Miscellaneous Flashcards
what is the purpose of RVCS professional code of conduct for vet nurses?
sets out nurses professional responsibilities and standards of practice
list the 5 principles of practice according to the RCVS code of conduct
professional competence honesty and integrity independence and impartiality client confidentiality and trust professional accountability
list some nursing interventions that can be done to help encourage inappetant patients to eat
avoid lots of food in kennel avoid unpalatable prescription diets anti-emetics appetite stimulants analgesia provide options for different foods
when are feeding tubes placed in patients?
anorexic for 48 hours
anticipate anorexia after a procedure
head, neck, mouth trauma
provide oral rehydration and medication if AKI
list equipment needed to place NO tube
surgical stapler feeding tube syringes LA sterile lube gloves sterile water tape
describe how NO tubes are placed
measure tube from 7th rib in cats and 9th in dogs to end of snout and mark on tube
give LA to one nares
apply sterile lube to end of tube and hold against muzzle
direct tube in medio-ventral-caudal direction and quickly insert up to the mark
patient should swallow when at pharynx so goes to oesophagus
check negative pressure with syringe
administer 10mls water slowly and check no respiratory distress
tape to nares and face and place collar
describe the process of feeding through NO or oesophageal feeding tube
draw food into syringe and leave in warm water bath
check for negative pressure
preflush 10ml water
feed over 10-15 minutes watching for nausea or regurgitation
follow with 10ml flush
what are considerations when feeding through NO tube?
keep face clean
tempt with food before tube feeding
how long can NO tubes be left in?
7 days
how are NO tubes removed?
gently pulling out of nose
when are NO tubes contraindicated?
cat flu congestion epistaxis head trauma oesophageal disease vomiting impaired gastric outflow comatose patients, no gag reflex need support longer than 7 days
list complications of NO tube
removal by patient displacement infection irritation preventing eating aspiration blockage
list advantages of NO tube
no GA
easy to place and remove
well tolerated
list disadvantages of NO tubes
short term
aspiration risk
not secured inside patient
time consuming feeds
list equipment for oesophageal feeding tube
sterile and non-sterile gloves curved artery forceps surgical prep equipment scalpel bandage material
what is nursing care for oesophageal tube?
check stoma site 2x daily
tempt food before feeding
no neck collar or lead
give medication through tube when possible
how is oesophageal tube stoma site checked?
remove dressing clean with 1:10 iodine assess if normal appearance check negative pressure flush with water redress
how long can oesophageal feeding tubes be left in place?
months
how are oesophageal feeding tubes removed?
cut suture holding in place
gently pull out
dressing over stoma site
list contraindications for placing oesophageal feeding tube
persistent vomiting
impaired gastric outflow
patients at risk of aspiration
oesophageal disease
list complications of oesophageal tubes
infection
displacement
suture failure
blockage
state advantages of oesophageal feeding tubes
larger volumes and medications can be given easier
can be managed at home
list disadvantages of oesophageal feeding tube
GA needed
infection at stoma site
time consuming feeds
list equipment needed for percutaneous endoscopic gastrotomy/PEG tube
PEG tube kit endoscope endoscope forceps suture material surgical prep equipment
describe how PEG tubes are placed?
clip in right lateral from costal arch, lateral edges of transverse processes to ventral 13th rib
use light from endoscope in stomach to see where to place needle through to stomach
introduce guide wire through needle
put loop of PEG tube through guide wire
feed through mushroom tip through PEG tube
guidewire pulled away so mushroom tip against stomach wall
peg tube secured
how do you feed through PEG tube?
wait 24 hours after placement preheat food in syringe aspirate stomach contents through tube, measure volume and replace feed over 20-25 minutes give medication flush with 10ml water
what are nursing considerations for patients with PEG tubes?
check stoma site 2x daily
tempt to eat before tube feeding
what are advantages of PEG tube?
large lumen for admin
can leave for months
owner can manage
list disadvantages of PEG tube
GA needed
needs to be in at least 7 days
cant use first 24 hours
describe how much patients are fed when feeding tube placed
24hrs- 1/3 RER
48hrs- 2/3RER
72hrs- full RER
what is the veterinary poisons information service?
24 hour helpline to give guidance regarding treatment of poisons
what is the benefit of the tox box service?
contains antibodies for uncommon poisons around the country so vets dont have to keep in stock when rarely used
what suggests intoxication?
acute onset signs usually towards an organ system
known or suspected accidental or rarely malicious exposure
list what is included in phone triage for poison victims
what
when
dose
current BW
call VIPS if asymptomatic, unknown poison or low risk
bring for immediate vet attention if symptomatic or known high risk ingestion
bring label and or sample
if dermal prevent self grooming and other contact with pet
how can you prepare for triaging poison patients?
inform vet hospital sheet IV catheter IVFT oxygen sample tubes decontaminants emetics
what history should be taken for poison patients?
patient signalment pre-existing conditions onset of problem progression of signs information of toxin signed consent
what is included in primary survey of poison patients?
respiratory rate, effort, lung sounds MM CRT pulses temperature mentation neuro exam bladder size pain haemorrhage trauma
what is initial care for poison patients after primary survey?
oxygen airway IVFT treat any cardiac abnormalities manage neuro issues secondary head to toe exam
how is poisoning diagnosed in patients?
history of exposure
acute onset signs
toxin panel potentially
what are the ways of managing intoxications?
remove toxin
reduce ongoing absorption
dilute toxin
what does inducing emesis in poison patients do?
empties 50% gastric contents
when is induced emesis indicated in poison patients?
2-3 hours after oral ingestion of non-corrosive intoxicant
when is induced emesis contraindicated in poison patients?
corrosive intoxicant
pre-existing aspiration risk
what emetics can be used for poison patients?
dogs- apomorphine
cats- xylazine
when is gastric lavage considered in poison patients?
intoxication within an hour
contraindicated to induce emesis
what are complications of gastric lavage in poison patients?
anaesthesia
aspiration
GO perforation or trauma
how is gastric lavage performed?
anaesthetised and intubated, placed in lateral measure nares to last rib lavage with 10-30ml water kink tube before removal suction oropharynx before recovery extubate after swallow reflex
how can you cutaneously decontaminate patients?
PPE
clip long haired patients in area
warm water and mild shampoo
what is haemodialysis used for for poison patients?
renal replacement
toxin removal
rarely used due to expense and availability
what is the purpose of enteric adsorbents in poison patients?
reduce absorption
facilitate excretion of toxin
name an example of an enteric adsorbent
activated charcoal
what is intralipid enteric adsorbent used for?
lipophilic toxins
when other treatment failed
what are complications of intralipid enteric adsorbents?
fat embolism
pancreatitis
state some supportive management for intoxication patients
antidote specific therapy organ care hydration and nutrition analgesia anti-emetics recumbency care eye lube
what are the effects of nephrotoxins?
AKI causing azotaemia, olig, an, polyuria
list clinical signs of nephrotoxication
sudden onset inappetence lethargy vomiting diarrhoea signs related to AKI
how is nephrotoxicity diagnosed?
azotaemia
submaximally concentrated urine
specific findings
list common nephrotoxins
NSAIDs
lillies in cats
grapes and raisins in dogs
ethylene glycol
how is nephrotoxicity managed?
decontamination by emesis, activated charcoal, dermal
specific antidotes
list nursing considerations for nephrotoxicity
maintain euhydration and euvolaemia
anti-emetics
analgesia
monitor for hypertension
what is prognosis for nephrotoxicity?
depends on toxin and extent of injury
list signs of neurotoxicity
hyper-excitability agitation tachycardia arrhythmia muscle tremor seizure coma low mentation
list common neurotoxins
theobromine, chocolate permethrin on cats metaldehyde, slug pellets tremorgenic mycotoxins cannabis
how are neurotoxins managed?
GI decontamination dermal decontamination muscle relaxants anti-epileptic therapy intralipids
list nursing considerations for neurotoxin patients
recumbency care
manage seizures
monitor respiration
if lack gag reflex IVFT, feeding tubes etc
list common hepatotoxins
xylitol mushrooms blue green algae alfatoxins penobarbitone paracetamol doxycycline
list general considerations for hepatotoxins
antioxidant support give lactulose if encephalopathic monitor electrolytes manage glucose levels plasma if coagulopathic
what is the effects of xylitol on pets?
stimulates endogenous insulin release
lethargic, weak, seizures
how is xylitol intoxication managed?
emesis
activated charcoal
manage hypoglycaemia
feed little and often of high fibre complex carbs
how do anticoagulant rodenticides affect the body when ingested?
prevent activation of clotting factors in the liver
how does anticoagulant rodenticide poisoning present?
symptoms after 2-5 days severe coagulopathy haemoabdomen haemothorax collapse hypovolaemic anaemia
what is advice for patients ingested who have anticoagulant rodenticides but are pre-symptomatic?
emesis
activated charcoal
measure clotting times at presentation and 48 hours after decontamination, base for diagnosis
treat with vitamin K if abnormal clotting times
what is advice for symptomatic cases of anticoagulant rodenticide poisoning?
urgent vet care
coagulopathic so care with blood sampling
vitamin K therapy
plasma if life threatening bleeding
what is the effect of paracetamol toxicity in cats and dogs?
cats- methaemoglobinemia
dogs- hepatic injury
what causes methaemoglobinemia?
RBC oxidative damage causes Fe3+, Hb can only bind to Fe2+
what are signs and diagnosis of methaemoglobinemia?
chocolate, dark cyanotic MM
diagnosed by drop of blood with brown discoloration
why are cats susceptible to paracetamol toxicity?
lack pathways for its metabolism
accumulate high oxidative metabolites
what is the effect of methaemoglobinemia?
reduced oxygen delivery shock CV distress neuro signs death oedema
how is paracetamol toxicity treated?
induce emesis
activated charcoal
anti-oxidants
what is prognosis for paracetamol toxicity?
guarded as highly toxic
what effects does adder venom have?
cytotoxic
cytolytic
CV effects
list clinical signs of adder bites
usually within 2 hours puncture wounds swelling to bite depression panting pyrexia cardiac arrhythmia
how are adder bites treated?
keep calm and quiet leave area alone to not distribute toxins further antivenom analgesia IVFT
what is prognosis for adder bites?
good with treatment
list examples of caustic substances
alkali
batteries
benzalkonium chloride
washing tablets
list clinical signs of caustic substance intoxication
oral, oesophageal, gastric ulceration pain hypersalivation anorexia regurgitation vomiting dermal alopecia, burns, ulcers
how is caustic intoxication treated?
dermal decontamination with warm water
analgesia
IVFT
tube feeding
what is prognosis for caustic intoxication?
depends on burn severity