Page 384 - Clinical Small Animal Internal Medicine

352 Section 5 Critical Care Medicine

use in veterinary medicine and provide a systemic and peripheral edema can rapidly develop and cause wraps
VetBooks.ir repeatable approach to evaluating pain and a patient’s or bandages to become tight and constricting. Soiled or
wet bandages should be immediately changed as they
response to pain medications.
provide an excellent source of infection. Wounds and
incisions should be closely monitored for healing and
Nursing Care and Patient Mobility
any changes that occur, including bruising, odor, swell-
While focusing on the medical care of a critically ill ing, and discharge, should be immediately investigated.
patient, it is easy to overlook patient comfort and
husbandry. In patients that require extensive nursing Tender Loving Care
care, these measures may be skipped due to the time and
staffing they require, especially in larger patients that may Amongst all the medications, procedures, and treat-
require multiple people to move and support them. Many ments, time should be taken to simply sit with a patient
of these patients are nonambulatory and physical therapy to provide comfort and affection. Once again, this is an
should be provided several times a day. Passive range of area that is easy to omit when a patient has intense medi-
motion of limbs keeps muscles and joints flexible and can cal treatments and support staff is spread thin. Patients
improve circulation. For patients with peripheral limb that require many treatments are often mislabeled as
edema, tissue massage from distal to proximal can assist being “difficult cases” rather than appreciated for the
in resolution. Deep bedding and frequent repositioning multiple levels of complex care they require to support
are necessary to prevent pressure sores, lung atelectasis, their severe disease states. Many times patients will only
and edema formation. Standing sessions are useful and eat when being petted. Owner visits should be encour-
allow patients to attempt supported ambulation. If possi- aged and efforts made to allow visits to occur outside the
ble, underwater treadmill therapy is an option for assisted hospitalization area to allow patients stress‐free periods
mobility to increase flexibility, strength, and circulation. during which they may eat or rest. In 24‐hour care facili-
Efforts should be made to frequently take nonambulatory ties, efforts should be made to allow the patients to have
patients out of their cages and, if feasible, outside for a treatment‐free periods during which uninterrupted rest
“visual vacation.” For patients with lung consolidation can occur. Clinicians should attempt to arrange treat-
from pneumonia or other conditions, positional coupage ments in groupings to establish greater intervals of time
based on afflicted region can be useful in resolving con- when the patient is not being handled or interacted with.
solidation. In patients with surgical incisions or traumatic Especially during evening hours, further emphasis
tissue injury, cold laser therapy can be considered to should be placed on treatment‐free periods. During
improve tissue blood supply and increase healing. Patients these evening times, lights should be dimmed and
should be diligently cleaned to prevent skin irritation and attempts made to decrease ambient noise. There may be
burns from urine and feces soiling. benefit to playing relaxing music such as soft classical or
nature sounds.
Bandage and Wound Care

All IV catheters should be routinely changed and cathe- Euthanasia
ter insertion sites evaluated for infection and inflamma-
tion. Each facility should establish a protocol for the For many critical patients, compassionate euthanasia
placement and maintenance of peripheral IV catheters may be the most humane treatment available. As a case
and advanced catheters such as central IV catheters and progresses, lines of communication regarding euthana-
arterial catheters. At a minimum, daily bandage changes sia should remain open between owners and the medical
should be required but other considerations include staff. Despite being common in veterinary medicine,
acceptable indwelling duration, flushing/locking proce- some owners may not know it is an option for their pets.
dures, level of sterility during placement and handling, Broaching the subject of euthanasia can be difficult and
and a protocol for investigation and treatment of needs to be handled with special attention. Even in cases
suspected catheter site infections. Indwelling urinary with a grave or guarded prognosis, owners may not
catheters also require set protocols for placement and consider euthanasia due to religious or ethical beliefs.
maintenance including prepuce/vulva flushing, collec-
tion system handling/changing, acceptable indwelling
duration, and a protocol for investigation of suspected Conclusion
infections due to catheterization. Bandages placed on
wounds require frequent changing to evaluate for Each critical patient will require a unique and custom-
changes in underlying wounds. During critical illness, ized approach to every element of their care. While the