Stephen Cital RVT, SRA, RLAT
United Veterinary Specialty and Emergency, Oakland Zoo, San Francisco Zoo
For more visit www.stephencital.com
Posted on 17 March 2016
At my practice we are growing and constantly have new people join our team. With every new person we do our best to instill a certain authority they have with the patients they are asked to watch during admission or shift change. While this doesn’t seem to be too challenging, it can be for a veterinary nurse that is not used to a specialty setting. Asking a veterinary nurse to take authority, in collaboration with the veterinarian, can also be somewhat daunting as to where to start. We also like to stress consistency with case management. Below is our hospital’s patient assessment checklist we emphasize during training. Each hospital should have something similar to help ensure patient safety and healing, while allowing the veterinary nurse to really take some ownership.
The other benefit of this tactic is personal development and fulfillment. Allowing the nursing staff to really use all of their skills and test their knowledge will encourage job satisfaction and employee retention.
- Physical exam: Do your own physical exam, including temperature, respiratory rate and effort, lung field sounds, heart rate and cardiac auscultation, and pulses. Palpate for any tenderness, bruising or swelling in any region or limb. Check weight every 24 hours. Check incision sites for redness, excessive tenderness, swelling and discharge. (*This exam should be done at the beginning of every shift, regardless of whether the treatment sheet indicates it or not, unless otherwise specified.)
- Pain score: Use one of the pain scoring systems available to determine the comfort level of each patient. Pain level can change over time, and adjustments to pain management may be required while hospitalized.
- IV catheter and u-cath assessment and maintenance: When was the IVC or u-cath placed? Does it flow correctly? Is it clean or need better securing? Are the lines kinked? Is there any swelling of the limb with the IVC in place? Palpate the bladder to ensure the urinary catheter is working correctly.
- Nutritional assessment: Animals that are healing have higher nutritional demands. Should we be feeding more? A better or different diet? What are the patient’s dietary restrictions? If the patient is not eating, ask the veterinarian to consider appetite stimulants or an NG tube.
- Fluid “ins and outs:” Ensure the fluid type, additives and rate match the treatment sheet. Redo the math to check that the CRI calculations are correct. Are fluid “ins” matching the “outs,” or at least close? Has your patient received more than 80-100mL/kg/day in a 24-hour period?
- Urination & bowel movements: What is the frequency and character of the stool? Take the patient out to void regularly if able. Record eliminations on treatment sheets.
- Is the cage appropriate? Is your patient a nervous animal? Would they be less anxious/stressed away from other animals (e.g., cats near barking dogs)? Do cats have enough litter to feel comfortable urinating in the box provided? Is the box too small or sides too high for the patient? If your patient is recumbent, is there enough bedding? Is the patient being rotated or need to be cleaned?
- TLC: Unless otherwise specified or the animal is aggressive, every animal will benefit from extra love and attention. This love and attention can also prove therapeutic. Ways to provide therapeutic TLC are massage of the limbs and back, extra walks and performing passive range of motion (PROM).
Inform the veterinarian of any changes that you identify.