Foal Nursing Flashcards
(250 cards)
1
Q
what is key when nursing foals?
A
be prepared as often an emergancy
2
Q
how can foal nursing equipment be managed?
A
equipment only used part of the year (january to june)
have a stock list and check stock before season
ICU/foal trolley or foal packs for cars
familiarise new staff with equipment, where it is and how to use it
3
Q
what level of nursing is needed for the recumbent foal?
A
almost continuous
4
Q
how often should a clinical exam be performed in a recumbent foal?
A
every 4-6 hours
could be fewer depending on stability
5
Q
what is involved in the clinical exam of the recumbent foal?
A
thoracic auscultation HR RR MM palpation of joints and umbilicus temperature
6
Q
what are joints assessed for in the recumbent foal?
A
swollen - presence of infection
7
Q
what are you looking at when assessing the umbilicus of a recumbent foal?
A
infection
urine leaking
8
Q
what is the temperature of a foal in the first 7 days after birth?
A
37.5 - 39 degrees
goes down to 37.2 - 38.3 after that
9
Q
when does the foal temperature range match that of the adult horse?
A
7 days after birth
10
Q
what position should foals be placed in when recumbent?
A
sternal
11
Q
why is lateral recumbancy in a recumbent foal unsafe?
A
affects perfusion and breathing
12
Q
how should recumbent foals be placed in sternal?
A
chests are pointed so will not stay on their own
support
bean bag
nurse to reposition especially as they start to improve and fight!
13
Q
what respiratory support may recumbent foals need?
A
intra-nasal oxygen (common) mechanical ventilation (rare)
14
Q
what should you ensure the recumbent foal is at all times?
A
clean
warm
dry
15
Q
how can foals be helped to stay dry and not urine soaked?
A
urinary catheter
16
Q
what is used to place IV catheters in the foal?
A
over the wire prefurrable for small, collapsed veins
use stylet if that is your preferred method
17
Q
under what conditions must an IV catheter be placed in foals?
A
sterile (use drape and may need sedation)
18
Q
why must the recumbent foals IV catheter be wrapped?
A
to prevent mum from chewing it
19
Q
how often should foal IV catheters be checked?
A
every 4-6 hors
20
Q
what are foal IV catheters checked for?
A
thromboplebitis
21
Q
what is the only flush that can be used in foal IV catheters?
A
saline only (no heparin)
22
Q
what are separate ports needed for on a foal IV catheter?
A
TPN
medication
23
Q
why does TPN need a separate port on an IV?
A
reduce port handling due to the high risk of infection associated with TPN
24
Q
what parameter may need additional support in recumbent foals?
A
BP
25
how is BP supported in recumbent foals?
pressor support
26
why do foals need pressor support?
severely ill
usually septic
get low BP which leads to multiple organ failure and death
27
what drugs are used for pressor support?
dobutamine infusion
28
how is BP in foals monitored?
tail cuff
29
what is a common complication of urinary catheters in foals?
cystitis
30
what can be monitored through a urinary catheter?
urine output
hydration
anuric renal failure secondary to sepsis
ruptured bladder
31
what is the only way to be sure of a foals hydration status?
urine specific gravity
32
what is the correct urine specific gravity for foals?
<1.010 (dilute)
33
what should be done with the mare (if present) when she has a sick foal?
milk regularly to maintain supply
| check for mastitis
34
how should the foal be fed if able to suck?
from the mare is best even if the foal has to be held there
if no mare or too weak to stand then feed milk/milk replacement from a bowl
NG tube
35
why should bottle feeding not be performed in foals?
risk aspiration pneumonia
36
how should the NG tube position be checked in a foal?
x ray
37
should foals be fed via a pump on an NG tube?
no - olny fed via gravity
38
what sort of nutrition should be used in horses if they have no suck reflex?
parenteral nutrition
39
how should foals who are unable to cope with milk be fed in the short term?
5% glucose spiked isotonic fluids
40
how should foals who are unable to cope with milk be fed in the long term?
parenteral nutrition
41
what is found in parenteral nutrition?
amino acids
glucose
fat
42
what needs to be monitored in foals receiving TPN?
glucose - may need insulin SC or CRI
43
what are the 2 main diagnostic tests performed on recumbent foals?
blood
| urine
44
what is the test performed on urine in recumbent foals?
USG
45
what are the blood tests performed in recumbent foals?
```
IgG SNAP ELISA
PCV
TP
glucose
white cells
creatinine
blood gas
electrolytes
lactate
culture
```
46
what is the IgG SNAP ELISA test for?
antibodies
47
what will PCV and TP tell us in sick foals?
less about hydration but indication of how sick they are
48
what information is gained from monitoring glucose in recumbent foals?
whether foal is self regulating
| if they require more glucose
49
what information is gained from monitoring WBC in recumbent foals?
presence of infection
50
what information is gained from monitoring creatinine in recumbent foals?
kidney function
51
what information is gained from monitoring lactate in recumbent foals?
perfusion
52
what information is gained from performing blood culture in recumbent foals?
look for bacteraemia
53
what protects the foal from infection after birth?
mare antibodies
54
how long do mare antibodies protect the foal after birth?
about 6 weeks
55
how can you ensure that the mare has the correct antibodies to pass on to the foal?
ensure vaccinations are up to date (flu, EHV, rotavirus, tetenus)
56
when should a mare's last tetanus vaccine be given before foaling?
4-6 weeks before
57
when should the mare be moved into her foaling environment?
6 weeks before due date
58
how does the foal get antibodies from it's mother?
only by drinking colostrum
59
how can you ensure that the foal will be able to receive colostrum?
check if there have been any problems in the pregnancy
| ensure that the mare has not leaked milk
60
what should happen if the mare has leaked milk during her pregnancy?
colostrum is lost and will not be available for the foal so need to plan to give colostrum from another mare or hyperimmune plasma
61
what is hyperimmune plasma?
plasma from a highly vaccinated horse
62
what size should a foaling box be?
5m x 5m
63
describe the foaling box
```
large
good ventilation
disinfected
warm
sheltered
thick bedding
```
64
what is the length of gestation for horses?
320-360 days - wide
65
what are the signs that a mare is ready to foal?
best indicator is when they have foaled before
some show no signs
waxing up
milk electrolyte changes
66
what is shown by milk electrolyte changes?
gives 48 hour warning of foaling
67
how long does stage 1 of foaling last for?
variable length
68
what happens during stage 1 of foaling?
foal moves into birth canal
69
what is the correct position of the foal in the birth canal?
nose pointing caudally
resting on forelimbs
one forelimb slightly in front of the other
70
what are the signs that a mare is in stage 1?
```
restless
agitated
sweaty
lies down and gets up
colic signs
```
71
what happens in stage 2 of foaling?
birth
72
how long should stage 2 of foaling take?
<30 mins - dangerous if any longer
73
what happens during stage 3 of foaling?
expulsion of the placenta
74
what should you do when the placenta is delivered?
check it is whole
75
how long after birth should the placenta be expelled?
1-2 hours
76
what should you do if the placenta has not been expelled after 3 hours?
walk
| give oxytocin to contract uterus
77
what should happen if the placenta has not been expelled 6 hours after birth?
aggressive treatment including oxytocin, lavage, walking, antibiotics, anti-endotoxins, weights
78
what is the risk associated with retained placenta?
laminitis
infection
can be fatal
79
what is the main complication of foaling?
dystocia
| red bag delivery - placenta delivered around foal incorrectly
80
what are the possible issues with dystocia?
death of foal
hypoxia (short term)
broken ribs
injury to mare
81
how long do you have once dystocia occurs to deliver the foal?
~1 hour
82
what can be done to buy you more time to deliver the foal if there is dystocia?
ET tube if possible to ventilate
83
how can foals be delivered if there is dystocia?
epidural and ropes, manipulation and lubrication
| GA - manipulation, C - section or fetotomy if deceased
84
what type of C-section can be performed in horses?
emergency only - will not survive planned
85
when should the foal take it's first breath?
within 30 seconds of birth
86
when should the foal be able to stand?
within 30 mons to 1 hr of birth
87
when should a foal drink colostrum?
within 1-3 hours of birth
88
what should the foal do within hours of being born?
pass meconium
| urinate
89
what should you do before deciding to resuscitate foals?
cursory physical exam
90
what conditions may mean a decision not to resuscitate?
hydocephalus
91
what almost always precedes cardiac arrest in foals?
respiratory arrest
92
what are the most common causes of respiratory arrest in foals?
premature placental separation
early severance or twisting of umbilical cord
dystocia
airway obstruction by fetal membranes
failure to spontaneously breathe due to unknown cause
93
what are the causes of CPA in equine neonates that are not associated with birth?
```
primary lung disease
sepsis
hypovolaemia
metabolic acidosis
hyperkalaemia
hypoglycaemia
hypothermia
```
94
what must be provided to all foals who require CPR?
ventilation
95
hy must ventilation be provided to all foals as a part of CPR?
as respiratory arrest underlies cardiac arrest
96
what is the success rate of CPCR in foals?
if resuscitation begins before non-perfusing rhythm develops the likelihood of revival is good
if delayed until after asystole survival is less than 10%
97
```
what should you do if any of:
HR <60 bpm/regular
slow / irregular respiration
foal in lateral
some muscle tone
grimace on nasal mucosal stimulation occurs?
```
```
stimulate foal (rub with towel etc)
intranasal O2
```
98
what should you do if any of:
HR / respiration undetectable
muscle tone limp or absent
unresponsive on nasal mucosal stimulation occurs?
neonatal resuscitation
99
how should the ventilation portion of resuscitation be performed?
clear the airway
place naso or endotracheal tube if possible (even with foal in birth canal)
ventilate (may respond)
100
how should a nasotracheal tube be placed?
extend head
| pass tube through nose ventral to medial
101
how many attempts to place nasotracheal tubes are before you should progress to ET tubes?
2 attempts
102
how should an ET tube be placed in an foal?
pull tongue forwards and lateral with one hand to stabilise larynx
advance tube in midline over the tongue
twist once you reach the larynx
check position, cuff and secure to head
103
how should the patient be ventilated?
abubag to tube if possible
104
how should the foal be ventilated if ET tube to bag is not possible?
mouth to tube
ambu bag to mask
mouth to nose and close opposite nostril
105
what must you do if a cuffed tube is not in place during ventilation?
ensure head is extended to reduce aerophagia
106
what is aerophagia?
stomach filling with air
107
what is the issue with aerophagia during CPR?
stomach distended with air can reduce thoracic capacity
108
how can you ensure tidal volume in the ventilated foal is sufficient?
look at chest
109
how may breaths are needed when ventilating a foal?
10 short breaths per min
110
when should the foal be reassessed after starting ventilation?
30 seconds
111
what is being assessed 30 seconds after ventilation commences?
HR presence
112
when should compressions be performed in foals?
after 30 secs of ventilation:
if no HR
HR less than 40 bpm
HR less than 50 bpm and not increasing
113
where should ribs fractures be placed if present?
fractured rib side down
114
what should you do if rib fractures are seen bilaterally?
place the side with more cranial rib fractures down
115
what position should chest compressions be performed in in foals?
kneel parallel to spine
foals back against wall
hands on top of each other
shoulders above hands to use body weight
116
where should hands be placed for compressions in foals?
caudal to triceps at highest point of thorax
117
what is the correct compression to ventilation ratio in foals?
15:1
118
what is the compression rate in foals?
100-120 per minute
119
what is the optimal compression depth in foals?
push hard
120
what should you do if the foal remains bradycardic following CPR?
give epinephrine every 3 mins until HR >60
121
how can epinephrine be administered?
IV
| intra-tracheal
122
what should you do with your patient following successful resuscitation?
keep warm with bandages and blankets
| keep off floor
123
what can be given IV to foals following resuscitation?
5% glucose at maintainance
124
what is maintenance rate for foals?
250 ml/hr for 50kg foal
125
what must you do before warming foals if hypoglycaemic?
give glucose to counteract protective response
126
how should hypothermic foals be warmed?
```
slowly
hot hands
bandage legs
rugs
care using heat lamps
```
127
how is dehydration diagnosed in foals?
```
history
clinical signs
lactate
high index of suspicion
USG**
```
128
when should dehydration in foals be presumed?
if no nursing for more than 4 hours
129
can adult signs of dehydration be used in foals?
no - not consistant
130
hwo can dehydration in foals be corrected?
1L hartmann's
| up to 3 additional boluses
131
what should be used to monitor hydration in foals?
USG
132
what imbalance is often seen alongside dehydration?
hypoglycaemia
133
how is glucose level measured?
glucometer
134
where are all foal antibodies received from?
colostrum
135
how long is a foals gut 'open' to antibodies for?
~24 hours (less if antibodies recived)
136
what is the issue with the gut being 'open' to antibodies?
also open to bacteria which is also gained from the mother which can enter the blood stream
137
what is the value of partial failure of passive transfer?
400-800 mg/dl
138
what is total FPT measured as?
<400 mg/dl
139
what is normal blood antibody concentration in foals if passive transfer has occurred?
>800 mg/dl
140
what is FPT a risk factor for?
spsis
141
when should foals be tested to see if passive transfer has occurred?
12-24 hours old
142
what foals should be tested for FPT?
all at risk
| but ideall all foals
143
how can FPT be tested for?
blood test or SNAP elisa
144
what is the benefit of a SNAP ELISA for FPT?
easy
cheap
done in the stable
saves lives by early detection of FPT
145
how is FPT treated?
hyperimmune plasma transfusion
146
why must antibodies be given IV if FPT has occurred?
gut is ineffective or has closed
147
why should hyperimmune plasma be defrosted slowly?
avoid denaturing antibodies
148
what should hyperimmune plasma be given via?
blood giving set with a filter
149
why should hyperimmune plasma transfusion be started slowly?
to check for transfusion reaction
150
what must be observed for to ensure volume overload doesn't occur during hyperimmune plasma transfusion?
adjust volume for size
| look for pulmonary oedema and protein reaction
151
when should foals plasma levels be reassessed following hyperimmune plasma transfusion?
after each bag of plasma
152
what is the most common reason for hospitalisation and death of neonatal foals?
sepsis
153
why may foals be born septic?
placentitis
154
what is a major risk factor for sepsis?
FPT
155
what is sepsis?
systemic bacterial infection (bacteraemia)
156
what is seen along side sepsis in foals?
infected joints
| infected umbilicus
157
what are the signs of sepsis in foals?
```
pyrexia
depression
recumbancy
injected mucous membranes
joint effusion +/- lameness
totally unresponsive
```
158
what tests are used to diagnose sepsis?
```
sterile blood culture
WBC count
SAA
SNAP test for antibodies
creatinine
USG - hydration
glucose level
lactate
culture from umbilicus and arthrocentesis sample if involvement
```
159
what will the WBC count be like in a septic patient?
low
160
why should creatinine be checked in septic patients?
sepsis attacks kidneys so they are at risk of anuric renal failure
161
what is the benefit of checking lactate levels in septic patients?
shows perfusion
| indication of prognosis
162
how is sepsis treated?
```
broad spectrum antibiotics
hyperimmune plasma (even if no FPT)
joint lavage - if joint involvement
removal of umbilicus (rare)
ICU
```
163
what disease makes foals more prone to seizures?
sepsis
164
what causes seizures in foals?
many causes
165
what are the signs of seizures in foals?
subtle - repetitive movement that you cannot interrupt
| generalised convulsions
166
how should seizures in foals be treated?
correct primary cause if possible
maintain airway if appropriate
administer oxygen
anticonvulsant therapy (diazepam)
167
what are the main causes of dummy foal?
range - unknown
| hypoxia at birth / in utero
168
what does dummy foal lead to?
brain and other organ damage
169
what is dummy foal also known as?
hypoxic ischaemic encephalopathy (HIE)
| perinatal asphyxia syndrome (PAS)
170
what are the signs of dummy foal?
```
may be born normal and decline
slow to swallow
not sucking
not following mare
ataxic
forget to breathe
seizure
```
171
how is dummy foal treated?
```
nursing is crucial
maintain cerebral perfusion
IVFT
correct metabolic imbalances
PPN or slow entral feeding
```
172
when may squeezing a dummy foal help?
if no brain damage present may stimulate the inhibitory neurotransmitters to be removed - can have profound effect
173
why can squeezing a dummy foal if there is no brain damage present help?
help loss of inhibitory neurotransmitters that are needed in utero and should be halted during birth
174
when is a foal classed as premature?
<320 days gestation
175
is a foal younger than 280 days likely to survive?
no
176
what is foal dysmaturity?
foal looks premature despite normal or often longer gestation
177
what is postmaturity?
long gestation and normal size foal but emaciated as dam is unable to meet nutritional demands
178
what are the signs of a premature / dysmature foal?
```
smaller than expected
silky short hair
floppy ears
domed head
weak
abnormal RR - either low or high
```
179
what organs are immature in prematurity or dysmaturity?
GI
respiratory
MSK
180
what is the most significant issue with premature / dysmature foals?
incomplete ossification of carpal and tarsal bones so bones are soft and compressed if weightbearing occurs
181
what effect can incomplete ossification of carpal and tarsal bones have on a horses future career?
unlikely to be athletes and even may struggle as pleasure horses
182
when is tendon laxity more likely?
if premature
183
what structures are affected by tendon laxity?
flexor tendons or ligements
184
what can tendon laxity be caused by?
premature / dysmature / postmature
| complication from bandage, cast or splint
185
how is tendon laxity treated?
resolves after a few days
box rest on limited bedding
walk on firm ground for 5m 3 times a day
186
what precautions must be taken when walking a foal with tendon laxity?
bandage heels for protection
187
how far should foals with tendon laxity be walked each day?
5m
| 3 times a day
188
what is the cause of tendon contracture?
unknown
may be due to positioning in uterus
can be acquired when older
189
when is tendon contracture often acquired?
secondary to orthopedic pain
190
what is the prognosis of tendon contracture?
varies in severity and number of affected limbs so prognosis is varible but usually fair to good
191
how is tendon contracture treated?
```
physio to stretch toes
walk on hard ground
oxytetracycline (for 3 days)
toe extensions
splint
half or full limb cast
surgery
```
192
what is the purpose of oxytetracycline in treatment of tendon contracture?
binds calcium so aids tendon stretch
193
what is of significant concern when giving oxytetracycline?
is nephrotoxic
194
what surgeries may be performed on tendon contracture patients if they have not responded to medical management?
check ligament desmotomy
| tentotmy
195
what are the main types of angular limb deformity?
valgus or varus of fetlock, carpus or tarsus
| windswept
196
how are angular limb deformities treated?
rest
farriery
surgery
197
when must surgery to correct angular limb deformity be completed?
before growth plate fused
198
what are the signs of meconium retention?
colic
restlessness
may have passed some meconium or none
199
what is often seen alongside meconium retention?
failure of passive transfer
200
what must be checked if foal has meconium retention?
patent rectum (atresia ani)
201
how can atresia ani be diagnosed?
rectal exam
| contrast study if glove clean on rectal
202
how is meconium retention treated initially?
soapy water / phosphate enema
203
what is given if a soapy water enema doesn't resolve meconium retention
acetylcysteine retention enema
204
how is a acetylcysteine retention enema performed?
foley catheter used to keep fluid in rectum and allow breakdown of mucus and meconium
205
what analgesia is often used for meconium retention?
buscopan
206
is surgery used to treat meconium retention?
rare
207
what tests must be performed on every foal with meconium retention?
IgG SNAP ELISA for FPT
208
what can cause diarrhoea in foals?
infection
209
what should be checked for if a foal has diarrhoea?
rotavirus
| IgG - FPT
210
how should dehydration in foals be treated if symptomatic?
dehydration resolved
electrolyte balance restored
acid base imbalance managed
211
what is foal heat diarrhoea?
seen 1-2 weeks post birth
caused by bacteria populating colon
not linked to dam's heat cycle
212
what must be prevented in hospitalised foals as it is so common?
gastric ulcers
213
do gastric ulcers form for the same reasons in foals as for in adults?
no - different pathophysiology
214
what can be given prophylactically in foals to prevent gastric ulcers?
sucralfate
215
what does sucralfate do?
encourgaes blood supply to stomach
216
how can an infected umbilicus be prevented?
dip regularly in 1% chlorhexidine for the first 2 days
217
when is an infected umbilicus more likely?
if FPT
218
what are the signs of infected umbilicus?
swelling and pus at site
219
how is infected umbilicus diagnosed?
ultrasound
| cutlure
220
how is infected umbilicus treated?
antibiotics
| surgery
221
what can cause a ruptured bladder in foals?
birth
| sepsis / other insult leading to damage
222
when is a ruptured bladder most often first noticed?
2-3 days ol
223
what are the signs of a ruptured bladder?
colic
distended abdomen
may still be able to urinate
224
how is ruptured bladder diagnosed?
ultrasound for excess fluid
| peritoneal sample for uroabdomen
225
what electrolyte imbalance can be caused by a ruptured bladder?
hyperkalaemia
226
what arrhythmia is common with hyperkalaemia?
bradycardia
227
how should bladder rupture be treated?
emergancy
0.9% NaCl at 250ml/kr/50kg
drain abdomen
surgery to repair
228
what rate should fluids be given for treatment of ruptured bladder?
0.9% NaCl at 250ml/kr/50kg
229
what is neonatal isoerythrolysis?
foal RBC antigen not recognised by the mare so antibodies are produced in response and mare becomes sensitised
when foal drinks mares colostrum the antibodies are passed over and foals RBC are attacked
230
when does neonatal isoerythrolyisis occur?
with the second foal as mare has produced antibodies from first?
231
what are the signs of neonatal isoerythrolyisis?
anaemia (as RBC are destroyed)
icterus
weakness
232
when is a blood transfusion needed for foals with neonatal isoerythrolyisis?
PCV <12%
233
how is neonatal isoerythrolyisis treated?
withdraw colostrum
prevent future foals from drinking colostrum from dam
blood typing of dam and sire
234
how is neonatal isoerythrolyisis prevented once it is known the mare carries the antibodies?
prevent future foals from drinking colostrum from dam
| blood typing of dam and sire
235
what puts foals at risk of pneumonia?
aspiration during bottle feeding (owners)
| FPT
236
what are the signs of aspiration pneumonia?
increased RR and effort
| pyrexia
237
how is pneumonia diagnosed?
radiography
| trans-tracheal wash for cytology and culture
238
how is pneumonia treated?
antibiotics
O2
foal in sternal
239
what bacteria often causes pneumonia in foals?
Rhodococcus equi
240
when should you suspect a foal can be infected with Rhodococcus equi?
from birth
241
what can cause infection with Rhodococcus equi?
environment (dust)
nose to nose contact with infected foals
faeces of dam
242
when do clinical signs of Rhodococcus equi appear?
until around 6 weeks old
243
why is Rhodococcus equi only a disease of foals?
change in T helper immunity in adulthood leading to immunity in adulthood
244
what are the clinical signs of Rhodococcus equi?
variable and difficult to interpret
one, all or some of: pneumonia, septic or immune mediated joint effusion
diarrhoea
245
how is Rhodococcus equi diagnosed?
thoracic radiograph for abscesses
tracheal wash for cytology, culture and sensitivity
joint fluid sample if effusion
blood smaple
246
what is seen on the blood sample of a foal with Rhodococcus equi?
very high WBC and fibrinogen
247
how is Rhodococcus equi treated?
clarithromycin and rifampicin
| joint lavage if appropriate
248
what must you be careful of when treating foals for Rhodococcus equi with Clarithromycin?
fatal diarrhoea can be caused in adult if ingested
| should be administered outside stable and ensure foals mouth is clean
249
how long should foal be treated for Rhodococcus equi?
until radiographically normal (~6 weeks)
250
how is Rhodococcus equi prevented?
clean environment
Rhodococcus hyperimmune plasma transfusion
routine ultrasound to check for any signs
antibiotics should not be given until clear infection and culture and sensitivity performed
