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Nursing Care and Procedures Michael Lavoie Veterinary Assisting Program Middlesex Community College March 2012 Record keeping Medical records provide documentary evidence of the patient’s illness, hospital care, and treatment Also serve as a basis for review, study and evaluation of the care and treatment given by the veterinarian Veterinary assistant may be responsible for many office procedures and administrative duties Creation, maintenance and organization of medical records Medical records Records detailed information for each veterinary patient Includes both client and patient information Patient history Surgical and medical records Progress notes Laboratory information Medical record is a legal document Keep private and confidential Record is owned by the facility and is the property of Medical records Original record must remain in the facility for at least 1-3 years from last visit Check state regulations Many keep records for 7 years Copies of the original record can be made and sent with owner to another facility May not withhold the release of the veterinary medical record contents Medical records Should be updated on a regular basis Includes Client and patient information sheet Master problem list- vaccine history, surgeries, previous medical problems Progress notes- allow for chronological logging each time a patient is seen and treatment is completed (SOAP) Laboratory reports, veterinary test results Radiology reports Pharmacy reports Surgical and anesthesia reports Content forms and other forms that may be recorded and documented Medical records Each facility will have a preference for medical forms used as well as their sequence within the medical record Keep each record in the same format with information in the same location Estimate, authorization forms, consent forms Discharge sheet- after treatments or procedures are completed; instructions for the client on the care of the animal; care for surgical sites; prescribed medication instructions Medical record Invoice Keeps a working list of itemized charges Should be updated and reviewed often Give to clients at discharge along with payment history All services rendered Medical record rules All information must be recorded in blue or black ink- no pencils or colored pens All information must be accurate and legible Never erase, use white out, or scribble If a mistake is made put one line through the error and initial the error and then place the corrected statement after the entry Indicates an error in writing occurred rather than suggesting the information has been changed Medical records Record all communication and phone conversations held with owners Detail the conversation including the date and the initial of the team member involved Help others identify and communicate with the patient’s caregiver Each patient record should contain one medical record for that patient only Exception laboratories, large farms, herds The “SOAP” Subjective- based on the animal’s overall appearances and the health care team’s description of the animal Objective- measured facts that can be recorded based on the patient TPR, weight Assessment- what the veterinarian determines to be the diagnosis or the patient’s problem Plan- treatment or procedures to be given to the patient Usually found in the progress notes and physical examination section on the record Sample SOAP S: 6 month old intact male DSH cat, friendly, well groomed O: T=102, P=180 bpm, R=purr, 10lbs, CV=NAF, EENT= NAF; bladder small, feces palpated in colon A: Healthy 6 mos old intact DSH P: castration, TGH later today with buprenorphine PO q 6 hrs x 3 doses, meloxicam PO x 3 days True or false? All errors in a medical record should be erased? FALSE The SOAP format is used as a system filing medical records FALSE Each medical file should have a format or sequence of where each form is place in the file TRUE You can use red ink to record patient information in the medical record FALSE QUESTIONS? Hospital patients- observations Essential for all staff members to learn to observe patients Necessary skill Includes the moment a patient enters the facility until it is discharged observation Watch and note an animal’s: behavior Appearance Mental status Overall health Some may be subtle and easily overlooked Compare to what is normal for the species and breed of the animal Monitor and note any changes in the medical record observation Visual Smell Palpation Auditory Use all of your senses Diarrhea, tense abdomen, ocular discharge Hospital patients- emergencies A situation that requires immediate life-saving measures Important that all of the staff members work together as a team Success relies on the staff working as a team and staying calm under pressure Emergencies are common in all veterinary facilities Vet assistants can help by locating supplies, medication, and emergency equipment Crash cart Moveable table that holds emergency equipment and supplies Should be easily accessible Contains items prepared ahead of time for emergency situations Tool chest Set a moveable plastic drawers Crash cart contents Emergency drugs- epinepherine, atropine, lidocaine Needles and syringes- all sizes Endotracheal tubes Ambu bags Tape IV catheters Fluid bags Administration sets, extension sets, t-sets Suction hoses/catheters EKG-defribulator Heparinized saline Be familiar with the contents and locations What can you do? Be able to locate the crash cart or emergency kit Be able to locate the emergency equipment that may not be located in or on the crash cart Be able to maintain emergency equipment, drugs, and supplies Be able to update and stock the emergency equipment Be able to identify common emergency equipment Be able to locate common general supplies Be able to restrain and position patients properly Perform simple in-house lab procedures Provide skin preparation as necessary Common emergency equipment Laryngoscope and blade Pulse oximeter EKG IV catheter Syringes and needles Stethoscope ET tubes of various sizes Ambu bag Emergency drugs Bandage materials Fluid bags and lines Training All staff members should be trained on what to do during an emergency Each member must understand the job Knowledge is invaluable during an emergency and is not the time to learn and be trained Mock events Call a code Model dog Things to watch for… No signs of a heartbeat No signs of breathing An animal that is not alert An animal that is having difficulty breathing An animal that is hemorrhaging excessively An animal that has a low body temperature and is pale in gum color An animal that has an excessively high body temperature What to do next? Notify the veterinarian or technician of your concern Follow orders as indicated by vet or tech Set up emergency equipment as directed Call for help Record events and any medications administered Be a runner Stay calm and focused Hospital patients- monitoring Look for warning signs that warrant further medical attention or the attention of a veterinarian or technician Important to observe and record in the patient’s medical record any pertinent observations Important to record changes in appetite, urinations, defecations, attitude, changes in body temperature Nutrition is often overlooked Maintain IVC and fluid pumps Trust your Gut! If you feel that something is not quite right speak up No questions are stupid Trust your gut Would you rather bring up your concerns, or dismiss them? Remember the patients are counting on you You are their voice, be loud! You may catch something that nobody else does You are caring for the patients intimately and often for days- you can get to know them! QUESTIONS? Flea life cycle Collectively, all of the species of fleas are categorized under the order name of Siphonaptera. The cat flea, Ctenocephalides felix, is the most commonly found flea in the US and infests cats, dogs, humans, and other mammalian and avian hosts. Fleas thrive in warm, moist environments and climates. The main flea food is blood from the host animal. Host animals are many species cats, dogs, humans, etc. Fleas primarily utilize mammalian hosts (about 95%). Fleas can also infest avian species (about 5%). Flea saliva, like other biting skin parasites, contains an ingredient that softens, or "digests" the host's skin for easier penetration and feeding. Fleas have four main stages in their life cycle: egg, larva, pupa, and adult. The total flea life cycle can range from a couple weeks to several months, depending on environmental conditions. Adult The adult flea is very flat side to side. There are hair-like bristles on the flea body and legs to aid in their navigation through pet hair. Fleas have 3 pairs of legs, the hindmost pair designed for jumping. Fleas are well known for their jumping abilities. Adult fleas prefer to live on the animal and their diet consists of blood meals courtesy of the host animal. The female flea lays white, roundish eggs. The adult female flea can lay up to 50 eggs per day, 500-600 eggs over several months. Egg The eggs are not sticky (like some parasites), and they usually fall off of the animal into the carpet, bedding, floorboards, and soil. When the flea egg hatches varies -- anywhere from two days to a few weeks, depending on environmental conditions. The larva emerges from the egg using a chitin tooth, a hard spine on the top of the head that disappears as the flea matures. Larvae The larval stage actually has three developmental stages within this stage. Larvae are about 1/4" long, and semitransparent white. They have small hairs along their body and actively move. They eat the feces of adult fleas (which is mostly dried blood) and other organic debris found in the carpet, bedding, and soil. the larval stage lasts about 5 to 18 days Pupa The pupa is the last stage before adult. The adult flea can emerge from the cocoon as early as 3 to 5 days, or it can stay in the cocoon for a year or more, waiting for the right time to emerge. Stimuli such as warm ambient temperatures, high humidity, even the vibrations and carbon dioxide emitted from a passing animal will cause the flea to emerge from the cocoon faster. Flea Control: Shampoos A shampoo, or "flea bath" is a good first attack on fleas for the pet that has large numbers of fleas visible on its body. Cats can be difficult to bathe. It is important to realize that a flea shampoo is not intended for lasting control. Shampoos are only effective for a day or less. They leave little residual chemical on the animal when properly used. Flea Control: Flea Dips Flea dips are strong chemical rinses to rid animals not only of fleas, but mites and ticks as well. Dips last approximately 1-2 weeks. That is a lot of chemical residue to leave on an animal! Flea shampoos and dips are effective for adult fleas. Flea Control: Flea Collars Flea collars work one of two ways - by emitting a toxic gas, and by being absorbed into the animal's subcutaneous fat layer. The toxic gas is usually only effective in the immediate area of the head and neck. This type of collar is best used in the vacuum cleaner bags to kill any fleas vacuumed up. The collars that absorb into the subcutaneous fat are much more effective. Flea collars are effective for adult fleas. Flea Control: Flea Powders Flea powders and sprays offer short term (2-3 day) protection from fleas, and with some products, ticks and mites too. Powders and sprays have fallen out of favor recently with the newer spot-on treatments that are available. Most flea powders and sprays are only effective for adult fleas, some offer additional flea protection by inhibiting flea egg and larval development. Flea Control: Spot on Treatments Common brand names include: Advantage (tm), Frontline®, and Bio-Spot® just to name a few. Please consult with your veterinarian for the best choice for your pet(s). These products are applied between the shoulder blades of the pet, and typically last about one month. Spot-on treatments are effective for adult fleas. Some include ingredients to inhibit the larva from emerging from the flea egg and some are active against larval development as well. Flea Control: Oral Medications Flea "pills", such as Sentinel® work by stopping the larva from emerging from the flea egg. Fleas ingest the blood of animals on these medications, and the female fleas then lay eggs that are unable to hatch. They do NOT kill adult fleas. These medications are essential to break the flea life cycle and stop the flea problem when used in conjunction with flea adulticide treatments. Flea Control for the House and Yard Only about 10% of the flea population (mainly the adults) are on your pet. The flea eggs, larvae, pupa, and the few adults that reside in the carpeting, bedding, and living areas make up approximately 90% of the flea population. Neglecting this population of fleas will ensure that the flea problem will continue and worsen over time. Daily vacuuming - this is very important for overall flea eradication. This will pick up (and get rid of) adults, eggs, larvae and pupae before they develop. Putting a flea collar in the vacuum bag and emptying the bag frequently are also important; otherwise, the fleas will hatch, develop, and leave the vacuum to re-infest the living quarters. Dispose of the vacuum bag properly and frequently. Wash all bedding, clothing, and removable furniture covers. Coccidia life cycle Coccidia are single celled organisms that infect the intestine. They are microscopic parasites detectable on routine fecal tests in the same way that worms are, but coccidia are not worms and are not susceptible to deworming medications. Coccidia infection causes a watery diarrhea that is sometimes bloody and can be a lifethreatening problem to an especially young or small pet. Coccidia Coccidia Life cycle Coccidia come from fecal-contaminated ground. They are swallowed when a pet grooms/licks the dirt off itself. In some cases, sporulated oocysts are swallowed by mice and the host is infected when it eats the mouse. Coccidia infection is especially common in young animals housed in groups This is a common parasite and is not necessarily a sign of poor husbandry. How is it Found? A routine fecal test is a good idea for any new puppy or kitten whether there are signs of diarrhea or not as youngsters are commonly parasitized. This sort of test is also a good idea for any patient with diarrhea and is recommended at least once a year for healthy dogs and cats as a screening test. How is it treated? The most common medicines used against coccidia are called coccidiostats. They inhibit coccidial reproduction. Once the numbers stop expanding, it is easier for the patient’s immune system to catch up and wipe the infection out. The time it takes to clear the infection depends on how many coccidia organisms there are to start with and how strong the patient’s immune system is. A typical treatment course lasts about a week or two, but it is important to realize that the medication should be given until the diarrhea resolves plus an extra couple of days. Medication should be given for at least 5 days total. Sometimes courses as long as a month are needed. In dogs and cats, sulfa-based antibiotics are the most commonly used coccidiostats. QUESTIONS?