Module 3 Behaviour in a clinical setting PDF

Module 3 Behaviour in a clinical setting Canine and Feline Communication Interacting with patients in an ethologically appropriate manner aims to ensure our patient wellbeing is maintained and veterinary professionals are kept safe during the handing process. Definition Ethology is the study of anim...

Module 3 Behaviour in a clinical setting Canine and Feline Communication Interacting with patients in an ethologically appropriate manner aims to ensure our patient wellbeing is maintained and veterinary professionals are kept safe during the handing process. Definition Ethology is the study of animal behavior Basic behaviour Task 1 Review Review the following infographics on moodle and identifying the animal behaviour on your pets at home or around your neighbourhood. Infographic one: Canine body language Infographic two: Body language of fear in dogs Infographic three: Feline body language Infographic four: Stress, fear and anxiety in cats Infographic five: Understanding rabbit behaviour Caine & feline communication Fear is the most common underlying reason for our patients to show aggression, however, an animal can become aggressive for a number of reasons; illness, pain, unfamiliar environment, unfamiliar items or people, previous poor experience etc. It is our responsibility as veterinary professionals to identify escalating behaviors, view our patients holistically, and respond accordingly. Assessing behaviour in clinical setting There are four steps you can follow when assessing behaviour in a clinical setting. Observation What is the patient doing? From this, we can try and predict how a patient will react. The key is to communicate the signals that you see. Following this we pause. Pause From the signals that you see is this patient safe to approach? Or does this patient need a break from this situation? Is chemical restraint required? Reassess How we think a patient my react might be the case or things may happen in the environment that results in our patients having a sudden change in behaviour. Reassessing and revaluation is important to keep us safe. Example: A person at appears confident public speaking may be very nervous on the inside but doesn't show it. Just like us our patients can appear quite confident on the outside but are feeling quite threatened on the inside. Context Are calming signals in isolation or in combination with other signs? Example: A dog at home yawns while curly up in bed, and shows no other calming signals. This dog is simply tired. However if a yawn was combined with a lip lick, whale eyes and tense body these signs should be interpreted differently. Caines Due to the development of canines in social groups, canines have well-developed and complex means of communication in order to ensure they avoid conflict. As a veterinary professional we can use this knowledge and apply low-stress handling techniques in our veterinary environments. Below find an infographic outlining the ladder of aggression in canines. If a canine patient considers a threat to be low they will be present with low level signaling such as blinking or yawning as the threat increases so too will the canine behaviour. Trigger stacking: Stacking occurs when our patients get exposed to a number of stressful events resulting in an inability to cope. Task 1: Stop! Pause! Think! List some triggers that you can think off that our patients experience before arriving at the veterinary clinic. Watch Trigger stacking video Activity time 4 mins trigger stacking part 1 Felines Although the domesticated cat has adapted to living in a social group, its ancestor lived a solitary life, for this reason felines have not developed an intricate system of escalating signals to appease threatening behaviours. However veterinary professionals can assess the likely hood of feline patient causing harm during handling by assessing facial expressions and body language. Below find an infographic outlining visual communication signals from felines. Recap Traffic light system when to approach and when not to approach Restraint overview Small Animal Restraint: Cats and Dogs Why do we restrain animals? To enable clinical examination To enable diagnostic procedures to be performed To enable treatment e.g. bandaging or administration of medication To enable safe transport of the animal (including within the clinic) To protect both humans and the animal patient from injury Types of restraint General restraint: Most domestic animals, which have been humanely handled on a regular basis by humans, will let you restrain them for various basic procedures and/or treatments without becoming unduly stressed. Chemical restraint: In some cases, chemical restraint is required using drugs (sedatives/anaesthetic agents). This may be because the animal's behaviour or temperament (e.g. anxious, aggressive...) would make the procedure difficult or dangerous to perform with them conscious and/or the procedure itself is not suitable to be performed on a conscious animal regardless of how compliant that individual is. Chemical restraint must only be used by trained professionals (veterinarians). Examples of restraint equipment: Collars, Slip leads, Towels, Blankets, Gloves, Cat-bags, Muzzles, Control poles, Carrier cages, "Crush" cages You should only use equipment that you have been trained to use correctly and safely. Principles of restraint Key considerations Human safety: The handler and anybody else involved including bystanders. Animal safety and welfare: Do not injury the animal or cause the animal to develop a fear of restraint/handling in the future. Some of the factors that need to be considered include minimising animal stress/anxiety, and also allowing animal's to thermoregulate when being restrained (maintain an appropriate body temperature). Know and recognise behaviours that indicate when an animal of that species is stressed/unhappy. Steps for successful handling Select the correct handling method for the individual animal, the situation, and the procedure to be performed. Organise any equipment you need prior to handling the animal. This includes any equipment for restraint (cage, muzzle etc) and any materials required to perform a procedure or treatment (bandages, needles and syringes, medications etc). Identify the technique you are going to employ to restrain the animal. Is it appropriate for the procedure to be performed? What part(s) of the animal's body need to be accessed? Where will you need to position yourself when restraining the animal? BUT be prepared to adapt your technique/plan should problems arise. Use the minimum amount of restraint necessary to complete the task/achieve the goal of the restraint Unnecessary and excessive restraint can simply serve to aggravate an animal. This is especially the case with cats. Less is more with this species. Be prepared to adjust your firmness/level of restraint in response to the animal's reactions when being handled. Use restraint equipment appropriately and responsibly e.g. muzzles. Use what you are comfortable with and what you know how to use safely. Always assess the environment and animal prior to approaching or restraining. Is there a lot of noise/distractions/other people or animals in the environment which may upset the animal being restrained? Assess the animal's behaviour (friendly, anxious, aggressive?). Is this animal SAFE to approach? Does this animal have any injuries/medical conditions that may affect how it responds to being handled and restrained? Do you need to modify your technique to allow for this? Be calm and confident Animals respond to the tone of your voice and body language. Talk gently and calmly to the animal (introduce yourself). Avoid sudden movements or loud noises. Take time with frightened animals. Allow the animal to approach you. Approach dogs in an appropriate manner (slightly to their side, do not stare at them, do not lean over them, extend your hand for them to smell if they seem receptive to you, touch/pat them under their chin/neck first-not the top of their head). Be aware of how animals can injure you o Teeth, claws... o Cats are not small dogs! They have more weapons (protection): teeth, four sets of claws and a flexible body. Use commands the dog knows already o If a dog is trained to "sit" or "lie down" then use these commands to assist you to get them into an appropriate position for restraint with minimal fuss. Use treats when appropriate, if unsure do not use. Close ALL possible exits, make the area “escape proof” (windows, doors…) Know your own "escape routes" (where appropriate). People involved in the restraint of an animal need to communicate with each other Let the other person know if you can sense you are losing control of the animal/situation Finally: Recognise your limitations. Ask an experienced handler for help when required e.g. if you are unsure whether you can handle the animal safely, difficult animals, unfamiliar species, or if you are inexperienced. ❑ Tick once the section is complete Equiment Slip lead Watch How to use a slip lead Activity time 2 mins How to use a SLIP LEAD for dogs correctly Towel wrapping Watch Comfort cats in a towel wrap Activity time 4.40 Comfort cats in a towel wrap mins Watch Correctly Containing a loses cat Activity time 30 secs Correctly Containing A Loose Cat Watch Examining a feral cat. Great use of towel and feline restraint. Activity time 3 mins Examining a Feral Cat | drsophiayin.com Muzzels A variety of styles exist Select the correct type for the task at hand (basket, soft...). Questions to ask include: How long is it required to be kept on the dog, does it allow the dog to pant/thermoregulate? Drink? Select correct size for the dog and adjust head strap if necessary before applying. Dogs need to be well restrained while a muzzle is being applied. Always approach the dog from the side and place the muzzle on from behind. Dogs wearing muzzles must be closely monitored. Improvised tape muzzles can also be applied. Muzzles specifically designed for cats also exist. Caine muzzles: Basket muzzle Mikki muzzles Gauze muzzles Feline muzzles: Task 1: Stop! Pause! Think! Muzzling a cat is really not ideal and should only be used as a last resort, why do you think this is? Watch Applying a Gauze Muzzle (Start video from 1.30 – 2.30) Activity time 1 min Applying a Gauze Muzzle Control poles Should only be used as a last resort. Watch How to Use a Catch Pole Activity time 7 mins How to Use a Catch Pole Crush cages Watch How to use a crush cage Activity time 1 mins Crush Cage Other equipment Cat gloves Heavy-duty gloves used to protect your hands when handling difficult cats. E-Collars and towels Fantastic for brachycephalic patients Cat bags Not ideal towel wrapping is a far better technique, but you may see these being used in a veterinary clinic. ❑ Tick once section is complete Moving, Lifting & Distraction Moving/carrying DO NOT carry animals in your arms from one place to another. They can get a fright and injure you or themselves and/or escape. Move cats and small animals in an appropriate carrier cage (which is secure and strong enough for the animal). It can often be easier to back cats in and out of carriers/cages. Many cats do not like coming out of cages but will frequently be happy to walk back into them. Use a lead and a correctly fitted collar/harness for moving dogs (or a slip lead). Carry non-ambulatory animals on a stretcher or trolley. Secure/restrain them appropriately to prevent them from rolling off and potentially being injured. Transporting When transporting an animal in a vehicle do so in a manner that promotes both human safety and animal welfare (avoid causing a car accident!). The carrier: Escape proof containment, consideration made for things such as temperature control, water access and toileting needs. Transportation to the veterinarian clinic: Adding the use of medication to ease transportation. Listening the client and identify any signs of fear, anxiety or stress that exist in patients and advising/ coaching owner on the best approach of patient transportation. Play quite or calm music in the cars Avoid loud starling noises Pheromones on blacker or towel if available Food rewards Using a towel to cover the carrier can help block out visual stimuli Non-slip mat or towel in carrier for comfort Rewarding calm behaviour How to carry a cat in a carrier Don't Carry by handle when cat is inside Transport carrier like a suitcase Do Carry it like a fragile gift, close to the chest and held with both hands Lifting Never lift a dog > 15kg on your own. Seek help when needed General lifting rules apply Bend knees Back straight Feet shoulder width apart Palms up for better control The animal's head should be restrained properly. The animal should be held close to your body. When lifting and carrying a dog with another person it is critical to communicate (timing the lift, which side the animal is going to be placed on etc...). Make sure you say if you are losing your grip. Task 1 Watch Megan Brashear, CVT, VTS (ECC), and assistant, Hannah Cohen, demonstrate the proper procedure for lifting a dog from the floor to the table. Link to video: https://www.atdove.org/video/safe-lifting Distraction This can help in a lot of cases and is worth trying. Small distractions can draw the cat or dogs attention away from the procedure being performed. Talk to them using their name/a reassuring voice tone. Use your fingers to pat/rub/gently scratch them or gently tap their nose/head/chest. Commands, use ones familiar to the animal, sometimes a strong/confident voice can calm and settle a dog and give you enough time to do what is needed. Special considerations Young kittens: Active and wriggly- they tend to fight if they are held too tightly. Older animals: Can be less tolerant- be aware of possible medical problems that may be aggravated by handling/restraint (e.g. "arthritic" joints). Pregnant Queens and Bitches: Avoid pressure on the abdomen ❑ Tick once the section is complete Restraint for procedures Restraint for procedures Be sure to put a towel down if the surface is slippery. Muzzle dogs you are not sure of, this increases safety and your confidence. If dealing with a cat and they become aggressive/angry try burrito wrapping them (wrapping in a towel). Restraint on the side (lateral recumbency) Get the dog lying in sternal recumbency and then use your forearm positioned over the neck region to roll them over onto their side, while holding their legs. Your two forearms can then be used to exert gentle downwards pressure over the dog's body/neck as necessary to prevent them from righting themselves. It is also important to hold the limbs closest to the table/ground to prevent them from getting up (see video below). Watch Restraint in Lateral Recumbency Activity time 2 mins Restraint in Lateral Recumbency The feline hold (tabby cat below) is similar to that of the dog above, however, both the cat's top and bottom limbs are held by the handler. Special handling situations: techniques for application of eye and ear medication Eye Medication Most animals will let you apply eye drops/ointment; however, it is important to realise that many eye conditions can be quite painful and the animal may require a muzzle, burrito wrap or a second handler. Never touch the eye directly with your fingers/or the medication container. Tilt the animals head back slightly. Using your thumb on the bottom lid and index finger on the top lid, gently hold the eye open. Drop/apply the appropriate amount of medication as directed (for some eye medications we are aiming to apply it to the area inside/behind the lower eyelid). Gently close the eye and let the lids go. When the animal blinks it will coat the surface of the eye with the medication. Ear medication Use a muzzle for dogs if needed. Ear conditions can be very painful. Hold the ear pinna and gently pull it back a little way to reveal and open up the entrance to the ear canal. Drop medication into the ear as directed (try to not make loud "squelching" noises with the medication as you do this so as not to disturb the animal). Afterwards gently massage the external ear canal at the base of the ear to help distribution of the medication. Restraint for medicating Oral medication Task Giving oral medication to a canine Watch from 6.30 mins Watch Approx. time: 9.22 mins How to Give Oral Medication to Your Dog at Home Task Giving oral medication to a feline patient Watch Approx. time: 2 mins How to Administer Oral Medication to Cats Scuffling cat for procedures Scruffling a cat is not ideal, as it can be stressful and potentially painful for cats. Where possible alternative methods such as towel wrapping should be used. However, there are some indications for scruffling particularly when human safety is involved. Watch the following video that discusses the consideration for scruffling in felines. Task Watch Approx. time 6mins Consideration for scuffing feline patients https://www.atdove.org/video/considerations-for-scruffing-felinepatients Restraint for IV samples or IV catheter placement Juglar blood sampling Felines: Canines: Cephalic blood sampling Feline: Canine: Saphenous blood sampling Task Watch Saphenous blood sampling in cat Watch from 0.45-1.33 https://www.atdove.org/video/basic-feline-restraint-for-commonprocedures Bring it all together Task Watch Approx time 5 mins Basic Caine Restraint Task Watch Approx time 5 mins Basic handling restraint https://www.atdove.org/video/basic-canine-restraint https://www.atdove.org/video/basic-feline-restraint After watching the following video reflect on the assistance restraint techniques, what did you think of them and is there areas that they could improve on when restraining this patient? Take home message ❑ Mind human safety (your own and others). Mind the animal's safety and welfare. Secure the environment and be organised (what technique are you going to use? what equipment do you need?...). Assess the animal prior to approaching and restraining. Use the minimum amount of restraint necessary to get the job done safely. Make it a pleasant experience for the animal (talk to them, use treats when appropriate-if you are unsure then do not use, distract when needed-pats/tapping...). Communicate with the examiner/any other handlers. Get help if required, another handler, restraint equipment (use these appropriately). Tick once the section is complete References (Chapter 8 and 10 of your textbook) Atkinson, T., Devaney J., & Girling, H. (2011). Animal handling, restraint and transport. In B. Cooper, E. Mullineaux, & L. Turner (Eds.). BSAVA textbook of veterinary nursing (5th ed.) (pp. 228-255). Gloucester, England: British Small Animal Veterinary Association. Argyle, S., Kennedy D., & Greet, T. (2011). Medicines: pharmacology, therapeutics and dispensing. In B. Cooper, E. Mullineaux, & L. Turner (Eds.). BSAVA textbook of veterinary nursing (5th ed.) (pp. 172206). Gloucester, England: British Small Animal Veterinary Association. Fear free handling Restraint of exotic species Avian restraint Watch Parrot Handling and Restraint. The video and article can be found on the lafeberVet website, this site is free to join https://lafeber.com/vet/parrot-handling/ Link to article with video: Parrot Handling and Restraint - LafeberVet Rabbit restraint Watch handling rabbits: Handling a rabbit Read: Minimising stress during rabbit examination - https://www.veterinarypractice.com/article/minimising-stress-during-rabbit-examinations Guinea pig restraint Watch how to HOLD a Guinea Pig: How to HOLD a GUINEA PIG | How to PICK UP a Guinea Pig | HANDLING Guinea Pigs Rats and mice Watch: Handling a rat - Handling a rat ❑ Tick on the section is complete Introduction to Nutrition Terminology Digestion = process of breaking down complex nutrients into simple molecules Mechanical breakdown – allows food to pass through the GIT + increases the surface area available to digestive enzymes. Mastication (chewing) and grinding in the stomach Chemical breakdown – splitting apart chemical bonds between food particles Enzymes must be secreted in an inactive form; otherwise, the active enzymes would digest the cells in which they are synthesised Absorption = process of transporting the simple molecules across the intestinal wall into the circulation for distribution Choosing the right receptacle Inherent risk is associated for our patient and ourselves when it comes to the food dishes and feeding areas, we use a veterinary professional. Read the following article on how often you should wash your pet food bowl and answer the questions below. Task 1 Read Approx: 10 mins How often should I Wash My Pet’s food Bowls? https://www.vetstreet.com/our-pet-experts/how-often-should-i-washmy-pets-foodbowls#:~:text=Not%20only%20should%20you%20wash,FDA%2C%20also %20recommend%20washing%20your Questions: What are the potential dangers of not cleaning your patient's food and water bowls regularly? Why is it recommended to wash your hands with hot water and soap before and after handling your pet's food? How can biofilm in a patient’s water bowl impact their health? Energy An animal's energy requirements are met through the metabolism of food. Dietary intake should be sufficient to meet the need for maintenance, growth, reproduction ect. When caloric intake exceeds energy requirements this excess energy will be stored as fat (adipose tissue). Equally, if the caloric intake is less than the body's energy requirements this will result in weight loss. Energy is commonly measured in kilocalories (kcal) or kilojoules (kJ). Energy in food is provided by three main macronutrients: carbohydrates, fats and protein which will be discussed in your anatomy and physiology classes. Why is this important to know as a veterinary nurse assistant? You may be asked to work out an animal's resting energy requirement (RER). This is the amount of energy required to maintain homeostasis while the animal rests quietly in a stress-free, non-fasted, thermoneutral environment. The calculation can then be multiplied by various factors depending on the specific requirements of the animal to work out the kcal requirement for the animal. This is done using the following calculations: RER = (30 x BWkg) +70(only for animals 3-25kg) OR RER = 70 x (BWkg)^0.75 (for patient 25k) Example: For a 3kg animal Calculation 1: (30 x 3) = 90 + 70 = 160kcal/24 hours Or Calculation 2: 70 x (3)^0.75 = 159.57 kcal/24 hours Depending on life stage and activity level RER can be multiplied by a factor to calculate the animal maintenance energy requirements (MER). The table below outlines these factors. Life stages Neonate: Newborns require high energy, approximately 13-18 kcal per 100g, and should be fed every 2-4 hours when very young. This can be increased to 6 hours as they age (Cooper, B., et al. 2021). If a puppy or kitten becomes an orphan, the ideal scenario is to find a lactating bitch or queen to foster them. If this is not possible, hand-rearing is the next best alternative. Ensure an appropriate speciesspecific milk replacer is chosen for the developing offspring, as alternative milk replacers like cow or goat milk will not contain adequate amounts of protein, fat, or carbohydrates. The goal in nursing kittens and puppies is that kittens gain 18-20g of body weight (BW) per day and puppies gain 2-4g of weight per kg of adult weight per day (Cooper, B., et al. 2021). Paediatric: Key requirements for growth include energy, protein, calcium, phosphorus, and fatty acids. Puppies and kittens have higher protein requirements than adults; additionally, they require a source of omega-3 fatty acid, docosahexaenoic acid (DHA), for normal brain and retinal development, as well as a balance of calcium to phosphorus. This means that a high-quality puppy or kitten diet is best for young animals. Although the goal in feeding puppies and kittens is to provide them with a high-quality balanced, palatable diet that meets their protein, omega-3, calcium, and phosphorus needs for growth, regular mealtimes from 3-4 weeks of age are better than ad libitum (ad lib) feeding. Ad-lib feeding can not only result in obesity but also in the development of orthopedic disease in large breed dogs (Cooper, B., et al. 2021). Adult: The main concern about feeding adult animals is meeting their energy requirements, which will change if a feline or canine has been neutered or is a working animal. Please see the infographic below outlining the additional values added to each animal's MER. Pregnant + Lactating: Canine and feline requirements vary during gestation and lactation. The bitch's energy requirements do not increase from a maintenance level until the third trimester of gestation (approximately 40 days). In the third trimester, rapid growth rate of the foetus begins, with energy needs peaking at 6-8 weeks of gestation. Due to the small stomach size of canines, it is best to feed an energy-dense diet such as a pregnant/lactating bitch diet or puppy diet and provide small, frequent meals during this time (Bowland, Z., 2014). Whereas the queen's energy requirements gradually increase during gestation. The most effective way to manage a queen during pregnancy is to provide ad-lib feeding and monitor weight, allowing them to adjust their intake (Bowland, Z., 2014). Geriatric: In general, as cats and dogs age, their energy requirements decrease, which can lead to obesity as reduced movement is observed with age-related conditions. Generally, a loss of lean body mass is a main factor in old age, and sarcopenia is a common feature in most species. A high-protein diet is recommended for the senior/geriatric pet. However, protein restrictions should be implemented in the presence of renal disease. A holistic approach with regular assessment should be implemented to manage the senior/geriatric patient, as age-related conditions play a huge role in the advice given for senior and geriatric patients. Dig deeper Read Nutrition (part1) life stage diet FOUND ON MOODLE: https://moodle.unitec.ac.nz/mod/resource/view.php?id=750937 Task 1: Read: Practical veterinary nursing – Feeding the hospitalised patient LINK TO ARTILE: https://www.vettimes.co.uk/app/uploads/wp-post-topdf-enhanced-cache/1/practical-veterinary-nursing-feeding-thehospitalised-patient.pdf At level six you will be applying this knowledge and discussing nutritional support for hospitalise patients. For now, below find a scenario of a real-life application of the use of RER (this will not be examined). Scenario 1: You have been asked to work out how much of a can of Hill Digestive Care I/D is required to feed a 8kg Jack Russel Terrier. This patient is a normal neutered adult. Examining the back of the label of the Hills I/D can you see that 375kcal are found in each can. Using the RER above calculate the MER for this animal. *Answer can be found on the scenario page. ❑ Tick once the section is complete References: Cooper, B etal. (2020) BSAVA Textbook of Veterinary Nursing (6th ed.). Gloucester. British Small Aniaml Veterinary Association. Killner, J. (2008). Practical veterinary nursing – Feeding the hospitalised patient. Vet Times, May, 1– 10. Distance examination Clinical examination Assess vital signs; clinical examination: As you perform the clinical examination take the patient’s vital signs as you go, which include heart rate (HR), respiratory rate (RR) , mucous membrane (MM) colour, capillary refill time (CRT) and temperature. Ensure you leave temperature to last. “Normal” vital are as follows: Species HR (bpm) VR (brpm) BP (mmHg) Temp (⁰C) SPO2 Dog (awake) 70-140 * 10-30 * Systolic: 110-160 Diastolic: 60-90 Mean: 75-100 (Mean should never be