Nursing Care and Procedures

Michael Lavoie, B.S.Middlesex Community College

Veterinary Assistant ProgramMarch 2012

Common Abbreviations in the Vet FieldAb antibody AD right earAS left earAU both earsACL 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)

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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

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CHF congestive heart failureCNS central nervous system CPR cardiopulmonary resuscitation CSF cerebrospinal fluid DEA Drug Enforcement Agency DJD degenerative joint disease dL deciliter(s) DM diabetes mellitus

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

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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)

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

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kg kilogram(s) L liter(s) lat. Laterallb pounds (may be written #)LPF low-power field m meter(s) mEq milliequivalent(s) µg microgram mg milligram(s)

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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

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OD right eye OS left eye OU both eyesOTC over the counter oz ounce(s) PCV packed cell volume PE physical exam plt platelet PO per osPRN 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 areaExam roomsSurgical 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 equipmentAutoclave- piece of equipment in the form of a

sealed chamberObjects 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 sterilizationRadiation- use of ultraviolet or gamma rays that

radiate and kill living organismsUltrasound- passage of high frequency sound

waves through a solution to create a vibration that scrubs an item to remove debrisUltrasonic cleaner- machine where items soak in a

solution that vibrates and remove dirt and debrisUsed primarily for surgical instruments/equipmentDone prior to packing instruments for autoclavingPart of the cleaning process

Filtration

Method of sanitationRemove particles from the air using a physical

barrierCommon in lab areas, research facilitiesUsually 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 careSome have harmful vaporsCan cause burnsAlways read the label or MSDS (material

safety data sheet)Proper dilutionWear gloves, gogglesSpecific 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 agentsVariety of properties that alter their uses and

effectivenessSpectrum of activity- what the agent will killConcentration of the solution- strength of the solutionContact time- how long the disinfectant should sitAppropriate surface uses Inhibiting factors- uses that should be avoidedToxic effects- hazardous effects the agent may have to

humans or animals

Types/names

Chlorhexidine solution- disinfectantChlorhexidine scrub- disinfectant and antisepticBleach- cleaner and disinfectantAlcohol- disinfectant and antisepticHydrogen peroxide- antisepticBetadine/iodine- disinfectant and antisepticFormaldehyde- disinfectant

Hand Hygiene

HandwashingMost common method of spreading disease- direct hand

contactSneezingCoughingRestroomsTouching or handling each animalMoney Direct contact with peoplePhonesDoor handles

Proper hand washing

Antibacterial soap and use water or hand sanitizer

Avoid wearing jewelry, fake nails, long nails

Post reminder signsMoisturizers at wash stations

Exam Room Santiation

Important part of safety and disease control Include rooms, tools, equipment and suppliesAll staff members understand and practiceClean after every patientClean from top to bottom, dry to wet areas, sweep up

hair and debrisUse up and down and side to side motionsEmpty trashPlace items in sharps containersCold trayMop bucket- change water and mop head often

Antiseptic techniques

Most important principle in veterinary hospitalPractice of keeping a sterile environment and

keeping the environment disease and contaminant free

Especially vital in the surgical suitesGoverns 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 practicesAllowing contagious animals to contact

healthy animalsContamination 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 patientsA service and trained area essential to caring for

and preventing illness and disease in hospitalized patients

Essential to the health of the patientsTeam effortDental 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 brushingPreventative dental careClient educationMonitoring young animals for proper tooth

eruptionShould be part of a yearly exam

Daily dental care

Feed a hard, dry dietHard treatsDental toys or bonesTeeth brushing- proper method and

necessary toold and suppliesNo human toothpaste- non-digestible

enzymes

Daily dental care- continued

Dentifrices- toothpasteVariety of flavorsSafe, digestible enzymes that can easily be

broken down in the animal’s bodyFish, malt, beef, poultryHumans vs. pet toothbrushes

Needs to fit the size and shape of the animalPet 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 teethOnly the buccal, labial, and occlusion

surfaces in animalsBuccal- the surface of the teeth, located

on the outer area near the cheekLabial- surface of the teeth in the front

covered by the lipsOcclusal- 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 causedMost areas are easily accessed by lifting the lips

to expose the outer tooth surfaceBe patient- takes time and consistency for an

animal to acceptBegin 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 patternBrush all teethIntroduce at a young ageSample kits, models, encouragement to ownersWant a pleasurable experience!

Dental prophylaxis

Professional cleaning by a scaling and polishing the teeth

May need to be done once a year or moreConsiderations- health, age, and breed of

patientsLarge animals- floating

Prevents sharp edges from forming- difficulty eatingAdvanced technique that requires training and

experience

Dental prophylaxis- continued

Provided by the technicianSome participation by assistance Involves general anesthesiaTechnician scales all surfaces of the upper and lower

dental arcade; polishes all tooth surfacesVeterinarian checks any diseased areas or extracts teethComplete 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 animalsPet the animalsHold themUse a gentle and soothing voiceMost patients are accustomed to human

interactionPut patients at ease

Exercise of patients

Provided to hospitalized patients if ableImportant part of their recovery and treatmentImportant for eliminationWalk outside in a designated and safe areaUse appropriate leashesProper sanitation methodsTime 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 sufferingDecision based on personal beliefs, religious

beliefs, and previous experiencesVeterinarian guidance and recommendationsDifficult for owners as well as the veterinary staff

Process of euthanasia

As pain free and stress free as possibleStaff should be supportive and

sympathetic to owner’s needs and valuesMaintain client confidentialityClients signs a waiverDiscuss the procedure and process of

events with clientsDetermine 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 doneInform a client of any legal restrictions for

private/home burialDetermine how the client would like to care for

the animal’s remainsPet cemetery for burialPrivate cremationGroup 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 completelyMay have agonal response

Gasps of breath while the respiratory system shuts down

May be cyanoticLose control of bladder and bowelsOwners may want time alone after the process-

keep privateOwner may want the pets collar, hair or paw

printsReactions are variable

After the euthanasia

Be respectful of the remainsTreat professionallyPlace in a cadaver bagLabel the bag with an ID tag- “be accurate”Place in appropriate area of facility or package

for ownerCardboard coffins, sheets, waterproofClean or disinfect exam room or area as neededEnsure all controlled drugs and substances are

recorded

QUESTIONS?