lec6

• Subject: Hospitalized and Recumbent Patient Care

Care for Hospitalized Patients

• Patient needs include medical, physical and mental health
• Common inpatients include post-op cases, trauma patients, and the seriously/critically ill

Patient Routines and Kennel Setup

• Follow the patient's regular diet or offer their own food if able
• Stick to patients regular feeding schedule
• Follow the dogs regular routine
• Ask about preferred command/habits
• Home resources can ease the trauma
• Kennel setup is most important for cats
• Kennel setup includes bedding/hiding, litter preference, and pheromones

Housing Considerations

• Alert all patients when approaching
• Always approach patients slowly
• Consider wheter a kennel or open floor is best

Basic Inpatient Care

• Inform vet of any changes to the patient
• Perform a physical examinations, at least every 24 hours or as the parient condition requires, and address abnormal findings
• Keep patient clean and dry, groom and wash as required, addressing all needs without scalding
• Avoid UTIs
• Level of exercise is decided by a vet
• Be mindful that exercise may be contrainindicated
• Consider if a kennel or trolley is required for the patient
• Monitor the amount and properties of urination and defecation

Nutrition

• Prolonged anorexia might result in compromised GI tract, immune system or mentation
• Prolonged anorexia might result in infection, delayed healing or electrolyte imbalance
• Prolonged anorexia might result in Hepatic Lipidosis in cats if not careful

Nutrition Calculations - Resting Energy Requirement (RER)

• This calculation is for patient weights of above 2Kg but less than 30kg
• Use the formula: kcal/24h = (Body Weight in Kg x 30) + 70
• A dog requires frequent meals post anesthesia
• A vet prescribes 6 feedings each day
• The dog weighs 25 kg
• The dog will be eating Royal Canin Low Fat Gastro which contains 350kcal/285g per can:
  • kcal/24h = (25 x 30) + 70 = 820 kcal
  • 820kcal/350kcal per can = 2.34285714 cans per day
• Next calculation may be final one*...picture yourself in front of the patient's cage, realistically calculating the amount to feed...do not clear your calculator of this long number...just divide by 6!
• Number of cans equals approx. to 2.34
• Six feedings equals approx. to 6 feeding cans
• That equals approx 0.39 cans per feeding, this should be rounded realistically

Addressing Anorexia

• Consider reasons for refusal, such as pain, nausea, and any dietary restrictions
• Offer warm, wet foods to stimulate aroma
• Hand feed instead of bowl
• If anorexic try different types of food if allowed

Appetite Stimulants

• Mirtazapine is used as appetite stimulant in humans as an antidepressant
• Cyproheptadine is an antihistamine which inhibits serotonin receptors
• Serotonin receptor controls satiety
• Side effects of Cyproheptadine include excitement and aggression
• Cyproheptadine may take a few days to be effective

Liquid Diets and Feeding Tubes

• Liquid diets are a last resort with options like CliniCare and Emeraid Intensive Care
• Feeding Tube Options are a route for food, medications, removal of hypomotile contents
• The most common feeding tube is short term and nonsurgical
• Nasoesophageal or nasogastric tubes are placed via the nose
• Do not use nasoesophageal procedures when contraindicted
• Long term feeding tubes will be placed surgically
• Surgically placed feeding tubes include:
  • Esophagus-esophagostomy
  • Stomach-gastrostomy
  • Jejunum-jejunostomy

Recumbent Patient Care

• Non ambulatory Patients
• Bedding should include padding and pillows
• Padded grates/foam is good for e
• Underpads, yoga mats are also a good options
• Ensure that bedding is always clean & dry
• Do these things to prevent the build up of decubital ulcers:
  • Ensure that bedding is dense
  • Perform (P)ROM exercises
  • Position change

Patient Positioning

• Know the best positions for the patient
• Change positions every 2-4 hours
• Frequent movement can:
  • Prevent decubital ulcers
  • Prevent Atelectasis such as partial/complete lung collapse
• Keep a schedule and document all changes

Passive Range of Motion (PROM)

• Use PROM to maintain muscle tone and optimize perfusion
• PROM reduces the risk of decubital ulcers or ederma formation
• PROM will promote joint fluid production and prevent joint contracture
• PROM will promotes flexibility of tendons, ligaments and maintains the mobility of soft tissues layers
• PORM exersizes should include gentle flexion/extension and Abduction and adduction:
  • Abduction is when the limb travels away from the median plane of body
  • Abduction is when the limb travels towards median plane of body
• Cicumduct movement in circle motions
• Perform movement in short sessions frequently

Bladder Management

• Empty the bladder regularly to avoid urine scald or urinary tract infections (UTI)
• Prevent bladder wall overstretching and make the patient more comfortable

Urinary Catheter Management

• Intermittently insert a urinary catheter and remove when the bladder his emptied, or indwell for longer periods
• Record the patients volume in and volume out
• Record the characteristics of bladder contents
• Record the specific gravity of content
• Use antiseptics to clean the collection system a minimum of every 6 hours

Constipation

• This condition leads to excessive fecal matter in the rectum and colon
• Clinical signs include straining, abdominal pain, hunched posture, lack of eating, vomiting, and lethargy

Causes of Constipation

• Environmental factors such as a change in routine or litter type
• Pain from an injury, impacted anal glands, or nurological issue
• Obstruction from tumors, trauma, or a foreign material such as hair
• Dehydration due to medications or insufficient water intake
• GI Motility from electrolyte imbalances, intestinal inflammation, or medication
• Megacolon from hypomotility and dilation of the large intestine

Enema Procedure

• Enemas uses warm water, a water soluble lubricant
• Use Microlax or diluted dish soap solution
• Perform this outside or in a bathtub
• It is impirtant to lubricate a large size catheter and push far enough in for best results
• Can expect results in minutes, but up to hours

Maintaining GI Health

• Increase GI motility via:
  • High fibre diet for larger stool
  • A low fibre diet to assist with stool removal
  • Drugs such as Cisapride to increase muscle contractions

Eye Care

• Eye care is to avoid tear production or reduced blink activity (Regular cleaning or Lubrication)

Oral Care

• Is important because increases bacterial growth in oral cavity
• Oral care +/- mild oral antiseptic solution if necessary

Subcutaneous Fluids

• Can replenish and provide support for renal failure through urination

Fluids For Replacement - Equipment

• Can use:
  • 60 cc syringe and butterfly infusion set with smaller needles
  • Multiple syringes if the volume exceeds 60 mL
  • Fluid bag/line/needle, but amount administered is not exact

Monitoring SQ Fluids

• It is important to educate yourself and the owner regarding a patient fluid over load

Fluid Administration Recommendation - Home vs Clinic

• It is less stress on pet if administered at home, and if environment if familiar
• In some cases it easier for the client, making more easier for patient and client
• Can reduce client costs with supplies at home
• Clinic has trained staff to perfom procedures
• They are able to perform the patient monitoring during/post procedure
• Clinic is also adjust rate vs cost reduction

Fluid Administration Contraindications - Home vs Clinic

• Monitoring may be difficult to do correctly at home with regards of volume and location
• Stress for the client and the cooperation of the animal
• If not preformed safely maintenance with needles must be done properly
• Clinic may be stressful and more costly with less compliance

Euthanasia Considerations

• Requests must be honoured for the patients warefare, or chroncially ill patient
• Can be tough from an emotional stand point or if there are behavioural issues
• Regardless of the reason, there is not judgement

Euthanasia Procedure

• Offer client time to visit
• Via IV catheter
• Pelvic limb is a better option-
• Ensure IV patency

Euthanasia Drugs

• Can use a Propofol or Aceproamazine sedation
• Sodium Pentobarbital is commonly used for euthanasia
• This barbiturate depresses the central nervous system and is a controlled substance
• Animal becomes unconscious and stops breathing, resulting in cardiac arrest

Potential Complications

• The animal may struggle or vocalize during the procedure
• Studies have shown that this can disturb clients even if the animal is not actually conscious
• It is important to inform the client of the rare reaction
• Administer sedation prior to reduce this factor