Nursing Care and Procedures Michael Lavoie, B.S. Middlesex Community College Veterinary Assistant Program March 2012 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) 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 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 Continued… dx diagnosis ECG electrocardiogram EFA essential fatty acids eg for example EKG electrocardiogram ºF degree Fahrenheit FDA Food and Drug Administration 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) Continued… hr hour(s) IBD inflammatory bowel disease IC intracardiac IM intramuscular(ly) IN intranasal IV intravenous(ly) IVD intervertebral disc 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) 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 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 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) Sterilization Process of killing all living organisms on a surface Treatment area Exam rooms Surgical suites Several classifications 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 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 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. 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 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) 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 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 Remember… 1 teaspoon= 5 mL 1 tablespoon= 15 mL 1 ounce= 30 mL 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 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 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 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 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 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 Sterile techniques Changing of all surfaces with disinfectants to prevent spread of disease Glove wearing- animals and possible contaminants Frequent hand washing 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 QUESTIONS? 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 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 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 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 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 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 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! 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 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 QUESTIONS? 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 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 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 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 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 Things to consider A warm exam room or garden Tissues Keep things out of sight +/- use of sedatives, IV catheters Label remains accurately! 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 processkeep private Owner may want the pets collar, hair or paw prints Reactions are variable 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 QUESTIONS?