Case Study VLE Questions Flashcards
A client, whose dog has recently been treated for aspiration pneumonia and discharged from the practice, telephones to say they dog has stopped breathing and is returning immediately. The head nurse ask you to ensure the emergency crash trolley is complete and to assist with resuscitation.
Explain the equipment that is included in a emergency crash trolley and what it is used for?
*Tracheostomy tubes - for non patent larynx, pharyngeal obstructions or if unable to incubate the trachea
*endotracheal tubes - to maintain a patient airway, administer oxygen, to preform IPPV/ resuscitation
*suitable ties - to secure ET tube in place
*Laryngoscopes - to facilitate intubation
*Face mask - to administer o2
*large bore needles - for drainage/ trio are uses
*I/V catheters - for I/V accesses
*three-way tap- for drainage/act as a connector
*syringes and needles - for drug administration
*urinary catheters - for intratracheal drug administration
*dosage chart - for emergency drugs
Sundries - tapes, butterfly needles, bungs, scissors, scape blades.
A client, whose dog has recently been treated for aspiration pneumonia and discharged from the practice, telephones to say they dog has stopped breathing and is returning immediately. The head nurse ask you to ensure the emergency crash trolley is complete and to assist with resuscitation.
Explain the preparations to make for arrival of this patient?
- Suitable area
- table
- anaesthetic machine + o2
- anaesthetic breathing system (for this patient needs to be a rebreathe game system for IPPV - t-piece, circle with low resistance tubing, Bain or humphreys ADE)
- I/V catheter and flusH
- pressure infuser for rapid fluid administration
- emergency drugs - drawn up and labelled
- selection of ET tubes
- laryngoscpe with suitable blade and working light
- Observation chart
- clippers
- warming equipment i.e heat pads, Bair hugger, bubble wrap and blankets
Breed: West Highland White Terrier, Age: 2 years. Sex: Male neutered, Weight: 9.2 kg.
Hamish has suffered a cardiac arrest on arrival at the surgery. Emergency triage reveals: \:Clinical signs Absence of respiration Absence of heart rate Absence of pulse Cyanosis of mucous membranes Haemorrhage from the nose Eyes central and fixed with dilated pupils
Diagnosis:
*Hamish has relapsed from aspiration pneumonia.
*It is a condition that occurs when gastric acid is aspirated into the lungs, causing pneumonia.
*A condition, called Pulmonary Acid Aspiration Syndrome, can ensue.
*Acidic fluid causes damage to the lung tissue, known as chemical pneumonitis. It leads to oedema, alveolar haemorrhage, increased airway resistance and hypoxia.
*The result can be lung collapse and respiratory failure.
In the absence of respiration, there is no oxygen delivery to the cells and tissues and cardiac arrest follows.
*In cardiac arrest, there is no mechanical activity of the heart and therefore no circulation of blood to the organs and tissues
First aid treatment and Nursing Interventions:
The veterinary surgeon immediately starts to try and resuscitate Hamish with cardiac compressions and requests that you assist with CPR.
Question:
What are the actions that an assistant would be expected to undertake during the resuscitation procedure?
-What are the actions that an assistant would be expected to undertake during the resuscitation procedure?
Assist with cardiac compressions
Help intubate the trachea
Perform IPPV
Assist with placing, or place an IV catheter
Prepare and/or administer medications and fluids, as directed
Make observations on a monitoring chart
Note the time drugs were administered and when they are next due
Note the time each rescuer starts CPR and change rescuers every 2 minutes
Keep the area clean and tidy with a sharps bin available
Treatment and Nursing Interventions continued
After several minutes, a heartbeat is detected. Mucous membranes become pale pink and pulse oximetry reveals an SpO2 of 92%. Cardiac compressions and IPPV are continued until Hamish regains consciousness and is extubated.
Question
What methods exist for administering supplementary oxygen therapy to conscious patients, and what are the advantages and disadvantages of each method?
Flow-by:
Advantages – easy, no special equipment needed, non-invasive;
Disadvantages – does not increase FiO2 (fraction of inspired oxygen) significantly, not always effective.
Mask:
Advantages – easy, no special equipment needed, increases FiO2 significantly;
Disadvantages – may be stressful and therefore may be counter-productive.
Nasal prongs:
Advantages – increases FiO2 significantly, cheap to buy, minimally invasive;
Disadvantages – may not be tolerated by patient, may be difficult to secure in place, cannot use if suspected head trauma/raised intracranial pressure (ICP) or following some types of respiratory surgery.
Nasal catheter:
Advantages – increases FiO2 significantly, very effective, oxygen is delivered direct to the airway;
Disadvantages – patient interference may be a problem but easier to secure than prongs, should not be used if raised ICP is a concern, more expensive than other methods.
Oxygen “tent”:
Advantages – easy to make and deliver (Elizabethan collar and cling film or proprietary cage;
Disadvantages – need high flow rates to prevent rebreathing so more expensive, FiO2 increase is variable depending on method, patient can get too hot.
Oxygen generator:
Advantages – very efficient, can deliver varying concentrations so FiO2 can be controlled, easy to humidify, portable;
Disadvantages – need specialist equipment, need electricity supply nearby.
Oxygen cage:
Advantages – extremely efficient, can deliver varying concentrations so FiO2 can be controlled, oxygen is humidified;
Disadvantages – very expensive, only usually found at referral centres or veterinary universities.
Hamish is stabilised and returned to wards but the possibility of another cardiac arrest is high and he therefore requires constant supervision and monitoring.
Question
What parameters are particularly important to monitor in Hamish, in order to reduce the risk of a repeat cardiac arrest? For each parameter, state how it can be monitored
Cardiac rate and rhythm: this can be monitored with an ECG and a stethoscope used to auscultate the heart. Sinus rhythm and any dysrhythmias can be seen on electrocardiography.
Blood pressure: this can be monitored in one of several ways. Non-invasive methods include the Doppler technique, which measures systolic blood pressure only and oscillometric measurements, to detect systolic, diastolic and mean arterial pressures. These are carried out periodically. If an arterial catheter has been placed, invasive blood pressure monitoring can be performed, to detect real time values of systolic, diastolic and mean arterial pressures. A sudden or gradual drop in blood pressure can be a forewarning of imminent cardiac arrest.
Monitoring of pulses by manual palpation: both central and peripheral – can help assess cardiovascular status.
Respiration rate and rhythm: visual assessment can help detect any abnormalities.
Pulse oximetry: can be used to detect oxygen saturation of haemoglobin by placing a clip (transmittance) sensor on the lip or a reflectance sensor in the rectum. SpO2 readings of less than 92% can indicate severe hypoxaemia.
Colour of mucous membranes: any cyanosis or grey tinge indicates desaturation and imminent cardiac arrest.
Capillary refill time: this should be less than 2 seconds. If it is longer than this, the cardiovascular system is compromised somehow.
Temperature using a rectal or ear thermometer: a sudden decrease in temperature can be a warning sign of impending crisis
You take a telephone call from a client
who has rung to say her golden retriever, Millie, has eaten a large bar of chocolate. As there is no veterinary surgeon or qualified veterinary nurse on the premises, you must deal with the situation.
What questions should you ask the client in relation to the incident?
What advice should you give the client?
-What questions should you ask the client in relation to the incident?
How much chocolate Millie ate
When the incident occurred – how long ago
What type of chocolate it was – dark, milk or white
Whether the client still has the chocolate wrapper showing the active ingredients
Whether Millie is showing any signs of illness related to eating the chocolate, such as panting, vomiting, tachycardia
Full patient details should also be obtained
-What advice should you give the client?
Bring the dog to the surgery as quickly as possible. It is preferable to induce vomiting in the practice, in a controlled way using apomorphine, rather than the client trying to induce vomiting at home. This way, the dog can be monitored and the vomitus collected and examined.
Do not give Millie any food or water.
Bring the chocolate wrapper if it is available, as vital information, such as the amount of cocoa included may be shown. This will be useful in calculating the toxic dose of theobromine.
The client arrives at the surgery with Millie:
Clinical signs:
Dull but responsive.
Diagnostic Workup:
Physical examination reveals:
Tachycardia, with a heart rate of 150 beats per minute
Tachypnoea, with a respiratory rate of 32 breaths per minute
Temperature 38.9°C
Mucous membranes pale
Capillary refill time 1.5 seconds
Diagnosis:
The knowledge that Millie has eaten a bar of chocolate, together with presenting clinical signs, confirms theobromine poisoning.
The darker the chocolate/the higher the cocoa content, the more toxic it is. Theobromine is a stimulant and a diuretic. It stimulates the myocardium and also the central nervous system, leading to hypermetabolic states and cardiac abnormalities. Rehydration and reduction of the stimulant effects are key to effective treatment. In severe cases, it may be necessary to sedate the patient. Theobromine undergoes enterohepatic recirculation and it is vital that repeated doses of activated charcoal are given at 4-hourly intervals to improve elimination of the toxin.
The potential complications that may arise with this case include:
Cardiac arrhythmias Hyperthermia Vomiting and diarrhoea Aspiration pneumonia Muscle tremors Seizures Hypersensitivity to noise Urinary incontinence Blood pressure changes (usually hypertension, but occasionally hypotension is seen) Respiratory failure Cardiac arrest First aid treatment and Nursing Interventions
When the veterinary surgeon arrives, she tells you she will treat Millie with apomorphine, activated charcoal and fluid therapy.
Question:
Explain how to prepare for Millie’s first aid treatment
Prepare apomorphine, which is usually given by the subcutaneous route. Occasionally, it may be given into the eye, into the conjunctival sac, although this can be less effective than the injection. If it is given intraocularly, the eye should be irrigated after vomiting, so sterile saline should be prepared.
Prepare an area where controlled vomiting can take place – paper, gloves and paper towel will all be needed.
Activated charcoal to be given orally is also required. The initial dose for this is 1-5 g/kg, then half the dose should be repeated every 4-5 hours as enterohepatic recirculation of toxins is likely, meaning the metabolites are reabsorbed in the intestine. Activated charcoal is used following emesis or following gastric lavage, to prevent further absorption by adsorbing toxins. It is normally given orally, by syringe, but stomach tubing may be necessary. As this is a messy procedure, paper towel will be needed and gloves should be worn as the charcoal can be irritant to skin. A large syringe will be required and possibly a stomach tube.
An intravenous catheter should be placed for administration of fluids. As Millie is a retriever, an 18 or 20 gauge IV catheter will be most suitable. A balanced isotonic fluid, such as Hartmann’s, is likely to be infused, although if a large amount of acid is lost through vomiting, the veterinary surgeon may initially select 0.9% saline solution. Equipment necessary for IV fluid administration will be used.
As Millie is tachycardic, it would be good practice to monitor heart rhythm with ECG, as cardiac arrhythmias may occur with theobromine poisoning.
A client arrives at the surgery with her cat which has been missing for several days and is presumed to have been involved in a road traffic accident. The cat is mouth breathing and obviously in shock, although it does not appear to have any life-threatening injuries. As the veterinary surgeon is busy, you must take the necessary actions initially
Question
What is the immediate action to take in this situation?
hat is the immediate action to take in this situation?
Gain consent from the client to treat the cat
Perform a primary survey: airway, breathing, circulation, consciousness
If necessary, perform resuscitation. If this is not necessary, a secondary survey is performed. This is a systematic physical examination of the whole body, starting from the head and working towards the hind quarters
As the cat is in shock, oxygen therapy should be administered, using a stress-free method
Keep the cat warm, avoiding direct heat and taking care with any obvious injuries
Inform the veterinary surgeon as soon as possible of your triage findings
reatment and Nursing Interventions
The veterinary surgeon asks you to place a peripheral intravenous catheter and start fluid therapy with Hartmann’s fluid at a rate of three times maintenance. Intravenous opioid analgesia will also be instigated.
Questions
What equipment is necessary for placement of a peripheral intravenous catheter? In your answer, state the size of catheter that is most suitable for this cat.
Which is the most suitable vein to catheterise in this patient?
How is three times maintenance fluid rate calculated, and what is the rate of infusion for this cat, in ml per hour?
Explain how to care for the IV catheter on a daily basis.
What is meant by a compound fracture and what is the most likely complication of this type of fracture?
-What equipment is necessary for placement of a peripheral intravenous catheter? In your answer, state the size of catheter that is most suitable for this cat.
Equipment necessary for placement of a peripheral IV catheter:
Clippers
Swabs and chlorhexidine scrub
Sterile spirit wipe or surgical spirit
22G IV catheter (it may be possible to catheterise a vein in this cat using a 20G catheter)
Tape to secure the catheter
T or Y-connector
Sterile flush – heparinised saline or normal saline
Padding such as Soffban
Cohesive bandage (Vetrap)
-Which is the most suitable vein to catheterise in this patient?
The most suitable peripheral vein to catheterise in this cat is a cephalic vein as there will be amputation of the right hind limb and the pelvis is fractured, meaning that soiling of a left saphenous catheter is likely.
-How is three times maintenance fluid rate calculated, and what is the rate of infusion for this cat, in ml per hour?
Maintenance fluid rate is 2 ml/kg/hour, so three times maintenance is 6 ml/kg/hour. For this cat the rate of infusion is 6 x 4.8 = 28.8 ml per hour.
-Explain how to care for the IV catheter on a daily basis.
Inspect the site twice a day – unwrap all dressing material down to the tape, maintaining asepsis
Look for signs of swelling, redness and discomfort
Flush with saline – either heparinised or normal
If the catheter is not patent or if it appears uncomfortable, it must be removed and replaced with a new catheter
Redress with new dressing materials
-What is meant by a compound fracture and what is the most likely complication of this type of fracture?
A compound fracture involves an opening to the outside – the skin or mucous membrane has been penetrated. The most likely complication is infection – osteomyelitis.
Nursing care
You are required to ensure feeding of the Resting Energy Requirements (RER) is carried out, using the formula RER = 60 x body weight. The food is Convalescence Support, which provides 1.1 kilocalories per ml. You decide to split the total requirements into six daily feeds.
Questions
What is the total daily nutrition requirement for this cat, in kilocalories?
How many millilitres will be fed in each of the six daily feeds?
Explain how to care for an oesophagostomy tube.
What is the total daily nutrition requirement for this cat, in kilocalories?
The total daily nutritional requirement is 60 x 4.8 kg = 288 kilocalories.
-How many millilitres will be fed in each of the six daily feeds?
288 kilocalories ÷ 1.1 kilocalorie per ml = 261.8 ml in total.
261.8 ÷ 6 feeds = 43.6 (44) ml each feed.
Note: The usual regime for oesophagostomy tube feeding is on day 1, a third of the total calorie requirement is given, with two thirds water. On day 2, two thirds of the calorie requirement is given with one third water and on day 3, the total calorie requirement is given.
-Explain how to care for an oesophagostomy tube.
To care for the tube:
Inspect the entry site by unwrapping the dressing materials twice a day
The end of the tube must be capped when not in use
Any excess food or fluid should be removed from around the tube
The area around tube insertion must be kept clean
New dressing materials or new swabs should be used to pack around the tube end
The patient may require an Elizabethan collar to prevent interference
A German Shepherd Dog undergoing splenectomy for a ruptured spleen has haemorrhaged profusely during surgery and requires a second blood transfusion upon return to wards.
You are asked to prepare the equipment for transfusion of DEA 1.1 positive packed red blood cells.
Questions
List the equipment necessary for a canine blood transfusion
Explain how to assemble the equipment correctly
If 1.1 positive blood were not available, would it be possible to infuse 1.1 negative blood to this patient? Explain the reason for your answer, making reference to canine blood groups and antigens
List the criteria for a canine blood donor in the UK
-List the equipment necessary for a canine blood transfusion
Appropriate fluid – in this case, one unit of DEA 1.1 positive packed red blood cells
Blood administration set
Transfusion-compatible fluid pump may be used but following recent studies, it is recommended that packed red cells are transfused by gravity alone
Gloves for handling and assembling the equipment
Clean incontinence pad or similar for assembly of equipment
-Explain how to assemble the equipment correctly
Gloves should be worn to maintain asepsis whilst handling blood and blood products
Blood is not warmed after removal from the fridge as warming can accelerate erythrocyte deterioration and promote micro-organism growth. If the patient is hypothermic, or if large volumes need to be infused at high rates, then warming in a water bath may be acceptable
A giving set with a filter is used to prevent small thrombi and cellular debris from entering the circulation of the recipient
The giving set is removed from its package and the flow control roller clamp and clip are closed to stop fluid flowing into the chambers and down the line
The tab is removed from the infusion bag and the giving set inserted aseptically into the bag
The upper, then lower chamber is filled by gently squeezing each chamber
The clip is released and blood allowed to flow slowly down the line using the roller ball control. No blood should be lost from the giving set
The cap is left on the end of the giving set to maintain a sterile, closed system
-If 1.1 positive blood were not available, would it be possible to infuse 1.1 negative blood to this patient? Explain the reason for your answer, making reference to canine blood groups and antigens
If 1.1 positive blood were not available, it would be possible to infuse 1.1 negative blood. Blood types refer to different antigens on the erythrocyte surface. Recognised canine groups are prefixed DEA – Dog Erythrocyte Antigen. If the dog has the antigen, it is said to be DEA 1.1 positive and if it does not have the antigen, it is DEA 1.1 negative. However, it should be noted that current research suggests the group is DEA 1, graded 1+ (weak) to 4+ strong. This is how it is sometimes shown on labels of donor blood from Pet Blood Bank UK (PBBUK), which is the only supplier of canine blood in the UK at present. The universal donor is 1.1 negative as blood from a dog of this blood group can be transfused into recipients who do not have the antigen (negative) and those who do (positive). If a dog does not have the DEA 1.1 antigen, it must not receive blood from a positive donor, as a transfusion reaction is likely.
-List the criteria for a canine blood donor in the UK
Fit, healthy adults between 1 and 8 years old Friendly disposition Over 25 kg in weight Not had transfusion themselves Fully vaccinated Not travelled outside the UK Known blood type
Recovering from general anaesthesia and surgery to perform splenectomy, during which one unit of DEA 1.1 positive whole blood was given, blood typing and cross-matching having been performed before surgery commenced. Pre-operative PCV (Packed Cell Volume) was 18%.
Diagnostic Workup Physical examination as part of post-operative monitoring reveals Temperature 37.5°C Heart rate 90 beats per minute Respiratory rate 16 breaths per minute Mucous membranes pale Capillary refill time just over 2 seconds Post-operative PCV 22%
Diagnosis
Haemangiosacoma was previously diagnosed and surgery to remove the ruptured spleen performed.
Among other functions, the spleen is responsible for storing blood and when it is removed, blood volume decreases. In addition to this, haemorrhage during surgery leads to hypovolaemic shock. To replace the deficit, the best type of fluid to give is blood. Having already given one unit of whole blood (blood cells and plasma), the veterinary surgeon requested one unit of packed red cells be given, in order to increase the oxygen-carrying capacity and increase the PCV.
Blood typing identifies the blood group. Cross-matching checks compatibility between donor and recipient. As this will be a second transfusion from a different donor, it will be necessary to perform cross-matching again to minimise the risk of transfusion reaction.
Generally, a blood transfusion is considered necessary if 10% of the blood volume has been lost or if the PCV is less than 15%, as this is when the oxygen-carrying capacity will be affected.
Blood volume in a dog is around 88 ml/kg (and in a cat, 66 ml/kg).
Transfusions are started at a slow rate initially – usually 0.5-1 ml/kg/hour, the reason being that transfusion reactions are most likely to occur in the first 30-60 minutes. After this time, the remainder of red blood cell products should be given over 4 hours, so they are not out of the fridge for longer than this time to reduce the risk of bacterial contamination and growth. As a general rule, in non-emergency situations, the initial rate of transfusion is 0.5 ml/kg/hr for 30 minutes.
A Y-connector can be used as an isotonic crystalloid fluid should be infused alongside blood products. This is to reduce viscosity and the risk of hypovolaemia. However, calcium-containing crystalloids (such as Hartmann’s) cannot be given via the same catheter, due to precipitation in the hub, nor can glucose products. Either a separate catheter is used, or the fluid changed to normal saline for the duration of the infusion. If the latter is chosen, the entire giving set and catheter must be flushed through with normal saline before starting the transfusion.
What are the baseline parameters to measure before starting a blood transfusion?
How frequently are the results of monitoring recorded?
What are the signs of transfusion reaction?
What should you do if you suspect a transfusion reaction?
What are the baseline parameters to measure before starting a blood transfusion? Temperature, pulse and respiration Mucous membrane colour Capillary refill time Packed cell volume +/- total protein Demeanour
How frequently are the results of monitoring recorded?
Monitoring results are recorded every 5 minutes initially, then after 30 minutes, every 15-30 minutes. After the first hour, results may be recorded every 30-60 minutes until the transfusion has ended.
What are the signs of transfusion reaction?
Dyspnoea Tachypnoea Tachycardia Tremor Pyrexia Vomiting Jaundice Facial swelling Rubbing nose Incontinence Urticaria
What should you do if you suspect a transfusion reaction?
If a reaction is suspected, the transfusion must be stopped immediately. The veterinary surgeon is alerted and symptomatic treatment will be instigated according to veterinary instruction.
Nursing care
At the end of the transfusion, you are asked to check the PCV value.
Your next task is to check the stock levels in the blood refrigerator and to ensure correct storage requirements are met.
Questions
What is the relevance of packed cell volume in a patient that has received a blood transfusion?
How should blood be stored in the refrigerator?
What is the relevance of packed cell volume in a patient that has received a blood transfusion?
Packed cell volume measures the height of red blood cells in a column of whole blood. It estimates the percentage of packed red blood cells in a column of whole blood after it has been centrifuged in a haematocrit tube.
For transfusion patients, it gives an estimate of red cell content in the blood. Following a blood transfusion, it is hoped that the PCV will have increased, which will result in improved oxygenation for the patient as red blood cells are responsible for transporting oxygen (and iron) around the body.
How should blood be stored in the refrigerator?
To correctly store blood and blood products in a refrigerator, the temperature should be 1-6°C and products should be hung vertically. This is to maximise gas exchange and preserve red cell viability, both during storage and following transfusion. Storage should be for as short a time as possible, ideally less than 14-21 days, to avoid storage lesions.
This is a phenomenon whereby red cell function and viability are affected because of extended storage of blood and blood products. There is decreased survival of the red cells following transfusion and the pH of stored blood progressively decreases due to accumulation of acids.
A 19-year-old cat with chronic kidney disease
is admitted to the practice for the day, to have blood tests, intravenous fluids and blood pressure monitoring, as the condition has recently deteriorated.
You are required to prepare suitable accommodation for this patient.
Questions
What type of accommodation is best for this patient? Include details on the environment and bedding in your answer
Explain why it is important to keep stress to a minimum for this particular patient
Why is the blood sample taken before starting intravenous fluid infusion?
What type of accommodation is best for this patient? Include details on the environment and bedding in your answer
A cat kennel in a cat ward is best for this patient. The kennel must be easily accessible for personnel and should include the following:
Comfortable bedding as the cat is elderly and therefore may be lacking in body fat. Synthetic fleece bedding, such as a Vetbed, is ideal
Insulation under the bedding, such as a mattress or newspaper
A litter tray with cat litter
Suitable food and water bowls
A toy or blanket from the cat’s home may be included
-Explain why it is important to keep stress to a minimum for this particular patient
Stress must be kept to a minimum as the cat is to have his blood pressure monitored and if he becomes stressed, the blood pressure will rise. He is also likely to suffer from hypertension due to pre-existing chronic kidney disease. In addition, blood testing is planned and glucose levels rise when patients are stressed. This can give a false indication of other concurrent disease states, such as diabetes mellitus.
-Why is the blood sample taken before starting intravenous fluid infusion?
Blood samples are collected before starting intravenous fluid infusion so the effects of the fluid do not affect the results. It is especially important that the electrolyte results correlate with the pre-infusion state, in order to assess the cat’s condition accurately and to be aware of renal compensation for the diseases, or lack of.
Clinical signs
Abnormal gait with circling in an anticlockwise direction.
Diagnostic Workup Physical examination reveals: Temperature 37.6°C Pulse 120 beats per minute Respiratory rate 26 breaths per minute Mucous membranes pink Capillary refill time 1 second Dilated pupils Ketotic odour of breath
Laboratory test results: High BUN High creatinine High phosphate Low potassium Urine specific gravity (USG) 1.015
Diagnosis
Chronic kidney disease (CKD) is a condition that is progressive and is common in elderly cats. The kidneys are responsible for many metabolic processes, especially maintaining fluid and electrolyte balance in the blood, maintaining blood pressure and the excretion of waste products. When the kidneys fail, these processes no longer work efficiently.
Electrolyte imbalances occur and waste products such as urea build up in the blood. Damage to renal vessels stops them from removing waste products, leading to uraemia and fluid retention. This causes hypertension which in turn leads to more damage to the renal vessels, exacerbating uraemia and hypertension.
It is unclear as to the exact mechanism of the initial damage but it is thought that scar tissue forms in the arterioles and capillaries of older animals, especially in the glomerular capillaries.
The glomerulus is the part of the kidney that is responsible for filtering waste from the blood. Glomerular filtrate eventually becomes urine and is voided from the body. Scar tissue prevents filtration from occurring.
Treatment and Nursing Interventions
The veterinary surgeon examines the cat’s eyes using an ophthalmoscope. She then asks you to take a Doppler blood pressure reading after the cat has settled in and before starting intravenous fluid infusion.
Questions
Why are the eyes examined with an ophthalmoscope in hypertensive cats?
What equipment is needed to take a Doppler blood pressure reading?
Why is it important to use the correct sized cuff when taking blood pressure readings?
Explain why a series of readings is taken, rather than a single reading, each time the blood pressure is recorded
Why are the eyes examined with an ophthalmoscope in hypertensive cats?
The eyes of hypertensive patients are examined using an ophthalmoscope in order to assess the integrity of the retina. In cases of high blood pressure, the retina can become detached from the posterior part of the eye, resulting in sudden onset of blindness. This condition is called Hypertensive Retinopathy. Dilated pupils may be an indication of imminent retinal detachment.
-What equipment is needed to take a Doppler blood pressure reading?
The equipment needed to take a Doppler blood pressure reading:
Clippers Doppler unit Sphygmomanometer Lubricant gel Headphones Blood pressure cuff of correct size Patient monitoring chart for recording results
-Why is it important to use the correct sized cuff when taking blood pressure readings?
A cuff of the correct size must be used otherwise readings may not be accurate. Generally the cuff should be 40% the circumference of the limb (or tail). In cats, this may be 30%. If the cuff is too narrow or too loose, the readings will be falsely high. If it is too wide or too tight, the readings will be falsely low. The same size cuff should be used on the same location of the same limb every time readings are taken.
-Explain why a series of readings is taken, rather than a single reading, each time the blood pressure is recorded
Serial readings are taken in order to obtain the most reliable result. Generally, around 6 to 8 readings are taken. The first reading is discarded. Initially, it is likely that the cat will be stressed with the procedure and the reading will probably be high. As the cat settles down and becomes used to the process, his blood pressure will stabilise and the readings obtained are likely to reflect the true blood pressure at the time.
