The nursing of a hospitalized patient

1. Care of a Hospitalised Patient

2. Patient Criteria Covered
 Tomtom was an example of an intensive care
hospitalized case. He also underwent non-elective
surgery when a catheter was placed and he was a
non-infectious medical case both for the blocked
bladder and later for his liver failure.
 He was a male domestic short haired cat 2 years and
9 months old.
 His body score condition was 3-4/5 on the hills scale.
He was slightly overweight.

3. Medical history
 Tomtom was a young male cat who had been straining to
urinate and being quiet vocal at home causing his owners
to become worried. He was taken to the after hours
emergency care where he was diagnosed with a blocked
bladder. He was brought to us the following morning for
further treatment and monitoring. A blood
test and urine sample
taken and the results
analysed in order to
determine the appropriate
care.

4. Treatment Plan
 Our plan of treatment was to provide fluid therapy in order
to flush out the bladder, Monitor urination and patient
comfort, provide nutritional support and medication.
It was important to monitor urination both while his catheter was in place and
once it was removed to ensure he didn’t re-block. This did occur so the vets
attention was called to this and he was unblocked.
We insured his comfort by providing comfortable bedding that was warm and
drew moisture away as well as monitoring for pain and ease in urinating all of
which was to help Tomtom recover.
Tomtom’s diet was important in supporting the diuresis provided by fluid therapy
in flushing the bladder and dissolving the struvite crystals seen in a urinalysis
this is why he was placed on Hills s/d dry and c/d wet as a urinary diet.
 Emotional support was provided by the owner when they
came to visit.

5. Complications
 Tomtom was discharged after 8 days in hospital as we were confident
he would not block again.
 Two days later his owner came to us worried about his incontinence
and he was licking himself and growling and he had vomited.
 We admitted him for monitoring. His bladder was painful to palpate
but he was not blocked. He was prescribed some medication and closely
monitored through the day.
 The following day Tomtom was lethargic and inappetant with a low
blood pressure. Atropine was administered and this improved but his
demeanour did not. Attempts at hand feeding were made and they day
was spent encouraging him to walk and providing emotional support.
Most medication was stopped as there was some concern that the
multiple medications had caused him harm.
 The following day Tomtom’s mucous membranes had an icteric tinge
and he was diagnosed with liver failure.

6. Care Plan – Problem List
 Prevention – diet and medication
 Hygiene– clean cage frequently, incontinence sheets, change of bedding
 Urine scalding – patient hygiene and protection
 Patient discomfort – monitor pain and provide pain relief
 Patient interference – buster collar, bandaging site, stop chew spray
 Catheter patency – check for inflammation at site, occlusion of catheter
 Limb swelling – check limbs, bandaging, and catheter patency
 Hydration Level – Over or under Hydrated
 Recumbent patient– encourage movement, physiotherapy regime,
massage
 Temperature regulation – heaters set to right temp, heat pads, blankets
 Circulation – frequent repositioning, encourage to walk and remain
motile
 Toileting –ensure waste dealt with
 Depression – environmental enrichment, Owner visits

7. Special Considerations
 Because Tomtom was going to be spending a lot of time
hospitalised it was important we continue to support him
beyond just medicating him for his illness. Tomtom required
emotional support as he was normally an active guy and had
suddenly been confined to a cage. This was provided by owner
visits and the nurses taking time to give hi cuddles.
 He was given physical support in order to keep his joints
flexible and muscles toned we was given time throughout the
day to wander around and stretch his legs. When recumbent
in his last days we made sure that he was made to stand and
walk back to his cage hourly in order to help circulation,
muscle tone and joint flexibility.
 Tomtom was also provided with nutritional support for his
condition using the Hills prescription diet urinary range. This
was to supplement the medication and provide a foundation
for how the owner was to care for him long term after he cam
off the medication.

8. Nursing Considerations
 Tomtom was often incontinent so he required mutliple bedding
changes and cage cleans through out the day.
 The most important things we were monitoring was his urination,
Pain and demeanour all of which would indicate how he was
recovering.
 When he began to spend more time in his litter tray, became epresse
and grumpy and seemed hunched in a corner we realised he was
uncomfortable and liekly had blocked again. This turned out to be a
correct observation when we asked the vet to look at him and a plan
of action to unblock him was made.
 When Tomtom beccame lethargic and inappetant we chose other
signs to monitor. These were his vital signs for example: respiration,
heart rate, blood pressure, mucous membrane colour and CRT as
well as monitoring his food intake and demeanour.
 It became important at this point to make sure more hands on
physiotherapy tok place as Tomtom was not very active and
pressure points were of concern.

9. Case Outcome
 Unfortunately once Tomtom started exhibiting signs
of liver failure it was decided that the kindest thing
to do was to euthanize.
 Tomtom was put to
sleep on the
4th of September
after battling for
nearly three weeks.