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Advanced Clinical Nursing Theory > Equine Neonatal > Flashcards

Equine Neonatal Flashcards

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1
Q

how long should stage 1 of foaling last?

A

30-60 minutes

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2
Q

what signs are seen during stage 1 of foaling?

A

restlessness
coliky

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3
Q

what happens during stage 1 of foaling?

A

cervix relaxation
uterine contractions

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4
Q

what happens at the end of stage 1 of foaling?

A

rupture of chorioallantois (waters break)

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5
Q

how long does stage 2 of foaling last?

A

5-30 mins

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6
Q

what should happen during stage 2 of foaling?

A

delivery of foal

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7
Q

what is critical about stage 2 of foaling?

A

must not be longer than 30 mins

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8
Q

how long does stage 3 of foaling last?

A

2-3 hours

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9
Q

what happens during stage 3 of foaling?

A

placental (foetal membranes) expelled

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10
Q

what is necessary if stage 3 of foaling is delayed?

A

assistance

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11
Q

how soon after birth should foals be standing?

A

1 hour - may be a little wobbly

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12
Q

how long after birth should foals suckle?

A

within 2 hours - may take time to find udder

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13
Q

what should be checked for once foals start to feed?

A

milk at nostrils

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14
Q

how soon after birth should foals pass meconium?

A

within 3 hours

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15
Q

how soon after birth should foals urinate?

A

8-12 hours

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16
Q

what may effect how quickly foals urinate after birth?

A

colts may urinate earlier than fillies

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17
Q

how do healthy foals sleep?

A

legs extended in lateral

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18
Q

is foals sleeping with limbs curled up normal?

A

no - indicates something is wrong

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19
Q

what would be heard on lung auscultation of foals immediately after birth?

A

audible crackles

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20
Q

what RR is seen in newborn foals?

A

50-80 brpm

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21
Q

when will foals respiratory parameters get closer to normal?

A

within 2-3 hours of birth

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22
Q

what may be seen at foals nostrils immediately following birth?

A

mild nasal discharge

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23
Q

what is the normal HR for foals up to 7 days old?

A

80-100 bpm

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24
Q

what is the normal RR for foals up to 7 days old?

A

30-40 brpm

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25
Q

what is the normal temperature for foals up to 7 days old?

A

37.5-39.5 degrees C

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26
Q

what do normal MM look like for foals up to 7 days old?

A

pink and moist

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27
Q

what is the normal PQ for foals up to 7 days old?

A

good
warm extremities

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28
Q

what is the normal BP for foals up to 7 days old?

A

> 70 mmHg

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29
Q

how much colostrum do foals require in the first 24 hours?

A

1L

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30
Q

how much on average will a foal drink per day?

A

20-30% of body weight

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31
Q

how many calories do foals require per day?

A

100-160 kCal/kg/day

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32
Q

what is essential about colostrum?

A

contains antibodies from the mares blood which are absorbed by the foals gut

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33
Q

what is passive transfer?

A

antibodies from the mares blood which are absorbed by the foals gut through colostrum

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34
Q

how long does passive transfer last for?

A

12-24 hours after birth

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35
Q

what is the concentration of foals urine like?

A

very dilute

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36
Q

what can go wrong during birth?

A

trauma during birth
congenital abnormalities
acquired abnormalities
failure of passive transfer

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37
Q

what can cause trauma during birth?

A

dystocia

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38
Q

what trauma to the foal is commonly seen following dystocia?

A

rib fractures

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39
Q

what are some of the congenital abnormalities seen in foals?

A

cleft palate
microphthalmia
limb deformities

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40
Q

what acquired abnormalities may be seen in foals?

A

patent urachus

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41
Q

how can patent urachus be identified?

A

urine from umbilicus on urination

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42
Q

what can cause failure of passive transfer?

A

foal unable to drink
quality or quantity of colostrum poor

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43
Q

what is sepsis usually caused by?

A

failure of passive transfer
infection (usually umbilicus)

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44
Q

what is sepsis?

A

inflammatory response to systemic bacteria

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45
Q

what are the clinical signs of sepsis?

A

pyrexia
petechiae
injected MM
dull/flat
recumbent

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46
Q

what may be seen with concurrently with sepsis?

A

uveitis
synovial sepsis
diarrhoea
pneumonia
umbilical infection

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47
Q

what is the most common reason for diarrhoea in foals?

A

sepsis

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48
Q

what effect does sepsis have on BP?

A

hypotension

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49
Q

what are the signs of neonatal isoerythrolysis?

A

anaemia
icterus
weakness

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50
Q

what happens during neonatal isoerythrolysis?

A

mare produces antibodies against foals RBCs
foal absorbs colostrum and so has antibodies against own RBCs
own RBCs are then broken down by these antibodies

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51
Q

what can cause a mare to produce antibodies against the foals RBCs?

A

previous foal with the same sire
contact with foal RBC during delivary

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52
Q

how is neonatal isoerythrolysis treated?

A

separate nutrition from the mare until no more antibodies will be absorbed (24hours after birth)
supportive care until own RBC regenerate

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53
Q

what is neonatal maladjustment syndrome also known as?

A

hypoxaemic ischemia encephalopathy
perinatal asphyxia syndrome
dummy foal

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54
Q

what body system is mostly affected by neonatal maladjustment syndrome?

A

neuro

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55
Q

what is the clinical presentation of neonatal maladjustment syndrome?

A

variable
poor suck reflex
failure to nurse
hyperaesthesia
obtundation
coma

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56
Q

when will signs of neonatal maladjustment syndrome be seen?

A

abnormal from birth
may be normal from birth and then crash at 24-48 hours

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57
Q

how is neonatal maladjustment syndrome treated?

A

supportive care
foal squeeze (limited evidence)

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58
Q

what makes a foal premature?

A

<320 days gestation

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59
Q

what makes a foal dysmature?

A

normal gestation but appear premature

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60
Q

what are the signs of premature and dysmature foals?

A

silky coat
floppy ears
lax tendons
domed head
immaturity of other organs
incomplete ossification of cuboidal bones

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61
Q

why are cuboidal bones most affected by prematurity/dysmaturity?

A

last to mature

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62
Q

how can premature/dysmature foals be managed?

A

x-ray to assess cuboidal bones
foal kept in recumbancy to preserve bones

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63
Q

what can happen in premature/dysmature foals with incomplete ossification of cuboidal bones?

A

bones crushed when weightbearing

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64
Q

what can cause a ruptured bladder in foals?

A

trauma during birth
handling under the abdomen

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65
Q

when are clinical signs of bladder rupture seen?

A

afew days after birth

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66
Q

what are the signs of ruptured bladder?

A

colic
abdominal distension

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67
Q

why is a ruptured bladder life threatening?

A

electrolyte abnormalities caused

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68
Q

what electrolyte abnormalities are caused by bladder rupture?

A

hyperkalaemia
hyponatraemia
hypochloramia

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69
Q

how should foals be moved?

A

using stifles and forelimbs
never from abdomen

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70
Q

how soon after birth is meconium passed?

A

within 3 hours

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71
Q

what are the clinical signs of meconium impaction?

A

straining to defecate
mild colic

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72
Q

what may foals with meconium be referred to hospital for?

A

IVFT
management

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73
Q

what are the roles of the NICU nurse?

A

patient care
provide for foals needs
stay organised
keep foal unit cleaned and stocked
communication with team
care for mare

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74
Q

what is involved in the general nursing care of foals in the NICU?

A

maintain sternal recumbency
assist to stand
turn every 2 hours
weigh daily
careful exam

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75
Q

why should foals stay in sternal recumbency?

A

prone to atelectasis and so reduced oxygenation

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76
Q

how often should foals be assisted to stand?

A

every 2 hours to nurse

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77
Q

why is it important that foals are turned every 2 hours?

A

prevention of decubital ulcers

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78
Q

what is involved in the NICU exam?

A

demenour compared to last check
nose to tail
assess treatments
nutrition needs
urine and faecal output

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79
Q

how may foals urine output be managed?

A

U cath (preventio of scauld)

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80
Q

how often should sick foals be examined?

A

every 4 hours but may be every 2

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81
Q

how can foals CVS be assessed?

A

MM
CRT
HR

82
Q

what is indicated by MM?

A

systemic health

83
Q

where can MM be checked on the body?

A

buccal
conjuctiva
ear pinnae
coronary band

84
Q

what is normal HR for foals?

A

80-100 bpm

85
Q

what do foals rely on for cardiac output?

A

stable HR as unable to increase stroke volume

86
Q

why is HR compensation in foals so poor?

A

immature sympathetic nervous system exacerbated by hypotension and poor perfusion

87
Q

what is commonly heard on auscultation of foals under 4 days old?

A

murmurs

88
Q

how long should murmurs caused by adaption to life ex utero be heard for in foals?

A

only up to 4 days

89
Q

what is the normal range for RR seen in foals?

A

30-40 brmpm

90
Q

what may be heard on auscultation of foals lungs?

A

louder bronchial sounds than adults
wheezing only in first few hours of birth

91
Q

what should be assessed about foals RR?

A

rhythm
bronchial sounds
wheezes/crackles
effort
discharge
have there been rib fractures

92
Q

how can oxygenation be assessed?

A

blood gas

93
Q

what about the eyes may indicate dehydration?

A

sunken eyes
entropian

94
Q

what about the eyes may indicate sepsis?

A

injected MM
hypopyon
uveitis

95
Q

what is hypopyon?

A

fibrin and pus accumulation within anterior chamber of the eye

96
Q

what may indicate trauma around the eyes?

A

injected MM
swollen eyelids

97
Q

what are sick foals prone to developing in the eyes?

A

corneal ulcers

98
Q

why are foals more prone to developing corneal ulcers?

A

reduced corneal sensitivity so they may go untreated

99
Q

what should the foals MSK system be assessed for?

A

septic joints
osteomyelitis
incomplete ossification of cuboidal bones
flexural deformities
angular limb deformity

100
Q

how can the foal be checked for presence of septic joints?

A

joints checked at each check
no lameness

101
Q

what flexural deformities may be seen?

A

flexor or tendon laxity
contracture

102
Q

what direction are flexural deformities seen?

A

dorsal/ palmar or plantar

103
Q

what may cause colic in foals?

A

meconium impaction
atresia ani
ileus

104
Q

why is diarrhoea seen in foals?

A

secondary to sepsis if very young
acquired infectious diarrhoea

105
Q

what solution should the umbilicus be dipped into?

A

0.5% hibitane

106
Q

how often should the umbilicus be dipped if it is normal?

A

BID for 2-3 days post birth

107
Q

how often should the umbilicus be dipped if there is a patent urachus or sepsis?

A

QID

108
Q

what care should be provided to the mare if the foal is hospitalised?

A

TPR BID
check perineum
ensure milk supply
encourage mare/foal bond
check placenta has been passed

109
Q

what may be tried if the mare has retained foetal membranes?

A

ecbolics such as oxytocin

110
Q

what method of catheter placement is used in foals?

A

over-the-wire

111
Q

why is over the wire catheter placement used in foals?

A

less thrombogenic
vital if septic

112
Q

what position must foals be in to place a jugular IVC?

A

lateral recumbancy

113
Q

how often should foals IVC be checked?

A

Q4

114
Q

what about a IVC should be checked every 4 hours?

A

patency
vein integrity

115
Q

what should be done when administering drugs through a foals IVC?

A

flush well to prevent sedimentation

116
Q

when is extra vigilance around IVC required?

A

if on PN

117
Q

what else is the IVC used for in foals apart from fluids and meds?

A

drawing blood samples

118
Q

when should a blood culture be taken?

A

immediately from the catheter following aseptic preparation and IVC placement

119
Q

what is the purpose of the IgG SNAP test?

A

tests for failure of passive transfer

120
Q

what should the concentration of IgG be in healthy foals?

A

> 8.0g/L

121
Q

how long does the SNAP test for IgG take to work?

A

10 mins

122
Q

what can be done if the foal is <24 hours old and IgG is low?

A

supplement with colostrum via NG tube

123
Q

what can be done if the foal is >24 hours old and IgG is low?

A

plasma transfusion
GI tract no longer absorbs ABs

124
Q

what artery is used for blood gas analysis in foals?

A

lateral metatarsal

125
Q

what is normal PaO2 for foals?

A

80-110 mmHg

126
Q

what is normal PaCO2 for foals?

A

40-48 mmHg

127
Q

what effect can lateral recumbancy have on PaO2?

A

reduced by up to 30 mmHg

128
Q

what is venous blood gas used for in horses?

A

assessment of electrolytes

129
Q

what electrolyte derangement is common in septic foals?

A

hypoglycaemia

130
Q

why are foals at risk of hypoglycaemia?

A

poor glycogen and fat reserves

131
Q

how can foals glucose levels be supplemented?

A

dextrose spiked fluidsa

132
Q

what must foals on glucose spiked fluids be monitored for?

A

hyperglycaemia

133
Q

what does lactate monitor?

A

tissue perfusion

134
Q

what is normal lactate in neonates?

A

<3-4 mmol/L

135
Q

what is normal lactate in foals over 3 days old?

A

<2 mmol/L

136
Q

what does increased lactate indicate?

A

anaerobic metabolism

137
Q

what does anaerobic metabolism lead to?

A

insufficient O2 supply to tissues

138
Q

what is the result of insufficient O2 supply to tissues?

A

hypovolaemia
hypoxaemia
sepsis

139
Q

what is indicated by increasing levels of lactate?

A

poor prognosis

140
Q

what fluids will be used for fluid resuscitation in foals?

A

warmed Hartmanns

141
Q

what fluids should not be bolused?

A

spiked

142
Q

what is the maximum fluid volume for a 50kg foal?

A

max 4L

143
Q

what rate should be used for fluid resuscitation of foals?

A

20ml/kg over 20 mins

144
Q

what fluids may be used if the patient is not nursing?

A

hartmanns and 5% dextrose

145
Q

what fluid rate is required for hartmanns and 5% dextrose?

A

3-5 ml/kg/hr

146
Q

what rate of glucose is needed for foals?

A

3ml/kg/hr of 10% glucose

147
Q

what are foals at risk of if on large volumes of IVFT?

A

subcutaneous oedema on dependent side if in lateral

148
Q

why may foals develop subcutaneous oedema?

A

unable to tolerate high sodium concentrations in IVFT

149
Q

what electrolyte may need supplementation if foals are not nursing?

A

K+

150
Q

where are BP cuffs placed for NIBP measurement in foals?

A

tal

151
Q

how many NIBP readings should be taken?

A

3 and then get an average

152
Q

what BP indicates hypotension in foals?

A

<70 mmHg

153
Q

why does sepsis cause hypotension?

A

suppression of myocardial contractility which reduces SV and so circulating volume
blood vessels dilate due to distributive shock which further reduces SV

154
Q

how can hypotension caused by sepsis be treated?

A

IVFT will help but will not cure
medication also needed

155
Q

why will IVFT alone not solve hypotension caused by sepsis?

A

heart is nor working effectively

156
Q

what drugs are needed to treat hypotension induced by sepsis?

A

inotropes
vasopressors

157
Q

what is the role of vasopressors?

A

constriction of blood vessels to increase SVR

158
Q

what drugs increase the force of cardiac contractions?

A

inotropes e.g. dobutamine

159
Q

what volume of urine should foals produce?

A

50-70% of fluid input
>2ml/kg/hr

160
Q

how can foal urine concentration be described?

A

initially hypersthenuric then quickly become hyposthenuric

161
Q

what should foals USG be?

A

<1.008

162
Q

what should be done if foals USG is 1.008-1.012?

A

check kidney function

163
Q

what method can be used for urine collection in foals?

A

free catch (labor intensive)
U cath (risk of UTI)

164
Q

how is oxygen supplied to foals?

A

intranasal

165
Q

where should tubing be inserted to for intranasal oxygen?

A

level of medial canthus of the eye

166
Q

how can intranasal oxygen be secured in place?

A

taped to tongue depressor and run along face
tubing then runs through neck wrap/mane plait before connecting to oxygen

167
Q

what is the oxygen supply run through before it reaches the patient?

A

humidifier filled with sterile water

168
Q

what flow rate is usually needed for foals on oxygen?

A

2-15 L/min

169
Q

what rate of oxygen should patients be started on?

A

5 L/min

170
Q

how often should intranasal oxygen tubes be cleaned?

A

SID

171
Q

how often should intranasal O2 tubes be changed?

A

every other day

172
Q

what are the complications associated with intranasal O2?

A

nasal irritation
rhinitis
airway drying

173
Q

what is the purpose of nebulisation with sterile saline?

A

secretion removal from lungs

174
Q

what may be used for nebulisation?

A

sterile saline
bronchodilators
antibiotics

175
Q

what may be performed alongside nebulisation?

A

manual coupage

176
Q

what is the benefit of coupage?

A

aids mucocilliary escalator

177
Q

is ventilation an option for foals?

A

yes but prognosis is very poor

178
Q

what is the effect of prolonged seizure activity?

A

increases cerebral O2 demand
neurone damage

179
Q

how are seizures in foals treated?

A

5 mg Diazepam IV

180
Q

how long does diazepam last?

A

20 mins - can be repeated

181
Q

what can be done if seizure activity continues following diazepam?

A

midazolam CRI
phenobarbitol
leveteracitam

182
Q

what is essential when patients are seizuring?

A

protect from trauma

183
Q

what may seizures in foals be caused by?

A

NMS
hypoglycaemia
sepsis

184
Q

what energy requirements do sick foals have?

A

10% BW

185
Q

why should foals not be bottle fed?

A

risk of aspiration

186
Q

how much should foals be fed?

A

500ml every 2 hours for 50kg foal

187
Q

what food rate should foals be started at?

A

50ml and build up

188
Q

how can NG tube placement be checked?

A

x ray

189
Q

how should an NG tube be secured?

A

same way as intranasal O2

190
Q

what must be done before every feed is administered thorough an NG tube?

A

check for reflux

191
Q

how may foals be fed?

A

supported to feed from mum
NG tube
bucket
TPN

192
Q

what is the aim of TPN in foals?

A

prevention of negative energy balance rather than reaching full calorie requirement

193
Q

what are the main types of enema available?

A

phosphate
soapy water
acetylcystine retention emema

194
Q

how often can phosphate enemas be performed?

A

max twice in every 24 hours

195
Q

what volume of soapy water can be used for an enema in foals?

A

~200ml

196
Q

when is acetylcysteine retention enema needed?

A

if other 2 options have been tried

197
Q

where must acetylcysteine retention enemas be performed?

A

in hospital

198
Q

why must acetylcysteine retention enemas be performed in hospital?

A

usually requires sedation as foal needs to stay in lateral

199
Q

what is achieved by acetylcysteine retention enema?

A

meconium dissolved

200
Q

what is needed if foals are receiving enemas?

A

IVFT

Advanced Clinical Nursing Theory (36 decks)

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