Animal Nursing Flashcards
Normal HR for Cats and Dogs
Dogs: 60-160 bpm
Cats: 140-220 bpm
Normal MM color
Pink
Normal Capillary Refill Time (CRT)
1-2 seconds in cats and dogs
Define blood pressure
the pressure of circulating blood against walls of blood vessels
Define Direct Arterial Blood Pressure (DABP)
continuous systolic, diastolic, and MAP monitoring through an arterial catheter and a pressure transducer
Define Indirect Arterial Blood Pressure (IABP)
Non-invasive monitoring with a doppler or oscillometer
Systolic Blood Pressure
Direct pressure on arteries from the blood pumped from the heart
Normal Ranges
Dogs: 90-140 mmHg
Cats: 80-140 mmHg
Diastolic Blood Pressure
Pressure in arteries in between heartbeats when the heart is resting
Normal Ranges
Dogs: 50-80 mmHg
Cats: 55-75 mmHg
Mean Arterial Pressure
Average pressure in arteries during one cardiac cycle
Dogs and Cats: 60-100 mmHg
Respiratory Monitoring
Assessment of quality, rhythm, sound, and character of breath
Normal Ranges:
Dogs: 16-32 rpm
Cats: 20-42 rpm
Temperature Monitoring
Assessment of how well the body can make and eliminate heat
Normal Ranges:
Dogs and Cats: 100-102.5 F (37.8-39.1 C)
Colorado State Pain Score 0/4
No pain, comfortable, happy, content, minimal body tension, nontender response to palpation (ex. wound, surgery site), normal
Colorado State Pain Score 1/4
Content to slightly unsettled, slight pain, body tension, flinching/whimpering, reacts to palpation (ex. wound, surgery site)
Colorado State Pain Score 2/4
Uncomfortable, whimpering, licking wounds, droopy ears, worried expression, reluctant to respond, not eager to interact, cries on palpation, moderate body tension.
Reassess analgesic pain.
Colorado State Pain Score 3/4
Unsettled, crying, biting/chewing wound, guards wound, may have a subtle or dramatic response to palpation, may be unwilling to move at all. Reassess analgesic pain.
Colorado State Pain Score 4/4
Constantly groaning or screaming, potentially unresponsive to surroundings, difficult to distract from pain, cries at non-painful palpation (may react aggressively), may be rigid to avoid painful movement.
Reassess analgesic pain.
Explain Restraint
Process of holding back, checking, or suppressing an action and keeping something under control safely by some means of physical, chemical, or psychological action
*Should NEVER involve physical reprimands!
Explain the use of Sedatives/Tranquilizers
Sometimes needed to keep patients calm or pain-free during stressful procedures or circumstances
Standing Restraint Uses
General exams
SQ injections
IM injections
TPR
Specimen Retrieval
Nail Trims
Sitting Restraint Uses
General exams
Cleaning ears
Blood draws
Lateral Recumbency Restraint Uses
X-rays
Blood draws
Nail trims (extreme)
Sternal Recumbency Restraint Uses
Close examination
Blood draws
Placing IV catheters
Intubation for surgery
Dorsal Recumbency Restraint Uses
X-ray
Cystotomy
Cephalic Vein Location
Located on both front limbs
Jugular Vein Location
Located on either side of the neck
Saphenous Vein Location
inside (medial) and outside (lateral) of thigh in the rear limb
*Lateral saphenous used in dogs
*Medial saphenous used in felines
Define Enteral
Drug is introduced into the digestive tract orally or rectally
Oral Contraindications: Vomiting, injuries in mouth or digestive tract, and problem swallowing
Define Parenteral
Administered or occurring elsewhere in the body other than the mouth and alimentary canal
Can be injection or topical
Define Intravenous (IV)
Drug enters systemic circulation directly
Define intramuscular (IM)
Drug injected into muscles because of the high volume of blood flow in those areas
Define subcutaneous (SQ)
Drug injected under the skin but not into the muscle
Define intradermal (ID)
Drug injected into the dermal layer
Define topical/transdermal
Drug applied to the body surface and absorbed slowly by capillaries under the skin
Define inhalation
Drug is absorbed through the lungs by inhaling
Define intraosseous (IO)
Drug injected by placing needling into the bone
Locations of IM Injections
Quadriceps
Triceps
Hamstring
Lumbar
Locations of IV Injections
Cephalic
Femoral/Medial Saphenous
Lateral Saphenous
Jugular
Intraosseous Injection Information
Needle placed into the medullary canal of bone
Commonly used for smaller animals and neonatal animals
Most common sites: femur, humerus, and tibia
*Limit injections in neonates to one injection per bone
Reasons for Fluid Therapy
-Maintain hydration
-Replace fluid loss (dehydration)
-Correct hypovolemia, shock, anemia, and hypotension
-Improve urine output
-Correct electrolyte imbalance and pH
Dehydration vs Hypovolemia
Dehydration - water deficit in interstitial and intracellular compartments
Hypovolemia - loss of fluid in intravascular space
Define Hemorrhage
Fluid is lost from intravascular space (ex. plasma) and from ICF in cells lost (ex. RBCs, WBCs)
Signs of dehydration
-Skin tent remains standing
-Tachycardia
-Weak pulse
-Dry mucous membranes
Symptoms of 5-6% Dehydration
Subtle loss of skin elasticity
Symptoms of 6-8% Dehydration
-Delay in the return of skin to normal position (skin turgor)
-Slight increase in CRT
-Eyes slightly sunken into orbits
Symptoms of 10-12% Dehydration
-Dry mucous membranes
-Complete loss of skin turgor
-Eyes sunken into orbits
-Dull eyes
-Possible signs of shock (tachycardia, cool extremities, rapid and weak pulses)
-Possible alterations in consciousness
Symptoms of 12-15% Dehydration
-Signs of shock
-Death is imminent if not corrected
Colloid Solutions
-Solution containing protein or starch
-Stays in vascular space in expense volume
-Useful for patients with cerebral or pulmonary edema in hypoproteinemia
-Used when crystalloids are not effective at increasing blood volume
Ex. Hydroxyethyl starch, plasma, albumin solution
Crystalloid Solutions
-Solutions used to increase intravascular volume and electrolytes in water
-Balanced electrolyte solutions with small molecules
-Used for replacement or maintenance fluids
-Ex Sodium chloride 0.9% or LRS
Define tonicity
Effective osmotic pressure gradient
Isotonic solutions
-Overall concentration are equal so cells remain constant
-Similar concentration of dissolved particles as blood
-Ex LRS
Hypotonic solutions
-Outside concentration is lower than inside concentration
-Water moves into the cell and causes cells to expand and lyse
-Lower concentration of dissolved particles as blood
-Ex. D5W
Hypertonic solutions
-Outside concentration is higher than inside concentration
-Water moves out of the cell and causes cells to crenate (shrink)
-Higher concentration of dissolved particles such as blood
-Ex. NaCl 3%
List the Isotonic solutions and their uses
NaCl 0.9%: fluid resuscitation (ex. hemorrhage, severe vomiting, GI upsets, blood transfusions)
Lactated Ringer’s Solution: fluid resuscitation (ex. GI fluid loss, trauma, burns, metabolic acidosis)
Plasmalyte-A: volume replacement
Normosol-R: replacement of acute losses of extracellular fluid
List hypotonic solutions and their uses
NaCl 0.45%: treats intracellular dehydration and provides fluid for renal excretion
*Monitor closely for hypovolemia due to fluid shifting into intracellular space
List hypertonic solutions and their uses
NaCl 3%: treats severe hyponatremia and cerebral edema
*Monitor closely for hypovolemia
*Contraindicated for patients with heart or kidney failure *
List isotonic/hypotonic solutions and their uses
5% Dextrose in Water (D5W): starts as isotonic then changes to hypotonic when dextrose is metabolized
*Provides free water and helps with renal excretion
0.9% Sodium Chloride (Normal Saline) Characteristics
Tonicity: Isotonic
Clinical Uses:
- Fluid resuscitation in hypovolemia (e.g., blood loss, dehydration)
- Diluting IV medications
- Replacement of extracellular fluid in patients with vomiting, diarrhea, or surgical losses
- Used in conjunction with blood transfusions
Lactated Ringer’s (LRS) Characteristics
Tonicity: Isotonic
Clinical Uses:
- Resuscitation in trauma, burns, and surgical settings
- Correcting acidosis (lactate is metabolized into bicarbonate in the liver)
- Large volume fluid replacement
Dextrose 5% in Water (D5W) Characteristics
Tonicity: Isotonic in the bag, but hypotonic after administration as dextrose is rapidly metabolized
Clinical Uses:
- Providing free water for dehydration, especially in hypernatremia (since it’s hypotonic after dextrose metabolism)
- Short-term maintenance fluid in patients unable to eat
0.45% Sodium Chloride (Half Normal Saline) Characteristics
Tonicity: Hypotonic
Clinical Uses:
- Treating hypernatremia (elevated sodium levels)
- Maintenance fluid for patients with ongoing fluid losses
- Can cause cellular swelling, so avoid in patients at risk for increased intracranial pressure or edema
0.33% Sodium Chloride Characteristics
Tonicity: Hypotonic
Clinical Uses:
- Severe hypernatremia treatment
- Rarely used, as it can lead to significant cellular edema
3% Sodium Chloride Characteristics
Tonicity: Hypertonic
Clinical Uses:
- Treating severe hyponatremia, particularly in neurologically symptomatic patients (e.g., seizures)
- Reducing intracranial pressure in cases of traumatic brain injury or stroke
- Must be administered carefully to avoid rapid shifts in sodium levels, which can cause central pontine myelinolysis
Dextrose 10% in Water (D10W) Characteristics
Tonicity: Hypertonic
Clinical Uses:
- Providing additional calories in patients who need more energy (e.g., total parenteral nutrition)
- Treating hypoglycemia, particularly in insulin overdoses
- Maintenance fluid for patients on fluid restrictions
Dextrose 5% in 0.9% Sodium Chloride (D5NS)
Tonicity: Hypertonic
Clinical Uses:
- Used in fluid resuscitation when both glucose and sodium are needed
- Can be used in patients with low sodium who also need glucose, e.g., in diabetic ketoacidosis
Albumin (5% or 25%) Characteristics
Tonicity: Isotonic (5%) or Hypertonic (25%)
Clinical Uses:
- 5% Albumin is used for volume expansion in hypovolemic patients
- 25% Albumin is used for patients with low oncotic pressure, like liver cirrhosis or nephrotic syndrome, to pull fluid into the vascular compartment
- In burns, septic shock, and hypoalbuminemia
Hydroxyethyl Starch (HES) Characteristics
Tonicity: Isotonic
Clinical Uses:
- Volume resuscitation in trauma and surgical patients
- Risk of kidney injury and coagulopathy in large doses; use has decreased in some regions due to safety concerns
Fluids for Cardiac Disease
-Low-dose maintenance crystalloid (ex 0.45% Saline with Dextrose)
-May require potassium and/or magnesium supplementation
Fluids for Vomiting/Diarrhea
Replacement crystalloid (ex. LRS, Normosol-R, Plasmalyte-A)
Fluids for Diabetic Ketoacidosis
Replacement crystalloid (ex. LRS, Normosol-R)
Fluids for Hemorrhage
Natural colloid (ex. plasma, whole blood, pRBCs)
SQ Fluid Administration Information
-Used for mild vomiting, mild diarrhea, mild dehydration, or to support kidney function with chronic kidney disease
-Takes time to be absorbed
*Not appropriate for treating life-threatening conditions (ex. severe dehydration or shock)
IV Fluid Administration Information
-Provides pathway into the vascular system for fluid, blood products, or medication administration
-Gives rapid, unobstructed blood flow
*Peripheral veins (saphenous and cephalic) are more detrimental, blood flow is slow, and artifact samples occur
Define Poiseuille’s Law
The shorter the tube’s diameter, the smoother the flow, and the larger the tube’s diameter, the faster the flow
*Large-bore, short catheters are best choice when a large volume of fluid must be delivered quickly (ex. hypovolemic shock)
Explain Central Line Catheters
-Longer than typical peripheral IV catheters and reach central circulation via the vena cava
-Placed in the jugular vein
-Can also be reached with a long, through-the-needle catheter or a peripherally inserted central line catheter (PICC) placed in the lateral saphenous vein or the medial femoral vein
Intraosseous Route of Fluid Administration
-Ideal for medication injection in patients with difficult IV access (ex. patients with severe hypotension or complete cardiovascular collapse that are severely dehydrated or patients with limited IV access due to obesity, edema, burns, or thrombosis)
-Also useful for tiny patients such as neonates and pocket pets
-Catheter is inserted into the medullary cavity of a bone
-Limitations: Fluid cannot be provided at a rate equivalent to IV access, and needles not designed for long-term use
IV Fluid Monitoring Information
-Multiple weight checks throughout the course of therapy
-TBW is 60% of patient’s body weight so increases in fluid compartment lead to increase in weight
Define Fluid Overload
Major complication of fluid therapy and can lead to pulmonary edema, ascites, and peripheral edema with the potential development of compartment syndrome
Define chemosis and it’s role in fluid overload
-Swelling of the conjunctiva
-Late sign of fluid overload and requires urgent treatment
Define Maintenance Fluids
Required volume needed per day to keep the patient in balance, with no changes in total body water
When should maintenance fluid rates be lower?
-Lower in cats than in dogs
-Lower in patients with cardiovascular and renal disease
-Rate should be reduced if anesthetic procedure lasts more than 1 hour (Ideal to reduce fluid rate by 25% until maintenance rates are reached if the patient remains stable)
Initial Maintenance Fluid Rates for Cats and Dogs
Cats: 3 mL/kg/hr (2-4 mL/kg/hr)
Dogs: 5 mL/kg/hr (4-6 mL/kg/hr)
Replacement Fluids
Purpose: Rehydration, maintenance, replacement of insensible loss volumes, and replacement of ongoing loss volumes
*Dehydration can be corrected over 24-48 hours
Replacement Fluid Calculations
Volume (mL) of fluid needed = % dehydration x body weight (kg) x 1000
*Vets typically use the rule of 40-60 mL/kg/day
*Once deficit has been determined: total volume can be divided by number of hours over which the dehydration is to be corrected to obtain a mL/hr rate
Shock Fluid Boluses
-Given in increments (ex 1/3, 1/2) of the calculated amount over a period of 10-30 minutes
-Should be titrated to effect based on the improvement of clinical signs (decreased HR, improved CRT, mm, etc.)
-Crystalloid solution bolus is repeated as needed to achieve normal heart rate and blood pressure
Standard shock rate of crystalloid solutions in cats and dogs
Cats: 40-60 mL/kg
Dogs: 80-90 mL/kg
Why would a shock patient’s fluids be changed from crystalloid to colloid fluids? What’s the shock rate of colloid fluids?
-Used if a patient does not respond to crystalloid fluids
-Standard shock rate is 10-20 mL/kg for dogs and 5-10 mL/kg in cats (also given slower)
Define Ongoing Losses
Excessive urine output in polyureic animals, vomiting, diarrhea, blood loss, and third spacing
*Estimate amount of ongoing loss in a patient in mL/hr and reassess patient in 4-6 hours to determine whether this amount needs to be adjusted
Total Fluid Rate Formula
Total Rate = dehydration + maintenance + losses
Macrodrip vs Microdrip
Macrodrip delivers 10-20 gtt/mL
Microdrip delivers 60 gtt/mL
Define drip rate (drops/min)
Number of drops administered per minute
Drip Rate Formula
Drip rate (gtt/min) = volume (mL) / time (min) x gtt/mL
Purpose of venipuncture
-To collect samples for pathology tests (ex. RBC count)
-Administer fluid or medication
Common Venipuncture Sites in Dogs
External jugular vein
cephalic vein
lateral saphenous vein
accessory cephalic vein
Common Venipuncture Sites in Cats
External jugular vein
cephalic vein
lateral saphenous vein
medial saphenous vein
Potential Adverse Effects of Venipuncture
Hematoma
Hemorrhage
Damage to surrounding structures
Purple/Lavendar Tops
-Contains EDTA which prevents coagulation by binding to calcium ions
-Cell constituents are stable for up to 24 hours
-Used for CBCs, hematocrit/PCV, reticulocyte count, or any cell counts
-Can also be used to collect samples from body cavities that may require a cell count (ex. cerebrospinal fluid, peritoneal or pleural effusions, and synovial fluid)
Yellow Top Tube/Serum Separator Tube (SST)
-Contains clot activator and gel for serum separation
-Used for chemistry panels and to check any lab value seen on these panels or tests requiring a serum sample (ex. BUN, CREA, ALT, ALP, triglycerides, cholesterol, electrolytes, etc.)
Red-top Tube
-Glass tubes have no additive while plastic tubes have clot activators
-Used in immunology, in some specialized tests (ex. Pheno levels), and as a sterile tube for collecting samples for culture (ex. urine)
Blue-top Tubes
-Contain sodium citrate which is an anticoagulant that binds calcium in the blood
-Checks for coag disorders: includes testing of Prothrombin Time (PT), Partial Thromboplastin Time (PTT), Fibrin Degradation Products (FDP), D-dimer, von Willebrand factor, and other factor and fibroanalysis assays
Green-top Tube/ Plasma Separator Tube (PST)
-Contains heparin, which acts as an anticoagulant by activating antithrombins to block coagulation
-Produ es whole blood/plasma sample and used for collecting a plasma sample
Gray-top tube
-Contains sodium fluoride (glucose preservative) and some contain potassium oxalate
-Used if an accurate glucose measurement is needed and sample processing will be delayed because blood glucose tested from serum in a RTT in a delayed sample will be falsely low due to ongoing metabolism by RBCs in the tube
Fresh Whole Blood in Transfusions
Use: hemorrhagic shock, anemia, bleeding disorder, etc.
Should be transfused within 4-6 hours
Packed Red Blood Cells (pRBCs) in Transfusion
Use: hemorrhage, anemia, and non-regenerative anemia
-Fluid balance is osmotic pressure: maintained with crystalloid given with packed cells (only isotonic fluids are used except LRS as calcium can cause blood clots)
-Average K9 RBC has lifespan of 120 days with cats varying from 60-120
Oxyglobin solution (bovine hemoglobin) in transfusion
No blood typing on cross-matching needed
Can be stored up to 3 years
Plasma Uses in Transfusions
Use: coagulopathies (Ex. Thrombocytopenia), volume expansion, hypoppteinemia, sepsis, liver toxicity, pancreatitis, failure of passive transfer
Fresh frozen plasma (FFP) vs Frozen plasma (FP)
Fresh frozen plasma - frozen within 8 hours of collection, lasts up to 1 year, contains all coagulation factors
Frozen plasma - can last for over 1 year
