptic wound care, and providing humidifi cation of air.

Answer 79

A Thoracostomy drain is an in-dwelling catheter into the pleural space to drain air or fluid. Accumulation of fluid or air in the pleural space separates the lungs from the chest wall thereby applying pressure and creating difficultly for the lungs to expand and fill with air, consequently causing clinical signs of dyspnoea, tachypnoea and hypoxia

Answer 80

All staff must be properly trained or could cause life-threatening iatrogenic pneumothorax WHO handwash & aseptic technique The clamp must be compressed with a metal C clamp, and sealed with an adaptor and capped with a 3 way tap Record volume of air and fluid separately Frequency – Q4hrs for the first several hours then redice as volume decrease and clinical symptoms improve. A maximum 3–5ml of negative pressure should be applied to the drain to avoid trauma to the pleura and occlusion of the tube by mediastinal or pleural tissue Entry site can be cleaned with dilute chlorohexidine The drain should be. The drain site dressing must be removed and replaced twice daily using a sterile Monitor tube for clamps becoming disconnected Monitor Patients Respiratory rate, effort and pattern, mm colour and SPO2 (tissue perfusion) ECG monitoring (cardiac impact)

Answer 81

-These are long stay catehters for use in patients that will Be hospitlised for longer periods. -They allow multiple blood draws from the line -Allow larger volumes or rates of fluid therapy -Allow higher concentrations of medications in constant rate infusions that may be more irritant to perivascular tissue. -Monitor central venous pressures

Answer 82

coagulopathy, raised intracranial pressure, thrombosis, or a contaminated site/skin condition over the vessel

Answer 83

-Aseptic Tehcnique -Who handwash & Open glove -Remove bandage material and examine site Q12hrs e.g. phlebitis, haematoma, kinking, dislodgement -Clean site with dilute chlorohexidine & apply new dressing -Bandage in place. Any exposed ports should be secured in body stocking -Alcohol disinfecting caps should be applied over the needle free ports when not in use and should be changed each time the port is flushed -Swab each port with alcohol prior to use -Ensure that the catheter gate clamps are CLOSED whilst needle free valve is activated to prevent air embolism! -All ports not in use must be flushed every 4 hours with heparinised saline. (use patient labelled bag of saline replace Q24hrs) -If port becomes occluded – change needle free port for a red closed cap to prevent use & label DO NOT USE -Dogs – walk on harness to avoid lead on jugular region

Answer 84

The use of oesophagostomy tubes is indicated when feeding is required for more than 7–10 days in patients with a functioning, unobstructed oesophagus and healthy gastrointestinal tract. In patients with disorders of the nasal passages, jaw bones, oral cavity or pharynx oesophagostomy tubes bypass the injured site and enable enteral feeding.

Answer 85

Kinking, Blocking, Vomiting & Tube dislodgement

Answer 86

Oesophagostomy tube dressings should be changed and the stoma site cleaned daily at the minimum as infection can occur

Answer 87

drinking food metabolism

Answer 88

respiration urine faeces skin

Answer 89

Insensible losses are where the body cannot adjust the losses. They will sometimes increase the amount it loses (e.g. with infection), but not decrease.

Answer 90

Sensible losses are where the body can adjust the fluid loss to conserve or get rid of fluid.

Answer 91

10-20ml/kg/day

Answer 92

30-40ml/kg/day

Answer 93

a solute dissolved within a solvent

Answer 94

a solid, liquid or gas dissolved to make a solution

Answer 95

the liquid portion of a solution

Answer 96

concentration equal to plasma

Answer 97

concentration higher than plasma

Answer 98

concentration lower than plasma

Answer 99

a substance that dissolves in water and becomes ions which are charged particles. is conducts an electric current when dissolved / melted in water

Answer 100

positively charged ions

Answer 101

negatively charged ions

Answer 102

for cell function to occur

Answer 103

by the amount of bicarbonate and carbon dioxide

Answer 104

carbonic acid

Answer 105

decrease or increase in hydrogen or bicarbonate

Answer 106

the movement of water from an area of low conc to an area of high conc through a semi-permeable membrane until concs are equal

Answer 107

the pressure with which water molecules are drawn across the semi-permeable membrane

Answer 108

the force excreted by a fluid against a wall which causes movement of fluid between compartments

Answer 109

the balance between hydrostatic pressure generated by the heart and the oncotic pressure generated by the proteins present in plasma

Answer 110

In capillaries, hydrostatic pressure (also known as capillary blood pressure) is higher than the opposing “colloid osmotic pressure” in blood—a “constant” pressure primarily produced by circulating albumin—at the arteriolar end of the capillary . This pressure forces plasma and nutrients out of the capillaries and into surrounding tissues. Fluid and the cellular wastes in the tissues enter the capillaries at the venule end, where the hydrostatic pressure is less than the osmotic pressure in the vessel. Filtration pressure squeezes fluid from the plasma in the blood to the IF surrounding the tissue cells.

Answer 111

ECF and cytoplasm conc needs balanced so the osmotic pressure within the cell prevents excess fluid absorption. the fluid and nutrients move into cells from ECF. the fluid and waste is pushed out of cells to ECf. the fluid that is not absorbed into capillaries is then taken to the lymphatic system.

Answer 112

any self-regulating process by which an organism tends to maintain stability despite external factors

Answer 113

ECF is essential for normal cellular functions, and its composition is tightly regulated by homeostatic mechanisms. These mechanisms ensure that variables like pH, electrolyte concentrations, and fluid volume remain within optimal ranges, allowing our bodies to function effectively

Answer 114

brain, adrenal glands and kidneys

Answer 115

The main component of ECF is interstitial fluid, which surrounds cells. Blood plasma is another significant component of ECF, especially in animals with a circulatory system. Lymph constitutes a small percentage of interstitial fluid. Transcellular fluid accounts for about 2.5% of ECF1.

Answer 116

Osmolality is controlled by hypothalamic osmoreceptors that stimulate thirst and the release of antidiuretic hormone (ADH) from the posterior pituitary gland. If net water loss from the body exceeds net water gain, plasma osmolality will rise and hypothalamic osmoreceptors then stimulate thirst and release of ADH. The augmented water intake and increased reabsorption of water by the kidney combine to decrease plasma osmolality towards normal.

Answer 117

a drop in blood pressure or in fluid volume causes the kidney to release renin angiotensin is release from the liver renin acts on angiotensin to from angiotensin 1 the angiotensin converting enzyme is released from the lungs and it acts on angiotensin 1 to form angiontensin 2. angiotensin 2 also acts directly on blood vessels stimulating vastcontriction but it also acts on the adrenal gland to stimulate the release of aldosterone. aldosterone acts on the kidneys to stimulate reabsorption of salt and water.

Answer 118

loss of fluid that has similar osmolarity to plasma. e.g. vomiting and diarrhoea

Answer 119

loss of fluid that has a lower conc of water than plasma e.g diabetes insipid and panting

Answer 120

a loss of fluid that has a higher conc of water than plasma e.g. hypoadrenocorticism

Answer 121

water, water and electrolytes, blood, plasma

Answer 122

plasma become hypertonic. fluid moves from ICF to ECF by osmosis

Answer 123

loss hypotonic, isotonic or hypertonic. movement depends on tonicity of fluid. hypertonic dehydration as water only loss. hypotonic dehydration - fluid moves from ECF to ICF by osmosis isotonic dehydration- no fluid movement

Answer 124

most serious isotonic loss therefore no fluid movement

Answer 125

increased PCV, loss of plasma proteins proteins must be replaced

Answer 126

cannot drink e.g. injury cannot concentrate urine e.g. diabetes insipidus

Answer 127

vomiting and diarrhoea metabolic disorders

Answer 128

trauma surgery warfarin posioning

Answer 129

burns scalds

Answer 130

a lack of fluid in the interstitial compartment

Answer 131

a lock of fluid in the intravascular compartment

Answer 132

Mucous membrane moisture Skin turgor Eye position within orbit

Answer 133

Capillary refill time Heart Rate Pulse Quality Blood Pressure

Answer 134

1. Packed Cell Volume Test (PCV) – inexpensive and quite revealing. For each 1% increase in PCV a fluid loss of 10 ml/kg has occurred. This can be unreliable where there is preexisting anaemia. 2. Haemoglobin – dehydration results in an increase in haemoglobin values due to loss of plasma water, but care should be taken when interpreting results from an anaemic animal. 3. Total Plasma Protein (TPP) – dehydration causes a rise in values. This can be measured from either a biochemistry test or from your refractometer. Measuring the total plasma protein is done in the same way as measuring the specific gravity of urine. 4. Blood urea & creatinine – parameters will rise in the dehydrated patient but will also be high in an animal with renal disease. 5. The specific gravity of urine – can also be an indicator of dehydration. If urine is highly concentrated this can be a sign of dehydration.

Answer 135

1-2ml/kg/hr

Answer 136

under 0.5ml/kg/hr

Answer 137

1.015- 1.045

Answer 138

1.020-1.060

Answer 139

dehydration

Answer 140

is a measure of the amount of plasma proteins in the blood; these include albumin, globulins and fibrinogen. Due to effect of osmosis during dehydration, TS will become elevated

Answer 141

When breathing is inadequate, carbon dioxide (CO2, a respiratory acid) accumulates in the body, contributing to an acid state. The lungs can quite rapidly expel large quantities of carbon dioxide to reduce the quantity of acid in an effort to restore balance

Answer 142

The kidneys can also excrete more acid in their waste products, and retain more bicarbonate (HCO3−, a base or alkaline chemical), which is an important buffer employed within the body to help resolve or compensate for increased acid accumulation. If alkaline, the kidneys attempt to retain more acid and eliminate more bicarbonate (base substance) in an effort to maintain balance

Answer 143

clinical disease processes and can aid the clinician in identifying underlying causes of illness in the patient.

Answer 144

how many hydrogen ions or molecules of C02 are present

Answer 145

Hydrogen ions (H+) are a product of metabolism of protein and phospholipids. Carbon dioxide (CO2) is a byproduct of the metabolism of fat and carbohydrates. CO2 combines with H2O in the presence of carbonic anhydrase (enzyme/catalyst) to form carbonic acid.

Answer 146

The body contains several mechanisms in order to maintain the desired “normal”, pH level, which is called buffering. A buffer is a compound that can accept or donate protons (H+) and minimize a change in pH

Answer 147

Metabolic acidosis occurs when there is an increase in the amount of acid in the body. This can be due to abnormal metabolic function, or ingestion of an acid or substance that is metabolized into an acid. There is a decrease in HCO3 and a compensatory decrease in CO2.

Answer 148

vomiting diarrhoea renal failure shock

Answer 149

Metabolic alkalosis occurs when an excessive loss of sodium or potassium affects the kidney’s ability to control the blood’s acid‐base balance. There is an increase in HC03 and compensatory increase in C02.

Answer 150

vomiting stomach contents only over administration of bicarbonate

Answer 151

Where an acid state in the body occurs when respiratory system cannot excrete acid. Respiratory acidosis occurs when the lungs do not expel CO2 adequately. There is an increase in CO2, accompanied by a compensatory increase in HCO3−.

Answer 152

Respiratory obstruction Acute respiratory failure Hypoventilation for any reason Anaesthetic problems

Answer 153

Respiratory alkalosis occurs when too much CO2 is expelled from the bloodstream (typically from hyperventilation). There is a decrease in CO2 with a compensatory decrease in HCO3−.

Answer 154

Hyperventilation Pain, stress Hyperthermia Excessive IPPV

Answer 155

fluid volume required= Maintenance volume + Deficit volume + Ongoing Losses

Answer 156

50ml/kg/day

Answer 157

10ml x % dehydration or % PCV increase

Answer 158

4ml/kg x vomit or diarrhoea or %burns

Answer 159

fluid volume / 24hr fluid volume / 60 mins fluid volume / 20 fluid volume/ 60secs

Answer 160

crystalloids colloids blood/ blood products

Answer 161

solution containing water and electrolytes. the electrolytes move easily across the endothelium into the interstitial space. can be classed as isotonic, hypotonic, and hypertonic

Answer 162

solution containing large molecules; plasma expanders. they remain in intravascular space longer than crystalloids.

Answer 163

a plasma expander with 02 carrying abilities

Answer 164

r dogs with anaemia, Oxyglobin acts as an immediate oxygen bridge to stabilise anaemic dogs until the underlying condition can be controlled and the animal's body can produce its own new red blood cells. The treatment, which is now available in an individual 60ml transfusion bag, as well as a 125ml bag, maintains tissue oxygenation even when there is severe stenosis of blood vessels. It has a viscosity which is more than water but less than blood for ease of flow through vessels and also increases circulatory volume

Answer 165

whole blood- haemorrhage, anaemia, haemolysis plasma - burns, hypovolaemia packed red cells- anaemia cryoprecipitate- clotting/ bleeding disorders

Answer 166

oral subcutaneous intravenous intraperitoneal intraosseous

Answer 167

Use unopened, sterile materials Check bag is correct fluid, in date and clear Prepare aseptically Insert catheter up to the hilt Ensure catheter is taped in dry Change catheters ~ every 48-72hrs and dressings as needed if appropriate. Flush catheter every 6hrs. DO NOT use fluids from drip bag Check for signs of Phlebitis. Use Phlebitis Score system. (swelling, bruising, pain and perivascular fluid) Check line regularly for kinks, blockages and interference Prevent patient interference Standard Operating Procedure (SOP) for Care

Answer 168

Check clinical signs for hydration level Use calculated volumes Monitor TPR and mucous membranes Record urine output and SG Monitor PCV Monitor ongoing losses (Central venous pressure) Record all findings on fluid monitoring chart/ hospitalisation sheet Review fluid therapy plan regularly Monitor for signs of overperfusion Weigh patient daily

Answer 169

Central venous pressure (CVP) is an estimate of the blood pressure in the right atrium. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. CVP is directly proportional to the volume of blood in the anterior vena cava and venous tone. This pressure is decreased by hypovolaemia or vasodilation and is increased by fluid therapy or vasoconstriction. It can be used to guide fluid therapy administration in critically ill patients, or in patients with cardiac disease to help prevent volume overload

Answer 170

This is when the patient receives too much fluid. This is quite common in small mammals, cats and small dogs, which is why fluids must be carefully monitored. Fluid overload can lead to peripheral oedema, which can lead more seriously to pulmonary oedema and can lead to respiratory distress and death. Excessive administration of colloids can lead to right sided heart failure, and congestive heart failure. Crystalloid overload, in the early stages causes diuresis – the animal may produce lots of very dilute urine resulting in an increased risk of peripheral oedema and then pulmonary oedema, and death

Answer 171

shock is an acute circulatory failure resulting in inadequate tissue perfusion and energy production. as shock develops, pxs deteriorate rapidly

Answer 172

Cardiac output Circulating volume Peripheral vascular resistance

Answer 173

Inadequate perfusion Triggers compensatory mechanisms Altered efficacy of all systems

Answer 174

when the compensatory mechanisms can fix the underlying problem

Answer 175

Baroreceptors detect reduced cardiac output, stimulating adrenaline and noradrenaline release - causing increased heart rate and contractility Hypoxia of tissues results in metabolic acidosis. Ventilation increases to address acid – base balance. Hypoperfusion of kidney activating the RAA system. Aldosterone acts on the collecting ducts to retain Na and H2O. Also causes peripheral vasoconstriction.

Answer 176

Where shock is not treated, compensatory mechanism start to fail Fluid and proteins leak from circulation into the tissues due to peripheral vasodilation. Viscosity of blood increases. Acidosis increases As gut becomes ischaemic, bacteria enters the blood stream – toxic Increasingly stuporous or comatose

Answer 177

to much cell death that cannot be reversed

Answer 178

Systemic Inflammatory Response Sydrome (SIRS) Inflammtory Injury to one organ system that can cause damage to others. Can have infectious or non-infectious causes Disseminated Intravascular Coagulation (DIC) Activation of haemostatic mechanisms inducing a prothrombotic state leading to bleeding tendancies Multi-Organ Dysfunction (MOD) SIRS & Septic Shock can lead to MODS. Every organ and system within the body can be affected Death

Answer 179

Hypovolaemic Septic/ Distributive Cardiogenic Obstructive

Answer 180

The heart pumps well but Decreased, inadequate circulating volume Most common type of shock Occurs due to loss of blood, fluid or plasma Results in a severe tissue hypoperfusion E.g. trauma, ruptured abdominal organs, surgery, V &/or D, burns

Answer 181

Clinical Signs: * Tachycardia * Reduced pulse quality * Absent peripheral pulses * Prolonged CRT * Changes in mm colour * Reduced urine output * Obtundation Signs depend on phase of compensation/decompensation

Answer 182

Also classed as a Distributive shock due to hypotension Heart pumps well but there is peripheral vasodilation Gram –ve (and occasionally +ve) bacterial infection Endotoxins released from ruptured bacterial cells Toxins in the circulation increase capillary permeability, causing uneven fluid distribution E.g. peritonitis, pyometra, intestinal strangulation, gastric haemorrhage

Answer 183

* Brick red mucous membranes * Tachycardia * Rapid CRT * Bounding pulses * Neurological signs o Depressed o Collapsed

Answer 184

Hyperdynamic: Increased cardiac output to improve tissue perfusion Patient is compensating Clinical Intervention – fluid therapy Hypodynamic Myocardial dysfunction Patient is decompensating Prognosis is poor

Answer 185

Reduction in cardiac efficacy Heart loses its ability to pump effectively, leading to a reduction in cardiac output Resulting congestion in liver and lungs, and oedema Not a common type E.g. cardiomyopathies, pericarditis, congenital defects, arrythmias

Answer 186

* Dyspnoea * Presence of a heart murmur * Rhythm abnormality * History of heart problems * Very high HR (>220bpm in dogs) * Ascites

Answer 187

Obstruction of the normal blood flow The heart pumps well but outflow is obstructed Causes of obstructive shock include pericardial effusion and pulmonary thromboembolism Due to pericardial effusion, blood is unable to fill the ventricles and hence cardiac output is reduced Removal of the obstruction will cause resolution of the signs of shock

Answer 188

* Pale mucous membranes * Tachycardic * Slow capillary refill time

Answer 189

Tachycardia Hypotension Tachypnoea Pale mms Prolonged CRT Hypothermia + cold extremities Weakness/depression Reduced urine output As progresses, dilated pupils and coma Different types of shock can display other signs e.g septic shock causes congestion of the mms and an increased CRT

Answer 190

History Physical examination MM colour, CRT, hydration Heart rate Blood pressure Pulse rate and quality – peripheral pulse Temperature – core and periphery Blood tests – Hb, PCV/ TS, Total protein, glucose, BUN, lactate measurement

Answer 191

Lactate – a byproduct of anaerobic respiration. Therefore a direct indicator of inadequate cell perfusion. In one study of dogs requiring intravenous fluid therapy, those with lactate concentrations higher than the reference interval 6 hours after presentation were more likely to die (Stevenson et al., 2007).

Answer 192

Identify and rectify cause Establish adequate ventilation and oxygenation Restore optimum intravascular volume Maintain adequate cardiac output and renal perfusion Maintain optimum internal metabolic environment

Answer 193

Oxygenate; resuscitation where required Provide analgesia Control haemorrhage IVFT, increase circulating volume + restore perfusion Bicarbonate to address metabolic acidosis/ Hartmanns (Antibiotics) Maintain body temperature

Answer 194

Isotonic Fluid Dose Dogs: 90ml/kg (full blood volume) Cats: 50ml/kg As the patient won’t have lost its full blood volume, it is advised to administer 25% of this and then re-assess cardiovascular parameters. Continue until parameters returned to normal Hypertonic Fluid Dose Dogs: 4 to 5 mL/kg Cats: 2 to 4 mL/kg Administered over approximately 10 minutes. Infusion rates greater than 1 mL/kg/min may cause a vagally mediated bradycardia, vasodilation, and bronchoconstriction Hydroxyethyl Starches Dose Dogs: up to 20 mL/kg (divide into 5ml/kg boluses & reassess) Cats: up to 10 mL/kg (divide into 2.5-3ml/kg boluses & reassess) Titrate to effect Crystalloid & Colloid Dose Dogs: Colloid @ 5-10ml/kg + Crystalloid @ 4-45ml/kg Cats: Colloids @ 1-5ml/kg + Crystalloid @ 25-27ml/kg (equivalent to approx. half the shock dose) Titrate to effect and continually reassess clinical parameters to adjust type and rate of fluids

Answer 195

Carry out first aid Select method of oxygen delivery Organise fluid administration, IV, jugular, bilateral?, central line, intraosseous, lactated ringers / colloids / blood / Oxyglobin Analgesia – under the direction of the veterinary surgeon Dressings – haemorrhage control Warming patient Stress reduction measures Constant monitoring vital signs and records Liaise with owners

Answer 196

- heart rate - blood pressure - mm - temperature - respiration (visual) - repeat bloods- PCV re evaluating px

Answer 197

Blood collection Storage of blood and blood products Blood types and cross-matching Blood administration

Answer 198

Indications for Transfusion: Anaemia- Due to blood loss (regenerative – haemorrhage, haemolysis Due to failure of production (non-regenerative) Coagulopathy Thrombocytopaenia Packed Red Blood Cells indicated for patients: showing hypoxia as a result of anaemia (PCV 12-15%=hypoxia) In acute blood loss due to haemorrhage Plasma indicated for patients: Coagulopathy when there is active bleeding For patients with Von Willebrand’s Disease undergoing surgical procedure

Answer 199

Must be species specific Donors must meet certain requirements Methods of acquiring blood or blood products Practice register of donors Staff pets Blood collection organisations National donor register Practice protocol for blood transfusion

Answer 200

Fully vaccinated & reg wormed Health, fit adult (1 – 8yrs) Dogs>25kg, cats>4kg, BCS 4-6/9 Normal PCV & blood tests Not have travelled abroad No infectious disease, cats, –ve FIV, FeLV, FIP, toxoplasma, Mycoplasma haemofelis No sub-clinical renal disease Not on medication Good temperament Blood typed (or typed on collection)

Answer 201

Volume of donor blood req (ml) = 80(dog) x BW(kg) x Desired change in PCV divided by PCV of transfused blood

Answer 202

taken from animal to use later on same animal

Answer 203

blood taken from one animal to give to another animal

Answer 204

Attire Clean Scrub Top 2 Pairs of Examination Gloves Equipment Clippers/ cat clippers Comfortable table/location Local Anaesthetic Cream Diluted warm chlorhexidine or equivalent and sterile swabs Surgical Spirit Collection Equipment (450ml single collection bag with CPDA-1/CPD or syringe primed with anti-coagulant for cats) Electronic Scales weighing in grams Metal line clamps (optional – used by pet blood blank)/Guarded Haemostat Dressing Material for neck bandage Scissors Sedation drugs Eye lubricant IVFT 100ml crystalloid(for cats/small dogs)

Answer 205

2 people lift onto table and get comfortable Lie in left lateral recumbency, chin pulled forwards and front legs pulled caudally Put on gloves, wipe away local anaesthetic cream, and perform surgical scrub. Change gloves Place the collection bag below the patient and place on scales. Assistant should raise the jugular vein Phlebotomist should insert the needle bevel up in a caudal direction (cranial can be performed) Once in the vein, the assistant can remove the clamp on the collection set Blood should flow easily. Normal rate is 50ml/min so you can collect the full unit in under 10 minutes. Mix the anti-coagulant with the incoming blood with a gentle rocking motion at 15 second intervals. Assistant in charge of the collection bag should monitor the weight for the desired volume. Once full inform the phlebotomist and clamps the line Place a sterile swab over venipuncture site, remove the needle and have the assistant apply direct digital pressure for 2 minutes. Strip the blood from the collection line into the collection bag. leaving 5cm in the line from the bag. Place clamps on the line (can use knots but less secure and doesn’t prevent contamination) Fresh whole blood should be stored at room temperature and must be used within 4-6 hours from collection If transfusion is delayed blood can be refrigerated 4-6C, although platelet activity will be reduced.

Answer 206

check and record the donors demeanour, pulse rate and pulse quality and mm colour allow them to sit up slowly an lift them onto the floor continue to monitor for 10-15mins and offer them a drink of water and a small meal of food lead walk only for 24hrs. use a harness instead of collar / lead

Answer 207

Cats quite often sedated depending on temperament – if so, lubricate eyes and provide oxygen A ratio of 1ml citrate based anti-coagulant to 7ml whole blood Gently restrain in sternal recumbency with neck extended, using minimal restraint. Disinfect venipuncture site Change gloves System of primed butterfly catheter, line clamped with haemostat and syringe. Keeping vein raised throughout. Flow rate should be a rate of 5ml/minute or greater Rock the syringe throughout to mix blood and anti-coagulant Clamp and turn off 3 way tap before removing Apply digital pressure to venipuncture site for 5 minutes

Answer 208

monitor the pxs vitals and bp for hypotension whilst In a warm kennel donations of 10ml/kg or more will require IVFT. This should be administered post donation via i/v catheter at a rate of double the volume collected over 60-120 minutes once awake can be offered water and light meal outdoor cats should be kept indoors overnight

Answer 209

Bag clamped and blood removed from tubing Blood bags should be labelled with donor name, collection date and time, blood group and quantity of blood donated, name of phlebotomist Collected blood may be Given directly to patient Stored for future use Separated to use RBC’s, plasma, platelets and clotting factors Must be collected and stored in anti-coagulant Heparin – for immediate use Citrate phosphate dextrose (CPD) Acid citrate dextrose (ACD)

Answer 210

Whole blood Packed red blood cells Plasma Fresh frozen plasma (FFP) Frozen plasma (FP) Plasma products Cryoprecipitate (CP) – Factor VIII, vWf, fibrinogen Cryosupernatant (CS) – albumin, globulin, antithrombin, Proteins S and C, Factors II, VII, IX, X, XI and XII Platelet products Platelet rich plasma (PRP) Other platelet products not currently available in UK

Answer 211

If not used immediately blood should be stored at 4°C in a temperature controlled fridge Longer storage, Plasma may be frozen within one hour at -18°c for under one year (FFP) Plasma frozen for over a year – frozen plasma (FP) Cells can be refrigerated for three months Blood banks process and store blood and blood products to ensure maximum longevity

Answer 212

Dogs have DEA (dog erythrocyte antigen). Only DEA 1 can be typed, +ve or -ve Cats have three blood types (A, B, AB) 60% dogs are universal matches FIRST TIME Risk of reaction increases at each transfusion Higher risk of transfusion reaction in cats Best practice to identify blood type in either species; always determine blood type of cats before blood transfusion and any animal previously transfused Test kits available to identify if DEA +ve or –ve – Alvedia, Rapid Vet-H, DMEVet, Diamed G

Answer 213

donor RBCs and recipient plasma

Answer 214

donor plasma and recipient RBCS

Answer 215

blood volume to be transferred mls= k (70 for c, 60 for f) x weight x required PCV recipient PCV divided by PCV of red cell product

Answer 216

Check blood bag for damage Ensure it is correct blood type and/or is cross-matched Warm in water bath to 37°C (max) or room temperature Gently invert/mix whole blood MUST Use blood administration set – reduce risk of microclots MUST use appropriate infusion pump Administer slowly at start (0.5-1.0ml/kg/hr) and monitor for signs of transfusion reaction Increase rate (5-10ml/kg/hr) after 30mins if no signs Continue monitoring Stop once calculated volume been administered

Answer 217

Any blood product must be administered through a 170-260 μm filter to reduce the risk of microclots or debris and set up in an aseptic manner using non-sterile gloves to reduce the risk of iatrogenic bacteraemia. Avoiding disconnection of the transfusion once connected also reduces this risk. A giving set can be inserted into the unit or it can be drawn out into syringes if smaller volumes or rates are required. The blood product must be administered via an appropriate infusion pump as some may damage red blood cells (Kisielewicz & Self, 2014). A plasma warmer, such as the SAHARA©, is usually used for defrosting the plasma but can be used to gently warm the pRBCs to combat hypothermia, especially if multiple blood product transfusions are to be given, patients are small or particularly young, if the patient is under general anaesthesia or is already hypothermic (Kisielewicz & Self, 2014; Prittie, 2003).

Answer 218

Acute or delayed Acute signs – immediate Intravascular haemolysis – fever, tachycardia, dyspnoea, vomiting, shock, DIC, collapse, haemoglobinaemia Extravascular haemolysis – milder signs, hyperbilirubinaemia (large amount of bilirubin) Allery – urticarial type reaction, facial swelling Delayed signs – 24-48hrs to 21 days Ineffective transfusion, reducing PCV, fever, anorexia, jaundice

Answer 219

Monitor closely dedicated team member Obtain baseline parameters prior to transfusion Check and record all parameters on monitoring sheet Rate of transfusion: set by vet 0.5-1ml/kg/hr for the first 15-30 minutes If no reaction- then can administer the remaining over 4 hours Monitoring intervals: Continuous for the first 30 minutes. Record every 5 minutes. Then can monitor every 15 minutes till end of transfusion Signs of Reaction: Tachycardia Urticaria (facial swelling) Hypotension Vomiting or Diarrhoea, Dyspnoea/tachypnoea Pyrexia Haemoglobinuria. Transfusion reactions require treatment with glucocorticoids, antihistamines and/or adrenalin may be considered. Antipyretics may be required. If circulatory overload has resulted in pulmonary oedema, diuretic treatment and oxygen support may be required.

Answer 220

The severity of the patient’s condition The age of the patient The normal frequency of the activity The timescale of each goal/aim

Answer 221

The goals set in the planning stage to identify if they are met Nursing observations and clinical examination Vet information

Answer 222

It identifies which nursing interventions have been successful, and by how much. This is then used to decide whether to change the intervention, alter the frequency, adapt it or stop it completely. Therefore revising the care plan.

Answer 223

specific – describe the outcome in a focused way. Use an objective view. the outcome should be related to a number, a percentage, fraction or frequency Measurable - some form of measurable outcome so that a judgment can be made using a numerical element Achievable – Is the goal set achievable? Has it been done before? Are there any contraindications to doing it? Realistic - patient-specific factors should be taken into account to assess whether the goal is actually appropriate for the patient in question Timing - goals should include a date or time by which they will be accomplished or completed.

Answer 224

client info- symptoms seen at home? normal routine for dog, medication, history - any symptoms? clinical examination- as we are staying with the px the whole time, we need to know whats normal so when doing the re evaluation is it better or worse diagnostic tests assessment of px need and potential problems

Answer 225

fragile, open mouth, panting, a lot of movement in abdomen ( increased effort in breathing) - not just in chest, abdominal muscles are working hard as well. increased movement of chest resulting in reduced movement in lungs possibly due to a mass or fluid resulting in harder breathing

Answer 226

analyse breathing pattern any history of breathing problems reduce stress place in a quiet area give 02 provide rest or sedation open mouth breathing in cats don't handle animal - stress- death

Answer 227

thickened mitral valve and tricuspid valve. you won't see as much contraction of the muscle around the ventricle possible fluid around the heart enlarged heart- cardiomegaly on the x-ray there should be distinct areas of organs - there shouldn't be all white or all black

Answer 228

pulse rate- (femoral and sublingual come from the aorta) by using tarsal and metacarpal -peripheral pulse, the pulse might be different to indicate the heart - weak or binding or absent or irregular), rhythm and quality compare pulse and heart rate- pulse deficit blood pressure- detects low or high bp, vasoconstriction of blood vessels will maintain bp, if low, the blood can't get where it needs to go. may have to wait until the animal is calm. use stethoscope, listen to heart. muffled if fluid in heart, rate, rhythm, quality capillary refill time- indicated blood is getting to peripheries, delayed or compensatory phase. mm colour- pale if loss of blood volume resting respiratory rate crackling noises in lungs- fluid engaging abdominal muscles? is animal sitting up with head and neck extended for lung maximum extension or are they lying on their chest pulse oximetor- device which is placed on a pulse point which tells the level of 02 in blood- you want it to be above 95, if below they have low 02 abdominal fluid wave- if abdominal is full of fluid- ascites, if one hand is on one side of abdomen and other is tapping the other side of abdomen, you will feel a thrush of fluid

Answer 229

radiography- radiogrpah of chest can tell size of heart. the heart takes 3 rib spaces, measure from apex- bottom. can also tell if any mass or fluid in pleural cavity ECG- electrical activity of heart. is electrical impulses travelling through the heart normally? echocardiography- ultrasound, can do cross section of heart, measure vessel walls, look at valves, gives accurate presentation of a mass or blot clot. blood pressure

Answer 230

special attachment - halter or telemetry- this goes onto the animal and they go home with it. it takes a continuous ECG of the animal. animal is more relaxed at home therefore beneficial doing it this way. ECG performed in practice- only seeing what happens in heart in that time. they might be stressed from being in the vet

Answer 231

need a machine carry out in quiet, stress free environment place animal in R lateral recumbency with gentle restraint- if too stressful, can do sitting ( may affect ECG if panting) or use sedation however this could affect the ECG. needs to have a contact medium- ultrasound gel or surgical spirit. has a sticky pad or crocodile clip machines will have 3-4 leads that attach under the armpit and groin clip legs and swab with spirit

Answer 232

red- R foreleg yellow- L foreleg green- L hind leg black- R hindleg

Answer 233

30sec burst

Answer 234

shoudl be a P for every QRS should be a T for every QRS regular pattern

Answer 235

will show - heart structure. should see each atria and ventricle

Answer 236

function and blood flow

Answer 237

lub dub lub - closing of the AV valves dub- closing of aortic and pulomoric valves systole- time inbetween lub and dub

Answer 238

whooshing sounds, like a drum, very abnormal

Answer 239

cuff around leg 40% of leg/tail circumference

Answer 240

to stop blood flowing through vessels

Answer 241

133mmHg systolic

Answer 242

124mmHg systolic

Answer 243

invasive technique using arterial catheters

Answer 244

non- invasive using external cuff

Answer 245

cerphalic or tail clip hair apply surgical spirit apply ultrasound gel

Answer 246

urinating and defecating- may not have control as so stressed. animal will use up all of 02 reserves if being taken out eating as animal too stressed to eat body temp- as animal is stressed, we need to maintain temp as they will get very hot give animal 02 - compromised breathing prepare IV access place animal in quiet dark room, minimal staff, minimal handling may be showing abnormal behaviours as so stressed. can become aggressive as they are panicked. pain relief

Answer 247

stress free environment minimal handling, reduces stress and avoid restriction of chest/neck, harness, care with restraint technique controlled exercise- own pace, observe impact, care against syncope. provided minimum activity in advanced disease, use harness instead of collar. provide oxygenation, lung care IV access. warm food as increases palatability. frequent opportunity for urination, monitor fluid intake and weight (if loosing weight -not eating, dehydrated). restrict sodium- pulls fluid into areas of a body maintain body temp- environment temo- window, thermostat, radiator, fans, cool mat, cold towels placed beside them or underneath. DONT place on top as stops evaporation. support rest or sleep - comfy bed, no lights, don't have someone coming in all the time give accurate medication

Answer 248

educate the owner on what to do so they have realistic expectations ensure owner knows how to provide meds- if has side effects, tell owner. exercise in moderation - reduce walk time by half. cardiac diet- healthy treat options ( grain free) no smoking in household give boosters as don't want to get kennel cough

Answer 249

nasal discharge sneezing stertor stridor cough dyspnoea tachypnoea

Answer 250

wheeze crackles stridor- HIGH pitched sound created as air passes through a narrowed airway during breathing. may be present during inspiration and expiration. stertor- LOW pitches sounds (gasp or snore like) heard during inspiration. generally of pharyngeal origin

Answer 251

normal breathing

Answer 252

adopting an upright or standing or sitting position due to difficulty breathing

Answer 253

Initial Observation Assess Respiratory Rate, Effort and externally audible noise. Signs of trauma or abdominal distension Lung Auscultation Increased Lung Sounds e.g. crackles, wheezes, harsh lung sounds Are associated with lower airway and pulmonary parenchymal disease Decreased Lund Sounds are associated with pleural space disease Heart Auscultation Listen for any heart murmur or irregularities in heart rhythm that could indicate underlying heart disease

Answer 254

mm colour for signs of cyanosis pulse oximetry measures the % of haemoglobin that is saturated with 02 capnography- measures c02 in expired gas and assess partial pressure of c02 in arterial blood. it also assess ventilation. arterial blood gases- best assessment for ventilation and oxygenation ultrasonography and radiography

Answer 255

any px with dyspnoea airway obstruction pleural space disease pulmonary oedema pulmonary contusions pneumonia feline asthma pulmonary thromboembolism diaphragmatic rupture- need the diaphragm to breathe severe anaemia cardiac px shock cases

Answer 256

increase 02 saturation of the blood and tissues and decrease respirator effect. minimise stress, maintain optimum temperature, minimal handling

Answer 257

flow by oxygen - hold tube with 02 coming out of tube face mask- needs a close seal nasal prongs- cant have a high flow rate as damages nares nasal canula oxygen cage oxygen tent- cling film around kennel and apply 02 incubator - control temp, humidity, can feed 02 intubation +/- ventilator tracheostomy/ transtracheal catheterisation

Answer 258

30-50%, rates higher than 4% can be uncomfortable

Answer 259

Decrease of O2 saturation to vital tissues due to stress and handling Increased dyspnoea – keep sternal/lateral recumbency, NOT dorsal, do not lean on patient Drying of nasal mucosa – oxygenation longer than 2hrs, delivered directly into the respiratory tract or at rates of over 4L/min, requires a humidifier Oxygen toxicity - >50% O2 for over 12hrs. Start 100% then reduce to lowest level that provides effect Atelectasis – due to alveoli filling with fluid. Low intensity mobilisation, turning the patient, nebulisation and coupage, pain management

Answer 260

Maintain blood oxygen levels above 95% Maintain normal mucous membrane colour Decrease respiratory rate and effort, reduction of paradoxical breathing Monitor frequently to assess effect of interventions, review plan and identify complications

Answer 261

cell which is involved with bone formation

Answer 262

a type of bone cell that breaks down bone tissue

Answer 263

ceel found in mature bone

Answer 264

hard outer shell of bone

Answer 265

porous inner part of bone

Answer 266

a complete or incomplete break of the bone continuity with or without displacement of the resulting fragments. this is often accompanied by other injuries

Answer 267

no, less priority. you would need to establish px for bleeding, stabilise heart or any life threatening injury

Answer 268

2 radiography views to specifcally diagnose

Answer 269

a force to the bone

Answer 270

act to lengthen the bone

Answer 271

shortening of bone

Answer 272

typically parallel or tangential to the bone

Answer 273

create a convex aide of the bone and a concave side

Answer 274

ABCs breathing- panting? open mouth breathing? respiration rate, pattern, effort greater on inspiration or expiration, any noise, stridor or starter? dyspnoea? pulse- check heart rate with stethoscope, mm refill time and colour, feel the femoral pulse and peripheral pulse, do they match up? temperature- ear thermometer or rectal thermometer. if collapsed, assess airway shock- check bp , blood test if PCV is normal, total solids, lactate test- measure whether there is cell respiration occurring with the presence of 02. of cells don't have 02, circulation isn't going to tissues. if lactate is above 2.5, there is anaerobic respiration (lactate buildup). check for IV

Answer 275

Check and stabilize vitals (temperature, pulse quality and heart rate, respiration rate, blood pressure, pulse oximetry), if needed. Perform thorough physical, orthopaedic, and neurologic examinations. Pursue initial diagnostics, including blood analysis, thoracic and abdominal radiographs, and an AFAST ultrasound. Resolve any life-threatening issues, which means that surgery may need to be delayed for several days due to conditions, such as pulmonary contusions or hypovolemia. Administer proper analgesia as soon as possible ALWAYS SUPPLEMENT WITH 02

Answer 276

direct and indirect

Answer 277

Required rigid internal fixation. Occurs via a combination of contact and gap healing. Contact Direct Healing occurs when the surfaces of the fracture are in direct contact. The fracture is stable, and there is no compression applied to the fragments. Gap Direct Healing occurs when an interfragmentary gap of < 1 mm is present. Direct – bone edges so close together that callus doesn’t form and the bone forms without the interim stage of fibrous tissue and cartilage– usually require surgical fixing asap after trauma.

Answer 278

The most common 'natural' healing process, whereby the fracture ends are placed close to each other (but not apposed), with intervening haematoma and variable displacement and/or angulation.

Answer 279

The process for normal fracture healing starts immediately at the time of the fracture with formation of a haematoma. Inflammation: This phase traditionally lasts 3 to 4 days or longer, and is characterized by a fibrin-rich clot at the fracture site. This clot releases growth factors to simulate bone healing and potentially acts as a scaffold for migration of inflammatory and reparative cells. Repair: During this phase, the clot is slowly replaced by granulation tissue, which adds slight mechanical strength. As collagen fibers become more abundant, granulation tissue is replaced by connective tissue and, after formation of connective tissue at the fracture site, resident mesenchymal cells differentiate into chondrocytes to form cartilage. With the help of growth factors, such as bone morphogenic proteins, the cartilage begins mineralizing to form woven bone. Remodeling: This phase is characterized by a slow adaption of the bone to regain its original function and strength. It is a very slow process (up to 6–9 years in humans) that represents 70% of the fracture’s total healing time. The action of osteoclastic resorption and osteoblastic deposition is guided by Wolff’s law.

Answer 280

For normal fracture healing to occur a number of requirements must be met: viability of fragments (i.e. intact blood supply, if they dont they will die off and wont heal) mechanical rest: this can be achieved by not moving and external immobilisation, e.g. cast or internal fixation. absence of infection

Answer 281

spontaneous (indirect/secondary) healing contact (angiogenic/primary) healing gap healing

Answer 282

Immature animals – Improved vascularisation of callus in juvenile increasing rate of healing Geriatric – Reduced vascularisation of callus so prolonged healing compared to young and adult Debilitation - Hormone/kidney failure Osteomyelitis – Inflammation +/-Infection that interferes with healing Cancellous vs Cortical- Fractures in cancellous bone heal faster than cortical bone Fracture sight - Bone with good muscle coverage will have a good blood supply which will improve fracture healing ability Type of fracture- Oblique fractures have a larger surface area than a transverse fracture, improving contact to promote tissue regrowth Poor reduction/fixation- Good reduction to allow ‘Direct Healing’ will heal better. Poor reduction will have increased gap and callus formation and increased risk of malunion Movement- Movement to the fracture site will delay healing and increase risk of malunion

Answer 283

Non-union – Complete failure of fractured bone ends to unite Delayed union – Healing progresses slowly. Clinical union might occur but not achieved within expected time. Malunion – Healing occurs in an abnormal position Shortened limb – a form of malunion where the fracture hasn’t been reduced. Might be seen in cases that didn’t have veterinary intervention e.g. stray dogs Osteomyelitis – Inflammation of the bone characterised by progressive inflammatory destruction of new bone. Bacterial Osteomyelitis = Infection Fracture disease – A syndrome of muscle wastage and inability to flex joints in a limb after repair. Can occur due to scar formation. Sequestrum – piece of devitalised bone separated from bone not incorporated into repair. Implant failure – implants are foreign material and the body’s immune system may reject the implant. Can also occur due to poor choice of implant so it’s not compatible with the bone size/shape, and patient overactivity.

Answer 284

normal, transverse- directly across, oblique- diagonal , spiral, comminuted- numerous fragments, segmental, one segmented part, avulsed, pulling of part of bone, impacted- pressure, torus- compression with a bulge, greenstick- fracture but not all the way through the bone

Answer 285

Restoring the continuity of the bone Restoring length Restoring functional shape Maintaining soft tissue function of blood vessels, muscles and nerve supply.

Answer 286

External coaptation Internal fixation External

Answer 287

Classification of fracture Age Size Temperament Underlying diseases Cost Expectation of owner

Answer 288

To limit motion at a fracture sight but immobilizing the joint above and below the fracture.

Answer 289

casts, splints, and extension splints rubbing may occur resulting in additional issues- pressure sores relying on natural healing only used on stable fractures such as greenstick

Answer 290

Technically simpler Economical Non-invasive

Answer 291

Limited applications Not sufficient stabilisation Decubital ulcers Slow healing rate and greater callus formation Fracture disease Owner Compliance if cant go above or below the external coaptation isn't suitable

Answer 292

Aftercare advice sheets incorporating a care plan to address basic needs Providing protective cover for example with splint covered with bandage as can get wet. examples include empty drip bags, poo bags, carrier bags, medical pet shirts /anti-chew device such as bitter spray, collar. Monitor for swelling if too tight/chafing/staining/smell if wound being infected/slipping/collapse Medications (Analgesia, NSAID’s, Sedatives) may chew bandage if it's uncomfortable. Exercise - what is temperament of animal, will need mental stimulation. to limit exercise you cant walk them. only take them out in the garden on a lead. dont let cat out. limit pet on sofa, bed, stairs. keep at crate rest or restrict to one room, puppy pen, if multiplet household, take away other animals. you have to explain the result if they don't do this e.g. splint falling off, fracture getting worse. Mental Stimulation- snuffle pads, slow feeder, sit with the dog, radio, toys, activities Post-op checks dont have px with you when discussing after care as owner wont listen properly

Answer 293

something that goes into the bone such as a pin, wire, plate, screw

Answer 294

Any closed fracture, any bone Accurate reduction Rigid fixation Early return to full function – minimal risk of fracture disease

Answer 295

Expensive/time consuming Surgical Skill Equipment Surgery risks Not suitable for open fractures

Answer 296

Immobilisation if deemed appropriate- carrying? Coaptation as protection Surgical Site Infections (SSI’s), smell, colour of exudate (green yellow or milky purulent), necrotic tissue, inflammation with heat, swelling, temp Ability to mobilise sling, vet beds, memory foam mattress, manually lift the dog up to stand with 2-3 people. use rubber matts on floor, carpet to stop slipping. put on lead, does dog pee on or off lead/ certain substrate/ command to toilet? Ability to access 5 freedoms Patient Interference Monitor for complications

Answer 297

Train staff appropriately on protocols Protocol for cleaning, disinfection, and sterilization of Ortho Equip Swab patient skin prior to surgery Pre-operative surgical site preparation e.g. sterile gloves/sterile scrub materials/Chloroprep (remains on skin for 4 days after surgery) /contact time Peri-operative measures – surgeon double gloves/facemask/cap Post-operative surgical site care e.g. aseptically clean with sterile gloves & sterile swabs/apply dressing in theatre/residual effect Chloroprep 48hrs Monitoring & Document Infections that do occur Swab wound when infections occur Antimicrobial therapies for prevention of SSI should be based on the risk of SSI

Answer 298

If there is an open contaminated fracture. Where the wound needs to be treated as a open wound and/or needs bandage changes. If there is a concern that placing internal fixation will increase the risk of osteomyelitis or infection.

Answer 299

Minimal instrumentation/reuseable Minimal disruption to soft tissues/foreign materials Can manage open wounds Complements other techniques Adjustable/easy to assess Easy to remove

Answer 300

Soft tissue issues Skill/difficult to apply to proximal limbs Xrays can be hard to view Premature pin loosening

Answer 301

Open wound care Compression bandages for 2-3days, daily change Cover the pins! Air Cage rest/lead walks Scab formation – leave Excess exudate – clean and see VS Wound interference Written instruction – what’s next? Contact information

Answer 302

restoring maximum function, quality of life and independence following injury or disease. to limit pain build muscle return the animal to normal function where possible- all activities of daily living reduce recovery time

Answer 303

physiotherapy acupuncture hydrotherapy mctimoney

Answer 304

all members of the team including multi-disciplinary teams

Answer 305

inflammatory response articular cartilage damage increased joint stress muscle atrophy less ROM decrease in exercise

Answer 306

to promote natural body healing

Answer 307

insertion of a special needle into acupoints which are rich in nerve endings and blood vessels

Answer 308

enhances blood circulation and tissue blood flow/ oxygenation and removal of waste products/ toxins stimulate nervous system reduces swelling relives pain encourages healing by correcting energy imbalances in the body relaxes muscles

Answer 309

take the weight off joints and enable flexion and extension

Answer 310

aids muscle relaxation for exercise

Answer 311

relives pain reduction of swelling and stiffness circulatory benefits improved cardiovascular fitness muscle strength joint mobilisation increased mental stimulation improve gait pattern

Answer 312

orthopaedics spinal neurological muscle atrophy obesity show dog conditioning behaviour issues by relieving excess energy and promoting focus

Answer 313

animal manipulation that's hands on adjustments

Answer 314

Assess your patient – nose to tail health check with some enhancements – physio assessment – which includes…. Static Assessment: Posture (head, spine, tail) Conformation (spine, limbs, joint angle) Limb placement (cow hocked, wide, narrow) Dynamic Assessment Watch in walk and trot - Spinal Movement, Posture/Tail, Limb Placement, Weight Baring, Lameness, Swing Phase, Sit to Stand BCS!!! Lameness scoring -which scale? Force plates/gait analysis Measurements – pros and cons

Answer 315

Companion/working Multi animal/children Floor Stairs Bedding Exercise Previous therapy Aversion to water/touch/noises…

Answer 316

chronic pain relaxes tense muscle aches arthiritis

Answer 317

acute injury after surgery reduces swelling sprains bruises pain

Answer 318

Heat pad Bear Hugger Bubble Wrap Blankets Hot Water Bottle/Microwave heated pads Thermal socks/bubble wrap on feet Humidifiers attached to GA circuit- warm air so preserved body temp

Answer 319

recovery and depth of anaesthesia

Answer 320

presumed drugs administered

Answer 321

Thermotherapy Assisted standing PROM Massage Turning 2-4 hourly However, physiotherapy and rehabilitation after orthopaedic surgery can aid recovery by increasing muscle strength and reducing pain, swelling and inflammation (Connell and Monk, 2010). Restrict blood flow – reduce swelling – reduce pain - Ice packs are wrapped in a towel to prevent damage to the skin, and then placed on the area for 10–20 minutes (Connell and Monk, 2010; Drum et al, 2015) repeatedly throughout the day. The use of ice packs on cats can be difficult because of their reluctance to lie still for long periods of time (Drum et al, 2015), and can be painful on application. However, this may be easier during the recovery period when the patient is drowsy. *ice cubes* Slings/towels If the patient was recumbent for 2 hours, they were turned onto a different recumbency to aid patient comfort, prevent decubitus ulcers and hypostatic pneumonia (Murrell and Ford-Fennah, 2011).

Answer 322

Works directly with VS within sterile field Ensures sterility maintained and liases with Circulating nurse Organises sterile instruments and passes sterile Equip to vet

Answer 323

Tasks performed outside sterile field Organises nursing care with rest of team Tasks could include – passing instruments in sterile manner to scrubbed nurse Organising equipment Monitoring and recording Consumables

Answer 324

Area checked and clean All theatres damp dusted at start of day Spot cleaned after each procedure Room set appropriately for procedure Correct equipment and instruments Checking sterilised equipment Equipment Patient checked Check lists!!!!! Planning is key!!

Answer 325

Surgical preparation of skin Positioning of patient- bratty- elevated so less chance of regurgitation. nerve damage. breed. surgery. Equipment Drapes – “strike-through” Monitor patient for hypothermia and dehydration Swabs counted and weighed for blood loss calculations Post op bedding/environment Post op analgesia and close observations Wound interference Drains – dressings Factors that promote/delay healing

Answer 326

Aftercare advice sheets Providing protective cover/anti-chew device Monitor for swelling/chafing/staining/smell/slipping/collapse Medications Exercise Post-op checks

Answer 327

Buster collar Soft Inflat Stocking T-shirt/underwear Covers

Answer 328

Cats – what litter type and can they get into the tray? Lids/inco sheets How do they drink Decrease stress – pheromones/calming aids/things from home (label!!) Normal behaviour? Breed type what is the usual bedding at home what does the animal eat what does the animal eat out of is there any allergies or dislikes is the animal on meds does the animal have any previous history is the animal fully vaccinated how often does the animal toilet how active is the animal does the animal have any preferences of males or females what is the animals normal behaviour does the animal have a preference of where or how they toilet does the dog have high or low stress levels is there any mobility issues is there any command words Is there a food release word is there any grooming issues, like matts any health conditions has the dog had any vomiting or diarrhoea in the past 2-3 days is there any aggressions does the dog have issues with dogs or cats does he react okay around strangers when did he last eat and how much when was the last time he defecated or urinated any issues with respiration why does he take any medications how much water does he drink normally is there any toys he gets when he is anxious has he destroyed any bedding has he ever been away from owner any treats he prefers or gets after a walk etc how fast does he eat raw fed?

Answer 329

how did surgery go any complications open sutures? how long do you want sutures in for and when do you want them removal any medication to be given and how much how did anaesthetics go hypo/hyperthermic? have you phoned owner to let them know how surgery went any restrictions for the dog happy for nurse to discharge px how long do you need px to rest before toileting how your going to manage the medical case any particular diet how slow/fast to give IVFT when do they start meds any side effects of meds can I use ice packs do you need me to apply a bandage such as Robert jones how often do you need drain emptied and managed do you tell owner or shall VN tell owner for open drain or closed drain how do you want external fixation managed how long should animal rest how long should animal exercise for is it on fluids rate for fluids is it needing blood work how often is blood work needed pain score? does VN have to administer any med do they need to come in for post op checks is it allowed to jump

Answer 330

Sudden-onset anorexia, lethargy and depression. Oliguria and anuria, followed by polyuria. Vomiting and diarrhoea. Polydipsia. Dehydration. Uraemic breath. Abdominal pain.

Answer 331

Polyuria/nocturia (as the kidney loses its ability to concentrate the urine). Polydipsia. Uraemia – anorexia, vomiting, lethargy and depression. Weight loss. Dehydration. Oral ulceration and halitosis. Non-regenerative anaemia (due to lack of erythropoietin production by the kidney). Hypertension. Rubber jaw (renal hyperparathyroidism)

Answer 332

inflammation of the bladder

Answer 333

Idiopathic Feline lower urinary tract disease (see ‘Feline lower urinary tract disease (FLUTD)’ below) Trauma Urolithiasis (see ‘Urolithiasis (urinary calculi)’ below) Neoplasia Primary bacterial infection – often ascending, common in female dogs Bacterial infection secondary to other diseases (e.g. diabetes mellitus, hyperadrenocorticism (Cushing’s disease), immunosuppressive infection such as FIV and FeLV).

Answer 334

Pollakiuria = Abnormally frequent urination Urinary tenesmus. Haematuria. Stranguria. Incontinence. Dysuria. Inappropriate urination. Excessive grooming.

Answer 335

Loss of control over urination Passing of urine when lying down or walking. Urine around perineum which can cause urine scalding.

Answer 336

Pollakiuria. Urinary tenesmus= feeling of incomplete emptying of bladder after urination Haematuria. Dysuria. Distended bladder.

Answer 337

Distress – vocalizing and signs of abdominal pain Anuria Distended hard bladder Clinical signs of renal damage Anorexia and vomiting Lethargy and depression Dehydration Collapse and death if untreated. Hyperkalaemia- high K+ levels kidney damage

Answer 338

Record abnormal output, appearance, dipstix/SG results, micturition posture and frequency- collecting urine and comparing what's normal, volume, appearance Express bladder/catheterise where indicated Use aseptic techniques Take steps to reduce trauma Regularly check bladder size- not commonly used now a days as bladder may burst, catheter siting etc. Flush if required Empty bag every 4hrs, measuring output where required Check lines are not kinked or blocked, bag not full. urine will go on animal if not closed catheter. Prevent self-mutilation Keep patient and kennel clean and dry, use kennel liners under vet bed Clip perineum and apply barrier cream where risk of scalding Provide accurate medication

Answer 339

Equipment Analgesia Sedate/GA Gloves Catheter 3 way tap Closed urinary system Sterile lubricant Syringe Kidney dish Saline flush Suture material & instrument Preparation Bloods GA Clean site

Answer 340

Maintain fluid therapy, observe for fluid overload & care if potassium added! Monitor fluid ins+outs Assisted feeding Palatable diets, warming food Soft diets Hand feeding Pain management Feeding tubes Maintain body temperature Stress reduction

Answer 341

Monitoring urine output (1-2ml/kg/hr) Washable litter Weighing newspaper/kennel liner Catheter attached to closed system - collection bag Output, appearance, dipstix/SG results, micturition posture and frequency, signs of UTI infection Monitor body weight, condition and muscle mass Monitor hydration status Monitor water intake Pain levels and vital signs

Answer 342

evaluate kidney function

Answer 343

1.001-1.060

Answer 344

1.005-1.080

Answer 345

>1.030 in dogs and >1.035 in cats.

Answer 346

Appropriate diet (restricted protein and phosphate for CRF, restricted minerals for urolithiasis), ideally wet diet Encourage increased water intake Fresh water ad lib Broth (salt-free) Water fountain Renal nurse clinics Monitor food and fluid intake, BW, BCS & MCS Blood sampling, signs of deterioration and IRIS staging BP monitoring

Answer 347

diagnostic procedures owner education- understanding DM, creating routine, teaching to administer insulin and importance of records. monitoring and maintaining stabilisation client support and compliance

Answer 348

cost quality of life likelihood of owner compliance describe DM and effect on the px agree routine, food, insulin timing, exercise, monitoring discuss insulin storage, sharps disposal, signs of unstable DM, signs of hypo and first aid, what to do if pet unwell or off food. contact details and information sheet/ resources

Answer 349

support owners of newly diagnosed pets encourage compliance review records and monitor progress 3-6months identify and rectify problems monitor px symptoms and condition

Answer 350

insulin syringe or pen demonstrate with water and model allow owner to practise under supervision and teach several family members if possible ensure eating prior to administartion check expiry and broach date invert vial- do not shake draw up correct dose and check vary injection site if in doubt, only inject once dispose of sharps safely

Answer 351

high protein normal levels fat and complex carbohydrate no simple sugars as dont want a spike of sugar high fibre helps control obesity and reduce glucose surge same diet, same amount each day. two meals, half with each injection or 8-10hrs later if one injection no tidbits

Answer 352

high protein and low carbs fibre content not as important may graze if proffered if meal fed, 3rd daily requirements fed with injection rest at nadir of effect tins dilute carbs, though feed dry if only eat that form diet important in diabetic remission- reduced weight results in reduced beta cell destruction

Answer 353

important to maintain similar amount and time daily regular can increase gradually to assist weight loss

Answer 354

Supportive bedding Care handling, possibly no leads/collars- altered blood flow to the brain Sternal recumbency/turning every 2/4hrs - allows full expansion of lungs, turn to prevent pressure sores. Coupage - tapping side of chest to break up fluid, BUT THEY NEED TO BE ABLE TO COUGH, and nebulisation if required Supported walking or cage rest Decubitus ulcer checks and prevention Monitor urination and defaecation, manual expression or urinary catheterisation, can they do this by themselves? Assisted feeding (care to protect airways, tube feeding if necessary) Ensure RER is met, cant move to bowl, cant keep themselves up right, support with keeping them in sternal, hand feed. Pain management Skin care and grooming, preserve skin integrity. bum bathing, grooming Maintain body temperature- monitor regularly as if too hot they cant move off it. might get burned.

Answer 355

urinating / defecation- weigh bed before or after, calculate normal output. check for leakage or px interference. check whole line and tubing. empty in. jug and measure. for defecation, visually monitor frequency and consistency of stool, take px to toilet, lift tail and see if constricting anus or falling out. assisted feeding- if has feeding tube, calculate RER, calculate how much calories are in a g and measure how much to give animal. place in sternal to prevent regurgitation or aspiration (food entering trachea). elevate head higher than trunk. maintain body temp- check their temperature every 15mins, using a thermometer in rectum or ear.

Answer 356

Immediate Pain control Massage (20mins, 2-3 times daily) Cryotherapy (10-15mins, 2-4 times daily) Early Massage + Passive ROM exercises (10-15 cycles, 2-3 times daily) Thermotherapy (10-20mins, 2-3 times daily) Other therapies, such as ultrasound or TENS Late Exercise (active, active assisted, active resisted) Walkers/wheelchairs Low level light therapy

Answer 357

Results of neurological assessment Urination/defecation function assessment Mobility Independent feeding Rehabilitation plan

Answer 358

Attempt to evaluate level of sight Ability to cope with unfamiliar environments Level of stress

Answer 359

Use voice to make patient aware of approach- less stressed, less scared Reassurance, particularly when moving/carrying out procedures as scared Reduce stress/excitement as they cant see Careful handling Be aware of aggressive tendencies Keep routine for feeding and bowls so they have something familiar Prevent self trauma Occular hygiene and lubrication- put collar on as can rip out stitches, put in lubricating eye drops Accurate and careful medication Dim lights or cover kennel

Answer 360

behaviour- use pain scale, visual checks, grimace scale has pictures of different pictures of facial expressions mobility- dont move items such as food bowl, make sure kennel is safe, have a blanket from home, keep in a small kennel, observate their movement, pain score every hour if high, if normal, every 2-3hrs

Answer 361

May be separated into HDU and ICU Designed to allow effective observation and access Fixtures included and situated to support critical patients Equipment available to enable advanced monitoring, nursing support and resuscitation Staffing levels appropriate to ensure continuity and high level of care is maintained

Answer 362

Telephone and/or in-hospital assessment/triage Primary survey- abc Secondary survey- additional body systems Information used to inform VS diagnostic and treatment processes, and nursing care plan

Answer 363

Common method of initial contact from owner What has happened and when? Use questioning to establish condition of patient Think about the questions that should be asked of an owner and list them below.

Answer 364

Respiratory distress Neurological abnormalities Prolonged vomiting Abnormal heart rate Bleeding from orifices Pale mucous membranes Rapid, progressing abdominal distension Inability to urinate Severe coughing Toxin ingestion Extreme pain

Answer 365

On arrival of patient at surgery, or transfer of patient from another department Physical assessment Enables priorities to be established Set form assists process and provides record Equipment Exam gloves Thermometer Stethoscope Penlight

Answer 366

Immediate assessment of stability Identification if any life-threatening conditions Airway – check the airway is patent Breathing – check the animal is adequately oxygenated Circulation – check tissue perfusion and blood loss Also check level of consciousness and mentation – Small Animal Coma Score Where life-threatening conditions are identified immediate resuscitation and stabilisation is required www.acvecc-recover.org/ Ensure open airway is maintained

Answer 367

a- check the airway is clear, open mouth and check for blockages, pull tongue forward, get examination light b- check the animal is adequately oxygenated, mm, feel for breath sounds, see if chest is rising, pale pink- not enough circulation, blue if cyanotic no enough 02, brick red is carbon monoxide poisoning, pulse oximeter- over 95% is normal, blood test c- check tissue perfusion and blood loss, visual check of bleeding or haemorrhaging, mm should be pink, cpt, lack of circulation, blood test, feel for quality of pulse, peripheral pulse, and compare hr with stethoscope and pulse rate, check bp

Answer 368

Establish other abnormalities Head to tail – nose, mouth, eyes, ears, limbs, thorax, abdomen and tail. looks for disability, wounds or fractures

Answer 369

urine sample blood

Answer 370

pupils size pupil reflex to light

Answer 371

Restore circulating blood volume Often utilising central line Ensure correct fluid rate is being administered Check venous access regularly; heparinised saline flush q4-6hrs, cannula site inspected BID. Evaluate hydration status regularly Control haemorrhage Maintain body temperature as will be hypothermic if in shock Ensure medication is promptly administered, including analgesia Walking/physiotherapy q4hrs to maintain circulation and reduce risk of embolus formation Administer cardiac compressions

Answer 372

Oxygen supplementation O2 cage Nasal cannulae/prongs Intubation Tracheostomy – 24hr care, clean inner cannula q2hrs/as req. - nebulisation - suction; pre O2 & suction for <10secs Mechanical ventilation – monitor respiratory effort, body temperature, auscultate chest, ET tube obstruction, cuff deflated & moved q4-6hrs, gauze swab to moist mm if on ventilator, mouth cleaned with antiseptic solution q4hrs, ventilator tubing replaced q24hrs Body position altered q2-4hrs, change immediately if causes respiratory distress Postural drainage

Answer 373

Maintaining chest drain Aspirate q2-4hrs Aseptic technique Inspect & clean stoma site BID, infection, inflammation can occur. clean 2x a day Coupage – walking +/- nebulisation, then vibrations/coupage contraindicated in patients with chest tubes, rib fracture, open chest wounds, chest pain, thrombocytopaenia, arrhythmias Essential procedures and handling only Pain scoring/management

Answer 374

Head trauma – elevate head to 30°, aiding passage of blood to head. Avoid occlusion of jugular veins. dont occlude jugular vein as they are distended Secured to spinal board if spinal trauma/suspected Maintain nutrition – prevent hypoglycaemia. monitor glucose levels. Maintain body temperature – reduce in fitting patients. if seizing, they will get hyperthermic Prevent injury to fitting patients – large kennel, padding, remove toys/bowls etc. dont handle seizure pxs. most seizures only last 1-2mins May require sedation/anaesthesia to cease seizure activity, altered mentation or severe pain – monitor as GA, monitor temperature, maintenance IV fluids May require intubation (not nasal cannulation) to protect airway. Mechanical ventilation possibly required in head trauma cases Maintain moist ocular and oral mucous membranes Urinary catheterisation/bladder expressed BID/TID Turn patient regularly and provide physiotherapy to prevent decubitus ulcers Pain scoring/management

Answer 375

Urinary catheterisation Indwelling catheter and collection bag Empty every 2-4hrs and measure output Aseptic technique Palpate bladder size regularly Maintain hydration Administer medication as required

Answer 376

Assisted feeding Hand feeding Nasooesophageal/oesophagostomy/PEG tube Parentral feeding Individual assessment and nutrition plan; avoid ‘refeeding’ syndrome’ which causes liver damage. gradually give food. , early nutritional support, appropriate diet – high fat/protein, low carbohydrate Stoma site cleaned BID Tube fed until eating >85% daily requirement voluntarily Maintain hydration Administer medication as required; anti-emetics, analgesia

Answer 377

Maintain skin and coat health Wounds/dressings checked q4-6hrs Stoma sites cleaned daily Clean to remove soiling Keep dry Groom, bed baths Maintain skin circulation and protect bony prominences Pressure relieving bedding; mattress, layers vetbed, air bed, water bed Massage Turning q2-4hrs Limbs and joints maintained in neutral position Maintain temperature Warming – Bair hugger, blankets, warm water blanket, heat mats Cooling – cool packs, fan Core warming with isotonic fluids IV fluids Peritoneal lavage Intracolonic lavage

Answer 378

Increased risk – immunocompromised, indwelling devices, open wounds, long periods of hospitalisation Meticulous handwashing/alcohol sanitisation Exam gloves and aprons used routinely; sterile gloves when dealing with indwelling devices Dedicated staff clothing worn and laundered only in hospital Utilise closed systems where possible Barrier nursing

Answer 379

Level and frequency dependant on individual patient To include Circulation Respiration Temperature Renal function Pain assessment Neurological function Also demeanour, bodyweight etc

Answer 380

Tissue perfusion Compare central (e.g. femoral) and peripheral (e.g. metatarsal) pulses mm colour and CRT (also, increase indicates sepsis) BP (<80mmHG systolic – hypotension) CVP (pressure in Vena Cavae & Cardiac Preload) Urine output/other fluid loss – vomitus, faeces, wound effusions. Compare to fluid input Hydration status- oliguria Core temperature vs peripheral temperature (toe web) - difference should be <4°C indicates normal peripheral circulation. >5 inadequate perfusion (vasocontrcition in periphery) Blood lactate levels (<2.5mmHg normal),

Answer 381

BP Normal average values Dog – 133mmHg systolic Cat – 124 mmHg systolic Minimum 90mmHg required for adequate organ perfusion Direct or indirect methods Direct – invasive technique using arterial catheter Indirect – non-invasive using external cuff Commonly use doppler system with sphygmomanometer or electronic system

Answer 382

RR and effort Observation (chest movements, abdominal movement, posture) Auscultation Wheezing – narrowing of airways; inspiratory (stridor)– upper airway, expiratory – lower airway Crackles – fluid Muffled – pleural space disease Oxygenation mm colour Pulse oximetry (>95%) Arterial blood gases (PaO2, PaCO2, pH, HCO3-) Capnography (CO2)

Answer 383

Accurate assessment of core temperature Tympanic thermometry Rectal thermometer Traditional mercury or digital Indwelling probe Infrared device

Answer 384

Urine output Free-flow Closed system Weighing bedding/litter (1gram = 1ml urine/other fluids) SG Refractometer Multistix Also urea and creatinine blood testing

Answer 385

Pain assessment charts (Glasgow/Colorado) Observation of behaviour and clinical signs Increased HR Increased RR Increased temperature Increased BP Vocalisation Depression Unusual body posture Self mutilation Inability to rest or sleep Trembling Inappetant

Answer 386

Modified Glasgow Coma Scale (MGCS)/Small Animal Coma score (SAC) Assessment of consciousness Mentation Assessment of gait Pain response Reflexes Pupil size and symmetry