Foal Nursing Flashcards
(151 cards)
1
Q
how often does the recumbent foal need to be nursed?
A
often requires almost continuous nursing
2
Q
how often should a clinical exam be performed on a recumbent foal?
A
at least every 4-6 hours
3
Q
what should be included in the general clinical examination of a recumbent foal?
A
thoracic auscultation, HR, RR
mm check
palpation of joints and umbilicus (for infection signs, swelling)
temperature
4
Q
what should the temperature be in the foal for the first 7 days?
A
between 37.5 - 39.0°C
5
Q
what position should recumbent foals be placed in (ideally)?
A
sternal - support, beanbag
reposition often
6
Q
what types of IV catheter are used for recumbent foals?
A
over the wire or stylet - sterile placement important (may need drape and sedation)
7
Q
why should you wrap an IV catheter on a recumbent foal?
A
to keep clean
to avoid mother chewing it
8
Q
how often should an IV catheter be checked? what are you looking for?
A
every 4-6 hours
looking for signs of thrombophlebitis
9
Q
why should there be separate ports for medication and TPN?
A
bacteria will feed off material entering the TPN tube
10
Q
why do recumbent foals usually require vasopressor support?
A
severely ill and usually septic - get very low blood pressure, leads to multiple organ failure and death
11
Q
what type of vasopressor support do foals recieve?
A
usually start with dobutamine infusion
monitor BP with tail cuff
12
Q
how is BP monitored in recumbent foasl?
A
tail cuff
13
Q
why is it important to place a urinary catheter in recumbent foals?
A
avoiding cystitis
measuring urine output to monitor hydration status/anuric renal failure/ruptured bladder
14
Q
what should the USG of a foal be?
A
<1.010
15
Q
how can you care for mother and foal in regards to feeding?
A
milk mare regularly! and check for mastitis
if able to suck, direct drinking from mare is best
16
Q
how should the foal be fed if no mare/mare is not producing milk/foal cannot suck?
A
feed milk/milk replacement from bowl - risk aspiration pneumonia if bottle fed
17
Q
how can you feed a foal which cannot drink from a bowl?
A
indwelling naso-gastric tube - feed by gravity, do not pump
x-ray to check position
18
Q
what should the foal be given short-term if unable to cope with milk?
A
5% glucose-spiked isotonic fluids
19
Q
what should the foal be given long-term if unable to cope with milk?
A
partial parenteral nutrition - amino acids, glucose and fat (partial because doesn’t meet all nutritional needs)
20
Q
what is important to monitor when feeding the sick foal?
A
glucose - may need insulin s/c or CRI
21
Q
which blood parameters check how sick the foal is?
A
PCV and TP
22
Q
which blood parameter checks for sepsis/infection?
A
white blood cells
23
Q
which blood parameters check kidney function?
A
creatinine
24
Q
which blood parameters check perfusion efficiency?
A
lactate
25
how can you check for bacteriaemia?
blood culture
26
how can you check for common foal diseases?
IgG SNAP elisa tests
27
why is it important that the mare has the right antibodies in the colostrum?
foals do not receive placental antibodies - only through colostrum
28
how long do mare antibodies protect the foal after birth?
6 weeks
29
how can we ensure the mare has the correct antibodies for the foal?
vaccinations - influenza, EHV, rotavirus, tetanus
| last tetanus 4 weeks before foaling
30
when should the mare be moved to the foaling environment?
6 weeks before predicted foaling date
31
why is it an issue if the mare has leaked milk?
she will have likely leaked the colostrum with the important antibodies
32
what can be done if the mare has leaked milk?
need a plan to give colostrum from another mare, or a hyperimmune plasma transfusion
33
what dimensions/ features should the foaling box have?
5m x 5m
good ventilation
disinfected
warm and sheltered
thick bedding (straw easier for foals to stand up on than shavings)
34
how long is gestation?
320-360 days
35
what are the signs the mare is ready for foaling?
best indication is when they have foaled before
some will have no signs
wax from nipples
milk electrolyte changes (48 hour window)
36
how long is stage 1 of foaling?
variable length
37
what happens to the foal during stage 1 of foaling?
foal moves into the canal
| gets into correct position/posture/presentation = nose and forelegs pointing caudally
38
what happens to the mare during foaling stage 1?
restless, agitated and sweaty
will lie down and get up
colic signs
39
what happens in stage 2 of foaling?
birth
40
how long should stage 2 of foaling be?
<30 mins
41
what happens in stage 3 of foaling?
expulsion of the placenta
42
what is important to check after stage 3 of foaling?
check the placenta is whole
43
how long should stage 3 of foaling be?
1-2 hours
44
what should happen if the placenta has not been expelled at 3 hours?
walk mare
| give oxytocin to contract uterus
45
what should happen if the placenta has not been expelled after 6 hours?
aggressive treatment - oxytocin, lavage, walking, antibiotics, anti-endotoxins, weights
46
what are the risks of retained placenta?
laminitis, infection
| can be fatal
47
what can occur if there is dystocia during labour?
hypoxia (short-term brain damage)
broken ribs
injury to mare
death
48
how long can dystocia continue before foal dies?
1 hour
49
how can we extend the time a stuck foal can live?
pass an ET tube into foal to enable breathing - often very difficult to achieve
50
how can a stuck foal be delivered?
epidural and ropes, manipulation, lube
GA manipulation
C section
51
what is a fetotomy?
dissection of a deceased foetus in utero in order to aid delivery and increase the mare's chance of survival
52
what other foaling complication is common (besides dystocia and retained placenta)?
red bag delivery - placenta being born with foal, must be cut open immediately as foal will not be able to breathe
53
when should the newborn foal take its first breath?
within 30 secs of being born
54
when should the foal be standing?
within 30 mins - 1 hour
55
when should the foal have started drinking the colostrum by?
1-3 hours after birth
56
what should the foal do after birth (in addition to breathing/standing/feeding)?
pass meconium
| urinate
57
why should foals undergo a cursory physical exam before deciding whether or not to resuscitate?
some serious problems (e.g. hydrocephalus) may mean a decision not to resuscitate
58
what is RECOVER?
reassessment campaign on veterinary resuscitation
consensus-based guidelines for cardio-pulmonary arrest
can extrapolate to neonatal foals
59
how does the onset of CPA in foals differ to humans?
respiratory arrest almost always precedes cardiac arrest
60
what are the most common causes of respiratory arrest in neonatal foals?
premature placental separation
early severance or twisting of the umbilical cord
dystocia
airway obstruction by foetal membranes
failure to spontaneously breathe
61
list some of the causes for CPA in neonates not associated with birth.
```
primary lung disease
sepsis
hyperkalaemia
hypovolaemia
hypoglycaemia
hypothermia
metabolic acidosis
```
62
what is the relevance of respiratory arrest underlying cardiac arrest?
ventilation must be provided as part of foal CPR
63
what is the success rate of CPR?
good (50%) if resuscitation is begun before a non-perfusing rhythm develops
less than 10% if there is a delay until after systole
64
when should we consider stimulating the foal and administering intranasal oxygen?
if ANY of:
HR <60bpm/irregular
slow/irregular respiration
some muscle tone in lateral
grimace on nasal mucosal stimulation
65
when should we perform neonatal resuscitation?
IF any of:
HR/respiration undetectable
muscle tone limp/absent
unresponsive to nasal mucosal stimulation
66
what are the options for ventilating during resuscitation?
nasotracheal tube - 2 attempts to place
| if not, endotracheal
67
how is an ET tube placed for resuscitation?
pull tongue forward and lateral with one hand to stabilise the larynx
advance the tube in the midline over the tongue
twist once reach the larynx
check positioning, then cuff and secure to head with bandage material
68
which is the best method of providing ventilation during resuscitation?
ambu-bag to tube
69
what is ambu-bag to tube is not possible for ventilation?
mouth to tube
ambu-bag to mask
mouth to nose (close opposite nostril)
room air
70
how can aerophagia be reduced during manual ventilation?
if no cuffed tube in place, make sure head is extended (distended stomach with air can reduce thoracic capacity)
71
how many breaths for manual ventilation?
10 breaths/min - short and infrequent
72
when should you reassess the patient during CPR?
30 seconds after starting ventilation
73
when should you start chest compressions during CPR?
if heartbeat absent, less than 40bpm or less than 50bpm and not increasing
74
can chest compressions be performed if the foal has rib fractures?
chest compression may be fatal but you may have no choice - likely to die anyway if you do not perform them
75
how should patients with fractures be positioned for CPR?
place fractured rib side down
if bilaterally fractured, place the side with more of the cranial ribs fractured down
76
how should chest compressions be performed?
kneel parallel to the spine
hands on top of each other
caudal to the triceps at the highest point of the thorax
shoulders above the hands so you can use your bodyweight
77
what is the optimal compression depth?
as hard as you can?
78
what is the ideal compression to ventilation ratio?
15:1
79
what should the compression rate be?
100-120/min (as fast as possible!)
80
what should happen if the foal remains bradycardic after significant chest compressions and ventilation?
epinephrine administration IV or intra-tracheal
| every 3 mins until HR>60
81
what are the nursing considerations after resuscitation?
keep warm - bandages, blankets, keep off the floor
5% glucose IV infusion
82
what is important to consider when warming a foal after resuscitation?
warm slowly
do not warm before giving glucose if hypoglycaemic (protective response)
83
how would you diagnose dehydration in a foal?
diagnose on history, clinical signs, lactate, USG, high index of suspicion
often hypoglycaemic
no nursing for >4 hours = presume dehydrated
84
how would you treat dehydration in a foal?
1L bolus hartmanns then reassess
up to 3 additional boluses
5% glucose-spiked hartmanns on a steady drip (rather than bolus)
85
how can we treat hypoglycaemia in a neonatal foal?
often goes hand-in-hand with dehydration - 5% glucose spiked ringers and monitor with a glucometer
86
what is the main sign of metabolic acidaemia in foals?
diarrhoea
87
what is the main sign of respiratory acidaemia in foals?
respiratory distress
88
what is failure of passive transfer (FPT)?
when foals fail to absorb sufficient quantities of immunoglobulin from maternal colostrum in the first 24 hours of life
89
why are foals more at risk of sepsis in the first 24 hours of life?
gut is 'open' to allow antibodies to pass into bloodstream, but bacteria can also pass
90
what value is considered partial FPT?
400-800mg/dl
91
what value is considered total FPT?
<400mg/dl
92
what value is considered normal FPT?
>800mg/dl
93
which foals/when should foals be tested for FPT?
test every foal at 12-24 hours old
| at least all at-risk foals
94
how is FPT tested for?
blood test
| SNAP elisa - easy and cheap, performed in stable
95
how can FPT be treated?
with a hyperimmune plasma transfusion
96
why does hyperimmune plasma need to be defrosted slowyl?
so as not to denature antibodies
97
how much/how fast should a hyperimmune plasma transfusion be given?
start slow to reduce risk of transfusion reaction
1L over about 1 hour (adjust volume for size)
98
what can happen if a hyperimmune plasma infusion is given too quickly?
pulmonary oedema, protein reaction
99
what is the most common reason for hospitalisation and death of neonatal foals?
sepsis (30-50% die despite ICU)
100
what is a major risk factor for sepsis?
FPT
| can also be born septic (placentitis)
101
what is sepsis?
systemic bacterial infection
| +/- infected joints/umbilicus
102
what are the clinical signs of sepsis?
```
pyrexia
depression
recumbency
injected mms
may have joint effusion +/- lameness
may be totally non-responsive
```
103
how can sepsis be tested for?
blood culture (sterile sample)
white cell count (low if septic)
serum amyloid A (level of inflammation)
SNAP test (antibodies)
creatinine - risk anuric renal failure
USG (best indicator of hydration)
104
what is a useful test for prognosis of sepsis?
lactate
105
how can sepsis be treated?
intensive care
broad spectrum antibiotics
hyperimmune plasma
joint lavage if infected
remove umbilicus?
106
how can you manage seizures in a foal?
correct primary cause if possible
maintain airway and provide oxygen
anti-convulsant therapy
diazepam/midazolam admin IV, allow 5 mins for each 5mg increment
107
what causes 'dummy foal'?
hypoxia at birth or in utero - leads to brain and organ damage
108
what are the signs of dummy foal?
```
slow to swallow
not sucking
not following mare
forgetting to breathe
ataxic, seizures
```
109
how can dummy foal be treated?
nursing care
maintain cerebral perfusion
correct electrolyte imbalances
PPN/slow enteral feeding
squeeze?
110
what is considered premature?
birth at <320 days, will require vet attention
| 280 days unlikely to survive
111
what is dysmaturity?
look premature despite normal/longer gestation
112
what is postmaturity?
long gestation and normal size, but emaciated
113
what are the classic signs of a premature/dysmature foal?
```
smaller than expected
silky short hair
floppy ears
domed head
weak
abnormal RR (low or high)
```
114
what can prematurity/dysmaturity lead to?
immature GI/respiratory organs and musculoskeletal system
incomplete ossification of carpal and tarsal bones (main reason for euthanasia)
115
what is the prognosis for prematurity/dysmaturity?
fair prognosis overall but will require ICU
116
what flexural deformities can occur in foals?
tendon laxity
| tendon contraction
117
why does tendon laxity develop?
may be premature/dysmature/postmature
can occur as a complication from a bandage/cast/splint
118
how can tendon laxity be managed?
usually resolves after a few days - box rest and limit bedding
walk on firm ground 3x a day
bandage heels for protection
119
what causes tendon contracture to develop?
unknown cause - poss due to positioning in uterus but can also be acquired when horse is older
120
what is the prognosis for tendon contracture?
fair to good
121
how can tendon contracture be managed?
physiotherapy
walk on hard ground
oxytetracycline (1x a day for 3 days)
122
how can a tendon contracture be physically managed?
```
toe extensions
splint
half or full limb cast
check ligament desmotomy (dissection)
tenotomy (division of DDFT)
```
123
what types of angular limb deformities are possible?
valgus (lateral)
| varus (medial)
124
which joints can be affected by angular limb deformities (valgus and varus)?
fetlock
carpus
tarsus
125
how can angular limb deformity be managed?
rest
farriery
surgery (must operate before growth plates are shut)
126
what are the signs of meconium retention?
colic signs
| restlessness
127
what does meconium retention often occur alongside?
failure of passive transfer
128
how can meconium retention be treated?
soapy water enema/phosphate enema
acetylcysteine retention enema (breaks down mucus)
analgesia (buscopan)
surgery (rare)
IgG snap test to check antibody state!
129
how can gastric ulcers be prevented?
give sucralfate prophylactically - encourages blood supply to stomach wall
130
how can an infected umbilicus be identified/treated?
swelling and pus - culture
ultrasound
antibiotics to treat
surgery if severe/unresponsive to antibiotics
131
why might a bladder rupture occur?
compression during birth
| damage due to sepsis
132
how are the signs of a rupture bladder?
colic signs
distended abdomen
will still urinate but smaller amounts - much will be urinated into abdomen
133
how is a ruptured bladder diagnosed?
ultrasound
| peritoneal sample - fluid will smell like urine
134
why is a rupture bladder life-threatening?
increased K causes bradycardia - can be severe
135
how should a ruptured bladder be treated?
0.9% saline at 250ml/hr/50kg (to reduce potassium)
drain abdomen
surgery to repair bladder
136
how does neonatal isoerythrolysis (NIE) occur?
foal erythrocyte antigen not recognised by mare - mare is then sensitised to the erythrocyte antigen
foal drinks colostrum and antibodies in the colostrum attach the foal's red cells
137
what are the signs of NIE?
anaemia
icterus
weak
138
when does a foal with NIE require a blood transfusion?
PCV <12%
139
how can NIE be managed/prevented?
withdraw mare's colostrum and prevent future foals from drinking colostrum from same mare - use donor colostrum
can blood type dam and sire but is complicated
140
what is a common cause of pneumonia in foals?
aspiration pneumonia due to owners bottle feeding
more likely to present if FPT present
141
what are the signs of pneumonia?
increased RR/effort
pyrexia
often fatal if severe
142
how can pneumonia be diagnosed?
radiography
trans-tracheal wash for cytology and culture
143
how is pneumonia treated?
antobiotics
oxygen
keep in sternal recumbency to aid breathing
144
how can a foal become infected with Rhodococcus equi?
suspect infected at birth
lives in environment (dust)
nose to nose contact with infected foals
contact with dam faeces
145
when do clinical signs of rhodococcus equi arise?
not until at least 6 weeks old
| adults do not suffer clinical signs
146
why is rhodococcus equi a foal disease?
causes a change in T helper immunity
147
what are the clinical signs of rhodococcus equi?
can vary and be difficult to interpret
pneumonia
septic/immune-mediated joint effusion
diarrhoea
148
what diagnostic tests are available for rhodococcus equi infection?
thoracic radiograph (abscesses)
tracheal wash for cytology and C&S
joint fluid sample if effusion
very high WCC and fibrinogen
149
how can rhodococcus equi be treated?
clarithromycin plus rifampicin
treat until radiographically normal and blood normal (~6 weeks)
150
what care should be taken when treating a foal with rhodococcus equi?
beware of fata diarrhoea in adult (usually mare) - give foal antibiotic outside stable to lessen mare contact
151
how can rhodococcus equi be prevented?
environmental management
routine US scans
rhodococcus hyperimmune plasma transfusion
no antibiotics at birth - resistance
