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
what is respiratory arrest?
apnoea
what is cardiac arrest?
no CO
what is CPA?
no CO and apnoea
list risks for CPA
trauma systemic illness paediatrics geriatrics iatrogenic causes recent arrest
what are the aims of CPCR?
prefusion of heart lungs and brain
return of spontaneous circulation
how should you be prepared for CPCR?
regular training
crash box ready and accessible
what is considered basic life support?
CPCR
oxygen
what is considered advanced life support?
drugs
IVFT
cardioversion
list examples of the equipment in each drawer of the crash trolley
airway access
IV and IO access
ventilation
drugs
what drugs are included in the crash trolley?
adrenaline atropine 50% dextrose propofol naloxone
what equipment other than standard for life support can be used in CPCR?
capnography crash record chart ECG defib pulse oximetry BP monitor
what are the 2 types of compressions?
cardiac pump directly over heart in cats and small dogs
thoracic pump at widest part of thorax in large dogs
how are compressions carried out?
100-120/min
at least 50% depth of thorax
can do interthoracic direct compressions
when and how is IPPV done in CPCR?
as soon as suspect respiratory arrest
20brpm inflating thorax normal amount
what should happen after CPCR?
monitor for rearrest
treat underlying cause
consult owner
debrief
list blood products available for dogs
whole blood packed RBC fresh frozen or frozen plasma cyroprecipitate cyroprecipitate poor plasma
how do cats get access to blood?
local donation as no blood banks
who is whole blood broken down?
spun to produce packed RBC and fresh frozen plasma
how is cryoprecipitate produced?
partially thawing and spinning fresh frozen plasma
what are the components of fresh whole blood?
physiological concentrations of RBC, platelets, proteins, coagulation factors
what is meant by stored whole blood?
over 8 hours post collection up to 21 days at 2-6 degrees
no functional platelets, lots of clotting factors
how are packed RBC stored and what is its composition?
same as whole blood up to 42 days
PCV 70-80%
what is fresh frozen plasma?
stored less than a year at -18
contains coagulation factors and plasma proteins
what is frozen plasma?
FFP thawed and refrozen or over 1 year, up to 5 years
stable coagulation factors only
what is the composition of cyroprecipitate?
rich in fibrinogen. VII and vWF
state some diseases that can be treated with blood products
hypovolaemic anaemia
euvolemic anaemia
coagulopathy
thrombocytopenia
what are clinical signs that help determine whether to use blood to treat anaemia?
acute onset PCV weakness tachycardia tachypnoea high blood lactate
what is the best way to give blood products?
replace with whats most similar to whats missing
what determines blood type?
antigens on RBC surface
what causes transfusion reactions?
naturally occurring antibodies in recipients blood against donor antibodies
list signs of transfusion reaction
fever tachycardia dyspnoea muscle tremors vomiting collapse hemoglobinemia haemoglobinuria death
what as the most antigenic DEA?
DEA 1
no naturally occurring antibodies for DEA 1
why should dalmations only be give blood from other dalmations?
they are Dal negative but most other dogs are Dal positive
what blood can you give to dogs that are DEA 1 neg, DEA 1 pos?
neg- only DEA 1 neg
pos- DEA 1 neg or pos
why can you give the first transfusion in dogs untyped?
no naturally occurring antibodies so unlikely to get transfusion reaction
what blood should be given to dogs in emergency?
DEA 1 neg
what is the effect of DEA 1 neg being exposed to pos blood?
produce antibodies against DEA 1 antigens so future exposure will cause transfusion reaction
what are the blood types on cats?
A
B
AB
why do cats have to be typed and cross matched for blood transfusions?
have naturally occurring antibodies in plasma
what are the levels of antibodies in plasma of A and B blood in cats?
A- few anti-B antibodies
B- lots of anti-A antibodies
what blood type should be given in cats?
own blood type
if AB and cant because rare give A as low numbers of antibodies
how is cross matching of blood carried out?
determine serological compatibility, incompatible if agglutination
recipient serum and donor RBC for major cross match as most severe reactions from this
recipient RBC and donor serum for minor cross match
when is blood cross matching done?
recieved transfusion over 4 days ago history of transfusion reaction transfusion history unknown previously pregnant all females dalmatians
how are blood products obtained?
canine blood banks
local donors
what makes a pet a suitable donor for blood?
healthy 1-8 years old no travel history routine healthcare never received transfusion clear health screening good jugular veins large dogs over 25kg large cats over 4.5kg
what needs to be done to patients before donating blood?
clinical history full physical exam PVC TS haematology biochemistry blood typing infectious disease screening
describe the process of blood donation
place catheter for IVFT
clip and prepare jugular vein and apply EMLA
sedate if needed
anticoagulant at correct ratio to blood
what are the maximum amounts of blood that animals can donate?
15ml/kg for dogs
10-12ml/kg for cats
how are animals cared for after blood donation?
IVFT, volume of blood taken over 1-2 hours
give food and water
restrict activity for 24 hours
what are negatives to open blood donation?
more sites of bacterial contamination
need anticoagulant
what are negatives to closed blood donation?
only use for large dogs
need anticoagulant
what are benefits to closed blood donation?
needle uncapping is only exposure for contamination so has longer shelf life
what needs to be done before giving blood products?
inspect bag for contamination and abnormalities
thaw frozen products to body temperature
record and monitor patient
how is blood given to patients?
IV blood giving set
10-20ml/kg given
1ml/kg over 20 minutes monitoring for reactions, rest over 4-6 hours
what is monitored for recipients of blood?
mentation temperature PR RR MM CRT plasma and urine colour PVC and TS
when do blood recipients need to be monitored?
every 15-30 minutes during transfusion
1, 12 and 24 hours after transfusion
what are signs of antigen-antibody sensitivity reactions in blood transfusion?
fever tachycardia dyspnoea muscle tremors weakness haemolysis
list immunologic reactions to blood products
antigen-antibody sensitivity reaction
cytokines and leukocytes
allergic reaction
what are signs of allergic reaction to blood products?
pruritus erythema urticaria angioedema vomiting dyspnoea anaphylaxis
list examples of non-immunologic transfusion reactions
volume overload citrate intoxications coagulopathy ammonia intoxication bacterial contamination pre-transfusion haemolysis
what are signs of volume overload reaction to blood?
pulmonary oedema
jugular distention
chemosis
effusions
what is sign of citrate intoxication from blood?
hypocalcaemia
list signs of coagulopathy as a reaction to blood
petechia
ecchymoses
bruising
thrombocytopenia
list signs of blood infection
fever
distributive shock
vomiting
haemolysis
how do you manage transfusion reactions?
stop transfusion fluid resus for distributive shock antibiotics for contamination oxygen for dyspnoea monitor haemolysis, renal function slow infusion if volume overload
what causes periodontal disease?
inflammatory response to plaque
gingivitis left untreated progressing to periodontitis
describe the aetiology of periodontal disease
accumulation of plaque
what is plaque?
biofilm on all mouth surfaces
made up of mucopolysaccharides, glycoproteins, bacteria, oral debris
what is calculus?
mineralised plaque covered in plaque
what is gingivitis?
reversible plaque induced inflammation limited to gingiva
list clinical signs of gingivitis
inflammation
reddening
bleeding gums
halitosis
define halitosis
bad breath
what is mild, grade 1 gingivitis?
redness
swelling
no bleeding on probing
what is moderate, grade 2 gingivitis?
grade 1 with bleeding on probing
what is grade 3 severe gingivitis?
grade 2 with ulceration and spontaneous bleeding
how is gingivitis treated?
removal of calculus
improve oral hygiene
daily oral hygiene
what is periodontitis?
inflammation involving gingiva and surrounding periodontal ligament, alveolar bones and cementum
how does periodontitis develop?
untreated gingivitis
what are clinical signs of periodontitis?
dental deposits halitosis mucosal and glossal ulcers gingiva recession bleeding dysphagia pain teeth falling out
what are components of clinical dental exam?
halitosis dysphagia hypersalivation gingival health number of teeth GA exam of head, occlusions, individual teeth, oral cavity
how are patients prepped for dental exam under GA?
GA prep throat pack to prevent aspiration IVFT temperature regulation analgesia
what is the modified tridan system?
used on dental charts to number teeth with first number quadrant and second and third is tooth position
state normal number of adult teeth in dogs and cats
dogs- 42
cats- 30
what is examined in dental exam under GA?
calculus score
gingivitis score
periodontal probe depth
sulcus
define sulcus
gap between tooth and gingiva
what are causes of dental attachment loss?
periodontal pockets
gingival rescission
furcation exposure
tooth motility
what is dental caries?
softening and loss of enamel resulting in formation of pit in tooth
how is dental caries managed?
filling
extractions
what teeth are most commonly affected by crown fractures?
canines
carnassials
incisors
how are crown fractures managed?
polishing small chips
extraction
what is crown attrition?
wearing of crown leading to exposed pulp or fracture of tooth
how is crown attrition treated?
usually extraction
what are feline dental neck lesions?
pits affecting enamel, dentine and cementum
active destruction of unknown cause
how are feline dental neck lesions treated?
extractions
which deciduous teeth are most commonly retained?
incisors
upper canines
why do retained deciduous teeth need to be extracted?
malerruption and malocclusion of retained teeth
what is the problem of malocclusion?
abnormal wear
injury to mouth
how is malocclusion treated?
conservative management
extraction
orthodontics
what is the purpose of scaling teeth?
removal of plaque and calculus from tooth above and below gingival margin
what are the types of tooth scalers available?
manual
ultrasonic
sonic
what are considerations for ultrasonic scalers?
use flat surface on tooth, never tip
maximum each tooth 15 seconds at a time
water flowing before contact
why are sonic and rotosonic scales less commonly used for dentals?
potentially damage teeth and adjacent structures
describe the process of scaling teeth
remove gross deposits of calculus irrigate mouth examine teeth remove loose teeth probe sulcus remove calculus below gingival surface polish after scaling
what is the purpose of polishing after scaling teeth?
damage from scaling allows faster build up of calculus so polishing prevents this
list instruments used for dental surgery
curettes scalers periodontal probe extraction forceps dental mirror root elevators
what are indications for tooth extractions?
advanced periodontal disease caries or feline neck lesions retained deciduous teeth tooth trauma with exposed pulp malocclusion damaging soft tissues
list instruments for dental exam
mouth mirror periodontal probe mouth props gags retractors
list equipment for calculus removal
calculus removing forceps
subgingival curette
hand scaler
polishing cups and paste
list aftercare for dental surgery
tooth brushing once healed mouth washes soft food while healing no hard chews soft toys
how can owners be educated to prevent dental disease?
promote dental care from first visit
tooth brushing daily advised
nurse clinics or consults focused on prevention
list examples of conditions affecting pinnae
trauma
aural haematoma
neoplasia
what increases risk of aural neoplasia?
sun exposure
white fur
hairless
unpigmented skin
how is aural haematoma caused?
head shaking damages capillaries so bleed into ear
what causes otitis externa?
immune mediated
parasites
poor aeration
obstruction by fur, neoplasia, inflammation
what are common neoplasias of the ear?
squamous cell carcinoma
ceruminous gland adenoma
melanoma
basal cell carcinoma
what causes otitis media?
chronic otitis externa
list middle ear diseases
bacterial otitis media
tympanic membrane trauma allowing bacterial infection
tumours
polyps
how is pinnae trauma treated?
treat underlying cause clip pinnae place in lateral bandage buster collar consider contamination
how is aural haematoma treated?
drainage stitches to limit swelling massage flushing prevent further accumulation
what can pinnectomy be used for?
removal of invasive tumours
what is lateral wall resection?
removal of secretory epithelium, lateral cartilage of vertical ear canal
what is the purpose of lateral wall resection?
increase drainage and ventilation of ear
how is lateral wall resection prepared for?
clip whole pinnae and side of head
flush ear to remove debris
lateral with head elevated
what are indications for lateral wall resection?
non responsive to other treatment
external ear canal disease
what is vertical canal ablation?
excision of whole auricular cartilage
formation of stoma at level of horizontal canal
what are indications for vertical canal ablation?
disease affecting whole vertical canal
neoplasia
how do you prep for vertical canal ablation?
same as LWR
prep histology samples
what is total ear canal ablation and lateral bulla osteotomy?
removal of all epithelial lining and vertical and horizontal canal cartilage
what is the purpose of total ear canal ablation and lateral bulla osteotomy?
salvage procedure for chronic otitis externa, trauma and neoplasia
list potential complications for total ear canal ablation and lateral bulla osteotomy
hearing and facial nerve paralysis infection cosmetic affects haemorrhage vestibular issues trauma to deep structures fistula formation
describe prep for total ear canal ablation and lateral bulla osteotomy
clip whole pinnae, caudal border of eyelid, lateral neck
prep whole pinnae
when is ventral bulla osteotomy performed?
cats with middle ear disease
middle ear polyps
list complications for ventral bulla osteotomy
vestibular disease
haemorrhage
infection
