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CVNT2 > Foal Nursing > Flashcards

Foal Nursing Flashcards

1
Q

how often does the recumbent foal need to be nursed?

A

often requires almost continuous nursing

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2
Q

how often should a clinical exam be performed on a recumbent foal?

A

at least every 4-6 hours

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3
Q

what should be included in the general clinical examination of a recumbent foal?

A

thoracic auscultation, HR, RR

mm check

palpation of joints and umbilicus (for infection signs, swelling)

temperature

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4
Q

what should the temperature be in the foal for the first 7 days?

A

between 37.5 - 39.0°C

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5
Q

what position should recumbent foals be placed in (ideally)?

A

sternal - support, beanbag

reposition often

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6
Q

what types of IV catheter are used for recumbent foals?

A

over the wire or stylet - sterile placement important (may need drape and sedation)

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7
Q

why should you wrap an IV catheter on a recumbent foal?

A

to keep clean

to avoid mother chewing it

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8
Q

how often should an IV catheter be checked? what are you looking for?

A

every 4-6 hours

looking for signs of thrombophlebitis

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9
Q

why should there be separate ports for medication and TPN?

A

bacteria will feed off material entering the TPN tube

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10
Q

why do recumbent foals usually require vasopressor support?

A

severely ill and usually septic - get very low blood pressure, leads to multiple organ failure and death

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11
Q

what type of vasopressor support do foals recieve?

A

usually start with dobutamine infusion

monitor BP with tail cuff

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12
Q

how is BP monitored in recumbent foasl?

A

tail cuff

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13
Q

why is it important to place a urinary catheter in recumbent foals?

A

avoiding cystitis

measuring urine output to monitor hydration status/anuric renal failure/ruptured bladder

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14
Q

what should the USG of a foal be?

A

<1.010

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15
Q

how can you care for mother and foal in regards to feeding?

A

milk mare regularly! and check for mastitis

if able to suck, direct drinking from mare is best

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16
Q

how should the foal be fed if no mare/mare is not producing milk/foal cannot suck?

A

feed milk/milk replacement from bowl - risk aspiration pneumonia if bottle fed

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17
Q

how can you feed a foal which cannot drink from a bowl?

A

indwelling naso-gastric tube - feed by gravity, do not pump

x-ray to check position

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18
Q

what should the foal be given short-term if unable to cope with milk?

A

5% glucose-spiked isotonic fluids

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19
Q

what should the foal be given long-term if unable to cope with milk?

A

partial parenteral nutrition - amino acids, glucose and fat (partial because doesn’t meet all nutritional needs)

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20
Q

what is important to monitor when feeding the sick foal?

A

glucose - may need insulin s/c or CRI

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21
Q

which blood parameters check how sick the foal is?

A

PCV and TP

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22
Q

which blood parameter checks for sepsis/infection?

A

white blood cells

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23
Q

which blood parameters check kidney function?

A

creatinine

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24
Q

which blood parameters check perfusion efficiency?

A

lactate

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25
Q

how can you check for bacteriaemia?

A

blood culture

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26
Q

how can you check for common foal diseases?

A

IgG SNAP elisa tests

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27
Q

why is it important that the mare has the right antibodies in the colostrum?

A

foals do not receive placental antibodies - only through colostrum

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28
Q

how long do mare antibodies protect the foal after birth?

A

6 weeks

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29
Q

how can we ensure the mare has the correct antibodies for the foal?

A

vaccinations - influenza, EHV, rotavirus, tetanus

last tetanus 4 weeks before foaling

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30
Q

when should the mare be moved to the foaling environment?

A

6 weeks before predicted foaling date

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31
Q

why is it an issue if the mare has leaked milk?

A

she will have likely leaked the colostrum with the important antibodies

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32
Q

what can be done if the mare has leaked milk?

A

need a plan to give colostrum from another mare, or a hyperimmune plasma transfusion

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33
Q

what dimensions/ features should the foaling box have?

A

5m x 5m

good ventilation
disinfected
warm and sheltered
thick bedding (straw easier for foals to stand up on than shavings)

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34
Q

how long is gestation?

A

320-360 days

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35
Q

what are the signs the mare is ready for foaling?

A

best indication is when they have foaled before
some will have no signs
wax from nipples
milk electrolyte changes (48 hour window)

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36
Q

how long is stage 1 of foaling?

A

variable length

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37
Q

what happens to the foal during stage 1 of foaling?

A

foal moves into the canal

gets into correct position/posture/presentation = nose and forelegs pointing caudally

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38
Q

what happens to the mare during foaling stage 1?

A

restless, agitated and sweaty
will lie down and get up
colic signs

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39
Q

what happens in stage 2 of foaling?

A

birth

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40
Q

how long should stage 2 of foaling be?

A

<30 mins

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41
Q

what happens in stage 3 of foaling?

A

expulsion of the placenta

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42
Q

what is important to check after stage 3 of foaling?

A

check the placenta is whole

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43
Q

how long should stage 3 of foaling be?

A

1-2 hours

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44
Q

what should happen if the placenta has not been expelled at 3 hours?

A

walk mare

give oxytocin to contract uterus

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45
Q

what should happen if the placenta has not been expelled after 6 hours?

A

aggressive treatment - oxytocin, lavage, walking, antibiotics, anti-endotoxins, weights

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46
Q

what are the risks of retained placenta?

A

laminitis, infection

can be fatal

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47
Q

what can occur if there is dystocia during labour?

A

hypoxia (short-term brain damage)
broken ribs
injury to mare
death

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48
Q

how long can dystocia continue before foal dies?

A

1 hour

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49
Q

how can we extend the time a stuck foal can live?

A

pass an ET tube into foal to enable breathing - often very difficult to achieve

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50
Q

how can a stuck foal be delivered?

A

epidural and ropes, manipulation, lube
GA manipulation
C section

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51
Q

what is a fetotomy?

A

dissection of a deceased foetus in utero in order to aid delivery and increase the mare’s chance of survival

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52
Q

what other foaling complication is common (besides dystocia and retained placenta)?

A

red bag delivery - placenta being born with foal, must be cut open immediately as foal will not be able to breathe

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53
Q

when should the newborn foal take its first breath?

A

within 30 secs of being born

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54
Q

when should the foal be standing?

A

within 30 mins - 1 hour

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55
Q

when should the foal have started drinking the colostrum by?

A

1-3 hours after birth

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56
Q

what should the foal do after birth (in addition to breathing/standing/feeding)?

A

pass meconium

urinate

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57
Q

why should foals undergo a cursory physical exam before deciding whether or not to resuscitate?

A

some serious problems (e.g. hydrocephalus) may mean a decision not to resuscitate

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58
Q

what is RECOVER?

A

reassessment campaign on veterinary resuscitation

consensus-based guidelines for cardio-pulmonary arrest

can extrapolate to neonatal foals

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59
Q

how does the onset of CPA in foals differ to humans?

A

respiratory arrest almost always precedes cardiac arrest

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60
Q

what are the most common causes of respiratory arrest in neonatal foals?

A

premature placental separation

early severance or twisting of the umbilical cord

dystocia

airway obstruction by foetal membranes

failure to spontaneously breathe

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61
Q

list some of the causes for CPA in neonates not associated with birth.

A 
primary lung disease 
sepsis 
hyperkalaemia 
hypovolaemia  
hypoglycaemia 
hypothermia 
metabolic acidosis
62
Q

what is the relevance of respiratory arrest underlying cardiac arrest?

A

ventilation must be provided as part of foal CPR

63
Q

what is the success rate of CPR?

A

good (50%) if resuscitation is begun before a non-perfusing rhythm develops

less than 10% if there is a delay until after systole

64
Q

when should we consider stimulating the foal and administering intranasal oxygen?

A

if ANY of:

HR <60bpm/irregular

slow/irregular respiration

some muscle tone in lateral

grimace on nasal mucosal stimulation

65
Q

when should we perform neonatal resuscitation?

A

IF any of:
HR/respiration undetectable
muscle tone limp/absent
unresponsive to nasal mucosal stimulation

66
Q

what are the options for ventilating during resuscitation?

A

nasotracheal tube - 2 attempts to place

if not, endotracheal

67
Q

how is an ET tube placed for resuscitation?

A

pull tongue forward and lateral with one hand to stabilise the larynx

advance the tube in the midline over the tongue

twist once reach the larynx

check positioning, then cuff and secure to head with bandage material

68
Q

which is the best method of providing ventilation during resuscitation?

A

ambu-bag to tube

69
Q

what is ambu-bag to tube is not possible for ventilation?

A

mouth to tube
ambu-bag to mask
mouth to nose (close opposite nostril)
room air

70
Q

how can aerophagia be reduced during manual ventilation?

A

if no cuffed tube in place, make sure head is extended (distended stomach with air can reduce thoracic capacity)

71
Q

how many breaths for manual ventilation?

A

10 breaths/min - short and infrequent

72
Q

when should you reassess the patient during CPR?

A

30 seconds after starting ventilation

73
Q

when should you start chest compressions during CPR?

A

if heartbeat absent, less than 40bpm or less than 50bpm and not increasing

74
Q

can chest compressions be performed if the foal has rib fractures?

A

chest compression may be fatal but you may have no choice - likely to die anyway if you do not perform them

75
Q

how should patients with fractures be positioned for CPR?

A

place fractured rib side down

if bilaterally fractured, place the side with more of the cranial ribs fractured down

76
Q

how should chest compressions be performed?

A

kneel parallel to the spine

hands on top of each other

caudal to the triceps at the highest point of the thorax

shoulders above the hands so you can use your bodyweight

77
Q

what is the optimal compression depth?

A

as hard as you can?

78
Q

what is the ideal compression to ventilation ratio?

A

15:1

79
Q

what should the compression rate be?

A

100-120/min (as fast as possible!)

80
Q

what should happen if the foal remains bradycardic after significant chest compressions and ventilation?

A

epinephrine administration IV or intra-tracheal

every 3 mins until HR>60

81
Q

what are the nursing considerations after resuscitation?

A

keep warm - bandages, blankets, keep off the floor

5% glucose IV infusion

82
Q

what is important to consider when warming a foal after resuscitation?

A

warm slowly

do not warm before giving glucose if hypoglycaemic (protective response)

83
Q

how would you diagnose dehydration in a foal?

A

diagnose on history, clinical signs, lactate, USG, high index of suspicion
often hypoglycaemic

no nursing for >4 hours = presume dehydrated

84
Q

how would you treat dehydration in a foal?

A

1L bolus hartmanns then reassess
up to 3 additional boluses

5% glucose-spiked hartmanns on a steady drip (rather than bolus)

85
Q

how can we treat hypoglycaemia in a neonatal foal?

A

often goes hand-in-hand with dehydration - 5% glucose spiked ringers and monitor with a glucometer

86
Q

what is the main sign of metabolic acidaemia in foals?

A

diarrhoea

87
Q

what is the main sign of respiratory acidaemia in foals?

A

respiratory distress

88
Q

what is failure of passive transfer (FPT)?

A

when foals fail to absorb sufficient quantities of immunoglobulin from maternal colostrum in the first 24 hours of life

89
Q

why are foals more at risk of sepsis in the first 24 hours of life?

A

gut is ‘open’ to allow antibodies to pass into bloodstream, but bacteria can also pass

90
Q

what value is considered partial FPT?

A

400-800mg/dl

91
Q

what value is considered total FPT?

A

<400mg/dl

92
Q

what value is considered normal FPT?

A

> 800mg/dl

93
Q

which foals/when should foals be tested for FPT?

A

test every foal at 12-24 hours old

at least all at-risk foals

94
Q

how is FPT tested for?

A

blood test

SNAP elisa - easy and cheap, performed in stable

95
Q

how can FPT be treated?

A

with a hyperimmune plasma transfusion

96
Q

why does hyperimmune plasma need to be defrosted slowyl?

A

so as not to denature antibodies

97
Q

how much/how fast should a hyperimmune plasma transfusion be given?

A

start slow to reduce risk of transfusion reaction

1L over about 1 hour (adjust volume for size)

98
Q

what can happen if a hyperimmune plasma infusion is given too quickly?

A

pulmonary oedema, protein reaction

99
Q

what is the most common reason for hospitalisation and death of neonatal foals?

A

sepsis (30-50% die despite ICU)

100
Q

what is a major risk factor for sepsis?

A

FPT

can also be born septic (placentitis)

101
Q

what is sepsis?

A

systemic bacterial infection

+/- infected joints/umbilicus

102
Q

what are the clinical signs of sepsis?

A 
pyrexia 
depression 
recumbency 
injected mms 
may have joint effusion +/- lameness 
may be totally non-responsive
103
Q

how can sepsis be tested for?

A

blood culture (sterile sample)

white cell count (low if septic)

serum amyloid A (level of inflammation)

SNAP test (antibodies)

creatinine - risk anuric renal failure

USG (best indicator of hydration)

104
Q

what is a useful test for prognosis of sepsis?

A

lactate

105
Q

how can sepsis be treated?

A

intensive care

broad spectrum antibiotics

hyperimmune plasma

joint lavage if infected

remove umbilicus?

106
Q

how can you manage seizures in a foal?

A

correct primary cause if possible

maintain airway and provide oxygen
anti-convulsant therapy
diazepam/midazolam admin IV, allow 5 mins for each 5mg increment

107
Q

what causes ‘dummy foal’?

A

hypoxia at birth or in utero - leads to brain and organ damage

108
Q

what are the signs of dummy foal?

A 
slow to swallow 
not sucking 
not following mare 
forgetting to breathe 
ataxic, seizures
109
Q

how can dummy foal be treated?

A

nursing care

maintain cerebral perfusion

correct electrolyte imbalances

PPN/slow enteral feeding

squeeze?

110
Q

what is considered premature?

A

birth at <320 days, will require vet attention

280 days unlikely to survive

111
Q

what is dysmaturity?

A

look premature despite normal/longer gestation

112
Q

what is postmaturity?

A

long gestation and normal size, but emaciated

113
Q

what are the classic signs of a premature/dysmature foal?

A 
smaller than expected 
silky short hair 
floppy ears 
domed head 
weak 
abnormal RR (low or high)
114
Q

what can prematurity/dysmaturity lead to?

A

immature GI/respiratory organs and musculoskeletal system

incomplete ossification of carpal and tarsal bones (main reason for euthanasia)

115
Q

what is the prognosis for prematurity/dysmaturity?

A

fair prognosis overall but will require ICU

116
Q

what flexural deformities can occur in foals?

A

tendon laxity

tendon contraction

117
Q

why does tendon laxity develop?

A

may be premature/dysmature/postmature

can occur as a complication from a bandage/cast/splint

118
Q

how can tendon laxity be managed?

A

usually resolves after a few days - box rest and limit bedding

walk on firm ground 3x a day

bandage heels for protection

119
Q

what causes tendon contracture to develop?

A

unknown cause - poss due to positioning in uterus but can also be acquired when horse is older

120
Q

what is the prognosis for tendon contracture?

A

fair to good

121
Q

how can tendon contracture be managed?

A

physiotherapy
walk on hard ground
oxytetracycline (1x a day for 3 days)

122
Q

how can a tendon contracture be physically managed?

A 
toe extensions 
splint 
half or full limb cast 
check ligament desmotomy (dissection) 
tenotomy (division of DDFT)
123
Q

what types of angular limb deformities are possible?

A

valgus (lateral)

varus (medial)

124
Q

which joints can be affected by angular limb deformities (valgus and varus)?

A

fetlock
carpus
tarsus

125
Q

how can angular limb deformity be managed?

A

rest
farriery
surgery (must operate before growth plates are shut)

126
Q

what are the signs of meconium retention?

A

colic signs

restlessness

127
Q

what does meconium retention often occur alongside?

A

failure of passive transfer

128
Q

how can meconium retention be treated?

A

soapy water enema/phosphate enema

acetylcysteine retention enema (breaks down mucus)

analgesia (buscopan)

surgery (rare)

IgG snap test to check antibody state!

129
Q

how can gastric ulcers be prevented?

A

give sucralfate prophylactically - encourages blood supply to stomach wall

130
Q

how can an infected umbilicus be identified/treated?

A

swelling and pus - culture
ultrasound

antibiotics to treat
surgery if severe/unresponsive to antibiotics

131
Q

why might a bladder rupture occur?

A

compression during birth

damage due to sepsis

132
Q

how are the signs of a rupture bladder?

A

colic signs
distended abdomen
will still urinate but smaller amounts - much will be urinated into abdomen

133
Q

how is a ruptured bladder diagnosed?

A

ultrasound

peritoneal sample - fluid will smell like urine

134
Q

why is a rupture bladder life-threatening?

A

increased K causes bradycardia - can be severe

135
Q

how should a ruptured bladder be treated?

A

0.9% saline at 250ml/hr/50kg (to reduce potassium)
drain abdomen
surgery to repair bladder

136
Q

how does neonatal isoerythrolysis (NIE) occur?

A

foal erythrocyte antigen not recognised by mare - mare is then sensitised to the erythrocyte antigen

foal drinks colostrum and antibodies in the colostrum attach the foal’s red cells

137
Q

what are the signs of NIE?

A

anaemia
icterus
weak

138
Q

when does a foal with NIE require a blood transfusion?

A

PCV <12%

139
Q

how can NIE be managed/prevented?

A

withdraw mare’s colostrum and prevent future foals from drinking colostrum from same mare - use donor colostrum

can blood type dam and sire but is complicated

140
Q

what is a common cause of pneumonia in foals?

A

aspiration pneumonia due to owners bottle feeding

more likely to present if FPT present

141
Q

what are the signs of pneumonia?

A

increased RR/effort
pyrexia
often fatal if severe

142
Q

how can pneumonia be diagnosed?

A

radiography

trans-tracheal wash for cytology and culture

143
Q

how is pneumonia treated?

A

antobiotics
oxygen
keep in sternal recumbency to aid breathing

144
Q

how can a foal become infected with Rhodococcus equi?

A

suspect infected at birth
lives in environment (dust)
nose to nose contact with infected foals
contact with dam faeces

145
Q

when do clinical signs of rhodococcus equi arise?

A

not until at least 6 weeks old

adults do not suffer clinical signs

146
Q

why is rhodococcus equi a foal disease?

A

causes a change in T helper immunity

147
Q

what are the clinical signs of rhodococcus equi?

A

can vary and be difficult to interpret
pneumonia
septic/immune-mediated joint effusion
diarrhoea

148
Q

what diagnostic tests are available for rhodococcus equi infection?

A

thoracic radiograph (abscesses)

tracheal wash for cytology and C&S

joint fluid sample if effusion

very high WCC and fibrinogen

149
Q

how can rhodococcus equi be treated?

A

clarithromycin plus rifampicin

treat until radiographically normal and blood normal (~6 weeks)

150
Q

what care should be taken when treating a foal with rhodococcus equi?

A

beware of fata diarrhoea in adult (usually mare) - give foal antibiotic outside stable to lessen mare contact

151
Q

how can rhodococcus equi be prevented?

A

environmental management
routine US scans
rhodococcus hyperimmune plasma transfusion

no antibiotics at birth - resistance

CVNT2 (47 decks)

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