Nursing Care and Procedures

1. Nursing Care and Procedures Michael Lavoie, B.S. Middlesex Community College Veterinary Assistant Program March 2012

2. Common Abbreviations in the Vet Field • Ab antibody • AD right ear • AS left ear • AU both ears • ACL anterior cruciate ligament • ad lib as much as desired • ag antigen • ant. anterior • AP anterior posterior • bid twice a day (can also be written q12hrs)

3. Continued… • BP blood pressure • BW body weight • ºC degree Celsius (centigrade) • Ca calcium • cal calorie(s) • cc cubic centimeter • CDC Centers for Disease Control and Prevention • CF cardiac failure

4. Continued… • CHF congestive heart failure • CNS central nervous system • CPR cardiopulmonary resuscitation • CSF cerebrospinal fluid • DEA Drug Enforcement Agency • DJD degenerative joint disease • dL deciliter(s) • DM diabetes mellitus

5. Continued… • dx diagnosis • ECG electrocardiogram • EFA essential fatty acids • eg for example • EKG electrocardiogram • ºF degree Fahrenheit • FDA Food and Drug Administration

6. Continued… • FeLV feline leukemia virus • FIP feline infectious peritonitis • FIV feline immunodeficiency virus • FLUTD feline lower urinary tract disease • FUO fever of undetermined origin • fx fracture • g gram(s) • GDV gastric dilatation and volvulus GI gastrointestinal • gr grain(s)

7. Continued… • hr hour(s) • IBD inflammatory bowel disease • IC intracardiac • IM intramuscular(ly) • IN intranasal • IV intravenous(ly) • IVD intervertebral disc

8. Continued… • kg kilogram(s) • L liter(s) • lat. Lateral • lb pounds (may be written #) • LPF low-power field • m meter(s) • mEq milliequivalent(s) • µg microgram • mg milligram(s)

9. Continued • min minute(s) • mL milliliter(s) • MLV modified live virus • mm millimeter(s) • mo month(s) • MRI magnetic resonance imaging • NAF no abnormalities found • NSAIDS non-steroidal anti-inflammatories • O2 oxygen

10. Continued • OD right eye • OS left eye • OU both eyes • OTC over the counter • oz ounce(s) • PCV packed cell volume • PE physical exam • plt platelet • PO per os • PRN as required • qid four times daily q4h every 4 hours

11. qod every other day • RBC red blood cell(s) • rx treatment, prescription • SC subcutaneous(ly) • Sub Q subcutaneous(ly) • sx surgery • tid three times daily, q8hrs • UTI urinary tract infection • VD ventral dorsal • WBC white blood cell • wk week(s) • wt weight • yr year(s)

12. Sterilization • Process of killing all living organisms on a surface • Treatment area • Exam rooms • Surgical suites • Several classifications

13. Cold Sterilization • Process of soaking items in a disinfectant chemical until they are cleansed for reuse • Cold trays hold a chemical that acts as a sterilizing agent • Items that are used often and require a simple and quick sanitation method • Brushes, nail clippers, some instruments • Endotracheal tubes

14. Dry heat or incineration • Use of flame by exposing an item to extreme heat or through incineration • Incinerator- used to burn the remains of items that have the potential to spread disease • Incineration- necessary with biological hazards, medical wastes, and animal remains • Requires the items to be burned to ashes to prevent the spread of disease

15. Autoclave • Sterilizes items, especially surgical equipment • Autoclave- piece of equipment in the form of a sealed chamber • Objects are exposed to heat and steam under pressure at extremely hot temperatures to kill living organisms • Special preparation of instruments requires- different layers to protect instruments and self life • Indicator tape.

16. Radiation and ultrasound • Another method of sterilization • Radiation- use of ultraviolet or gamma rays that radiate and kill living organisms • Ultrasound- passage of high frequency sound waves through a solution to create a vibration that scrubs an item to remove debris • Ultrasonic cleaner- machine where items soak in a solution that vibrates and remove dirt and debris • Used primarily for surgical instruments/equipment • Done prior to packing instruments for autoclaving • Part of the cleaning process

17. Filtration • Method of sanitation • Remove particles from the air using a physical barrier • Common in lab areas, research facilities • Usually entails a separate room that is entered prior to entering the area where animals are housed or contained • Pressurized room that prevents organisms from entering a facility • Sterile clothing and personal protective equipment (PPE)

18. Sanitation • Involves cleaning and disinfecting the veterinary facility • Controls the direct spread of organisms on surfaces, in the air and on other objects within the facility • Employees must follow standard sanitation procedures and policies • Failure- harm to patients, loss of clients, decrease in revenue, loss of jobs • Awareness of potential transmission of diseases from patient to patient and patient to people

19. Sanitation chemicals and cleaners • Handle with care • Some have harmful vapors • Can cause burns • Always read the label or MSDS (material safety data sheet) • Proper dilution • Wear gloves, goggles • Specific chemicals for specific areas

20. Remember… • 1 teaspoon= 5 mL • 1 tablespoon= 15 mL • 1 ounce= 30 mL

21. Antiseptics • Solutions that destroy microorganisms or inhibit their growth on living tissue • Effective disinfecting agents • Variety of properties that alter their uses and effectiveness • Spectrum of activity- what the agent will kill • Concentration of the solution- strength of the solution • Contact time- how long the disinfectant should sit • Appropriate surface uses • Inhibiting factors- uses that should be avoided • Toxic effects- hazardous effects the agent may have to humans or animals

22. Types/names • Chlorhexidine solution- disinfectant • Chlorhexidine scrub- disinfectant and antiseptic • Bleach- cleaner and disinfectant • Alcohol- disinfectant and antiseptic • Hydrogen peroxide- antiseptic • Betadine/iodine- disinfectant and antiseptic • Formaldehyde- disinfectant

23. Hand Hygiene • Handwashing • Most common method of spreading disease- direct hand contact • Sneezing • Coughing • Restrooms • Touching or handling each animal • Money • Direct contact with people • Phones • Door handles

24. Proper hand washing • Antibacterial soap and use water or hand sanitizer • Avoid wearing jewelry, fake nails, long nails • Post reminder signs • Moisturizers at wash stations

25. Exam Room Santiation • Important part of safety and disease control • Include rooms, tools, equipment and supplies • All staff members understand and practice • Clean after every patient • Clean from top to bottom, dry to wet areas, sweep up hair and debris • Use up and down and side to side motions • Empty trash • Place items in sharps containers • Cold tray • Mop bucket- change water and mop head often

26. Antiseptic techniques • Most important principle in veterinary hospital • Practice of keeping a sterile environment and keeping the environment disease and contaminant free • Especially vital in the surgical suites • Governs how the facility is cleaned, how equipment and instruments are cleaned, and how sugical and medical procedures are preformed • A break in technique leads to possible infection, disease, and potential patient death

27. Sterile techniques • Changing of all surfaces with disinfectants to prevent spread of disease • Glove wearing- animals and possible contaminants • Frequent hand washing

28. Nosocomial infections • A human causes disease and or contamination of an animal • Unsterile surgical practices • Allowing contagious animals to contact healthy animals • Contamination of a health animal due to unsafe sterile practices with hands or equipment not being cleansed

29. QUESTIONS?

30. Veterinary Assisting • Similar to nursing care in human patients • A service and trained area essential to caring for and preventing illness and disease in hospitalized patients • Essential to the health of the patients • Team effort • Dental care, monitoring IV fluids and catheters, providing injections for the health of the patient, understand the needs and process of euthanasia

31. Dental Care • Essential part of veterinary medicine and patient care • Small animals, large animals and pocket pets • teeth brushing • Preventative dental care • Client education • Monitoring young animals for proper tooth eruption • Should be part of a yearly exam

32. Daily dental care • Feed a hard, dry diet • Hard treats • Dental toys or bones • Teeth brushing- proper method and necessary toold and supplies • No human toothpaste- non-digestible enzymes

33. Daily dental care- continued • Dentifrices- toothpaste • Variety of flavors • Safe, digestible enzymes that can easily be broken down in the animal’s body • Fish, malt, beef, poultry • Humans vs. pet toothbrushes • Needs to fit the size and shape of the animal • Pet toothbrushes- small round head, soft bristles, short narrow handle- fits comfortable into the mouth of an animal • Fingerbrush- small tool that fits on the end of the finger, thimble-like device

34. The brushing procedure • Similar to brushing one’s own teeth • Only the buccal, labial, and occlusion surfaces in animals • Buccal- the surface of the teeth, located on the outer area near the cheek • Labial- surface of the teeth in the front covered by the lips • Occlusal- top of the teeth

35. Some things to consider • It is not safe to open an animal’s mouth to brush the inside surfaces of the teeth • Injuries may be caused • Most areas are easily accessed by lifting the lips to expose the outer tooth surface • Be patient- takes time and consistency for an animal to accept • Begin with small amounts of toothpaste on the tip of your finger; allow animal to smell +/- taste

36. Other considerations • Start with your finger and then work your way up to the tooth brush • Hold the tooth brush at a 45 degree angle over the tooth • Brush in a circular pattern • Brush all teeth • Introduce at a young age • Sample kits, models, encouragement to owners • Want a pleasurable experience!

37. Dental prophylaxis • Professional cleaning by a scaling and polishing the teeth • May need to be done once a year or more • Considerations- health, age, and breed of patients • Large animals- floating • Prevents sharp edges from forming- difficulty eating • Advanced technique that requires training and experience

38. Dental prophylaxis- continued • Provided by the technician • Some participation by assistance • Involves general anesthesia • Technician scales all surfaces of the upper and lower dental arcade; polishes all tooth surfaces • Veterinarian checks any diseased areas or extracts teeth • Complete dental exam performed • Damaged teeth • Broken teeth • Gingivitis • Missing teeth • Excessive plaque

39. QUESTIONS?

40. Socialization of patients • Provide positive social interaction to all hospitalized patients during treatments, cage cleaning, and/or exercise • Talk to the animals • Pet the animals • Hold them • Use a gentle and soothing voice • Most patients are accustomed to human interaction • Put patients at ease

41. Exercise of patients • Provided to hospitalized patients if able • Important part of their recovery and treatment • Important for elimination • Walk outside in a designated and safe area • Use appropriate leashes • Proper sanitation methods • Time outside varies from patient to patient

42. Humane euthanasia • Euthanasia is the process of putting an animal to sleep using humane methods by means of a painless death • Way to end an animals suffering • Decision based on personal beliefs, religious beliefs, and previous experiences • Veterinarian guidance and recommendations • Difficult for owners as well as the veterinary staff

43. Process of euthanasia • As pain free and stress free as possible • Staff should be supportive and sympathetic to owner’s needs and values • Maintain client confidentiality • Clients signs a waiver • Discuss the procedure and process of events with clients • Determine what the owner would like done with the remains

44. Process- continued • Will the client be present? • Would the client like to pay before? • Complete all the necessary paperwork before the procedure is done • Inform a client of any legal restrictions for private/home burial • Determine how the client would like to care for the animal’s remains • Pet cemetery for burial • Private cremation • Group cremation

45. Things to consider • A warm exam room or garden • Tissues • Keep things out of sight • +/- use of sedatives, IV catheters • Label remains accurately!

46. After the euthanasia • Patient’s body will relax completely • May have agonal response • Gasps of breath while the respiratory system shuts down • May be cyanotic • Lose control of bladder and bowels • Owners may want time alone after the process- keep private • Owner may want the pets collar, hair or paw prints • Reactions are variable

47. After the euthanasia • Be respectful of the remains • Treat professionally • Place in a cadaver bag • Label the bag with an ID tag- “be accurate” • Place in appropriate area of facility or package for owner • Cardboard coffins, sheets, waterproof • Clean or disinfect exam room or area as needed • Ensure all controlled drugs and substances are recorded

48. QUESTIONS?