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Medical nursing

An Orogastric tube is important because it is a way to administer medication, food, or fluids directly into the stomach. In some situations, it is necessary to use activated charcoal which help absorb chemicals in the stomach to treat a drug over dose or a dog that has been poisoned (Molldrem, 2015). There are a few reasons a Vet Tech would need to administer food through an Orogastric tube. A technician may use a orogastric tube to feed newborn puppies if the female has not produced milk yet. Also, if you have a weak newborn puppy who cannot nurse or an Orphan who can be fed milk replacer. The milk replacer is placed a tube passed through the mouth and into the stomach. An orogastric tube is sometimes used to relieve a patient with gastric dilation (Molldrem, 2015). According to Bassert and Thomas (2014), “The proper way to insert a orogastric tube is first to premeasure an appropriate size for the stomach tube so you know how far you are able to insert the tube. Then by holding a tube against the outside of the nose of a canine to the last rib (which is the thirteenth rib) and then mark it with a piece of tape” (Bassert and Thomas, 2014, p.587). If the tube is being placed in the distal esophagus to feed an animal, the measurement would go from the outside of canine’s nose to its eighth rib and mark it with a piece of tape. The tip of the tube should be lubricated with a water-soluble gel, before inserting the tube. The canine can either be in a standing, seated or in a restrained a sternal recumbency. A wooden speculum with a hole in the middle or a plastic syringe case with a smooth end can be placed behind the canine teeth to help hold the mouth open. The tube is slowly inserted through the mouth (Bassert and Thomas, 2014, p.587). As the canine swallows the tube, the tube is passed over the tongue and into the esophagus. If the animal coughs the tube must be removed because it may have been inserted into the trachea. If the tube must be removed, retry inserting the tube again. After the tube is in the esophagus it should be at the first mark of tape, which means it is at the eight ribs (Bassert and Thomas, 2014, p.587). Once the tube has been entered in the stomach it should be at the next mark of tape and at the thirteenth rib. The tube should be in the correct placement of the digestive tract and double checked before any medication or fluids are inserted. Once the technician knows that the tube is in the correct place then fluid is added to the tube with a 60 ml syringe, a metal drench pump, or a funnel (Bassert and Thomas, 2014, p.587). Once the fluid is administered, the tube is bent, pinched or kinked to cut off liquids from flowing and then tube is removed in a downward direction, while the tube is remained bent. This technique prevents fluid from entering the trachea and preventing the canine to aspirate (Bassert and Thomas, 2014, p.587). In “Vet Girl”,” Molldrem (2015) the article describes correct orogastric tube placement. To assure the orogastric tube is placed correctly you can feel for it or blowing into the orogastric tube when listening for bubbles at the same time. You can also check correct placement by feeling the neck for two different tube-like structures such as, trachea or esophagus tube placements (Molldrem, 2015). When using an orogastric tube, there may be some complications such as risk of sedation, aspiration pneumonia, physically injuring the mouth, or oropharynx, esophagus, stomach and respiratory issues (Turner, 2017).

Fluid Administration

When administering fluid to a feline, it is important to do a physical exam to get a clear understanding of the symptoms of the patient the technician is helping treat. In “the nest”,” Meggitt (2017) discusses some of the dehydration symptoms in a cat include, sunken eyed look, appetite loss, constipation, lethargy, and pale mucous membranes. Some ways to determine whether the patient is dehydrated is the color of the mucous membrane. If the mucous membrane is pink to pale pink that is normal. If the gums are pale or white means the patient has lack of blood or red blood cells and could be anemic. Gums that are blue or purplish means that patient is lacking oxygen. Gums that are a yellowish can mean a patient has too much bilirubin in the blood and this is called Hyperbilirubinemia (McCurnins textbook, 2014). There is a couple physical test a technician can do to tell if a patient is dehydrated too. In the article “Dvm360″,” Terry (2010) explains the appearances with each percentage of dehydration in a patient. Patients with five to six percent dehydration have slight loss of skin elasticity. Patients six to eight percent dehydrated has a delay of skin to normal position, slight increase in capillary refill time and eyes maybe slightly sunken into the eye sockets. For patients that are ten to twelve percent dehydrated, they have extremely dry mucous membranes, complete loss of skin tissue, eyes sunken into eye sockets, dull eyes, possible sign of shock or weak pulse and possible lack of consciousness. Patients who are twelve to fifteen percent dehydrated have definite signs of shock, death will occur if not corrected or treated. There are a few circumstances that can affect the results of whether how dehydrated a patient is for example, emaciated animals that absorbed and fat around their eyes and skin (Terry, 2010). An example of calculating fluid rate for a feline patient that is not showing any signs of shock, vomiting or diarrhea. The patient comes in ten percent dehydrated and weighing eight pounds. First you convert the patients weight of eight pounds in kilograms which is 3.63, times that by the percentage of how dehydrated the patient is which is ten percent and then times it by ten again to convert to milliliters. The total amount of fluid the patient is administered to hydrate the patient is three hundred and sixty-three milliliters. From there you divide total amount of fluid by twenty-four, because that is how many hours in a day. The fluid rate would be fifteen. There are two different type of fluids; crystalloid and colloid solutions. In “dvm360″,” Terry (2010) explains the difference of the two fluids. Colloid Solutions can be used in patients with severe low blood level known as hypoalbuminemia (Terry, 2010). Crystalloid Solutions contain electrolyte and non-electrolyte solutes, that move freely around the body’s fluid. Isotonic Crystalloids are mostly used for reviving a patient, rehydration and maintenance fluids (McCurnins Clinical Textbook, 2014). So, because the feline patient is dehydrated it is best to use the Isotonic Crystalloid fluid. To determine the hourly maintenance rate, take the cats body weight of 8x8x8=512. Then take square root of 512= 22.63 and the square root of 22.63=4.76. Then take the formula of 80x 4.76=380.8 and divided that by 24 because that’s how many hours per day. Add the 15.86 to the fluid rate of 15, the maintenance rate is 30.86. Once fluids are administered the staff should perform basic monitoring for the patient. Basic patient monitoring consists of checking the patient’s temperature, pulse, respiration, CRT, mucous membranes, skin turgor, body weight, consciousness, appetite, urination and bowel movements (McCurnins, 2014). The staff should monitor the fluid intake as well as the output. Monitoring for signs of too much fluid intake by listening for presence of lung crackles, presence of new heart murmur, presence of swelling, increased body weight, increased nasal discharge and increased blood pressure (McCurnins, 2014). It is very important for patients that are on IV Fluid Therapy because of the potential risk and one of the biggest concerns are too much fluid being administered.

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Dental Prophylaxis

The difference between dog and horse deciduous (puppy/foal) is that dog deciduous teeth has twelve incisor teeth, four canine teeth and twelve premolar teeth. A horse foal has twelve incisor teeth, no canine teeth and twelve premolar teeth. The difference between dog and horse permanent teeth is that dog permanent teeth include twelve incisor teeth, four teeth, sixteen premolars and ten molars. Some horse permanent teeth include twelve incisor teeth, zero to four canine teeth, max of eight premolar teeth and twelve molars (McCurnins Clinical Textbook for Veterinary Technicians, 2014). Dental prophylaxis is very important for both dog and horses. Intraoral radiographs which are x-ray film of the mouth are important when planning dental treatment for dogs and is also used in horses too (McCurnins Clinical Textbook for Veterinary Technicians, 2014). In “PlosOne”,” Flancman (2014) states periodontal disease is a common disease diagnosed in dogs caused by dental plaque. Periodontal disease can lead to bone loss, cavities between the gum and teeth. Also, periodontal disease can cause damage to the tissue too. Once the plaque is removed from the crown surfaces, this helps eliminate bacteria and developing a healthier environment in the oral cavity (Anon, 2019). Horses should have dental examinations at least once a year to prevent dental disease. Dental disease can cause behavioral problems. It is also necessary for horses to have dental examinations to prevent long-term illness and more expensive veterinary bills (Exclusively Equine Veterinary Services, 2019). The technician performing dental cleaning on a dog is responsible for subgingival scaling, polishing, educating dog owner on home care and suggesting a proper diet, treats (McCurnins Clinical Textbook for Veterinary Technicians, 2014). In “dvm360″,” Anon, (2019) explains what the twelve steps are to a complete dental cleaning appointment. The first step, is the oral exam when the dog is awake. During your exam is a good time to go over any issues you see, get permission for treatment at this time and give the client an estimate with a low to high range including, extractions, medications that might be required. Step two, is the exam on the patient under anesthetic. During this time, you will locate the tongue and tonsils at the time intubation, examine each tooth for fractions, misaligned teeth, enamel defects or signs of periodontal disease. Step three is the Supragingival cleaning. This process is the removal of the plaque and tartar from the crown surface. Also, removing plaque is helping promote a healthier environment in the oral cavity. Step four is Subgingival cleaning, which is removing plaque, dead tissue and tartar below the gingival edge. If the debris is not removed, periodontal disease can progress. Step five is Polishing, smoothing out surface defects and removing any missed plaque. Step six is Irrigation, removing tissue, plaque, polishing paste from grooves and gingival pockets. Irrigation can be completed with a three and one dental system or a blunted twenty-three-gauge needle and syringe. Step seven is the Fluoride treatment applied to dry teeth and should sit for at least four minutes. OraVet can then be applied acting as a sealant. Step eight is the post cleaning exam where each tooth should be examined. Also, during post cleaning the technician will periodontal probe check the grooves and normal values are one to three millimeters in dogs. Radiographs can be taken at this time to look for periodontal disease. Step nine is charting and recording the patients oral chart that includes any missing, loose teeth or fractured teeth. Also, record any discolored teeth, periodontal pockets and anything found on the radiographs too. Step ten is therapy; go over treatment options for dental abnormalities including extractions or enamel defects. Step eleven is discharging the patient. During discharge you should educate the dog owner of proper home care and typed discharge instructions should include treatment performed that day, medication needed for patient, diet or exercise restrictions. Also, include when to recheck on the typed discharge instructions. Last Step is when the technician has a follow up with the patient to reevaluate the dogs oral cavity (Anon, 2019). During a horse dental examination, the veterinary will check for signs of dental disease, uneven wear or other abnormalities. The Veterinary will then use a power float to file the horse’s teeth. Horses need their teeth floated to remove any sharp edges on the enamel and can prevent damage to the tongue and cheeks (Exclusively Equine Veterinary Services, 2019). Dental prophylaxis is normally done with little restraint and the use of sedatives. If the Veterinarian is using motorized dental instruments they should be using a low speed grinder with short contact times and light pressure. The veterinarian should not remove more than three to five millimeters over a six-month span. Wolf teeth are located front, upper cheek tooth row and normally extracted in performance horses. Some small forceps can be used to pull a crown from its socket. In major dental cases such as repulsions and fracture repairs require general anesthesia and radiograph evaluation. During major dental procedures the Veterinarian should protect the airway from debris and some decayed teeth can be extracted using any of the following, molar separators, extraction forceps and elevators (Easley, 2019). The dental procedures for dogs is a lot different from the dental procedures done for horses. One of dental procedure dogs and horses have in common is Intraoral radiographs. Also, both dogs and horses should have their teeth done at least once a year. But the technique used in horses is called floating. The tool to file the horses teeth is called a power float and the tools used in dogs include, hand scalers, curettes, and calculus forceps. Dogs teeth are different from horse teeth because dog’s teeth do not need to be filed like horses.

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Emergency Care

CPR is called Cardiopulmonary resuscitation is where a person performs chest compressions on a dog and mouth to mouth on a dog/animal that you cannot hear or feel a heartbeat. If a dog stops breathing, the heart will go into a cardiac arrest (PetMD, 2018. CPR should not be performed on a healthy dog because it can cause severe damage. CPR is performed to stabilize the patients pulse rate and normal heart rate. To perform CPR (cardiopulmonary resuscitation) on a Labrador retriever, the technician will lay the dog on a flat surface with the patient’s right side against the surface. The technician will be on the back side of the dog. Once the dog is in the correct position the technician will take one hand on the dog’s rib cage, near the heart and then place the other hand on top of the hand on the rib cage (PetMD, 2018). With the technician’s arm locked straight they will press down one third to one half the width of the chest. After the technician completes that count they will release for one. The rate should be one hundred to one hundred and twenty per minute. Also, the technician should close the muzzle with their hand before beginning mouth to mouth. The technician should give two breaths into the nose ever ten to fifteen compressions. The best and sufficient way is to have two technicians one to give the breaths and one to do compressions at the same time (PetMD, 2018). Another technician should take over compressions every two minutes to reduce fatigue. CPR and rescue breaths should be continued until the dog begins to breathe and have a steady pulse. After ten minutes of the dog not showing any signs of improvement, the technician can stop CPR (PetMD, 2018). Every Clinic should have an emergency care station and resuscitation area. An oxygen source and crash cart should be close to or near the emergency care station. The size of the crash cart depends on the size of the clinic and the severity of the patients that are normally treated at that clinic (McCurnins Clinical textbook for Veterinary Technicians, 2014). Normally on a crash cart is where the emergency drugs, attached or with the crash cart should be a defibrillator. A defibrillator is an electric device that applies electric shock to restore the rhythm of the heart. The crash cart should also include needles, syringes, a laryngoscope (instrument used to examine the larynx or inserting a tube through it). Other necessary items that should be found on a crash cart are endotracheal tubes of various sizes and an Ambu bag (McCurnins Clinical textbook for Veterinary Technicians, 2014). For larger carts, they should contain instrument packs that are used in emergency procedures such as a tracheostomy or open chest cardiopulmonary cerebrovascular resuscitation. A few items that could be found on the crash cart and used during CPR include, a defibrillator, oxygen source and Ambu bag (McCurnins Clinical textbook for Veterinary Technicians, 2014). All these items found on the crash cart should be inspected to make sure they work properly, and expiration dates are a minimum of once a week or immediately after being the supplies have been used. The emergency crash cart should remain stocked too (McCurnins Clinical Textbook for Veterinary Technicians, 2014).

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