Page 93 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir comfort, ease of patient positioning and fracture. Standing exercises provide many
bene ts to a recumbent patient; they restore the
reduced drag from anaesthetic equipment.
body to its natural orientation, allow for
Prolonged care of recumbent patients
presents a multitude of challenges, not least, proprioceptive development, and promote
the additional pressure it places on veterinary normali ation of neuronal ring. Standing
sta to provide the high level of care re uired exercises provide a degree of pulmonary
for these patients. Several pathologies can rehabilitation, mental stimulation, permit
lead to prolonged recumbency; for example, expenditure of energy, and may encourage
neurological, neuromuscular or toileting behaviour. If manual thoracic
musculoskeletal conditions. physiotherapy such as coupage is required, it is
Prolonged recumbency is an unnatural state essential that the patient is upright to allow for
for any species to maintain. Extended postural drainage and coughing. Specialized
immobility leads to physiological changes in the hoists, standing frames, slings, harnesses (Figure
muscles, joints and bones. Muscles atrophy, 6. and manual supports are physical aids that
bones demineralize and joints contract. Lungs can be used to allow patients to stand upright.
develop dependent airway closure and Some harnesses (e.g. the Pet Support Suit™ by
atelectasis. Pulmonary secretions pool and Animal Suspension Technology, USA) can be
stagnate, leading to infections. Integument worn for prolonged periods, making it easier to
pressure damage can occur over bony move these patients as often as necessary.
prominences where local soft tissue is
compressed against a surface. Excessive Bedding and padding
moisture from urinary or faecal incontinence or Two major types of support surfaces exist for
wound drainage can also damage the comfort and pressure relief: static and dynamic.
integument. Pathology of the cardiorespiratory Static surfaces are more common and include
system due to prolonged recumbency can air, foam, and water mattress overlays. Dynamic
easily be missed without appropriate surfaces for more advanced pressure reduction
monitoring. ther organ systems a ected by (e.g. alternating air overlay, low air-loss beds
recumbency are the endocrine system, the and air uidi ed beds are commonly used in
gastrointestinal system, the immune system, human medical care to reduce the incidence of
and uid and electrolyte balance. bed sores; however, these are uncommon in
Human intensive care units have dedicated the veterinary practice. Foam mattresses of
sta trained in a multitude of physical therapies varying materials are readily available for the
to aid recumbent patients. These physical veterinary patient. Given the abundant
therapists incorporate treatments such as evidence proving the positive e ect of
passive range of motion, active range of motion, appropriate padded bedding in the care of
active-assisted range of motion, active-resisted recumbent human patients, mattresses for all
range of motion, and exercise. In veterinary veterinary inpatients should be standard.
medicine, this responsibility for physical Additional methods of padding may further aid
therapies usually resides with the veterinary in pressure relief. Improvise with pillows,
nurse. Details of these therapies are addressed towels, blankets igure 6.4 or use more
elsewhere in this book, and further practical specialized equipment such as foam shapes
continuing education in this area is valuable. For and gel protectors. Carers should be proactive
example, sta training by a uali ed veterinary in padding areas that are naturally bony and
physiotherapist in techniques appropriate for can be in direct contact with surfaces during
recumbent patients with various conditions will recumbency, for example, the sti es and hocks.
enhance patient care and outcomes. Moisture accumulation in bedding can be
Supported standing in recumbent patients avoided by using padding that wicks away
should be encouraged if no contraindications moisture, by creating a regular faecal and
exist, for instance spinal instability or an unstable urinary voiding schedule, by using highly

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