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Medical Nursing Flashcards

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1
Q

what is the process of a lameness workup?

A

signalment and presenting complaint
history
gait exam
physical exam
differential diagnosis
diagnostic plan
aids to diagnosis
arthrocentesis

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2
Q

why is signalment and presenting complaint important in lameness work up?

A

indicates possible conditions
signalment can make conditions more likely

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3
Q

what history should be taken for lameness cases?

A

current medications
duration of lameness
onset
progression
continuous or intermittent
effect of exercise and rest
effect of ground surface - if feet affected
which limb
activity levels
concurrent issues

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4
Q

what is assessed in stance for lameness cases?

A

asymmetry
weight bearing
angular limb deformity
weight shifting - to thorax if hindlimbs

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5
Q

what are the types of angular limb deformities?

A

varus - distal medial
valgus - distal lateral

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6
Q

how do you perform gait evaluation?

A

walk and trot
stairs
circles
stride length
head nodding - down on sound
scuffing nails
ataxia
paraparesis
paraplegia
bunny hopping
lateral sway

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7
Q

how is lameness graded?

A

out of 10

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8
Q

what is lameness grade 0?

A

sound

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9
Q

what is lameness grade 1?

A

occasionally shifting weight

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10
Q

what is lameness grade 2?

A

mild lameness at slow trot

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10
Q

what is lameness grade 3?

A

mild lameness while walking

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10
Q

what is lameness grade 4?

A

obvious lameness when walking
places foot when standing

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11
Q

what is lameness grade 5-8?

A

degrees of severity of worsening lameness

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12
Q

what is lameness grade 9?

A

places toes when standing
carries limb when trotting

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13
Q

what is lameness grade 10?

A

unable to weight bear

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14
Q

what is the benefit of lameness grading?

A

consistency between care and assessment

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15
Q

why is physical exam important in lameness pateints?

A

may have more severe injuries

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16
Q

what are you feeling for when palpating lameness cases (done on standing)?

A

asymmetry
swelling
muscle atrophy
joint enlargement
abnormal conformation
compare limbs, may have bilateral disease

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17
Q

what can be seen in patients with joint disease?

A

swelling
joint effusion
pain
instability
decreased range of motion
crepitus on manipulation

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18
Q

how should you examine joints?

A

lateral recumbency
examine unaffected limbs first for comparison

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19
Q

what can be seen in patients with limb disease?

A

swelling
muscle atrophy
pain

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20
Q

why is neuro exam useful in some lameness cases?

A

neuro issues may be causing lameness

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21
Q

how is neuro exam in lameness cases performed?

A

palpate spine
screening neuro exam of proprioception and reflexes
full neuro exam if concerned

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22
Q

how is cranial drawer test performed?

A

under sedation/GA
lateral recumbency
hold tibia and femur and try to move tibia cranially to see if CrCL ruptured

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23
how is tibial thrust test performed?
hold femur with finger on tibial tuberosity flex hock to see if tibial tuberosity moves forwards if CrCL ruptured can be done awake
24
how do you test for patella luxation?
stifle extended with quads relaxed shift patella medially and laterally
25
how is ortolani test performed for hip laxity?
dorsal recumbency subluxate hips by pressing down abduct femurs to reduce hips adduct femurs to subluxate hips
26
what aids to diagnostics can be used for lameness work up?
US x-ray CT MRI arthocentesis EMG if neuro or muscular issue
27
what is an arthrocentesis?
fluid obtained from the joint to diagnose disease
28
when is joint tap indicated?
persistent or cyclical fever lameness in joint localised
29
how do you determine which joint to tap?
systemic lameness - multiple joints one joint affected - one joint, possibly next one along
30
how do you prep for arthrocentesis?
GA patient lateral recumbency strict asepsis - gloves, drape clip and prep area prepare equipment guide with bony landmarks
31
list equipment for arthrocentesis
20-25G needles - solution quite viscous 5/8th-2.5 inch needles - joint dependent 2.5-5ml syringe - create negative pressure
32
what are characteristics from arthrocentesis fluids when abnormal?
larger volume less viscous as diluted with plasma and serum abnormal colour
33
why is it important to release negative pressure before drawing out needle for arthrocentesis?
contaminate with blood from tissue
34
what should you do with fluid samples from arthrocentesis?
EDTA for cytology and smear smear most important plain if enough for protein plain for culture if possible infection give info on volume, viscosity, contamination
35
what should synovial fluid look like?
clear viscous small volume
36
define tap
to obtain
37
define arthrocentesis
surgical puncture and aspiration of joint
38
what equipment is needed for scapulohumeral joint tap?
radiograph - assess needle length 5ml syringe 1.5-2.5 inch, 20-21G spinal needle
39
how is scapulohumeral joint tap performed?
palpate acromion needle inserted distal and directly perpendicular, slightly dorsal and medial gentle traction to open shoulder joint
40
what equipment is needed for elbow/cubital joint tap?
5ml syringe 1-1.5 inch, 23G needle
41
how is elbow/cubital joint tap performed?
elbow flexed to 45 degrees needle inserted at level between anconeal crest and epicondyle, perpendicular to epicondylar crest alongside anconeal process
42
what equipment is needed for carpal joint tap?
2-5ml syringe 5/8th, 23-25G needle
43
how is carpal joint tap performed?
flex carpus to 90 degrees to open joint space and avoid NV bundle insert needle perpendicular to skin aspirate all joints
44
what equipment is needed for MCP/MTP/IP joint tap?
1-2ml syringe 5/8th 25G spinal needle
45
how is MCP/MTP/IP joint tap perfromed?
hard if no aspiration short bevel needle so whole needle tip is in the joint and avoid contamination
46
what equipment is needed for coxofemoral joint tap?
5-10ml syringe 1.5-2.5inch 20G spinal needle
47
how is coxofemoral joint tap performed?
VD radiograph to measure needle length needle inserted craniodorsal to greater trochanter, angled medially and caudoventrally hip abducted and internally rotated to open up joint
48
what equipment is needed for stifle joint or femoropatella joint tap?
5ml syringe 1-1.5inch 21-23G needle
49
how is stifle joint tap performed?
stifle partially flexed needle inserted lateral to patella ligament midway between patella and tibial tuberosity angled caudomedially until hits bone goes through fat pad
50
how is femoropatella joint tap performed?
stifle extended needle inserted at angle between patella and femur towards proximal
51
what are benefits and risks of femoropatella joint tap?
benefits - avoids passing through fat pad which can impede aspiration risks - iatrogenic damage to articular cartilage possible
52
what equipment is used for tarsal joint tap?
2.5-5ml syringe 5/8th-1 inch 23-25G needle
53
how is tarsal joint tap performed?
joint partially flexed manipulate joint to feel articulation angle needle perpendicular to skin into the joint take fluid from craniolateral or caudolateral aspect of the joint push effusion for easier access
54
what is CKD?
gradual, progressive, irreversible nephron loss functional or structural disease over 3 months
55
how common is CKD?
most common kidney disease 3x more in cats than dogs
56
how does therapeutic management of CKD help patients?
slow progression of disease maintain quality of life
57
what is the goal when managing CKD?
reduce workload of nephrons and prevent further damage
58
why is most CKD subclinical?
kidneys have considerable reserve function
59
what is seen in 50% nephron loss (one kidney or 50% reduced function overall)?
subclinical disease
60
what is seen in 67% nephron loss?
lose concentration ability USG <1.030 dogs USG < 1.035 cats
61
what is seen in 75% nephron loss?
azotemia
62
what is seen in 75-100% nephron loss?
decreasing quality of life to incompatible with life
63
what is the pathogenesis of CKD?
chronic interstitial nephritis (inflammation of renal interstitium)
64
what should be ruled out in CKD cases?
treatable or reversible causes: pyelonephritis - inflammation of kidney and renal pelvis ureterolithiasis infection FIP FIV
65
describe the disease process of CKD
reduced GRF initial compensatory hypertrophy of remaining nephrons over time their increased workload leads to progressive nephron loss progressive reduced GFR
66
list effects of CKD
loss of water and electrolyte regulation PUPD dehydration hypokalaemia loss of acid base regulation acidaemia - vomiting, inappetence azotaemia hyperphosphatemia - vomiting, inappetence, secondary hyperparathyroidism anaemia from lack of synthesis of erythropoietin hypertension end organ damage
67
describe common presentation of CKD patients
older cats young if congenital disorder - polycystic or malformed kidneys long term illness incidental finding
68
what can you ask to screen for CKD in geriatric cats?
weight or condition change PUPD appetite demeanour activity V or D hypertension - blindness, neuro signs ability to give meds
69
what assessments do you make in cats with CKD?
hydration weakness uraemic ulcers uraemic halitosis hypertensive retinopathy small and irregular kidneys rubber jaw (from renal secondary hyperparathyroidism)
70
how is CKD diagnosed?
USG urine protein : creatinine serum creatinine and urea GFR - most sensitive test SDMA/symmetric dimethylarginine US radiography UOP
71
what indicates early CKD?
low urine conc BW change
72
what confirms reduced renal function?
azotaemia with inappropriately concentrated urine SDMA bloods
73
how is structural kidney disease diagnosed?
US - size and structure x-rays - ureteroliths
74
how is hypertension associated with CKD?
CKD complication makes CKD worse
75
what is the effect of hypertension in CKD?
blindness neuro signs organ damage
76
what is the goal for systolic BP in CKD patients?
140mmHg
77
how can you reduce stress when taking BP for cats?
minimal restraint gaba feliway calm and patient cat friendly headphones on doppler
78
how does renal secondary hyperparathyroidism occur in CKD?
CKD increases serum phosphate as kidneys fail to excrete phosphate more PTH secreted to low phosphate but also increased calcium fails as kidneys cant excrete excess phosphate progressive increase in phosphate and PTH PTH causes bone resorption and rubber jaw
79
when is renal secondary hyperparathyroidism most commonly seen?
renal dysplasia
80
what causes hypokalaemia in 20-30% CKD cats?
inappetence GI losses urinary losses
81
what are the effects of hypokalaemia in CKD?
muscle weakness inappetence
82
how is hypokalaemia in CKD cats managed?
supplementation
83
84
how does proteinuria in CKD occur?
protein leaks from the blood to urine when glomerulus damaged more common in dogs
85
how is proteinuria measured in CKD?
urea to creatinine ratio
86
what causes anaemia in 30-65% CKD cases?
lack of erythropoietin production reduced RBC lifespan GI losses
87
what is the effect of anaemia in CKD?
weakness lethargy inappetence
88
89
what is monitored in CKD cats?
3-6 months when stable appetite drinking GI signs weight BCS BP retinal exam PCV urea creatinine phosphate calcium electrolytes urinalysis
89
how is iris staging for CKD used?
after diagnosis to treat and monitor CKD appropriately once reversible problems addressed - creatinine, proteinuria, BP
89
what is stage 1 CKD?
non-azotemic renal abnormalities mild SDMA increase
90
what is stage 2 CKD?
mild increase of creatinine mild azotaemia SDMA increase
91
what is stage 3 CKD?
moderate azotaemia clinical signs increased SDMA
92
what is stage 4 CKD?
increased clinical signs azotaemia increased SDMA
93
how can you manage CKD cats?
maintaining hydration renal diet supportive therapy
94
why is managing hydration so important in CKD cats?
dehydration advances CKD
95
what is a renal diet composed of?
low protein - toxins produced as by product of protein low phosphate good antioxidants and fatty acids - blood flow and reduce inflammation high potassium high bicarb - prevent acidosis
96
what supportive therapy can be done for CKD?
calcium channel blockers to open blood vessels and manage hypertension - amlodipine (cats) or ACE inhibitors (dogs) renal diet and phosphate binders for hyperphosphatemia renal diet and potassium supplements for hypokalaemia renal diet, ACE inhibitors, omega 3 PUFAs, antiplatelets for proteinuria
97
what is a senior cat?
11-14yo
98
what is a geriatric cat?
15yo +
99
list common conditions affecting older cats?
hyperthyroidism hypertension CKD feline cognitive dysfunction dental disease DJD DM intestinal lymphoma IBD
100
list signs of hyperthyroid in older cat
PUPD increased appetite weight loss
101
list signs of hypertension in older cats
vision issues neurological changes systolic BP over 160mmHg
101
list signs of CKD in older cats
lethargic unkept weight loss azotemia generalised illness hypertension
101
how prevalent is feline cognitive dysfunction?
55% cats over 11yo 80% cats over 16yo
101
list signs of dental disease in older cats
gingivitis periodontal disease tooth resorption
102
list signs of DM in older cats
increased urination increased appetite weight loss
103
what is seen in intestinal lymphoma in older cats?
digestive issues
104
what may be included in pre-assessment forms for screening geriatric cats?
behaviour changes interactions with other pets household changes current medications
104
what is a sign of IBD in older cats?
ravenous as cant absorb food
105
how is disease detected in older cats in nurse clinics?
pre-assessment history parameters diagnostics if concerned clinical exam
106
what history should be taken in geriatric cat clinics?
parasite control vaccination status diet confirm signalment
107
describe structure of geriatric cat clinics
done by same person ideally patient dependent history weight BP clinical exam diagnostic tests as needed - urinalysis, bloods recommendations - vet referral, minor changes summarise arrange follow up
108
how should hydration be managed in geriatric cats?
always available encourage to drink measure intake every 6 months for any change
108
what are features of feline senior diets?
reduced energy and fat - less active reduced calcium and phosphorus - manage possible kidney issues increased fibre - increase digestion, support weight loss wet - better support of hydration
109
how are condition scores used for geriatric cats?
ensure consistent weight calculate % weight changes BCS and MCS <5% not significant 5-10% significant >10% big concern
110
why is maintaining hydration in older cats so important?
maintain acid base balance maintain osmoregulation
111
list effects of hypertension
retinal oedema retinal haemorrhage retinal detachment left ventricular hypertrophy progressive renal failure bleeding into the CNS ataxia disorientation seizures coma death
111
why is it important to monitor BP in older cats?
secondary hypertension common as a result of CKD, hyperthyroidism, other endocrine disorders
112
what can cause hypotension (<120mmHg) in geriatric cats?
heart failure shock hypovolaemia
113
what is normal SBP in cats?
120-160mmHg
114
what can cause SBP to be slightly elevated in cats at 160-180mmHg?
stress
115
what can cause hypertension (>180mmHg) in geriatric cats?
CKD hyperthyroidism endocrine disease
116
what should be assessed in clinical exam in geriatric cats?
slowly and cat friendly head to toe assess gait auscultate observe resp check thyroid examine muscles
117
what are common conditions that geriatric cats may have?
ear infections neurological conditions trauma infections tumours
118
what bloods are common in geriatric cats and why?
biochem haem BG thyroid assess organs and systems
119
what urinalysis is commonly done in cats?
SG dipstick UPC ratio
120
what are considerations for restraining geriatric cats?
temperament disease injury preference age DJD push not pull limbs towel wrap minimal
121
define dyspnoea
difficult or laboured breathing
122
define tahcypnoea
increased rate of respiration
123
define orthopnoea
upright position with extended neck to create space in chest to aid breathing
124
what is normal awake and sleeping RR?
awake <35, panting normal in dogs sleeping <25
125
list causes of tachypnoea and dyspnoea
stress pain excitement exercise hypoxaemia hypercapnia respiratory disease cardiac disease
126
what is localisation for upper airway disease?
nasal passages pharynx larynx trachea
127
list signs of upper airway disease
inspiratory dyspnoea (difficulty breathing in) stertor or stridor abnormal sounds heard without touching patient
128
list causes of upper airway disease
laryngeal paralysis BOAS FB neoplasia polyps inflammation tracheal collapse
129
how is upper airway disease initially managed?
GA and intubation if obstructed care for rapid decompensation
130
what is localisation for lower airway disease?
bronchi bronchioles
131
list signs of lower airway disease
quick short inspiration prolonged expiration harsh lung sounds on auscultation wheezes due to broncho constriction crackles from secretions blocking airways
132
what can cause lower airway disease?
asthma bronchitis smoke inhalation bronchopneumonia COPD
133
list signs of lung parenchyma disease
expiratory and inspiratory components
134
list causes of dyspnoea caused by lung parenchymal disease
pulmonary oedema - cardiac or non-cardiac pneumonia infection fibrosis haemorrhage contusion neoplasia thromboembolism parasites
135
how do lung parenchymal disease appear on x-rays?
fluid is white can see masses or pathologies
136
list signs of pleural space disease
restrictive breathing pattern increased RR reduced depth of inspiration - lungs cant expand
137
list causes of pleural space disease
penumonia pleural effusion masses diaphragmatic hernia pneumothorax heamothorax
138
list causes of pleural effusion
haemorrhage infection neoplasia heart failure chylothorax
139
what changes in lung auscultations with pleural effusions present?
muffled heart sounds muffled lung sounds dorsally
140
how is pleural effusions and pneumothorax diagnosed?
physical exam thoracic radiographs US
141
why are US favoured for pleural effusion and pneumothorax diagnosis?
quick to diagnose can do conscious dont have to position patient
142
how do you stabilise patients with pleural effusion or pneumothorax?
thoracocentesis
143
how do you do a thoracocentesis?
sedate prep area collect samples for cytology, culture, biochem drain space
144
what is the clinical approach when presented with respiratory emergencies?
oxygen clinical exam upper or lower disease RR and effort MM HR and heart abnormlaities pulses minimise stress
145
what is the goals of oxygen in respiratory emergencies?
increase oxygen content in arterial blood increase oxygen delivery to tissues
146
what determines oxygen delivery to tissues?
haemoglobin concentration blood oxygenation CO
147
list methods of oxygen supplementation
flow by - inefficient but fine if nothing else mask nasal prongs nasal catheter - further in so more secure and better delivery collar - fine for temporary oxygen cage intubation ventilation
148
what are considerations for using oxygen cages?
care for temperature, humidity and carbon dioxide cages can control this but are expensive
149
what are considerations when giving respiratory patients oxygen?
is it needed oxygen toxicity correct rate
150
list goals of oxygen supplementation in respiratory patients
resolve life threatening hypoxaemia relieve resp distress
151
when can oxygen toxicity occur?
100% o2 for 12-24 hours
152
how do you prevent oxygen toxicity in resp patients?
give less than 60% if long term aim for lowest oxygen level can tolerate
153
what should be monitored in resp patients?
physical exam arterial BG pulse ox RR and effort MM hydration HR pulses stress/anxiety
154
why is it important to measure arterial BG in resp patients?
partial pressure of oxygen gold standard for arterial oxygenation
155
how do you take arterial blood samples for BG?
dorsal metatarsal or femoral artery keep in airtight and specific syringe apply pressure after sample
156
what affects PaO2?
oxygen barometric pressure
157
what is normal PaO2 on room air and 100% oxygen?
100mmHg - room air 500mmHg - 100% oxygen
158
what values are seen in hypoxaemia?
PaO2 <80mmHg <95% saturation
159
what is the goal for PaO2 and saturation for resp patients?
PaO2 80-120mmHg 95-100% saturation
160
what does a pulse ox do?
measure partial oxygen saturation calculates haemoglobin oxygen saturation continuous and non-invasive monitoring
161
when does pulse ox work best?
moist, non-pigmented skin with adequate perfusion
162
what heart failure is normally seen in dogs?
left or right sided congestive heart failure
163
what heart failure is normally seen in cats?
biventricular failure
164
what are the commonly seen left sided heart failure in dogs?
myxomatous mitral valve disease in small dogs dilated cardiomyopathy in large breeds (systolic dysfunction)
165
what is a common cause of right sided heart failure in dogs?
pericardial effusion
166
what heart failure is common in young dogs?
congenital heart failure
167
what heart failure is commonly seen in cats?
hypertrophic cardiomyopathy (diastolic dysfunction)
168
describe left sided congestive heart failure
backwards failure pressure in the heart increased so pressure in pulmonary veins entering the heart have increased pressure fluid cant enter pulmonary capillaries in due to pressure in vessels fluid collects in pulmonary tissues
169
what are the effects on the body of left sided congestive heart failure?
pulmonary oedema tachypnoea dyspnoea coughing due to enlarged heart pressing on receptors in trachea and bronchi
170
describe presentation of left sided heart failure
heart murmur - not always present or an indicator of this disease tachypnoea dyspnoea tachycardia pale MM slow CRT arrhythmia weak pulses pulse defecits
171
describe clinical approach to left sided heart failure cases
history physical exam stabilise before diagnostic tests - fragile and may decompensate
172
how do you stabilise patients with left sided heart failure?
minimise stress sedate with low dose butorphanol oxygen furusamide IV if pulmonary oedema pimobendan PO or IV to improve myocardial contractility
173
how does furusamide help with pulmonary oedema?
reduces circulating volume so reduces pressure in heart and reduces fluid not in circulation
174
how is left sided heart failure diagnosed?
echo throacic radiography ECG BP bloods
175
how does echo help diagnose heart failure?
diagnosis and severity of disease
176
how does x-rays and CT help diagnosis of heart disease?
identify pulmonary oedema see heart size find neoplasia
177
why are ECGs used in diagnosis of heart disease?
identify arrhythmia
178
why are BP measurements used in diagnosis of heart disease?
identify hypotension caused by low CO
179
why are bloods done in heart disease diagnosis?
electrolyte and renal parameters diuretics can lower K, cause dehydration and azotaemia
180
what is seen on x-rays in the progression of cardiogenic pulmonary oedema?
begins in dorsal region, spreads caudal then ventral
181
list monitoring for left sided congestive heart failure pateints
RR and effort less than 40 breaths per min SBP above 80mmHg HR pulse quality EGC if arrhythmia x-ray if pulmonary oedema not improving
182
when is the patient seen as improving in left sided CHF?
RR and HR decreased
183
how is left sided CHF managed once stabilised?
lifelong therapy feeding to prevent cardiac cachexia bloods week after meds started or changed 3 monthly bloods, echo and other tests as needed (patient dependent)
184
describe right sided congestive heart failure
backwards failure increased pressure in the vena cava causing effusions to form around organs as fluid cant re enter the circulation
185
what is the effect on the body in right sided congestive heart failure?
distended peripheral veins and jugular ascites pleural effusion tachypnoea dyspnoea
186
what are causes of right sided CHF?
pulmonic stenosis tricuspid dysplasia pericardial effusion neoplasia
187
how is right sided CHF diagnosed?
history physical exam echo thoracic x-ray US ECG CT
188
describe a pericardial effusion
increased fluid in pericardium leading to tamponade as right atrium collapses due to external pressure right side of heart filling impaired
189
what can cause left side of heart filling to be impaired in pericardial effusion?
septum can move with filling of the heart and breathing which can impair the left side
190
what is the impact of pericardial effusion?
decreased CO
191
what are common causes of pericardial effusion?
neoplasia idiopathic
192
how is pericardial effusion stabilised?
pericardiocentesis IVFT - counteract lower pressure in heart to improve filling and CO
193
what do you see post-pericardiocentesis?
HR pulses and demeanour improved
194
how do you manage patients following pericardiocentesis?
12-24 hour hospitalisation to monitor for arrhythmia effusion can recur at any point
195
describe reduced cardiac output
forwards failure left or right sided failure causing weak peripheral pulses and tachycardia leading to low SV
196
when is reduced CO commonly seen in heart disease?
DCM - reduced systolic function end stage heart disease
197
what is the most common cause of feline cardiac emergencies?
HCM can be caused by stress or anaesthesia
198
how do cats with cardiac disease present?
murmur gallops tachypnoea dyspnoea open-mouth breathing tachycardia bradycardia (more severe than tachy) weak pulses hypothermia older overweight males more prone
199
when does arterial thromboembolism tend to have poor prognosis in cats?
when presenting with HF
200
what are signs of arterial thromboembolism in cats with HF?
sudden onset hindlimb paralysis/paresis pain pallor/cyanosis of pads and nail beds pulselessness poikilothermy/cold leg poor hindlimb perfusion
201
how should you manage feline cardiac emergencies?
history physical exam stabilisation - fragile and easily decompensate tests once stable
202
how should you stabilise cats with cardiac emergency?
avoid stress oxygen furusomide for pulmonary oedema drain pleural effusion gentle warming analgesia for ATE
203
how do you diagnose feline cardiac emergencies?
history exam stabilise echo - POC until stable thoracic x-ray ECG BP bloods
204
how do you manage feline cardiac patients in hospital following diagnosis?
adjust therapy to lowest effective dose feed manage thromboembolism - warm soft bedding and physio home as soon as possible manage stress
205
what is long term management for feline cardiac patients?
food intake to prevent cardiac cachexia repeat bloods and echo owner monitor RR and effort, signs of embolism
206
what is prognosis for feline cardiac patients?
guarded may suddenly die
207
what is normal HR of dog?
60-120
208
what is normal cat HR?
160-220
209
what is a bradyarrhythmia?
HR lower than normal range
210
what is a tachyarrhythmia?
HR above normal parameter
211
how do patients with arrhythmias present?
syncope (collapse) weakness exercise intolerance CHF abnormal HR weak pulses pulse deficits
212
how are arrhythmias diagnosed?
ECG
213
define hyperpnoea
deeper breaths without dyspnoea
214
how do you triage a patient?
assess most life threatening concern CV, resp and neurological
215
what are important considerations for dyspnoeic cat?
fragile keep low stress provide oxygen where possible
216
what should be examined in dyspnoeic cat?
RR and effort and pattern clinical exam auscultate percussion cranial rib spring assess oxygenation
217
what can cause inspiratory dyspnoea?
dynamic extrathoracic upper airway obstruction
218
what can cause expiratory dyspnoea?
intrathoracic upper airway obstruction lower airway disease
219
what does rapid shallow breathing indicate in dyspnoiec cats?
pleural space disease parenchymal disease
220
what is meant by adventitious lung sounds?
abnormal respiratory noises
221
what can you hear on auscultation in respiratory disease?
breath sounds wheezes crackles stertor stridor
222
what can you palpate for in respiratory disease?
thoracic compressibility percussion
223
what can cause URT obstruction?
FB polyps laryngeal tumours
224
how do you manage URT obstruction?
intubate
225
what can cause LRT disease?
asthma bronchitis bacterial infection lung worm FB neoplasia
226
what can occur secondary to LRT disease?
pneumothorax
227
how do you manage general LRT disease?
bronchodilators
228
what causes feline asthma?
type 1 hypersensitivity to allergen airway hyperresponsiveness reverse bronchoconstriction secondary inflammation
229
describe chronic bronchitis
airway inflammation excess mucus production airway narrowing
230
how is lower airway disease managed?
oxygen minimise stress bronchodilators
231
what are examples of bronchodilators given in cats?
terbutaline 0.015mg/kg IM/SC q4 salbutamol 1-2 puffs to effect
232
how is parenchymal disease managed in cats?
cage rest oxygen sedation as needed furusomide
233
what can be the fluid in pleural effusion?
transudate modified transudate exudate
234
what are possible types of exudate in plural effusion?
pyothorax (septic) neoplasia or FIP (non-septic) chyle (CHF, trauma or idiopathic) blood (trauma, coagulopathy, neoplasia)
235
what equipment is needed for thoracentesis?
clippers sterile prep kit sterile gloves butterfly catheter 3 way tap EDTA and plain tube 20ml syringe procedures book helpful
236
describe thoracocentesis procedure
7-8th intercostal space, costochondral junction EDTA for cytology plaint tube for biochem and culture and sensitivity IV antibiotics as needed supportive care
237
what are examples of glucocorticoids in dyspnoic cats?
dexamethasone fluticasone inhaler
238
when should you give furusomide to dyspnoeic cats?
if suspect HF
239
what is the action of the heart?
pump blood around the body and lungs
240
what is myocardium?
cardiac muscle that contracts rhythmically and autonomically without nervous input, controlled by electrical impulses
241
what is heartrate controlled by?
sympathetic and parasympathetic nervous systems
242
how does SNS control HR?
releases catecholamines adrenaline and noradrenaline to increase HR
243
how does PNS control HR?
PNS releases hormone acetylcholine to decrease HR
244
what are cardiac cells?
electrical cells and myocardial cells
245
what are functions of electrical cells of the heart?
conduction system of the heart in orderly fashion spontaneously generate electrical impulses and respond to impulses transmit electrical impulse along to next cell
246
what is the role of myocardial cells in the heart?
make up walls of the atrium and ventricles responsible for contraction and ability to stretch
247
what needs to happen for the heart to function properly?
co-ordinated contraction 2 atria then 2 ventricles pushing blood to circulation and lungs
248
describe the conduction system of the heart
at rest cardiac cells are polarised depolarise when stimulated by electrical impulse causing contraction repolarise back to resting state to allow filling between contractions
249
what is the sinoartial node?
area of modified cardiac muscle cells in right atrium wall that initiates heart beat and controls HR influenced by PNS and SNS
250
how does the SA node initiate heart beats?
fires electrical impulses causing depolarisation to spread through atrial muscle cells causing atrial systole and blood to move to the ventricles
251
what is the atrioventricular node?
specialised group of muscle cells at the top of intraventricular septum that coordinates ventricular contraction with atrial contraction by its slow transmission of the impulse through it
252
why is it important the atrial and ventricular contraction is coordinated?
allows full filling of the ventricles before contraction
253
what is bundle of his?
bundle of nerve fibres running down the interventricular septum and divides into left and right bundle branches
254
what is the role of the bundle of his?
connects to the AV node to pass the impulse to the ventricles
255
what are purkinjie fibres?
network of specialised neurones organised into fine fibre branches connected from bundle of his going into the ventricles myocardium
256
describe ventricular contraction
begins at bottom of the ventricle and moves upwards causing ventricular systole and pushing blood out of the heart
257
what does an ECG do?
measures and records changing electrical activity of the heart using positive and negative electrodes records changes in potential difference
258
describe how an ECG works
when parts of atria nearest SA node depolarise electrical potential difference is created with parts still in resting state when negative and positive electrodes are placed either side of the heart ECG detects this depolarisation wave travelling across the heart and records as a wave deflection
259
when are ECGs used?
diagnose arrhythmia triage anaesthetic monitoring general monitoring critical patients monitor idenitfied pulse defecits and arrhythmias CPR to identify shockable rhythms in patients with metabolic and electrolyte abnormlaities pericardiocentesis and central line placement hands off monitoring
260
where are the ECG leads placed?
red - right fore yellow - left fore green - left hind black - right hind
261
what are the different types of electrodes for ecg?
crocodile clips directly to skin pads on patients paws or thorax
262
what are general considerations for using ECGs?
remove interference sources such as mobiles good skin contact patient ideally in right lateral
263
list types of ECG machines and most important uses for each
multiparameter - continuous monitoring paper trace - diagnosis holter - long periods and can wear at home telemetry - remote monitoring
264
list troubleshooting for ecg
check machine check leads minimise patient movement ideally in right lateral purring/panting interferes check contact clip fur
265
what is the p wave?
atrial electrical activity positive deflection small electrical change as small muscle mass of atria
266
what is the PR interval?
time between atrial and ventricular depolarisation occurs during atrial depolarisation, wave depolarises AV node
267
what is the Q wave?
ventricular septum depolarises first following depolarisation wave passing bundle of his and purkinjie fibres causing small downwards wave on trace negative deflection
268
what is the R wave?
majority of ventricular myocardium is depolarised causing depolarisation wave travelling towards positive electrode large muscle mass so large deflection positive deflection
269
what is the s wave?
after depolarisation of most of ventricles, final depolarisation occurs at base of the heart small negative deflection
270
what is QRS complex?
waveform representing depolarisation of ventricles followed by ventricular contraction
271
what is the baseline on an ecg?
when atria and ventricles are depolarised there is no longer electrical potential difference before repolarisation
272
what is the t wave?
repolarisation of ventricles following complete depolarisation ready for next impulse small positive deflection
273
why can the T wave be positive, negative or biphasic?
can be random repolarisation of myocardium
274
how should you interpret ECGs?
HR complexes - present and normal any arrhythmias
275
list types of arrhythmia
regularly regular irregularly irregular regularly irregular bradyarrhythmia tachyarrhythmia intermittent continuous sinus ventricular supraventricular
276
what makes an arrythmia heart beat abnormal?
its rate, impulse conduction or ectopia (out of place)
277
can all cells in the heart generate electrical activity?
yes
278
what are types of sinus rhythms?
normal sinus rhythm sinus arrhythmia
279
what is sinus rhythm?
normal PQRST complex regular heart sounds pulse on every heart beat normal HR regularly regular rhythm
280
what is sinus arrhythmia?
regular variation on HR coinciding with respiration due to PNS activity/vagal tone on SA node normal P for every QRST pulse for every heart beat electrical impulse originates from SA node regularly irregular rhythm
281
list bradyarrhythmias
sinus bradycardia sick sinus syndrome AV blocks escape beats hyperkalaemia
282
what is a sinus bradyarrhythmia?
SA node impulse and depolarisation slower than normal normal sinus rhythm and PQRST complex slow HR no pulse deficits regularly regular rhythm
283
what can cause sinus bradyarrhythmia?
can be normal in giant or athletic dogs issue with SA node secondary to disease - causing increased vagal tone, hypoadrenocorticism, hyperkalaemia, BOAS, high ICP leading to cushings reflex, hypocalcaemia hypothermia hypoglycaemia hypothyroidism
284
how do you treat sinus bradycardia?
treat underlying cause give anticholinergic - atropine or glycopyrrolate positive inotrope - dopamine or dobutamine
285
what is sick sinus syndrome?
SA node fails to discharge electrical impulse leading to severe bradycardia or periods of asystole
286
what causes sick sinus syndrome?
degenerative common in WHWT, cocker, cairn, mini schnauzer
287
how is sick sinus syndrome treated?
pacemaker poor response to atropine
288
what are downsides and risks to pacemakers?
last 5-10 years expensive infection lead dislodgement failure to place correctly venous thrombosis
289
list nursing considerations following pacemaker
no waking for 48 hours harness only walks no neck restraint or jug samples
290
what is an AV block?
impulses from SA node delayed or blocked going through AV node, signal may fail to reach the ventricles issue with conduction system in the heart
291
what can cause AV block?
disease process drugs that effect AV node
292
what is the difference between AV block and bundle branch block?
AV affects AV node bundle branch block affects left or right bundle branch
293
list signs of AV block
decreased CO lethargy syncope collapse
294
how is AV blocks treated?
manage underlying condition vagolytic drugs - atropine, glycopyrrolate pacemaker for 2nd and 3rd
295
what is a first degree AV block?
delayed conduction through AV node normal PQRST prolonged PR interval
296
what is a second degree AV block?
longer conduction delay some P waves wont have QRS, dropped beat
297
what is mobitz type I second degree AV block?
PR interval gets longer and longer until beat is dropped and then back to normal
298
what is mobitz type II second degree AV block?
PQRS complex normal occasional P wave without QRS
299
what is a third degree AV block?
complete lack of conduction through AV node multiple P waves without QRS complexes some tall QRST complexes which are ventricular escape beats acting as rescue beats usually slow HR
300
what are rescue beats?
electrical impulses occurring from random cells to keep animal alive leads to bizarre and wide complexes with absent P wave
301
how does hyperkalaemia affect bradycardia?
as potassium increases, severity of bradycardias and arrhythmias increase
302
what is seen in hyperkalaemia arrhythmias?
reduced/absent p waves spiked t waves short QT interval prolonged QRS complex progression to atrial standstil, sine wave pattern, v fib and asytsole
303
what diseases can cause hyperkalaemia?
urethral obstruction AKI hypoadrenocorticism
304
how is hyperkalaemia treated?
calcium gluconate bolus to reduce risk of v fib and protect cardiac myocytes from high k insulin infusion to move k into cells dextrose as cells uptake glucose with k to prevent hypoglycaemia
305
list tachyarrhythmias
sinus tachycardia supraventricular tachycardia atrial fibrillation ectopic beats accelerated idioventricular rhythm ventricular tachycardia r on t phenomenon
306
what is sinus tachycardia?
SA node generates impulse at faster rate than normal normal PQRST complexes regularly regular rhythm faster HR than normal pulse for every beat
307
when can sinus tachycardia be normal?
pain stress exercise hypovolaemia anaemia
308
what is supraventricular arrhythmia?
atrial origin occurs at point other than SA node then conducts via AV node to the ventricles QRS normal but often narrower and taller p wave abnormal premature heart beat irregularly irregular rhythm
309
what are other names for supreventricular arrhythmia?
atrial premature complex premature atrial contraction atrial premature beat
310
what is supraventricular tachycardia?
3 or more supraventricular arrhythmias rapid HR narrow and upright QRS, may or may not be with P wave regularly irregular rhythm
311
what is seen in slow SVT?
normally no clinical signs
312
whatclinical signs is seen in fast SVT?
weakness collapse poor pulse quality poor peripheral perfusion pale MM prolonged CRT inadequate diastolic filling
313
what can cause SVT?
cardiac disease systemic disease causing toxicity, hypovolaemia, electrolyte imbalance, ischemia
314
how is SVT managed?
lower HR treat underlying disease beta blockers calcium channel blockers - IV then oral for maintenance
315
what is ventricular arrhythmia?
ventricular origin normal conduction pathway not followed QRS complexes wide and bizarre
316
what is an ectopic beat?
beat generated not from SA node but other cells in the heart premature and interrupts normal rhythm before SA node would initiate other rhythm abnormal PQRST complex
317
what are types of ectopic beats?
atrial premature complex junctional premature complex ventricular premature complex supraventricular tachycardia escape beats
318
what is atrial fibrilation?
supraventricular tachyarrhythmia rapid and irregular arrhythmia of atria pulse deficits common irregular pulse ventricles contract before filling rapid irregular HR fibrillating baseline taller and narrow QRS no visible p wave irregularly irregular rhythm
319
how is atrial fibrillation treated?
decrease HR increase CO calcium channel blockers beta blockers digoxin amiodarone
320
what is junctional premature complex?
ectopic beat arising from area in AV junction ventricles activated normally premature narrow QRS before P wave
321
what is a ventricular arrhtyhmia?
SA node no longer controls ventricular contractions abnormal electrical impulse at ectopic site below AV node takes control of pacemaker role complexes wide and bizarre
322
what can cause ventricular arrythmia?
underlying cardiac disease complication of GDV, splenectomy, pancreatitis, anaemia
323
what is ventricular premature complex?
ectopic beat occurring before normal SA node depolarisation, begins in abnormal location in ventricles no p wave wide and bizarre QRS weak pulses pulse deficits
324
what is accelerated idioventricular rhythm?
3 or more VPC together elevated HR unlikely to effect CO, hypotension or haemodynamic compromise
325
how do you manage accelerated idioventricular rhythm?
monitor closely for progression to v tach
326
what is ventricular tachycardia?
3 or more VPCs rapid HR bizarre and wide QRS complexes absent P waves large t waves
327
what are signs of v tach?
weak pulses and deficits rapid irregular HR low CO hypotension collapse haemodynamic compromise altered mentation hypoperfusion
328
what can cause v tach?
primary cardiac disease abdo pathology inflammation severe anaemia abnormal autonomic activity electrolyte disturbances drug toxicity neoplasia
329
list effects of v tach
decreased systemic tissue perfusion/cardiogenic shock myocardial failure malignant arrhythmia/v fib sudden death
330
what is treatment aims for v tach?
convert to sinus rhythm slow HR improve CO and peripheral perfusion
331
how do you treat v tach?
manage underlying cause lidocaine beta blockers amiodarone procainamide magnesium
332
how do you manage pulseless v tach?
emergency start CPR shock
333
what is r on t phenomenon?
VPC premature so superimposed on T wave of preceding complex on sinus or ectopic beat ventricles not fully repolarised before depolarising
334
what can be the consequences of r on t phenomenon?
v tach or v fib
335
list cardiac arrest rhythms
ventricular fibrillation pulseless ventricular tachycardia pulseless electrical activity asystole
336
how does defibrillation work?
sends high energy electric shock to heart to reset electrical state of the heart and convert to sinus rhythm
337
which CA rhythms are shockable?
v fib pulseless ventricular tachycardia
338
why is it important not to shock non-shockable rhythms?
can be detrimental for survival
339
what is v fib?
pre-terminal condition leading to patient death unless managed no effective ventricular contractions rapid ECG with irregular wavy baseline no CO or pulses can be coarse or fine
340
how do you manage v fib?
CPR and shock
341
what is pulseless electrical activity?
electrical impulses in the heart no corresponding myocardial contractions varied HR normal complexes become wide and bizarre no heart beat or pulses can occur minutes after patient death
342
how do you manage pulseless electrical activity?
CPR adrenaline atropine defib if converts to shockable rhythm
343
what is asystole?
flat line most common arrest rhythm no pulses or CO associated with end stage disease caused by high vagal tone
344
how do you manage asystole?
CPR shock if converts to shockable rhythm
345
what are the stages of a normal cell lifecycle?
interpahse - cell matures and DNA replicates mitosis - prophase, metaphase, anaphase and telophase prophase - preparation to split, chromosomes form metaphase - chromosomes line up anaphase - chromosomes split telophase - chromosomes stretch out cytokinesis - cell splits in 2
346
when do cells enter apoptosis?
after replicating a set number of times, depending on function and replication frequency controlled by the nucleus
347
what signals do cells responds to?
growth and environmental signals
348
what makes cancer a rare event?
processes in place to prevent it occuring
349
what is cancer?
phenotypic end result of whole series of changes that take long time to develop
350
how is cancer prevented?
cell cycle inhibited for repair or apoptosis tumour suppressor genes
351
describe how cancer arises
accumulation of genetic mutations which eliminate cell constraints very slow process and may not occur in lifetime of animal
352
what is one factor that is increasing the amount of cancer we see?
longer lifespan of animals as more mutations can accumulate
353
list environmental causes of cancer (not proven in animals but can assume as in humans)
chemical carcinogens physical agents hormonal causes cancer causing/oncogenic viruses (inherited cancer, not recognised in animals)
354
list types of chemical carcinogen
tobacco smoke pesticides herbicides insecticides cyclophosphamide (chemo drug linked with bladder cancer)
355
list physical agents that can cause cancer
sunlight trauma chronic inflammation magnetic fields radiation surgery implanted devices asbestos
356
how can hormones effect cancer?
neutering can prevent some neutering can increase risk of others such as lymphoma
357
how do oncogenic viruses lead to cancer?
indirect or direct action on causing cancer
358
list examples of oncogenic viruses
papilloma virus FeLV
359
list mutations resulting in cancer
sustain proliferative signalling evade growth suppressors resist cell death - cant recognise DNA damage enable replicative immortality - telomeres dont reduce on division (apoptosis when no longer present) induce angiogenesis - new blood vessels active invasion and metastasis
360
how many mutations are needed for cancer to occur?
5-6 critical mutations
361
what is a tumour?
benign or malignant neoplasm
362
define neoplasia
formation of abnormal growth that is not responsive to physiological control mechanisms benign or malignant
363
define cancer
malignant neoplasms
364
define benign tumour
space occupying can cause tissue distortion
365
define malignant tumour
locally destructive, may metastasise and cause death
366
how does chemotherapy work?
targets dividing cells different drug classes work at different stages of DNA replication and cell division, or interfere with cell signalling
367
when can chemotherapy be used?
primary induction therapy - sole therapy primary neoadjuvant chemo - before treatment adjuvant chemo - mop up after surgery consolidation chemo - haemopoietic chemo after remission maintenance chemo - low intensity over long term rescue or salvage chemo - failed response to previous chemo palliative chemo - maintain quality of life, not cure
368
what are the benefits of multimodal chemo plans?
maximal cell kill in range of tolerable host toxicity broader range of interaction between drugs and tumour cells slows development of tumour drug resistance
369
what are considerations for using multimodal chemo plans?
only drugs with single use efficacy against tumour type ideally use drugs without overlapping toxicity so dont have to wait for toxicity to settle before next drug use drugs at optimum dose and schedule to lower resistance by tumour use consistent intervals
370
list effects of chemo on cells
affects dna replication so go inot apoptosis
371
list types of chemo agents
alkylating agents antitumour antibiotics antimetabolites antimicrotubule agents corticosteroids platinum l-asparginase target agents
372
what are examples of alkylating agents and how do they work?
cyclophosphamide, chlorambucil, lomustine binds alkyl groups to cellular macromolecules cross linking DNA
373
what are examples of anti-tumour antibiotics and how do they work?
doxyrubicin, mitoxantrone multimodal action of cellular toxicity
374
how do antimetabolites work?
inhibit use of cellular metabolites in cellular growth and division
375
what are examples of antimicrotubule agents and how do they work?
vincristine, vinblastine interfere with cellular function and replication
376
what are examples of corticosteroids used in chemo and how do they work?
prednisolone induction of apoptosis in haematologic cancers
377
what are examples of platinum used for chemo and how do they work?
cisplatin, carboplatin bind DNA
378
how does L-asparginase work as a chemo drus?
induces apoptosis in tumour cells
379
what are examples of target agents for chemo and how do they work?
palladia, masivet tyrosine kinase inhibitors, block receptors on cell surface
380
what is lymphoma?
diverse group of neoplasm of common origin from lymphocytes, lymph nodes, spleen, bone marrow can affect all areas of the body
381
how does lymphoma present in cats and dogs?
cats - intestinal presentation dogs - 80% have multicentric form, one of most common tumour in dogs
382
how is lymphoma treated?
consistent chemotherapy cycles restrart chemo if leave remission can live 2+ years with treatment
383
what is the CHOP protocol?
cyclophosphamide hydroxydaunorubicin/doxorubicin oncovin/vincristine prednisolone
384
when is prednisolone given in the CHOP protocol?
if systemically unwell
385
how does the CHOP protocol work?
given over several months discontinuous so stopped when finished and restart as needed
386
what causes chemo toxicities?
drugs targeting normally dividing cells
387
what is commonly affected by chemotherapy in the body?
bone marrow GI
388
list side effects of vincristine
myelosuppression peripheral neurotoxicity GI ileus
389
list side effects of cyclophosphamide
neutropenia GI toxicity haemorrhagic toxicity
390
list side effects of chlorambucil
myelosuppression
391
list side effects of epirubicin
anaphylaxis myelosuppression GI toxicity cardiotoxicity - rare
392
what is a possible side effect of doxorubicin?
changes leading to CHF
393
list nursing considerations for chemo patients
feeding toileting barrier nurse care pre-diagnosis, during treatment if ill and end of life care
394
list considerations for administering chemo
bolus or infusion, or orally for some IV needs to be clean stick check drug and dose use PPE correct protocols correct disposal
395
what chemo drugs are group 1 vesicants?
vinchristine epirubicin
396
how do you manage chemo admin gone wrong?
leave ICV in and aspirate inject saline around area heat compression
397
how do you manage excretions following chemo?
drug is excreted for 4-5 days handle with gloves double bag urinate in low traffic areas and wash away
398
how can you support owners with chemo pets?
understand condition and treatment for discussion understand owners needs provide supportive care, curative treatment, palliative care, hospice or euthanasia as appropriate to help patient keep owners involved provide support as needed
399
what are the two types of dietary sensitivities?
non-immunologically mediated immunologically mediated
400
what are the types of non-immunologically mediated dietary sensitivities?
repeatable food intolerances non-repeatable dietary indiscretion - over eating, eating things shouldnt, gluttony intoxication contamination/poisoning
401
what are immunologically mediated food sensitivities?
repeatable food allergy or hypersensitivity
402
define a food allergy
immunologically mediated adverse food reaction/AFR to dietary component
403
what is the most common dietary component causing food allergies?
proteins
404
what defence mechanisms does the body have against AFR?
constant exposure to foreign antigens peristalsis mucus layer gut not designed to let large molecules through protients hydrolysed before entering blood oral tolerance is series of signalling and processing leading to tolerance of foreign antigens body learns whats harful
405
when does AFR occur?
failure of bodys defence mechanisms against them
406
how do most AFR manifest?
delayed hypersensitivity/type 4 anaphylaxis in some cases
407
list the systems affected by AFR
dermatological GI
408
list common food allergens in dogs
beef dairy wheat
409
list common food allergens in cats
beef dairy fish
410
what is canine epileptoid cramping syndrome?
severe muscle and intestinal cramps of short duration in border terriers as a result of gluten allergens
411
how is canine epileptoid cramping syndrome treated?
eliminating gluten
412
list cutaneous clinical signs of food allergies
pruritis erythema
413
list GI signs of food allergy
vomiting diarrhoea, usually LI non-specific so need to differentiate cause
414
what is the systemic reaction to food allergies?
anaphylaxis
415
how do patients with food allergies present?
younger pets typically derm signs LI diarrhoea, GI signs other causes of issues excluded
416
how are food allergies diagnosed and managed?
exclusion/limitation challenge and rescue provocation and rescue maintenance
417
what is the exclusion/limitation phase of food trials?
feed novel protein or hydrolysed diet exclusively
418
what is the challenge and rescue phase of food trials?
feed original diet to confirm was the problem return to elimination diet if problems return key phase of diagnosis
419
what is the provocation and rescue phase of food trials?
adding individual foods to identify triggers and whats fine
420
what is maintenance phase of food trials?
continuing to feed whats okay and excluding triggers
421
when are blood tests not useful for food allergies?
when have GI manifestation
422
how long does it take to see improvement in food allergies when starting management?
GI signs - 6 weeks derm signs - 10 weeks
423
what is chronic inflammatory enteropathies/CIE?
group of disease with chronic GI inflammation any of vomiting, diarrhoea, dysorexia (abnormal appetite), weight loss of over 3 weeks duration
424
what needs to be done before diagnosis of CIE?
exclusion of other diseases such as exocrine pancreatic insufficiency, abdo organ inflammation, metabolic disease
425
how is CIE diagnosed?
everything else is normal and ruled out biopsies indicate both inflammation and villi atrophy
426
what are advantages and disadvantages of intestinal biopsies via laparotomy?
adv - full thickness biopsies, full exploration of other organs disadv - surgical, risk of dehiscence, peritonitis and sepsis
427
what are advantages and disadvantages of intestinal biopsies via endoscopy?
adv - minimally invasive disadv - small mucosal biopsies, jejunum hard to access
428
list possible causes of CIE
food responsive disease/FRD antibiotic responsive disease/ARD - common in breeds such as german sheperd idiopathic disease
429
describe antibiotic responsive disease
gut flora prone to random changes causing diarrhoea and inflammation which leads to further changes in gut flora
430
how is antibiotic responsive disease managed?
metronidazole
431
describe idiopathic CIE
previously known as IBD immunological disorder loss of tolerance to mucosal flora cycle of GI inflammation and shift in mucosal flora, each making each worse
432
list consequences of CIE
dehydration protien malabsorption/protein losing enteropathy leading to hypoalbuminaemia leading to effusions and oedema and thromboembolic events as blood more viscous (lowers oncotic pressure) hypocobalaminaemia/low b12 GI haemorrhage anaemia GI perforation leading to spetic peritonitis
433
describe supportive therapy for CIE
haemodynamic stability fluid balance and electrolytes to manage hypovolaemia and hydration manage diet tube feed in severely effected patients anti emetics appetite stimulants
434
what therapy can be done for idiopathic CIE?
immunosuppression if immune mediated problem to allow gut to recover - preds at minimum effective dose consider fenbendazole, metronidazole, vitamin b12, anti-platelet drugs as needed
435
describe what a diet trial is
exclusive feeding with food and water for upto 10 weeks hypoallergenic not sensitivity diet novel proteins
436
why may diseases other than food allergies respond to diet trials?
food is high quality and digestible
437
define a novel protien
proteins patient wont have come across before
438
what are food options for diet trials?
novel proteins - home cooked or commercial, Hills d/d for example hydrolysed proteins - hills z/d, purina HA for example
439
list nursing considerations for food allergy patients
manage hydration, inappetence and nausea nutrition status and caloric needs manage potassium and B12 consider abdo discomfort manage hypoproteinaemia manage diarrhoea and fecal scold
440
how do you manage nutrition in hospitalised patient with dietary sensitivities?
record food intake monitor BCS and weight considering fluid balance nutritional support if less than 80% RER intake, >10% BW loss after fluid balance, over 3 days hyporexia, severe underlying disease keep GI system working even if small amounts of micronutrition encourage eating
441
what are examples of diseases that increase nutritional requirements?
trauma sepsis severe burns
442
how can you manipulate diet to aid food allergy patients?
smaller frequent meals adust posture of feeding low fat - gastric emptying and for reflux supplement fibre for large bowel function and colonic disease support
443
how do you manage abdo discomfort in food allergy patients?
omeprazole or sucralfate - GI dilation or ulceration postural feeding to manage reflux avoid opioids due to ileus buscopan - stomach cramps
444
how do you manage patients with diarrhoea?
keep clean and dry topical barriers - cavilon or vaseline avoid over grooming with collar and enrichment tail bandage inco sheets soft blanket on top
445
list monitoring considerations for dietary patients
weight appetite demeanour vomiting or diarrhoea hydration HR RR comfort bloods
446
what is CPCR?
cardiopulmonary cerebral resusitation
447
list goals of CPCR
perfusion of heart lungs and brain - require lots of oxygen and glucose to function ROSC
448
what is ROSC?
self perfusion by heart pumping cant necassarily breath or do anything else by them selves
449
what is respiratory arrest?
apnoea
450
what is cardiopulmonary arrest?
no CO apnoea
451
list patients at risk of arresting
trauma systemically unwell paeds geriatric recently arrested iatrogenic causes
452
describe risks and benefits of a patient iatrogenically arresting
likely have less monitoring by will be more likely to recover due to more cardiac reserves
453
what are risks and benefits of unwell patients arresting?
likely have close monitoring so faster response already compromised so less likely to recover
454
what is the process of starting CPCR?
as soon as think patient has crashed, resp arrest quickly causes cardiac anyone can help
455
how do you prepare for CPCR?
regular CPCR training crash kit ready crash alarm or call for help
456
what is BLS?
CPCR cycles oxygen therapy can do without a vet
457
what is ALS?
drugs fluids cardioversion under schedule 3
458
describe the CRCP algorithm briefly
BLS - 1 cycle is 2 minutes ALS evaluate patient if ROSC go to post-cpa algorithm if VF, pulseless VT, asytole, PEA, continue management and BLS
459
describe how cardiac compressions should be performed
100-120 per min 50%-2/3 depth of thorax, full recoil between compress from dorsal side of patient ideally right lateral but either fine
460
describe the cardiac pump
compression of thorax directly over heart, can use thumbs in cats to not cause damage in small dogs and cats
461
describe thoracic pump
compression on widest part of thorax dorsal caudal thorax or over xiphisternum medium to large breed dogs
462
describe internal cardiac compressions
needs thoracotomy or laparotomy good if external compressions not effective or large dogs everyone needs to be happy to do it
463
how do you provide ventilation to crash patients?
10-12 breaths a min 100% oxygen if possible, room air fine CO2 to guide breaths ambu bag start if suspect resp arrest CO2 to guide breaths
464
how are crash trolleys managed?
reflect cases seen inform people of changes one persons primary responsibility stocked and checked after use and regularly
465
what can be found in the airway access drawer in crash trolley?
ETTs laryngoscope tube tie cuff inflator guide wire plain gause swabs intubeze u cath with 3 ETT connector
466
what can be found in IV access drawer of crash trolley?
various catheters IV/IO connectors tape scissors cut down kit - rarely used, swab, forceps, scalpel, kidney dish scaplel - stab incision placement wide bore caths for GDV
467
what can be found in ventilation drawer of crash trolley?
paediatric and adult ambu bags capnography connectors inline capnograph - no prime cycle
468
what can be found in drugs drawer of crash trolley?
low and high dose adrenaline atropine saline pre-prepared syringes ECG pads naloxone atipamezole flumazenil amiodarone glucose propofol
469
what is adrenaline used for in CPCR?
given in asystole positive inotrope so increases strength of heart beat chronotrope so increases HR vasopressor causing vasoconstriction results in increased SVR and MAP
470
how do you give adrenaline to crash patients?
low dose first - 0.1mg/ml high dose - 1mg/ml IV or IO or intratracheal
471
how do you give meds intratracheally?
double dose with room air down trachea efficacy questionable
472
what is atropine used for in crash patients?
pre arrest when bradying down, profound bradycardia or PEA positive chronotrope so increases HR
473
how do you give atropine in crash patients?
IV, IO or intratracheal only one dose
474
what is the role of reversal drugs in crash patients?
reverse all possible drugs that may affect resus
475
what is amiodarone used for in crash patients?
prolonged v tach or v fib anti-dysrhythmic sodium channel blocking IV or IO
476
why is amiodarone potentially causing anaphylaxis not a concern in crash situation?
is likely to be unable to generate immune response if crashed
477
what is glucose used for and how in crash situation?
treat hypoglycaemia IV IO or transmucosally dilute but in emergency can give neat, may cause phlebitis
478
why is propofol useful in crash patients?
give in respiratory distress so can intubate
479
how do you manage drug doses for crash?
pre calculated doses drug chart and use closest weight
480
what is found in thoracotomy draw if in crash trolley?
gown gloves drapes chloraprep thoracotomy kit scalpel swabs finochietto retractors internal defib paddles saline
481
list other equipment useful in crash trolley
capnograph suction crash record chart ECG defib and gel IO access
482
what is the benefit of capnography in crash?
shows ventilation informs of perfusion, gas exchange and metabolism
483
what capnography values are significant in crash situation?
ideally maintain minimum of 12 sudden increase indicates patient alive
484
what are the benefits of having suction for CPCR?
remove airway secretions improve larynx visualisation reduce aspiration risk
485
what should be recorded through a crash?
record of events and timings
486
what does ECG show in crash?
electrical impulse and conduction complexes and HR
487
what does a defib do?
resets the heart
488
how do you use a defib in a crash?
used of v fib and pulseless v tach increase 50% voltage per shock likely to return to same rhythm or asystole user is responsible for everyones safety good idea to have fire blanket around
489
when is IO access useful?
IV access hard fast access to central circulation easy to place with easy IO gun
490
list IO placements
flat medial surface of proximal tibia - ideal greater tubercle of humerus - small cats trochanteric fossa of femur tibial tuberosity wing of ielum
491
how do you manage patients post arrest?
likely to re arrest treat condition and cause
492
describe the process of a debrief following crash
done after all crashes go through events good and bad improvements needed no blame
493
what are considerations for equipment in ECC nursing?
know equipment and how to use make sure equipment is working make sure everyone knows how to use assess along side patient
494
list procedures that are done in ECC settings
normal nursing triage stabilisation sedations GA invasive lines advanced procedures ventilation blood transfusions coma scoring
495
why are discussions so important in ECC settings?
client and patients advocate calm and rationale discussions plan what to do and what should be done
496
what are considerations for end of life care?
can be challenging must have discussions all options presented opinions shouldnt influence decisions
497
how can you train in ECC setting?
from ourselves and others training CPD active reasoning
498
what are some types of ECC patients?
systemically unwell immunocompromised trauma paeds geriatrics post-op/post-GA
499
why is self care so important?
some days hard easy to get overloaded figure out how to care for self
500
how do you initially manage spinal fractures?
stabilise keep calm
501
how do you initially manage 3rd degree block patients?
keep calm, if stressed may die as HR cant increase
502
how do you manage IMHA patients?
cross match and transfuse
503
how do you manage thrombocytopenia patients?
soft food gentle handling medical management can give platelets
504
how is blood available to give to patients?
stored blood direct blood collection
505
how do you manage hyperthermia patients?
active cooling clip fur manage seizures
506
how do you manage airway obstruction patients?
emergency intubation/trach
507
how does CPAP work?
pressure/resistance on exhalation to open airways
508
what is the 5th vital sign following TPR and pain?
adequate nutrition
509
list benefits of good patient nutrition
reduced mortality and morbidity reduced hospitalisation reduced complications
510
when should nutrition be provided to patients?
as soon as possible
511
list consequences of not eating
got function and patient appetite reduced
512
list indicators and risk factors of malnutrition
poor MCS - sarcopenia or cachexia poor BCS - >5% short term or >10% long term reduced appetite poor coat condition underlying disease increased protein losses due to disease
513
define sarcopenia
muscle loss in old age in absence of disease
514
define cachexia
muscle loss in presence of disease
515
describe what happens in simple starvation
normal metabolic adaptations utilisation of glycogen stores conservation of protein and muscle increased fat usage
516
describe what happens in stress starvation
clinical disease hypermetabolism breakdown of protein/muscle wasting in catabolic state reduced time to state of malnutrition, cachexia poorer prognosis
517
what should be assessed before nutrition in patients?
hydration electrolytes acid base balance pain
518
what are aims for short term nutrition?
provide for ongoing nutritional needs - energy and nutrients prevent or correct nutritional deficiencies/imbalances minimise metabolic derangements prevent further catabolism of lean body mass
519
what are long term nutritional aims?
restoration of optimal body condition provision of nutrients to the animal in own environment
520
list main types of feeding tubes
naso-oesophageal or naso-gastric for short term oesophagostomy, gastrostomy or jejunostomy for longer term, need GA
521
what type of feeding is used where possible?
enteral
522
what affects choice of feeding tube?
patient tolerance risk of GA duration needed clinician experience risk of complications type of diet owner cost ability to use at home is needed
523
what is re-feeding syndrome?
complex metabolic derangements that occur when enteral or parenteral nutrition is fed to severely malnourished patients or following period of prolonged starvation potentially fatal complication
524
what changes are seen in refeeding syndrome?
change from catabolic to anabolic state sudden insulin release causing severe hypophosphatemia, hypokalaemia, hyponatraemia, hyperglycaemia, hypocalcaemia
525
list clinical signs of refeeding syndrome
peripheral oedema haemolytic anaemia cardiac failure neurological dysfunction respiratory failure
526
what needs to be ensured before feeding patients?
haemodynamically stable fluids and electrolytes balanced
527
describe approach to feeding anorexic patient
assess malnutrition gradual introduction microenteral nutrition with oral rehydration - no calories but has electrolytes small frequent meals tube feed until eating >85% daily RER
528
how do you reach full RER in patients with no anorexia?
day 1 - 1/2 RER day 2 - full RER
529
how do you reach full RER in patients with less than 3 days anorexia?
day 1 - 1/3 RER day 2 - 2/3 RER day 3 - full RER
530
how do you reach full RER in patients with more than 3 days anorexia?
day 1 - 1/4 RER day 2 - 1/2 RER day 3 - 2/3 RER day 4 - 3/4 RER day 5 - full RER
531
what is parenteral nutrition?
providing patient with nutrition via IV route when cant do enteral
532
what are considerations for parenteral nutrition?
highly skilled practice referral level many complications possible
533
what is the general composition of parenteral nutrition?
lipids amino acids dextrose/glucose
534
describe how to give parenteral nutrition
through peripheral lines only monitor for infection or phlebitis mix solution to prevent separation monitor for complications cover bag if b12 added as light sensitive deliver through CRI pump replace line and bag after 24-48 hours keep lines in for walking give microenteral nutrition to prevent intestinal atrophy wean off as increases insulin, will cause hypoglycaemia
535
list possible complications for parenteral nutrition
metabolic complication occlusion dislodgement patient interference sepsis hyperglycaemia if more than 50% or 4mg/kg/min dextrose
536
what are parenteral nutrition requirements for dogs and cats?
dogs - 4-5g protein per 100kcal cats - 6g protein per 100kcal then 50:50 lipid : dextrose for remaining cals
537
when do you lower protein in parenteral nutrition?
hepatic or renal failure
538
what conditions do you increase protein in parenteral nutrition?
protein losing conditions sepsis burns head trauma
539
how do you calculate RER?
(BW x 30) + 70
540
how can you prevent complications associated with parenteral nutrition?
experienced people managing patient clear protocols in place aseptic techniques prevent patient interference regular monitoring and recording
541
list considerations for nutrition in acute pancreatitis case
fluids anti-emetics analgesia - no NSAIDs until eating feed depending on how long not eating microenteral nutrition low fat, highly digestible food NO tube short term daily weighing feed to avoid increasing pancreas inflammation
542
list considerations for nutrition in mandible fracture case
fluids as likely dehydrated o tube opioids no nsaids until eating possible refeeding syndrome daily weighing blood monitoring
543
list nutritional considerations for AKI
bloods fluids and supplements anti-emetics analgesia renal diet microentral nutrition supplement - increased loss of water soluble vitamins reduced protein in food highly digestible and quality food tube feed
544
list reasons for alternative diets
money beliefs source of education personal experience surrounding influences health reasons allergies believed better quality or healthier
545
what is raw feeding?
BARF/biologically appropriate raw food/bone and raw food
546
what are the forms of raw feeding available?
pre-prepared homemade
547
what is difference in dogs compared to wolves in terms of digestion?
dogs have increased ability to digest starch dogs live longer have balance of energy and other nutrients based on lifestyle
548
list risks of raw feeding
imprecise nutritional measurement low vitamin and mineral content microbiological infection salmonella, listeria, toxoplasma, crypto, mycobacterium bovis can cause hyperthyroid if eating throat tissue
549
list considerations when feeding raw
irradiated diet better as kills pathogens cooking kills pathogens without changing nutrients good hygiene important dietary calcium and other deficiencies common keep on top of worming minced meat more prone to pathogens due to processing home freezing doesnt kill pathogens risk of bone risk if vulnerable people in house risk of disease to humans
550
what is the WSAVA stance on raw feeding?
no documented evidence for raw feeding but documented risks
551
what is the BSAVA stance on raw feeding?
can be safely fed if good hygiene and correct nutrient levels met
552
what is the raw feeding veterinary society stance on raw feeding?
has researched health benefits risks studied outdated lack of evidence to support risk of ingested bones argue against nutritional inadequacy
553
how should you discuss raw feeding with owners?
dispel misconceptions understand views discuss risks assess patient health assess home environment keep on top of worming support as much as possible
554
how should raw food be sourced?
irradiated ingredients avoid ground meat cook to kill bacteria good hygiene
555
why cant cats be veggie or vegan?
obligate carnivores need higher protien requirement need taurine from meat
556
why is synthetic taurine not reccomended in cats?
unknown if biologically available
557
what are negatives of commercial veggie and vegan animal diets?
nutritionally inadequate low palatability low digestibility low biological value
558
what should guide home cooking of meals for pets?
nutritional diplomat
559
list common signs of eye pain
blepharospasm/increased blink rate reduced palpebral fissure/how open eye is ocular discharge/epiphora hyperaemia/redness
560
list local signs of eye pain
photophobia/light avoidance miosis/small pupil third eyelid protrusion head shy self trauma
561
list systemic signs of eye pain
reduced appetite quiet depressed headache
562
how should you triage eye pain?
assess on the day assess systemic signs assess ocular signs onset duration clients may not be able to accurately identify eye conditions
563
why is normal pain scoring not ideal for eye pain?
depend on facial expressions so is effected by blepharospasm
564
what is the ophthalmic pain score?
score specifically for eyes, needs analgesia for scores over 3 assesses demeanour, blepharospasm and rubbing of the eye
565
what are options for managing ophthalmic pain?
topical or systemic medical options surgery analgesia treat cause advocate for patient
566
list causes of ocular pain
scratchy dry eyelids ulcers cramping spasm uveitis intractable glaucoma orbital swelling other
567
how is dry eyelids treated?
lubrication with hyaluronic acid eye drops - clinitas
568
how are eye ulcers treated?
bandage contact lens analgesia topical lube infection management
569
how is cramping spasm uveitis treated?
atropine/cyclopentolate drops
570
how is orbital swelling treated?
NSAIDs and opioids
571
how is cherry eye treated?
surgery
572
how is ocular FB treated?
removal
573
how is entropion treated?
surgery to correct
574
what are important considerations for handling ocular patients?
blind or reduced sight painful fragile eye - may rupture go slowly talk to patient avoid bumps guide through things
575
how do you handle patients for ocular exams?
assess temperament keep steady and calm end of table so comfortable for examiner rewards and reassurance
576
what can cause vision loss?
cateract glaucoma SARDS toxins PRA brain disease trauma
577
what are cataracts?
inherited or caused by diabetes opacity of lens
578
what is glaucoma and what can cause it?
high pressure in the eye primary genetic defect or secondary to intraocular neoplasia, uveitis or lens luxation
579
how is glaucoma treated?
medical management surgical shunt implant laser usually enucleation
580
what is SARDS?
sudden acquired retinal degeneration syndrome flat line on electroretinogram no treatment
581
what are toxins that can effect the eyes?
ivermectin enrofloxacin
582
what is PRA?
progressive retinal atrophy night vision loss then day vision loss rods not responding on ERG common in cocker spaniels
583
how is PRA diagnosed?
simple maze test
584
what is the order of important senses in cats and dogs?
smell hearing vision
585
how can you help owners with blind animals?
how they feel how patient feels and is coping well most likely sources of support materials such as bump bars, training to help patient lead walks more ideal
586
how long do simple ulcers ulcers take to heal?
7 days
587
why are eye ulcers at risk of infection?
bacteria can enter as corneal epithelium not present to protect against infection
588
what is keratomalacia melting (risk in eye ulcer)?
tear enzymes liquify cornea leading to perforation, endophthalmitis, glaucoma, phthisis, blindness, necrotic end stage eye
589
define phthisis
shrunken globe due to reduced aqueous humour formation
590
describe the layers of the eye
cornea limbus sclera
591
what is the anatomy of the cornea?
0.5mm thick transparent stratified squamous epithelium corneal epithelium corneal stroma descemets membrane endothelium covered by tear film
592
what is the anatomy of the limbus?
transitional zone between cornea and sclera stem cells present
593
what is the anatomy of the sclera?
white of the eye fibrous tunic gives glove rigidity
594
what are the different layers of eye ulcers from least to worst depending on depth of stroma effected?
superficial deep descemetocele - bottom layer of cornea perforation - ruptured
595
what is meant by fragile eye?
over 50% stromal loss very fragile when down to descemets layer increase of IOP can cause rupture
596
list causes of increased IOP?
barking jugular bloods coughing vomiting pulling on neck firm restraint
597
why are brachycephalic commonly effected by fragile eye?
reduced corneal sensitivity cant blink properly shallow globes
598
how should you handle patients with fragile eye?
avoid pressure on neck or lids high venous pressure results in high IOP avoid stress regular meds keep eyes clean
599
what is SCCED?
spontaneous chronic corneal epithelial defect
600
how is SCCED treated?
algar brush grid - not on cats or pugs superficial keratectomy
601
what is a superficial keratectomy?
removal of top layer of cornea
602
how are stromal ulcers treated?
medical management surgical graft
603
how are melting ulcers treated?
medical management corneal cross linking - if too mushy to operate corneal graft
604
how is descemetoceles treated?
tectonic or structural support CCT/corneoconjunctival transposition - moving healthy cornea over ulcer
605
what can eye ulcer perforation lead to?
endophthalmitis - inflammation of inner eye
606
how are perforated eye ulcers treated?
suturing patch graft enucleation
607
list considerations for inpatients with ocular disease
low stress smooth induction and recovery cats separate horses dark stables with atropine
608
list post op care for ocular surgery
harness walks no jug samples buster collar manage pain eye meds keep wounds clean and dry keep patient calm
609
list examples of trauma to the eye
sharp trauma - cat claw blunt trauma - rta etc proptosis - eyelid behind globe, eye out of orbit penetrating FB
610
how do you manage ocular emergencies?
assess ABCs analgesia lubrication to support ocular surface and prevent ulcers prevent more trauma stabilise FB buster collar
611
why are puppies susceptible to cat claw injuries to the eye?
menace response develops at 8-12 weeks
612
what can be consequences of cat claw injuries to the eye?
lacerates cornea, can heal over lens puncture capsular tear cataract formation lens induced uveitis
613
what is seen in glaucoma patients?
non-traumatic emergency, often late presenting blue cornea red sclera and conjunctiva blindness pain chronic cases have enlarged globe IOP over 30mmHg
614
why does the high IOP in glaucoma cause rapid blindness?
damages photoreceptors
615
what is normal IOP?
10-25mmHg
616
define exophthalmos
protrusion of the globe
617
list causes of exophthalmos
FB causing abscess mass elevator slip trauma from dental work stick injuries
618
list signs of exophthalmos
protruding eye pain on opening mouth excessive conjunctiva visible excessive 3rd eyelid
619
what is the role of lubricants for eyes?
protect soothe and support healing of eyes reduce evaporation prevent ulceration replace missing tears
620
what is an example of eye lube?
clinitas
621
what are antibiotics used for in eye management?
treatment or prophylaxis of infection
622
list an example of ocular antibiotic
chloramphenicol
623
what anti-inflammatories are used for eyes?
NSAIDs, steroids acular
624
what are immune modulators used for for treating eye disease?
immune mediated disease
625
list an example of immune modulator for eye disease
optimune
626
what are anti-glaucoma drugs used for and an example?
lower eye pressure azarga
627
what do mydriatics do and an example?
dilate pupil mydriacyl
628
when are LAs used for eyes and an example?
diagnosis and pre-op proxymetacaine
629
how do serum drops work in the eye?
reduces corneal breakdown as contains factors present in tears provides replacement nutritional tear film promoting ocular surface renewal immunological defence
630
how is serum eye drops made?
FFP or serum defrosted and 3ml drawn up sterilely stored in freezer
631
when are serum eye drops commonly used?
melting ulcers prevent keratomalacia
632
describe considerations for applying eyedrops
correct med clean discharge one drop enough avoid touching surface of eye
633
how long should be left between eye drops?
10 minutes between drops 60 minutes between gel and ointments
634
list order of eye drop admin
watery aqueous drops suspension gel ointment
635
what is meant by OS?
left eye
636
what is OD?
right eye
637
what is OU?
both eyes
638
how do you prepare ocular patients for surgery?
assess physical mobility systemic health concurrent disease likely diabetic if non-traumatic cause - manage insulin and feeding
639
what are anaesthetic considerations for ocular surgery patients?
smooth induction prevent movement of patient with vacuum bags vet to position specifically back end monitoring where possible armoured ETT NMB and vent
640
describe clipping for lid surgery
wear gloves copious lube in eye for hairs small sharp clippers scissors for eyelashes avoid skin irritation flush hairs and lube away with saline
641
how do you prep eye for surgery?
povidone iodine - not scrub as contains soap or tincture as contains alcohol 1:50 for globe 1:10 for eyelid made up with sterile saline 2 minute contact time then flush with sterile saline to prevent toxicity
642
what is included on trolley for occular surgery?
drapes - fenestrated, sticky, drape tape gloves gown chair equipment saline flush operating microscope sterile handles ventilator phacoemulsification machine for cataracts kits suture material
643
what kits are used in eye surgery?
lid kit corneal kit phaeco kit intraocular kit general eye kit in first op
644
list considerations for enucleation
local retrobulbar block occulo-cardiac reflex avoid trauma to chiasm haemorrhage histology recommended with specialist pathologist
645
describe the 2 types of enucleation
trans-conjunctival - 2 phases, eye and lids removed separately trans-palpebral - eyelids sutured together then removed with eye, common in tumours
646
what is the oculo-cardiac reflex?
reflex bradycardia on eye pressure due to vagal stimulation
647
what is the chiasm of the eye?
fibres and nerves from eyes meet together
648
what is the effect of traction on the chiasm?
blindness in other eye especially prone in cats with shorter optic nerves
649
how do you manage haemorrhage from removing eye?
haemostasis collagen pads and powders adrenaline pressure
650
list common eye surgeries
entropion mass removal rhytidectomy - face lift for droopy dogs distichasis/ectopic cilla correction (management of extra hairs on eyelids) with cryosurgery or electrolysis medial canthoplasty on pugs - correct droopy eyelids cherry eye lid to lid transpositions parotid duct transposition for dry eye
651
list considerations for corneal surgery
horizonal eye positioning central eye with NMB or stay sutures removal of damaged cornea or CCT
652
how do you assess pre cataract surgery?
screen for inherited causes - BVA, KC or ISDS eye schemes gonioscopy to check glaucoma risk post op ERG to check retinal function, no point if blind anyway US for tumour check and detached retina post op meds practicality cost test for comorbidities impact on owner
653
what is gonioscopy?
assesses drainage angle in eye assess signs of inherited glaucoma done conscious with LA drops
654
how is ocular US performed?
conscious local proxymetacaine to desensitise cornea lots of gel/lube
655
what can be seen in ocular US?
eye structures - lens, cataracts, retinal detachment, retrobulbar mass, FB normal lens is black
656
what is the purpose of ERG?
records retinal electrical response to light stimulus assessment of retinal function
657
what are other methods of assessing eyes?
CT and MRI
658
what is the risk of cataracts following diabetes diagnosis?
50% develop them in 6 months 75-80% develop them in year
659
what are the risks of diabetic cataracts?
lens rupture lens induced uveitis
660
what are the positives of cataract surgery?
restore vision
661
what is aftercare for cataract surgery?
meds for first week upto 12 times a day quiet for 2 weeks topical NSAIDs and steroids for uveitis glaucoma meds for IOP management antibiotics until wound healed lube for comfort
662
what are GA risks for ocular surgery?
usually older patients commonly have co-morbidities brachycephalics prone so come with risks cardiac issues
663
what analgesics are used for ocular surgery patients?
topical proxymetacaine LA in skin line or retrobulbar systemic NSAIDs, opioids, CRI
664
why are NMBs useful for ophthalmic surgery?
provide central eye
665
what is brachycephalic ocular syndrome?
one or multiple of: medial entropion shallow orbit relative exophthalmos/bludging eye macropalpebral fissue/excessive limbal and scleral exposure lagophthalmos/cant close eyes medial caruncular trichiasis/hair arising from the inner corner of eyelid nasal fold trichiasis/facial hair contacting eyes pigmentary keratitis/black brown pigment in cornea causing blindness epiphoria from kinking of nasolacrimal duct and obscuring punctum exacerbated by other conditions such as dry eye or distichiasis/eyelashes in inner eyelids
666
list considerations for brachy airways in GA
pre-oxygenate keep cool reduce stress get home soon care for URT obstruction in recovery extubate late
667
what are considerations for brachycephalic reflux?
short starve so acid doesnt build up risk of hiatal hernia omeprazole to reduce reflux or ulceration paracetamol if liver okay walk to stimulate peristalsis maintain hydration low fat meal
668
list considerations for diabetic patients undergoing ophthalmic surgery
monitor glucose starve from morning and withhold insulin hyper easier to manage than hypo higher hypertension risk dry eye delayed healing and infection higher fluid requirements
669
what are considerations for communicating with clients for ocular surgery?
likely expensive train for eye drops habituate brachy puppies for drops discuss breed specific considerations
670
why are primary care clinics important for eye disease?
monitor for subclinical disease educate owners support medication compliance training eye meds schirmer test for high risk breeds early tests for diagnostics
671
what makes up the tear film?
lipid layer aqueous layer mucus layer
672
what is the purpose of the lipid layer?
prevents evaporation aids distribution
673
what is the purpose of the aqueous layer?
supplies corneal nutrition antebrachial properties removal and remodelling with proteases and antiproteases
674
what is the purpose of mucus layer of the eye?
lubrication refractive properties anchors aqueous layer to cornea
675
what is keratoconjunctivitis sica?
dry eye immune mediated adenitis/inflammation deficiency of aqueous teat slow onset
676
what breeds are predisposed to KCS?
WHWT yorkie min schnauzer english bulldog pugs pekinese boston terrier lhasa apso american cocker springer CKCS blood hounds
677
how is KCS diagnoses?
schirmer tear test clinical signs
678
what is normal schirmer tear test?
15-25mm/min
679
what schirmer tear test is seen in different levels of KCS?
early - 10-14mm/min moderate - 6-10mm/min severe 0-5mm/min
680
list clinical signs of KCS
strings of mucus poor corneal clarity poor corneal shine low STT reading
681
what does a pulse ox do?
measure SpO2 and Hb saturation
682
what does capnography measure?
ETCO2
683
what are the types of NIBP?
osscillometric doppler
684
how is IBP measured?
arterial catheter
685
why is central venous pressure not commonly used?
needs central venous line other ways to measure haemodynamic status
686
list common equipment in ICU
pulse ox capnograph NIBP IBP multiparameter glucometer lactate monitor lab machines syringe driver and infusion pump
687
what should lactate be below?
2.4mmol
688
when is lactate machine useful?
if no blood gas machine
689
what are useful lab machines in ICU?
biochem haem centrifuge
690
what is pH?
measure of hydrogen ions
691
what is PaO2/PvO2?
partial pressure of oxygen in arterial/venous plasma
692
what is PaCO2/PvCO2?
partial pressure of CO2 in arterial/venous plasma
693
which partial pressure of CO2 is more accurate?
PaCO2
694
what is a base excess?
hydrogen ions needed to return pH back to normal can be excess or deficit
695
what is the role of bicarb?
buffer
696
what is the anion gap?
unmeasured ions in the blood ketones, uric acid, ethylene glycol etc
697
what is normal pH?
7.35-7.45
698
what is normal PaO2?
80-100mmHg
699
what is normal PaCO2?
35-45mmHg
700
what is normal bicarb?
21-24
701
what is normal base excess?
+/- 2mEq
702
what is normal anion gap in dogs and cats?
dogs - 12-24mEq/L cats - 13-27mEq/L
703
define metabolic acidosis
pH less than 7.35 acidaemia
704
what are compensatory mechanisms for metabolic acidosis?
bicarb buffer - results in low bicarb hyperventilation - results in low PaCO2
705
what can cause metabolic acidosis?
increased lactate
706
define metabolic alkalosis
pH more than 7.45 alkalaemia
707
what are compensatory mechanisms for metabolic alkalosis?
bicarb buffer - results in high bicarb hypoventilation - results in high PaCO2
708
define respiratory acidosis
PaCO2 over 45mmHg
709
what is compensation for respiratory acidosis?
hyperventilation to remove CO2 and increase pH
710
define respiratory alkalosis
PaCO under 25mmHg
711
how is respiratory alkalosis compensated?
hypoventilation to retain CO2 and decrease pH
712
what can cause secondary metabolic acidosis?
primary respiratory acidosis
713
what can cause secondary metabolic alkalosis?
primary respiratory alkalosis
714
what can cause compensatory respiratory alkalosis?
metabolic acidosis
715
what can cause compensatory respiratory acidosis?
metabolic alkalosis
716
list causes of metabolic acidosis?
diarrhoea DKA renal failure addisons lactic acidosis/sepsis
717
list causes of metabolic alkalosis
vomiting - loss of H ions hypoalbuminaemia - weak acids neoplasia dehydration
718
what is the rule of 20?
list of critical parameters to check in critical patients, frequency depends on severity of case
719
list the rule of 20 parameters
fluid balance oncotic pull/albumin glucose electrolytes and acid base oxygenation and ventilation consciousness and mentation BP HR, contractability and rhythm temperature coagulation RBC and Hb renal function immune status GI motility drug doses and metabolism nutrition pain control patient mobilisation wound care TLC
720
what are the effects of sepsis/SIRS and high inflammation on rule of 20 parameters?
impairs BP impairs HR, rhythm and contractility
721
what are considerations for fluids in rule of 20?
boluses in increments of 10ml/kg consider blood loss and haemorrhage losses higher in high flow oxygen therapy
722
what are considerations for oncotic pull in rule of 20?
manage feeding to prevent hypoalbuminaemia
723
what can cause glucose requirements to be increased in ECC setting?
head trauma
724
what are considerations for ventilation in rule of 20?
decresed when respiratory centres effected monitor SpO2, PaO2, PaCO2 CPAP better than ventilation as prevents ARDS
725
what is ARDS?
acute respiratory distress syndrome lots of surfactant produced causing lots of inflammation
726
what considerations should be made for patient positioning in ECC setting?
tilt head up to reduce risk of regurg and lower ICP as needed
727
what should be considered for BP in rule of 20?
cushings reflex if head trauma
728
what should be considered for HR and ECG in rule of 20?
monitor for changes and abnormalities
729
what should be considered for RBC and Hb in rule of 20?
any haemorrhage
730
what should be considered in temperature in rule of 20?
risk of high temperature if pyrexia, hyperthermia risk of hypothermia manage as needed
731
what are considerations for coagulation in rule of 20?
trauma may need TXA for clotting to stop bleeding TXA can induce emesis so dilute and give slow IV
732
what should be considered for renal function in rule of 20?
monitor UOP and ins of fluids
733
when would antibiotics be appropriate to give in critical patients?
concern or risk of aspiration pneumonia
734
what should be considered for drugs and analgesia in rule of 20?
case by case considerations
735
what are nutrition considerations in rule of 20?
tube feeding or parenteral nutrition as needed
736
what are considerations for mobilisation in rule of 20?
regular walks turn 4 hourly if immobile oral and eye care physio
737
what are considerations for wound management in rule of 20?
prevent urine scalding manage any wounds appropriately
738
what is consideration for TLC in rule of 20?
important for all patients
739
what are considerations for nursing long term ventilator patients?
eye care mouth care airways humidification of air flow physio and positioning line, drain and tube management manage excretions drugs treat underlying disease communication with team record everything acid base, blood gases and electrolyte management
740
how should care be managed in ECC patients?
tailor to each patient equipment depends on whats available use rule of 20
741
what is GCPS?
validated for use in hospitals to determine if need more analgesia
742
what is modified glasgow coma scale?
measurement of mentation, should be 18/18 if drops more than 2 is a concern
743
why is anaemia common in cats?
mask illness and disease so diagnosed later and more severe by diagnosis have shorter RBC than dogs so clinical signs appear in shorter time lower total RBC mass feline haemoglobin has lower affinity for oxygen so give up oxygen to tissues easily can be more tolerant of anaemia
744
list clinical signs of anaemia in cats
pallor of MM, may be yellow lethargy weakness hyperdynamic pulses tachycardia haemic murmurs (reduced viscosity of bloods so moves around heart chambers) tachypnoea enlarged lymph nodes and spleen pica signs associated with underlying case
745
how is feline anaemia investigated?
haematological investigation PVC to confirm presence of anaemia and type of anaemia
746
what is seen on PCV for anaemia from acute blood loss?
normal PVC as same loss of plasma and RBCs overall reduced oxygen carrying ability
747
what is seen in PCV for chronic anaemia?
low RBCs to plasma low PCV
748
what is seen in volume overloaded anaemia PCV?
low PCV due to normal RBCs but increased plasma volume
749
how do you distinguish between chronic anaemia and volume overloaded anaemia?
haematology
750
what are normal PCVs in dogs and cats?
dog - 35-55% cats - 25-45%
751
what is seen in regenerative anaemia?
reticulocytes higher than 50x10^9/L anisocytosis polychromasia increased MCV (mean cell volume) MCHC decreased (mean cell haemoglobin concentration) bone marrow actively trying to produce blood cells
752
what is seen in non-regenerative anaemia?
reticulocyte lower than 50x10^9/L normocytic normochromic normal MCV normal MCHC bone marrow not releasing more RBCs to correct anaemia
753
define anisocytosis
variation in different RBC size
754
what causes anisocytosis?
bone marrow releasing younger cells to increase RBC numbers
755
what causes reduced MCHC in non-regenerative anaemia?
younger cells have less Hb carrying ability
756
define polychromasia
variation in RBC colour due to haemoglobin
757
define hypochromic
pale as less Hb per RBC
758
why are nucleated RBCs seen?
earlier release from bone marrow
759
define normocytic
normal sized RBC
760
define microcytic
small RBC
761
define macrocytic
large RBC
762
what is a reticulocyte?
immature RBC
763
what is a normoblast?
very early RBC
764
what is an erythrocyte?
mature RBC
765
describe RBC maturation in the cat
normoblasts mature into aggregate reticulocytes mature into punctate reticulocytes mature into erythrocytes
766
what reticulocytes are seen in a normal cat and why?
punctate frequently aggregate rarely takes longer for RBCs to mature in the cat so some get released early
767
what does the presence of aggregate reticulocytes in cats indicate?
active bone marrow regeneration regenerative anaemia
768
what is the purpose of reticulocyte count?
establish if anaemia is regenerative detect presence of reticulocytes in the blood estimate growth of patients RBCs how quickly RBCs are being produced and released from bone marrow
769
how is absolute reticulocyte count (x10^9/L) calculated?
observed % reticulocytes x RBC count (from haem) x 10
770
what equipment is needed for complete reticulocyte?
new methylene blue stain or brilliant cresyl blue EDTA with 1ml whole blood 1 eppendorf test tube 37 degree water bath 3 capillary tubes 3 glass microscope slides pencil for labelling
771
describe how to prepare a slide for reticulocyte count
add 3-4 drops of new methylene blue/brilliant cresyl blue to 3-4 drops of mixed EDTA anticoagulated blood to eppendorf tube mix contents and incubate for 10 minutes in 37 degree water bath mix blood and solution make blood smear label slides air dry examine under microscope
772
describe the process of a reticulocyte count
look for reticulocytes in monolayer count 500 cells and number of these that are reticulocytes calculate % of reticulocytes use in reticulocyte calculation
773
what are safety measures for using new methylene blue?
PPE safety glasses gloves dont eat drink or smoke during use
774
what values are seen in negligible regeneration?
<50x10^12/L reticulocytes
775
how any reticulocytes is seen in mild regeneration?
50-100 x 10^12/L
776
how many reticulocytes is seen in moderate regeneration?
100-200 x 10^12/L
777
how many reticulocytes are seen in substantial regeneration?
>200x10^12/L
778
when are the only times regenerative anaemias are seen?
blood loss haemolysis
779
what can affect categorising of anaemias?
duration of anaemia concurrent disease
780
how does duration of anaemia affect categorisation of the anaemia?
regenerative anaemias take 3-5 days for reticulocytes to be released from bone marrow and appear in circulation will appear initially as non-regenerative but is pre-regenerative
781
what is the effect of chronic blood loss on regenerative anaemia?
eventually leads to iron deficiency which impairs RBC formation overtime becomes poorly or non regenerative
782
what is the main reason for cats getting iron deficiency?
chronic flea infestation in kittens
783
what concurrent diseases impair regeneration from bone marrow in anaemia?
FeLV chronic disease infectious disease - cat flu inflammatory disease
784
how does bone marrow respond in regenerative anaemia?
responds best it can to correct anaemia
785
list causes of regenerative anaemia from haemorrhage in cats
trauma coagulopathies congenital or inherited clotting defects anti-coagulant rodenticide poisoning chronic flea infestation infected tumours or GI tract
786
what is the name of regenerative anaemia that is non-regenerative due to iron deficiency?
non-regenerative microcytic-hypochromic iron deficiency anaemia
787
list haemolytic causes of regenerative anaemia in cats
FeLV FIA/feline infectious anaemia immune mediated - drugs, neoplasia, infection heinz body anaemia - paracetamol or onion toxicity, lymphoma severe hypophosphataemia - refeeding syndrome incompatible blood transfusions neonatal isoerythrolysis inherited defects
788
list factors that indicate haemolytic anaemia in cats
jaundice haemoglobin lymphadenopathy splenomegaly
789
what causes feline infectious anaemia?
mycoplasma haemofelis, spread by fleas
790
how is feline infectious anaemia diagnosed?
demonstrating organisms on RBCs on air dried blood smears, unreliable PCR on blood with 0.5ml EDTA blood
791
list signs of feline infectious anaemia
pallor lethargy anorexia weight loss pyrexia dehydration jaundice if severe acute disease
792
how is feline infectious anaemia treated?
doxycycline antibiotic
793
what is important when giving doxycycline?
can cause oesophageal strictures needs to give before food and water so moves into stomach
794
what is heinz body anaemia?
irreversibly denatured oxidised haemoglobin premature destruction by haemolysis
795
what causes heinz body anaemia?
paracetamol or onion toxicity lymphoma DKA
796
what causes neonatal isoerythrolysis to occur?
type b queen give birth to type a kitten queen has agglutinating anti-a antibodies in blood which are passed onto kittens in colostrum and RBCs are haemolysed
797
why type of anaemia is more common in cats?
non-regenerative anaemia
798
what happens in non-regenerative anaemia?
bone marrow doesnt respond to anaemia so doesnt produce adequate new RBCs
799
list causes of non-regenerative anaemia in cats
disorders of bone marrow suppression of normal bone marrow due to systemic disease
800
how is non-regenerative anaemia diagnosed?
bone marrow sampling in severe anaemia - femur or humerus
801
list systemic disease causing non-regenerative anaemia
neoplasia FeLV FIV FIP bacterial infection CKD chronic inflammation
802
how does chronic inflammation lead to non-regenerative anaemia?
leads to marrow suppressive effects of circulating toxins and suppression of iron reserves
803
how does chronic kidney disease induce non-regenerative anaemia?
reduced RBC lifespan blood loss impaired iron utilisation erythropoeitin deficiency - produced by kidneys in response to hypoxia, stimulates RBC production
804
how should anaemia treatment be approached?
tailor depending on cause supportive measures also good
805
when can blood transfusions be useful in anaemia treatment?
may be lifesaving in cats in critical condition adjunct treatment in FIA and non-regenerative anaemias while waiting response to therapy or results
806
when should blood transfusions be used in anaemia cases?
based of clinical signs as even with very low PVC may be coping very well
807
when can erythropoietin be useful in treating feline anaemia?
can be successful in CKD newer recombinant human erythropoietin can be successful
808
what is bone marrow stimulation for anaemia patients?
anabolic steroids for first line treatment to stimulate erythroid precursors in bone marrow vie EPO activation little evidence
809
what treatment may be considered for immune mediated anaemias that have bone marrow failure?
preds
810
list general nursing considerations for anaemia patients
monitoring vitals drugs assisting diagnostics keeping patient comfortable managing stress IVFT nutritional management
811
what are nursing care for haemorrhagic anaemia patients?
control haemorrhage IVFT oxygen blood transfusion care for specific cause
812
what is nursing care for haemolytic anaemia patient?
IVFT nutritional supplements - iron, folic acid, B vitamins feeding tubes padded bedding and turning as often recumbent barrier nurse - on immunosupressants
813
list nursing considerations for non-regenerative anaemia patients
treat primary systemic disease transfusion if needed feeding high iron, folic acid and b vitamins feeding tube
814
why is barrier nursing often important for anaemia patients?
may causes are from infection or patients are on immunosuppressants
815
define bleeding disorder
abnormal condition which allows blood to escape from injured vessels in unregulated transfer or interferes with haemostasis so vessels cant repair
816
how do bleeding disorders occur?
primary secondary to underlying disease process
817
which species more commonly has bleeding disorders?
dogs
818
describe the process of primary haemostasis
reflex constriction of blood vessels to restrict bleeding and helps the platelet plug not be moved away formation of platelet plug due to activation of platelets, adheres to vessel collagen at site of the damaged vessel
819
why are platelet activation factors important?
they would be constantly forming clots if they didnt need activation
820
what is von willebrands factor?
important in platelet adhesion genetically coded factor aids activation factors and makes platelets sticky to aid clumping
821
what is von willebrands disease?
commonest inherited disorder of haemostasis, especially in dobermans platelet adhesion and clumping impaired caused by dominant gene with incomplete penetrance
822
describe secondary haemostasis
stabilisation of platelet plug by fibrin mesh formation by coagulation factors results from activation of clotting cascade only occurs in larger vessels where the platelet plug isnt stable enough on its own compared to in small vessels where its stable enough
823
describe coagulation factors
most are protease enzymes that are sequentially activated to produce cascade phenomenon divided into intrinsic and extrinsic pathways with final common pathway resulting in formation of fibrin from fibrinogen numbered by roman numerals
824
how are coagulation factors synthesised?
in liver requires vit k
825
what can cause vitamin k deficiency leading to reduced synthesis of coagulation factors?
liver disease rodenticide toxicity problems with fat digestion or fat malabsorption - is fat soluble vitamin
826
what are primary haemostatic defects?
quantitative and qualitative disorders of platelets reduced number or function of platelets vessel wall defects
827
what are secondary haemostatic defects?
quantitative and qualitative disorders of coagulation factors reduced amount of clotting factors reduced function of clotting factors
828
what is the clinical approach to bleeding case?
history clinical signs lab investigation
829
what history can be taken for bleeding cases?
when owner noticed bleeding signalment - age may show if inherited or acquired, doberman, malers affected by haemophillia as sex linked any issues in relatives previous bleeding, trauma, surgery, issues toxins drugs
830
list clinical signs of primary haemostasis diseases
multiple minor bleeds prolonged bleeding petichiea echmotic haemorrhages - large bruises multiple sits of bleeding surface bleeding of skin and MM
831
list clinical signs of secondary haemostatic diseases
single large bleeds rebleeding haematoma localised bleeding delayed or re bleeding from cuts deep cavity bleeds - joints, abdomen, thorax
832
describe blood sampling for bleeding disorders
take sample before treatment atraumatic collection to avoid activation of haemostasis and local platelet consumption fill citirc acid tubes correctly handle samples correctly
833
what tests are ran for primary haemostasis?
platelet count - inhouse BMBT for platelet function and vessel abnormalities
834
what tests are ran for secondary haemostasis?
activated clotting time/ACT for intrinsic and extrinsic pathways activated partial thromboplastin time/APTT for intrinsic and extrinsic pathways prothrombin time for extrinsic and common pathways
835
how are platelet counts done in lab?
collect blood into EDTA and send to lab
836
describe in house platelet count
estimate stained blood smear from fresh EDTA under low power to scan for platelet clumps under oil immersion for platelet count, count 10 fields and average
837
what does each platelet per high power field represent?
20x10^9/L platelets in circulation
838
what is normal platelet count (high power field and in circulation)?
high power field - 11-25 platelets - 200-500x10^9/L
839
what level of platelets can spontaneous bleeding occur?
<50x10^9/L
840
what is the purpose of BMBT?
test platelet function and vessel wall defects
841
what will be seen in BMBT if there are clotting defects?
poor platelet function - prolonged bleeding normal BMBT with rebleeding - coagulation defect
842
describe how to do a BMBT
dog awake, cat sedated in lateral with lip folded up with bandage standard incision to buccal mucosa with spring loaded bleeding time device timer started blood blotted away with filter paper without disturbing clot formation
843
what is normal BMBT in dogs and cats?
dogs - <3.5 min cats - <3 min
844
list causes of prolonged BMBT
von willebrands disease thrombocytopenia vascular wall abnormalities DIC/disseminated intravascular coagulation
845
how do you perfrom a ACT test?
2ml blood collected into ACT test tube (activates intrinsic pathway) tube gently inverted and left undisturbed for 40 seconds invert every 10 seconds until time to complete clot formation
846
what is normal ACT time?
<165 seconds
846
how is APTT and PT carried out?
in lab blood collected into sodium citrate tube, ratio 1:9 (sodium citrate : blood)
847
what is normal APTT?
15-25 seconds
848
what is normal PT?
7-10 seconds
849
how would you triage a patient with bleeding disorder?
owners history previous issues toxins signalment clinical exam
849
what are considerations for patients with bleeding disorders caused by liver disease?
thermoregulation prolonged meds no hepatic excreted drugs possble encephalopathy low clotting factors
849
list general considerations for bleeding disorder patients
handle with care padded kennel keep calm manage hypothermia especially if liver disease analgesia avid aspirin and heparin as affects clotting give meds PO or through IVC one stick IVC buster collar to prevent interference pressure bandage after IVC removal blood type harness to avoid jug pressure
849
what should you monitor in bleeding disorder patients?
demeanour TPR MM HR - tachycardia ECG auscultation for heart murmurs BP - may be reduced if low circulating volume petichiea ecchymosis haematoma contusion haematemesis haematochezia
849
how do you manage nutrition in bleeding disorder patients?
vitamin K supplement liver disease diet highly digestible and pallatable high iron, B vits and vit K
849
how is bleeding disorders treated?
restoration of circulating oxygen carrying capacity manage cause blood transfusion antithrombotic therapy desmopressin for VWD admin of vit K
850
850
why are POC analysers for clotting times beneficial?
can determine APTT and PT without delay on small volumes of whole blood i-stat can do ACT and PT thromboelastography machines can determine viscosity of blood which changes with blood clotting
850
what is specific factor assays?
specialist labs can determine deficiencies of specific factors
850
list underlying causes of bleeding disorders
liver disease pancreatitis bile duct obstruction rodenticide poisoning VWD
850
list possible diagnostics for bleeding disorder patients
SpO2 and blood gas liver parameters - ALT, AST BMBT PT APTT PCV platelet count haem bone marrow sample biochem - underlying cause PCR for VWD
851
what causes majority of the body heat?
muscular activity - exercise and seizures
851
what controls thermoregulation?
anterior hypothalamus monitored by peripheral and central thermoreceptors to detect if too hot or cold
851
what happens in the body when thermoreceptors detect body is too hot?
heat dissipation
851
what happens in the body when thermoreceptors detect body is too cold?
heat conservation and production
851
define hyperthermia
increased body temperature above 39.2 degrees
851
list causes of hyperthermia
pyrexia increased heat production due to increased muscular activity heat stroke
852
what is classic heat stroke?
reduced heat loss
852
what is exertional heat stroke?
over exercise in high temperatures
852
list causes of heat stroke
failure of heat dissipation URT obstruction increased environmental temperature/humidity poor environmental ventilation circulatory compromise obesity breed predisposition
852
what are the risks of body temperature over 41.6 degrees?
permenant organ damage - especially kidneys and brain cell death - due to large increase in oxygen demand DIC
852
list clinical signs of heat stroke
stress hyperthermia tachycardia hypovolaemia - GI losses and vasodilation hyperdynamic pulses peripheral vasodilation collapse hyperaemia MM rapid CRT endotoxin translocation - increased intestinal mucosal permeability, impaired GI perfusion sepsis tachypnoea secondary resp complications - aspiration pneumonia, pulmonary oedema, pulmonary haemorrhage DIC - coagulopathies AKI CNS compromise - direct effects or hypoglycaemia hyperbillirubinaemia hypoglycaemia epithelial desquamation thrombosis myopathy electrolyte derangements
853
what happens when advanced heat stroke patient appears normothermic?
peripheral perfusion is impaired so appears normothermic but core temperature is still very high
853
how is most of the heat lost through the body?
body surface so peripheral dilation and circulation increases leads to reduced CO and decreased perfusion of vital organs
853
describe emergency management of heat stroke patients
actively cool if over 41 degrees by losing heat from the skin stop cooling at 39.4 to prevent hypothermia oxygen if needed maintain patient airway, intubate if needed IVFT - water lost when panting, isotonic crystalloids to support circulation, replace defecits and continually assess bloods - PVC, TS, glucose, electrolytes, abnormal coagulation factors monitor ICP
853
what shouldnt you do for cooling patients?
use too cold water as peripherally vasoconstricts impairing heat loss
854
why shouldnt you cool patients with pyrexia?
pyrexia is beneficial to patients with infection as decreases replication of pathogens and increases function of WBC protective function
855
in what cases should you treat pyrexia with drugs such as paracetamol and NSAIDs?
immune compromised or cancer patients
856
list causes of pyrexia
infectious or immune mediated inflammatory disease neoplastic disease opioids hepatic encephalopathy blood transfusion
857
what is meant by endoscopy?
to view within
858
how is endoscopy images transmitted?
light source to body cavity resulting image to eyepiece or monitor
859
list types of endoscopy and their uses
flexible - GI, bronchoscopy rigid - rhinoscopy, female cystocopy
860
what are the roles of endoscopy?
diagnosis therapeutic
861
list diagnostic roles of endoscopy
observation sampling - fluid in BAL, brush cytology for cells from linings, FNAs, biopsy
862
list therapeutic reasons for endoscopy
FB removal stricture dilation feeding/gastrotomy tube placement
863
list benefits of endoscopy
minimally invasive low morbidity/mortality no convalescence needed so can start steroids immediately
864
list limitations of endoscopy
cant visualise the whole GI tract - cant see middle 6 ft can visualise all but cant toake biopsies in capsule endoscope only assesses appearance/morphology not function mucosal evaluation only cant evaluate extravascular GI disease like in surgery
865
list contraindications for GI endoscopy
known GI disease such as perforation or mass lesion if not adequate for full investigation not suitable for anaesthesia - inadequate CP function, hepatic or renal function coagulopathy inadequate prep of pateints GI tract
866
how can gastric over distension make endoscopy challenging for the operator?
lesser curvature has much higher angle and increased antro-pyloric motility so harder for pyloric intubation
867
how do you avoid gastric overdistension during endoscopy?
look at stomach last as needs to fill with air to view
868
how can gastric overdistension affect the GA during endoscopy?
caudal vena cava compression leading to reduced VR, CO and BP diaphragmatic splinting so becomes less compliant in respiration so reduced TV
869
list possible complications in endoscopy and how to manage
acute bradycardia +/-AV block due to vagal reflex - atropine/glycopyrrolate aspiration - suction oesophagus and pharynx at end transient bacteraemia in colonoscopy - antibiotics if patient at risk GI perf if servere pathology or ulcers or abdo swelling haemorrhage - laceration during FB removal or stricture dilation, or mucosal
870
what makes up the endoscopy system?
light source air/water insufflator suction pump endoscope and insertion tube forceps
871
describe the light source of an endoscope
cold light historically tungsten halogen - cheap, red tint, not bright can use metal halide or LED now use xenon arc - 1000 hours, brighter and white light
872
describe the air/water insufflation and suction on the endoscope
housed in light source air pump for insufflation seperate suction for deflation water reserviour for washing lens
873
list components of the flexible endoscope
light guide connector light guide tube control body video remote switches insertion tube internal instrument channels bending section
874
what transmits non-coherent illumination?
glass fibre optics
875
how are endoscopy images transmitted?
fibre optics video endoscopy
876
describe fibre optic transmission in an endoscope
individiual glass fibres coated in lower optical density glass cladding light transmitted by total internal reflection in coherent bundles
877
how does video endoscopy work?
image transmitted via wire from CCD video chip behind lens
878
list advantages of fibre optic transmission endoscopes
portable wide range of sizes moderate cost
879
list disadvantages of fibre optic endoscopy
faceted/honey comb image fragile individual fibres can stop working size of endoscope dictates image quality eye piece vs video
880
list advantages of video endoscopy
mechanically identical to fibre optic non-coherent illumination CCD detects image and is shown on screen excellent image image control buttons
881
list disadvantages of video endoscopy
expensive not portable smallest diameter of scope not possible
882
what are the different features possible on the insertion tube?
varying diameters - 5.5-9.5mm for gastro, 10-13mm for colono varies length front or side veiwing angle steering in uni or multiplanar accessory channels
883
what is the importance of tip retroflexion on endoscopes?
visualise cardia and FB retrieval
884
what affects biopsy quality?
smaller the channel the worse the quality cup size pressure bigger biopsy the better
885
list accessories available for endoscopy
biopsy forceps cytology brush sheathed needles lavage tubes
886
what are the types of biopsy forceps?
ellipsoid/oval round fenstrated with spike swing jaw reusable or disposable
887
which biopsy forceps are better?
oval better than round fenestrated better than whole no spike alligator over smooth rotatable better non-swing jaw better
888
how do you confirm endoscopy is indicated?
exclude extra GI causes of disease exclude surgical disease consider contraindications
889
describe preparation for gastroscopy
12 hour fast to empty stomach and duodenum
890
why is important the GI tract is empty before scoping?
visualisation manoeuvrability food clogs scope decrease risk of reflux and aspiration
891
what are extra considerations for fasting patients before GI scope?
wait 24hrs if barium used as damages scope consider patients with delayed gastric emptying
892
describe how you prepare for colonoscopy
fast for 24-36 hours so whole GI tract empty oral lavage multiple high enemas
893
how is an oral lavage performed?
polyethylene glycol electrolyte solution/klean prep day before scope dogs - 25-30ml/kg x3, 2-4hrs apart cats - 20ml/kg, x2 normally given in stomach tube (dogs) or NO tube (cats) as unlikely to drink
894
list risks of oral lavage?
tracheal intubation and admin aspiration trauma from tube placement
895
how is a high enema done?
warm water higginson pump or enema bucket 1L/30kg in dogs, 20ml/kg in cats until clear running 1-2 hours before colonoscopy, may repeat under GA never phosphate as can be absorbed into blood no cleansers or laxatives
896
list GA considerations for endoscopy
opioids may affect sphincter tone atropine affects GI tone and motility smooth induction to avoid aerophagia and stomach distension familiar routine cuff ETT avoid nitrous as accumulates in gas filled organs care fir gastric dilation, reflux and aspriation
897
how are patients positioned for GI endoscopy?
left lateral for entering pylorus easier right lateral if placing g tube to secure on left side, or for FB removal if needed mouth gag to prevent biting scope ETT secured
898
why is it important to be careful placing mouth gags in cats?
may compromise blood supply to the brain and cause blindness
899
how do you clean endoscopes?
ensure channels are clear immediately post op flush with air and water ethylene oxide sterilisation or disinfectant protocol never autoclave as melts
900
what colour is a serum gel/plain tube?
brown pink or red vacutainer
901
how does a serum gel/plain tube work?
contains gel which begins coagulation or contains CAT/clotting activation thrombin produces serum
902
what is serum gel/plain tubes used for?
bichemistry hormonal assays - t4 serology - antibodies external samples as more stable than heparin
903
what colour are heparin blood tubes?
orange green vacutainer
904
how do heparin tubes work?
contains heparin anticoagulant so can test immediately
905
what is heparin tube used for?
in house biochemistry
906
what colour are EDTA tubes?
pink purple vacutainer
907
what are EDTA tubes used for?
haematology
908
what colour are citrate tubes?
purple
909
what are citrate tubes used for?
coagulation profiles
910
what colour are oxalate tubes?
yellow grey vacutainer
911
what are oxalate tubes used for?
glucose testing rare as can do patient side
912
which blood tubes contain anticoagulant?
heparin EDTA citrate oxolate
913
what is plasma and which blood tubes result in this?
whole blood anticoagulant tubes
914
what is serum and which blood tubes result in this?
clotted blood without platelets or clotting factors serum tubes
915
list the order of filling blood tubes
serum gel heparin EDTA
916
why do you fill EDTA tubes last?
chelates/binds to calcium as blood cant clot without calcium 2 potassium per EDTA if biochem contaminated shows low calcium and high potassium
917
what is meant by reference range in lab results?
range in 95% animals
918
what is meant by mild out of range?
within the range away from the reference interval
919
what is meant by moderate out of range?
more than one range away from reference interval
920
what is meant by marked out of range?
2 or more range away from reference interval
921
list suffixes for TP, albumin, bilirubin, cholesterol and ALT, ALP and GGT?
TP - proteinemia albumin - albuminemia bilirubin - bilirubinaemia cholesterol - cholesterolaemia ALT, ALP and GGT - just high or low
922
what are the primary and secondary causes of high ALT?
primary - hepatopathy/liver disease secondary - cholestasis, artefact, muscle damage
923
what determines if high ALT is determined by muscle damage?
high creatinine kinase - only found in muscle
924
list markers of hepatocellular disease
ALT AST GLDH SDH
925
list markers of cholestasis
ALP GGT
926
what is meant by functional liver markers?
substances produced in the liver - cholesterol, urea, glucose, albumin, globulins, coag factors substances conjugated and excreted by the liver - bile acids, bilirubin
927
what can cause primary hepatocellular disease?
trauma toxins drugs inflammation infection neoplasia intrahepatic cholestasis bile toxicity
928
what can cause secondary hepatocellular disease?
anything non-specific disease
929
what is seen in decreased hepatic function on lab results?
increased bile acids and bilirubin decreased albumin, cholesterol, urea, glucose, clotting factors
930
what is seen in xylitol toxicity?
acute hepatic failure hypoglycaemia
931
how is xylitol toxicity treated?
plasma infusion to increase protein vitamin k therapy for coags liver supportive treatment fluids to increase BP and dilute toxins antibiotics as liver function impaired
932
what are possible outcomes for xylitol toxicity?
recovery death complications such as DIC
933
what is seen on a stress leukogram?
neutrophilia (increased) monocytosis (increased) lymphopenia (decreased) eosinopenia (decreased)
934
what is acanthocytes?
RBC membrane changing usually artefact but can be due to toxin
935
what shows mild, moderate and marked on heamatology?
mild - + moderate - ++ marked - +++
936
define anisocytosis
different sized RBCs
937
what can cause hyperglycaemia on blood results even if no disease present?
stress
938
what is the impact of hyperkalaemia on the body?
bradycardia, even at small levels
939
what tests can be done for azotemia?
urinalysis USG dipstick sediment exam US
940
what is hypersthenuria?
very concentrated urine to conserve water
941
what is hyposthenuria?
very dilute urine as kidneys putting out excess water
942
what is isothenuria?
kidney disease urine same concentration as plasma, kidneys not filtering
943
what is the impact of antifreeze/ethylene glycol ingestion and how is it managed?
AKI IVFT, supportive care, ethanol
944
when may you see an absence of stress leukogram?
chronic disease immunosuppression bone marrow disease
945
what is important to remember when looking at lab results?
consider patient and clinical signs alongside
946
what is cytology?
study of cells screening tests looking at cells in fluids (BAL, CSF, synovial fluid, body cavities) or tissue samples (lumps, LNs) not diagnostic
947
what are the benefits of cytology?
quick cheap easy relatively non-invasive
948
what clinical information should you provide for cytology?
history lesion evolution previous treatment characteristics of lesion
949
what information should be provided for characteristics of a lesion for cytology?
localisation firm or soft dimensions painful or not ulcerated or not cutaneous or SC adherent or non-adherent aspirate
950
how should you prep for FNA?
surgical prep
951
when should you do a suction FNA?
hard cutaneous or SC masses bone lesions when non-suction doesnt work
952
describe the process of a suction FNA
suction while moving around lesion release suction before withdrawing to not pull in other cells
953
when are non-suction FNAs performed?
soft cutaneous or SC masses LNs vascular lesions/organs
954
how is a non-suction FNA performed?
insert needle into tissue pull out fill syringe with air attach and push out contents
955
list techniques for making cytology smear
line squash twist if few cells star - not ideal as no monolayer splatter if no choice
956
list methods of collection that arent FNA
impression smear scraping biopsy imprint ear swab
957
describe Malassezia found on cytology
yeast peanut shaped low numbers on normal skin, infection if multiple organisms per high power field
958
how are cytology samples stained?
diff quick methanol fixation eosin eosinophillic (base) staining methylene blue basophilic (acid) staining
958
describe sample preparation for cytology smear samples
after collection air dry or hairdry quickly stain label with animal and site
959
what are considerations for stains for cytology?
replace regularly methylene blue deteriorates quickly have clean and dirty sets
960
how much magnification is in the eye piece of a microscope?
10x
961
what is low magnification (10x) used for?
looking at cellularity, preservation, staining, haemodilution, cell distribution, background
962
what is the aim in cytology samples?
have good cellularity
963
what is meant by cell preservation?
how well its fixed
964
what is high magnification (40x) used for in cytology?
looking at cellular and non-cellular elements inflammatory vs neoplasia malignant and benign
965
what is high magnification (100x) used for in cytology?
look for presence of cytoplasmic granules, nuclear details, presence of pathogens
966
how is leishmania spread?
sand flies
967
when are neutrophils present and what do they look like?
inflammation crisp, clear nuclear outlines with purple chromatin, clear pale pink cytoplasm, segmented nucleus
968
when are degenerate neutrophils seen and what do they look like?
toxic change such as infection loss of segmentation, lighter fluffy nuclear chromatin, swollen appearance
969
what should you do if you suspect infection but cant see bacteria on cytology?
culture
970
what is the importance of quality control?
ensure results are reliable and decisions correctly made based on these
971
what makes results reliable in lab?
set up of system maintainance of analysers and system interpretation of results checks ensuring values are acceptable accurate record keeping
972
list advantages of in house labs
fast turn around time potential for improved monitoring smaller volume of sample needed available OOH available in remote areas may be cheaper
973
what factor affects lab results?
total variability
974
what factors affect results before sampling?
biological interindividual and intraindividual factors
975
what are interindividual factors that may affect lab results?
inherent differences between groups of animals due to different signalment (age, breed, sex, species)
976
what are intraindividual factors that may affect lab results?
transient difference in same animal, due to environmental and external factors such as diet, stress, excitement, reproductive status, drugs, method of sampling should be minimised
977
what are the types of analytical factors affecting lab results?
pre-analytical analytical post-analytical
978
list pre-analytical factors that may affect lab results
poor sampling techniques haemolysed, lipaemic or icteric plasma wrong anticoagulant to blood ratio sterile or nonsterile container transportation storage
979
describe sample handling for lab
fridge if delayed in running tests to slow metabolism 50ml postal sample limit, sealed container, leak proof bag, absorbant for full sample, rigid container
980
list analytical factors that may affect lab results
different methods causing different results so cant compare patient side vs lab equipment used and function technician training lab environment analytical procedure and technique
981
when should quality control be done?
voluntary process based on recommendations should be done regularly
982
what is quality control?
control material of known concentration measured to check accuracy of analytical process performed during analysis to ensure validity of results not the same as calibration
983
how do you manage if quality control fails?
check for obvious problems - reagent expiry or depletion, faults, clots in machine use another control sample repeat control new reagent and recalibrate run routine maintenance consult manufacturer
984
what post analytical factors can affect lab results?
transfer of results to patient record archiving results storing sample for follow up test
985
what is the most common feline endocrine condition?
feline hyperthyroidism
986
what usually causes feline hyperthyroidism?
benign tumour (uni or bilateral) secreting excess thyroid hormone
987
what concurrent diseases are often associated with feline hyperthyroidism?
HCM CKD hypertension are either alongside due to age or secondary to HT
988
list clinical signs of feline hyperthyroidism
polyphagia weight loss tachycardia palpable enlarged thyroid glands
989
how is feline hyperthyroid diagnosed?
T4 bloods
990
how can feline hyperthyroidism be treated?
medical management diet surgery radioactive iodine
991
how can feline hyperthyroid be managed medically?
anti-thyroid drugs - methimazole or carbimazole lifelong, increasing dose with growth of adenoma
992
how do you monitor cats on medical management for hyperthyroid?
euthyorid within 2-3 weeks check t4 3 weeks after starting treatment or changing dose monitor haem for side effects and biochem for concurrent disease ongoing 3-12 month monitoring also with BP and urine
993
why should pregnant women be careful handling antithyroid drugs?
can cause fetal abnormalities
994
list side effects and prevalence of antithyroid drugs
vomiting, anorexia, lethargy - 10-20% cats, minor GI signs, bone marrow suppression, facial pruritis, hepatopathy - rare, stop treatment
995
what diet can be used to manage feline hyperthyroid?
iodine restricted - hills thyroid care y/d lifelong and sole food
996
why is iodine restricted diets able to cause euthyroid in 3 weeks?
iodine is needed for thyroid hormone synthesis
997
what are negatives to managing feline hyperthyroid with diet?
can be less effective than other options cant use if severely hyperthyroid, other dietary requirements or if euthyroid cats in house
998
what are curative treatments for feline hyperthryoid?
thyroidectomy radioactive iodine
999
why should you do medical management for feline hyperthyroid before curative treatment?
HT can mask kidney disease so should assess renal function after treatment before irreversible treatment can help stabilise before surgery/GA due to metabolism effect in hyperthyroidism
1000
list nursing considerations for hyperthyroid cats
careful handling often fractious due to high metabolism concurrent disease
1001
what are the benefits of senior cat clinics and hyperthyroid?
can screen for the disease
1002
what is the cause of canine hypothyroidism?
thyroid tissue destroyed
1003
what is signalment for canine hypothyroid?
middle aged doberman, boxer, malamute more prone
1004
list clinical signs of canine hypothyroidism
weight gain lethargy bradycardia endocrine alopecia myxodema coma
1005
how is canine hypothyroid diagnosed?
measure t4 and TSH in blood
1006
how is canine hypothyroid treated?
oral synthetic t4 - sodium levothyroxine
1007
list nursing considerations for canine hypothyroid patients on medication
look for derm signs rarely cause of weight gain monitor treatment to find optimum dose consistent dosing important as bioavailability affected by food
1008
when should monitoring should be done long term in hypothyroid dogs?
t4 6-8 weeks after starting treatment 2-4 weeks after adjusting dose long term 6-12months measure peak (3 hours post pill) and trough (just before dose) values
1009
what is the purpose of calcium in the body?
muscle contraction nerve conduction other function
1010
how is calcium found in the body and is it inactive or active?
bones with phosphate ionised in blood - active complexed in blood - inactive protein bound in blood - inactive
1011
what is total calcium?
all calcium in the blood
1012
what does PTH do?
increases calcium in the blood by increasing calcium resorption in the kidneys and bone increases calcitriol formation
1013
where is calcitriol/vitamin d produced?
kidneys
1014
what does calcitriol/vitamin d do in the body?
increases calcium in the blood by increasing calcium resorption in the kidney and increasing calcium absorption in the gut
1015
where is calcitonin produced?
thyroid gland
1016
what does calcitonin do in the body?
reduces calcium in the blood by reducing calcium release from bone
1017
how is hypocalcaemia managed by the body?
PTH released increased calcium resorption in kidneys, increased calcium mobilisation from bone, activation of calcitriol leading to increased calcium resporption in kidneys and increased calcium absorption in gut increased calcium
1018
how is hypercalcaemia managedby the body?
calcitonin released increased calcium storage in bone, increased calcium excretion in kidneys decreased calcium
1019
list parathyroid diseases
primary hyperparathyroidism secondary hyperparathyroidism hypoparathyroidism
1020
what causes hyperparathyroidism?
one or more parathyroids overactive usually due to benign tumour
1021
what dog breed is predisposed to hyperparathyroidism?
keeshond
1022
list clinical signs of hyperparathyroidism
neurological weakness lethargy exercise intolerance trembling GI reduced appetite nausea vomiting constipation urinary PUPD urolithiasis UTI CV hypotension arrhythmias
1023
how do primary hyperparathyroidism patients normally present?
systemically well due to mild disease 1/3 cases hypercalcaemia is incidental finding
1024
how is primary hyperparathyroidism diagnosed?
elevated iCa PTH
1025
how is iCa measured?
blood gas external lab istat machine
1026
how is primary hyperparathyroid treated?
surgical removal of tumour ethanol injection US glandular heat ablation
1027
what are considerations when sending samples to the lab for iCa and PTH?
iCa - air can effect level PTH - must be frozen for transport
1028
what are considerations following parathyroid treatment?
can damage recurrent laryngeal nerve monitor iCa as can become hypocalcaemic
1029
what can cause secondary hyperparathyroidism?
renal failure - resorbing too much calcium fed too little calcium or vitamin d deficient so calcium mobilised from bone
1030
what is secondary hyperparathyroidism?
chronically low calcium leading to elevated PTH and calcium mobilised from bone
1031
what is hypoparathyroidism?
low PTH despite low calcium
1032
list causes of hypoparathyroidism
surgical excision of parathyroid trauma idiopathic immune mediated usually all glands affected in significant disease
1033
list clinical signs of hypoparathyroidism
seizures muscle twitching weakness ataxia anorexia vomiting facial rubbing
1034
how is hypoparathyroidism diagnosed?
measure iCa phosphorus PTH
1035
how are severe cases of hypoparathyroidism treated?
IV calcium bolus or CRI calcium
1036
how do you manage mild clinical signs of hypoparathyroidism?
oral calcium supplement calcitriol/vitamin d supplements
1037
what are important considerations when giving IV calcium?
close monitoring of ECG and HR usually 10% calcium gluconate slow admin to prevent arrhythmia and CA can cause bradycardia skin necrosis if not in vein
1038
how do you manage IV calcium extravasion?
infiltrate tissue with saline and manage wound
1039
what is hyperadrenocorticism?
excess cortisol production from adrenal gland
1040
what is the typical signalment for hyperadrenocorticism?
dogs not cats
1041
what are the three types of causes of hyperadrenocorticism?
pituitary dependent - 85%, pituitary tumour adrenal dependent - 15%, adrenal tumour iatrogenic - admin of glucocorticoids
1042
list clinical signs of hyperadrenocorticism
PUPD lethargy endocrine alopecia pot belly thin skin poor wound healing panting polyphagia calcinosis cutis - calcium deposits in skin
1043
how is hyperadrenocorticism diagnosed?
ACTH LDDS - low dose dexmethasone depression test
1044
how is hyperadrenocorticism treated?
trilostane to block synthesis of cortisol
1045
what are considerations for patients on trilostane?
montior clinical signs ACTH or pre-pill cortisol to monitor side effects uncommon - GI iatrogenic hypoadrenocorticism, sudden death
1046
list nurse clinic considerations for hyperadrenocorticism
look for signs in older patients monitor treatment - biochem adn ACTH/pre pill cortisol 10 days after treatment or dose change then 4 weeks, 12 weeks and 3 monthly give dose in morning monitor for iatrogenic addisons and addisonian crisis
1047
how is ACTH testing done?
pre-pill cortisol measured when dose due ACTH stim 4-6 hours after dose
1048
what is hypoadrenocroticism?
lack of glucocorticoids and mineralocorticoids
1049
list signalment for hypoadrenocorticism
young to middle aged females dogs
1050
list clinical signs of hypoadrenocorticism
vague, waxing and waning illness vomiting diarrhoea weight loss
1051
list signs of an addisonian crisis
collapse hypotension weakness bradycardia severe dehydration hypovolaemia
1052
how is hypoadrenocorticism diagnosed?
electrolyte abnormalities ACTH showing no cortisol
1053
how is an addisonian crisis treated?
fluid resus correct electrolytes glucose and insulin if severe hypokalaemia ACTH stim if suspect addisons
1054
what is long term treatment for hypoadrenocorticism?
glucocorticoid replacement - low dose preds, increase at times of stress mineralocorticoid replacement - zycortal, 4 weekly injection frequent bloods with starting treatment
1055
what causes disease of the exocrine pancreas?
pancreatic enzymes prematurely activated so start digesting pancreas
1056
list causes of pancreatitis
idiopathic dietary indiscretion trauma surgery - hypoperfusion in GA
1057
what are more common types of panceratitis seen?
mild, acute, subclinical disease
1058
list clinical signs of pancreatitis
anorexia vomiting abdo pain dehydration lethargy generalised inflammation DIC renal failure multiorgan failure death vague in cats
1059
what can be done to diagnose pancreatitis?
bloods - not reliable abdo US
1060
how is pancreatitis treated?
supportive care - IVFT, monitoring clinical signs, analgesia nutrition - anti emetics, keep feeding, feeding tube as needed long term palatable, low fat, highly digestible food
1061
why is altering diet for pancreatitis in cats less important?
likely have concurrent disease that dietary management is more needed for
1062
what is DM?
failure of pancreas to produce insulin
1063
list signalment for DM
middle aged to older animals dogs and cats burmese predisposed obesity
1064
how is DM treated in dogs compared to cats?
dogs need insulin, cats may be managed without insulin
1065
list clinical signs of DM
PUPD polyphagia weight loss cateracts - dogs peripheral neuropathy - cats, plantigrade stance DKA - vomiting, dehydration, collapse persistent hyperglycaemia - glucosuria
1066
how can DM be treaed in cats?
insulin injections - pro-zinc, caninsulin diet - low carb, high protein, regulates glucose, control calories for BCS. wet food for better glycaemic control. consistent feeding oral liquid senvelgo - blocks 90% glucose resporption in kidneys for excretion, can absorb some to prevent hypoglycaemia
1067
why is it important to monitor cats in DM remission?
may become diabetic again later in life
1068
how is DM treated in dogs?
insulin - pro-zinc, caninsulin diet and exercise to help management - high carb high fibre, consistent feeding, calorie controlled, good exercise schedule
1069
describe how to correctly administer insulin
SC injection SID or BID - patient and insulin dependent SID - feed in morning with insulin and 6 hours later BID - feed at same time as insulin
1070
why should insulin be given with or after food?
in case they dont eat and become hypoglycaemic
1071
how does glucose curve assess BG?
measure BG every 1-2 hours may be affected by stress
1072
what are the benefits of measuring BG with freestyle libre?
continuous BG monitoring more accurate as in normal routine
1073
why should the first insulin be given in hospital?
in case become hypoglycaemic
1074
how long does it take to stabilise BG after first insulin dose?
7 days
1075
list clinical signs of hypoglycaemia
weakness ataxia depression altered behaviour muscle twitching seizures
1076
how is hypoglycaemia treated?
conscious - give food, rub honey on gums, contact vet unconscious - rub honey on gums, contact vet seizing - contact vet treat if in doubt as high BG better than low
1077
what are considerations for using insulin?
correct syringe for insulin type correct storage and handling mix before use
1078
why is it important to take BG samples from the same site?
venous and capillary blood has different BG levels
1079
what would be discussed in initial post diagnosis clinic for DM?
make aware of disease teach to inject discuss routine
1080
what would be discussed in follow up clinic 7 days post DM diagnosis?
more info for owner, check managing okay
1081
what is discussed in DM stabilisation clinics until insulin dose found?
check managing discuss changes support through
1082
what should be discussed in DM maintenance clinics every 3-6 months?
any changes discuss long term issues

Advanced Clinical Veterinary Nursing (4 decks)

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