Nursing Care and Procedures

Michael LavoieVeterinary Assisting Program

Middlesex Community CollegeMarch 2012

Record keeping

Medical records provide documentary evidence of the patient’s illness, hospital care, and treatment

Also serve as a basis for review, study and evaluation of the care and treatment given by the veterinarian

Veterinary assistant may be responsible for many office procedures and administrative dutiesCreation, maintenance and organization of medical

records

Medical records

Records detailed information for each veterinary patient Includes both client and patient informationPatient historySurgical and medical recordsProgress notesLaboratory informationMedical record is a legal documentKeep private and confidentialRecord is owned by the facility and is the property of

Medical records

Original record must remain in the facility for at least 1-3 years from last visit

Check state regulationsMany keep records for 7 yearsCopies of the original record can be made

and sent with owner to another facilityMay not withhold the release of the

veterinary medical record contents

Medical records

Should be updated on a regular basis Includes

Client and patient information sheet Master problem list- vaccine history, surgeries, previous medical

problems Progress notes- allow for chronological logging each time a

patient is seen and treatment is completed (SOAP) Laboratory reports, veterinary test results Radiology reports Pharmacy reports Surgical and anesthesia reports Content forms and other forms that may be recorded and

documented

Medical records

Each facility will have a preference for medical forms used as well as their sequence within the medical record

Keep each record in the same format with information in the same location

Estimate, authorization forms, consent formsDischarge sheet- after treatments or procedures

are completed; instructions for the client on the care of the animal; care for surgical sites; prescribed medication instructions

Medical record

InvoiceKeeps a working list of itemized chargesShould be updated and reviewed oftenGive to clients at discharge along with payment

historyAll services rendered

Medical record rules

All information must be recorded in blue or black ink- no pencils or colored pens

All information must be accurate and legibleNever erase, use white out, or scribbleIf a mistake is made put one line through the

error and initial the error and then place the corrected statement after the entry Indicates an error in writing occurred rather than

suggesting the information has been changed

Medical records

Record all communication and phone conversations held with owners

Detail the conversation including the date and the initial of the team member involved

Help others identify and communicate with the patient’s caregiver

Each patient record should contain one medical record for that patient onlyException laboratories, large farms, herds

The “SOAP”

Subjective- based on the animal’s overall appearances and the health care team’s description of the animal

Objective- measured facts that can be recorded based on the patient TPR, weight

Assessment- what the veterinarian determines to be the diagnosis or the patient’s problem

Plan- treatment or procedures to be given to the patientUsually found in the progress notes and physical

examination section on the record

Sample SOAP

S: 6 month old intact male DSH cat, friendly, well groomed

O: T=102, P=180 bpm, R=purr, 10lbs, CV=NAF, EENT= NAF; bladder small, feces palpated in colon

A: Healthy 6 mos old intact DSHP: castration, TGH later today with

buprenorphine PO q 6 hrs x 3 doses, meloxicam PO x 3 days

True or false?

All errors in a medical record should be erased?FALSEThe SOAP format is used as a system filing

medical recordsFALSEEach medical file should have a format or

sequence of where each form is place in the file TRUEYou can use red ink to record patient information

in the medical recordFALSE

QUESTIONS?

Hospital patients- observations

Essential for all staff members to learn to observe patients

Necessary skillIncludes the moment a patient enters the

facility until it is discharged

observation

Watch and note an animal’s:behaviorAppearanceMental statusOverall health

Some may be subtle and easily overlookedCompare to what is normal for the species and breed of

the animalMonitor and note any changes in the medical record

observation

VisualSmellPalpationAuditoryUse all of your senses

Diarrhea, tense abdomen, ocular discharge

Hospital patients- emergencies

A situation that requires immediate life-saving measures

Important that all of the staff members work together as a team

Success relies on the staff working as a team and staying calm under pressure

Emergencies are common in all veterinary facilities

Vet assistants can help by locating supplies, medication, and emergency equipment

Crash cart

Moveable table that holds emergency equipment and supplies

Should be easily accessibleContains items prepared ahead of time for

emergency situationsTool chestSet a moveable plastic drawers

Crash cart contents

Emergency drugs- epinepherine, atropine, lidocaineNeedles and syringes- all sizesEndotracheal tubesAmbu bagsTape IV cathetersFluid bagsAdministration sets, extension sets, t-setsSuction hoses/cathetersEKG-defribulatorHeparinized salineBe familiar with the contents and locations

What can you do?

Be able to locate the crash cart or emergency kitBe able to locate the emergency equipment that may not

be located in or on the crash cartBe able to maintain emergency equipment, drugs, and

suppliesBe able to update and stock the emergency equipmentBe able to identify common emergency equipmentBe able to locate common general suppliesBe able to restrain and position patients properlyPerform simple in-house lab proceduresProvide skin preparation as necessary

Common emergency equipment

Laryngoscope and bladePulse oximeterEKG IV catheterSyringes and needlesStethoscopeET tubes of various sizesAmbu bagEmergency drugsBandage materialsFluid bags and lines

Training

All staff members should be trained on what to do during an emergency

Each member must understand the jobKnowledge is invaluable during an

emergency and is not the time to learn and be trained

Mock eventsCall a codeModel dog

Things to watch for…

No signs of a heartbeatNo signs of breathingAn animal that is not alertAn animal that is having difficulty breathingAn animal that is hemorrhaging excessivelyAn animal that has a low body temperature and

is pale in gum colorAn animal that has an excessively high body

temperature

What to do next?

Notify the veterinarian or technician of your concern

Follow orders as indicated by vet or techSet up emergency equipment as directedCall for helpRecord events and any medications

administeredBe a runnerStay calm and focused

Hospital patients- monitoring

Look for warning signs that warrant further medical attention or the attention of a veterinarian or technician

Important to observe and record in the patient’s medical record any pertinent observations

Important to record changes in appetite, urinations, defecations, attitude, changes in body temperature

Nutrition is often overlookedMaintain IVC and fluid pumps

Trust your Gut!

If you feel that something is not quite right speak up

No questions are stupidTrust your gutWould you rather bring up your concerns, or

dismiss them?Remember the patients are counting on youYou are their voice, be loud!You may catch something that nobody else doesYou are caring for the patients intimately and

often for days- you can get to know them!

QUESTIONS?

Flea life cycle

Collectively, all of the species of fleas are categorized under the order name of Siphonaptera.

The cat flea, Ctenocephalides felix, is the most commonly found flea in the US and infests cats, dogs, humans, and other mammalian and avian hosts.

Fleas thrive in warm, moist environments and climates.

The main flea food is blood from the host animal. Host animals are many species - cats, dogs, humans, etc.

Fleas primarily utilize mammalian hosts (about 95%).

Fleas can also infest avian species (about 5%).

Flea saliva, like other biting skin parasites, contains an ingredient that softens, or "digests" the host's skin for easier penetration and feeding.

Fleas have four main stages in their life cycle: egg, larva, pupa, and adult.

The total flea life cycle can range from a couple weeks to several months, depending on environmental conditions.

Adult

The adult flea is very flat side to side.

There are hair-like bristles on the flea body and legs to aid in their navigation through pet hair.

Fleas have 3 pairs of legs, the hindmost pair designed for jumping.

Fleas are well known for their jumping abilities.

Adult fleas prefer to live on the animal and their diet consists of blood meals courtesy of the host animal.

The female flea lays white, roundish eggs.The adult female flea can lay up to 50

eggs per day, 500-600 eggs over several months.

Egg

The eggs are not sticky (like some parasites), and they usually fall off of the animal into the carpet, bedding, floorboards, and soil.

When the flea egg hatches varies -- anywhere from two days to a few weeks, depending on environmental conditions.

The larva emerges from the egg using a chitin tooth, a hard spine on the top of the head that disappears as the flea matures.

Larvae

The larval stage actually has three developmental stages within this stage.

Larvae are about 1/4" long, and semi-transparent white.

They have small hairs along their body and actively move.

They eat the feces of adult fleas (which is mostly dried blood) and other organic debris found in the carpet, bedding, and soil.

the larval stage lasts about 5 to 18 days

Pupa

The pupa is the last stage before adult. The adult flea can emerge from the cocoon as

early as 3 to 5 days, or it can stay in the cocoon for a year or more, waiting for the right time to emerge.

Stimuli such as warm ambient temperatures, high humidity, even the vibrations and carbon dioxide emitted from a passing animal will cause the flea to emerge from the cocoon faster.

Flea Control: Shampoos

A shampoo, or "flea bath" is a good first attack on fleas for the pet that has large numbers of fleas visible on its body.

Cats can be difficult to bathe. It is important to realize that a flea shampoo is

not intended for lasting control. Shampoos are only effective for a day or less. They leave little residual chemical on the animal

when properly used.

Flea Control: Flea Dips

Flea dips are strong chemical rinses to rid animals not only of fleas, but mites and ticks as well.

Dips last approximately 1-2 weeks. That is a lot of chemical residue to leave

on an animal! Flea shampoos and dips are effective for

adult fleas.

Flea Control: Flea Collars

Flea collars work one of two ways - by emitting a toxic gas, and by being absorbed into the animal's subcutaneous fat layer.

The toxic gas is usually only effective in the immediate area of the head and neck.

This type of collar is best used in the vacuum cleaner bags to kill any fleas vacuumed up.

The collars that absorb into the subcutaneous fat are much more effective.

Flea collars are effective for adult fleas.

Flea Control: Flea Powders

Flea powders and sprays offer short term (2-3 day) protection from fleas, and with some products, ticks and mites too.

Powders and sprays have fallen out of favor recently with the newer spot-on treatments that are available.

Most flea powders and sprays are only effective for adult fleas, some offer additional flea protection by inhibiting flea egg and larval development.

Flea Control: Spot on Treatments

Common brand names include: Advantage (tm), Frontline®, and Bio-Spot® just to name a few.

Please consult with your veterinarian for the best choice for your pet(s).

These products are applied between the shoulder blades of the pet, and typically last about one month.

Spot-on treatments are effective for adult fleas. Some include ingredients to inhibit the larva from

emerging from the flea egg and some are active against larval development as well.

Flea Control: Oral Medications

Flea "pills", such as Sentinel® work by stopping the larva from emerging from the flea egg.

Fleas ingest the blood of animals on these medications, and the female fleas then lay eggs that are unable to hatch.

They do NOT kill adult fleas. These medications are essential to break the

flea life cycle and stop the flea problem when used in conjunction with flea adulticide treatments.

Flea Control for the House and Yard

Only about 10% of the flea population (mainly the adults) are on your pet.

The flea eggs, larvae, pupa, and the few adults that reside in the carpeting, bedding, and living areas make up approximately 90% of the flea population.

Neglecting this population of fleas will ensure that the flea problem will continue and worsen over time.

Daily vacuuming - this is very important for overall flea eradication.

This will pick up (and get rid of) adults, eggs, larvae and pupae before they develop.

Putting a flea collar in the vacuum bag and emptying the bag frequently are also important; otherwise, the fleas will hatch, develop, and leave the vacuum to re-infest the living quarters.

Dispose of the vacuum bag properly and frequently.

Wash all bedding, clothing, and removable furniture covers.

Coccidia life cycle

Coccidia are single celled organisms that infect the intestine.

They are microscopic parasites detectable on routine fecal tests in the same way that worms are, but coccidia are not worms and are not susceptible to deworming medications.

Coccidia infection causes a watery diarrhea that is sometimes bloody and can be a life-threatening problem to an especially young or small pet.

Coccidia

Coccidia Life cycle

Coccidia come from fecal-contaminated ground. They are swallowed when a pet grooms/licks the

dirt off itself. In some cases, sporulated oocysts are

swallowed by mice and the host is infected when it eats the mouse. Coccidia infection is especially common in young animals housed in groups

This is a common parasite and is not necessarily a sign of poor husbandry.

How is it Found?

A routine fecal test is a good idea for any new puppy or kitten whether there are signs of diarrhea or not as youngsters are commonly parasitized.

This sort of test is also a good idea for any patient with diarrhea and is recommended at least once a year for healthy dogs and cats as a screening test.

How is it treated?

The most common medicines used against coccidia are called coccidiostats. 

They inhibit coccidial reproduction. Once the numbers stop expanding, it is easier

for the patient’s immune system to catch up and wipe the infection out.

The time it takes to clear the infection depends on how many coccidia organisms there are to start with and how strong the patient’s immune system is.

A typical treatment course lasts about a week or two, but it is important to realize that the medication should be given until the diarrhea resolves plus an extra couple of days.

Medication should be given for at least 5 days total.

Sometimes courses as long as a month are needed. 

In dogs and cats, sulfa-based antibiotics are the most commonly used coccidiostats.

QUESTIONS?