Foal nursing Flashcards
1
Q
nursing the recumbent patient
A
- clinical exam every 4-6hrs:
- thoracic auscultation, MM, palpation (joints, umbilicus), temp
- sternal support (beanbag)
- intra-nasal oxygen
- keep clean, warm, dry (potential urinary catheter)
2
Q
temp range for foals
A
37.5-39 degrees C for first 7 days
3
Q
how to know hydration status
A
urine specific gravity (<1.010)
4
Q
feeding the sick foal
A
- milk mare regularly (check for mastitis)
- replacement milk from bowl if necessary
- risk of aspiration pneumonia if bottle fed
- indwelling NO tube- x-ray to check position, feed by gravity
- glucose spiked isotonic fluid short term if can’t cope with milk
- PPN long term (parental nutrition)
5
Q
maternal antibodies
A
- make sure mare has right antibodies
- vaccinations for influenza, EHV, tetanus
- last tetanus 4-6 weeks before foaling
- maternal antibodies protect foal for 6 weeks after birth
6
Q
leaking colostrum
A
- not normal
- foal only gets antibodies by drinking colostrum
- if leaking, colostrum lost
7
Q
foaling box
A
- 5m x 5m
- good ventilation, warm, sheltered
- disinfected
8
Q
foaling complications
A
- have about 1hr to get foal out before death
- can be slightly longer if ET tube can be placed
9
Q
newborn foal
A
- 1st breath within 30 secs
- attempt to stand within 1hr
- drink colostrum within 1-3hrs
- pass meconium and urinate
10
Q
neonatal resuscitation decision
A
- physical exam before deciding to
resuscitation - serious physical problems (hydrocephalus) may mean a decision not to resuscitate
11
Q
respiratory arrest in neonates
A
- resp arrest precede cardiac arrest
- resp arrest caused by:
- premature placental seperation
- twisting of umbilical cord
- dystocia
- airway obstruction by fetal membranes
12
Q
causes of CPA not associated with birth
A
- primary lung disease
- sepsis
- hypovolaemia
- metabolic acidosis
- hypoglycaemia, hyperkalaemia
- hypothermia
13
Q
success rates of CPA
A
- 50% if resuscitation begun before heart stops
- 10% if delayed start of resuscitation until asystole
14
Q
when to perform neonatal resuscitation
A
- HR <60bpm/irregular
- if slow/irregular respiration
- some muscle tone in lateral
- grimace on nasal mucosal stimulation
stimulate, give intranasal oxygen
15
Q
resuscitation steps- ventilation
A
- clear airway
- place naso/ET tube
- ventilate (many respond to this alone)
- mouth to tube
- ambu-bag to mask
- mouth to nose (close opposite nostril)
- short breaths, 10 per min - ensure neck extended to reduce aerophagia (air in stomach)
16
Q
nasotracheal tube placement
A
- extend head, pass ventral and medial
- 2 attempts to place
- if unsuccessful move onto ET tube
17
Q
ET tube placement
A
- pull tongue forwards and lateral with one hand to stabilise larynx
- advance tube in midline over tongue
- twist once reached the larynx
- check positioning then cuff and secure to head with bandage
18
Q
resuscitation steps- CPR
A
- reassess 30 secs after starting ventilation
- begin CPR if HR absent, less than 40bpm
1. put back of foal against wall
2. check for fractured ribs, place them side down - if bilaterally fractured, place side with more cranial ribs fractured down
- compress 100-120 bpm
19
Q
chest compression position
A
- knees parallel to spine
- hands on top of each other
- caudal to triceps at highest point of thorax
- shoulders above hands to use body weight
20
Q
dehydration in foals
A
- adult signs not consistent in foals
- diagnose on history, clinical signs, lactate, high index of suspicion and USG
- may present as flat
- often hypoglycaemic
- no nursing for >4hrs= presume dehydrated
21
Q
treatment of dehydration in foals
A
for 50kg foal:
1. 1L bolus hartmanns then reassess
2. up to 3 additional boluses
3. 5% glucose spiked hartmanns
4. use USG to monitor
22
Q
transfer of antibodies to foal
A
- gut ‘open’ for 24hrs letting in antibodies but also bacteria
- immunologically naive
23
Q
failure of passive transfer (FPT)
A
partial= 400-800 mg/dl
total= <400 mg/dl
normal- >800 mg/dl
- massive risk factor for sepsis (87.5%)
- measure with blood sample (snap)
- test every foal at 12-24hrs old
- 10-33% foals affected
24
Q
treatment for FPT
A
hyperimmune plasma transfusion
- defrost slowly (prevents antibody denature)
- 1l over 1hr
- too much/too fast= pulmonary oedema
- retest after each bag
25
sepsis in foals
- most common reason for hospitalisation and death of neonatal foals
- 30-50% die despite ICU
- FPT major risk factor
- systemic bacterial infection (+/- joints, +/- umbilicus)
26
clinical signs of sepsis
- pyrexia
- depression, recumbency
- injected mucus membranes
- +/- joint effusion, lameness
- collapse, non responsive
27
tests for sepsis
- blood culture
- WBC count
- SAA
- snap test
- creatinine (risk anuric renal failure)
- USG
- glucose
- lactate
28
treatment for sepsis
- broad spectrum antibiotics
- plasma
- joint lavage if have effusion
- remove umbilicus if infected
- intensive care
29
seizures in foals
- subtle signs, generalised convulsions
- many causes
30
treatment for seizures
- correct primary cause
- maintain airway, give oxygen
- anticonvulsant therapy:
- diazepam
31
dummy foal
- also called hypoxic ischaemic encephalopathy, perinatal asphyxia syndrome
- hypoxia at birth, brain and other organ damage
32
clinical signs of dummy foal
- slow to swallow
- not sucking
- not following mare
- ataxic
- forgetting to breathe
- seizure
33
treatment for dummy foal
- nursing
- maintain cerebral perfusion- careful IV support
- correct metabolic imbalances
- PPN/slow enteral feeding
- squeeze? (removes inhibitory neurotransmitters that usually occurs during birth)
- don't do if cause is known to be hypoxic
34
prematurity
<320 days
35
dysmaturity
look premature despite normal or often longer gestation
36
postmaturity
long gestation, normal size but emaciated
37
prematurity, dysmaturity physical signs
- smaller than expected
- silky, short hair
- floppy ears
- domed head
- weak
- abnormal RR
38
internal implications of prematurity, dysmaturity
immature organs:
- GI tract
- respiratory
- musculoskeletal
- incomplete ossification of carpal + tarsal bones
- flexural deformity (tendon laxity)
39
flexural deformity- tendon laxity causes
- flexure tendons/ligaments
- may be premature/dysmature/postmature
- complication from bandage/cast/splint
40
flexural deformity- tendon laxity treatment
- usually resolve after a few days
- box-rest- limit bedding
- walk on firm ground
- bandage heels for protection
41
flexure deformity- tendon contracture causes
- unknown (possible positioning in uterus)
- can acquire when older
- varying severity, number of limbs
42
flexural deformity- tendon contracture treatment
- physiotherapy
- walk on hard ground
- oxytetracycline (care- nephrotoxic)
- toe extensions
- splint
- half/limb cast
- check ligament desmotomy
- tenotomy
43
angular limb deformity
valgus (away from midline) or varus (towards midline)
- fetlock, carpus, tarsus
treatment:
- rest, farriery, surgery
44
meconium retention
- colic/restlessness signs
- often meconium retention and FPT together
- check rectum is patent
45
treatment of meconium retention
- soapy water enema/phosphate enema
- acetylcysteine retention enema
- breaks down mucus
- analgesia- buscopan
- surgery (rarely needed)
- IGG snap test (antibody status)
46
diarrhoea
- infectious cause?
- check rotavirus
- check IgG
- treat dehydration, electrolyte, acid base imbalance
47
gastric ulcers (prevention)
- sucralfate- encourages blood supply to stomach wall
- give prophylactically (preventative)
48
infected umbilicus
- dip regularly first 2 days (1% chlorhexidine)
- higher risk infection if FPT
- ultrasound, culture
- antibiotics, surgery (rare)
49
ruptured bladder
- occurs 2-3 days old
- colic, distended abdomen
- urination?- can still wee
- ultrasound, peritoneal sample
- high K- bradycardia
50
ruptured bladder treatment
- medical emergency
- saline (250ml/hr/50kg)
- drain abdomen + surgery
51
neonatal isoerythrolysis (NIE)
- foal erythrocyte antigen not recognised by mare
- mare sensitised to that antigen
- foal drinks colostrum and antibodies attack foals RBCs
- no antibodies transferred through umbilical cord
52
NIE clinical signs and treatment
- anaemia (killed RBCs)
- icterus (yellow)
- weak
- require transfusion at PCV <12%
- withdraw colostrum
- prevent future foals drinking colostrum or blood type parents
53
pneumonia causes
- aspiration (care when bottle fed)
- FPT
54
pneumonia clinical signs and diagnosis
- increased RR and effort
- pyrexia
- diagnose through radiography
55
treatment of pneumonia
- trans-tracheal wash (cytology and culture)
- antibiotics
- oxygen
- sternal recumbency
56
rhodococcus equi
infected at birth
- bacteria lives in environment (dust)
- nose to nose contact with infected foals
- contact with dam's faeces)
- no clinical signs until 6 weeks old
- foal disease, not seen in adults although they can shed it
57
clinical signs of rhodococcus equi
- can vary
- pneumonia
- sepsis, immune mediated joint effusion
- diarrhoea
58
diagnosing rhodococcus equi
- thoracic radiograph for abscesses
- tracheal wash, cytology, C + S
- joint fluid sample if effusion
- very high WBC count and fibrinogen
59
treatment of rhodococcus equi
- clarithromycin
- plus rifampicin
- can cause fatal diarrhoea in adult
- treat for 6 weeks
