Nursing Interventions Flashcards
What would you do to heat a patient before actively heating them?
Insulate the patient.
- blankets under to prevent heat loss to kennel
- blankets over patient - layers are better as trap a layer of warm air between
- tinfoil reflects heat back to patient (place between the blankets)
Describe the methods of actively heating the patients
- Wheat Bags - microwave and store heat
+ mouldable to patient
- Need to monitor heat levels - Hot water bottles
+ easy to use
- can chew / burst/ leak
- can scold patient - Infrared light (heat-producing bulb)
+powerful hotspot (ideal for mothers and pups)
- not ideal for recumbent patients
- bulb can explode if comes into contact with fluid - Heat Mat
+Warm ambience created in that kennel
+Can control to maintain a specific temperature
- can chew wires
- fans just blow air around. Hot hand can burst*
Describe the methods used to cool a patient
- A/C
+ very effective in creating a cool environment
- non-specific - Fan
- kicks up dust and can affect other patients - Ice packs or ‘cool hands’
+ effective and reuseable
- small. Have to use multiple
- chewable - Cool mat
+ can lie on it and is effective
What can be done to reduce barking and stress in patients?
Exercise dogs regularly
Environmental Enrichment
Owner Visits
What should you do during the physical examination of the patient?
Examine from head to tail to avoid missing anything
Conduct more thorough exam of problem area
Auscultate heart and lungs
Measure vital signs
observe gait and mobility
Test reflexes
Describe some differences between dogs and cats you would find during a physical exam
Cat nose a little dryer than dogs
Cats MM are paler than dogs
Cat claws are retractable
Cat penis has barbs but appears smooth after castration
State the 5 vital signs
- Temperature
- Pulse rate and Heart Rate
- Respiration Rate and Effort
- MM and CRT
- Blood Pressure
State the normal temperature range for dogs, cats and rabbits
Dog: 38.3 - 38.7
Cat: 38.0 - 38.5
Rabbit: 38.5 - 40
State the normal temperature range of guinea pigs, hamsters, rats and horses
Guinea Pigs: 39-40
Hamsters: 37-38
Rats: 37.5-38
Horse: 37-38
What is the difference between hyperthermia and pyrexia?
Hyperthermia - increased body temp usually due to environmental conditions
Pyrexia (fever) - increased body temp usually due to infection
What term describes a fluctuating body temperature? What can cause it?
Diphasic
Canine Distemper Virus
State the normal pulse rate ranges for dogs, cats, rabbits and horses
Dog: 60 - 140 bpm
Cat: 110 - 180 bpm
Rabbit: 205 - 235 bpm
Horses: 36 - 42 bpm
State the 3 variation in pulse rate?
Tachycardia - increased HR
Bradycardia - decreased HR
Dysrhythmia - abnormal HR
State the normal ranges for RR for dogs, cat, rabbits ad horses?
Dog: 10 - 30 breaths/min
Cat: 20 - 30 breaths/min
Rabbits: 35-60 breaths/min
Horse: 8-12 breaths/min
Describe the 5 variations in RR
Tachypnoea - increased RR Bradypnoea - decreased RR Dyspnoea - difficulty breathing Apnoea - Stopped/Not breathing Cheyne-Stokes Respiration - abnormal rhythm and rate of breathing (often last gasp)
Describe the variation in MM colour
Pale - reduced tissue perfusion ( delivery of RBC) or anaemia (not enough RBC)
Cyanotic - hypoxia (not enough O2 in blood)
Icteric/ jaundiced - bilirubin accumulation
Brick Red - vasodilation
What is the normal CRT ?
1-2 seconds
What does an increased and decreased CRT mean?
increased (prolonged) = poor circulation
decreased (faster) = increased blood pressure
What are the normal average BP values for dogs and cats?
Dog = 133mmHg Cat = 124mmHg
Describe how to use a doppler?
Select correct cuff
Keep cuff level with heart
Apply spirit and small amount of gel to fur over pulse site
apply gel to doppler transducer and inflate cuff slowly until pulse disappears
inflate another 20mmHg over and then slowly release the pressure in the cuff
Take the reading when the pulse returns - systolic pressure
Repeat and take average
Name some problems a recumbent patient may face?
Problems eating and drinking properly Problems with natural elimination Soiling of the skin and fur Hypostatic pneumonia Hypothermia Decubitus ulcers
What intervention are there to assist patient mobility?
Supported sitting
Supported standing and walking
Physiotherapy
(massage improves circulation and maintains muscle tone; passive exercise maintains and improves, muscle tone and joint suppleness)
What is hypostatic pneumonia?
Lack of movement results in pooling of blood within the lungs, accumulation of blood within the tissues, collapse of lung, decreased oxygenation and increased risk of infection.
How can you treat a decubitus ulcer?
Apply water-soluble jelly to ulcer, clip hair and then wash up. Dry thoroughly, apply a dressing, a foam ring and a bandage. Monitor and change dressings regularly.
What are the aims of physiotherapy?
Reduce pain Promote Healing Improve mobility Regain strength and flexibility Prevent recurrence of injury CV fitness and Respiratory function
When is massage contraindicated?
When there is acute inflammation, pyrexia, unstable fractures, open wounds, infectious skin diseases
What is effleurage used for?
Stroking, smooth movements encourages venous return and reduces oedema
What massage technique is used to loosen secretion?
Coupage
What does passive range of movement involve?
Gently flexing and extending the joint whilst supporting it.
What does heat help?
pain reduction
reduces blood pressure
increases circulation
What does cold help?
Reduces pain
Vasoconstriction
Reduces inflammation
When will a patient require assisted feeding?
- If they have been anorexic/unable to eat/inappetant for more than 3 days ( including time at home)
- If Body condition score is less than 3/9
- Recent weight loss is more than 10% body weight
- Severe Cachexia (severe breakdown of fat and muscle stores- can use muscle condition score to measure)
Describe the process when starting to initiate feeding support in a patient (i.e. first step to last step)
Want to work from least invasive first!
- Tempt/ encourage
- syringe feeding
- Tube feeding
- Parenteral Feeding
What do we have to be careful of when feeding an anorexic patient?
Re-feeding syndrome.
potentially fatal shift in fluids and electrolytes e.g. can cause hypophosphataemia
What must the animal be/have to be syringe fed?
Must be conscious
Have normal GI function and ability to swallow
Name and describe the 4 types of feeding tube
- Naso-oesophageal (NO) or Naso-gastric (NG)
- NO doesn’t interfere with cardiac sphincter so not as many problems with acid reflux
- These a shorter term -several days.
- stomach and intestines must be functioning
- use liquid food and flush before and after - Oesophagostomy tube (O tube)
- tube placed through lateral neck by vet under GA
- sutured in place and stoma site dressed.
- can get more volume and slightly more solid food in
- also needs to be flushed before and after
- slightly longer term - PEG tube
(percutaneous endoscopically-placed gastrostomy tube)
- placed through surgical opening in lateral abdominal wall under GA by vet. Endoscope pulls feeding tube down oesophagus into stomach.
- Longer term (minimum 7-10 days)
- Higher liquid volumes as food administered directly into stomach
-mushroom head prevents it coming back out stomach. - Stomach tube
- good for reptiles, birds etc
- passes from mouth to stomach
- good to ‘kick-start’
What is parenteral feeding?
Feeding of nutritional components intra-venously using central vein.
Used when GI tract is not functioning
No room for error! Expensive
What should be done to avoid re-feeding syndrome?
Feeding little and often - 4-6 meals/day
Introducing food back gradually
e.g. Day 1 = 1/3 RER, Day 2 = 2/3 RER, Day 3 =RER
Can introduce over 4 days if want!
Feed slowly!
Observe animal when feeding for signs of aspiration, discomfort, nausea.
What is the calculation to work out the patients daily resting energy requirement (RER)?
What is the formula for calculating this in animals that weigh less than 2kg and more than 30kg?
Weight (kg) x 30 + 70 = ___ kcals
Weight (kg) x 70 =
How can you assess if the nutritional support has worked?
Evaluate Body Weight (BW), Body Condition Score (BCS) and Muscle Condition Score (MCS)
What are the requirements for a diet that’s suitable for a patient that requires assisted feeding?
High protein - to maintain muscle mass
Easy to Digest - breakdown and absorb
Good texture for syringe/tube - smooth consistency but not too liquid
High nutrient/energy density - allows you to meet patient’s RER with just a small amount of food.
Antioxidant complexes - vitamins essential!
Palatable (& aromatic) - to encourage patient to eat
Describe the equipment needed and the process of placing a NO/NG tube
Equipment: tube, local Ax, Zinc oxide tape, lubricant, nylon suture material, water, syringe, collar.
- Prepare the equipment
- Restrain patient
- Apply local anaesthetic drops to nostrils and wait 5-10 minutes
- Measure tube from nose to rib 9, mark with tape (count ribs from 13 back)
- Lubricate tube and insert into nostril (tip patients head up)
- Advance tube in caudoventral and medial direction
- Gently push nose pad to open nasal cavity
- Advance tube and animal should swallow (means its in the correct place!) Keep advancing into oesophagus until mark is reached.
- Flush tube with sterile water (if in trachea the animal will cough) - ideally you should x-ray to check correct placement.
- Tape or suture in place and put collar on patient
What is the difference between committing and regurgitation?
Vomiting is the active expulsion of stomach contents and regurgitation is the passive return of undigested food from the oesophagus
What consequences of committing affect the abilities of living?
Not eating leads to lethargy, cachexia
Not drinking and vomiting leads to dehydration
Dehydration can cause constipation but v and d sometime also go hand in hand.
At risk of aspirating vomit.
May develop hypothermia due to soiling and washing. May be pyrexic if vomiting is infectious,
May overgroom or not have the energy to groom. Vomit may cause skin scolding.
May not have enough energy to move. May require more rest. - vomit may disrupt sleep.
What nursing interventions would you carry out for a vomiting patient?
- possible nil by mouth under instruction from VS (vet may prescribe an anti-emetic)
- Feeding should be re-introduced at the earliest possible stage
- Where infectious disease is suspected - barrier nurs and isolation
- ensure patient and kennel are not soiled
- monitor patient for vomiting episodes and signs of nausea
- assess hydration status and maintain IVFT
What things would you monitor when nursing the vomiting patient?
- Is the patient meeting its RER?
- Check if still vomiting
- check body weight, MCS and BCS
- monitor frequency of soiling and skin integrity
- monitor spread of infectious diseases e.g. swabbing
How should water be offered to the vomiting patient?
Small amounts every 15-30 mins.
Make luke warm. Taking the chill of the water makes it easier on the stomach.
What are some highly digestible foods that can be fed in small amounts to vomiting patients?
Boiled chicken Boiled white rice Boiled white pasta Scrambled eggs (no milk!) Boiled white fish for cats
What is the normal intake of water for a dog ?
20-70mls/kg/day
- usually between 50-60mls/kg/day
How much water intake would be classed as polydipsia
90-100mls/kg/day
What are the early signs of dehydration in an animal?
slight loss in skin elasticity (tested by pulling up scruff and releasing) and hair standing on end. Tacky MM, slightly increased urine specific gravity
Describe the later stages of dehydration (7-12%)
decreased urine output (oliguria) and increased USG
sunken eyes
tachycardia, but weak pulse
prolonged CRT
eventually: shock, collapse and death
What are concerns of dehydration?
Dehydration itself,
Anuria (UTI, toxicity, renal damage)
Constipation
How can we provide fluid to patients?
Bowl of water (various bowls, bottles, fountains etc)
Can flavour water i.e. cook chicken in it - not a stock cube!
Electrolyte replacement drinks and foods
IVFT
What should we be monitoring in a patient on IVFT?
- check administration site at least once daily for swelling, bruising, pain and perivascular fluid.
- Check line for kinks and blockages
- check fluids are running and bag volume
- monitor clinical signs for hydration levels e.g. TPR,MM,CRT, USG.
- Monitor outgoings (U and F)
- calculate the animal’s expected fluid intake and calculate amount the patient drinks
- observe drinking
What are signs of overhydration in a patient on IVFT?
Moist cough or crackling in lungs
Low PCV (cells too dilute)
Dyspnoea, Tachypnoea or Tachycardia
Increased urine output
(if any of these signs occur - stop the fluids and refer to VS!)
What are the normal elimination values in dogs and cats?
Faeces - once or twice per day
Urine = 1-2mls/kg/hr
How should you nurse a patient with diarrhoea?
Isolate if suspect infection - barrier nurse
Provide access to toilet area frequently and use kennel liners
Provide easily digested diet - and probiotics?
Provide small amounts of water/ electrolyte solution regularly
Ensure to check patient and kennel for soiling
Monitor skin condition
Monitor hydration status
Can apply a tail bandage and barrier cream/sprays
How should you nurse a patient with constipation?
Ensure patient is adequately hydrated
Encourage mobilisation to stimulate gut motility (may need to be supported walks but not around abdomen)
Feed high fibre diet
Possible use of lactulose with food
Enema - putting a solution into the rectum to breakdown the contents e.g. Microlax for cats.
Manual evacuation under GA(VS)
Describe the equipment needed for an enema
Higginson’s syringe or urinary catheter with end cut off (good for cats) or a pre-prepared enema (no other equipment required if using this)
- gloves
- lubricant
- enema solution
Give the positives and negatives of different enema solutions
- Water
+non-toxic and readily available
- no lubricating properties - Mineral oil
+ readily available, lubricating and softens faeces
-requires shampoo to get out of coat after - Saline (phosphate enema)
+lubricates faeces, promotes osmotic draw and comes in a pre-prepared sachet - Pre-prepared enema
+no other equipment required
- expensive
Describe the procedure of carrying out an enema
- Prepare equipment and solution - push solution to the end of the tubing to avoid putting air into the rectum of the patient.
- Suitable location and someone to restrain patient
- Wash hands and use PPE
- Lubricate the nozzle
- Elevate tail and insert the nozzle into the rectum with gentle rotation
- GENTLY introduce solution (aim for 10mls/kg, but see how patient is dealing with it)
- Remove tube
- Massage rectum gently by palpating abdomen and moving towards the rectum
- Allow patient to go for walk immediately post-enema
This will need to be repeated frequently, but if no movement after 2/3 times, refer to VS
How should you nurse a patient with urinary problems?
Provide access to toilet area frequently and use kennel liners in bed.
(For cats, ensure appropriate litter e.g. sandy litters encourage urination)
Keep patient and kennel free from soiling
Monitor skin condition - clip if req and apply barrier sprays
Monitor hydration status
Consider catheterisation (consult VS)
What equipment is needed to place a urinary catheter?
- Urinary catheter
- Gloves
- Swabs and antiseptic
- Water-based lubricant
- Kidney dish to collect urine
- Speculum and pen torch (needed in females)
- sterile water, needle and syringe
- Urine collection bag ( and bung for closed bag)
- Suture material and tape
Describe the procedure of placing a urinary catheter
- Prepare equipment
- Get someone to restrain patient (sedation may be req)
- Wash hands and use PPE
- Clean area with antiseptic (may also need to clip)
- May need to use speculum and pen torch to see at this point
- Analgesic gel or lube with analgesic properties onto the catheter end
- Insert the catheter gently into the urethra (no touch method best where catheter comes straight out of bag and into urethra without being touched by gloves)
- Stop inserting when urine flows down the catheter (be careful not to go too far as may just be no urine in bladder)
- Fix in place if indwelling
Describe the 6 types of catheter
- Dog catheter
- long hardplastic tube with lots of holes for urine to exit so prevents blockages.
- different sizes
- used for male and female dogs
- not indwelling! - Foley
- Rubber, latex or silicon therefore non-irritant
- flexible (can be challenging to insert - sometimes come with metal rod to help guide in initially)
- used mostly in female dogs
- indwelling (inflate balloon with saline to keep in place) - Tieman’s
- PVC
- curved end designed to make it easier to get into female urethra
- used mostly in female dogs
- indwelling - Cat catheter
- essentially a mini dog catheter
- nylon
- not indwelling
- used in male and female cats - Jackson Cat catheter
- nylon
- indwelling
- usually used in male cats - Tomcat or Slippery Sam
- has guide wire for placement
- very flexible
- Teflon with silicon end (designed to be comfortable for patient)
- usually used in male cats
- indwelling
What are the potential problems associated with urinary catheters and how can they be avoided?
- Urethral/bladder trauma
- to avoid, use an appropriate size catheter and don’t over-insert - Iatrogenic infection
- to avoid, use a closed system and aseptic technique - Patient interference
- to avoid, ensure patient is comfortable and monitor pain. Check catheter isn’t blocked or irritating. Use prevention methods e.g. collar - Blockage
- to avoid, regularly empty bag, check bladder size, keep collection bag lower than patient and ensure catheter can be flushed
What is the normal respiration rate for dogs and cats?
Dogs = 10-30 Cats = 20-30
How would difficulty breathing affect the activities of living?
May find it difficult to eat or drink as struggling to breathe - can lead to cachexia, muscle atrophy, weight loss, dehydration.
Tachypnoea can also contribute to fluid loss
Increased respiratory effort raises body temperature.
Mobility affect due to deoxygenation of muscle tissue.
Handling or movement may lead to syncope.
Decreased O2 to brain may affect mentation - stuporous/comatose (this would be an emergency!)
What is a syncope?
Mini faint / black-out
What nursing interventions to support breathing can be carried out?
- Provide o2 (via o2 kennel/tent, mask, nasal prongs or cannulae, endotracheal tube- under Ax -careful!)
- Supported sitting/regular turning - avoid dorsal recumbency!
- Minimal handling/restriction of neck, chest etc
- Remove collar and harness
- Keep environmental temperature constant and cool & keep patient’s body temperature in normal range.
- Minimise stress
- Bed baths around mouth and nose.
- Nebulisation+/- coupage
- Suction to remove nasal and oral secretions e.g. nasal aspirator
How might we monitor if interventions for breathing support have been successful?
Monitor RR, effort, MM, SPO2 level - ideally back to normal ranges.
Is the o2supply method working for that patient?
Monitor for positional dyspnoea e.g. if you moved the patient into a different position and its breathing got much worse- make sure to record!
Monitor environmental and body temperatures
What can be done to reduce soiling in patients?
- Regular walking
- Appropriate cat litter
- Absorbent bedding
- Regular checks
- Regular cleaning up of face and removing excess secretions e.g. saliva and mucus
- Bed baths and skin/tail protection
- Potentially indwelling closed-system catheter
- Monitor wounds
Describe the procedure for bathing a soiled patient
Clean ASAP Wash hands - use PPE Use helper to restrain patient Remove excess soiling with paper towel Use warm water Use appropriate shampoo Rinse thoroughly and Dry thoroughly Remove matts, check for skin scold, tics etc Clip problem area if necessary and apply barrier cream
Describe oral care in patients
Regular brushing with a toothbrush Dry kibble diet helps maintain dental health Chewing materials (need to be able to make a dent with fingernail)
describe aural care in patients
gentle removal of excess wax with dry swab (do not enter the ear canal). If you remove too much wax, the body will just produce more wax!
Take care when using ear cleaners
Describe ocular care in patients
If only one eye infected, clean uninfected eye first!
Gently remove secretions with a damp swab.
Under GA, lubricate eyes as blink reflex absent and eyes can dry out.
Describe the different types of brushes and what they’re good for?
- Soft-bristled brush
- good for removing top layer of dry dirt - Pin brush (have rubber tips)
- Good for removing dead hair from thick coats, but can irritate skin - Slicker brush(finer pins with no rubber)
- can scratch skin
- removes loose hair in all but smooth hair types - Comb
- removes matts - Rubber brush
- removes loose hair and smooths coat (use after another brush) - Flea Comb
- very fine pins to find flea dirt
Describe the 2 different types of nail clippers
- Scissor type
- can use a guard on them to prevent chopping off too much - Guillotine
How should you cut patient’s nails
- Sideways to not crush nail and get cleaner cut
- Cut clear nails first to get an idea of how long quicks are
- Do not cut past the quick!
- Will have to push cats claws out to cut
* don’t forget dew claw
What is the difference between fear and anxiety?
Fear is a response to a potentially harmful stimulus that is actually happening.
Anxiety is a response to a potential situation where the patient anticipates a negative outcome
Describe the release of the stress hormone?
Hypothalamus - pituitary - adrenal gland. Adrenal gland releases Cortisol (stress hormone). This causes the body to prepare for danger by making more enrgy available - slows conversion of glucose to glycogen in the liver
Describe the sympathetic NS response to stress
Stimulates release of adrenaline/noradrenaline. Increases HR, RR, dilates pupils, Decreases GI motility. Cats may freeze (extreme stress)
This:
-increases glucose availability
-increases oxygen intake
- heightened senses and memory
- increased blood flow to skeletal muscles
- reduced immune function and pain sensation
Why might patients be more prone to stress in the veterinary environment?
Senses heightened. More sensitive to:
- smell e.g. pheromones given off by another stressed patient
- hearing - esp since noises different to normal
- vibrations e.g. closing kennel doors, a/c, washing machine
- sight - may perceive our approach differently
Does stress affect the abilities of living?
Yes. Pretty much all of them!
- unwilling to eat/drink - anorexic
- catecholamines increase HR and RR and affect normal body movements and body language
- potentially overgrooming
- anxiety may affect ability to sleep rest
What nursing interventions can be used to reduce stress and anxiety in patients?
- familiarity - own bed, blanket, toys, food, litter etc.
- manage sensory stimuli e.g. reduce noise, use calming background music, dim lighting, don’t use strong cleaning chemicals
Define pain
Sensation created by a noxious stimulus.
Can be acute/chronic, in an area with a lot nerve endings and therefore worse, can be an inflammatory response, swelling in an enclosed area, dull or stabbing pain etc.
What effect does pain have on the patient?
Increases HR, RR BP Increases intestinal secretions Urine retention Increased metabolism and O2 Reduced efficacy of immune system can escalate further pain response/sensitivity
How does pain affect the abilities?
Uncomfotable - may not want to eat/drink , posture to urinate/defaecate.
May not be able to get comfy for rest.
Reduces mobility
RR and body temperature increased
Wont groom or will overgroom affected area,
How would you assess pain in a patient?
Their behaviour - aggressive, withdrawn, vocalising licking, chewing , self-mutilation, restlessness, abnormal gait.
Their facial expression - tension? no eye contact, pupils dilated.
Physiological indicators e.g. HR, weight loss, poor coat.
Owner questions
Glasgow Composite Measure Pain Scale
What are nursing interventions that can be administered to a painful patient?
- 1st! Ensure pain medications are given timeously and prior to noxious stimulus
- Provide cryotherapy (cold reduces heat, swelling and will hopefully reduce pain and shorten healing time) Thermotherapy can help once inflammation gone,
- Comfortable, stress-free environment
- Care RE handling and restraint
- Prevent self-mutilation e.g. collar
- Physiotherapy, hydrotherapy
- Weight management - really helpful with chronic pain e.g. arthritis
- Ensure home environment is appropriate and accessible
- Therapeutic laser, acupuncture etc.
Describe the levels of consciousness
- Alert
- Obtunded - slow and sluggish
- Stuporous - in and out of consciousness . Less control over muscular and skeletal functions.
- Coma
What physiological signs would you expect in a patient that has consciously collapsed?
HR, RR - increased or normal
Eyeball position normal, Cornea moist and corneal reflex present.
Swallow reflex present
Pupil size is still variable as normal and pupillary reflex is present.
Movement is limited and body temperature is constant.
What physiological signs would you expect in a patient that is unconscious?
HR - regular but a little slower
RR- varies
Eyeball position is ventromedially rotated
Corneas moist and reflex present
pupil size variable and light reflex present
Can be roused.
Body temp constant - tho may be lowered
What would you expect the signs to be in a dead patient?
HR absent for more than 3 minutes RR - absent of Cheyne Stokes Eye position is central Corneas glazed and pupils fully dilated All reflexes absent Body temp begins to cool within 15 minutes
How should the nurse respond to conscious collapse?
- Protect the airway!
2. Recovery position , oxygenate if required
How should the nurse respond to unconscious collapse?
Check ABCs
resuscitate if required, intubate +/- o2, circulatory support (fluid therapy)
