Page 98 - BSAVA Guide to Pain Management in Small Animal Practice

6 | Physical methods used to alleviate pain: nursing considerations

VetBooks.ir example, immunosuppressed patients, intervals improved oral hygiene in human
patients. While traditional tooth brushing is not
neutropenic patients, malnourished patients
common practice in veterinary inpatients, oral
and patients with circulatory impairments. Extra
caution with sterility and technique should be health should be attended to. This is particularly
applied in these higher risk patient populations. important in inappetant or tube-fed patients.
Clear guidelines do not exist in the Aural hygiene is also imperative as
veterinary patient for replacement of long-term recumbent animals can be predisposed to ear
peripheral venous cannulae. A 1 Cochrane infections and irritation of the pinnae. They may
review suggests that, in humans, removal be unable to display behaviours that would give
should only take place when clinically evidence of this, such as head shaking or
necessary. The report found that there was no scratching. Any patient with skin folds should
evidence to support changing catheters every have regular examinations and cleansing of
7 96 hours and suggested that clinicians these areas as required.
consider changing to a policy whereby
catheters are changed only if clinically indicated Stress and sleep
(Webster et al., 1 . Hospital environments are stressful for
To minimize peripheral cannula-related veterinary patients, and hospitalization has been
complications: shown to increase psychological stress in
humans. Typical problems that are encountered
■ Place under strict aseptic technique, in hospitalized veterinary patients are:
including a generous area of clipped hair in
veterinary patients ■ Struggling during handling
■ In emergency cases, it is worth replacing a ■ i culty in treating
peripheral cannula that was pre-placed ■ Anxious patients being aggressive or
urgently when asepsis was compromised unpredictable
■ Insertion site should be inspected at each ■ Frustrated dogs barking and whining
changeover of sta , including complete continually, or chewing through dressings
removal of bandaging and observation of and giving sets
the entry point of the cannula ■ Stress-related anorexia
■ The cannula should be removed if signs of ■ Urinary and faecal retention.
in ammation, in ltration or blockage occur. Stress is a cognitive perception of
uncontrollability and unpredictability that is
Recumbent patients are a high-risk expressed in physiological and behavioural
patient group for compromised eye integrity and responses (Geva et al., 14 . Individuals
thus are dependent on regular eye care. These experience this phenomenon to di erent
patients are susceptible to corneal dehydration, degrees. In veterinary patients, there are
abrasions and infection because of impairment individuals that are strongly in uenced by stress
of primary eye protective measures, and the and others that are more resilient; this variation
e ects of certain medications. In human in resilience to stress is mirrored in humans.
intensive care units, eye care is performed every There are studies that link stress and pain
hours to prevent corneal abrasions, modulation in people, with ndings relating
dehydration and infection; this interval is similarly stress to a reduction in pain inhibition, and pain
recommended by veterinary ophthalmologists. intensi cation eva et al., 14 . Exposing
Eye care consists of gentle cleaning of the area animals to prolonged stress without the ability
around both eyes and application of appropriate to adjust to their immediate environment has
lubrication to the cornea. negative consequences. Stress makes the
Frequency of oral care has been reported at patient harder to care for and contributes to
, and 1 hour intervals in human intensive adverse associations. These negative
care patients. ral care at and 4 hour associations are linked to the clinic and

93

Ch06a Pain Management.indd 93 19/12/2018 10:37