practical sessions april 2013

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Lab Manual VN117
2013
Introduction to medical veterinary nursing, toxicology, and
first aid
Name_________________________________
By j.hebden 2007-02-16
1
PLEASE NOTE: Your professionalism and communication skills will be a focus for
assessment by your tutor in these sessions and your animal care sessions. You may
have the opportunity to contribute to observations of these skills by completing
checklists for your classmates in these sessions.
Your professional presentation, communication, and attitude will be a focus as well as
the actual technical nursing skills. Evaluation will include checking for initiative,
cooperative team contribution, leadership, clean and tidy, appropriate language
listening skills (following instructions) personal hygiene and professional presentation
etc.
Failure to attend sufficient sessions to enable this assessment or to perform at a
reasonable professional level will result in your placement being delayed or refused
until there is evidence of a suitable standard of professional performance
By j.hebden 2007-02-16
2
Session 1
lab safety, restraint of animals, terminology, care and maintenance of equipment
Objectives



In small groups predict lab hazards and plan prevention and emergency responses
Identify a range of equipment used routinely in veterinary practice, follow
protocols to clean equipment and identify the maintenance requirements as
required
Correctly use positional terminology on work-sheets and activities with models
Reference
Seymour, J. (2003). Observation and care of the patient. In B. Cooper & D. Lane
(Eds.) Veterinary Nursing(3rd ed.)(pp83-99).Edinburgh: ButterworthHeinemann
Pasquini, C. Pasquini, S. &Spurgeon, T. (Eds.)(1997). Anatomy of domestic animals
(9th ed.). Pilot Point, USA: Sudz
Activities
1. Find the evacuation notice, the first aid kit, and the fire extinguisher. Brainstorm
the hazards that you can identify in the lab and any others that may affect the
safety of the personnel and animals we will work with next week. Be ready to
explain to the class how you will minimise eliminate or isolate the hazard.
2. Identify the following equipment: ophthalmoscope, otoscope, speculum, clippers,
muzzle, leash, cat-bag, Elizabethan collar.
3. Complete the work-sheet on equipment.
4. Identify positional terms using work-sheet and dog models
5. Identify the positions of the superficial lymph nodes and palpable pulses of the
dog cat and horse on the models and or worksheet
By j.hebden 2007-02-16
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Equipment work sheet
1. Auroscope/otoscope and opthalmoscope
Examine the otoscope. Make sure you can attach and detach the plastic cones, and
turn the light on and off. To clean the otoscope between patients only the cones need
to be disinfected. Completely immerse in an antiseptic solution. Ensure inside is
clear by passing a cotton ear bud soaked in antiseptic through the hole. Don’t force if
the hole is small
 What pathogens are likely to infect the otoscope cone? Therefore what
strength solution of your antiseptic will be appropriate? (refer to resource
sheet)
 Which disinfectants/antiseptics should not be used on these cones and why?
 How should you clean the rest of the instrument if it does become dirty?
 What is an otoscope used for?
 What is an opthalmoscope used for?
2. Speculum: Examine the speculum and clean it ensuring you gently scrub the joints.
Use the following basic protocol for cleaning instruments (when you don’t have an
ultrasonic cleaner).
Put on gloves
Rinse gross soilage and salty solutions off with cold running water
Soak in enzymatic cleaner then scrub with a toothbrush gently under warm
running water or scrub with approved instrument cleaner and rinse with warm
running water
Pat dry with a clean towel


What is the key difference in this piece of equipment from the otoscope and
opthalmoscope?
What is it used for? What other piece of equipment would be needed to make
this speculum work appropriately
3. Clippers
To clean and disinfect clippers follow the procedure outlined on a separate procedure
sheet.
4. Thermometer. Digital thermometers need to be checked to see the battery is
charged and the thermometers are cleaned before and after use with alcohol swabs.
Mercury thermometers are often held in a cetrimide or alcohol solution in the prep
room so they are suitable for the next patient. Check the reading about what to do if a
mercury thermometer is broken, (many practices still use these, although UCOL does
not because of the health risk)
5. Apply the cat muzzle to the cat (soft toy), the dog muzzle to the tiger, the e.collar to
one of the dog toys and a tape muzzle to the other. Put one of the dogs in the cat bag
as demonstrated. Ensure you do the neck Velcro up first.
By j.hebden 2007-02-16
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Worksheet: Positional terms and terminology
Positional terms refer to the diagram of the dog below
1. You have been asked to place a dog in dorsal recumbency. How would you
position him?
2. You are told that a dog has a torn plantar pad. Which feet would you check?
3. You have been asked to place a catheter in the Saphenous vein which runs on
the lateral side of the hind leg distal to the stifle. Mark this location on your
dog diagram with an X.
4. Proximal or distal?
 The hock is __________________ to the stifle
 The carpus is ___________________to the shoulder
 The elbow is __________________to the phalanges
 The hip is ___________________to the tarsus
5. Cranial or caudal?
 The elbow is ______________ to the umbilicus
 The inguinal canal is ______________ to the pinna
6. Ventral or dorsal?
 The sternum is __________________ to the vertebrae
 The anus is ___________________to the vulva
7. Medial or lateral?
 The ribs are ____________________to the lungs and heart
 The penis is ____________________to the stifle
8. External or internal?
 The pericardial sac is ____________________ to the heart
 Epidermis is _________________ the dermis
 The lumen of the gut is _______________ to the muscularis
 The endocardium is __________________ to the heart muscle
9. Superficial or deep?
 The sweat glands are _____________ in the dermis and hypodermis
 The ulcer was a shallow and _____________________ erosion of the
mucosa of the stomach
 The abscess was ______________ to the quadriceps muscle so
drainage was a problem
By j.hebden 2007-02-16
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Dog diagram positional terminology
By j.hebden 2007-02-16
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Pulses, lymph nodes and blood sampling sites
The common sites for palpation of the pulse in the dog and cat are:
 The femoral artery on the proximal and medial aspect of the thigh in the
groove caudal to the femur.
 The digital artery on the palmer aspect of the carpus
 The coccygeal artery on the ventral aspect of the base of the tail
 The lingual artery: on the underside of the tongue
The common sites for palpation of the pulse in the horse are:
 The facial artery in the notch of the mandible medial and at the rostral end of
attachment of the masseter muscle
 Transverse facial artery just caudal to the lateral canthus of the eye
 Median artery on the medial aspect of the forearm
 Great metatarsal artery between metatarsal 3 and metatarsal 4 of the hind limb.
 Digital artery(medial and lateral branches) just distal to the fetlock.
Locate these sites on the cat model and the diagram of the horse below.
By j.hebden 2007-02-16
7
Pasquini, C. Pasquini, S. &Spurgeon, T. (Eds.)(1997). Anatomy of domestic animals (9th ed.). Pilot Point, USA: Sudz, p19
By j.hebden 2007-02-16
8
Session 2
The physical examination of the dog (up to the viscera of the thorax)
Tutorial objectives
 Know how to use equipment required for a physical exam
 Use safe and effective restraint procedures required for a physical exam.
 Perform a PE and record the information using appropriate terminology
 Know the normal values for RR, PR, and temp in the dog and know why these
values are assessed in this order
 Estimate and measure the weight of a dog
 Know the characteristics of the superficial structures of the head and oral cavity,
the lymph nodes, respiratory and heart sounds.
Use correct restraint techniques at all times so proficiency can be developed.
Tip-of-the Nose to Tip-of-the-Tail approach develops consistency.
Reference
Seymour, J,(2003). Observation and care of the patient. In B. Cooper & D. Lane
(Eds.) Veterinary Nursing (3rd ed)(pp.141). Edinburgh:ButterworthHeinemann.
1. General visual inspection prior to physical examination:









Conformation
Body condition
Demeanour
Attitude
Gait
Posture
Skin and hair coat
Discharges
Abnormal noises
What is the breed of the animal?
What is the sex of the animal? (Neutered?)
Estimate its weight. Confirm(after vital signs)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Kg
2. Record TPR in the following order.
RR ---------------------per min
PR ---------------------per min
To ----------------------------oC
Why is the order important? --------------------------------------------------------------Record the pattern of breathing.
------------------------------Record the pulse characteristics.
------------------------------Rectal temperature: Is this normal?
------------------------------List causes of an elevated temperature.
In a normal animal ------------------------------------------------------------In a sick animal
------------------------------------------------------------List causes of a subnormal temperature in an animal------------------------------------
By j.hebden 2007-02-16
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3. Examine structures of head.
Overall inspection symmetry, movement of ears, eyes and nostrils.-----------------What is the colour of the conjunctival mucous membrane?
---------------------Prolapse the third eyelid
---------------------4. Examine all the structures of the oral cavity
Are the mucus membranes moist or dry and tacky?
---------------------What does this indicate about the hydration status of the animal?--------------------What is the colour of the oral mucous membrane?
---------------------Give 2 abnormal mucous membrane colours and possible causes of these
--------------------------------------------------------------------------------------------------What is the capillary refill time?
---------------------What does this indicate? -------------------------------------------------------------------Record the dentition of this animal. (I ------ C. ------ PM. ------ M------.) x 2
What are the normal dental formulae for permanent and deciduous teeth of dogs?
(I ------ C. ------ PM. ------ M------.) x 2 =deciduous teeth
(I ------ C. ------ PM. ------ M------.) x 2 =permanent teeth
At what age do permanent canine and deciduous teeth erupt?
In the dog:
deciduous teeth----------------------permanent teeth--------------In the cat:
deciduous teeth ---------------------permanent teeth--------------Why is this useful?--------------------------------------------------------------------------Examine the tonsils and the palate. Can you see the entrance to the larynx? ------5. Palpate all superficial lymph nodes
Name and locate all superficial lymph nodes in the dog.
Is there any difference in size and texture?
------------What does that signify?---------------------------------------------------------------------6. Larynx, trachea, thyroid gland
Can you elicit a cough on palpation of the larynx and trachea?
------------What does that signify?---------------------------------------------------------------------7. Auscultate the heart
Adjust the stethoscope if required
Record the heart rate while recording the pulse rate
When would the heart rate differ from the pulse rate?
What is the character of the heart rate?
-------------------------------------
8. Auscultate the lungs and airways
Are the nostrils patent?
------------How do you assess this?
---------------------------------------Describe the breath sounds in the trachea and the thorax.------------------------------
By j.hebden 2007-02-16
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Ensure that you have achieved the following objectives in this session.
1. Practiced the assessment and restraint of the animal for taking
temperature pulse and respiration. (Your technique will be
assessed in further sessions, and you need to show sufficient skill
to ensure basic safety and success using the techniques that have
been demonstrated before you will be allowed on placement)
2. Reviewed the normal values of TPR for the dog. (So you will be
able to comment on whether the TPR of your group’s dog
suggests it is appropriate to vaccinate the animal. Be able to
justify your decision).
3. Estimated the weight and weighed your dog. (Your ability to
consistently estimate the weight of dogs and cats within 10% of
their actual weight is a professional skill you are expected to
develop. Skills such as this are the things that are noted by the
work place when you are on placement and are what is noticed
when jobs are on offer).
4. Practiced naming the superficial lymph nodes as you palpated
them. (these will be assessed in tests)
5. Your performance, professional skills and presentation was
check listed. (Sufficient checklisted success in practicals
including professional presentation and skills is required as a
prerequisite for placement. Insufficient attendance will be
assessed in the same manner as insufficient skill and placement
will be delayed till the check list requirements are met)
By j.hebden 2007-02-16
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Session 3
Physical Examination II (the complete exam)
Objectives
 Use correct restraint techniques at all times so handling proficiency can be
developed.
 Develop consistency of approach in the examination.
 Complete the body systems not examined in the first session
1. General visual inspection prior to physical examination:
Record findings after observation of symmetry, conformation, body condition,
attitude, demeanour, gait, orifices, noises and odours from a distance.
------------------------------------------------------------------------------------------------------What is the breed?
------------------------------------------------------------------What is its sex?
------------------------------------------------------------------Estimate its weight. ----------------- Kg
Confirm: -----------------------------------Kg
2.
Record TPR.
RR ........................... PR .......................... T
...........................
3. Examine structures of head.
Observe for symmetry and prolapse the third eyelid.
Record the colour of the mucous membrane
---------------------------------------4. Examine the oral cavity
Mucous membrane colour and hydration
CRT
Dentition of this animal.(I ------ C. ------ PM. ------ M------.) x 2
5. Palpate lymph nodes
6. Examine larynx trachea and thyroids
7. Auscultate heart lungs and airways
Heart rate and character-----------------------------------------------------------------Patency of nostrils
--------------------Sounds and character of the breathing in the airways--------------------------------------8. Skin hair coat and trunk
Examine skin and hair coat for dermatitis wounds and allopaecia. Palpate gently for
lumps, wasting, crepitus and note any guarding. Record your findings.
------------------------------------------------------------------------------------------------------Tent the loose skin on the back of the neck or trunk and estimate the hydration status
of the animal from this finding and the other indicators you have observed.------------9. Abdomen
Gently palpate the abdominal structures, in a relaxed animal you may be able to
palpate the kidneys and bladder. Note size, consistency and any evidence of guarding
------------------------------------------------------------------------------------------------------By j.hebden 2007-02-16
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10. Visually examine and palpate the external genitalia.
Testes------------------------------------------scrotum------------------------------------------Prepuce----------------------------------------penis and urethral orifice----------------------Vulva------------------------------------------clitoris--------------------------------------------How do you examine the prostate gland? ----------------------------------------------------9. Examine the anus.
Record the tone of the anal sphincter and observe the anal reflex when you tap the
anus gently with a gloved finger. These observations are used in assessment of
anaesthetic depth ---------------------------------------------------------------------------------Palpate the two anal glands. Where are the duct openings of the glands?---------------How can you recognise you needs to express anal glands and how is that done?-------------------------------------------------------------------------------------------------------------10. Examine the mammary glands.
How many nipples are present?----------------------------------------------------------------11. Palpate the limbs and flex all limb joints.
Observe the degree of flexion and extension you achieve in all joints including the
digits
-----------------Palpate the patellas
-----------------Examine the pads of the feet
-----------------Is D1 present on the fore and hind feet?
------------------
Ensure you have used this session to perfect your techniques and have your
performance check listed for anything you did not cover or achieve last time. Also
complete the following:
1. Use your text book to guide your practice of your holds for blood collection
and injection (cephalic, jugular),
2. Practice your holds for examination and administration of medications to eyes
and ears
3. Practice ‘pilling’ your animal using the dog biscuits provided
4. Ensure your performance is recorded in the checklist
By j.hebden 2007-02-16
13
Session 4
Physical Examination of the Cat
Objectives
 Use correct restraint techniques at all times so handling proficiency can be
developed.
 Develop consistency of approach in the examination.
 Note differences in handling and anatomy and physiology of the dog and cat.
1. General visual inspection prior to physical examination:
Record findings after observation of symmetry, conformation, body condition,
attitude, demeanour, gait, orifices, noises and odours from a distance.
------------------------------------------------------------------------------------------------------What is the breed?
------------------------------------------------------------------What is its sex?
------------------------------------------------------------------Estimate its weight. ----------------- Kg
Confirm: -----------------------------------Kg
2.
Record TPR.
RR ........................... PR .......................... T
...........................
3. Examine structures of head.
Observe for symmetry and prolapse the third eyelid.
Record the colour of the mucous membrane
---------------------------------------4. Examine the oral cavity
Mucous membrane colour and hydration
CRT
Dentition of this animal.(I ------ C. ------ PM. ------ M------.) x 2
Record the dental formulae of the normal deciduous and permanent teeth of cats
(I ------ C. ------ PM. ------ M------.) x 2
(I ------ C. ------ PM. ------ M------.) x 2
Smell the breath----------------------- what does this signify?------------------------------5. Palpate lymph nodes
6. Examine larynx trachea and thyroids
7. Auscultate heart lungs and airways
Heart rate and character------------------b/min-----------------------------------------------Look for a jugular pulse. When would this occur?-----------------------------------------Patency of nostrils
--------------------Sounds and character of the breathing in the airways--------------------------------------8. Skin hair coat and trunk
Examine skin and hair coat for dermatitis wounds and allopaecia. Palpate gently for
lumps, wasting, crepitus and note any guarding. Record your findings.
------------------------------------------------------------------------------------------------------Tent the loose skin on the back of the neck or trunk and estimate the hydration status
of the animal.-------------------------------------------------------------------------------------By j.hebden 2007-02-16
14
9. Abdomen
Gently palpate the abdominal structures, in a relaxed animal you may be able to
palpate the kidneys and bladder. Note size, consistency and any evidence of guarding
------------------------------------------------------------------------------------------------------10. Visually examine and palpate the external genitalia.
Testes------------------------------------------scrotum------------------------------------------Prepuce----------------------------------------penis and urethral orifice----------------------Vulva------------------------------------------clitoris--------------------------------------------How do you sex kittens? ----------------------------------------------------9. Examine the anus.
Note the tone of the anal sphincter------------------------------------------------------------Palpate the two anal glands. Where are the duct openings of the glands? --------------10. Examine the mammary glands.
How many nipples are present?----------------------------------------------------------------11. Palpate the limbs and flex all limb joints.
Observe the degree of flexion and extension you achieve in all joints including the
digits
-----------------Palpate the patellas
-----------------Examine the pads of the feet
-----------------Is D1 present on the fore and hind feet?
------------------
Ensure you have used this session to perfect your techniques and have your
performance check listed for anything you did not cover or achieve last time.
By j.hebden 2007-02-16
15
Session 5
History taking, clinical records and handwashing for medical cases
Objectives
 Identify unprofessional behaviours of veterinary nurses and their
consequences and describe more appropriate behaviours.
 Role play client interaction
 Describe the sequence of questions that should be asked when taking a history
over the telephone.
 Review terminology
 Fill in clinical record forms for case scenarios using appropriate terminology
and abbreviations.
 Complete a worksheet of case scenarios about clinical signs and their
significance
 Watch handwashing video and practice the clinical handwash
References
Goodwin, J. (2003). First aid. In B. Cooper &D. Lane (Eds.) Veterinary Nursing (3rd
ed.) (pp.101-141). Edinburgh: Butterworth-Heinemann.
PLEASE NOTE: Your professionalism and communication skills will be a focus for
assessment by your tutor in this session.
Activities
1. With your group read the scenario you are given about an unprofessional vet
nurse.
Record these behaviours and note what you think the consequence of each
behaviour will be.
Explain how a professional vet nurse would behave in this situation
2. With your partner, practice taking a history from a typical animal owner who
has come in to make a booking for an appointment. Use Goodwin (2003) pg.
101-102 to guide the sequence of questions you ask your partner. If you are
playing the part of the owner try using your own experience of an animal with
a problem when you respond.
Record the sequence of questions you should ask.
1)
2)
3)
4)
5)
6)
7)
8)
Why should the questions follow this sequence?
By j.hebden 2007-02-16
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3. With out looking at the terminology sheet or a dictionary define the following:
oliguria,
hyperpnoea,
arrhythmia,
vascularity,
periodontal,
parapharyngeal,
supra-mammary,
lymphadenitis,
pyrexia,
pneumothorax,
pica,
icteric,
dysphagia,
pyometra,
ataxia,
syncope
4. Give the meanings of the following abbreviations:
HBC,
FX,
RADS,
DV,
VD,
BAR,
TPR,
RTG,
SX,
CRT,
CRF,
UA,
TX,
V/D,
AD LIB,
CBC,
NPO,
SR
5. Fill in the record forms you are given correctly as a case history and clinical
details are described
6. Answer the following questions about Chloe by finding the information on his
record sheet
7. After viewing the video about hand-washing, practice the clinical hand wash
that should be used between handling patients in the hospital
8.
Complete the following worksheet on disinfectants
By j.hebden 2007-02-16
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Disinfectant and antiseptic tutorial
1. Examine the products commonly available in veterinary clinics. For those
products complete the chart:
Active ingredient
Recommended use contraindications
Virkon
Trigene
Hibicet
Bleach
Dettol
Biocil
scrub(detergent
iodophor)
2. Show the calculations to make up:
300mL of 1% Virkon (Virkon is supplied as a powder)
5 litres of 0.25% bleach. (Janola is supplied as 42g/L)
3. Which products are suitable for disinfecting plastic otoscope cones and clipper
blades to ensure there is no transmission of fungi/yeast infection. (What
strength?)
4. Which product can be used for disinfecting the stones in aquariums?
By j.hebden 2007-02-16
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5. Which products can be used in the presence of organic matter? Which
cannot?
Trigene
Virkon
Janola
Povidine iodine
Hibiclens
6. Which products have residual activity?
Trigene
Virkon
Janola
Povidine iodine
Hibiclens
7. which may be used as antiseptics?
Trigene
Virkon
Janola
Povidine iodine
Hibiclens
8. When should a solution of Virkon be changed?
9. When should a solution of Hibitane used to disinfect thermometers be changed
By j.hebden 2007-02-16
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Procedure for cleaning and disinfection of cages:
Approach animal carefully(consider age, condition etc). Note cage warning tags such
as “urine sample required”. Best practice hygiene protocols essential.
(1) Remove animal from cage/kennel into a designated isolation exercise area (not
another animal’s cage), patient should be handled in a way that minimises stress,
discomfort or exacerbates its injury.
(2) Remove bed, bedding, toys feeding bowls etc
(3) Remove any gross soiling with shovel and scraper or similar equipment
(4) Hose/slosh out hair and any debris
(5) Scrub with detergent
(6) Rinse with water
(7) Apply disinfectant at correct dilution, time contact
(8) Rinse thoroughly
(9) Dry (remove excess water with a squeegee), Leave to air dry
(10) Replace bedding etc
(11) Return animal to cage
Question sheet - hospital records practical vn117
Hospitalisation Sheet
1.
2.
3.
4.
Who is the owner
What’s the animal name and what sort of animal
What will you need to ensure goes home with the animal afterwards
What comment would you make about expected temperament of dog from
these notes?
Problem Sheet
1. What problems has this animal had in the past
2. When were they resolved is anything ongoing
Hospital Record
1.
2.
3.
4.
5.
6.
What was the status of this animal when admitted.
What time was it taken for an opportunity to eliminate
What does NPD mean
What do the vital signs indicate over time
Why would the animal vomit? When did it vomit
Why did the vet sign the record at 11.30 what would the nurse have done at
11.10 and why
7. What kind of med is temgesic
8. Give the SOAP classification for the progress notes
By j.hebden 2007-02-16
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Hx for paired role play
You are an owner of a dog with a skin problem. The following are details about the
dog and the problem that you must tell your role play partner if they ask you relevant
questions. If they ask other questions you may make up the information you give but
it should not be suggestive of any clinical problem.
If asked you should say:
 The dog is a female adult Labrador
 Neutered
 Has a weeping 3 cm lesion circular on skin near tail base, reddened.
 Dog has been biting and licking area for one week.
 Has had flea treatment (advantage) but is at the end of the time of
effectiveness.
 Family was at home for holidays took the dog a lot of places. Everyone is
now back at work and the dog is left at home tied up to the kennel until the
children come home from school.
 It is summer – very hot and humid.
 1 cat in family – free range
 Weighs 37 kg – a bit overweight.
 The dog is purebred
 No other significant problems noted by owner.
 Had a problem with tartar build-up on teeth in past – not currently a problem
 Being food dog biscuits/bones/dog/roll.
By j.hebden 2007-02-16
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Session 6: sample collection and other common procedures
Objectives:
 Practice blood sampling and injection techniques
 Review urine and faecal collection techniques and equipment
 Recognise the equipment used for giving an enema and describe the protocol
for giving one
Activities:
1. Look at examples of syringes and needles and answer the following questions
 What is the difference between a central and eccentric luer on a syringe
 What is the advantage of a luer lock over a plain luer
 Needles and colour coded for the size of the aperture by the manufacturer.
Given the range of examples what is the colour code for the following
sizes: 25g, 23g, 22g, 21g, 20g, 18g, 16g.
 Which size should be used for blood sampling in a cat, medium sized dog,
and a horse
 Which length of needle is more appropriate for s/c, or i/m injection in a
horse
2. Do the exercise in drawing up a solution from a multi-dose bottle following the
protocol outlined.
3. Do the exercises in injecting medication using the S/C, I/M, I/V protocols
outlined. Read the material below outlining key points in the protocols.
4. Inspect the urinary catheters (ensure you can tell them apart from intravenous
catheters or feeding tubes). Identify the tom cat catheter and the male dog
catheter and Foley catheter. Make notes on the protocol for catheterising a cat,
male dog, female dog and discuss restraint requirements. Answer the following
questions on maintenance of indwelling catheters
 How much urine does an animal usually produce and what situations will the
amount collected be increased/decreased
 What usually happens to the USG of an animal on fluid therapy
 What are four indications for the use of an indwelling urinary catheter
 What checks are done on patients with indwelling catheters to ensure infection
is not developing
Maintenance of indwelling catheter





Flush the prepuce or vulva once daily (use dilute povidone iodine)
Ensure a closed system at all times. If the patient is disconnected for any
reason from the urine collection tubing and bag then the end of the urinary
catheter should be capped with a sterile IV catheter bung or in-stopper and the
tubing capped with a sterile, capped needle.
Flush with sterile saline once daily.
Urine dipstick once daily to check for infection.
During the first 24-48 hours of placing the catheter, blood will be seen in the
urine bag; this should clear within a few hours and is not a reason to remove
the catheter.
By j.hebden 2007-02-16
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5. Inspect and identify the enema equipment. Discuss and record a protocol for its
use
6. Inspect the materials for the Schirmer tear test and the fluorescein dye used to
identify corneal ulcers, ensure you can differentiate those from the dye used to
identify dental plaque and understand the function and precautions for use of these
three test materials
7. Discuss how you would respond to the vets instructions to “clean the orifices” of a
dog in the isolation unit with parvovirus that was recumbent and has still got
significant diarrhoea and vomiting.
8. Role play giving instructions to an owner about how to give eye and ear drops to a
cat. (animal care notes/labs will have material on protocols)
By j.hebden 2007-02-16
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Session 7
Fluid therapy
References
Leece, E. & Hill, N. (2003). High dependence nursing. In B. Cooper & D. Lane (Eds.)
Veterinary Nursing (3rd ed.)(pp.559-587). Edinburgh: ButterworthHeinemann.
Objectives
 Recognise the equipment used in fluid therapy and identify its purpose
 Know how to correctly assemble the fluid therapy set and place a catheter
 Know what to check if the IV fluids have stopped flowing in a catheterised
animal
Activities
Station 1
I.V. Administration Sets
Take the sets out of the package and familiarise yourself with the various parts by
reading the back of the package. Note the difference in the drip chambers and
identify the difference between the drop formers of the 10 and 60 drop/ml sets
Station 2
Fluid bags
Note the osmolarity of the compound sodium lactate solution as well as the individual
millimoles of
Na+
K+
Ca++
ClHCO3Total osmolarity of the solution
Station 3
Reading
Read the article and answer the following questions
 Why not use a hypodermic needle for IV fluid therapy
 What is the main disadvantage of the butterfly needles, and for what are they
mainly used.
 What is the reason the through the needle catheters are used in the jugular vein
 Why should over the needle catheters be replaced after 48 hours
 Why should the longest largest diameter catheter possible be used
 What is the function of a burette and an extension set
 A three way tap is a useful piece of ancillary equipment, why
 What is heparinised saline used for
Station 4
Connecting the bag and setting the drip rate
Connect the giving set to the fluid bag following the instructions on the back of the
box and set the drip rate to 30 drops/min. Then disconnect it so the next person can
have a go.
By j.hebden 2007-02-16
24
Station 5
Fluffy dog set up
Answer the questions on the cards then turn them over to check your answers
Station 6
Identify Equipment and practice placing and stabilising a catheter
 Identify the over the needle catheter and the butterfly needle
 Identify the T junction and the three way tap (ancillary equipment)
Place a catheter in the cardboard roll “leg” following an aseptic protocol.
Cf. protocol outlined by Leece &Hill (2003, pp.565-568)
Attach the catheters to the giving set appropriately. Place the ancillary equipment in
the fluid line and identify how you could give an intermittent injection of medication
through the ancillary equipment and the standard line
Station 7
sizes of fluid bags
Identify the different sizes of the fluid therapy bags and discuss appropriate times for
their use
Why is 5% dextrose in water (D5W) considered a hypotonic solution and which way
will this fluid move across the vascular / extra cellular boundary
Station 8
bag labels and markings
What is the purpose of the red labels on these fluid bags
What has been added and why might that be
Why are each of the recordings important
What is the purpose of the black line on one of the bags
Station 9
calculations
To calculate the total amount of fluid the animal requires over a given period of time
(unless otherwise noted this will be calculated for 24 hours(daily),you need to
consider,
 the amount of fluid the animal needs to replace the volume it is dehydrated
(replacement volume), replacement volume / rehydration requirement
 the amount of fluid the animal needs to support its normal bodily losses over
the period of time (maintenance volume), maintenance requirement
 the extra fluid it may need because it is loosing more than usual fluid due to
some pathological process eg. Vomiting, continuing losses
so to calculate an animals needs for the next 24 hours
Rehydration requirement (in litres) =
Bwt of the animal in kg x %dehydration
(% estimated from clinical signs)
Maintenance requirement (in mls) =
50 ml/kg Bwt/day
Continuing losses (in mls) =
Equal to the measured or estimated extra
fluids lost by vomiting, diarrhoea, urine
losses in renal failure or diabetes
Total volume (required in 24hours) =
total of rehydration requirement,
maintenance volume and continuing losses
By j.hebden 2007-02-16
25
NB The replacement volume is measured in litres, this should be converted to mls
before the total amount is worked out.
Eg. A 20kg dog is estimated to be 5% dehydrated and is loosing about 50 mls of fluid
each time it vomits. It is vomiting 5 times a day. To calculate the total fluid it
requires in fluid therapy over the next 24 hours…
Replacement volume (in litres) =
20kg x 5%
20kg x 0.05 = 1 litre
(1000 ml)
Maintenance volume (in mls) =
50ml x 20kg = 1000 ml
Continuing losses (in mls) =
50ml x 5 times/day = 250 ml
Total volume (required in 24hours) = 1000ml + 1000ml + 250ml = 2250ml
Examples for you- set (a)
1. A 15kg dog is estimated to be 8% dehydrated and is loosing about 50 mls of fluid
each time it vomits. It is vomiting 4 times a day. Calculate the total fluid it
requires in fluid therapy over the next 24 hours…
2. A 22kg dog is estimated to be 6% dehydrated and is loosing about 300mls of fluid
from diarrhoea each day. Calculate the total fluid it requires in fluid therapy over
the next 24 hours…
3. A 3kg cat is estimated to be 5% dehydrated and is loosing about 20 mls of fluid
each time it vomits. It is vomiting 5 times a day. Calculate the total fluid it
requires in fluid therapy over the next 24 hours…
4. A 3.5kg cat is estimated to be 8% dehydrated and is loosing 150 mls from
diarrhoea. Calculate the total fluid it requires in fluid therapy over the next 24
hours…
5. A 25kg dog is estimated to be 10% dehydrated and is loosing about 500mls of
fluid from a burn site each day. Calculate the total fluid it requires in fluid
therapy over the next 24 hours…
6. A 5kg cat is estimated to be 8% dehydrated has no extra losses. Calculate the
total fluid it requires in fluid therapy over the next 24 hours…
7. A 2.5kg cat is estimated to be 5% dehydrated and is loosing about 15 mls of fluid
each time it vomits. It is vomiting 7 times a day. Calculate the total fluid it
requires in fluid therapy over the next 24 hours…
8. A 65kg Giant Snauzer is estimated to be 10% dehydrated and has no extra losses.
Calculate the total fluid it requires in fluid therapy over the next 24 hours…
9. A 0.79kg Chihuahua pup is estimated to be 10% dehydrated and has no extra
losses. Calculate the total fluid it requires in fluid therapy over the next 24
hours…
10. A 30kg working dog is estimated to be 10% dehydrated and has no extra losses.
Calculate the total fluid it requires in fluid therapy over the next 24 hours…
By j.hebden 2007-02-16
26
To calculate the drip rate for your giving set if the fluid is to be delivered
continuously over the next 24 hours the calculation is as follows…
Step 1= find the ml/hour to deliver
Step 2= find the volume to deliver per min
Step 3= find the volume to deliver per sec
Step 4 = use the size of the drip set to work out the drops per sec to deliver
Step 4= work out how many seconds between drops
Eg. the dog in the previous example needs 2250ml in 24
hours and the fluid will be delivered continuously over that
time. To calculate the drip rate if a 10 drip/ml set is used
Amount to deliver in 1 hour = 2250 ÷ 24 hours = 93.75ml
Volume to deliver per minute = 93.75ml ÷ 60min = 1.5625 mls / min
Volume to deliver per sec = 1.5625ml / min ÷60 sec = 0.02604ml/sec
Drip rate = 0.02604ml/sec x 10 drop/ml set = 0.2604 drops / sec
This is not a countable rate so the time(secs) can be increased until the volume
can be rounded to a whole drop (but no more than + or – 0.1 of a drop)
Eg.
0.2604 drops / sec
0.5208 drops /2 sec
0.7812 drops /3 sec
1.0416 drops /4 sec
1.3020 drops /5 secs
1.5624 drops /6 sec
1.8229 drops /7 sec
2.0833 drops /8 sec
Only the amounts calculated for 4 seconds and 8 seconds are close enough to a
whole drop to round to a safe and accurate drip rate ie
1 drop /4 sec
Or
2 drops /8 sec
Examples for you – set (b)
1. A dog needs 2000ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 10 drip/ml set is used.
2. A dog needs 1680ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 20 drip/ml set is used.
3. A cat needs 600ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 60 drip/ml set is used.
4. A cat needs 550ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 30 drip/ml set is used
By j.hebden 2007-02-16
27
5. A dog needs 2400ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 60 drip/ml set is used
6. A cat needs 500ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 10 drip/ml set is used
7. A cat needs 700ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 60 drip/ml set is used
8. A dog needs 2160ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 60 drip/ml set is used
9. A dog needs 2700ml in 24 hours and the fluid will be delivered continuously over
that time. Calculate the drip rate if a 15 drip/ml set is used
The calculated drip rate should be between 0.16 and 1.5 drips /sec if you are to be
able to accurately count the drips in the drip chamber manually. If your calculated
rate is too fast or too slow, you should change the drip set you choose to deliver a
different size drop so you can count more easily. E.g.
The calculated volume to deliver is 0.028ml/sec. With a 60 drop/ml set the delivery
rate is 1.69 drops/sec or 5 drops in 3 sec
A better choice of drip set is a 10 drop /ml set. This gives a rate of 0.28drops / sec or
1 drop in 4 sec. This drip rate is much easier to set and monitor.
Some of the above calculations gave rates that were too fast or too slow for manual
counting. Try choosing a different drip set to give better rates of delivery
By j.hebden 2007-02-16
28
Answers to fluid therapy calculation examples
Set A
1. 2150ml
2. 2720ml
3. 400ml
4. 605ml
5. 4250ml
6. 650ml
7. 355ml
8. 9750ml
9. 118.5ml
10. 4500ml
Set B (rounded drip rates given )
1. 0.2314drops/sec or 0.9259drops/4sec (rounds to 1 drop/4sec)
2. 0.3888drops/sec or 1.1666drops/3sec (rounds to 1 drop/3 sec)
3. 0.4166 drops/sec or 2.0833drops/5sec (rounds to 2 drops /3 sec)
4. 0.1909drops/sec or 0.9548drops /5secs (rounds to 1 drop /5 sec)
5. 1.6666 drops/sec or 4.999drops/3 sec (rounds to 5drops/3 sec)
6. 0.057drops/sec or 1.14drops/ 20sec (rounds to 1 drop/20sec)
7. 0.4861 drops/sec or 0.9722drops/2 sec (rounds to 1 drop/2 sec)
8. 1.5 drops/sec or 3drops/2 sec
9. 0.4687drops/sec or 0.9375 drops/2 sec (rounds to 1 drop/2 sec)
question 5, and question 6 need reworking
choose any other drip set for question 5 to get the drip rate in the range but in practice
it is usual to have a limited range of giving sets available so a 10 drop/ml set would
probably be used
question 6 in practice 60 drop/ml sets are used for cats and other small animals that
brings the drip rate into an accurately countable range
By j.hebden 2007-02-16
29
Session 8
Medications and dispensing
Objectives
 Describe and recognise common drug formulations
 Perform common drug calculations
 Recognise and know the properties of various packaging(eg. safety and
information)
 Write a legal label for drugs dispensed
 Describe safe practices in handling and dispensing medications
 Describe the legal limits of the veterinary nurses ability to dispense and
administer medications
Activities
1. Look at packaging examples and answer the following questions.
 Is the following information on the packaging you inspect: brand name,
generic name, manufacturer, indications for use including species and
dosage, actions, warnings antidote and contraindications, expiry date,
volume and concentration of ingredients, route of admin, withholding
periods,
 What materials are used in the examples make a table outlining advantage
and disadvantage of each
 Highlight 3 safety issues of the packaging examples given
 Ensure you can identify the following types of packaging: blister and foil
packaging, ampoules, bottles syringes and tubes, boxes and packets,
capsules
2. Use Seymour (2003 pg. 96) and review the procedures for administering an oral
tablet or capsule to a cat or dog.
3. Look at the drug formulations and complete the worksheet on formulations and
calculations, including review of fluid therapy calculations.
4. Use the information from IVS about Clavulox tabs to write a legal label for the
medication which is to be dispensed for an infected abscess Rover the 35kg
Labrador has developed. Invent information about the animal owner and clinic as
appropriate to complete the label.
5. Read the material on storage and disposal of drugs and answer the following
questions
 What should you do with left over antibiotic tablets
 What should you do with used scalpel blades after surgery
 Why is it important to ask which fridge to store your lunch in when you go on
placement
 Why must you be careful when planning your purpose buildt clinic to consider
where the pharmacy is in relation to the reception area
 What other measures might be important to include in your pharmacy design
for “safety”
 Why is rotating drugs on the storage shelf important and what is the protocol
for doing it
 How often was the pharmacy stock checked, tidied and reordered when you
were on placement
By j.hebden 2007-02-16
30
Mandatory label information
All labels must include:















the statement “FOR ANIMAL TREATMENT ONLY”*;
the statement “RESTRICTED VETERINARY MEDICINE”, if applicable*;
trade name*;
active ingredient(s) and quantities*;
use claim(s);
directions for use;
registration number*;
withholding statements, if applicable*;
registrant/New Zealand agent and contact information;
batch number*;
expiry date*;
net contents;
storage instructions;
regulatory statements;
adverse effects, cautions and contraindications.
* Required to be on the primary label
For labels of restricted size (such as vial labels) the following minimum information
would be acceptable provided the complete information is conveyed on secondary labels
and/or the package leaflet, and the product is not marketed as a separate unit:
 trade name;
 active ingredient(s) and quantities;
 registration number;
 net contents;
 “RVM”, if applicable;
 withholding period(s), if applicable;
 batch number;
 expiry date.
eg
FOR ANIMAL TREATMENT ONLY
RESTRICTED VETERINARY MEDICINE
Rimadyl ®
Paws and claws clinic
Ph (06) 3567104
After hours ph (06)3283888
For Johnny Brown’s dog ‘Spot’
Give 1 tablet by mouth daily for 5 days
Rimadyl ® (carprophen), 75mg x 5 tabs
ACVM No:A3452
Batch # 112233
Expires 11/12/13
(store below 250C, out of reach of children and dogs, ensure water is always
available)
22/1/13
By j.hebden 2007-02-16
J.Hebden BVSc
31
Write your label for Rover below:
What are the legal requirements for a vet nurse to dispense this RVM to Rover’s
owner?(5 points)
What is the difference if the medication being dispensed is an unrestricted veterinary
medicine?
By j.hebden 2007-02-16
32
DISPENSING, FLUID THERAPY AND CALCULATIONS
A solution. The drug to be administered is dissolved in sterile water (aqueous
solution) or another type of solvent. The liquid is clear or transparent though it may
be coloured.
A suspension is a cloudy liquid in which large particles are not completely dissolved
in the liquid and tend to settle out at the bottom of the container. This mixture needs
to be stirred or shaken well before drawing up for use.
Emulsion these are cloudy liquid preparations which consist of a mixture of aqueous
solutions and oil which must be shaken before application. The lighter liquids in the
mix tend to settle out at the top of the water. These should be well shaken before
drawing up for use.
Cream is a semi-solid emulsion of oil or fat and water (which usually contains the
drug). They spread easily without friction and penetrate the outer layers of skin,
particularly if the fat is lanolin. Water soluble drugs are more active in creams than in
ointments.
Ointment – semi-solid and greasy, insoluble in water; the drugs are present in a base
of wax of fat (usually petroleum jelly). They are non-penetrating and more occlusive
than creams and are most suitable for drug chronic lesions.
Gel – is a semisolid mixture of a very large colloid molecule in water. It is clear non
greasy and water soluble.
Dusting powder finely divided powder for application to the skin, usually containing
ecto parasiticides or antibacterials.
Aerosol Spray liquid solutions or suspensions in fine droplet form.
Eye ointments or drops when applied to the surface of the cornea they melt to form a
thin film which covers the whole surface of the eye. Eye drops are aqueous and
shorter acting than ointment and therefore need to be applied more often.
Tablets an oral medication which contains the drug and some inert ingredients
(binder and excipients), tablets may be coated to:
 Protect the tablet from the atmosphere, particularly moisture
 Delay disintegration of the tablet and protect the active drug from acidic
environment of the stomach or to protect the stomach from irritant effects of
the drug
 Hide the unpleasant taste of the drug and to facilitate dosing
Capsules are oral medications that contain powder or granules. The outer case is
made of hard gelatine. Some capsules contain granules of differing size and
composition so that they dissolve at different rates, providing a sustained release of
drug from the GI tract.
By j.hebden 2007-02-16
33
Block Lick is a solid block that contains the active ingredient(s) combined with
formulating excipients (usually salt or molasses and other palatable substrates) which
is designed for large animals self medication.
Bullet is a large elliptical or cylindrical tablet which maybe metallic and heavy. It is
introduced to the stomach per os and remains there, releasing its active ingredient
over a relatively long period of time. They are commonly used for trace element
medication in livestock.
Bolus is a large tablet or device designed to deliver a large volume of active
ingredient into the GI tract which is often rapidly dissolved. Anthelmintic boluses are
a specialised form of this treatment device and may release their ingredients from a
plastic capsule.
Packaging
Drugs come in plastic or paper packs, foil, glass (clear or dark) or plastic containers.
Generally the packaging is necessary to protect the active ingredient in its original
form and to maintain the drug. In addition safety to humans, animals and the
environment also needs to be considered in packaging.
Fluids are administered:
 Orally (per os)
 Subcutaneously (SC or SQ or Subcut)
 Intravenous
 Intraperitoneal
 Intraosseus
Solutions commonly used in fluid therapy are: Whole blood, plasma, plasma
substitutes, gelatins, dextrans, crystalloids (sodium chloride, dextrose, Hartmanns
solution, Potassium chloride, Sodium bicarbonate).
Type of fluid replacement, volume and rate of infusion are calculated from history,
clinical signs and simple laboratory tests.
By j.hebden 2007-02-16
34
DISPENSING AND CALCULATIONS
Objectives
At the end of this practical session you should be able to:
1. Define and recognize common drug formulations
2. Recognise and know the reason for packaging
3. Demonstrate accurate calculations of dose rates, volumes and total medicines dispensed.
To test yourself answer the following questions.
1. A suspension is _______________________________________________________________
2. A solution is _________________________________________________________________
3. A cream is ___________________________________________________________________
4. A tablet contains ______________________________________________________________
5. Why are tablets often coated? ____________________________________________________
1.
____________________________________________________________________
2.
____________________________________________________________________
3.
____________________________________________________________________
6. What do capsules contain? ______________________________________________________
7. What is a block lick? ___________________________________________________________
____________________________________________________________________________
8. Describe a bullet (in relation to Veterinary Medication) _______________________________
____________________________________________________________________________
____________________________________________________________________________
9. Why are some injectable solutions stored in a dark stained glass bottle? ___________________
____________________________________________________________________________
____________________________________________________________________________
10. If the dose rate of a common antibiotic drug for a cat is 25 mg/kg, a cat patient weighs
4kg, the tablets are available as 50 mg tablets and the cat requires treatment for 10 days
SID. How many tablets should be dispensed for the course?
Show your calculations
____________________________________________________________________________
____________________________________________________________________________
By j.hebden 2007-02-16
35
11. The dose is required for a canine patient is 10 mg/kg and the dog weighs 18 kg. For
injection you are given a drug in solution which is 7.5%. What volume of the drug
should be given to the dog by injection?
amount of active ingredient required =DRxBWT _____________________________________
NB Tip: To convert the concentration of a solution expressed in percentage
into mg/ml which can be used to work out how much to administer, multiply the
percentage figure by 10.
conc of drug (in mg/ml) = % conc x10 = conc in mg/ml _______________________________
volume of drug required = amount / conc (in mg/ml) __________________________________
12. What are the routes available to administer fluids? ___________________________________
_______________________________________________________________________________
13. What are the veins used for IV administration in the cat, dog and horse? __________________
_______________________________________________________________________________
NB. You need to provide a poisonous plant and research next week about it
By j.hebden 2007-02-16
36
Session 9: poisonous plants research and identification
Objectives
 Identify a few of the common poisonous plants that affect companion animals and
stock
 Research and report the cause and effect prevention and treatment of some common
poisonous plants
Task
1. Present the poisonous plant you have gathered from last week in the class quiz. Be
ready to identify it for the class afterwards
2. Research your plant and present it to the class orally
3. Post your research on the moodle forum with a photo of the plant or a picture
obtained from the net of that plant
By j.hebden 2007-02-16
37
Session 14: first aid and CPR
Objectives:
 Use appropriate communication skills, triage and first aid protocols when being
the first responder to a first aid emergency
 Practice CPR protocols for large and small animals using thoracic pump or
cardiac pump method and appropriate ratios for the animals size
Task:
1. In a group research the first aid response to your scenario patient and be ready to role
play the scenario for the rest of the group
2. Practice your CPR techniques on Humphrey and the small “cat”
Remember your breathing to compression ratio, your breathing and compression rates
and your position and hand use differ with the size of the patient.
CPR technique
Always alert the veterinarian of the arrest or potential arrest situation at the
first available opportunity.
call for help
Airway







Place the patient on it’s side on a firm surface
Open and assess the back of the oral pharyngeal area (always use a
laryngoscope, if one is available).
Extend neck and pull the tongue forward
Clear any visible obstructions from the mouth
If possible intubate with a cuffed ET tube, if no tube available then use a tightfitting face mask
Check that any existing tube is in the correct position and has not become
blocked.
In the event of an upper airway obstruction, a long cannula can be passed to
the tracheal bifurcation and oxygen insufflated until an emergency
tracheostomy can be performed
Without a functioning airway all other resuscitation attempts will be unsuccessful
Breathing
 If the patient is anaesthetised at the time, turn vaporiser off, flush the circuit
with oxygen and begin ventilating with 100% oxygen at a high flow rate e.g.14 litres/minute
 Initially give the patient two breaths rapidly of 1-1.5 second duration then
artificially ventilate at a normal rate for the animal. If the patient is intubated
and an oxygen supply is available begin IPPV with 100% oxygen,
alternatively begin “mouth to tube” or “mouth to nose” at the above rate.
 Chest wall should rise and fall with each ventilation. It is important to allow
the lungs to deflate fully after each ventilation to facilitate venous return.
By j.hebden 2007-02-16
38


Reassess breathing and check pulse – no pulse, or breathing: Continue
ventilation and proceed to next step, unless directed by veterinarian to stop
CPR attempts.
Avoid lifting the patients head as this can decrease the blood flow to the brain.
Ideally the head should be in a slight downward inclination.
Circulation

Check for a palpable heart beat and take a rate by placing your hand around
the sternum midway along the ribcage (between ribs 4 and 6). You should
assess the cardiac function by feeling for a femoral pulse, if a palpable pulse is
absent you can estimate that the systolic blood pressure has dropped below
60mmHg (normal 90-110mmHg). If no femoral pulse is present you should
start cardiac compressions immediately, as cardiac output is either absent or
insufficient to sustain vital cell function even though a heartbeat may be
present.

Cardiac Pump Mechanism: This method of cardiac compression is the method
of choice for dogs weighing less than 7kg or for very narrow-chested dogs,
e.g. greyhounds. The animal should be placed in right lateral recumbency. One
or both hands are placed between the fourth or fifth intercostal space and the
chest wall is compressed with the arms being extended, force being applied by
bending at the waist. The chest should be compressed by approximately one
third in order to compress the heart and drive blood out of the heart and into
the circulatory system. In small dogs and cats (<5-7kg) the heart is
compressed by grasping the chest with the thumb and fore-fingers, just behind
the elbow and squeezing the ribs together. The rate of compressions should be
similar to the normal rate for the patient you are working with, i.e.
approximately 120bpm in the cat and 60-100bpm in the dog. The patient
should be ventilated once every fifth compressions if there are 2 people
working, if there is only one operator the rate is 15compressions to 2 breaths.
By j.hebden 2007-02-16
39

Thoracic Pump Mechanism: In larger animals or those with barrel chests, it is
not possible to achieve sufficient or effective output from the cardiac pump
method. Instead the dog should be placed in right lateral recumbency and the
chest wall compressed using the heels of both hands over the heart region at
the widest part of the chest to increase intra-thoracic pressure. This is
transmitted to the intra-thoracic vasculature, which leads to improved tissue
perfusion. You should “rock” forward with your arms held straight and your
elbows locked. A sandbag can be placed under the opposing chest wall for
support. You can either stand with the patients back towards your abdomen or
work from the ventral side of the patient. This system works because
compression of the chest wall and the organs within sets a forward flow of
blood. Rates as above.

Additional ways of improving venous return are:
1. synchronous lung inflation with chest wall compression
2. abdominal binding of the hind-limbs and abdomen. This will direct
blood flow towards the head.
3. intermittent abdominal compression. The abdomen is slowly
manually compressed as another means of improving blood flow.
4. placing the patient in dorsal recumbency and compressing the
sternum.
The effectiveness of cardiac compressions can be assessed either by the detection of a
femoral pulse, or ideally by placing a well-lubricated Doppler probe onto the cornea
of the eye and monitoring flow through the retinal vessels. It must be monitored
within 3-4 minutes of onset. If the resuscitation efforts are not sufficient, the
resuscitation method must be changed.
The following signs indicate generation of forward blood flow:
 palpation of a pulse during compression
 constriction of pupil
 improvement in mucous membrane colour
By j.hebden 2007-02-16
40
CPR is physically hard work, you should always ask for any help available, the first
person on the scene should assume the role of team coordinator until a veterinarian
can take over the role. It helps to alternate between team members so the effective
cardiac compressions can be maintained without the operator becoming tired and the
compressions less effective. If there is additional assistance available, then one person
should orchestrate the resuscitation and assign tasks, such as placement of an IV
catheter, setting up and ECG, recording drug doses, timing etc, drawing up drugs and
a ‘gofer”.
CPR must be immediate: all members of the practice should keep their CPR
knowledge current. Wall charts or instruction sheets near to work areas or in
emergency kits are an excellent way to ensure that correct techniques are followed in
time of crisis.
As a veterinary Nurse you are limited to non-invasive techniques of resuscitation,
however once a veterinarian is present then more specialised treatment can be
instigated following the DEF mnemonic. Drugs (D), Electric Defibrillation (E),
Follow-up or further treatment (F)
By j.hebden 2007-02-16
41
Session 15: dressings and bandages
Reference
Anderson, D. & Smith, J. (2007). Surgical nursing. In D.R. Lane, B. Cooper & L
Turner (Eds.), BSAVA Textbook of Veterinary Nursing (4th ed.) (pp. 590-649).
Gloucester: BSAVA.
Chandler, S. Seymour, J. & Jeffery, A.(2007) General nursing, the nursing process
and nursing models. In D.R. Lane, B. Cooper & L Turner (Eds.), BSAVA
Textbook of Veterinary Nursing (4th ed.) (pp. 246-279). Gloucester: BSAVA.
Objectives
 Explore a variety of media to find further material on this subject
 Reference researched articles using the UCOL guidelines
Activity
 Inspect bandaging and materials to identify primary contact layer materials,
secondary intermediate layers and tertiary layer materials. Make a table of the
dressings you find to identify trade name, layer type, and recommendations for
use of your bandaging materials
key questions
1. List the functions of wound dressings.
2. Describe the properties advantages and disadvantages of dressings and be able
to classify them as
 Adherent/non-adherent
 Absorbent/ non-absorbent
 Passive, interactive or bioactive
 Occlusive/semi-occlusive or non occlusive
3. Identify what stage of wound healing each is appropriate for and why.
4. List and discuss some of the more commonly used topical wound treatments
5. List and describe the properties advantages and disadvantages of secondary
and tertiary layer bandage materials. Describe the properties of
adhesive/cohesive and conforming/ loose open weave materials
6. Describe the signs that indicate a dressing change is required. Ensure you
know the time frames recommended for dressing changes for the following
dressings:
 Wet-to –dry sterile gauze swabs
 Allevyn
 Intrasite gel
 Opsite flexigrid
 Melolin
 Jelonet
7. Justify using as few as possible dressing changes as possible.
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Session 16: bandaging techniques
Reference
Anderson, D. & Smith, J. (2007). Surgical nursing. In D.R. Lane, B. Cooper & L
Turner (Eds.), BSAVA Textbook of Veterinary Nursing (4th ed.) (pp. 590-649).
Gloucester: BSAVA.
Chandler, S. Seymour, J. & Jeffery, A.(2007) General nursing, the nursing process
and nursing models. In D.R. Lane, B. Cooper & L Turner (Eds.), BSAVA
Textbook of Veterinary Nursing (4th ed.) (pp. 246-279). Gloucester: BSAVA.
Objectives
 Practice bandaging
 Practice aseptic wound swab techniques
 Review factors that affect the outcome of wound healing
Activities
1. Use the protocol outlined in J. Molyneux’s first aid treatment and cleaning of
open wounds for treating a wound, (or use a similar protocol, identify how it
was not the same and why your protocol differed in your case).
2. Use the protocol outlined in your textbook for ear bandaging
3. Apply the Robert Jones bandage to your partners arm following the methods
provided in Bandaging factsheets (1995), McCurnin (1994) or Chandler,
(2007).
4. Apply a splint to the other arm using the Zimmer splints or use your creativity
to prepare a splint for your buddies finger
5. Use the texts to identify the situations in which the following bandages are
indicated: Robert Jones, lower limb, foot, carpal and tarsal bandages, head
bandage, ear bandage, tail bandage.
6. Justify your choices of bandaging materials and identify the layers you have
used in the 2 exercises above.
7. Take a wound swab using the protocol that follows.
8. Answer the questions on the true false sheet for review.
Taking a wound swab
 Gather the swab stick, transport media, forms and biohaz bag for transport
 Prepare hands for aseptic technique (clinical hand was and open glove)
 Gently swab the area, place the swab into transport media, seal inside biohaz
bag, fill in the form with the client and animal details the date and time taken
wound and antibiotic therapy, and enclose the form in the pocket of the biohaz
bag
 Keep sample cool (not frozen) and ensure it is transported to the lab asap.
 Choose a transport media for the organisms theclinical condition indicate may
be present
 Consider doing a direct impression smear or cytological exam of exudates.
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TRUE/FALSE WORKSHEET
1. Wound exudate is a hindrance to the management of wounds
2. Epithelial migration proceeds faster in a moist environment
3. Exudate if allowed to collect under an occlusive dressing , constitutes a
favourable environment for bacterial growth
4. Bacterial contamination of a wound retards the healing process.
5. Frequent changing of soiled absorbent dressings enhances the rate of healing
6. Scabs formed on exposed wounds effectively protect a wound
7. Unsightly scars are associated with dry/exposed wounds
By j.hebden 2007-02-16
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large animal dressing and wound care practical
(on the farm: Physical examination of horses and bandaging )
References
Hosgood, G., Burba, D.J., Berg, R.J. & McIllwraith, C.W. (1994) Wound
management and bandaging. In D.M. McCurnin (Ed.) Clinical textbook for
veterinary technicians.(pp. 278-306). Philadelphia: W.B. Saunders.
Midcentral Health (1997). Initial wound care. Midcentral Health Self Directed
educational module number: wc 01.
Molyneux, J. (1997). Veterinary nursing seminar 2. Palmerston North: Pet Elite Ltd
Objectives
 Justify the preliminary assessment of the whole patient
 Identify the factors likely to interfere with wound healing: local and systemic
 Discuss and justify choices of lavage solutions and cleansing methods
 Discuss and justify bandaging techniques and choice of material for layers.
 Perform an “aseptic” dressing procedure
 Identify when and how a wound should be swabbed for culture
 Describe the properties of an effective dressing
 Identify when and why the various dressing types should be used
Activity
Use the protocols for dressings (McCurnin, 1994):lower limb, hock, carpal foot and
head bandages to practice large animal bandaging for the following scenarios:
lower limb-an acute wound needs bandaging to maximize epithelialisation of a
granulating and slightly exudative wound,
hock – a hock has had arthroscopy and needs a counter pressure bandage to limit
the swelling in the area,
a carpal bandage is required to cover a kick wound which has led to extensive
bruising and a jagged bleeding and rather muddy laceration on the cranial aspect
of the carpus.
A foot bandage is required for a large stone bruise that has just been opened and
drained.
A head bandage for a laceration over the eye received in a floating accident.
By j.hebden 2007-02-16
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Discussion and key questions
1. Discuss and justify the following guidelines for wound management from
midcentral health guidelines.
 Assess the whole patient
 Treat underlying contributing factors (relieve pressure, treat systemic
infection, etc)
 Debride necrotic and sloughy wounds
 Always use aseptic technique
 Use only clinically proven products that are hypoallergenic and nonirritant
 Know the difference between infected and colonised wounds
 Use safe cleansing solutions warmed to body temp
 Think – what is the status of the wound, what are you trying to achieve, what
products are available
 Minimise dressing changes
Discuss the relevance of these human guidelines for veterinary medicine. Discuss the
emphasis on the ‘whole patient’ and the benefits of such a rationale.
2. Discuss limitations and difficulties of aseptic technique in the farm setting.
Brainstorm - How to best achieve an aseptic technique for wound bandaging in
the yard setting. How to ensure supplies and resources are available (warm lavage
solution/an aseptic area for instruments and supplies etc.)
3. use the protocols for dressings (McCurnin, 1994):lower limb, hock, carpal foot
and head bandages to practice large animal bandaging for the following scenarios:
lower limb-an acute wound needs bandaging to maximize epithelialisation of a
granulating and slightly exudative wound,
hock – a hock has had arthroscopy and needs a counter pressure bandage to limit
the swelling in the area,
a carpal bandage is required to cover a kick wound which has led to extensive
bruising and a jagged bleeding and rather muddy laceration on the cranial aspect
of the carpus.
A foot bandage is required for a large stone bruise that has just been opened and
drained.
A head bandage for a laceration over the eye received in a floating accident.
4. Review the procedure to take a wound swab then identify the clinical situations
where wound swabs are appropriate from the following list.
Wound pain
Presence of granulation tissue
Erythema surrounding wound
Heat in wound and surrounding tissue
Temp and pulse of patient elevated
New skin tear less than 6 hours old
As a routine after suture removal
If a dry surgical wound begins to ooze
For the first three days in a major burn
Delayed healing in graft sites
By j.hebden 2007-02-16
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5. Answer the following questions relating to wound swab submission and results
 Why is important to record the site of the wound
 Why is important to record the antibiotic therapy the patient is already on
 How long is it before gram stain results are known? What is the significance
of this test?
 How long is it before culture results are known? What is the significance of
culture results?
 How long before sensitivity results are known? What is the significance of
these tests?
6. Complete the following sentences
An effective dressing should allow pus and excess exudate to drain to drain
because
An effective dressing should keep the wound surface moist because
An effective dressing should prevent the wound from cooling because
An effective dressing should act as a barrier to microorganisms because
An effective dressing should not leave particles in the wound because
An effective dressing should be removable without causing trauma because
By j.hebden 2007-02-16
47
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