Discharging Patients Flashcards
discharging requirements?
often job of VN
should be familiar with routine procedures and their associated discharge requirements
- what had done
- what need to go home with
- when should next come back
protocols will vary between practice and may slightly between patients
planning discharge? what is consider?
if a discharge to referral
- need to call referral practice to hand over
- give directions to patient?
condition of patient
- fit to go home
- fully recovered from anesthetics
home circumstances
- can’t be using stairs/jumping on furniture
transportation home
- discuss with owner
owners capability of carrying out necessary aftercare
- write down instructions clearly
- make sure understand quickly - “it is protocol t repeat”
- consider difficulties (eg. sight/hearing)
transporting home?
not all owners have their own transport
- need to call in advance/ arrange pick up day so can make arrangements
- taxis may not accept pets
need to consider transport type
- mare and foal will need more space but post op fracture will need little space
- cats and small mammals need carrier
- dogs need lead nd collar
consider previous travel experience
- used to it?
- likely to panic?
- sedation needed?
discharge step 1?
confirm with vet if patient is ready to leave
establish who will be discharging
- sometimes vet will want to speak to owner
- but often vet who has been looking after all day
ensure correct patient
- use collar/labels
- name on kennel/stable
- include any possessions
ensure patient is clean and tidy with all catheters removed
- no blood around wound
- brush shampoo out
- if not letting you, let owner know. must acknowledge attempt
check all wounds
- not bleeding/discharging
- check all stitches in place
check an bandages are clean, secure and dry
- may need to redress
check all extras are done
discharge step 2?
check patients records
- ensure billing is up to date
- receptionists wont know what in for unless recorded
ensure discharge form is ready/correct
- plus any extra forms/information sheets (eg bandage care or referral forms)
ensure patient belongings are collected and ready
check correct strength and mount of medications has ben prepared
- don’t assume something by kennel is correct
ensure food, buster collars, bandage bag (equine) are ready if needed
discharge step 3?
take client to quiet/consult room for privacy
explain procedure (everything involved an extras) and any aftercare to client
- good time to go through invoice to stop disrepute
- bring in printed copy aware of what it includes
ensure client understanding
- use written information (eg discharge forms and drug charts)
- talk through drugs - when, how, amount - demos are good (you and them)
ensure all client questions are answered
explaining procedure?
state procedure
- eg. routine spay under general anesthetic
- eg. emergency colic surgery to correct a 360° colon torsion under general anesthetic
confirm any extra procedures performed
explain any medication given
- amount and when
- explain when next and how to administer
- explain taken fine - ease owner
explain how patient is recovering
- awake?
- toileting well?
general aftercare?
first evening/day requirements once home?
- keep warm
- small but frequent meals
general monitoring necessary for few days
- explain what owner needs to be monitoring
- often demeanor
general after care?
medications?
explain medications
- when should be taken - write on box
ensure happy and capable to administer
- demonstration both ways
explain any precautions
- eg. PPE
- eg risks for pregnant women
need clear dispensing label
general after care?
wound management?
explain what to expect and what to look for
- show where it is
- explain that it is healing nicely
explain importance of preventing interference
- responsible for any additional costs
provide bandage care if relevant
- how and when to change/remove
- not case for SA
general after care?
returning to exercise?
ensure owner understands plan and is capable of adhering to it
physiotherapy? why?
gently moving limb in its full capacity
- my need to demonstrate basics to owner
improves range of motion
maintains muscle tone
improves muscle strength
rehabilitates normal gait pattern
controlled exercise program to regular performance
discharge step 4?
book follow up appointment
- do with them in consult
ensure client has all practice contact details including OOH provisions
send to reception to pay
then bring patient through/the owner through to yard to collect horse
- so all focus has been on information given and payment nd not on seeing pet again
payment?
types?
check practice policy - certain payment types not allowed itemised bill should be available once payment is processed, record it provide receipt - must have price, TAX/VAT, and practice info
cash - check it
cheques - signature must be same as guarantee card
debit/credit cards
standing order - fixed amount transferred by client
direct debits - amount paid can be altered by practice
post-op care for neutered dogs
process?
bitch spay - removal of womb and ovaries
castration - removal of testicles
post-op care for neutered dogs
diet?
note if already given some
- eat it or not?
- how much?
advice reduced portion that evening, little and often
- due to increased risk of vomiting caused by anesthesia - monitor
- bland/gastrointestinal food (eg boiled chicken and rice)
monitor appetite
- not eat at all = issue
- eating a little= fine
- should be to normal next day
bowel movements may be reduced 24-36hrs after
- urination should be fine
post-op care for neutered dogs
medications?
NSAIDs (non-steroidal anti-inflammatory drugs)
3-5 days
post-op care for neutered dogs
exercise?
keep quiet and warm
on lead in garden first night
10-14 days post op lead only walks for 15-20mins
bitches should avoid stairs and jumping onto furniture/in cars
- wound across abdomen so chances of hernia if stiches split
post-op care for neutered dogs
wound aftercare?
usually no longer than 3” long
- bitch - underside of abdomen
- male - between base of penis and scrotum
check at least twice daily for swelling, discharge, redness, discomfort
- weeping can be gently bathed - but let vets know
avoid interference
post-op care for neutered dogs
general demeanor?
should be lively next day
- not sleeping all week
try and check gums, resps, pain, weakness , alertness
post-op care for neutered dogs
follow up appointments?
2-3 days after
again 10-14 days - removal of stitches if necessary
post-op care for neutered cats
diet?
note if already been offered some food
advise reduced portion that evening, little and often
- bland due to increased risk of vomiting up to 24hrs after
monitor appetite
- should be eating something
post-op care for neutered cats
medications?
usually female only
NSAIDs for 3-5 days
post-op care for neutered cats
exercise?
restricted - kept warm indoors with litter tray
avoid stairs and furniture
- reduces stress on wound
ensure constant access to water
post-op care for neutered cats
wound aftecare?
queen - underside/left side of abdomen
tom - x2 directly over testicle
- male cats may appear as if they still have testicles
- often skin glue is used instead of sutures - stop interference
avoid interference/touching
- may need to assist with grooming
post-op care for neutered cats
general demenour?
check gums, resps, pain, weakness, alertness
post-op care for neutered cats
follow up appointments?
2-3 days after
again 10-14 days
- usually females only
- when stitches are removed if necessary
post-op care for dentals
diet?
small amounts of soft food first evening
may need to continue soft food for around 14 days depending on procedure
monitor for any difficulty
post-op care for dentals
medications?
NSAIDS
3-4 days
post-op care for dentals
exercise?
restrict first evening
return to normal following day
post-op care for dentals
wound aftercare?
some blood tinged saliva is to normal at start
monitor for halitosis (bad breath) as sign of infection
avoid brushing for 7 days after
- after that, brush 3 times a week with enzymatic toothpaste
- demonstration?
post-op care for rabbits and rodents
exercise?
keep warm and quiet for the evening
- must be inside as GA stops regulation
reduce handling for 12 hours
keep other pets away if pestering
post-op care for rabbits and rodents
diet?
eating is vital - encourage as much as possible
recovery food may be necessary
- syringe fed - demonstrations?
expect normality after a few days
remember rabbits need to eat caecotrophs if wearing a collar
- stops chances of fly strike
provide shallow food bowls
post-op care for rabbits and rodents
wound aftercare?
provide bedding that wont catch any sutures
- eg shredded paper or towels
may need to assist with grooming
check for urine scalding
- result of urinary incontinence or inability to assume normal posture
post-op care for rabbits and rodents
medications?
NSAIDs
owners may be less confident than with cats/dogs
consider demonstrations
equine general care? box rest considerations?
owners may worry about box rest
- causes stress which can cause injury
- can e hard to manage/muck out
- excitement of release may cause more injury
diet
- less as on box rest
- depends on type - competition horse, brood mare etc
- use forage based diet
- reduce to 1/4 amount of hay
- little and often
- return to normal after first dropping
alleviate boredom on box rest
- prevent stable vices (undesirable habits)
- eg, rotation of horses for companions
if swelling in distal limbs massage and use stable bandaging to support
grooming is good for muscle tone and well-being
post-op colic care
feeding?
small amount of soft food few times a day
re-introduce hard feed after 30 days
examine manure for characteristics
slowly reintroduce fibre diet
- gradual increase of grass to gradual increase in hay
monitor appetite and colic symptoms
post-op colic care
exercise?
whole gut weight on incision so don’t want to stress or cause infection
-if stiches open - get fall out - death
first 30 days
- box rest with 10mins hand walking to grass 3-4 times daily
50-60 days
- round pen or small paddock exercise if incision healing well
- increase hand walking
60-90 days
- gradually return to normal activity providing no complications
post-op colic care
monitoring?
temperature should be taken for 14 days afterwards
monitor HR and resps
monitor wound
- swelling, discharge, discomfort
post-op colic care
follow up appointments?
staples (if any) removed at 10-14 days
check at 30, 60 and 90 days
post-op equine castration
exercise?
restrict first 24 hours
start exercise after 24 hours to reduce swelling and faciliate drainage
- lunge 15mins 1-2 times a day at trot
stiffness should ease
post-op colic care
monitoring?
apply fly spray and summer fly cream around wound
apply terramycin spray (antibiotic spray)
wound should heal 2-14 days
watch swelling of scrotum and sheath
- may swell through days 2-5 but should reside afterwards
some dripping from site is expected for first few hours
- but should not be streaming
for first few days small amount of clear, red tinged fluid is okay
- yellow or pus coloured is not
any tissue hanging from site is not okay
- emergency as could be part of gut
