Triage/initial assessment 1.1 Flashcards
What is included in a minimum database?
PCV
TS
BUN
Blood glucose
What is included in an extended database?
Minimum +
Electrolytes
Blood gases
Lactate
Blood smear
Alongside the emergency database, what other bloods are useful to obtain during the initial exam period?
Biochemistry
Haematology
Coagulation profile
What might snappy pulses indicate?
Anaemia
What does bounding pulses indicate?
Sepsis due to vasodilation
What can a prolonged CRT indicate?
Hypoperfusion/shock
What do pale mucous membranes but normal CRT indicate?
anaemia
What is the definition of tachycardia in dogs?
Above 140bpm. Although it is important to note trends more than individual readings if possible
Name potential causes for tachycardia in dogs
Arrhythmias
CHF
anaemia
stress
pain
excitement
electrolyte abnormalities
intoxications
What is the definition of tachycardia in cats?
Above 180bpm
Name potential causes for tachycardia in cats
Stress
Pain
Anxiety (white coat effect)
Hyperthyroidism
CHF
Electrolyte disturbances
Intoxications
Name potential causes for bradycardia in dogs
Hyperkalaemia
Increased vagal tone
Drugs
Bradyarrhythmias
Raised ICP
Hypothermia
Name potential causes for bradycardia in cats
Shock (later stage)
Sepsis
Hyperkalaemia
AV block
Hypothermia
High vagal tone (uncommon in cats)
What is a special consideration when assessing pulses in cats with aortic thromboembolism?
Compare femoral pulses bilaterally
Also assess forelimbs as ATE can occasionally affects these
What would muffled/absent heart sounds ventrally indicate?
Pleural effusion
What would muffled/absent heart sounds dorsally indicate?
Pneumothorax
When might a gallop rhythm be noted in a cat?
HCM
When might an increase in respiratory effort be seen?
Pleural space disease
Pulmonary parenchymal disease
Upper airway disease/airway obstruction
At what rate is a respiratory rate considered tachypnoea?
Above 50 breaths per minute
Name potential causes for tachypnoea in both cats and dogs
Stress
Pain
Pyrexia/fever
Hyperthermia
Compensation for metabolic acidosis
Describe the changes to a patients breathing pattern that would be noted with increased respiratory effort
Increased chest and abdominal muscle movement
Perceived as laboured breathing
Describe the changes to a patients breathing pattern that would be noted with an upper respiratory tract obstruction
Marked inspiratory effort and paradoxical abdominal movement
Describe the changes to a patients breathing pattern that would be noted with bronchial disease
Marked expiratory - due to air entrapment
What could cause a decreased respiratory effort?
Head/spinal injury
Intoxications (i.e. tetanus)
End stage respiratory fatigue
Describe the changes to a patients breathing pattern if paradoxical respiration was noted
Increased intercostal muscle action
Abdominal muscles appear to move inwards
Why does the abdomen appear to be ‘sucked inwards’ during paradoxical breathing?
The increased intercostal muscle action during inspiration draws the diaphragm cranially
Name potential causes for paradoxical breathing
Upper airway obstruction
diaphragmatic injury (rupture or paralysis secondary to the cervical spinal cord or phrenic nerve injurt)
Severe decrease in pulmonary compliance
Describe the correct method of auscultating the lungs
Each hemi-thorax is divided into dorsal, middle and ventral lung fields
Depending on patient size, this may be split into two or three cranial to caudal zones
Each lung field should be auscultated and compared to the adjacent and contralateral fields
Describe stridor
High pitched sounds of upper airway origin
Occurs when damage or obstruction to the upper airways
Abnormally loud sound created as air passes through narrowed airway
What should you always check if a high pitched noise is heard on lung auscultation?
Ensure is not referred stridor
Complete laryngeal and tracheal auscultation to localise the noise
Describe stertor
Lower pitched sound
generally of pharyngeal origin
Often described as gasp or snore-like
Heard on inspiration
What would a decrease or absence of lung sounds indicate?
Pleural space disease
Can also be soft tissue or organ displacement due to diaphragmatic hernia
Describe the changes to a patients breathing pattern that would be noted with pleural space disease
Rapid, shallow breaths
Air hunger (dependant on severity)
Name potential causes for pleural fluid
Pure transudate (right sided heart failure)
Haemorrhage (rodenticide intoxication, neoplasia, trauma)
Chylothorax
Pyothorax (pus, open wound, extension of lung infection)
Over how long is a patient with pulmonary contusions likely to deteriorate?
6-24 hours
Laboured inspiration and audible noisy breathing indicates what?
Upper airway issue
Laboured expiration indicates what?
Lower airway issue
Laboured inspiration and expiration indicates what?
Parenchymal disease
Rapid and shallow inspiration and expiration alongside abnormal lung sounds indicates what?
Pleural space disease
Paradoxical breathing indicates what?
Loss of negative pressure in the pleural space
What methods can provide better information on a patients oxygenation and ventilation rather than mucous membrane colour? and specifically what information do they provide?
Arterial blood gas analysis (PaO2 and PaCO2)
Pulse oximetry (SpO2)
Why might pulse oximetry be difficult in a dyspnoeic patient?
Potential stressor
Requires pulsatile tissue bed to be accurate, perfusion may be altered due to peripheral vasoconstriction
Describe a ‘depressed’ mentation
Alert but not appropriately responsive to stimuli
Describe an ‘obtunded’ mentation
Decreased consciousness or appearing unconscious but rousable with non-nnoxious stimuli
Describe a ‘stuporous’ mentation
Unconscious and only rousble with noxious stimuli
Describe a ‘comatose’ mentation
Unconscious and not rousble with any stimuli including noxious
What would episodes of delirium indicate?
Common with space-occupying lesion, problem with brain structure or intermittent increases in ICP
Why is it important to carefully assess decreased mentation during a neurological assessment?
May be secondary to hypoperfusion and hypoxia
Why should a neurological patient with decreased mentation be monitored after administering fluids (if indicated?)
To re-assess mentation
If improved then indicates clinical sign of decreased mentation is attributable to hypoperfusion
If a decreased mentation is deemed to not be due to hypoperfusion, what are the next steps?
Full neurological examination
Electrolytes and acid-base balance
What is involved in a neurological exam?
Gait, ataxia, knuckling, hypermetria, stance, asymmetry, trembling, head tilt
Eyes: Pupil size, PLR, eyelid aperture, nystagmus
Describe schiff-sherrington posture and what this indicates
Forelimb extensor rigidity and hind-limb flaccidity secondary to a serious spinal cord lesion between T2 and L4
Describe decerebrate rigidity
Opisthotonus (arched back) with hyperextension of all four limbs and loss of consciousness
Describe decerebellate rigidity
Hyperextension of the forelimbs with variable flexion and extension of the hind-limbs with appropriate level of consciousness
When is a deep pain assessment indicates?
Serious spinal cord injury/disease
How do you assess withdrawal reflex?
Punching the webbing or skin between the toes on the hind leg
How do you assess for deep pain?
Pinching p3 (periosteum) with forceps, gradually close until significant pain response elicited
Which scoring system was developed to determine the severity of a neurological injury?
Modified Glasgow Coma Score (MGCS)
What is vital to consider when presented with a patient with a head injury? and why?
Not to cause a rise in intra-cranial pressure
Increased ICP decreases cerebral blood flow
What should be avoided in a patient with a head injury so not to raise ICP?
Applying pressure to jugular veins/jugular blood sampling
Placement of intra-nasal catheters or any irritation to the nose as may cause sneezing
Inducing gag reflex or administering drugs that can cause vomiting
How should a patient with a head injury be positioned and why?
Head and neck elevated 15-30 degrees, with a flat board, to decrease intracranial pressure
Which drugs can be administered to decrease intra-cranial pressure?
Mannitol
Hypertonic saline
How would you calculate cerebral perfusion?
MAP - ICP
How should a patient with a suspected spinal or neck trauma be transported?
Backboard
What is a nursing consideration in a patient with a spinal injury?
Abnormal urination/difficulty
Urination pattern and bladder size should be closely monitored
Some may require catheterisation, especially if recumbent for more than 12 hours
Why should additional care be taken if a patient with a spinal injury is unconscious/sedated?
Relaxation of the muscle which would normally support the unstable vertebral column
What is a potential complication of urinary catheterisation?
Urinary tract infection
What can repeated bladder expressions or intermittent catheterisation cause?
Bruising
Bladder wall trauma
Cystitis
List potential nursing considerations for patients with a spinal injury
Assessment of nerve function daily
Suitable bedding
Regular movement to prevent pneumonia
Padding of bony prominences
Grooming
Care of urinary catheter
Mental stimulation
How often should a patients nursing care plan be reviewed and why?
At least every 24 hours
To ensure objectives are being met by the care implemented
