Page 258 - Zoo Animal Learning and Training

266 Section IV: Postoperative Care and Rehabilitation

permanent disabilities, and design of an adequate home environment must be altered. The use of pillows might be needed to keep the
are some of the main topics discussed in the following sections. patient in a comfortable position. Positioning the patient sitting
up is recommended to prevent aspiration pneumonia, especially
Skin Integrity when eating or drinking. The patient should be looking out of the
Skin infections and wounds are commonly found in the neurologi- cage instead of facing the back of the cage or a wall so that it is
cal patient but these could be reasonably prevented. A pressure stimulated by environmental interaction.
ulcer characterized by full‐thickness tissue loss is a concern during • Skin should be checked twice daily for early signs of pressure
the long healing process and may indicate a worse prognosis or sores, especially in predisposed regions of the body. Pressure
even become life‐threatening if infected. This can change the direc- sores can be classified in four stages. Early lesions will appear as a
tion of recovery of the patient, increase the cost, and limit the type small region of hyperemia over a bony skin region with intact
of rehabilitation (restricting it to only dry rehabilitation); some skin (stage I). If this progresses, the small hyperemic region
owners may even decide to stop therapy and give up trying to get becomes a little larger and the hair will appear wet due to the
their pet better. Prevention is highly recommended in dogs at risk exudate from the inflammatory skin process (stage II). Usually,
of pressure sores, principally those patients with thin skin and bony this is the phase observed when the skin is checked regularly. The
prominences, the two most frequent locations being the greater tro- earlier hyperemic stage might not be seen because the hair will
chanter (Figure 29.21) and acromion. Urine scald is a potential cover the skin. At this point, shaving the area and close monitor-
issue in any patient with some degree of urine/fecal incontinence or ing is recommended. If the wound progresses, it becomes larger
movement disability. A patient leaking urine will lie on a wet bed with a pale region at the center due to ischemia. This central
and management of urinary incontinence and frequent bed chang- region progresses to dark skin and necrosis involving the subcu-
ing will be necessary. Abrasion sores are frequent in patients with taneous fat (stage III) or even muscle and bone tissues (stage IV).
neurological deficits. For instance, decreased or lack of propriocep- Do not forget bony regions in the medial aspects of the limbs. An
tion predisposes the patient to abrasion sores in the dorsal aspect of additional pillow between the limbs is also recommended in
the toes and worn‐down nails that bleed easily. Some of the prophy- patients with severe mobility problems. Pressure sores can also
lactic measures to apply in the recumbent patient are listed below. appear in non‐bony regions due to position. For example, the
• Keep bed clean, dry, and well padded at all times (Figure 29.22). skin in the cranial aspect of the elbows in patients kept too long in
• Turn the patient every 4 hours when the animal cannot do it by a sitting‐up position with only turns of the hips are predisposed
itself. Right side, left side, and sternal (if possible) recumbency to ulcer.
• Check toes and nails regularly for early signs of abrasion sores.
Patients with dysfunction of postural reactions drag the affected
limb(s) and develop sores on the dorsal aspect of the toes and
worn‐down nails (Figure 29.23). Boots, socks, plastic fake nails,
and elastic bands must be used in patients with these types of
deficit.
• Prevent skin irritation by urine and feces. Management of blad-
der incontinence is essential to keep the neurological patient
clean and dry. Patients predisposed to urine/fecal leakage,
overflow or diarrhea should be monitored closely and medically
treated as needed. If the skin appears hyperemic, wash with a
soft wet sponge using water and soap, rinse well with water, dry

Figure 29.21 Pressure sore over the greater trochanter in recumbent patient Figure 29.22 Recumbent patient with clean, dry and padded bed. Note the
with prominent bones. Note the dark round region over the hip due to extra pillow between his hind limbs for protection of ulcers in the medial
necrosis of the skin covering the prominent lateral aspect of the femur. aspect of the hind limbs.