Tag: veterinary doctors

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Medical Nursing for Veterinary Technicians

Part 1: Orogastric tube placement

Orogastric tube is normally used to decompress the stomach of the patient, especially if the stomach is distended so much that it makes it difficult for adequate ventilation. Decompression is done by placing the orogastric tube (a flexible tube) into the canine’s mouth into the stomach (Jack & Watson, n.d.).

Procedure of placing and removing orogastric tube

Similar to any other procedure, several steps are needed to conduct this process to ensure safe tube placement and efficient decompression.  To begin with, the healthcare provider must prepare in advance all the equipment required, as indicated by the proper sizes of tubes as based with the patient’s age. The healthcare provider must get donned with the appropriate personal protective equipment to protect the canine and himself from infection causative agents (Jack, Watson & Heeren, 2014).

 The patient is then properly positioned. For instance, in non-trauma and non-intubated patient, the head should be placed in a flexed position. This helps easier passage of the orogastric tube through the oesophagus. However, most of the patients that demand gastric decompression are often intubated; thus, head movements may jeopardize positioning of the endotracheal tube. In this case, the head position should be neutral.

To estimate the depth of tube, measurements should be done from the mouth, around the patient ears to position just below the xyphoid process.  Starting from the procedure, the distal end of the tube must be coated with a lubricant that is water soluble (usually Viscous Lidocaine) to minimize injuries and discomforts (Jack, Watson & Heeren, 2014).

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 For the intubated patients, the endotracheal tube should be held by the assistant provider firmly, as the provider inserts the orogastric tube in the mouth, down to the oesophagus. The tube should pass with ease, and if any resistance is felt; then it should be withdrawn and procedures begun again. The tube is then placed on the premeasured depth.  The syringe is then inserted at the end of the orogastric tube to withdraw the stomach content. In advanced healthcare facility, the tube is hooked directly to suction that will withdraw gastric contents. 

To ensure that the tube is properly place, a syringe filled with air is usually placed on one end of orogastric tube, and the provider listens above epigastrum instil air rapidly at least 20cc. If it was well placed, the injected air is heard. The tube is then secured in place using a tape (Kirk, Othmer, Grayson & Eckroth, 2013).

 If the correct placement of orogastric tube is bot confirmed, it should be removed immediately.  The tube should be removed immediately if the patient develops shortness of breath or breathing difficulties. During the removal procedure, the patient should be administered with activated charcoal through the tube, by either blowing it into the tube of flushing with water.

The tube should be kinked to prevent the aspiration of lavage fluid.  Once the tube has been kinked, it should be removed in one quick sweep. The patient should be extubated upon the return of gag reflex. The patient should remain head elevated in sternal recumbency position to avoid aspiration (Osweiler, 2011).

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Advantages and contraindications

The advantage of this procedure is that it facilitates the decompression of air from the patient distended stomach, thus improving the patient’s ventilation. Additionally, it orogastric tube is also used to empty the stomach content to avoid regurgitation and potential aspiration. This root is preferred as it helps minimize health complications that occur with the nasal routes such as bleeding and nasal trauma.

The contraindications of this method is that it should not be performed in patients identified with intact gag reflex, but it is the most safe methods for patients with major trauma in  the head, spinal cord or facial as it minimizes complications (Kirk, Othmer, Grayson & Eckroth, 2013).

Complications of orogastric tube placement

If the tube is well inserted, minimal complications should arise. However, some of the complications noted includes mal-positioning of the tube causing discomfort. Oesophageal variceal haemorrhage and posterior pharyngeal perforations could occur during insertion. The complications that could arise during use include reflux, sinusitis, blockage and kinking of the tube. In some cases, unprecedented dislodgement could occur and mucosal adherence complications could arise during removal processes (Osweiler, 2011).

Part 2:  Fluid administration

1. Physical parameters

 Fluid therapy is very vital for most of the medical conditions for veterinary patients. To identify the exact need for fluid therapy, the patient history and physical exam findings play a huge role in determining the fluid selection, volume, location needed and composition of the fluid. Therefore, fluid administration is individualised to patient needs (O’Grady, 2011).  

The health assessment conducted includes pulse rate, respiratory rates, lung sounds, body weight, skin turgor, mental state, and mucous membrane colour and temperature extremity. These assessments provide clue of dehydration. The clinical signs that correspond to dehydration percentages are shown below (Gajewski and Hillel, 2012).  

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2. Phases of fluid therapy for feline patient

 The patient in this case study is a cat that weighs 8 lbs; dehydration rate is reported at 10%. The patient does not present signs of shock. The cat does not suffer from diarrhoea or vomiting.

 a) Calculating the fluid need rates

 To identify the fluid replacement volume, the veterinarian needs to know the dehydration percentage, the ongoing fluid losses as well as the fluid maintenance requirement. This is calculated as based using the following formula (Hansen, 2012).;

 Fluid deficit (ml) = Body weight in Kg x percentage dehydration (in decimal point)

The ongoing fluid loss includes sensible as well as the insensible fluid losses. The sensible fluid losses include those which can be quantified such as urination. The insensible losses includes   those which cannot be quantified e.g. through faeces and cutaneous losses.  Maintenance fluid is the volume required by the patient per day to sustain the patient balance.

Most of the providers apply the standard requirements such as 40- 60 ml/kg/day.  However, it is important to monitor the maintenance requirements by calculating the hydration deficit.  In this case, the patient is has no ongoing losses, thus the fluid maintenance is as calculated below (Davis, 2013).

Fluid deficit (ml) = Body weight (lb) X percentage dehydration (in decimal) X 500

                                    8 x 0.1 x 500 = 40ml/kg/day

Monitoring IV fluid therapy and its importance

 The patient IV fluid therapy is monitored by conducting serial measurement of the body weight to monitor excessive or inadequate fluid therapy. The new weights will be compared with the base line weight. The serum chlorides measurements will also be conducted to enable identify electrolytes imbalances. The measurements of urinary output are a good indicator of fluid balance. Therefore, monitoring is important it enables the veterinarian identify of there is over or under provision of fluid; and early identification of electrolyte imbalances that could lead to further complications (O’Grady, 2011).

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Part 3 Dental Prophylaxis

a) Difference between horse and dog teeth

Like any living animals that have teeth, horses and dogs have premolars, molars, incisors and canines. The tooth structure is similar to the other animals.  The horses have hyposodont tooth and the jaw conformation is anisognathic. The upper jaw and the maxilla are considerably wider in comparison of the mandible and the lower jaw (Kirk, Othmer, Grayson & Eckroth, 2013).

This enables the horse maximize their chewing efficiency, making them fed adequately for long time.  On the other hand, dogs are carnivore and thus their teeth reflect the evolutionary history of carnivores. However, pet dogs are omnivores; which requires dental management practices such as prophylaxis. The differences of the two species teeth is as summarized in table 1.2 below (Berkovitz, Moxham, Linden & Sloan, 2010):

b) Importance of dental prophylaxis in both species

 The dental prophylaxis consists of examination of oral dental, coupled with odontoplasty of the enamel points that are extremely sharp.  In horses, the sharp enamels should be removed two times year when the permanent dentition; and after as many times as required, depending on the horse management practices. For horses that graze freely in the range may require dental prophylaxis yearly; whereas those confined should be done twice a year. In dogs, they should have dental prophylaxis performed at least once per year (Gajewski and Hillel, 2012). 

In both, the aim and importance of this practice is to remove the sharp enamel edges that could cause irritation of the soft tissue. Additionally, it is also done to clean the two species teeth and make the evaluation of the oral cavities or any dental related health complication present (Kirk, Othmer, Grayson & Eckroth, 2013).

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c) Comparison of dental prophylaxis procedures in both species

 The procedure is quite similar, where the animals are put under general anaesthetic care, to ensure that the patient is comfortable and to ensure effective cleaning. It also allows insertion of endotracheal tube in the trachea of the patients, in order to protect the bacteria from cleaned teeth from invading the lungs. The dental prophylaxis includes (Berkovitz, Moxham, Linden & Sloan, 2010):

 a) supra-gingival cleaning; which involves the cleaning of the regions above the gum line done suing the mechanical scalers.

 b)  Subgingival cleaning; involves cleaning of the ears below the gum line to remove the plaques as well as the calculus responsible for periodontal infection. This stage mainly causes the roughening of the teeth.

c) Polishing;  The roughened surfaces increases retentive ability of plaque and calculus, causing faster build up  and progression of periodontal disease progression. Polishing is done to smoothen tooth surface, reducing the adhesive plaque ability.

d) Sulcal and subgingival lavage; the polishing as well as the scaling and polishing makes lots of debris get trapped, the gingiva is flushed with antibacterial solution, where periodontal disease occurs, then it is flushing is done using saline. 

e) Fluoride treatment; done to strengthen and harden the dentin, which causes the tooth sensitivity to reduce, and is known to retard the formation lesions.

f) Treatment planning; done using dental graphs and all other modalities responsible in reestablishment of oral health.

g) Dental charting: involves recording if the findings and oral health recommendations. The chart is used to examine the disease progression or regression.

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Part 4

What is CPR? What is its goal?

 Cardiopulmonary Resuscitation (CPR)  is used  to check dog’s heartbeat when the dogs gets accidentally  injured and stops  breathing with the aim of bringing it back to life.  The pet’s owner should report the incidence to the provider so that they can prepare the emergency room adequately. The procedure used to perform CPR includes is described (Sirois, 2013).

 Procedure of performing CPR

To begin with, the veterinary should be armed with their crash cart. The basic items in this cart include endotracheal tube, needles/syringes, Dopram, IV catheter supplies, bandaging materials, epinephrine and atropine. To perform CPR, the dog’s mouth is open gently, and the tongue pulled out.  The dog’s neck and head is straightened gently to avoid further injuries. The dog’s chest is examined to check sign of respiration (Sirois, 2013); which can be evaluated by holding the dog’s mouth to feel any respirations.

If the dog is not breathing, then one performs mouth to snout by holding the mouth closed, the provider should cup his or her hand around the dog’s nose and blow two breaths into the dog’s snout. The breathing should go in, the procedure should be continued. The recommended breaths are one breath for every 3 seconds or an average or 20 breaths/min (Macintire et al., 2012).

The next step is to check for circulation. The dog’s femoral artery should be checked to check if it has pulse. If no pulses are felt, chest compressions should be done. The dog should be positions on its right side; the dog’s chest is located (normally at the position where elbow joins the ribcage).  The compression should be done based on the dog’s size. For dogs below 16 pounds, compression should be done using thumb and forefinger in both chest sides (Jack, Watson & Heeren, 2014).

For larger dogs, palm method compression is the most effective.  The compression should be done 1.5 inches for each compression.  The compression rate which is recommended should be at least 3 compressions/ 2 seconds.  For every 15 compressions, at least two breaths should be done. Where there are no abdominal injuries, the healthcare provider assistant should perform interposed compression of the abdominal simultaneously.  This aids in making the blood flow back to the heart. The CPR procedures should be repeated until the sign for breathing or pulse is heard from the dog (Lopate, 2012).

References

Berkovitz, B., Moxham, B., Linden, R., & Sloan, A. (2010). Master Dentistry Volume 3 Oral Biology. London: Elsevier Health Sciences UK.

Davis H. (2013). Fluid therapy for veterinary technicians. Retrieved from http://www.dcavm.org/11%20oct%20 technotes2.pdf.

Gajewski M, Hillel Z. (2012). Anesthesia management of patients with hypertrophic obstructive cardiomyopathy. Prog Cardiovasc Dis 2012;54(6):503–11.

Hansen B.(2012). Technical aspects of fluid therapy. In: DiBartola SP, ed. Fluid, electrolyte, and acid-base disorders in small animal practice. 4th ed. St. Louis (MO): Elsevier Saunders; 2012:373

Jack, C., & Watson, P. Veterinary technician’s daily reference guide.

Jack, C., Watson, P., & Heeren, V. (2014). Veterinary Technician’s Daily Reference Guide: Canine and Feline, 3rd Editi. John Wiley & Sons.

Kirk, R., Othmer, D., Grayson, M., & Eckroth, D. (1984). Encyclopedia of chemical technology, third edition. New York: Wiley.

Lopate, C. (2012). Management of Pregnant and Neonatal Dogs, Cats, and Exotic Pets. Hoboken: John Wiley & Sons.

Macintire, D.K., Drobatz, K.J., Haskins, S.C., et al.(2012). eds. Manual of small animal emergency and critical care medicine. 2nd ed. Philadelphia (PA): Wiley Blackwell:69.

O’Grady, NP. (2011). Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheterrelated infections, 2011. Department of Health & Human Services, USA. Centers for Disease Control. Retrieved from www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.

Osweiler, G. (2011). Small animal toxicology. Ames, Iowa: Wiley-Blackwell.

Sirois, M. (2013). Mosby’s Veterinary PDQ. London: Elsevier Health Sciences.

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