Podcast
Questions and Answers
Hospital patients need to be approached with a calm and confident ______, not a rushed or aggressive demeanor.
Hospital patients need to be approached with a calm and confident ______, not a rushed or aggressive demeanor.
demeanor
Being ______ will ensure that the assessment or treatment of that patient is efficient and smooth, and will reduce excessive time for the patient being handled which in turn limits stress.
Being ______ will ensure that the assessment or treatment of that patient is efficient and smooth, and will reduce excessive time for the patient being handled which in turn limits stress.
prepared
Check all the tools needed to do a ______ are working including a stethoscope, thermometer, and monitoring equipment.
Check all the tools needed to do a ______ are working including a stethoscope, thermometer, and monitoring equipment.
TPR
Before handling and examining your patients do a last check of the front of the cage to ensure there are no warnings or special notes about the patient and do a final assessment of ______ language.
Before handling and examining your patients do a last check of the front of the cage to ensure there are no warnings or special notes about the patient and do a final assessment of ______ language.
Even if you feel uncomfortable with a pet, don't work alone, get a team member to assist because Cats and dogs can sense when you are ______, it won't help make them feel comfortable with you.
Even if you feel uncomfortable with a pet, don't work alone, get a team member to assist because Cats and dogs can sense when you are ______, it won't help make them feel comfortable with you.
Before opening the cage door always talk to the patient and use their name and quietly ______ them that you are there.
Before opening the cage door always talk to the patient and use their name and quietly ______ them that you are there.
Disease processes such as tick paralysis and snake bite require caution about encouraging ______ in the patient.
Disease processes such as tick paralysis and snake bite require caution about encouraging ______ in the patient.
If an assessment is scheduled and a patient in ICU is sleeping soundly, check with the vet if you can ______ the assessment, to allow them to rest for proper healing.
If an assessment is scheduled and a patient in ICU is sleeping soundly, check with the vet if you can ______ the assessment, to allow them to rest for proper healing.
Patient assessment is the overall assessment of body systems to gather information from the ______ signs.
Patient assessment is the overall assessment of body systems to gather information from the ______ signs.
Patient assessment can be broken down into two categories; the first is a visual assessment from a ______ and the second being a physical examination.
Patient assessment can be broken down into two categories; the first is a visual assessment from a ______ and the second being a physical examination.
Normal mentation is characterised by appropriate ______ with and responses to external stimuli.
Normal mentation is characterised by appropriate ______ with and responses to external stimuli.
Patients that are bright, alert, and responsive are usually associated with the normal happy patient although this does not ______ disease.
Patients that are bright, alert, and responsive are usually associated with the normal happy patient although this does not ______ disease.
A patient that is ______ will be able to get up and walk slowly & tentatively and this is often associated with pain or severe illness.
A patient that is ______ will be able to get up and walk slowly & tentatively and this is often associated with pain or severe illness.
A patient that is ______ is often very slow to respond to stimulation and can't maintain an alert state, and will quickly become drowsy after being stimulated.
A patient that is ______ is often very slow to respond to stimulation and can't maintain an alert state, and will quickly become drowsy after being stimulated.
A ______ patient is often bright, but is displaying neurological changes, can be due to medications or to the disease process causing pacing, head pressing, head tilt, and/or constant barking.
A ______ patient is often bright, but is displaying neurological changes, can be due to medications or to the disease process causing pacing, head pressing, head tilt, and/or constant barking.
Using the visual assessment for your initial respiratory assessment allows you to see what the patient's ______ and effort is before you disturb or interact with them.
Using the visual assessment for your initial respiratory assessment allows you to see what the patient's ______ and effort is before you disturb or interact with them.
If the respiratory rate and effort are already concerning before you disturb a patient, especially if a cat is ______, then seek veterinary reassessment ASAP!
If the respiratory rate and effort are already concerning before you disturb a patient, especially if a cat is ______, then seek veterinary reassessment ASAP!
______ is defined as a normal breathing pattern that is the reliance on abdominal breathing to ventilate the lungs for gas exchange and subsequent oxygen delivery to body tissues.
______ is defined as a normal breathing pattern that is the reliance on abdominal breathing to ventilate the lungs for gas exchange and subsequent oxygen delivery to body tissues.
______ is defined as difficulty breathing and is more common, is either because they cannot get sufficient air into the lungs or cannot sufficiently exhale, or both. Laboured and forced movements
______ is defined as difficulty breathing and is more common, is either because they cannot get sufficient air into the lungs or cannot sufficiently exhale, or both. Laboured and forced movements
______ is defined as an elevated respiratory rate, (Over 40 BPM).
______ is defined as an elevated respiratory rate, (Over 40 BPM).
______ is defined as a reduced respiratory rate <10 BPM and is less commonly due to disease process, more commonly due to medications or hypothermia.
______ is defined as a reduced respiratory rate <10 BPM and is less commonly due to disease process, more commonly due to medications or hypothermia.
When assessing the respiratory effort, you are looking for how much 'work' the patient puts into ______ on inspiration and expiration.
When assessing the respiratory effort, you are looking for how much 'work' the patient puts into ______ on inspiration and expiration.
In assessing a patient's posture, when they could be painful, scared or defensive, and they are about to lunge it is important to look at ______ features.
In assessing a patient's posture, when they could be painful, scared or defensive, and they are about to lunge it is important to look at ______ features.
A hunched posture is often associated with pain of what origin?
A hunched posture is often associated with pain of what origin?
Patients in ______ recumbency will be laying down, may just be sleeping, but they could also be painful and unwilling to move, paralysed or even mentally altered and this usually is a sign of deterioration.
Patients in ______ recumbency will be laying down, may just be sleeping, but they could also be painful and unwilling to move, paralysed or even mentally altered and this usually is a sign of deterioration.
For a cat in a ______ position, this is where the cat tucks its feet and tail in under the body resembling a loaf of bread and is Usually considered a relaxed, content position.
For a cat in a ______ position, this is where the cat tucks its feet and tail in under the body resembling a loaf of bread and is Usually considered a relaxed, content position.
______ is where a patient has its head resting up against the wall, they are often standing and look like they are leaning into the wall with their head as this is Not a normal position, and this patient is neurologically altered.
______ is where a patient has its head resting up against the wall, they are often standing and look like they are leaning into the wall with their head as this is Not a normal position, and this patient is neurologically altered.
Animals that are overweight in hospitals can create different challenges and flag illnesses and issues that are more common with obesity; Joint pain and discomfort being caged needs to be managed and patients assisted to move around if mobility if affected, with additional ______.
Animals that are overweight in hospitals can create different challenges and flag illnesses and issues that are more common with obesity; Joint pain and discomfort being caged needs to be managed and patients assisted to move around if mobility if affected, with additional ______.
Sweet smelling breath, which smells like acetone, in animals means the patient is likely ______ and may be in diabetic ketoacidosis (DKA) and producing sweet smelling biproducts that are released in breath.
Sweet smelling breath, which smells like acetone, in animals means the patient is likely ______ and may be in diabetic ketoacidosis (DKA) and producing sweet smelling biproducts that are released in breath.
An example of a respiratory noise that is normal is some respiratory noise, ______ respiratory noise is not and certain types of noise are of concern.
An example of a respiratory noise that is normal is some respiratory noise, ______ respiratory noise is not and certain types of noise are of concern.
After performing a visual assessment, gather subjective information, and gather some actual numbers in the form of the physical examination or more specifically the ______ (temperature, pulse, respiration).
After performing a visual assessment, gather subjective information, and gather some actual numbers in the form of the physical examination or more specifically the ______ (temperature, pulse, respiration).
It is important to assess respiratory rate/effort and ______ first including SpO2 as well as go from head to toe of the patient and record the findings as you go to perform an accurate physical examination.
It is important to assess respiratory rate/effort and ______ first including SpO2 as well as go from head to toe of the patient and record the findings as you go to perform an accurate physical examination.
The lungs should be auscultated from both the left and right side of the chest as well as upper and lower ______.
The lungs should be auscultated from both the left and right side of the chest as well as upper and lower ______.
Before initial palpation of the heart be sure to listen for a full ______, so you don't miss possible abnormalities like irregular heartbeats.
Before initial palpation of the heart be sure to listen for a full ______, so you don't miss possible abnormalities like irregular heartbeats.
When auscultating the heart we are doing two things; calculating the heart rate and assessing for ______.
When auscultating the heart we are doing two things; calculating the heart rate and assessing for ______.
The colour of the ______ can tell a lot about the body's ability to appropriately perfuse and oxygenate the tissues and texture can tell us about the hydration status of the patient.
The colour of the ______ can tell a lot about the body's ability to appropriately perfuse and oxygenate the tissues and texture can tell us about the hydration status of the patient.
______ is a non-invasive blood pressure which is the act of measuring the systolic, diastolic, and mean arterial pressures taken from the outside of the patient using a cuff.
______ is a non-invasive blood pressure which is the act of measuring the systolic, diastolic, and mean arterial pressures taken from the outside of the patient using a cuff.
______ is the term used for low blood pressure, this is defined by the Mean Arterial Pressure being below 60mmHg or the systolic being below 90mmHg.
______ is the term used for low blood pressure, this is defined by the Mean Arterial Pressure being below 60mmHg or the systolic being below 90mmHg.
______, or the ability of the patient to regulate its own internal temperature by means of generating or losing heat, can be impacted by disease processes, the external environmental temperature, and medications.
______, or the ability of the patient to regulate its own internal temperature by means of generating or losing heat, can be impacted by disease processes, the external environmental temperature, and medications.
______ is whereby the temperature is elevated due to infection which increases temperature to try and kill the microorganism that is causing illness.
______ is whereby the temperature is elevated due to infection which increases temperature to try and kill the microorganism that is causing illness.
Any time a pain scale is performed, the result needs to be recorded on the hospital chart, this allows the team to see a trend and ensure that any current pain management plans are ______ or not.
Any time a pain scale is performed, the result needs to be recorded on the hospital chart, this allows the team to see a trend and ensure that any current pain management plans are ______ or not.
A change in any of these parameters in a patient can indicate pain, a vet should be notified at this point so that a pain management plan can be determined because Presence of pain not only affects the behaviour of the patient, but it will ______ affect the patient.
A change in any of these parameters in a patient can indicate pain, a vet should be notified at this point so that a pain management plan can be determined because Presence of pain not only affects the behaviour of the patient, but it will ______ affect the patient.
______ is one of the ancillary nursing care actions that consist of giving all patients the opportunity to urinate and defecate in a normal environment and not be forced to soil themselves on the bedding.
______ is one of the ancillary nursing care actions that consist of giving all patients the opportunity to urinate and defecate in a normal environment and not be forced to soil themselves on the bedding.
Nutrition allows the body to have ______ - fuel to heal, fuel to fight infection, so Every single patient in hospital needs to have a nutrition plan..
Nutrition allows the body to have ______ - fuel to heal, fuel to fight infection, so Every single patient in hospital needs to have a nutrition plan..
Monitoring ______ daily is essential for every hospitalised patient, for several reasons including a patient's weight can reflect both improvement and deterioration.
Monitoring ______ daily is essential for every hospitalised patient, for several reasons including a patient's weight can reflect both improvement and deterioration.
Hospital patients need to be approached with a calm and confident ______, not a rushed, dominant or aggressive demeanor.
Hospital patients need to be approached with a calm and confident ______, not a rushed, dominant or aggressive demeanor.
Stress of any sort induces a ______ release; high levels of this hormone reduce the healing ability of the body.
Stress of any sort induces a ______ release; high levels of this hormone reduce the healing ability of the body.
Before handling and examining a patient, remember to do a last check of the front of the cage and do a final assessment of their ______.
Before handling and examining a patient, remember to do a last check of the front of the cage and do a final assessment of their ______.
Many patients in hospital, particularly in ICU or emergency settings, rarely sleep well, if at all, so check with the vet if you can ______ the assessment if the patient is sleeping soundly.
Many patients in hospital, particularly in ICU or emergency settings, rarely sleep well, if at all, so check with the vet if you can ______ the assessment if the patient is sleeping soundly.
It is important to talk with the patient's ______, asking what the patient is like at home to differentiate between normal behaviors and altered demeanors in a hospital setting.
It is important to talk with the patient's ______, asking what the patient is like at home to differentiate between normal behaviors and altered demeanors in a hospital setting.
______ is the outward behavior of a patient, whereas mentation is more specifically the interactions and response to stimuli.
______ is the outward behavior of a patient, whereas mentation is more specifically the interactions and response to stimuli.
Normal ______ is characterised by appropriate interactions with and responses to external stimuli.
Normal ______ is characterised by appropriate interactions with and responses to external stimuli.
If the respiratory rate and effort are already concerning before you disturb them, or if a cat is open mouth breathing, then seek veterinary reassessment ______!
If the respiratory rate and effort are already concerning before you disturb them, or if a cat is open mouth breathing, then seek veterinary reassessment ______!
Reliance on abdominal breathing to ventilate the lungs for gas exchange and subsequent oxygen delivery to body tissues.
Reliance on abdominal breathing to ventilate the lungs for gas exchange and subsequent oxygen delivery to body tissues.
______ is more common, is either because they cannot get sufficient air into the lungs or cannot sufficiently exhale, or both. Laboured and forced movements
______ is more common, is either because they cannot get sufficient air into the lungs or cannot sufficiently exhale, or both. Laboured and forced movements
When assessing the respiratory effort, you are looking for how much ______ the patient puts into breathing on inspiration and expiration.
When assessing the respiratory effort, you are looking for how much ______ the patient puts into breathing on inspiration and expiration.
A cat’s meow can be deep in tone with ______ and very different from their normal meow.
A cat’s meow can be deep in tone with ______ and very different from their normal meow.
The posture of a patient or the way they are positioned in a cage will often give you significant clues as to how they are feeling and what is happening with them. As with all ______, this is constantly assessed and you are looking at trends, both improving and deteriorating.
The posture of a patient or the way they are positioned in a cage will often give you significant clues as to how they are feeling and what is happening with them. As with all ______, this is constantly assessed and you are looking at trends, both improving and deteriorating.
Patients with abdominal discomfort often take on a '______' and patients suffering from spinal disease will adopt a ‘centred sit with splayed hind legs’.
Patients with abdominal discomfort often take on a '______' and patients suffering from spinal disease will adopt a ‘centred sit with splayed hind legs’.
______ is considered a relaxed, content position for patient.
______ is considered a relaxed, content position for patient.
The most importance of the ______ condition is when a patient has been ill for some time suggesting chronicity.
The most importance of the ______ condition is when a patient has been ill for some time suggesting chronicity.
A sweet smelling breath – 'Fruity Scent' (Smells like acetone - note not everyone can smell this) - The patient is likely a ______ and may be in diabetic ketoacidosis (DKA) and producing sweet smelling biproducts that are released in breath.
A sweet smelling breath – 'Fruity Scent' (Smells like acetone - note not everyone can smell this) - The patient is likely a ______ and may be in diabetic ketoacidosis (DKA) and producing sweet smelling biproducts that are released in breath.
The visual assessment, is most beneficial when performed first.
The visual assessment, is most beneficial when performed first.
While some respiratory noise is normal, ______ noise is not and certain types of noise are of concern.
While some respiratory noise is normal, ______ noise is not and certain types of noise are of concern.
While the primary purpose of a walk is an opportunity for the patient to urinate and defecate, it is a great opportunity for them to stretch their legs, be ______ by the surroundings and get some TLC from you!
While the primary purpose of a walk is an opportunity for the patient to urinate and defecate, it is a great opportunity for them to stretch their legs, be ______ by the surroundings and get some TLC from you!
Replicating as much as possible the home situation, means that when something is different (not defaecating/urinating) you can rule out as these ______.
Replicating as much as possible the home situation, means that when something is different (not defaecating/urinating) you can rule out as these ______.
Unless there is a medical reason as to why a patient cannot have fresh water, then they should have ______ to clean fresh water, regardless of whether they are on fluids or not.
Unless there is a medical reason as to why a patient cannot have fresh water, then they should have ______ to clean fresh water, regardless of whether they are on fluids or not.
The most common site for determining the temperature of a patient is rectally, although it can also be determined via an oesophageal thermometer probe or an ______ thermometer.
The most common site for determining the temperature of a patient is rectally, although it can also be determined via an oesophageal thermometer probe or an ______ thermometer.
Any time a pain scale is performed, the result needs to be recorded on the ______, this allows the team to see a trend and ensure that any current pain management plans are working or not.
Any time a pain scale is performed, the result needs to be recorded on the ______, this allows the team to see a trend and ensure that any current pain management plans are working or not.
If the patient is anaesthetised, sedated, or obtunded, a ______ may be placed around the limb above the catheter site to occlude the vessel for catheter placement.
If the patient is anaesthetised, sedated, or obtunded, a ______ may be placed around the limb above the catheter site to occlude the vessel for catheter placement.
Flashcards
Demeanour
Demeanour
Outward behaviour of a patient.
Mentation
Mentation
The interactions and response to stimuli.
BAR
BAR
Bright, Alert, Responsive.
QAR
QAR
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Eupnoea
Eupnoea
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Dyspnoea
Dyspnoea
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Tachypnoea
Tachypnoea
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Bradypnoea
Bradypnoea
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TPR
TPR
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Hypotension
Hypotension
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Hypertension
Hypertension
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Thermoregulation
Thermoregulation
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Hypothermia
Hypothermia
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Normothermia
Normothermia
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Hyperthermia
Hyperthermia
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Pyrexia
Pyrexia
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Accurate Hospital Chart
Accurate Hospital Chart
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Common IV Catheter Site
Common IV Catheter Site
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USG
USG
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Fecal Float
Fecal Float
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Study Notes
Module 1: Embrace Emergency Nursing
- Upon completion of this module, candidates should have a systematic approach to the assessment and care of hospitalised emergency patients.
- This module aims to assist in developing a systematic approach to visual assessment of patients.
- This module aims to assist in developing a systematic approach to the complete physical assessment of patients.
- This module aims to help identify the patient's normal and abnormal vital signs.
- This module aims to help perform ancillary nursing care for patients, including pain scoring, indwelling catheter care, & monitoring.
- This module aims to help perform clinical pathology sampling and storage.
- This module aims to help interpret basic clinical pathology changes.
- This module aims to help perform common in-house diagnostic pathology tests.
Approaching the Hospitalised Patient
- The goal is to successfully work with each patient so they feel safe and comfortable.
- Hospital patients should be approached with a calm and confident demeanour to avoid triggering their 'fight or flight' response.
- Preparation ensures efficient and smooth assessment or treatment, reducing patient stress which impacts cortisol release and healing capacity.
How to be prepared
- Know the patient.
- Assess the patient's hospital chart for additional needs, tasks, or assistance required.
- Have all necessary tools for TPR (temperature, pulse, respiration) readily available and ensure they are working.
- Have a stethoscope, thermometer, and monitoring equipment like SpO2 and NIBP on hand.
- Have a working pen, paper, or iPad chart for recording information.
- Consider specific nursing care requirements, such as urinary catheter, deafness/blindness, aggression, non-ambulatory status, or geriatric concerns.
- Have bedding and cleaning products ready.
- Ensure bedding aligns with the patient's specific nursing care and disease requirements.
- Have food and medications prepared.
- Prepare materials for any necessary pathology samples.
- Check for cage cards or behaviour notes indicating potential negative behaviours or traits.
- Conduct a visual assessment before approaching the cage.
- Check the cage front for warnings or special notes and assess the patient's body language.
- If feeling uncomfortable or fearful, seek assistance from another team member.
- Before opening the cage, talk to the patient using their name to alert them.
- If the patient does not respond to verbal cues, gently open the cage door while continuing to talk to them.
- If the patient has altered mentation, approach quietly and gently touch their back leg (away from their face) to avoid startling them.
- Be cautious about encouraging excitement.
- Diseases like tick paralysis and snake bite require careful handling to prevent aspiration, increased venom uptake, or elevated heart/respiratory rates.
- Many patients in hospital settings, especially ICU or emergency, rarely sleep well, if at all.
- If possible, delay an assessment if the patient is sleeping soundly to allow for rest and healing.
- Further Learning: Today's Veterinary Nurse - Back to Basics: https://todaysveterinarynurse.com/articles/back-to-basics/
Patient Assessment
- Patient assessment gives an indication of a patient's health or specific conditions.
- It is broken down into visual assessment from a distance and physical examination.
Visual Assessment
- The visual assessment is obtained by observing the patient from a distance.
- It allows for accurate data before stimulation can alter vital parameters, and provides clues about the patient's condition before hands-on examination.
- A visual assessment includes demeanour, respiratory rate and effort, posture, body condition, odour, abnormal sounds, and obvious injuries/defects.
Demeanour & Mentation
- Demeanour refers to a patient's outward behaviour while mentation refers to interactions and response to stimuli.
- Being in a hospital setting will significantly modify how most animals will behave, be that anxious, fearful, excited, quiet.
- It is important to talk with the patient owner, asking what the patient like at home or how they have been in the past in a hospital environment.
- Assess demeanour from outside the cage, then compare it to their demeanour upon interaction.
- Continuously assessing demeanour and mentation allows a trend for that animal so deterioration or changes are easily identified.
- Normal mentation involves appropriate interactions and responses to external stimuli.
- Disease processes and certain medications can affect mentation.
Common Demeanour and Mentation Terms
- BAR (Bright, Alert, Responsive): Generally associated with a normal, happy patient, but does not rule out illness. Sign: Tail wagging, interacting.
- QAR (Quiet, Alert, Responsive): Cats in a hospital environment, unwell, painful, scared, or reserved. Sign: Alert and responsive to stimuli but is on the quiet side.
- ANX (Distressed/Anxious): Breeds anxious in a hospital environment, any animal can become stressed in a hospital. Sign: Vocalization, panting, digging at cage, chewing cage bars, chewing/licking a bandage, overgrooming, urine spraying.
- Dull/Flat: The patient is able to get up and walk slowly and tentatively. Associated with pain or severe illness. Sign: Abnormally quiet but will still respond minimally to stimuli.
- OBT (Obtunded/Stuporous): Often very slow to respond to stimulation and cannot maintain an alert state. Quickly becomes drowsy after being stimulated. Severely unwell, such as a young kitten with hypoglycemia or a patient with severe HGE (haemorrhagic gastroenteritis). Sign: Lethargic, hard to rouse, and uninterested in their surroundings.
- COM (Comatose): At risk of arresting unless aggressive intervention is initiated. Often seen in severe cases of head trauma. Sign: Collapsed and does not respond to noxious stimuli.
- ALT (Altered): Bright but displays neurological changes, due to medications or disease process. Sign: Pacing, head pressing, head tilt, constant barking.
Respiratory Rate and Effort
- Visual assessment to see what the rate and effort are before you disturb the patient.
- This gives a more accurate representation of "normal".
- This assessment is repeated after the physical examination is done.
- From a distance, observe their respiratory rate, effort, panting (dogs), open-mouth breathing (cats), abdominal effort, posturing (elbows out, head extended), and excessive/abnormal sounds.
- Reassessment is needed ASAP for open-mouth breathing or in an animal with already concerning rates and effort.
- The patient may decompensate when performing a physical examination and should be prepared for oxygen supplementation prior to further stress.
Respiratory terms
- Eupnoea: Reliance on abdominal breathing to ventilate the lungs for gas exchange and subsequent oxygen delivery to body tissues.
- Dyspnoea: Difficulty breathing, either cannot get sufficient air into the lungs or cannot sufficiently exhale.
- Tachypnoea: Elevated respiratory rate, (Over 40 BPM).
- Bradypnoea: Reduced respiratory rate <10 BPM, less commonly due to disease process, more commonly due to medications or hypothermia.
- Normal adult dog or cat respiratory rate is 12-30; neonates is 24-60.
- There should be no exaggerated effort required to breathe and no abnormal respirations sounds.
Assessing effort
- Look at how much "work" the patient puts into breathing on inspiration and expiration.
- Diaphragmatic contraction pushes the abdominal viscera caudally and passively abdominal wall moves out.
- A patient's ability to breathe is impacted by reduced space, general pain, paralysis of respiratory muscles, and lungs filled with fluid.
- Effort for Slight increase in chest rise is mild.
- Moderate increase in the effort or "work" to breathe means moderate.
- Marked/severe increase, patient is only concentrating on breathing indicates severe.
- In dogs, this will often be seen as panting with profound effort.
- Cats will often be seen open mouth breathing - THIS IS AN EMERGENCY.
Assessing sounds
- Excessive or abnormal respiratory sounds can be of concern.
- Assess for excessive inspiratory or expiratory noise such as whistling, snoring, or coughing.
- Is the patient panting? Is it excessive? Is the patient's breathing normal?
- Additional air sound for e.g. escaping from a penetrating wound?
- Note any abnormal vocal sounds and compare that to trends and changes
- Cats with saddle thrombus may have a distinctive, high-pitched vocalization indicating extreme pain and distress.
- Dogs with tick or respiratory paralysis may have a deep vocal sound with an end-expiratory grunt.
- A cat's meow may be deep in tone with laryngeal paralysis, distinct from its normal meow.
- Panting is normal for dogs for excitement, pain, anxiety, hyperthermia, or respiratory distress.
- Difficult to tell the relevance of the panting so discuss with a veterinarian.
Posture
- Assessed constantly to determine trends that show improving or deteriorating status.
- Standing should not be mistaken for patient being well.
- Crouched means this patient could be painful, scared or defensive.
- Hunched or "prayer position" generally indicates spinal or abdominal pain.
- Recumbent means patient lying down and may be sleeping, painful, unwilling, paralyzed or mentally altered.
- Bread loaf (cat) is a relaxed, content position of feet and tail tucked under.
- Head pressing where patient has its head against the wall, this is neurologically altered.
- Further Learning: ResearchGate.net Fig 2. Pericardial-effusion-affected-dog with-respiratory- distress fig2 339892036 https://sevneurology.com/blog/dog-head-pressing/
Body Condition
- May not give you much information as to the specific issue for the pet at that point in time, it will give you significant information as to the overall health condition of the patient and will indicate additional care that you may need to provide.
- It can determine care for conditions such as underweight, overweight, joint pain or difficulty to retain heat.
- It is particularly important in patients that have been ill for an extended period.
- Further Learning: WSAVA Body Condition Score Dog: https://wsava.org/wp-content/uploads/2020/01/Body-Condition-Score-Dog.pdf and WSAVA Body Condition Score Cat: https://wsava.org/wp-content/uploads/2020/01/Cat-Body-Condition-Scoring-2017.pdf
Odour
- It will often not give you strong indication as to what is happening with the patient, certain smells will give you clues as to what is happening or that you need to prepare for specific care of the patient before getting them out of the cage.
- If the breath odour is halitosis (bad breath) this is due to significant dental disease
- If the breath is fruity, the patient is likely in diabetic ketoacidosis (DKA) and producing sweet smelling biproducts.
- General odour includes infections, diarrhoea, malodorous urine or skin disease
Obvious Injury or Defects
- Visual observation looks for obvious injuries or defects, old or new.
- Examples include wounds, fractures, dislocations, lameness, paralysis.
Performing a Physical Assessment
- It is time to get actual numbers of the patient by performing a physical examination and checking their TPR (temperature, pulse, respiration)
- Depending on the clinic, the terms may be interchangeable, at times the vet will complete the physical examination and the nurse will complete the TPR.
- If you perform it the same way every time it increases the accuracy of the information gained.
- Performing a TPR in reverse minimizes the effects of stimuli on results.
Tips for Accurate Physical Examination
- First, assess respiratory rate/effort, including SpO2 and auscultation.
- Go from head to toe.
- Record findings as you go to minimize forgetting or mixing up the numbers/results.
- Errors may be significantly detrimental to the patient.
- If possible, assess in a quiet, minimally stimulating space.
- Give TLC during the assessment to keep patient comfortable.
Parameters to Include in Examinations
| Parameter | Specifics |
|---|---|
| Temperature | Rectal or oesophageal (under anaesthesia) |
| Pulse | Heart Rate/Femoral pulse- rate Heart auscultation Pulse Rate and quality Mucous Membranes (MM) Capillary refill time (CRT) NIBP |
| Respiratory | Respiratory Rate Respiratory Effort Respiratory auscultation SpO2/ETCO2 |
| Presence of Defects/abnormalities | Presence of lumps, fractures, wounds, change in feel (i.e. is the abdomen tympanic or doughy), discharge, swelling |
| Neurological | Can the patient ambulate? Are there any changes in gait? Is the eye positioning/response normal? Mentation and Demeanour Pain and sensation Seizures? |
| Sounds | Auscultating heart, chest, abdomen Are there any other abnormal sounds? |
| Urological | Are they able to urinate? Is the urination normal? Frequency? Reproductive function (in season? Prepuce normal size, discharge) |
| Gastrointestinal | Vomiting present? What is in it? Regurgitation present? Colour? Faecal consistency? Frequency |
| Pain | What is the pain score? Where is the pain source? |
Pulse oximeters
- SpO2: Measures oxygen saturation level of haemoglobin. If a patient is not getting enough oxygen to the tissues, the saturation (%) in their blood will decrease.
- Normal SpO2 on room air should be above 97%.
- Try to do this at the start of your assessment and if possible, for the duration of the assessment.
- A good measurement to monitor for trends specifically in the patient with a disease process that is directly/indirectly affecting respiration.
- Many Pulse oximeters (the machine that measures SpO2) are manufactured specifically for people, therefore the accuracy may be affected, particularly due to the presence of a lot of hair on the skin.
- Readings locations on tongue, lip, prepuce, vulva, between toes, ear.
- Take the reading from is important to take into consideration the disease process, effectiveness of peripheral circulation (don't use the toes if you know the patient is in shock) and behaviour
- The SpO2 reading may be affected by a reduced number of red cells, skin pigmentation, poor perfusion, shock, hypothermia or patient movement.
Auscultation
- Auscultation is a great tool to assess issues with the heart and lungs.
- Always listen to as many patients as possible and consult.
- Always listen on both sides of the chest
- Lung sounds may be mimicked when the hair moves against the stethoscope
- If a patient is panting or purring you may need to distract the patient in order to hear
- Look to see if it's coming from upper or lower airway
Reading Lung Sounds
| Term/Reason | Lungs |
|---|---|
| Normal lung Sounds | Soft and Low in pitch |
| Abdnormal | Crackles, Wheezing |
| No Lung sounds | No sound due to a pneumothorax |
Heart function
When auscultating the heart we are calculating the heart rate and assessing for murmurs. Auscultation of the heart should start from the left side between the third and sixth rib of the ventral aspect of the chest. It is easier to hear the heart sounds on this side.
Normal heart rates
- Dog - Small breed 100-160 bpm
- Dog - Large Breed 60-120 bpm Dog Neonate -200 bpm
- Cat 120-200 bpm
- Cat Neonate 140-200 bpm
PMI Locations
Structure: Mitral valve (left apex) Location: Dog: left side 5th intercostal with costochondral junction OR Cat: left side, 5th-6th intercostal space near sternum Structure: Aortic Valve( Left Base) Location: Dog : Left side, 4th intercostal space, Just above costochondral junction Structure: Pulmonic Valve (Left base) Location : Dog- Left side 2-4th Intercostal space just above sternum Also Cat: 2-3rd intercostal â…“ of the way up from sternum Structure: Tricuspid valve (Right Apex) Location: Dog right side 3-5th intercostal space near sternum cat right side, 4-5th intercostal space near sternum
Heart Mummer Grading
Grade Low Intensity 1: Low intesity murmur heard in a quiet environment only after careful asucultation over a localized carciadc area Grade Low Intensity ||: Low Intensity murmer heard immedialty when the stephascope is placed over the PMI Grade Moderatiy Intercity ||| : Murmer Is at a moderate intensity Grade Moderaitely Intensity |V : Hugh intensity murmer thar can be auscultated over seversl areas with out a palpitating area Grade High intensigty |V : high intesnity murmur with a palatable Precardial thill Grade High intensity V/ high interestiy murmur with a palpable precordial thrill that may evan be heard with the stepchope is lightly lifted off the chest
Mucous Membranes
- MM are moist, inner lining of the body cavities (or some organs).
- Colour of MM can tell about the body's ability to appropriately perfuse and oxygenate tissues.
- Texture can tell us about the hydration status of the patient.
- The capillary refill time (CRT), which is the time it takes for blood supply to return to the small capillaries after they have been occluded for a short period, gives us information about hydration and peripheral perfusion.
- Indication can say if its a sign if anemia, decreased perfusion, or low O2 levels.
- Note that pigmantation on the mucus membrane of dogs affects this test so look for breed.
Texture
Moist: Normal To feel: wet but your finger doesn't stick to the gum. Tacky: A degree of dehydration is present. To feel: it's not moist, it's not dry, your finger will stick to the gums Dry: Dehydration To feel: Your finger won't stick at all, and it doesn't feel wet.
Capillary Refill Time (CRT)
Colour: 1-2 second indication: Normal CRT Prolongned: Indication of <2 seconds Short: Indications >2 seconds
Blood Pressure (NIBP)
Non invasive blood pressure measurements
Canine : Systolic 110-160 mmHg Diastolic 55-110 >80mmHg Feline: Systolic 120-170 mmHg Diastolic 70-120 mmHg >80mmHg
Hypotension & Hypertension
Hypotension- low blood pressure. This would mean map is below 60 mmHg and Systolic being Below mmHg. From this you can infer there is: hypoethermia, shock, dehydration Hypertension Is High blood pressure defined by systolic being above 140hmg in dog’s and 180 mmHg can also happen form stess or the white coat effect
Accurate Blood Pressure
Can be achieved by pre forming before blood take or taking temperatures while In environment Take average of 3 -5 readings and then Use a Doppler BP monitor
Temps
Thermogenis - ability of pet ro regulate the temperature which is effected by disease, medication, and temperature Temps can be taken from rectal, esophageal, infrared thermometer
Normal Temps are 37.8 - 39.2 c for Canine and From 38 C to 39.2C for felines please note if there differences is temps
Tips: Angle towards the rectum, use lube, can’t get good read take again.
Key Terms in Temperature
Hypothermia; temps below range caused environmental Normothermia within range Hyperthermia temp above due to environ or stress Kyresia is elevation due to infection
Pain Scaling in Patients
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Assess the patient's behaviour by using a Pain Scale will allow you to inform the pain medication to the vet
-
Each patient shuld be assessed for pain using the follow Parameter
-
Heart rate and respiratory rate
-
Blood pressure
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Elevates temps Elevating blood pressure which is a sign if is the patient is in good health if so the drug has to be decreased
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The CSU pain scale is divided by cats and dogs due to the certain positioning that it can cause
Ancillary Nursing Care
When walking out a Dog always be aware if it okay to come out for A walk the Dog can be in good health for that and after the TPR vitals you always need to use a litter box Also a walk allows him To strect the limns If has had an fractures get appropitate support If condition causes stress then provide small work or lay in place allow them to rest
Access to Nutrition
It gives body fuel this also allows for treating a feedinf tube When checkinf feeding before you see what are the allergies and there are food in the cage before hand be aware if there are medications to give
To increase food appeal - warm it ip and strong scents such as tuna Make Sure large enough the crate of food is next to crate check size - Start the Nutrition Supplement EARLY! Use Appetites stimulants if needed Ensure Pain is well controlled If anorexia continues place a feeding tube,
Precautions to Always Remember
For Medication there are Many -what’s route giving etc are any Interactions? Note it all prior Before-pre Existing help distinguish normal VS abnormal Watch weights and balance for what Is given
Hospital Charts
- Ensure accurate and legal is must
- Smart flow helps makes sure treaters are given appropriate
- Before administer swop with alcohol and then add them is medication
Intravenous Catheter
Placed for rapid venues For longevity of catheter to place are site care common locations: ceohalhc being at head or sapnoses being at leg:
- Required Equipment - chlohexifidinesoacked swabs multiple sizes of IVCs and also pre cut tape also scissors for cuts
- After procedure - must clean had’s then start process neatily clip after which an assistant will needed to immbilzied. If patient in sedation or andehestiad tourniquet can be good for placement
- Once placed - keep styehe to place in hold, after do bandage then flush, and after bandage make sure tape is not TOO TIGHT TO CAUSE BLOOD FLOW STOP AND REMOVABLE
Intravenous Catheter Care:
- Proper hand hygiene should be a priority at all times.
- Each bandage should be unwrapped and checked every 12 hours with the same actions done ASAP is discomforted
- Check for Odeamas & swelling, Phlubeits, Pyremia
- After any infection - bandaged need change
Disconnection: the cause could be due to no louer lock, occlusions causes can be too much thirst so always checked so remove always
Intravenous Catheter
- If the same is the thing is not donre re do so asap
- Must change after 72 hrs are removed cleaning each time
- Always. -Swab before injecting into ports never used cotton - and a,wye always flush minimum 4
Urinary and Fecal Tests
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0.5 % auqiws used and all equipment used
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Urinary is when all urine is tested from and is all the information that comes to the Kidney
-
Also remember to get what the doctor needs and to always used proper procerdues and make sure all info is correct
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Know patient by 12 ml /kg/ hour
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4 hrs with when urainary was placed
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IDUC always needs catheter care also be cautious when swabbing
Fecal Tests
- A test will detest virus and also Parovirus also Giarda
- These are a easy and simple as always where gloves cause parasites are at risk also for test red is bad don’t put hot things close used appoiatlye
- Stool will give you information about the gut but are not always needed Use a cotton swab and test it
- Fecal float = help diagnose parasitic but this needs an analyst to do so look for parasites egg and oocysts
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