Foal Nursing Flashcards
how often does the recumbent foal need to be nursed?
often requires almost continuous nursing
how often should a clinical exam be performed on a recumbent foal?
at least every 4-6 hours
what should be included in the general clinical examination of a recumbent foal?
thoracic auscultation, HR, RR
mm check
palpation of joints and umbilicus (for infection signs, swelling)
temperature
what should the temperature be in the foal for the first 7 days?
between 37.5 - 39.0°C
what position should recumbent foals be placed in (ideally)?
sternal - support, beanbag
reposition often
what types of IV catheter are used for recumbent foals?
over the wire or stylet - sterile placement important (may need drape and sedation)
why should you wrap an IV catheter on a recumbent foal?
to keep clean
to avoid mother chewing it
how often should an IV catheter be checked? what are you looking for?
every 4-6 hours
looking for signs of thrombophlebitis
why should there be separate ports for medication and TPN?
bacteria will feed off material entering the TPN tube
why do recumbent foals usually require vasopressor support?
severely ill and usually septic - get very low blood pressure, leads to multiple organ failure and death
what type of vasopressor support do foals recieve?
usually start with dobutamine infusion
monitor BP with tail cuff
how is BP monitored in recumbent foasl?
tail cuff
why is it important to place a urinary catheter in recumbent foals?
avoiding cystitis
measuring urine output to monitor hydration status/anuric renal failure/ruptured bladder
what should the USG of a foal be?
<1.010
how can you care for mother and foal in regards to feeding?
milk mare regularly! and check for mastitis
if able to suck, direct drinking from mare is best
how should the foal be fed if no mare/mare is not producing milk/foal cannot suck?
feed milk/milk replacement from bowl - risk aspiration pneumonia if bottle fed
how can you feed a foal which cannot drink from a bowl?
indwelling naso-gastric tube - feed by gravity, do not pump
x-ray to check position
what should the foal be given short-term if unable to cope with milk?
5% glucose-spiked isotonic fluids
what should the foal be given long-term if unable to cope with milk?
partial parenteral nutrition - amino acids, glucose and fat (partial because doesn’t meet all nutritional needs)
what is important to monitor when feeding the sick foal?
glucose - may need insulin s/c or CRI
which blood parameters check how sick the foal is?
PCV and TP
which blood parameter checks for sepsis/infection?
white blood cells
which blood parameters check kidney function?
creatinine
which blood parameters check perfusion efficiency?
lactate
how can you check for bacteriaemia?
blood culture
how can you check for common foal diseases?
IgG SNAP elisa tests
why is it important that the mare has the right antibodies in the colostrum?
foals do not receive placental antibodies - only through colostrum
how long do mare antibodies protect the foal after birth?
6 weeks
how can we ensure the mare has the correct antibodies for the foal?
vaccinations - influenza, EHV, rotavirus, tetanus
last tetanus 4 weeks before foaling
when should the mare be moved to the foaling environment?
6 weeks before predicted foaling date
why is it an issue if the mare has leaked milk?
she will have likely leaked the colostrum with the important antibodies
what can be done if the mare has leaked milk?
need a plan to give colostrum from another mare, or a hyperimmune plasma transfusion
what dimensions/ features should the foaling box have?
5m x 5m
good ventilation
disinfected
warm and sheltered
thick bedding (straw easier for foals to stand up on than shavings)
how long is gestation?
320-360 days
what are the signs the mare is ready for foaling?
best indication is when they have foaled before
some will have no signs
wax from nipples
milk electrolyte changes (48 hour window)
how long is stage 1 of foaling?
variable length
what happens to the foal during stage 1 of foaling?
foal moves into the canal
gets into correct position/posture/presentation = nose and forelegs pointing caudally
what happens to the mare during foaling stage 1?
restless, agitated and sweaty
will lie down and get up
colic signs
what happens in stage 2 of foaling?
birth
how long should stage 2 of foaling be?
<30 mins
what happens in stage 3 of foaling?
expulsion of the placenta
what is important to check after stage 3 of foaling?
check the placenta is whole
how long should stage 3 of foaling be?
1-2 hours
what should happen if the placenta has not been expelled at 3 hours?
walk mare
give oxytocin to contract uterus
what should happen if the placenta has not been expelled after 6 hours?
aggressive treatment - oxytocin, lavage, walking, antibiotics, anti-endotoxins, weights
what are the risks of retained placenta?
laminitis, infection
can be fatal
what can occur if there is dystocia during labour?
hypoxia (short-term brain damage)
broken ribs
injury to mare
death
how long can dystocia continue before foal dies?
1 hour
how can we extend the time a stuck foal can live?
pass an ET tube into foal to enable breathing - often very difficult to achieve
how can a stuck foal be delivered?
epidural and ropes, manipulation, lube
GA manipulation
C section
what is a fetotomy?
dissection of a deceased foetus in utero in order to aid delivery and increase the mare’s chance of survival
what other foaling complication is common (besides dystocia and retained placenta)?
red bag delivery - placenta being born with foal, must be cut open immediately as foal will not be able to breathe
when should the newborn foal take its first breath?
within 30 secs of being born
when should the foal be standing?
within 30 mins - 1 hour
when should the foal have started drinking the colostrum by?
1-3 hours after birth
what should the foal do after birth (in addition to breathing/standing/feeding)?
pass meconium
urinate
why should foals undergo a cursory physical exam before deciding whether or not to resuscitate?
some serious problems (e.g. hydrocephalus) may mean a decision not to resuscitate
what is RECOVER?
reassessment campaign on veterinary resuscitation
consensus-based guidelines for cardio-pulmonary arrest
can extrapolate to neonatal foals
how does the onset of CPA in foals differ to humans?
respiratory arrest almost always precedes cardiac arrest
what are the most common causes of respiratory arrest in neonatal foals?
premature placental separation
early severance or twisting of the umbilical cord
dystocia
airway obstruction by foetal membranes
failure to spontaneously breathe
list some of the causes for CPA in neonates not associated with birth.
primary lung disease sepsis hyperkalaemia hypovolaemia hypoglycaemia hypothermia metabolic acidosis
what is the relevance of respiratory arrest underlying cardiac arrest?
ventilation must be provided as part of foal CPR
what is the success rate of CPR?
good (50%) if resuscitation is begun before a non-perfusing rhythm develops
less than 10% if there is a delay until after systole
when should we consider stimulating the foal and administering intranasal oxygen?
if ANY of:
HR <60bpm/irregular
slow/irregular respiration
some muscle tone in lateral
grimace on nasal mucosal stimulation
when should we perform neonatal resuscitation?
IF any of:
HR/respiration undetectable
muscle tone limp/absent
unresponsive to nasal mucosal stimulation
what are the options for ventilating during resuscitation?
nasotracheal tube - 2 attempts to place
if not, endotracheal
how is an ET tube placed for resuscitation?
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
which is the best method of providing ventilation during resuscitation?
ambu-bag to tube
what is ambu-bag to tube is not possible for ventilation?
mouth to tube
ambu-bag to mask
mouth to nose (close opposite nostril)
room air
how can aerophagia be reduced during manual ventilation?
if no cuffed tube in place, make sure head is extended (distended stomach with air can reduce thoracic capacity)
how many breaths for manual ventilation?
10 breaths/min - short and infrequent
when should you reassess the patient during CPR?
30 seconds after starting ventilation
when should you start chest compressions during CPR?
if heartbeat absent, less than 40bpm or less than 50bpm and not increasing
can chest compressions be performed if the foal has rib fractures?
chest compression may be fatal but you may have no choice - likely to die anyway if you do not perform them
how should patients with fractures be positioned for CPR?
place fractured rib side down
if bilaterally fractured, place the side with more of the cranial ribs fractured down
how should chest compressions be performed?
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
what is the optimal compression depth?
as hard as you can?
what is the ideal compression to ventilation ratio?
15:1
what should the compression rate be?
100-120/min (as fast as possible!)
what should happen if the foal remains bradycardic after significant chest compressions and ventilation?
epinephrine administration IV or intra-tracheal
every 3 mins until HR>60
what are the nursing considerations after resuscitation?
keep warm - bandages, blankets, keep off the floor
5% glucose IV infusion
what is important to consider when warming a foal after resuscitation?
warm slowly
do not warm before giving glucose if hypoglycaemic (protective response)
how would you diagnose dehydration in a foal?
diagnose on history, clinical signs, lactate, USG, high index of suspicion
often hypoglycaemic
no nursing for >4 hours = presume dehydrated
how would you treat dehydration in a foal?
1L bolus hartmanns then reassess
up to 3 additional boluses
5% glucose-spiked hartmanns on a steady drip (rather than bolus)
how can we treat hypoglycaemia in a neonatal foal?
often goes hand-in-hand with dehydration - 5% glucose spiked ringers and monitor with a glucometer
what is the main sign of metabolic acidaemia in foals?
diarrhoea
what is the main sign of respiratory acidaemia in foals?
respiratory distress
what is failure of passive transfer (FPT)?
when foals fail to absorb sufficient quantities of immunoglobulin from maternal colostrum in the first 24 hours of life
why are foals more at risk of sepsis in the first 24 hours of life?
gut is ‘open’ to allow antibodies to pass into bloodstream, but bacteria can also pass
what value is considered partial FPT?
400-800mg/dl
what value is considered total FPT?
<400mg/dl
what value is considered normal FPT?
> 800mg/dl
which foals/when should foals be tested for FPT?
test every foal at 12-24 hours old
at least all at-risk foals
how is FPT tested for?
blood test
SNAP elisa - easy and cheap, performed in stable
how can FPT be treated?
with a hyperimmune plasma transfusion
why does hyperimmune plasma need to be defrosted slowyl?
so as not to denature antibodies
how much/how fast should a hyperimmune plasma transfusion be given?
start slow to reduce risk of transfusion reaction
1L over about 1 hour (adjust volume for size)
what can happen if a hyperimmune plasma infusion is given too quickly?
pulmonary oedema, protein reaction
what is the most common reason for hospitalisation and death of neonatal foals?
sepsis (30-50% die despite ICU)
what is a major risk factor for sepsis?
FPT
can also be born septic (placentitis)
what is sepsis?
systemic bacterial infection
+/- infected joints/umbilicus
what are the clinical signs of sepsis?
pyrexia depression recumbency injected mms may have joint effusion +/- lameness may be totally non-responsive
how can sepsis be tested for?
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)
what is a useful test for prognosis of sepsis?
lactate
how can sepsis be treated?
intensive care
broad spectrum antibiotics
hyperimmune plasma
joint lavage if infected
remove umbilicus?
how can you manage seizures in a foal?
correct primary cause if possible
maintain airway and provide oxygen
anti-convulsant therapy
diazepam/midazolam admin IV, allow 5 mins for each 5mg increment
what causes ‘dummy foal’?
hypoxia at birth or in utero - leads to brain and organ damage
what are the signs of dummy foal?
slow to swallow not sucking not following mare forgetting to breathe ataxic, seizures
how can dummy foal be treated?
nursing care
maintain cerebral perfusion
correct electrolyte imbalances
PPN/slow enteral feeding
squeeze?
what is considered premature?
birth at <320 days, will require vet attention
280 days unlikely to survive
what is dysmaturity?
look premature despite normal/longer gestation
what is postmaturity?
long gestation and normal size, but emaciated
what are the classic signs of a premature/dysmature foal?
smaller than expected silky short hair floppy ears domed head weak abnormal RR (low or high)
what can prematurity/dysmaturity lead to?
immature GI/respiratory organs and musculoskeletal system
incomplete ossification of carpal and tarsal bones (main reason for euthanasia)
what is the prognosis for prematurity/dysmaturity?
fair prognosis overall but will require ICU
what flexural deformities can occur in foals?
tendon laxity
tendon contraction
why does tendon laxity develop?
may be premature/dysmature/postmature
can occur as a complication from a bandage/cast/splint
how can tendon laxity be managed?
usually resolves after a few days - box rest and limit bedding
walk on firm ground 3x a day
bandage heels for protection
what causes tendon contracture to develop?
unknown cause - poss due to positioning in uterus but can also be acquired when horse is older
what is the prognosis for tendon contracture?
fair to good
how can tendon contracture be managed?
physiotherapy
walk on hard ground
oxytetracycline (1x a day for 3 days)
how can a tendon contracture be physically managed?
toe extensions splint half or full limb cast check ligament desmotomy (dissection) tenotomy (division of DDFT)
what types of angular limb deformities are possible?
valgus (lateral)
varus (medial)
which joints can be affected by angular limb deformities (valgus and varus)?
fetlock
carpus
tarsus
how can angular limb deformity be managed?
rest
farriery
surgery (must operate before growth plates are shut)
what are the signs of meconium retention?
colic signs
restlessness
what does meconium retention often occur alongside?
failure of passive transfer
how can meconium retention be treated?
soapy water enema/phosphate enema
acetylcysteine retention enema (breaks down mucus)
analgesia (buscopan)
surgery (rare)
IgG snap test to check antibody state!
how can gastric ulcers be prevented?
give sucralfate prophylactically - encourages blood supply to stomach wall
how can an infected umbilicus be identified/treated?
swelling and pus - culture
ultrasound
antibiotics to treat
surgery if severe/unresponsive to antibiotics
why might a bladder rupture occur?
compression during birth
damage due to sepsis
how are the signs of a rupture bladder?
colic signs
distended abdomen
will still urinate but smaller amounts - much will be urinated into abdomen
how is a ruptured bladder diagnosed?
ultrasound
peritoneal sample - fluid will smell like urine
why is a rupture bladder life-threatening?
increased K causes bradycardia - can be severe
how should a ruptured bladder be treated?
0.9% saline at 250ml/hr/50kg (to reduce potassium)
drain abdomen
surgery to repair bladder
how does neonatal isoerythrolysis (NIE) occur?
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
what are the signs of NIE?
anaemia
icterus
weak
when does a foal with NIE require a blood transfusion?
PCV <12%
how can NIE be managed/prevented?
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
what is a common cause of pneumonia in foals?
aspiration pneumonia due to owners bottle feeding
more likely to present if FPT present
what are the signs of pneumonia?
increased RR/effort
pyrexia
often fatal if severe
how can pneumonia be diagnosed?
radiography
trans-tracheal wash for cytology and culture
how is pneumonia treated?
antobiotics
oxygen
keep in sternal recumbency to aid breathing
how can a foal become infected with Rhodococcus equi?
suspect infected at birth
lives in environment (dust)
nose to nose contact with infected foals
contact with dam faeces
when do clinical signs of rhodococcus equi arise?
not until at least 6 weeks old
adults do not suffer clinical signs
why is rhodococcus equi a foal disease?
causes a change in T helper immunity
what are the clinical signs of rhodococcus equi?
can vary and be difficult to interpret
pneumonia
septic/immune-mediated joint effusion
diarrhoea
what diagnostic tests are available for rhodococcus equi infection?
thoracic radiograph (abscesses)
tracheal wash for cytology and C&S
joint fluid sample if effusion
very high WCC and fibrinogen
how can rhodococcus equi be treated?
clarithromycin plus rifampicin
treat until radiographically normal and blood normal (~6 weeks)
what care should be taken when treating a foal with rhodococcus equi?
beware of fata diarrhoea in adult (usually mare) - give foal antibiotic outside stable to lessen mare contact
how can rhodococcus equi be prevented?
environmental management
routine US scans
rhodococcus hyperimmune plasma transfusion
no antibiotics at birth - resistance
