Exam Revision ... Flashcards
What are the stages of the Nursing Process?
-
Assessment
(Assess px + what the nursing diagnosis is) -
Planning
(Creating short-term nursing goals) -
Intervention
(Decide what nursing interventions are req) -
Evaluation
(Eval why those interventions are req)
In basic terms, What is the Nursing Diagnosis?
RVN identifying the Actual + Potential problems/patient needs
What are the 4 phases of Wound Healing?
- Haemostatis
- Inflammation
- Repair
- Maturation
Homeostasis is the 1st phase within wound repair, can you describe, in order, what happens at each stage?
- Initial bleeding flushes wound
- Vasoconstriction occrurs - lasting 5 - 10 mins
- Platelet plug formation is triggered by damaged BV wall
- Formation of fibrin plug + scab
Which of the following would cause a delay in wound healing?
A) Moist wound environment
B) Tissue oxygenation
C) Infection
D) Limited movement of the wound edges
C) Infection
2 ..
What type of wound is this?
- Open
- Burn
2. ..
What type of wound is this?
- Closed
- Contusion/bruise
Which type of dressing is best used on a superficial wound?
A) Low/non-adherent
B) Hydrocolloid
C) Anti-microbial
D) Film
D) Film
How many drops/ml does a Standard Giving Set deliver?
20 drops/ml
How many drops/ml does a Paediatric Giving Set deliver?
60 drops/ml
Name 3 catagories of Fluid used in the VP
- Crystalloid
- Colloid
- Blood/blood products
List 8 reasons a blood transfusion may be given to a px
- Haemorrhage
- Sx
- Trauma
- Hypovolaemia (due to haemorrhage)
- Anaemia
- Thrombocytopenia
- Blood clotting/factor deficiency
- Low protein/Albumin
7 …
What is the fluid rate of a 26kg dog that has V+ 2x today?
(Assuming the drop rate is 20 drops/ml)
-
Maintenance = 50 ml x BW(kg)
= 50 ml x 26kg
= 1300 ml p/day -
Ongoing losses = 4 ml x BW (kg) x (No. of episodes of V+)
= 4 ml x 26kg x 2
= 208 ml/day -
Total fluid requirements = Maintenance + Ongoing losses
= 1300ml + 208
= 1508 ml/day -
P/hr = Total fluid / 24hr
= 1508ml/24hr
= 63 ml/hr -
P/min = P/24hr/60 min
= 63ml/60min
= 1.05ml/min -
Drops p/seconds = Drip factor x P/min
= 20 x 1.05ml
= 21 drops/min -
Drop p/1 second = 60 seconds/Drop p/seconds
= = 60 sec/21 drops
= 1 drop, every 2.8 seconds or (3 sec)
8 steps…
A 15kg Border Collie was admitted to the practice with a PCV of 50%
He has V+ 2x + D+ 2x in 24hrs
Calculate the fluids req in Drop per second
-
Maintenance = 50 ml x BW(kg)
= 50 ml x 15kg
= 750 ml p/day -
Deficit = 10ml x BW (kg) x % of loss
= 10ml x 15kg x 5%
= 750 ml -
Ongoing losses = 4 ml x BW (kg) x (No. of episodes of V+)
= 4ml x 15kg x 4 (2x D+, 2x V+)
= 240ml -
Total 24hr fluid req = Maintenance + Deficit + Ongoing losses
= 750 + 750 + 240
= 1740 ml p/day -
P/hr = Total fluid / 24hr
= 1740ml/24hr
= 73 ml/hr -
P/min = P/24hr/60 min
= 73ml/60min
= 1.2ml/min -
Drops p/seconds = Drip factor x P/min
= 20 x 1.2ml
= 24 drops/min -
Drop p/1 second = 60 seconds/Drop p/seconds
= 60 sec/24 drops
1 drop, every 2.5 seconds or (3 sec)
List 10 nursing interventions can be carried out to help a cardiac px?
- Reduce stress
- Minimal handling
- Avoid restricting chest + neck
- Controlled exercise, only at px’s own pace
- Provide oxygenation
- Restricted sodium diet + but ensure palatable
- Support them to sleep + recieve adequate rest
- Ensure they have frequent opportunites for the toilet
- Make sure they recieve accurate medication (Communicate with VS)
- Ensure they stay at an appropriate temp + ensure they don’t become hypo or hyperthermic
State 8 possible problems that may arise when nursing a cardiac px
- Fluid overload - if on IVFT
- Dyspnoea
- Hypothermia
- Weight loss
- Cachexia
- Polyuria
- Dehydration
- Reduced activity/mobility
Give 8 methods by which to assess a respiratory px
- RR (Observation)
- Resp effort
- Resp noise (Ausculatation of chest)
- MM colour
- Pulse oximetery (> 94%)
- Arterial blood gasses
- Capnography
- X-ray
- Ultrasound
List 10 conditions that are candidates for O2 therapy
- Dyspnoea
- Airway obstruction
- Cardiac px
- Shock
- Severe anaemia
- Diaphragm rupture
- Feline asthma
- Pleural space disease
- Pneumonia
- Pulmonary oedema/Contusions
List 8 methods of providing O2 therapy
- Flow-by
- Mask
- Nasal prongs
- Nasal catheter
- Oxygen cage
- Incubator
- Oxygen collar
- Intubation
Give 4 disadvantages of placing an animal in an 02 cage
-
Requires large volumes of oxygen
2.Can take a long time to fill cage
3.Hyperthermia
4.Difficult to monitor px
4..
What are some advantages for Nasal Prongs in administering 02?
- Direct oxygen delivery
- Good for larger dogs
- Easy to monitor px
- Can carry out other tasks whilst they are inserted (Eating, drinking etc)
Identify 3 nursing interventions we can use to encourage an animal to increase their water intake?
- Fresh water ad-lib
- Salt-free broth
- Water fountain
What are some methods of encouragement that can be used to help an px eat?
- Warming food
- Hand-feeding
- Using strong-smelling food
- Putting food on paw or lips
- Little + often
Name 6 measures you could put in place to help an animal suffering with regurgitatoin
- Elevated feeding/feed from height
- Use soft foods
- Small meals (Little + Often)
- Keep animal upright after feeding
- Calorie dense foods
- No exercise before + after eating
8 steps…
A 5kg dog has had a FT placed today.
Work out a feeding plan based on their RER, feeding a Recovery diet of 1kcal/ml
-
RER = (BW(kg) x 30) + 70
= (5kg x 30) + 70
= 220 kcal/day -
Day 1 = 33%
= 33/100 x RER
= 33/100 x 220
= 73 kcal/day -
Day 2 = 66%
= 66/100 x 220
= 145 kcal/day -
Day 3 = 100%
= 220 kcal/day -
IN MLS, must convert> Day 1 = Day 1 kcal/day /ml of diet
= 73 kcal/1
= 73 ml/day -
Day 2 = Day 2 kcal/day /ml of diet
= 145kcal/1
= 145 ml/day -
Day 3 = Day 3 kcal/day /ml of diet
= 220 kcal/1
= 220 ml/day -
Max Feeding volume = 10 mg/kg
= Vol of max to feed at time x BW(kg)
= 10 x 5
= 50ml per feed
( 4 - 5 meals)
How would you instruct an owner to store + mix the Insulin for their diabetic cat?
- Store in fridge
- Don’t shake vial
- Gently invert/roll
Which condition affects the Endocrine system + an be treated by Radioactive Iodine?
A) Hypothyroidism
B) Hyperthyroidism
C) Hypoadrenocorticism (Addisons)
D) Hyperadrenocorticism (Cushings)
B) Hyperthyroidism
Identify 9 nursing intervention for a Neurological px
- Supportive bedding
- Supported walking
- Cage rest
- Decubitus ulcer prevention - Turn Q2-4 hrs
- Monitor urination + defecation
- Assisted feeding (Meet RER)
- Pain management
- Skin care
- Maintain body temp
State 7 pieces of PPE to be used when handling or administering Chemotherapy medication
- High-quality Nitrile gloves
- Full-Length long-sleeved gown
- Face shield
- Goggles
- Mask
- Respirator
- Shoe covers
What is the Deficit calculation?
Deficit = 10ml x BW (kg) x % body water loss
I.e ;10ml x 15kg x 5%
= 750 ml
What is the Ongoing losses calculation?
Ongoing losses = 4ml x BW (kg) x No/ of epsiodes (V+, D+)
- REMEMBER = if a px has 3x V+, 2x D+ the total number = 5!
I.e; 4ml x 15kg x (2x V+, 2x D+ = 4)
= 240ml
What endocrine condition presents w/:
* High blood Glucose levels
* Due to disruption
or
* Effect of Insulin
Diabetes Mellitus
List 4 symptoms of DM
- PU
- PD
- Polyphagia
- Weight loss
What are DM at risk of developing?
Glaucoma
5 ..
What do Diabetic Clinics do?
- Support O’s of newly dx pets
- Encourage compliance
- Review records + monitor progress Q 3-6 mo
- Identify + Rectify problems
- Monitor px’s symptoms + condition
What is Caninsulin?
A prescription Insulin inj to tx DM in Dogs + Cats
10 ..
Explain how you would show a client how to admin an Insulin inj
- Use Insulin syringe or pen
- Demonstrate w/water + model to client
- Allow O to practice under supervision + teach several other family members
- Ensure eating prior to admin
- Check expiry + broach date
-
Invert vial
(Explain don’t shake, as cause different concentrations within the bottle, so could get a very high or very low - causing Hypoglycaemia!) - Draw up correct dose + check
- Vary Inj site (Some req 2x inj)
- If in doubt, only inj once
- Dispose of sharps safely
8 ..
What would a Canine DM diet px consist of?
- High protein
- Normal fat + complex carbs
- No simple sugars (cause spike)
- High-fibre (Control obesity + reduce Glucose surge, slow digestion)
- Same diet, same ax - each day
- 2 meals p/day
-
1/2 w/each inj
or
8.1x full inj - if 8 - 10hrs later - No titbits!
7/8 ..
What would a Feline DM diet px consist of?
- High protein
- Low carbs
- Fibre content not as important - still no simple sugars
- Allow to graze (if pref) but not before Insulin inj
- If meal fed - 1/3 of Daily req w/ inj - Rest @ nadir (lowest)
- Tins = ‘dilute’ carbs - feed dry if only eat that form
- Small portion of food 8hrs after Insulin inj
Diet important in remission - reduced weight results in reduced B cell destruction
4 ..
What should exercise look like for DM px?
- Regular
- Similar ax + same time of day + same length
- Full walk = dangerous = req greater levels of blood Glucose!
- Important as can help increase weight loss
10 ..
What are the different ways you can monitor a DM px?
- Csigns (Polyphagia, PUPD, Glaucoma)
- Periodic sx checks
- Diabetic clinics (Weigh food + calculators RER)
- Owner obs
- **Check for long-term effects **(Cataracts, Plantigrade stance)
- Blood test w/Glucometer
- Use cephalic, pinna or footpad prick
- Single test or BGC (Blood Glucose Curve)
- Intermittent or (CGMS) Continous Glucose Monitoring System
- Urinalysis (USG, Dipstick)
- Record - sheet, diary
Note - if use pinna or footpad, never change sites, stay with 1 or other to prevent variations in results - but obv vary sites
What 6 factors may contribute towards an unstable DM px?
- Insulin that was admin out of date
- Insulin damaged (Incorrect storage, handling)
- Ketodiastix damaged
- Glucometer not working
- O dosing incorrectly (Technique, dosage, timing)
- O feeding titbits or extra food
Refer to VS for dx + res-stabilisation
What 2 Emergency conditions may a DM px present with?
- Diabetic ketoacidosis (DKA)
- Hypoglycaemia
In basic terms…
How would you tx a DKA px, in an emergency?
3 …
- Maintain px airway
- IVFT - Hartmanns 0.9% Saline
- Rapid acting Insulin
What Type, % + Content of fluids should be given to a DKA px?
- Hartmanns
- 0.9%
- Saline
5 ..
How would you tx a Hypoglycaemic px, in an emergency?
- Feed immediately
- Give Glucose water
- Hypo-stop
- Rub Sugar/Syrup (Honey) solution on mm
- IV Glucose
A white small dog presents to the practice with the following symptoms:
- PUPD
- Polyphagia
- Pot-belly
- Panting
- Bilateral alopecia on his flanks
- Thin inelastic skin
- Muscle atrophy
- Weakness
What disease am I?
Hyperadrenocorticism!!
(Cushings)
..Pot-belly!!..
What are the 8 symptoms of Hypoadrenocorticism in Dogs?
- PUPD
- Polyphagia
- Pot-belly
- Panting
- Bilateral alopecia on his flanks
- Thin inelastic skin
- Muscle atrophy
- Weakness
What condition does this dog have?
Cushing’s!
(Hyperadrenocorticism)
Cushings..
How would you care for a px with Hyperadrenocoriticism?
9 ..
- Reduce stress levels
- Take care when handling
- Fat restricted diet (Generally overweight presentation - depending on concurrent conditions, as indicated by VS)
- Ensure nutrition maintained
- Monitor BCS, MCS + BW (Weigh Q morning)
- Monitor Csigns ( + O questionnaire)
- ACTH stim tests (Q 3 - 6 mo)
- Monitor skin integrity, infections + especially urinary infections
- Educate client!
A Canine px presents to the VP with the following symptoms:
- Anorexia
- Haemorrhagic V+
- Nauseous
- Malnourished
- Haemorrhagic D+
- Lethargy + Inappetence that wax and wanes..
- Painful + sore abdomen
I’m tricky to dx, what could I be?
Hypoadrenocorticism..!!
(Addison’s)
7 Csigns..
What are the Clinical signs associated with Hypoadrenocorticism?
+
What species is it normally seen in?
- Commonly presented in Dogs
- Clinical signs are:
* Anorexia
* Haemorrhagic V+
* Nauseous
* Malnourished
* Haemorrhagic D+
* Lethargy + Inappetence that wax and wanes..
* Painful + sore abdomen
What is Addison’s/Hypoadrenocoriticsm?
+
How is it usually caused?
- Reduction or inability to produce steroids in the adrenal glands
- Usually occurs as a result of Immune destruction of adrenal gland
Or - Consequence of tx Hyperadrenocorticism!
What is the term given to a px who is an emergency state of Hypoadrenocorticism?
Addisonian Crisis!
How do you handle + tx a patient in an Addisonian Crisis?
- Emergency IVFT @ shock rate of 0.9% NaCl
- Medical management
- Monitor:
- BP
- ECG
- Electrolytes
- Acid-base-balance
- Stabilise
- Reduce stress levels
- Don’t handle abdomen (painful)
- Monitor Csigns (O questionnaire)
- Monitor WBC counts + Na : K ratio!
- Educate client on tx, effects of stress + signs of Crisis!!
What type, % + content of emergency IVFT fluids should you use for a px in an Addisonian Crisis?
Emergency IVFT
1. Shock rate
1. 0.9%
1. NaCl
NaCl = Sodium Chloride
What 3 things should you educate a client, regarding an Addisonian Crisis?
Educate client on
1. How to admin tx
2. Effects of stress
3. Signs of Crisis!!
A Canine has been brought into the VP with the following Csigns..
- Lethargy
- Exercise intolerance
- Obesity
- Bradycardia
- Hypothermia
- Alopecia
- Seborrhoea
- Hyperpigmentation
- Pyoderma
What condition may they have?
Hypothyroidism!
In basic terms, what is Hypothyroidsim?
- An underactive thyroid gland
- Resulting in a decreased Metabolic rate
What is Seborrhoea?
Greasy skin
True or False.
Due to the Csigns that Hypothyroid Dog’s present with, they may be more susceptible to dermatological infections
True!
As they present with the following dermatological signs:
1. Alopecia
2. Seborrhoea
3. Hyperpigmentation
4. Pyoderma
These skin abnormalities disrupt the skin integrity + barrier function, thus, more susceptable to infection!
What levels are of most concern when monitoring Hypothyroid px’s?
T4 levels!
(Thyroxine in blood)
How long may it take for Hypothyroidism clinical signs to improve in px’s?
A) 5 - 6 weeks
B) 4 - 6 weeks
C) 3 - 8 weeks
D) 2 - 4 weeks
B) 4 - 6 weeks
If it may take 4 - 6 weeks for Hypothyroid px’s clinical signs to improve, how long may it take for the dermatological signs?
A) Years
B) Weeks > months
C) Days > weeks
D) Months > years
D) Months > years
This Cat is brought in to the practice.
It also presents with the folliowing Csigns..
* Polyphagia w/weight loss
* Emaciation
* Hyperactive
* Aggressive
* Heart murmur
* Tachycardia
* PUPD
* V+
* D+
* Depression
* Weakness
* Dehydration
Name this infamous condition!
Hyperthyroidism!!
12 …
List the Csigns of Hyperthyroidism
- Polyphagia w/weight loss
- Emaciation
- Hyperactive
- Aggressive
- Heart murmur (if long-term)
- Tachycardia
- PUPD
- V+
- D+
- Depression
- Weakness
- Dehydration
In basic terms, what is Hyperthyroidism?
+
How is it caused?
- Overactive thyroid gland
- Overproduction of T4 (Thyroxine) > increases metabolic rate
- Usually a results of benign hyperplasia
3 ..
How may Hyperthyroid px’s be treated?
(To include how can RVN assist, client education + diet)
- RVN assist w/:
* Medical management
* Dietary control
* Radioactive Iodine
* Thyroidectomy - Client education:
* Re importance of accurate dosing
* Advise on tablet admin
* If long-term - how to monitor Csigns - Diet
* Not guaranteed control
* Precription only diet
* Monitor T4 levels
What are 2 potential tx options for Hyperthyroidism in Cats
- Thyroidectomy
- Radioactive Iodine
What is the likely dx for this px?
Looks to be…
Hyperthryoidism!
What is of great importance to monitor post-Thyroidectomy?
CSigns of Hypocalcaemia
What is ‘131I’?
Radioactive Iodine
What type of tx is this feline px recieving?
Radioactive Iodine Therapy
What 3 ways can Radioactive Iodine normally administered in the VP?
- IV
- S/C
- Per os
How is Radioactive Iodine excreted in the body?
Through:
1. Urine
2. Faeces
Who can perform RIT?
Radioactive Iodine Therapy
Trained personnel ONLY
4 ..
What must you advise client’s re-px’s Radioactive Iodine Therapy?
- Minimise close contact
- Stay away from Immuno-comprimised people + animals
- Exercise in restricted area
- How to dispose of urine, faeces + litter ( < 3 weeks post discharge)
Define Cancer
- Process of normal cells transformed to undergo
- Excessive or restrained growth
Name the 4 types of Cancer
- Sarcoma
- Carcinoma
- Lymphoma
- Leukaemia
3 ..
What is a Sarcoma?
- Begin in tissue
- Connects, supports or surrounds other tissues + organs
- Muscle, bone + fibrous tissue
6 ..
What is a Carcinoma?
-
Originate in tissues that:
* Cover a body surface
* Line a body cavity
* Make up an organ - Derive from glandular tissue
- Prefixed w/ ‘adeno’..
3 ..
What is a Lymphoma?
- Occur in cells that make up an important components of:
- Immune system
- Protect the body’s cells
Lymph cells + tissue
3 ..
What is a Leukaemia?
- Occur in blood
- Forming tissues
- Blood cells
12 ..
What is the role of the RVN in tx Cancer px?
- Assisting with diagnostics (CT, MRI, x-rays)
- Admin of tx
* Chemotherapy
* Reduction of side-effects
* Pain management - Meeting nursing care needs
- Monitor + manage side effects
- QOL assessments
- Client education
- Emotional support for O (Euthanasia)
- Palliative care
- Patient assessment + care plans
What are 3 major goals of treating Cancer px’s?
- Preserving QOL
- Tumour control
- Remission
What are the 5 main treatment options for Cancer px’s?
- Sx
- Chemotherapy
- Radiotherapy
- Biotherapy
- Complementary therapy
What are the 3 main surgical tx options for Cancer px’s?
- Curative
- Biopsy
- Debulking
Why might a px recieve Chemotherapy?
To tx systemic cancers
When is Radiotherapy more indicated with Cancer px’s?
More sensitive with rapidly dividing cells
True or False.
Radiotherapy can be used only in combination with other therapies
False
It can also be used independently
When is Biotherapy used in Cancer px’s?
- To:
1. Stop
Or
2. Suppress - The growth of a tumour
What type of therapy is..
* Likely to have little supportive data
* Potentially be used in conjunction to alleviate symptoms
* Could potentially cause harm if used as an alternative?
Complimentary therapies
Name a complimentary therapy used for Cancer px’s?
CBD
What tx may this px be recieving?
Chemotherapy
True or False.
Chemotherpy drugs can be used as:
* Sole agent
* In combo with others
* Before sx
* Before or after radiation therapy
* For Solid tumours
True!!
What type of tumours is Chemotherapy most inclined to tx?
Solid tumours!
Why is Chemotherapy more tolerated in Veterinary medicine?
- More palliative
- Used to minimize toxicity
3 ..
Why do typical Chemotherapy protocols require a rest period between treatments?
To allow healthy cells to
1. Repair
2. Regenerate
3. Minimise side effects
2 …
Despite typical Chemotherapy protocols consisting of having a rest period between treatments, allowing healthy cells to undergo repair, regeneration + minimise side effects.
What is the unforunate risk that can come from this?
- It allows the damaged tumour blood vessel’s to recover
* 2. Thus lessens overal efficacy of the protocol
Name 7 disadvantages of Chemotherapy
- Expensive
- If using typical protocol of rest between tx’s, lets tumour BVs to recover + regenerate
- Cause unpleasant side effects
- Requires specific training
- Cytotoxic to handle - saftey risk
- No guaranteed effects
- Difficult to dispose of
What type of drug are Chemotherapy drugs?
Cytotoxic
List 4 potential effects of Cytotoxic drugs if ingested
- Tissue damage
- Liver damage
- Chronic headaches
- Reproductive problems
Identify 6 ways in which staff may come into contact with Cytotoxic drugs during Chemotherapy tx
- Need stick injury
- Inhalation
- Direct contact on skin
- Ingestion when preparing + administering
- Handling waste
- Contact with excretions
What class of person must not be around Cytotoxic drugs?
Pregnant women
Ideally, how should Cytotoxic/Chemotherapy drugs be prepared?
Within a fume cabinet
Why should you have closed adminstration systems when administering Cytotoxic drugs to px’s?
To prevent spillage
What type of PPE should you use for Chemotherapy?
Impervious!
How are Cytotoxic drugs disposed of in the VP?
In Cytotoxic waste (Purple bin)
(Which is Incinerated)
What 3 things should you never do around Cytotoxic drugs or during Chemotherapy?
- Eat
- Drink
- Touch face
Who should be removed from the area in which Chemotherapy takes place?
All non-essential personnel
What 8 essential details must Chemotherapy records include?
- Px’s BW
- Drug used
- Dosage given
- Route of admin
- Where/site of admin
- Who administered it
- Any sedation used
- Any adverse reactions
Depending on the drugs, what are the 3 methods in which Chemotherapy drugs are administered to px’s?
- Well-sited Indwelling catheter
- Orally
- IM
Why should you never given Chemotherapy drugs via IV?
Incase it spills!
What should you be familiar with before providing a px when Chemotherapy?
- Px treatment schedule
- Patient records prior to EACH admin
- Re-check dosage calculation
Should you change sites per each admin of Chemotherapy drugs?
Yes
What type of tx is this px recieving?
Chemotherapy
What type of sign must you have on the door, before performing Chemotherapy?
- Warning sign
- Stating “Chemotheraphy in progress, DO NOT ENTER”
(+ block the door if you need to, to prevent entering)
6 ..
List the PPE required for adminstering Chemotherapy
- Impervious full-length + sleeved. gown
- Glasses/goggles
- Chemo gloves or Double gloved
- Masks
- Shoe covers
- Hair nets
What must you consider about the floor when performing Chemo?
- That its washable
- You have a protective mat to prepare + admin
What type of saline should you use to flush the catheter pre + post admin of Chemo drugs?
Non-heparinised Saline
4 ..
How should you store Cytotoxic drugs?
- Well-labelled box + biohazard bag
- Locked away
- Labelled Cytotoxic + dangerous
- According to manafacture’s instructions
7 …
How should you decontaminate a spillage of a Cytotoxic drug?
- Contain the spill
- Prevent traffic
- Wear PPE
- Bleach area 3x times
- Use UV light
- Use Chemotherapy spill kit
- Waste disposal: Bedding in Infectious + hazardous (labelled as Cytotoxic) + Cytotoxic in purple bin
What are 4 nursing interventions for Chemotherapy px’s?
- Reduce V+ + nausea
- Admin of Gastroprotectants
- Pain management
- Nutritional/anorexia management
How can reduce V+ + nausea in Chemo px’s?
- Monitor V+ + nausea levels (Csigns etc)
- Anti-emetics
- Pre-emptive tx most effective
2 …
Why are Chemo px’s given Gastroprotectants?
- Because they are at risk of Gastric Ulceration due to medications
Or - Type of cancer
6 …
What must you consider when managing pain in Chemo px’s?
- Affects QOL
- Negative physical effects
- Tx side effects
- Occurance of secondary syndromes
- Effective assessments + re-assessments req
- Multi-modal approach is often req
What can effective nutritional management provide Chemo px’s?
Improves:
1. QOL
2. Survival time
What 6 nutrients should a Chemo px’s diet consist of?
- High BV protein
- High fat
- Omega-3 FAs
- Arginine
- Low carbs
- High fibre
How many days should a Chemo px’s diet be changed over to it’s new one?
Over 10 - 14 days
What are the 3 basic minimal requirements for a Chemo px’s diet?
Maintain:
1. Calorific intake
2. Body condition (BCS, MCS)
3. Avoid cachexia
What 2 types of feeding may be req for Chemo patient’s?
- Enteral
- Parenteral
(If V+ + naseous from chemo drugs)
What 4 things must be monitored in Chemo px’s daily?
- BW
- BCS
- MCS
- Hydration status
What 9 adverse effects must you inform the Client of, for pet’s that have undergone Chemo?
- Alopecia
- Neutropenia (7 - 10 days)
- Nausea
- D+ (2 - 7 days)
- V+ (2 - 7 days)
- Anorexia (2 - 7 days)
- Perivascular tissue damage
- Allergic reactions
- Myocardial damage
How many hrs post Chemo admin should an O avoid high-risk groups for?
24 - 72 hrs
How should clients dispose of Chemo waste at home?
- Treat as hazardous
- Provide :
1. PPE
2. Waste disposal equipment
Identify 10 potential Infectious diseases that require Barrier Nursing
- CPV
- KC
- CDV
- FURTD
- FeLV
- FIV
- Ringworm
- Campylobacteriosis
- Salmonellosis
- MRSA
6 …
Who are considered Immunocompromised in the VP?
- Any reduction in Neutrophil count
- Immunodeficiency disease
-
Neonates (unvacced, only on colostrum)
* Px’s treated w/: - Immunosuppressive drugs (Glucocorticoids, Azathioprine, Cyclosporine)
- Chemotherapy
- Radiation tx
16 …
List some ideal principles of Isolation
- Own ventilation system
- SOPs (no visitors etc)
- Own equipment, PPE, cleaning chemicals, waste disposal, food, bedding, utensils, sink, lighting, heating system etc
- Good levels of hygiene (paper towels for hand dyring, WHO technique etc)
- Clear communication (whiteboard, records)
- Clear sinage
- Donning section prior entering
- Specific staffing (essential only, 1x RVN only)
- Wipeable surfaces
- Stainless steel materials etc where bac can’t live
- Colour coded system (red - re-usable, spec colour of Vetbeds)
- Glass windows for easy visualisation
- No visitors
- Disposable PPE, equipment (Like pulp food bowls)
- Autoclave or dispose of all resuable equip before using on another px
- Disinfectable - Radio, speaker system, toys, bordem breakers, TLC, bedding from home (Comfort)
Why should you not let a Parvo px toilet in a public area?
Because it stays in the environment for up to 2 years
Where should you walk Barrier nursed px’s?
Away from public areas
A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.
She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy
- The O reports she has been drinking increased ax over the last few months.
- She is on IVFT + also exhibiting signs of stress when hospitalized.
- Describe the nursing process for this px.
- List 5 possible nursing diagnoses.
- Needs support w/drinking adequate ax (Due to PD, Kenneling, use IV fluids)
- Needs support w/maintaining skin integrity (Aid of IV cannula)
- Needs support to urinate (Due to PU, use IV fluids + kenneling)
- Needs to support to eat adequate ax (Due to Nausea, use appropriate diet)
- Needs to support to maintain normal behaviours (Due to Stress, kenneling, req tx)
A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.
She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy
- The O reports she has been drinking increased ax over the last few months.
- She is on IVFT + also exhibiting signs of stress when hospitalized.
- Provide 5 nursing interventions
- Use gloves + aseptic technique when placing cannula
* Flush w/sterile/heparinised saline Q24hrs to maintain catheter
* Change dressing Q24hrs or as needed
* Change catheters Q48-72hrs - Provide access to fresh, clean water, bowl for px access.
* Wash mouth with damp swab -
Provide litter tray with familiar little of non-absorbant litter (if VS requests urine testing)
* Absorbent bedding (Vetbed) + kennel liners to provide comfort + draw any excretions away - Supportive feeding - shallow, non-reflective bowl, aromatic, palatable, soft-foods
* If ulcerated mouth, warm food
* Refer to VS if signs of nausea
* No tube if anorectic - Provide calming environment seperate cat ward
* No loud noises/barking
* Calm background music
* Pheromone plug in
* Provide TLC
* Sensitive handling
A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.
She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy
- The O reports she has been drinking increased ax over the last few months.
- She is on IVFT + also exhibiting signs of stress when hospitalized.
- Describe 6 methods of monitoring the patient during fluid administration
-
Signs of hydration:
* Skin turgor
* CRT
* Mm moistness
* Nictating membrane position
* HR
* PR
* BW - Signs of overhydration:
* Peripheral oedema
* Soft, moist cough
* Dyspnoea
* Inc RR
* Runny nose
* Chemosis - Urine output = 1-2 ml/kg/hr
- Central Venous Pressure
-
Core v Peripheral temperature
* Peripheral within 4 degrees celcius of core -
Check administration site for:
* Swelling
* Bruising
* Pain
* Perivascular fluid
* Interference
Chemosis = swelling of conjunctiva
A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.
She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy
- The O reports she has been drinking increased ax over the last few months.
- She is on IVFT + also exhibiting signs of stress when hospitalized.
- Describe the discharge + home care instructions for the O of this px
5 …
-
Appropriate diet:
* Restricted phosphate
* High BV protein
* Ideally - wet diet
* Encourage eating
* Gradual change in diet to minimize anorexia + prevent food aversion -
Encourage:
* Inc water intake
* Fresh water ad lib
* Water fountain -
Refer to renal nurse clinics:
* Monitoring blood parameters + BP -
Monitor:
* Food + fluid intake
* BW
* BCS
* MCS
* Severity of Csigns - Admin prescribed medications + instruct on tableting cats
What 4 things does the Nursing Process provide?
- Provide:
1. Organized
2. Structured
3. Holistic
4. Individualised - Px care
List these in order.
- Evaluation
- Assessment
- Interventions
- Nursing diagnosis
- Planning
- Assessment
- Nursing diagnosis
- Planning
- Interventions
- Evaluation
How should you structure short/long-term goals?
- Using SMART system
- Subjective
- Measurable
- Achievable
- Realistic
- Time-bound
What does the Assessment stage of the Nursing Process?
- Clearly establishes individual needs
- Can only occur after following has been given:
* Collected necessary info systematically from own obs, client, other team members
* Reviewed collected info
* Identified actual + potential problems
* Identified priorities (among problems) - Can ask O to fill out a questionnaire
What is the Nursing diagnosis stage of Nursing Process?
- Differs from medical dx, as it’s not concerned w/judgement about disease
- Identifies actual + potential problems
- Focused on providing the most appropriate nursing intervention
What is the Planning stage of the Nursing Process?
Making plans to overcome the identified nursing problems
What are the 6 Aims of the Planning stage, of the Nursing Diagnosis?
- Solve identified actual problems
- Prevent identified potential problems (from becoming actual)
- Alleviate any problems that cannot be solved
- Help px + client cope positively w/problems that cannot be solved or alleviated
- Prevent recurrence of treated problem
- Help make px as comfortable as poss, even when death is inevitable
What is the Interventions stage of Nursing Process?
- The do-ing stage of the process
- Carrying out Nursing Interventions
What is the Evaluation stage of Nursing Process?
- Reflection-part of the process
- Involves evaluating the care been given to the px:
* Has it worked?
* Has it not?
* How can it be adapted?
During the Evaluation stage of the Nursing Process, if it is evident that the desired goals have not been met, what 8 questions should be considered?
- Has the goal set for the px been partially achieved?
- Is more info from VS or Client req to decide the next step in nursing care?
- Is a specific problem unchanged?
- Should the nursing intervention be changed or stopped?
- Is there a worsening of the problem?
- Should the goal + nursing intervention be reviewed?
- Was the goal set inappropriate or unrealistic?
- Does the goal req interventions from other members of the Vet team? (VS, Physio etc)
What stage of the Nursing Process is this?
- Ben Jones is an 11 y/o MN Golden Retriever
- Has been admitted for hospitilization by VS for investigation of:
1. Lethargy
1. PUPD
1. He has had these for several days - VS requests he is kennelled for obs + prelimniary urine + blood tests are carried out
- To investigate cause of problem
The collection of info from Client + VS, in the
Assessment stage
What stage of the Nursing Process is this?
- It is already known from admitting VS that Ben has:
1. Exercise Intolerance
1. PUPD - However, if RVN had spoken to the O earlier
- They would have ascertained that Ben is:
1. Deaf in his L-ear
1. Eats 1 meal p/day (In evening)
1. Will only urinate + defecate on concrete - not grass
Assessment stage,
Had the RVN asked these questions, this would greatly improve Ben’s care
What stage of the Nursing Process is this?
- The VS has made a dx of DM
- Planning Ben’s care can now be carried out - using all info collected
- The actual problems are:
1. Exercise intolerance
2. PUPD due to unstable DM
3. Unilateral deafness due to age-related degeneration - The potential problems, if the actual problems are not solved, are:
1. Weight loss
2. Dehydration
3. Hypoglycaemia
Planning stage!
(Identified actual problems + potential problems)
What stage of the Nursing Process is this?
- Short-term goals for Ben while DM is being stabilized:
Problem = PD
* Short-term goal = Prevent dehydration
* Timing = At all times
* Nursing interventions = Provide measured volumes of fresh drinking water + record
Problem = PU
* Short-term goal = Ensure Ben has the opportunity to urinate regularly
* Timing = Q 1hr
* Nursing Interventions = Take Ben into an outside concrete run to allow him the opportunity to urinate + record
Planning stage!
(Identified actual problems + what nursing interventions can be put in place)
5 ..
What questions should you ask the O for ‘Eating adequate amounts’?
- What does the px normally eat?
- How much?
- How often?
- When?
- Does the px prefer any particular bowl?
What is the rationale behind asking an O questions regarding eating?
- Get’s px back to eating normal food
- Allows calculation of RER or MER to maintain BW
- Bracycephalic cats (Persians) prefer flat bowls
- Cats generally prefer china or ceramic bowls, rather than plastic
What questions should you ask the O for ‘Drinking adequate amounts’?
- How much do they normally drink?
- Do they often drink water from containers outside (collected rain water)?
What is the rationale behind asking an O questions regarding drinking?
- Will vary from ax to ax
- May depend on whether the ax’s normal diet is wet or dry
- What type of water can be important
- Cats may drink from a dripping tap
- Rabbits + other SAs may drink from a bottle or bowl
What questions should you ask the O for ‘Urinating normally’?
- Where do they urinate?
- Does the O use any commands?
- Do they have any problems urinating?
What is the rationale behind asking an O questions regarding urinating?
- Diff px’s may show different preferences
- Inside or outside?
- Cats - use LT?
- What type of litter?
- Does dog urinate on walks?
- Always on grass or concrete?
- Commands for well-trained ax
- Do they have arthirtits? Joint stiffness can affect how the px urinates
What questions should you ask the O for ‘Defecating normally’?
- How often?
- Where?
- On what?
What is the rationale behind asking an O questions regarding defecating normally?
- How often - depends on diet provided
- Some dogs have preferences on where they urinate/defecate
- Cats may have a preference for type of litter
What questions should you ask the O for ‘Breathing normally?
- Any problems?
- Do they snore?
What is the rationale behind asking an O questions regarding breathing?
- Linked to exercise
- Indicate underlying disease
- Might be indicative of allergy
- Facial conformity may result in breathing difficulties (Persians, Pugs)
What is the Dogs normal:
- HR
- RR
- Temp
- Urine output p/day
- Water intake p/day
Dogs
- HR = 70 - 140 bpm
- RR = 10 - 30 rpm
- Temp = 38.3 - 39.2 degree c
- Urine output = 1-2 ml/kg/hr or 24-48 ml/kg/day
- Water intake = 40 - 60 ml/kg/day
What is the Cats normal:
- HR
- RR
- Temp
- Urine output p/day
- Water intake p/day
Cats
- HR = 100 - 200 bpm
- RR = 20 - 30 rpm
- Temp = 38.2 - 38.6 degrees c
- Urine output = 1-2 ml/kg/hr or 24-48 mnl/kg/day
- Water intake = 40 - 60 ml/kg/day
What is the Rabbits normal:
- HR
- RR
- Temp
- Urine output p/day
- Water intake p/day
Rabbits
1. HR = 130 - 325 bpm
2. RR = 30 - 60 rpm
3. Temp = 38.5 - 40 degrees c
4. Urine output = 12 - 48 ml/kg/day (variable)
5. Water intake = 50 - 150 ml/kg/day (variable)
What is the normal USG for a Dog?
1.015 - 1.045
30 difference!
What is the normal USG for a Cat?
1.020 - 1.060
40 difference!
What is the normal pulse oximetry reading for a Cat + Dog?
95 - 100%
What is the normal PCV of a Dog?
37 - 55
What is the normal PCV of a Cat?
24 - 45
Identify the 6 functions of the Skin
-
Protection
(Micorog, dehydration, UV light, mechanical damage) -
Sensation
(Pain, temp, tough, deep pressure starts) -
Mobility
(Smooth motion) -
Endocrine activity
(Vit D prod, Ca absorp, bone metabolism) -
Exocrine activity
(Release of water, urea, ammonia, sebum, sweat, pheromens, cytokines) -
Immunity
(Pathogens) -
Thermoregulation
(Conserving + releasing heat, maintain water + homeostatic balance)
State the 3 layers of the skin in order
- Epidermis
- Dermis
- Hypodermis
List the 5 layers of the Epidermis
Stratum…
1. Corneum
2. Lucideum
3. Granulosum
4. Spinosum
5. Basale
Name the functions of these layeres of the skin:
1. Epidermis
2. Dermis
3. Hypodermis
-
Epidermis:
* Outermost
* Waterproof
* 3 types of cells: Squamous, Basal + Melanocytes -
Dermis
* Middle layer
* 2 layers: Papillary + Therectiular
* Provides flexibility + strength
* Contains: BVs, CT, Hair follicles, Lymph vessels, sweat glands
* Held together by collagen
* Contains pain + touch receptors -
Hypodermis
* Deepest layer
* Protects body from injury
* Acts as shock absorber
* Contains: Fat, CT + Collagen
Name the 5 types of open wounds
- Incision
- Abrasion
- Avulsion
- Laceration
- Puncture
Name the 2 types of closed wounds
- Contusion
- Crushing injury
What’s the characteristics of a Incision wound?
+
Give 1 example
- Open
- Created by sharp tool
- Minimal tissue trauma
- Scalpel blade
What’s the characteristics of a Abrasion wound?
+
Give 1 example
- Open
- Loss of Epidermis
- Loss of portion of Dermis
- Scuffed skin
What’s the characteristics of a Avulsion wound?
+
Give 1 example
- Open
-
Tearing of tissue away from:
* Attachments
* Underlying tissues
* Underlying structures - Dog bite
What’s the characteristics of a Laceration wound?
+
Give 1 example
- Open
- Irregular
- Superficial damage underlying tissue
- Barbed wire injury
What’s the characteristics of a Puncture wound?
+
Give 1 example
- Open
- Penetrating
- Created by sharp object
- Can introduce contaminates deep into tissue
- Resulting in high-risk infection
- Cat Bite
What’s the characteristics of a Contusion wound?
+
Give 1 example
- Closed
- Blunt-force trauma
- Doesn’t break skin
- Causes damage to skin + underlying tissue
- Bruise
What’s the characteristics of a Crushing injury wound?
+
Give 1 example
- Closed
- Force applied to tissue
- For long-period of time
- Fallen from height
What is the duration of Contamination?
- Time between:
1. Infliction
+
1. Treatment
What is a Class 1 contaminated wound?
- Clean wound
- Minimal contamination
- 0 - 6 hr duration
What is a Class 2 contaminated wound?
-
Significant contamination
or - 6 - 12 hr duration
What is a Class 3 contaminated wound?
-
Gross contamination
or - > 12hr duration
What are the 4 classications given to Surgical wounds?
- Clean
- Clean-contaminated
- Contaminated
- Dirty
List the 4 stages of wound healing
- Haemostasis
- Inflammation
- Repair
- Maturation
How long does Haemostasis last for?
- Occurs immediately
- Lasts = varies
How long does Inflammation last for?
- Occurs within 6 hrs
- Lasts = 3 - 6 days
How long does Repair or Proliferation last for?
Occurs 3 - 7 days post injury
How long does Maturation or Remodelling last for?
- Occurs 5 - 7 days post injury
- Lasts = Up to 2 years
What intention is used for Clean wounds?
Primary
What intention is used for Clean-Contaminated wounds?
Delayed primary
What intention is used for Contaminated or Dirty wounds?
Secondary
What intention is used for Wounds with Extensive contamination or Devitalisation wounds?
Second Intention
How are Clean wounds, under Primary Intention be managed?
- Immediate closure
- No tension
- Surgical sutures
How are Clean-Contaminated wounds, under Delayed primary Intention be managed?
- Lavage
- Debridement
- Appropriate dressing
- Closure after 2 - 3 days
How are Contaminared wounds, under Secondary Intention be managed?
- Lavage
- Debridement (Sedation)
- Closure after 5 - 7 days to allow granulation bed to form. (ONLY IF OPEN)
How are Extensively Contaminated or Devitalised wounds, under Second Intention be managed?
- Unsuitable for sx closure
- DO NOT consider over joint (Blood flow restriction)
- Open wound management
- Lavage
- Debridement
- Appropriate dressing
- Allow to heal by self
- Only dressings + bandages
If trauma has caused a wound, why should you wait?
To allow the wound to declare itself
8 ..
How do you prepare a wound for Debridement?
- Sterile gloves + apron
- Adequate analgesia + had time to take effect
- GA (usually)
- Keep covered w/sterile, non-linting dressing (Guaze swabs) prior to prep
- Swab around wound bed for culture + sensitivity (Store in fridge)
- Insert Sterile water soluble Jelly into wound (Soaks hair)
-
Clip around wound
* Total injury visible
* Clip passed unviable tissue
* Provide 2cm margin - Debridement
10 ..
How do you perform a Lavage on an open wound?
- Sterile gloves + apron
- Use towel or liner to protect px from environment
- Ensure patient warm enough
- Lavage solution (Compatable w/tissues) Isotonic Sterile saline - Hartmann’s
-
Dilute antiseptic scrub (DO NOT SCRUB as CYTOTOXIC) for contaminated
* Chlorohexidine = 0.05%
* Sterets Unisept sachets
* Povidone Iodine 1% (NOT IN healing wounds) - 20 ml syringe
- 19G needle
- Large vol = minimum of 100ml/cm
- Pressure = 8 - 12 psi
- Prevent cross-contamination
3 …
Why are wounds Lavaged?
- Removes debris
- Reduces contamination
- Significantly reduces infection risk
If a pressure greater than 12 psi is used to lavage a wound, what can this cause?
Drives pathogenic bacteria into wound + cells
If a pressure lower than 8 psi is used to lavage a wound, what can this cause?
Has minimal to no affect
Define Bioburden
No. of micro-organisms that the wound is contaminated with
Define Biofilm
- Form of multispecies bacterial communities
- Organised onto a wound surface
- Forms extracellular matrix of:
* Polysaccharides
* Proteins
* Nucleic acids - To provide protection + ensure survival
Name 3 forms of Debridement
- Autolytic
- Mechanical
- Surgical
What does bioburden cause?
- Prolonged inflammation
- Healing delay
What does a protein rich, devitalised wound tissue do?
Perfect environment for bacterial proliferation > Infection
3 ..
When a Bioburden + Biofilm is removed, alongside a moist wound-healing technique, what can this do?
- Optimise cell proliferation
- Mainitain comfort
- Avoid Eschar formation
What is Active debridement?
Use of soft-purpose-made brush
(Debrisoft)
What is Biological Debridement?
- Use of medical maggots + leeches
- M + L grown in sterile environment
- Applied to wound bed
- Maggots can be applied w/pre-constructeed dressing or individually created dressing, to keep maggots secure in wound bed
Expensive..
6 ..
Describe Autolytic Debridement
- Use of primary layer applications:
* Alginates
* Hydrocolloids
* Hydrogels
* Manuca Honey
* Sugar - Most selective form of debridement
- Spares healthy cells
- Maintain intact matrix of molecules
- While removing damaged cells
- With Microscopic precision
6 ..
Describe Mechanical Debridement
- Physical removal
- Of tissue adheered to
- To a dried-on dressing
- Non-selective + non-desirable form of debridement
- Very painful
- Req GA/Analgesia
4 …
Describe Surgical Debridement
- Gold-standard technique
- Tissue removed by VS
- According to:
* Colour
* Texture
* Vascular supply
* Temperature - Selective form of debridement on a Macroscopic level
Name 4 types of Closure techniques for wounds
- Sutures
- Staples
- Surgical Reconstruction (Flaps + Grafts)
- Drains (Active + Passive)
List 2 disadvantages of Surgical Staples for wound closure
- Doesn’t go very deep
- Less reliable
Identify 1 advantage of Surgical drains for wound closure
Minimises fluid build-up/oedema
What is open wound management?
- Covering wound with appropriate dressing + bandage
- DOES NOT MEAN left open to environment
What are the aims of Open wound management?
- Work syngeristically with cells
- Provide best environment possible
- Support healing process
What is it called when a wound closes by itself?
Second Intention
3 ..
When is Second Intention appropriate for Open wounds?
- Healing is progressing well
-
Reconstructive sx is not required:
* To prevent contracture or scarring
* Might inhibit mnobility
* Cosmetically unacceptable - If px tolerates banadging
What does normal Exudate look like?
- Clear
- Pink-tinged
What does Infected Exudate look like?
- Cloudy
- Varied in colour
* Yellow
* Tan
* Green
* Reddish
* Black
* Milky
* Thick
* Viscous
What is Exudate?
+
What does it contain?
- Exudate is:
* Discharge from fluid
* Plasma leaking from capillaries - Contains:
* Nutrients
* Growth factors
What is Exudates function for the body?
Provides a moist environment for cell viability
When should Exudate normally reduce?
- Towards the end of the Inflammatory phase
- As granulation tissue + epitheliasation forms
If Exudate is still present after the Inflammatory stage, what may this indicate?
- Increased bacterial burden
- Oedema
- Excess movement
- Patient interference
What is Maceration?
- Wound with excessive production of Exudate
- Spilling onto adjacent healthy skin
- Inc susceptibility to infection
What is Excortiation?
- Exudating wound
- Had contact with toxins from wound
- Causes damage to top layers of skin
What is Granulation?
- Tissue build up by fibroblasts
- Secrete new extracellular matrix molecules (Collagen, Elastin) + Endothelial cells
- Which help build new BVs
3 ..
What does healthy Granulation tissue look like?
- Bright red
- Moist
- Slightly un-even appearence
(Wound fluid levels depend on wound)
3 …
What is Epithelialisation?
- Process of Epithelial cells migrate onto Granulation tissue
- Which provides:
* Oxygen
* Moisture -
Surface req for epithelial cells to:
* Proliferate
* Cross wound
* Create new Epidermis
How long would Wound Epithelialisation Process take for a 1mm wound?
10 days!
If it takes 10 days for a 1mm wound to undergo Epithelialisation, how long would a 10cm wound take?
Up to 500 days!
Out of these 3 options, chose when you should change the dressing
Medium Exudate!
- Low = good ax of absorbancy left
- Perfect time
- Excess = Fully saturated, leads to Maceration of surrounding healthy tissue
4 ..
What does Laser therapy do?
- Enhance wound healing times
- Reduce/prevent infection
- Inc blood flow + oxygenation
- Red inflammation + pain
Identify 7 types of advanced dressings
- Hydrogels
- Hydrocolloids
- Polyurethane foam
- Polyhexamthylene biguanide (PHMB)
- Alginates
- Sodium chloride
- Super-absorbant
What is a Hydrogel dressing?
+
When is it appropriate to use?
- They are:
* Fluid donators for dry wounds
* Donate + trap water
* Hydrate necrotic material within wound
* Absorb exudate - Used for:
* Wounds at risk of drying out
* Necrotic wounds
* Wounds within excess exudate
What is a Hydrocolloids dressing?
+
When is it appropriate to use?
- They are:
* Actively stimulate wound healing
* Encourage debridement
* Degrade on interaction with exudate - Used for:
* Dry > semi-dry wounds
* Req additional moisture + natural debridement
What is a Polyurethane foam dressing?
+
When is it appropriate to use?
- They are:
* Foam
* Highly absorbant
* Act by drawing excess exudate away from wound
* Maintain some moisture + humidity
* Keeps wound moist
* Now avaliable w/antimicrobial properties - Used for:
* Applied on top of other products (Hydrogels, Honey)
What is a Polyhexamthylene biguanide (PHMB) dressing?
+
When is it appropriate to use?
- They are:
* Protozoan
* Antimicrobial agent
* Broad spectrum of activity
* Against bacteria + fungi
* Breaks down bio-film
* The PHMB attacks bacteria in wound exudate as it is absorbed - Used for:
* Staphylococci (Inc MRSA)
* Pseudomonas
* Proteus etc
What is a Alginates dressing?
+
When is it appropriate to use?
- They are:
* Fine
* Fiborous
* Absorb moisture
* Dereived from Kelp
* Wound exudate interacts w/Alginate to release cations that actively stimulate the wound - Used for:
* ??
What is a Sodium Chloride dressing?
+
When is it appropriate to use?
- They are:
* New
* Guaze
* Saturated w/20% Hypertonic saline solution
* Promotes biological cleaning
* Promotes autolytic debridement process - Used for:
* Non-infected
* Highly exudating wounds
What is a Super-absorbant dressing?
+
When is it appropriate to use?
- They are:
* Cope w/high vol of exudate
* Incoperated Polyacrylate crystals
* Hi-tech silicone adhesives - Used for:
* Excessive exudate
* Difficult to manage
Name 2 types of Anti-microbial dressings
+
What they consist of?
+
When they are used?
-
Manuka Honey
* Excellent anti-microbial effects
* Helps granulation bed form
- Must be medical-grade
- High-level filtering to remove debris
- Effective against:
- Pseudomonas spp
- MRSA
- E-Coli
-
Silver dressings
* Silver + salts have antispetic + antibacterial properties
* Silver - ionises to release active silver ions into wound
- Req activation prior to use
- By moistening w/water for 10 sec
- Effective against:
- Pseudomonas spp
- MRSA
- E-Coli
- Common yeasts + fungi (Candida)
What is VAC?
- Vaccum Assisted Closure
- Use of negative pressure
- To encourage epitheliaisation + contraction of wound
- Through vaccum pump
- Sealed within plastic dressing
Name 5 wound complications
- Devitalised tissue
- Large vol exudating wounds
- Infection
- Oedema
- Necrosis
List 5 signs of wound infection
- Erythema
- Pain
- Oedema
- Localised heat
- Inflammation
Name 4 types of Suture material
- Absorable
- Non-absorable
- Monofilament
- Natural or Synthetic
Name 4 types of needle shapes
- Round bodied
- Straight
- Half-curved
- Curved
What are the 3 types of main suture patterns?
- Apposing
- Everting
- Inverting
Identify 7 suture patterns
- Simple interrupted
- Horizontal mattress
- Simple continous
- Ford interlocking
- Cruciate
- Vertical mattress
- Intradermal/Subcurticular
Name the 3 main components of Surgical knots
- Loop
- Knot
- Ears
List 4 types of Surgical knot
- Simple throw
- Surgeon’s knot
- Square knot
- Granny knot
Name 7 techniques to overcome skin tension
- Px positioning
- Undermining
- Wound geometry
- Suture patterns
- Skin streching
- Tissue expanders
- Incisonal ‘‘plasty’’ techniques - V, Y, Z
Identify 3 tension relieving techniques
- Subcuticular sutures
- Walking sutures
- Relaxing incisions (parrallel or multiple)
Flaps..
Name 6 primary closures of large skin deficits
- Single pedicle advancement flap
- Bipedicle advancement flaps
- Rotation flaps
- Transposition flaps
- Axillary + Inguinal flaps (Trunk, Ventral, Thorax, Abdomen)
- Distant direct flaps (distal limbs)
What are 5 complications of skin flaps
- Self-trauma
- Seroma
- Discharge
- Dehiscence
- Necrosis
When do you use a drain?
- Repeated lavage of a space
- Repeated aspiration of fluid from a space (drain dead space)
- Prevention of seromas
What is the most common Passive drain?
Penrose
When are passive drains used?
- Wounds w/dead space
- Where fluid accumilates
- Cat bite abscesses
How do passive drains work?
- Gravity
- Capillary action
When are passive drains contraindicated?
- Latex allergies
- Thoracic wounds
-
Abdominal wounds
* As will draw fluid into cavities - causing Pneumothorax or Peritonitis
How are Passive drains removed?
- Trim 1 end to level of skin
- Pull
- But if 1 end exiting - cut top off before to not bring the outside through internally - compromising sterility
What are Active drains?
- Rigid tube
- With a device that exerts constant gentle negative pressure
What is the most common Active drain?
Jackon-Pratt
How do Active drains work?
- Active suction
- Under negative pressure
- Using bulb/chamber
When should Active drains be used?
- Body cavities
- Large dead spaces
- Following surgery
What are the contraindications of Active drains?
- None!
- Generally wouldn’t use if small ax of fluid is expected
How are Active drains removed?
- When fluid production decreases (2-5 days)
- Less than 2-4ml/kg/day
- Large surgery decficits (Can be up to 3 weeks of fluid production)
What should you inspect of drains?
- Kinks
- Blockages
- SSI at stoma site
- Px interferance
What should you apply around passive drain stoma sites?
Barrier creams
How do you empty a closed drain?
- PPE
- Empty Q 4-6 hrs or when full
- BE AWARE - frequent emptying can inc chance for contamination + ascending infection
True or False.
All px’s with open wounds should be barrier nursed
True!
What type of drain has a lesser risk of ascending infection?
Active drains
What are passive drains commonly made of?
Rubber or Latex
What is this?
Jackson Pratt, Active drain
How long may it take for Jackson Pratt drains to work well?
3 - 5 days
What ax of fluid indicates removal of a drain?
Fluid production < 2ml/kg/24hrs
What is the expected ax of fluid production from a drain?
2 - 4ml/kg/24hrs
When are Tracheostomy tubes used?
- Complete upper airway obstruction
- Req Airway protection
- Airway patency
- Mechanical ventilation
- Unable to intubate (BOAS)
- Laryngeal paralysis
What are the complications that can occur from Tracheotomy tubes?
- Underlying disease
- Tube dislodgement
- Obstruction
- Aspiration pneumonia
- Infection
- Tracheal necrosis
- Tracheal stenosis
- Pneumothorax
- Pnuemomediastinum
How do you remove secretions from Tracheotomy tube?
- Remove inner cannula Q 4-6 hrs minimum + disinfect
- Replace w/sterile cannula
- Single-lumen - entire tube needs replaced
When is a Chest drain required?
In-dwellng catheter into pleural space to drain air or fluid
If not trained when placing a chest drain, what can you cause?
Iatrogenic pneumothorax
What is a Central Line?
- Long-stay catheters
- Used for long-term hospitilization
- Allow for:
1. Multiple blood draws
2. Large vol or rates of IVFT
3. High concentrations of medications at constant rate
When are Oesophagostomy tubes used?
- Feeding longer than 7-10 days
- Functioning, unobstructed oesophagus + GI tract
* Disorders of: - Nasal passages
- Jaw bones
- Oral cavity
Which are Insensible/Inevitable losses?
- Respiration
- Urine
- Faeces
- Skin
- Respiration
+ - Skin
Which are sensible losses?
- Respiration
- Urine
- Faeces
- Skin
- Urine
+ - Faeces
What is the maintence fluid calculation?
M = 50ml x BW(kg)
What % of hydration causes:
1. Slight loss of skin elasiticity
2. Hair standing on end
1%
What % of hydration causes:
1. Dry mm
2. Slight dec skin elasitcity
3. Slight inc USG
5%
What % of hydration causes:
1. Marked loss of skin elasticity
2. Inc USG
3. Dec urine output
4. Sunken eyes
5. Tachycardia
6. Slightly prolonged CRT
7%
What % of hydration causes:
1. Skin tenting
2. Sunken eyes
3. 3rd eyelid protrusion/nictating membrane
4. Oliguria then anuria
5. Weak pulse
6. Prolonge CRT
7. Signs of shock
8. Lethargy
10%
What % of hydration causes:
1. Depression
2. Collapse
3. Shock
4. Moribund
5. Death
12 %
What is general normal pH of Dogs + Cats?
7.35 - 7.45
How can fluid therapy be admin?
- Orally
- IV
- SC
- IP
- IO
What is a solute?
- Solid
- Liquid
- Gas
- Dissolved to make solution
What is a solution?
A solute dissolved within a solvent
What is a Solvent?
Liquid protion of solution
What is an Isotonic solution?
- Concentration
- Equal to
- Plasma
Name the 2 intracellular + 2 extracellular Electrolyte Cations
- Intracellular
1. Potassium
2. Magnesium - Extracellular
1. Sodium
2. Calcium
Name the 2 intracellular + 2 extracellular Electrolyte Anions
- Intracellular
1. Phosphate
2. Proteins - Extracellular
1. Chloride
2. Bicarbonate
What is the pH of blood dependent on?
Concentration of hydrogen ions (H+) dissolved within the blood
What is Hypovolaemia?
- Inc concentration of blood
- Low plasma volume
What is an Oedema?
- Dec plasma proteins
- Ineffective lymphatic drainage
What 3 organs maintain Fluid balance?
- Brain
- Adrenal glands
- Kidneys
What is lost in V+, despite water?
Stomach acid
What is lost in D+, despite water?
Bicarbonate
What is the difference between dehydration + hypovolemia?
- Dehydration = Lack of fluid in interstitial space
- Hypovolaemia = Lack of fluid in intravascular space
What parameters are affected by Hypovolemia?
- CRT
- HR
- Pulse quality
- BP
What are 3 main methods of assessing hydration?
- Clinical exam
- Urine testing
- Blood testing
Identify 5 lab tests used to assess dehydration
- All will rise:
1. PCV (1% loss = fluid loss of 10mg/kg)
2. Haemoglobin
3. Total Plasma Protein (TPP)
4. BUN + Creatinine
5. USG
What is the TP for a Dog?
54 - 71 g/dl
What is the TP for a Cat?
54 - 78 g/dl
Name the 4 primary acid-base distrubances
- Metabolic Acidosis
- Metabolic Alkalosis
- Respiratory Acidosis
- Respiratory Alkalosis
When may Metabolic Acidosis occur?
+
What are the signs?
- Inc of acid in body
- Due to abnormal metabolic function
- Ingestion of acid substance
- Dec in Bicarbonate
- Compensatory dec in CO2
- Csigns:
- V+
- D+
- RF
- Shock
When may Metabolic Alkalosis occur?
+
What are the signs?
- Excessive loss of Sodium or Potassium
- Affects Kidney’s ability to control acid-base balance
- Inc is Bicarbonate
- Compensatory inc CO2
- Csigns:
1. V+ stomach contents only
2. Over admin of Bicarbonate
When may Respiratory Acidosis occur?
+
What are the signs?
- Resp system cannot excrete acid
- Lungs don’t expel Co2
- Inc Co2
- Compensatory inc Bicarbonate
- Csigns:
1. Resp obstruction
2. Acute RF
3. Hypoventilation - for any reason
4. Anaesthetic problems
When may Respiratory Alkalosis occur?
+
What are the signs?
- Excessive CO2 expelled from bloodstream
- Hyperventilation
- Dec Co2
- Compensatory dec in Bicarbonate
- Csigns:
1. Hyperventilation
2. Pain
3. Stress
4. Hyperthermia
5. Excessive IPPV
What must you considere prioir to admin of Fluid Therapy?
- Type of dehydration
- pH of body
- Type req
- Ax req
What is fluid vol req?
Maintenance vol + Deficit vol + Ongoing losses!
What is a Crystalloid fluid?
Solution containing water + electrolytes
What is a Colloid fluid?
Solution containing large molecules or plasma expanders
How often should you change catheters?
Q 48 - 72hrs
How often should you flush a catheter?
Q 6hrs
11 ..
How should you monitor a px on IVFT?
- Check Csigns of hydration
- Use calculated vol
- Monitor TPR + MM
- Record urine output + USG
- Monitor PCV
- Monitor ongoing losses
- Central Venous Pressure
- Record all findings on fluid monitoring chart
- Review fluid therapy reg
- Monitor signs of overperfusion
- Weigh px daily
Why is improtant to weight px’s on IVFT?
Because if they are dehydrated, they’ll weight less!
IMPORTANT!!
What is Central Venous Pressure?
- Estimate of BP in Right Atrium
- Reflects ax of blood returning to heart
- Reflects heart’s ability to pump blood into arterial system
- Proportional to vol of blood in Anterior Vena Cava + Venous tone
5.** Dec w/hypovolaemia or vasodilatio**n - Inc by IVFT in critically ill px or w/cardiac disease
List 9 Csigns of overperfusion
- Soft, moist cough
- Pulmonary oedema
- Dyspnoea
- Tachypnoea
- Tachycardia
- Lethargy
- Runny nose
- Dec PCV
- Inc urine output
What are the 5 aims of Rehabilitation?
- Restore maximum:
* Function
* QOL
* Independence
* Following injury or illness - Limit pain
- Return to normal functions (All activities)
- Build muscle
- Reduce recovery times
List 4 types of Rehabilitation
- Physiotherapy
- Acupuncture
- Hydrotherapy
- Mctimoney
What is Acupuncture?
+
When is it used?
- Insertion of needles into specific points on body to produce a healing response
- To:
* Promote natural healing
* Enhance blood circulation
* Enhance oxygenation to BVs
* Relax muscles
* Relieve pain
* Reduce swelling
* Removal of waste products/toxins
* Correcting energy imbalances within body
* Stimulatese nervous system
What is Hydroptherapy?
+
When is it used?
- Any healing or therapuetic water
- Controlled exercise in water
- Zero or low impact
- Non-weight baring in controlled weight bearing exercise
- Uses Buoyancy, Hydrostatic pressure, Cohsion + Turbulence
- To:
- Relieve pain
- Reduce swelling + stiffness
- Circulatory benefits
- Improved cardiovascular fitness
- Inc mental stimulation
- Improved gait pattern
- Muscle strength
- Joint mobilisation
When is Hydrotherapy indicated?
+
Contraindicated?
- Indicated
* Pre + Post orthopaedic sx
* Pre + Post spinal sx
* Muscle atrophy
* Obesity management
* Orthopdic conditions/disease
* Neurological conditios
* Performance, working or show dog conditioning
* Behavioural issues - Contraindicated
* Cardiac dysfunction (overheat)
* Respiratory dysfunction (hydrostatic pressure > inc effort)
* Severe peripheral vascular disease (Damage BVs)
* Infections (Spread)
* Coagulopathies (Inc blood flow)
* Unstable fractures (must be fully hx)
* V+
* D+
* Precautionary conditions (Season, Epilepsy, Chemo, DM)
What is Mctimoney?
+
When is it used?
- Physical manipulation using gentle hands to realign balance + muscoskeletal system
* Precise + rapid adjustments of spine + pelvis by Chiropractor/VS referral - Used:
* Post-Ortho sx
* Injurd/accident
* Working or competing dogs
* Mobility issues (Conformation defects, Obese)
* Lameness
* Exercise intolerance
* Uneven gait
* Stiff + pain post-exercise
* Changes in performance, behaviour + temperament
* Uneven muscle development
* Signs of discomfort when back touchde
What is Physiotherapy?
+
When is it used?
- Combo of techniques to create a tailor made rehabilitative program for an individual
* Thermotherapy
* Massage
* Therapuetic exercises
* Laser therapy
* Electrial stimulation
* Therapuetic ultrasound
* Extracorporeeal shockwave therapy (ESWT) - Used for:
* Geratrics
* Post-op recovery
* Stable post-sx
When is Physiotherapy contraindicated?
- Pyrexia (Inc blood flow = inc heat)
- Infection (Spread)
- Vascular compromise
- Coagulopathy
- New or Unstable fractures
- Spinal instability
When do you use Thermotherapy?
+
When do you use Cyrotherapy?
- Thermotherapy
* Chronic pain
* Relax tense muscles
* Aches
* Arthiritis - Cyrotherapy
* Acute injury
* After activity
* Reduce swelling
* Sprains
* Bruises
* Pain
Name the 4 types of massage techniques
- Stroking
(Long, slow gliding strokes) - Effleurage
(Firm stroking movements towards lymph nodes) - Petrissage
(Kneading, picking up, rolling + compressions) - Frictions
(Deep transverse massage w/fingertips)
Give 1 indication of each of these Massage techniques:
1. Stroking
2. Effleurage
3. Petrissage
4. Frictions
- Stroking
(Long, slow gliding strokes)
* Aids circulation
* Inc lymph flow
* Stimulates sensation - Effleurage
(Firm stroking movements towards lymph nodes)
* Inc lymph flow
* Reduces oedema - Petrissage
(Kneading, picking up, rolling + compressions)
* Mobilises soft-tissue
* Enhances deeper circulation
* Aids toxin removal - Frictions
(Deep transverse massage w/fingertips)
* Breaks down adhesions
* Improves fibre alignment
What is ROM or PROM?
Range Of Movement
Or
Passive Range Of Movement
Identify nursing care for suspect Spinal/Non-ambulatory px
- Massage - Effleurage in UPWARDS DIRECTION
- Standing
- Toothbrush
- ROM
- Turning
- Urinary catheter care +/- Manual bladder emptying
- Grooming
- Feeding
- Wound interferance
- Nursing Care Plan
What is Shock?
Acute circulatory failure resulting in inadequate tissue prefusion + energy production
What is Stage 1 shock?
- Compensatory shock
- Attempt to reduce effects of shock
- Baroreceptors detect reduc cardiac output
- Stimulate adrenaline + noradrenaline
- Causes inc HR + contractility
- Hypoxia of tissues > metabolic acidosis
- Inc Ventilation - to address acid-base balance
- **Hypoperfusion of kidney **activates RAA system
- Aldosterone acts on collecting ducts to retain Na + H20
- Causes peripheral vasconstriction
What is Stage 2 shock?
- Decompensatory
- No longer able to compensate
- When shock is not treated
-
Fluid + proteins leak from circulation > tissues - due to peripheral vasodilation
3.** Inc blood viscosity** - Acidosis inc
- Gut becomes Ischaemic
- Bac enter blood stream
- Inc stuporous of comatose
What is Stage 3 shock?
- Irreversible
- Too much cell death - non-reversable
-
Systemic Inflammatory Response Syndrome (SIRS)
* Inflammatory injury to 1 organ systems
* Causes knock-on effect
* Infectious or non-infectious cause -
Disseminated Intravascular Coagulation (DIC)
* DEATH IS COMING
* Activiation of haemostatic mechanisms
* Induces prothrombotic state
* Leads > bleeding tendencies (can’t clot) -
Multi-Organ Dysfunction (MOD)
* SIRS + Septic shock > MODs
* Every organ + system is affected - Death
- SIRS
- DIC
- MOD
List 3 stages of shock
- Compensatory
- Decompensatory
- Irreversible
Name 4 types of shock
- Hypovolaemic
- Septic/Distributive
- Cardiogenic
- Obstructive
What happens in Hypovolaemic shock?
- Heart pumps well
- But dec circulating vol
- Due to blood, fluid or plasma loss
- Results in Hypoperfusion
What happens in Septic/Distrubitive shock?
- Distrubitive due to hypotension
- Heart pumps well
- But peripheral vasodilation
- Gram-ve bac infection
- Endotoxins released from ruptured bac cells
- Toxins > circulation inc capillary permeability - causing uneven fluid distrubution
What happens in Cardiogenic shock?
- Reduc in cardiac efficacy
- Heart loses ability to pump effectively
- Leads to reduc in cardiac output
- Results in congestion in Liver + Lungs
- Causes oedema
What happens in Obstructive shock?
- Obstruction of normal blood flow
- Heart pumps well
- Outflow obstructed
- Causesed by pulmonary thromboembolism or pericardial effusion
- Pericardial effusion - blood unable to fill ventricles > cardiac output is red
- Removal of obs will resolve signs
What is the Isotonic fluid shock rate for a Dog?
90ml/kg
What is the Isotonic fluid shock rate for a Cat?
50ml/kg
What is the Hypertonic fluid shock rate for a Dog?
4 - 5 ml/kg
What is the Hypertonic fluid shock rate for a Cat?
2 - 4 ml/kg
What is the Hydroxyetyl starches fluid shock rate for a Dog?
- Up to 20ml/kg
- Divide into 5ml/kg boluses + reassess
What is the Hydroxyetyl starches fluid shock rate for a Cat?
- Upe to 10 ml/kg
- Divide into 2.5 - 3 ml/kg boluses + reassess
What is the Crystalloid or Colloid fluid shock rate for a Dog?
- Crystalloid = 4 - 45 ml/kg
- Colloid = 5 - 10ml/kg
What is the Crystalloid or Colloid fluid shock rate for a Cat?
- Crystalloid = 25 - 27 ml/kg
- Colloid = 1 - 5 ml/kg
How much blood can Cats + Dogs donate?
20%
Max in Dogs = 18ml/kg
Max in Cats = 11ml/kg
What is the formula for finding out correct total blood volume required for a transfusion?
Vol of donor blood req (ml) x BW(kg) x Desired change in PCV
ALL DIVIDED BY
PCV of transfused blood
Give calculation of how much blood volume to be transfused in mls to a px
k = Constant rate, 70 for dogs, 60 for cats
k x BW(kg) x req PCV - Recipient PCV
Divided by (only req PCV»_space;)
PCV of red cell product
How many mls of PCV does it take to raise a PCV by 1%?
1 ml/kg of PCV
OR
2ml/kg Whole blood
Collate a list of questions you would ask an owner on a care plan
- What is Fluffy’s normal routine? When does she normally eat, go to the toilet and sleep?
- How much/what type of exercise does Fluffy get? What type, for long how?
- What does Fluffy eat, how much, how many meals? Does she have any treats, if so, what are they? What type of bowl does she use?
- How much does Fluffy drink + How is she given water?
- What are her normal activities behaviours? Does Fluffy have any stress triggers?
- Where does Fluffy normally go to the toilet? What are her normal toileting behaviours? Type of area? How often does she pass urine/stools?
- How do you normally groom Fluffy?
Collate a list of questions you would ask an VS on a care plan
- Were there any complications during surgery or GA?
- What is the volume, strength, frequency + time due for Fluffy’s medications?
- Is Fluffy NPO (nil per os) or what/when can she have food/water?
- Is Fluffy on strict cage rest? If no cage rest - Can Fluffy be allowed out for toileting/exercise?
- What are the bladder considerations?
- Does Fluffy have a buster collar on?
- Any specific wound care considerations?
- What’s the plan?
- How long might the ESF be inplace for?
- Is there any specific monitoring information required by the VS?
How would you provide adequate nutrition for a Cardiac patient?
- Palatable diet
- Maintain calorie intake
- Provide high-quality BV protein
- Restricted sodium diet
- No high-salt treats
How would you provide maintain hydration for a Cardiac patient?
- Ensure accurate fluid plan in place + followed
- Check for overperefusion
- Provide oral fluids
How would you ensure a Cardiac patient is able to defecate normally?
- Maintain hydration
- Low intensity exercise, if possible to stimulate persistaltic contractionss
- Oral lubricants with food - if palatable
How would you ensure a Cardiac patient is able to urinate normally?
- Allow frequent toilet trips - if able to mobilse
- Indwelling catheter
- Kennel liners
How would you provide maintain oxygenation for a Cardiac patient?
- Provide 02; oxygen cage, flow-by + nasal cannula
- Limited handling - reduce stress, care around neck + chest regions
- Peripheral catheter inserted as precaustion if no fluids
- Crash cart avaliable if required
- Weight management
How would you provide maintain body temperature for a Cardiac patient?
- Insultate to ensure peripheral circulation is maintained
- Normal environmental temp/fan to ensure no overheating
How would you provide maintain skin + coat conidtion for a Cardiac patient?
- Maintain skin integrity - skin care, bathing if soiled, keep skin dry
- Assist with - grooming, eye + oral hygiene (Particulary if not drinking + panting)
How would you provide mobilise adequately for a Cardiac patient?
- Cage rest - where appropriate
- Low Intensity exercise - care with steps + inclines
- Use harness, instead of collar
- PROM exercises
How would you provide maintain adequate sleep + rest for a Cardiac patient?
- Minimal procedures + handling
- Group together observations, nursing interventions + medications
- Periods with reduced lighting
How would you ensure a Cardiac patient is able to Express normal behaviours?
- Stress-free handling - minimal contact, no scruffing, avoid neck area
- Provide hide - care with monitoring
- Reduce environmental noise - away from noisy patients, domestic noises, radio etc
15 ..
What nursing interventions may you use for nursing Neurological patients?
- Supportive bedding
- Care handling
- No leads or collars
- Sternal recumbency + Turn Q2 hrs
- Coupage
- Nebulisation if required
- Supported walking or cage rest
- Decubitus uclers - check + prevent
- Monitor urination + defecation
- Manual expression or urinary catheterisation
- Assisted feeding - care to protect airways, tube feeding if required
- Ensure meet RER
- Pain management
- Skin care + grooming
- Maintain body temperature (Q15 mins until within normal ranges)
What may a Neurological + Assessment + Plan involve?
- Results from Neurological assessment
- Urination + Defecation function assessment
- Mobility
- Independent feeding
- Rehabilitation plan
When may this be used?
To perform a Neurological assessment
What nursing care is involved in the Immediate Post-op rehabilitation period for Neurological patients?
-
Pain control
* Buprenorphine, Methadone etc
* Pre + Post-op -
Massage
* 20 mins
* 2-3 x day
* Warms the muscles -
Cyrotherapy
* 10-15 mins
* 2-4 x day
* Reduce inflammation, pain, heat
* 3 days for post-Orthopeadic-surgery
What nursing care is involved in the Early Post-op rehabilitation period for Neurological patients?
- Massage
-
Passive ROM exercises
* 10-15 cycles
* 2-3 x day -
Thermotherapy
* 10-20 mins
* 2-3 x day
* Depends on weight
* 3-post surgery
* Chronic conditions -
Alternative therapies
* Ultrasound
* TENS
What nursing care is involved in the Late Post-op rehabilitation period for Neurological patients?
-
Exercise
* Active
* Active-assisted
* Active-resisted - Walkers/wheelchairs
- Low-level light therapy
What may a Opthalmic + Assessment + Plan involve?
- Attempt to evaluate level of sight
- Ability to cope w/unfamiliar environments (will bring stress)
- Level of stress
9 …
What possible Nursing Interventions would you use for Opthalmic patients?
-
Use voice to make patient aware of approach
* Call name, make presence known - Reassurance, particulary when moving/carrying out procedures
-
Reduces stress + excitement
* Quiet ward
* Reduced light
* Blanket over kennels
* Pheremones -
Careful handling
* Opthalmic pain is extreamly painful - Be aware of aggresive tendencies
-
Keep routine for feeding + bowls
* Ask O for familiar items + scent -
Prevent self-trauma
* E-collar
* Don’t let them rub their eye, will if sutured, may be in for 10+ days, as will req another op if so!
8.Occular hygiene + lubrication
* Use gentle, clean, cotton guaze
* Lubricating eye drops
* Remove secretions + blood etc - Accurate + Careful medication
- Dim lights