Clinical Small Animal Care

Promoting Patient Health through Preventative Nursing

Kimm Wuestenberg

• Publisher: Wiley-Blackwell
• Year: 2012
• Print ISBN:
  9780813805146
• eBook ISBN:
  9781118233160
• Edition: 1
• Topic: Medicine
• Subtopic: Veterinary Medicine

Clinical Small Animal Care: Promoting Patient Health through Preventative Nursing is an introduction to the principles of day-to-day veterinary practice, with coverage ranging from the initial assessment, fluid therapy monitoring, and perioperative management to care of animals with specific diseases. The book offers concrete guidance on best practices for promoting patient health in veterinary care, emphasizing specific techniques to prevent complications before they happen. A practical, clinically relevant resource for veterinary technicians, Clinical Small Animal Care provides step-by-step descriptions of the core tasks associated with examining, nursing, and monitoring small animal patients.

Taking a hands-on approach to the fundamentals of clinical practice, the book gives specific advice for how to perform tasks associated with patient care. Chapters begin with basic information on topics such as husbandry and nutrition, then move into more specialized information on applied nursing and the care of tubes and catheters. The final section presents information on caring for animals with a variety of conditions organized by body system. Clinical Small Animal Care: Promoting Patient Health through Preventative Nursing offers veterinary technicians and nurses with achievable steps for improving health in their small animal patients.

Section 1: Clinical Fundamentals in Promoting Good Health

Chapter 1

The Elements of Environmental Husbandry

Nursing care of the veterinary patient involves astute knowledge of normal anatomy and physiology, a clear understanding of disease pathology, and practical critical thinking skills. However, a key nursing aspect often overlooked is basic nursing care of the patient and the patients’ environment. Influences such as noise, temperature, hygiene, and surface area cleaning protocols can influence the heath of the patient. For example, a postoperative patient experiencing hypothermia is at risk for delayed healing, pain, surgical site infection, and a longer hospital stay, which means a possibility of developing a nosocomial infection. This section will cover basic nursing skills which have a profound affect on the patients’ ability to recover from illness.

Nosocomial Infections

Nosocomial infections are those that occur within the hospital setting, often referred to as “hospital-acquired” infections. They are also known as “super infections” or “super bugs,” since nosocomial infections pose a great threat to the debilitated and immunocompromised veterinary patient. Microorganisms such as bacteria take Darwin’s “survival of the fittest” theory to the next level when it comes to multiple antibiotic resistances in a hospital setting. They not only survive, they thrive, and veterinary patients can fatally fall victim to these “super bugs.” Human medicine hospital rates for nosocomial infections tend to be higher in intensive or critical care settings; however, incidence is not limited to these areas. In addition, human nosocomial infections tend to be one of the leading causes of death in the intensive care unit (ICU) due to causing septic shock and subsequent multiple organ failure. Surprisingly, sources of nosocomial infections are the patient and the healthcare worker.

Pathogens such as Escherichia coli, Pseudamonas spp., Acinetobacter spp., Serratia spp., Enterobacter spp., and Klebsiella spp. are common culprits of nosocomial infections. More recently, methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus intermedius (MRSI), vancomycin-resistant Staphylococcus aureus (VRSA), and vancomycin-resistant Enterococci (VRE) have made way to veterinary practices. Sources for these infections include (but are not limited to) venous access sites, urinary catheter sites, and surgical sites or wounds. Maintenance and handling of access sites is an essential part of veterinary patient nursing when it comes to prevention of nosocomial infection and is discussed in the section “Proper Care of Tubes and Catheters.”

Preventing nosocomial infection is a simple task; however, compliance tends to be the challenge. The single most effective way to prevent a nosocomial infection is hand washing. Veterinary personnel who do not wash hands between patients virtually become fomites and transfer microorganisms from one patient to another. When these microorganisms are transferred to an ill or injured patient, the effects can be devastating due to the compromised immune system of the patient. Hand washing mechanically removes debris and transient microorganisms. A non-antimicrobial soap should be used, as resistance to an antimicrobial soap can build. Warm water should be used during a thorough wash and the hands dried completely, either with paper towels or a hot air dryer.

In addition to hand washing, the patients’ housing should be properly disinfected at least every 24 hours, more frequently as needed (soiling with urine, feces, vomit, blood, etc.). The patients’ bedding should also follow these guidelines, being changed or washed at least every 24 hours. Soiled bedding should be removed immediately and replaced with fresh, clean bedding. A visual surveillance of the patients’ immediate environment should be frequent, ensuring a clean housing area at all times.

A microbiological surveillance plan should be established for every practice. Disinfectants and detergents can be placed on a rotating schedule to prevent resistance from developing. In addition, samples for laboratory culture can be taken from surfaces such as exam tables, surgical tables, kennels, and kennel doors as well as containers holding products used on patients (cleansers, gauze, etc.) to monitor the hospital environment for potential pathogens (Fig. 1.1).

Figure 1.1 Culture survey of nosocomial pathogens.

Bedding and Dish Rotation

General standards for kennel cleaning include providing fresh bedding and complete disinfecting of the kennel at least once in a 24-hour period, more frequently if needed. Everything should be removed from the kennel prior to cleaning, including wastes. Kennels should be cleaned first from the top, then the sides, and finally the bottom. The kennel doors should be cleaned inside and out. Large runs should be power washed and a squeegee used to remove excess water. It is recommended to deep clean all kennels and cages once a week and rotate disinfectants to prevent nosocomial infections.

Bedding materials may range from mats, paper, sheets, towels, or blankets. Patients requiring long-term care or those with a decreased ability to ambulate should have thick bedding to prevent decubital ulcers. Although blankets and towels provide warmth and comfort to the patient, it is essential for the nursing staff to maintain cleanliness of these materials. They should be checked, both visually and by touch, to ensure the material has not been soiled. Soiled materials should be removed from the kennel, the kennel disinfected, and fresh bedding material placed. Providing comfortable, clean bedding to the patient may require more work; however, the benefits to the patient are dynamic (Fig. 1.2).

Figure 1.2 Padded bedding and absorbent pad used in a geriatric patient.

Cats and smaller dogs may feel more comfortable when given a bed to rest in. A towel can be rolled up and placed in a circular shape. Adding a small box to a kennel may also reduce stress for some cats as some prefer to remain hidden (Fig. 1.3).

Figure 1.3 Many cats prefer to remain hidden while hospitalized. Here a simple cardboard box was used.

Dishes should be rotated at least every 24 hours or more frequently if needed. Dried food material or contaminated water remaining in dishes may contribute to bacteria growth and illness. Once food remains at room temperature for 2 hours, it begins to grow bacteria in rapid numbers. Food left out may begin to have a strong odor or may change in consistency (sticky, slimy, etc.), indicating bacteria growth. It is best to discard food not consumed within 2 hours and store perishable diets in a refrigerator at 40°F. Bacteria may still grow in this temperature so all food should be inspected prior to feeding.

Noise and Air Quality

Ventilation, heating, and cooling are essential in maintaining patient husbandry in a clinical setting. Reducing noise is also imperative when it comes to patient comfort. Patients should be kept in a well-ventilated area. Many facilities have a smaller room with a door in which the vocal patients are kept. However, with this door being...

Table of contents

• Cover
• Companion website
• Title page
• Copyright page
• Preface
• Acknowledgments
• Section 1: Clinical Fundamentals in Promoting Good Health
• Section 2: Applied Nursing of the Veterinary Patient
• Section 3: Proper Care of Tubes and Catheters
• Section 4: Comprehensive Areas of Focus
• Appendix 1 Formulas
• Appendix 2 Anatomy Illustrations
• Appendix 3 Clinical Quick Reference Guides
• Appendix 4 General Forms
• Appendix 5 Employee Skill and Knowledge Advancement Plans
• Index