Foal Nursing Flashcards
what is key when nursing foals?
be prepared as often an emergancy
how can foal nursing equipment be managed?
equipment only used part of the year (january to june)
have a stock list and check stock before season
ICU/foal trolley or foal packs for cars
familiarise new staff with equipment, where it is and how to use it
what level of nursing is needed for the recumbent foal?
almost continuous
how often should a clinical exam be performed in a recumbent foal?
every 4-6 hours
could be fewer depending on stability
what is involved in the clinical exam of the recumbent foal?
thoracic auscultation HR RR MM palpation of joints and umbilicus temperature
what are joints assessed for in the recumbent foal?
swollen - presence of infection
what are you looking at when assessing the umbilicus of a recumbent foal?
infection
urine leaking
what is the temperature of a foal in the first 7 days after birth?
37.5 - 39 degrees
goes down to 37.2 - 38.3 after that
when does the foal temperature range match that of the adult horse?
7 days after birth
what position should foals be placed in when recumbent?
sternal
why is lateral recumbancy in a recumbent foal unsafe?
affects perfusion and breathing
how should recumbent foals be placed in sternal?
chests are pointed so will not stay on their own
support
bean bag
nurse to reposition especially as they start to improve and fight!
what respiratory support may recumbent foals need?
intra-nasal oxygen (common) mechanical ventilation (rare)
what should you ensure the recumbent foal is at all times?
clean
warm
dry
how can foals be helped to stay dry and not urine soaked?
urinary catheter
what is used to place IV catheters in the foal?
over the wire prefurrable for small, collapsed veins
use stylet if that is your preferred method
under what conditions must an IV catheter be placed in foals?
sterile (use drape and may need sedation)
why must the recumbent foals IV catheter be wrapped?
to prevent mum from chewing it
how often should foal IV catheters be checked?
every 4-6 hors
what are foal IV catheters checked for?
thromboplebitis
what is the only flush that can be used in foal IV catheters?
saline only (no heparin)
what are separate ports needed for on a foal IV catheter?
TPN
medication
why does TPN need a separate port on an IV?
reduce port handling due to the high risk of infection associated with TPN
what parameter may need additional support in recumbent foals?
BP
how is BP supported in recumbent foals?
pressor support
why do foals need pressor support?
severely ill
usually septic
get low BP which leads to multiple organ failure and death
what drugs are used for pressor support?
dobutamine infusion
how is BP in foals monitored?
tail cuff
what is a common complication of urinary catheters in foals?
cystitis
what can be monitored through a urinary catheter?
urine output
hydration
anuric renal failure secondary to sepsis
ruptured bladder
what is the only way to be sure of a foals hydration status?
urine specific gravity
what is the correct urine specific gravity for foals?
<1.010 (dilute)
what should be done with the mare (if present) when she has a sick foal?
milk regularly to maintain supply
check for mastitis
how should the foal be fed if able to suck?
from the mare is best even if the foal has to be held there
if no mare or too weak to stand then feed milk/milk replacement from a bowl
NG tube
why should bottle feeding not be performed in foals?
risk aspiration pneumonia
how should the NG tube position be checked in a foal?
x ray
should foals be fed via a pump on an NG tube?
no - olny fed via gravity
what sort of nutrition should be used in horses if they have no suck reflex?
parenteral nutrition
how should foals who are unable to cope with milk be fed in the short term?
5% glucose spiked isotonic fluids
how should foals who are unable to cope with milk be fed in the long term?
parenteral nutrition
what is found in parenteral nutrition?
amino acids
glucose
fat
what needs to be monitored in foals receiving TPN?
glucose - may need insulin SC or CRI
what are the 2 main diagnostic tests performed on recumbent foals?
blood
urine
what is the test performed on urine in recumbent foals?
USG
what are the blood tests performed in recumbent foals?
IgG SNAP ELISA PCV TP glucose white cells creatinine blood gas electrolytes lactate culture
what is the IgG SNAP ELISA test for?
antibodies
what will PCV and TP tell us in sick foals?
less about hydration but indication of how sick they are
what information is gained from monitoring glucose in recumbent foals?
whether foal is self regulating
if they require more glucose
what information is gained from monitoring WBC in recumbent foals?
presence of infection
what information is gained from monitoring creatinine in recumbent foals?
kidney function
what information is gained from monitoring lactate in recumbent foals?
perfusion
what information is gained from performing blood culture in recumbent foals?
look for bacteraemia
what protects the foal from infection after birth?
mare antibodies
how long do mare antibodies protect the foal after birth?
about 6 weeks
how can you ensure that the mare has the correct antibodies to pass on to the foal?
ensure vaccinations are up to date (flu, EHV, rotavirus, tetenus)
when should a mare’s last tetanus vaccine be given before foaling?
4-6 weeks before
when should the mare be moved into her foaling environment?
6 weeks before due date
how does the foal get antibodies from it’s mother?
only by drinking colostrum
how can you ensure that the foal will be able to receive colostrum?
check if there have been any problems in the pregnancy
ensure that the mare has not leaked milk
what should happen if the mare has leaked milk during her pregnancy?
colostrum is lost and will not be available for the foal so need to plan to give colostrum from another mare or hyperimmune plasma
what is hyperimmune plasma?
plasma from a highly vaccinated horse
what size should a foaling box be?
5m x 5m
describe the foaling box
large good ventilation disinfected warm sheltered thick bedding
what is the length of gestation for horses?
320-360 days - wide
what are the signs that a mare is ready to foal?
best indicator is when they have foaled before
some show no signs
waxing up
milk electrolyte changes
what is shown by milk electrolyte changes?
gives 48 hour warning of foaling
how long does stage 1 of foaling last for?
variable length
what happens during stage 1 of foaling?
foal moves into birth canal
what is the correct position of the foal in the birth canal?
nose pointing caudally
resting on forelimbs
one forelimb slightly in front of the other
what are the signs that a mare is in stage 1?
restless agitated sweaty lies down and gets up colic signs
what happens in stage 2 of foaling?
birth
how long should stage 2 of foaling take?
<30 mins - dangerous if any longer
what happens during stage 3 of foaling?
expulsion of the placenta
what should you do when the placenta is delivered?
check it is whole
how long after birth should the placenta be expelled?
1-2 hours
what should you do if the placenta has not been expelled after 3 hours?
walk
give oxytocin to contract uterus
what should happen if the placenta has not been expelled 6 hours after birth?
aggressive treatment including oxytocin, lavage, walking, antibiotics, anti-endotoxins, weights
what is the risk associated with retained placenta?
laminitis
infection
can be fatal
what is the main complication of foaling?
dystocia
red bag delivery - placenta delivered around foal incorrectly
what are the possible issues with dystocia?
death of foal
hypoxia (short term)
broken ribs
injury to mare
how long do you have once dystocia occurs to deliver the foal?
~1 hour
what can be done to buy you more time to deliver the foal if there is dystocia?
ET tube if possible to ventilate
how can foals be delivered if there is dystocia?
epidural and ropes, manipulation and lubrication
GA - manipulation, C - section or fetotomy if deceased
what type of C-section can be performed in horses?
emergency only - will not survive planned
when should the foal take it’s first breath?
within 30 seconds of birth
when should the foal be able to stand?
within 30 mons to 1 hr of birth
when should a foal drink colostrum?
within 1-3 hours of birth
what should the foal do within hours of being born?
pass meconium
urinate
what should you do before deciding to resuscitate foals?
cursory physical exam
what conditions may mean a decision not to resuscitate?
hydocephalus
what almost always precedes cardiac arrest in foals?
respiratory arrest
what are the most common causes of respiratory arrest in foals?
premature placental separation
early severance or twisting of umbilical cord
dystocia
airway obstruction by fetal membranes
failure to spontaneously breathe due to unknown cause
what are the causes of CPA in equine neonates that are not associated with birth?
primary lung disease sepsis hypovolaemia metabolic acidosis hyperkalaemia hypoglycaemia hypothermia
what must be provided to all foals who require CPR?
ventilation
hy must ventilation be provided to all foals as a part of CPR?
as respiratory arrest underlies cardiac arrest
what is the success rate of CPCR in foals?
if resuscitation begins before non-perfusing rhythm develops the likelihood of revival is good
if delayed until after asystole survival is less than 10%
what should you do if any of: HR <60 bpm/regular slow / irregular respiration foal in lateral some muscle tone grimace on nasal mucosal stimulation occurs?
stimulate foal (rub with towel etc) intranasal O2
what should you do if any of:
HR / respiration undetectable
muscle tone limp or absent
unresponsive on nasal mucosal stimulation occurs?
neonatal resuscitation
how should the ventilation portion of resuscitation be performed?
clear the airway
place naso or endotracheal tube if possible (even with foal in birth canal)
ventilate (may respond)
how should a nasotracheal tube be placed?
extend head
pass tube through nose ventral to medial
how many attempts to place nasotracheal tubes are before you should progress to ET tubes?
2 attempts
how should an ET tube be placed in an foal?
pull tongue forwards and lateral with one hand to stabilise larynx
advance tube in midline over the tongue
twist once you reach the larynx
check position, cuff and secure to head
how should the patient be ventilated?
abubag to tube if possible
how should the foal be ventilated if ET tube to bag is not possible?
mouth to tube
ambu bag to mask
mouth to nose and close opposite nostril
what must you do if a cuffed tube is not in place during ventilation?
ensure head is extended to reduce aerophagia
what is aerophagia?
stomach filling with air
what is the issue with aerophagia during CPR?
stomach distended with air can reduce thoracic capacity
how can you ensure tidal volume in the ventilated foal is sufficient?
look at chest
how may breaths are needed when ventilating a foal?
10 short breaths per min
when should the foal be reassessed after starting ventilation?
30 seconds
what is being assessed 30 seconds after ventilation commences?
HR presence
when should compressions be performed in foals?
after 30 secs of ventilation:
if no HR
HR less than 40 bpm
HR less than 50 bpm and not increasing
where should ribs fractures be placed if present?
fractured rib side down
what should you do if rib fractures are seen bilaterally?
place the side with more cranial rib fractures down
what position should chest compressions be performed in in foals?
kneel parallel to spine
foals back against wall
hands on top of each other
shoulders above hands to use body weight
where should hands be placed for compressions in foals?
caudal to triceps at highest point of thorax
what is the correct compression to ventilation ratio in foals?
15:1
what is the compression rate in foals?
100-120 per minute
what is the optimal compression depth in foals?
push hard
what should you do if the foal remains bradycardic following CPR?
give epinephrine every 3 mins until HR >60
how can epinephrine be administered?
IV
intra-tracheal
what should you do with your patient following successful resuscitation?
keep warm with bandages and blankets
keep off floor
what can be given IV to foals following resuscitation?
5% glucose at maintainance
what is maintenance rate for foals?
250 ml/hr for 50kg foal
what must you do before warming foals if hypoglycaemic?
give glucose to counteract protective response
how should hypothermic foals be warmed?
slowly hot hands bandage legs rugs care using heat lamps
how is dehydration diagnosed in foals?
history clinical signs lactate high index of suspicion USG**
when should dehydration in foals be presumed?
if no nursing for more than 4 hours
can adult signs of dehydration be used in foals?
no - not consistant
hwo can dehydration in foals be corrected?
1L hartmann’s
up to 3 additional boluses
what should be used to monitor hydration in foals?
USG
what imbalance is often seen alongside dehydration?
hypoglycaemia
how is glucose level measured?
glucometer
where are all foal antibodies received from?
colostrum
how long is a foals gut ‘open’ to antibodies for?
~24 hours (less if antibodies recived)
what is the issue with the gut being ‘open’ to antibodies?
also open to bacteria which is also gained from the mother which can enter the blood stream
what is the value of partial failure of passive transfer?
400-800 mg/dl
what is total FPT measured as?
<400 mg/dl
what is normal blood antibody concentration in foals if passive transfer has occurred?
> 800 mg/dl
what is FPT a risk factor for?
spsis
when should foals be tested to see if passive transfer has occurred?
12-24 hours old
what foals should be tested for FPT?
all at risk
but ideall all foals
how can FPT be tested for?
blood test or SNAP elisa
what is the benefit of a SNAP ELISA for FPT?
easy
cheap
done in the stable
saves lives by early detection of FPT
how is FPT treated?
hyperimmune plasma transfusion
why must antibodies be given IV if FPT has occurred?
gut is ineffective or has closed
why should hyperimmune plasma be defrosted slowly?
avoid denaturing antibodies
what should hyperimmune plasma be given via?
blood giving set with a filter
why should hyperimmune plasma transfusion be started slowly?
to check for transfusion reaction
what must be observed for to ensure volume overload doesn’t occur during hyperimmune plasma transfusion?
adjust volume for size
look for pulmonary oedema and protein reaction
when should foals plasma levels be reassessed following hyperimmune plasma transfusion?
after each bag of plasma
what is the most common reason for hospitalisation and death of neonatal foals?
sepsis
why may foals be born septic?
placentitis
what is a major risk factor for sepsis?
FPT
what is sepsis?
systemic bacterial infection (bacteraemia)
what is seen along side sepsis in foals?
infected joints
infected umbilicus
what are the signs of sepsis in foals?
pyrexia depression recumbancy injected mucous membranes joint effusion +/- lameness totally unresponsive
what tests are used to diagnose sepsis?
sterile blood culture WBC count SAA SNAP test for antibodies creatinine USG - hydration glucose level lactate culture from umbilicus and arthrocentesis sample if involvement
what will the WBC count be like in a septic patient?
low
why should creatinine be checked in septic patients?
sepsis attacks kidneys so they are at risk of anuric renal failure
what is the benefit of checking lactate levels in septic patients?
shows perfusion
indication of prognosis
how is sepsis treated?
broad spectrum antibiotics hyperimmune plasma (even if no FPT) joint lavage - if joint involvement removal of umbilicus (rare) ICU
what disease makes foals more prone to seizures?
sepsis
what causes seizures in foals?
many causes
what are the signs of seizures in foals?
subtle - repetitive movement that you cannot interrupt
generalised convulsions
how should seizures in foals be treated?
correct primary cause if possible
maintain airway if appropriate
administer oxygen
anticonvulsant therapy (diazepam)
what are the main causes of dummy foal?
range - unknown
hypoxia at birth / in utero
what does dummy foal lead to?
brain and other organ damage
what is dummy foal also known as?
hypoxic ischaemic encephalopathy (HIE)
perinatal asphyxia syndrome (PAS)
what are the signs of dummy foal?
may be born normal and decline slow to swallow not sucking not following mare ataxic forget to breathe seizure
how is dummy foal treated?
nursing is crucial maintain cerebral perfusion IVFT correct metabolic imbalances PPN or slow entral feeding
when may squeezing a dummy foal help?
if no brain damage present may stimulate the inhibitory neurotransmitters to be removed - can have profound effect
why can squeezing a dummy foal if there is no brain damage present help?
help loss of inhibitory neurotransmitters that are needed in utero and should be halted during birth
when is a foal classed as premature?
<320 days gestation
is a foal younger than 280 days likely to survive?
no
what is foal dysmaturity?
foal looks premature despite normal or often longer gestation
what is postmaturity?
long gestation and normal size foal but emaciated as dam is unable to meet nutritional demands
what are the signs of a premature / dysmature foal?
smaller than expected silky short hair floppy ears domed head weak abnormal RR - either low or high
what organs are immature in prematurity or dysmaturity?
GI
respiratory
MSK
what is the most significant issue with premature / dysmature foals?
incomplete ossification of carpal and tarsal bones so bones are soft and compressed if weightbearing occurs
what effect can incomplete ossification of carpal and tarsal bones have on a horses future career?
unlikely to be athletes and even may struggle as pleasure horses
when is tendon laxity more likely?
if premature
what structures are affected by tendon laxity?
flexor tendons or ligements
what can tendon laxity be caused by?
premature / dysmature / postmature
complication from bandage, cast or splint
how is tendon laxity treated?
resolves after a few days
box rest on limited bedding
walk on firm ground for 5m 3 times a day
what precautions must be taken when walking a foal with tendon laxity?
bandage heels for protection
how far should foals with tendon laxity be walked each day?
5m
3 times a day
what is the cause of tendon contracture?
unknown
may be due to positioning in uterus
can be acquired when older
when is tendon contracture often acquired?
secondary to orthopedic pain
what is the prognosis of tendon contracture?
varies in severity and number of affected limbs so prognosis is varible but usually fair to good
how is tendon contracture treated?
physio to stretch toes walk on hard ground oxytetracycline (for 3 days) toe extensions splint half or full limb cast surgery
what is the purpose of oxytetracycline in treatment of tendon contracture?
binds calcium so aids tendon stretch
what is of significant concern when giving oxytetracycline?
is nephrotoxic
what surgeries may be performed on tendon contracture patients if they have not responded to medical management?
check ligament desmotomy
tentotmy
what are the main types of angular limb deformity?
valgus or varus of fetlock, carpus or tarsus
windswept
how are angular limb deformities treated?
rest
farriery
surgery
when must surgery to correct angular limb deformity be completed?
before growth plate fused
what are the signs of meconium retention?
colic
restlessness
may have passed some meconium or none
what is often seen alongside meconium retention?
failure of passive transfer
what must be checked if foal has meconium retention?
patent rectum (atresia ani)
how can atresia ani be diagnosed?
rectal exam
contrast study if glove clean on rectal
how is meconium retention treated initially?
soapy water / phosphate enema
what is given if a soapy water enema doesn’t resolve meconium retention
acetylcysteine retention enema
how is a acetylcysteine retention enema performed?
foley catheter used to keep fluid in rectum and allow breakdown of mucus and meconium
what analgesia is often used for meconium retention?
buscopan
is surgery used to treat meconium retention?
rare
what tests must be performed on every foal with meconium retention?
IgG SNAP ELISA for FPT
what can cause diarrhoea in foals?
infection
what should be checked for if a foal has diarrhoea?
rotavirus
IgG - FPT
how should dehydration in foals be treated if symptomatic?
dehydration resolved
electrolyte balance restored
acid base imbalance managed
what is foal heat diarrhoea?
seen 1-2 weeks post birth
caused by bacteria populating colon
not linked to dam’s heat cycle
what must be prevented in hospitalised foals as it is so common?
gastric ulcers
do gastric ulcers form for the same reasons in foals as for in adults?
no - different pathophysiology
what can be given prophylactically in foals to prevent gastric ulcers?
sucralfate
what does sucralfate do?
encourgaes blood supply to stomach
how can an infected umbilicus be prevented?
dip regularly in 1% chlorhexidine for the first 2 days
when is an infected umbilicus more likely?
if FPT
what are the signs of infected umbilicus?
swelling and pus at site
how is infected umbilicus diagnosed?
ultrasound
cutlure
how is infected umbilicus treated?
antibiotics
surgery
what can cause a ruptured bladder in foals?
birth
sepsis / other insult leading to damage
when is a ruptured bladder most often first noticed?
2-3 days ol
what are the signs of a ruptured bladder?
colic
distended abdomen
may still be able to urinate
how is ruptured bladder diagnosed?
ultrasound for excess fluid
peritoneal sample for uroabdomen
what electrolyte imbalance can be caused by a ruptured bladder?
hyperkalaemia
what arrhythmia is common with hyperkalaemia?
bradycardia
how should bladder rupture be treated?
emergancy
0.9% NaCl at 250ml/kr/50kg
drain abdomen
surgery to repair
what rate should fluids be given for treatment of ruptured bladder?
0.9% NaCl at 250ml/kr/50kg
what is neonatal isoerythrolysis?
foal RBC antigen not recognised by the mare so antibodies are produced in response and mare becomes sensitised
when foal drinks mares colostrum the antibodies are passed over and foals RBC are attacked
when does neonatal isoerythrolyisis occur?
with the second foal as mare has produced antibodies from first?
what are the signs of neonatal isoerythrolyisis?
anaemia (as RBC are destroyed)
icterus
weakness
when is a blood transfusion needed for foals with neonatal isoerythrolyisis?
PCV <12%
how is neonatal isoerythrolyisis treated?
withdraw colostrum
prevent future foals from drinking colostrum from dam
blood typing of dam and sire
how is neonatal isoerythrolyisis prevented once it is known the mare carries the antibodies?
prevent future foals from drinking colostrum from dam
blood typing of dam and sire
what puts foals at risk of pneumonia?
aspiration during bottle feeding (owners)
FPT
what are the signs of aspiration pneumonia?
increased RR and effort
pyrexia
how is pneumonia diagnosed?
radiography
trans-tracheal wash for cytology and culture
how is pneumonia treated?
antibiotics
O2
foal in sternal
what bacteria often causes pneumonia in foals?
Rhodococcus equi
when should you suspect a foal can be infected with Rhodococcus equi?
from birth
what can cause infection with Rhodococcus equi?
environment (dust)
nose to nose contact with infected foals
faeces of dam
when do clinical signs of Rhodococcus equi appear?
until around 6 weeks old
why is Rhodococcus equi only a disease of foals?
change in T helper immunity in adulthood leading to immunity in adulthood
what are the clinical signs of Rhodococcus equi?
variable and difficult to interpret
one, all or some of: pneumonia, septic or immune mediated joint effusion
diarrhoea
how is Rhodococcus equi diagnosed?
thoracic radiograph for abscesses
tracheal wash for cytology, culture and sensitivity
joint fluid sample if effusion
blood smaple
what is seen on the blood sample of a foal with Rhodococcus equi?
very high WBC and fibrinogen
how is Rhodococcus equi treated?
clarithromycin and rifampicin
joint lavage if appropriate
what must you be careful of when treating foals for Rhodococcus equi with Clarithromycin?
fatal diarrhoea can be caused in adult if ingested
should be administered outside stable and ensure foals mouth is clean
how long should foal be treated for Rhodococcus equi?
until radiographically normal (~6 weeks)
how is Rhodococcus equi prevented?
clean environment
Rhodococcus hyperimmune plasma transfusion
routine ultrasound to check for any signs
antibiotics should not be given until clear infection and culture and sensitivity performed
