Vet Tech Essentials: Module 5

LLC
bluedoor, Veterinary Nursing
© Module 5
M o d u l e 5 | V e t e r i n a r y N u r s i n g 97

LLC
This module will address a variety of patient care topics. Topics include basic hospital procedures,
diagnostic and therapeutic procedures, and preventative medicine. Practice is essential to doing these
skills well, and this does not include only the time you are in class.
The study material for this module consists of:
• Principles and Practice of Veterinary Technology, 3rd Edition, Sirois, Elsevier, 2010.
• Kirk & Bistner’s Handbook of Veterinary Procedures and Emergency Treatment, 9th Edition, Ford &
Mazzaferro, Saunders, 2012.
• Case Studies in Veterinary Technology, A Scenario-Based Critical Thinking Approach, 1st Edition, Rockett &
Christensen, Rockett House Publishing, 2010.
• McCurnin’s Clinical Textbook for Veterinary Technicians, 7th Edition, Bassert and McCurnin, Elsevier, 2010.
This module bluedoor, is divided into seven lessons with assignments to help present the material in smaller, more
easily understood, doses.
This study guide also provides:
• Additional information and illustrations to accompany your reading assignments.
• Self-checks and practice exercises to measure your understanding of each lesson.
© 98 V e t e r i n a r y N u r s i n g | M o d u l e 5

Lesson 1
B a s i c N u LLC
r s ing P r inc ipl e s
ESENTIAL SKILS
• Trim toenails
• Clean ears in a dog or cat
• Ear sample collection/Preparation in a
dog or cat
• Express anal sacs – Canine
• Bathe a patient – Small animal
• Dip a patient – Small animal
• Groom a small animal patient
• bluedoor, Administer enteral medications
• Hand pilling (dog, cat)
READING ASIGNMENTS
• Principles and Practice of Veterinary Technology,
© 3rd Edition, Sirois, Chapter 20, pages 613–618.
• Clinical Textbook for Veterinary Technicians,
7th Edition, pages 674–679.
Read the assigned pages in your textbooks and
then read the section below. Complete the student
activities once the reading is completed.
Basic Nursing
Part of your role as a veterinary technician is to
care for and monitor the condition of animals in
the veterinary hospital as well as provide routine
care to patients presented for examination. This
includes bathing, grooming, trimming nails, and
cleaning the external ear canal.
Bathing and Grooming
Animals require bathing when their coat is
heavily soiled or prior to administration of topical
parasiticides or therapeutic dips. Prepare the
animal by ensuring that any matted hair has been
combed or cut out of the hair coat. Place a small
amount of sterile lubricating ophthalmic ointment
into the animal’s eyes and a small piece of cotton
in each ear to protect the external ear canals from
excessive water. Water should be slightly warmer
than room temperature.
Monitor the water temperature while the bath fills
to prevent scalding. Thoroughly wet the animal
with plain water and then apply a small amount of
the shampoo. Begin lathering the animal toward
its nose and work toward the tail. Always check the
shampoo label for recommended wait times. Some
therapeutic shampoos must be left in place for five
to 10 minutes before rinsing. Thoroughly rinse the
animal with clean water and pay close attention
to rinsing the axillary and inguinal regions. Verify
that no soap residue remains. Towel dry the animal
and place in a cage until hair is dry. Always monitor
the patient for signs of overheating if a cage blow
dryer is used. Monitor young puppies and kittens
to ensure they are not becoming hypothermic.
Once the animal’s hair coat has dried, brush and/
or comb the hair to ensure no mats are present.
Always clean brushes, combs, and any other
grooming equipment used after each use.
Trimming Nails
Nail trimming is an important general care
technique for dogs and cats. Nails that are too long
L e s s o n 1 | B a s i c N u r s i n g P r i n c i p l e s 99

may alter the patient’s ability to walk and lead to
lameness. Long nails may also snag on objects and
be torn away. Ingrown toenails can also result from
excessively long nails and can become abscessed.
The animal must be properly restrained for the nail
trimming procedure. A variety of nail trimmers is
available. (Figure 1.1) Hold the cutting surface of
the trimmer parallel to the surface of the footpads.
For trimming cat nails, grasp the paw between
your thumb and index finger and slide the cat’s
skin back to expose the nail. Should the blood
vessel in the nail start to bleed, apply firm steady
pressure to stop the bleeding. Silver nitrate sticks
and styptic powder can also be used to stop the
bleeding.
LLC
bluedoor, Figure 1.1: A variety of nail trimmers for use with
dogs and cats.
© Expressing Anal Sacs
The anal sacs are paired glands, located on either
side of the anus, that can become impacted. There
are two methods used to express the fluid from the
sacs. The external expression procedure is usually
used with cats while either the internal or external
method can be used with dogs.
Cleaning the External Ear Canal
Removal of cerumen (wax) from the external ear
canal of dogs and cats is a commonly performed
nursing procedure. The collection of samples
for analysis is performed prior to the cleaning
procedure. A cotton-tipped applicator is gently
inserted into the ear canal and rolled around to
collect some of the debris within the ear canal.
100 V e t e r i n a r y N u r s i n g | M o d u l e 5
The applicator is then rolled onto a clean glass
microscope slide.
If the ear has excessive wax, a wax-softening
agent may first be instilled in the ear. The external
ear canal is then lavaged with warm water using
a soft rubber bulb syringe. Dilute antiseptic
solution may be added to the water. The solution
is flushed into the ear and then the ear canal area
gently massaged. Cotton balls are then used to
remove the debris and wax from the ear canal.
Topical medications can then be instilled into the
ear canal. Take care to never touch the tip of the
medication bottle to the surface of the ear to avoid
contamination of the medication. Massage the
medication into the ear canal. (Figure 1.2)
Figure 1.2: Massaging the ear canal after instilling
medication.
Oral Medications
Oral administration is a convenient method
for animal owners and veterinary personnel to
administer medications. Oral medications may be
liquid, tablets, or capsules. One disadvantage of
the oral route is the potential for inhaling liquid
medications into the lungs as well as the possibility
that the animal will spit out the medication. Oral
administration is contraindicated in animals that
are vomiting or do not have a protective gag reflex
in place.

To administer liquid medications orally, measure
the dose using a syringe. Gently pull out the
animal’s lower lip at the corner of the mouth.
Slightly tilt the animal’s head up and pour small
amounts of liquid into this pocket. Hold the
animal’s mouth closed to ensure the medication is
swallowed.
Hand Pilling for Dogs and Cats
Hand pilling is not a complicated procedure, but
some animals do not tolerate it well. Assistive
devices like a pet piller and pill pockets may
simplify the procedure. (Figure 1.3) Capsules and
tables can also be wrapped in a small amount
of cream cheese, peanut butter, or other treat
that the animal likes. To hand pill a dog or cat,
hold the tablet between the thumb and fingers
of your dominant hand. Use your other hand to
open the animal’s mouth by grasping the upper
jaw with the thumb on one side and fingers on
the other and press the lips over the upper teeth.
Using the thumb on your dominant hand, press
downward on the lower jaw in the space behind
the incisors to open the animal’s mouth. Place the
tablet or capsule in the center on the base of the
tongue and close the animal’s mouth. Gently tap
the animal on its nose or stroke under its chin to
trigger the swallowing reflex.
© bluedoor, LLC
Figure 1.3: Pet piller and pet pockets for
administration of oral medications.
Additional Resources
Visit http://www.bluedoorpublishing.com/
vt-resources/ to view sources that can be used
to aid you in your study and review additional
information related to basic nursing principles.
L e s s o n 1 | B a s i c N u r s i n g P r i n c i p l e s 101

Lesson 2
Nursing P r inc ipl e s f o r the LLC
I l l Pat i ent
ESENTIAL SKILS
• Obtain a thorough patient history
• Demonstrate the ability to obtain objective
patient data: TPR, thoracic auscultation
• Perform a physical examination on a small
animal
• Administer subcutaneous injection to a
dog or cat
• Administer vaccinations
READING bluedoor, ASIGNMENTS
• Clinical Textbook for Veterinary Technicians, 7th
© Edition, pages 184–202.
3rd Edition, Sirois, Chapter 12, pages 291–304;
Chapter 22, pages 559–577; Chapter 24, pages
607–616, 620–622.
• Kirk & Bistner’s Handbook of Veterinary
Procedures and Emergency Treatment, 9th
Edition, Ford & Mazzaferro, Section 3.
OVERVIEW
For many patients, the first indication that they
are ill is found during the physical exam process.
A disease is any alteration from the normal for
that animal. This can range from superficial skin
problems to widespread metastatic cancers. Fevers
and inflammation are protective responses by
the body in response to an infection resulting
from pathogens such as viruses, bacteria, and
parasites. As you continue to practice your physical
examination skills, focus on common clinical
signs and their significance to the patient. Some
common clinic signs are listed in Table 2.1.
Table 2.1: Common clinical signs of disease.
Alopecia
Arthropathy
Ascites
Ataxia
Cachexia
Cough
Cyanosis
Diarrhea
Dyspnea
Dysuria
Edema
Emaciation
Fatigue
Hematemesis
Hematuria
Icterus
Jaundice
Lethargy
Lymphadenomegaly
Oliguria
Pollakiuria
Polydipsia
Polyuria
Regurgitation
Seizures
Vomiting
Patient Identification
Before the physical exam and nursing procedures
can begin, you must first confirm the identity of
your patient. Patients must be properly identified
while in the hospital. Collars and tags with
identifying information that clients place on their
pets are usually removed at time of admission. For

most dogs and cats, a temporary collar is placed
on the patient at the time of admission to the
hospital. Dogs and cats may also have permanent
identification in the form of a tattoo or microchip.
Clients are usually counseled to have permanent
identification for their pet at the time of their first
visit to the clinic. Microchip identification numbers
are recorded in national registries and can aid
in returning a lost pet to the client. Microchip
or tattoo numbers are recorded in the patient
medical record as part of the signalment.
Patient History and
Physical Examination
Outpatients as well as hospitalized patients will
be examined at least daily and a record kept of
their weight, consumption of food and water,
and overall mentation. Annual examinations are
generally recommended for all patients of the
clinic. Veterinary technicians complete and record
the results of the examination and the findings
are then confirmed by the veterinarian. Patients
that are critically ill will undergo more frequent
evaluations and SOAP format records completed.
Additional evaluations will vary depending on the
patient status and may include gastrointestinal
system monitoring and neurological system
evaluations. A consistent systematic approach
is necessary to ensure that all evaluations are
completed and recorded.
LLC
bluedoor, REPORT OF PHYSICAL EXAMINATION
Best Friends Pet Center
Paradise FL Client Name ____________________________________
Date ___________________ Animal ID _______________
Gender __________________ Description ______________
(1) General
(2) Integument
(3) M/S
(4) Circulatory
(5) Respiratory
(6) Digestive
 N
 N
 N
 N
 N
 N
 Abn
 Abn
 Abn
 Abn
 Abn
 Abn
 NE
 NE
 NE
 NE
 NE
 NE
(7) GU
(8) Eyes
(9) Ears
(10) NS
(11) Lymphatic
(12) Mucosa
 N
 N
 N
 N
 N
 N
 Abn
 Abn
 Abn
 Abn
 Abn
 Abn
 NE
 NE
 NE
 NE
 NE
 NE
Temp Pulse Resp Weight
Temperament Assessment; Demeanor: shy, assertive, etc.
Describe Examination Findings Below:
© #1; Conformation and symmetry
#2: Note evidence of parasites, alopecia, rashes, lesions, wounds, skin flakiness, etc. Describe location if
present. Check hydration status
#3: Note any swelling in joints. Manipulate limbs to evaluate range of motion/pain response; Note any
limping, guarding, crepitus, tenderness; evaluate overall symmetry
#4: Ausculate cardiac sounds; note heart rate, rhythm, pulse deficit, CRT
#5: Ausculate lung sounds. Note respiratory rate/character; presence of nasal discharge, rales, ronchi,
dyspnea, etc.
#6: Note evidence of diarrhea, vomitus; palpate abdomen. Evaluate nutritional status. Note evidence of
tenderness, guarding. Evaluate oral cavity for mucous membrane color, condition of teeth, gums
#7:Palpate kidneys, bladder; Check mammary glands for nodules, cysts, pain; Check vulva for discharge
or swelling: Check prepuce, penis, testes
#8:Evaluate / record evidence of abrasions, ulcers, ocular discharge
#9: Evaluate for presence of parasites, odor, discharge, tenderness; Check pinnae for alopecia, scaling,
self-trauma
#10: Evaluate for presence of head tilt, tremors, pupillary light response
#11: Palpate peripheral lymph nodes
#12: Check color of mucous membranes.
Figure 2.1: Systematic method for performing physical examination.
L e s s o n 2 | N u r s i n g P r i n c i p l e s f o r t h e I l l P a t i e n t 103

The first step in performing the physical
examination is recording the patient signalment.
Signalment refers to the species, breed, gender,
age, and reproductive status of the patient. The
physical appearance (coloration, markings, etc.)
should also be recorded and the patient scanned
for presence of a microchip. The body systems
review involves evaluation of each of the organ
systems. Consistency in performance is important
to minimize the potential to miss any evaluations.
Figure 2.1 illustrates a method for performing
the physical examination with notes on specific
evaluations that should be made for each organ
system. Figure 2.2 is an example of a completed
physical examination record.
Figure 2.2: Sample section of a completed
physical examination record.
Parenteral Medications
Parenteral refers to administration of medication
via routes other than the gastrointestinal tract.
Routine sites for parenteral injections in dogs
and cats are subcutaneous, intramuscular, and
intravenous routes. The characteristics of the
medication may dictate the route that must be
used. Medications are absorbed at different rates
depending on the route so a particular route might
be chosen if the veterinarian desires a route with
faster absorption such as in a critically ill patient.
The animal’s condition and temperament may also
play a role in choosing a specific route of injection.
Preparing Medications
Many medications are supplied in multi-dose
vials. The proper amount for an individual patient
must be removed without contaminating the
medication vial. Always swab the top of the
medication vial with an alcohol swab. Turn the vial
upside down and insert the needle just outside
the “bullseye” area of the stopper. This eliminates
the likelihood of developing a hole in the stopper
from repeated puncture of the stopper in the
center of the bullseye. Draw out the correct dosage
as measured by the calibration on the syringe.
Expel any air bubbles from the syringe prior to
administering the medication.
Reconstituting Vaccines
Many vaccines are supplied as a two-vial dose
that must be mixed together to administer to
the patient. One vial is liquid and the other a
lyophilized (powder) form of the vaccine. Insert
the needle into the vial that contains the liquid.
Withdraw all the liquid by pulling back on the
syringe plunger. Inject the liquid in the syringe into
the vial that contains the powdered portion of the
vaccine. Remove the syringe and needle from the
vial and shake the vial for a few seconds to mix
contents well. Insert the needle back into the vial
and withdraw the entire mixed contents. Remove
the needle and syringe from the vial. If there is air
in the syringe, push on the plunger slowly to eject
the air through the needle.
© bluedoor, LLC

Subcutaneous (SC) Injections
Nonirritating medications can be injected
subcutaneously, or just under the skin. Vaccines
are routinely administered by this route. A
22- or 25-gauge needle is adequate for most
subcutaneous injections in dogs and cats. The
dorsal area from the shoulder to the rump is a
common subcutaneous injection site in dogs and
cats. The site is prepared by parting the hair and
cleaning the skin with alcohol. A fold of skin is
picked up and the needle placed beneath the skin.
The syringe is aspirated to make sure the needle is
subcutaneous and the medication then injected
into the fold of skin. The needle is removed and the
injection site gently massaged to help distribute
the medication.
Administration of Subcutaneous
Fluids
Animals that are mildly dehydrated are sometimes
administered fluids subcutaneously. While this
method results in a longer period of time for
rehydration, it tends to be less stressful for most
patients. Only isotonic fluids can be administered
by this route and must be warmed to body
temperature before use. Large volumes cannot
be administered by this route, thus no more than
10/mL/kg/site should be given. Multiple sites may
be needed and no more than 60ml/kg should be
administered in total via this route.
information related to nursing principles for the ill
patient.© bluedoor, LLC
L e s s o n 2 | N u r s i n g P r i n c i p l e s f o r t h e I l l P a t i e n t 105

Lesson 3
NURSING P R I N C I P L E S F O R THE
MEDICAL PAT I E N T: LLC
D I AGNOSTICS
ESSENTIAL SKILLS
• Properly collect diagnostic specimens for
analysis
• Feline cephalic venipuncture restraint
• Feline jugular venipuncture restraint
• Venipuncture cephalic
• Venipuncture jugular
• Venipuncture saphenous
• Collect and evaluate skin scrapings
• Perform bluedoor, ocular diagnostic test (including
tonometry, fluorescein staining, and Schirmer
tear test)
• Administer ophthalmic medications
• Collecting urine sample – Free Catch – Small
Animal
READING ASSIGNMENTS
© • Clinical Textbook for Veterinary Technicians,
7th Edition, pages 170–173, 450, 531–537,
586–606, 613, 698–699.
3rd Edition, Sirois, pages 125–127, 189–203.
OVERVIEW
Collection of blood samples is a routine procedure
for which the veterinary technician is responsible.
Proper patient restraint is vital to correct
performance of the procedure. Always perform the
venipuncture with the least tissue injury possible
to minimize contamination of the sample with
tissue fluid and to minimize hemolysis.
Skin scraping is a common diagnostic procedure
done for microbiology, cytology, and parasitology
evaluations. While the procedure may differ
slightly depending on the purpose of the
evaluation, the procedure is not generally painful
to the patient and can be accomplished quickly
with minimal equipment.
Opthalmology evaluations commonly performed
by veterinary technicians include the Schirmer tear
test and the fluorescein dye test. Tonometry, used
for evaluation of intraocular pressure, requires
specialized equipment.
Venipuncture
Venipuncture can be performed either with a
needle and syringe or with the vacuum system.
The size of the patient and the volume of blood
required will dictate the size of the needle and
syringe or vacuum tube. In general, a 1- to 3-mL
syringe or vacuum tube and a 20- to 25-gauge
needle is used. Larger gauge needles may be used
in larger dogs. The hair over the blood vessel to be
used is usually shaved and the area cleaned with
alcohol or surgical scrub. (Figure 3.1) Always insert
the needle into the vein with the bevel facing up in

one smooth motion. When a sufficient volume of
blood has been collected, remove the needle from
the vein and apply gentle digital pressure to the
venipuncture site until hemostasis occurs.
LLC
Figure bluedoor, 3.1: Procedure for collection of blood from
the cephalic vein.
© The blood must be placed in an appropriate blood
collection tube immediately after collection.
If a tube containing anticoagulant is used, the
blood and anticoagulant must be thoroughly
mixed by gentle inversion. Under-filling any tube
that contains an additive may alter the sample
sufficiently that the test results are adversely
affected and may not accurately represent the
patient’s status. The color of the stopper in the
top of the tube indicates the type of additive,
if any, and the specific type of tests that can be
performed with that sample. (Figure 3.2)
The quality and accuracy of test results are
influenced by the manner in which samples are
collected, stored, and shipped. The preferred
venous blood samples are collected from a large
vein and free-flowing blood. Most commercial
laboratories recommend collecting a minimum
volume of 2.0 mL whole blood for routine
biochemical analyses; 2.0 mL of whole blood will
yield close to 1.0 mL of serum. Dehydrated patients
are expected to have a higher hematocrit (Hct),
and therefore a larger volume of whole blood may
be required in order to obtain a 1.0-mL sample of
serum. Collection of samples from animals that are
overly excited or stressed is not advisable and such
samples generally show artifactual changes in
several laboratory parameters (e.g., glucose).
Figure 3.2: Blood collection tubes are color-coded
depending on the presence or absence of any
additives or anti-coagulants.
Fasting the patient for eight to 12 hours (an
overnight fast with free access to water) is often
helpful to reduce the likelihood of lipemia. Lipemia
interferes with several tests by falsely increasing
or decreasing the results. When applicable,
comments about the presence and influence
of lipemia and/or hemolysis should appear on
the laboratory reports. Hemolysis during blood
drawing can be minimized by adhering to the
following recommendations. Procure a nonlipemic
(fasted) sample, because lipemia can increase
red cell fragility and cause hemolysis. During
phlebotomy, negative pressure created by the
vacuum tube or syringe may collapse the lumen
of the vein against the needle, thereby crushing
numerous red cells. The flutter of the lumen
against the needle can be stopped by reducing the
negative pressure exerted during collection and
by repositioning the needle with a slight rotation
or deeper insertion. Hemolysis often occurs during
the transfer of blood from a syringe into vacuum
or other tubes. If a small-gauge needle is used,
transfer of blood to specimen tubes is slowed,
especially if small clots are present. Forcing the
blood through a small-bore needle contributes
to hemolysis. This problem can be avoided by
L e s s o n 3 | N u r s i n g P r i n c i p l e s f o r t h e M e d i c a l P a t i e n t : D i a g n o s t i c s 107

removing the needle and top of the specimen tube
and transferring the blood directly into the open
tube. Accuracy of the final test results can only be
ensured when the correct sample is collected from
the correct patient into the correct tube and run
correctly.
Skin Scraping
The skin scraping procedure is used to recover
mites, as well as for evaluation of skin lesions
and for identification of mycotic infections. The
procedure requires a scalpel blade (usually a
#10 blade), a drop of mineral oil, and a clean
microscope slide. A stainless steel spatula may also
be used in lieu of the scalpel blade.
LLC
bluedoor, Figure 3.3: Procedure for performing a skin
scraping.
© The blade can be touched to a small drop of
mineral oil before use or a drop of mineral oil
placed on the site to be scraped. The scraping
is performed by grasping the patient’s skin
between the thumb and forefinger. Hold the
blade perpendicular to the skin to avoid incising
the skin. (Figure 3.3) Depending on the reason
for performing the procedure, scraping may be
needed at multiple sites. When attempting to
recover mites that live in hair follicles, the scraping
should be deep enough to elicit a small amount of
capillary blood. The material on the scalpel blade
is then spread onto the microscope slide. A drop of
mineral oil should be placed on the slide and the
sample from the blade smeared onto the slide.
Schirmer Tear Test
The Schirmer tear test procedure is used for
evaluating tear production. Always perform
this test prior to application of any ophthalmic
medications. The tear test strips come in individual
sterile packages. (Figure 3.4) The strip is an
absorbent paper with a small notch near one end
and millimeter markings along the entire strip.
The strip is folded at the notch and the folded end
below the notch is placed into the conjunctival sac
of the lower eyelid. The eye is gently held closed
for 60 seconds while taking care to not touch the
paper. (Figure 3.5)
Figure 3.4: Schirmer tear test.
After 60 seconds, the strip is removed and the
distance that the tears travelled from the notch is
determined. The test is then repeated on the other
eye. Some strips incorporate dyes to facilitate
visualization of the measurement.
Figure 3.5: Gently hold the eye closed for
60 seconds to allow tears to diffuse up the tear
test strip .

Fluorescein Staining
The fluorescein staining procedure allows for
visualization of ulcers on the cornea. The test
requires fluorescein dye-impregnated test strips.
(Figure 3.6) The tip of the strip is moistened
with sterile saline and then the moistened tip
gently touched to the cornea. The eye is then
immediately rinsed with sterile irrigation solution
to remove excess dye. Subsequent examination
will show dye uptake in the stroma of the eye
when an ulcer is present.
Figure 3.6: Fluorescein strips.
Tonometry
Tonometers are used to measure intraocular
pressure. There are several types of tonometers
that function slightly differently. The most
common type is the Tono-Pen®. (Figure 3.7) Before
use, a drop of topical anesthetic is applied to the
cornea and the patient is gently restrained. The
Tono-Pen tip is covered with a disposable cover
and the tip placed in contact with the cornea at a
90-degree angle using a gentle tapping motion.
The tap is repeated several times and the readings
averaged.
Figure 3.7: Tono-Pen for measuring intraocular
L e s s o n 3 | N u r s i n g P r i n c i p l e s f o r t h e M e d i c a l P a t i e n t : D i a g n o s t i c s 109
pressure.
Cleaning the Eye
Eyes should always be cleaned and medicated
with extreme care. Sterile, isotonic eye cleaning
solutions are used. Ensure that the solution is
near body temperature and the patient gently
restrained. Moisten cotton balls with the eyewash
solution and gently pull the eyelid up or down
against the eye’s bony orbit. Hold the eyelid in this
position and gently wipe it with the moistened
cotton ball. Never apply pressure to the eyeball
itself. Irrigate the eye by applying the eyewash
directly on the eyeball and into the conjunctival
sac. Never touch the tip of the eyewash dispensing
container to the eye or eyelids.
Applying Ophthalmic Medications
Hold the ophthalmic solution in your dominant
hand and rest that hand on the animal’s head. Pull
back (evert) the lower eyelid and place the drops in
the conjunctival sac without touching the dropper
tip to the eyeball. Apply ophthalmic ointment in a
similar manner, placing a 3-mm-wide strip on the
lower eyelid border without touching the tip of the
tube to the eyeball.
Free Catch Urine Sample Collection
In addition to collection of ear swab samples
for evaluation, the veterinary technician often
collects urine samples from hospitalized patients.
The simplest method is by free-catch during the
normal voiding process. Dogs may be walked on a
leash and samples collected into clean containers.
A cup attached to the end of a stick, a large soup
ladle, or a small aluminum pan can be used and
then the sample transferred into a sterile urine
collection cup. Free-flow samples are usually
collected from cats by placing non-absorbent
plastic beads or similar non-absorbent materials
into the litter pan. (Figure 3.8)
© bluedoor, LLC

LLC
Figure 3.8: Non-absorbent cat litter may be used
for collection of urine samples.
information related to diagnostic nursing
principles.
bluedoor, © 110 V e t e r i n a r y N u r s i n g | M o d u l e 5

Lesson 4
NURSING P R I N C I P L E S F O R THE
MEDICAL PAT I E LLC
N T: T H E R APEUTICS
ESSENTIAL SKILLS
• Develop an understanding of wound
management and abscess care
• Monitor therapeutic responses
• Administer intramuscular injection to a
dog or cat
• Administer intravenous injection to a
dog or cat
READING ASSIGNMENTS
• bluedoor, Clinical Textbook for Veterinary Technicians,
7th Edition, pages 611, 1,231–1,249.
3rd Edition, Sirois, Chapter 13, Chapter 24,
pages 622–623.
© OVERVIEW
Veterinary technicians are also involved in
wound care for patients both in the hospital and
presented for injuries occurring outside of the
hospital. A thorough knowledge of the physiology
of wound healing and wound care is vital for
providing high-quality patient care. In order to
provide adequate pain management as well
as appropriate therapeutics, animals requiring
wound care will often times also require various
injectable medications. In order to deliver these
medications in the most optimal way, it is essential
that veterinary technicians are both skilled and
comfortable with the various delivery routes of
these therapeutics.
Wound Management
Types of Wounds
The veterinary technician encounters a variety of
types of wounds. These include open wounds that
cut skin and closed wounds such as contusions.
The five types of open wounds are abrasions,
avulsions, incisions, lacerations, and punctures.
Abrasions commonly occur when an animal
is hit by a car and scrapes on the ground. An
abrasion is essentially a rubbing wound that
destroys the epidermis of the skin. An abrasion
has a red irritated appearance and often shows
evidence of capillary blood oozing. An avulsion
involves tissue that has been torn from its
underlying attachments. Dog bites often cause
avulsion injuries. An incision has a smooth edge
and minimal trauma to the surrounding and
underlying tissues. Sharp objects such as broken
glass cause incisions. A laceration has irregular
edges and damage to the surrounding and deeper
tissues. Lacerations are usually caused by dull
objects that tear tissue. A puncture is a penetrating
wound caused by a projectile or a sharp object.
Wound Healing
Wounds heal in an orderly fashion, following
a specific sequence of events. Wound healing
occurs in four phases: the inflammatory phase,
L e s s o n 4 | N u r s i n g P r i n c i p l e s f o r t h e M e d i c a l P a t i e n t : T h e r a p e u t i c s 111

the debridement phase, the repair phase, and the
maturation phase. The rate of progression through
each phase is affected by a variety of factors, such
as the age of the patient, nutritional status, and
metabolic status. The presence of bacteria, foreign
bodies, or significant anti-inflammatory drugs can
also influence the rate of healing.
Wound Care
Initial Presentation
Initial assessment of a patient presented for
wound care focuses on overall patient status.
Patients that have experienced traumatic injury
require stabilization prior to focusing on wound
care. Cover any exposed wounds with sterile
dressing until the animal is stable. Wounds that are
actively bleeding must have a pressure bandage
applied. Direct pressure should slow or stop any
bleeding. Further assessment will occur after any
life-threatening issues are addressed.
Lavage
Lavage is the flushing (irrigation) of a wound and
serves to dilute and rinse bacteria, foreign material,
and blood clots from the wound. Lavage fluid
must be sterile, isotonic, and warmed to body
temperature. Normal saline (0.9% sodium chloride)
is a commonly used lavage solution. (Figure 4.1) Tap
water can be used as an initial lavage solution for
wounds that are heavily contaminated. Antiseptic
solutions are sometimes added to lavage solutions
but some can damage tissue. Hydrogen peroxide
should be avoided for lavage as it does damage
the internal tissues.
Figure 4.1: Sodium chloride solution designed for
wound irrigation.
Lavage solution is applied with a bulb syringe, a
large injection syringe, or a tube connected to a
bag or fluid bottle that can be squeezed to flush
the wound. Care must be taken to make sure that
the pressure applied to the wound via lavage does
not exceed 7psi. This can be easily achieved by
using a squeeze bag (rapid infusion bag) with a 1L
bag of fluids inflated to 300mm/hg.
Debridement
Debridement is the excision of diseased or
damaged tissue and foreign matter from a wound.
It is typically done at the same time as lavage.
Debridement can turn a traumatic wound into a
clean wound with healthy tissue and a good blood
supply. The extent of debridement depends on the
injury. Dead muscle tissue in a wound can lead to
significant problems and should be removed. The
veterinarian will try to preserve damaged tendons
and ligaments and larger bony fragments from a
broken bone until fracture repairs are undertaken.
Debridement may be accomplished with an
enzymatic procedure or using a wet-dry bandage
method. Enzyme debridement uses chemical
agents to remove dead tissue from the skin. A wet
gauze sponge can then be blotted against the
tissue if any remaining debris in the wound needs
to be removed. Bandage debridement employs
a wet-dry bandage. A wet bandage is applied
to the wound. As the bandage dries, it clings to
dead tissue and debris. Debridement occurs when
the bandage is removed. Bandage debridement
can be painful and may require sedation for each
bandage change. Surgical instruments, such as
forceps, can also be used to remove foreign bodies
from a wound.
Should an abscess form at a wound site, the
veterinarian usually allows it to drain. This involves
removal of any accumulated pus in the tissue as
well as providing a mechanism for any additional
purulent discharge to drain away from the wound.
Once the drainage from an abscess is reduced to a
minimal level, the veterinarian may choose to close
the wound to facilitate healing.
© bluedoor, LLC

Closing a Wound
The veterinarian will determine the method of
wound closure based on a number of factors such
as the length of time since the injury occurred, the
degree of contamination of the wound, and the
size and location of the wound.
Once the small wound has been thoroughly
cleaned and debrided, the veterinarian usually
chooses to close it with sutures. This is referred to
as a primary closure, or first-intention healing. A
drain is sometimes placed in the wound to allow
continued removal of any tissue fluid so that it
does not accumulate under the skin. (Figure 4.2)
Wounds that are not able to be completely cleaned
and debrided right away may be left open for a few
days and then sutured. This is referred to as delayed
primary closure. Wounds that cannot be sutured
can be left to heal and require bandages to protect
them while they heal.
LLC
bluedoor, Figure 4.2: Drains can be placed to remove fluid
from wounds. A) Penrose drain. B) Jackson-Pratt
© L e s s o n 4 | N u r s i n g P r i n c i p l e s f o r t h e M e d i c a l P a t i e n t : T h e r a p e u t i c s 113
drain.
Bandages and Bandaging
Techniques
Bandages function to protect a wound from
environmental contamination, to absorb wound
secretions, and to immobilize the wound so that
it can heal. Some bandages may also serve to
exert pressure on a wound to prevent swelling
and bleeding. Regardless of the specific location
or function of the bandage, bandages have three
main layers:
1. Primary layer: material that is in contact with
the wound; sterile wound dressing
2. Secondary layer: absorbs secretions and
provides padding to protect the wound from
trauma
3. Tertiary layer: holds the bandage in place
Wound dressing may not be needed on all
bandages but are required for open wounds. That
primary layer may be an adherent wound dressing
or nonadherent. Some wound dressings can also
be occlusive, meaning that they do not absorb
fluid. Some are hydrocolloidal: a type of wound
dressing that combines with fluid from the wound
to form a gel.
The secondary bandage layer is often cotton
cast padding, which is absorbent and provides
padding. Roll gauze may be placed on top of
the cotton. If a splint is needed, it is generally
incorporated into this secondary layer. (Figure 4.3)
Figure 4.3: Splints can be incorporated into the
bandage.
The final layer is usually a stretch adhesive layer
such as VetRapTM or ELASTIKON. The adhesive
holds the bandage in place and the elasticity of the
material can provide some wound compression as
well. Depending on the type of bandage, stirrups
may be needed. These are anchoring strips usually
made of adhesive tape. (Figure 4.4)
Figure 4.4: A variety of bandage materials are
often needed.

There are numerous specialty bandages used in
veterinary medicine. Of these, the modified Robert
Jones bandage is probably the one used most
often. Others include the Velpeau sling, the Ehmer
sling, the hobble, and Mason-meta splint. Casts are
also applied when an injury needs a high degree of
immobilization.
Caring for Bandages,
Casts, and Slings
One of the most important rules of bandage
care is to keep the bandage clean and dry. A wet
bandage can harm the wound and the healthy
skin around it as well as become less effective at
doing its job. Owners are usually instructed to cover
limb bandages with a plastic bag while the pet is
outside and then remove it when they are inside.
The bandage should be checked regularly to be
sure it is remaining in place and to verify that there
is no tissue swelling adjacent to the bandage (which
might indicate that the bandage is too tight). A
bandage that has slipped, feels wet, or smells bad
needs immediate attention. If an animal is licking or
chewing on a bandage, it may be an indication of a
problem with the bandage. If no problem exists, an
Elizabethan collar should be placed on the animal
to prevent it from disturbing the bandage.
Removing a bandage occurs when the bandage
is no longer needed or when the wound needs to
be re-assessed. Lister bandage scissors that have a
blunt tip are used to remove bandage material. Cut
each layer of the bandage separately, starting with
the outer layer. Take care not to disturb the wound.
Check the underside of each bandage layer as it is
removed for any signs of discharge.
Intramuscular (IM) Injections
Medications that are slightly irritating may need
to be injected intramuscularly. The volumes
administered by IM injection are usually less than
3 mL per site. A common site for IM injections
in dogs and cats is the semimembranosus/
semitendinosus muscle mass (hamstring muscles)
in the hind leg. The lumbosacral musculature
is also sometimes used. For injection into the
hamstring muscles, the needle is inserted from
the lateral aspect of the muscle at a slight caudal
© bluedoor, LLC
angle in order to avoid the sciatic nerve. Prepare
the injection site as for SC injection. With the animal
restrained in a standing or sternal position, grasp
the muscle between the thumb and fingers. Insert
the needle perpendicularly to the muscle and
slightly retract the plunger to ensure that the needle
hasn’t entered a vein. Inject the medication and
withdraw the needle. Gently massage the area to
aid absorption and distribution of the medication.
Intravenous (IV) Injection
Medications administered intravenously are
absorbed into circulation more rapidly than SC or
IM. Intravenous injection sites in dogs are generally
the cephalic and lateral saphenous veins and the
cephalic and medial saphenous veins in cats. To
administer IV medications to dogs and cats, the
patient is restrained in sternal recumbency for a
cephalic vein injection and in lateral recumbency
for a saphenous vein injection. An assistant
applies pressure above the venipuncture site or a
tourniquet may be used. (Figure 4.5)
Figure 4.5: An assistant can apply pressure to the
venipuncture site while restraining the animal for
cephalic blood collection.
The needle is inserted at a 45-degree angle
through the skin and into the vein. A small amount
of blood is aspirated to verify proper positioning
of the needle. The assistant then removes the
digital pressure or the tourniquet is released and
the medication injected slowly into the vein. The
needle is withdrawn and digital pressure applied
at the injection site to ensure hemostasis.
Visit http://www.bluedoorpublishing.com/vt-resources/
to view sources that can be used to aid
you in your study and review additional information
related to therapeutic nursing principles.

Lesson 5
Nursing P r inc ipl e s o f Spe c LLC
i a l P opulat i ons
ESENTIAL SKILS
• bluedoor, Demonstrate understanding of nursing care of
newborns
• Identify unique aspects of medical nursing for
geriatric and cancer patients
READING ASIGNMENTS
• Clinical Textbook for Veterinary Technicians,
© 7th Edition, Chapters 15, 36, 37.
3rd Edition, Sirois, Chapters 27, 28, 29; pages
640–645, pages 779–793.
Care of Neonatal
Puppies and Kittens
Newborn puppies and kittens rely on their mother
for warmth, food, elimination, and cleanliness.
They are incapable of thermal regulation for the
first six days of life and require an external heat
source to stay warm for the first one to three weeks
of life. Puppies and kittens should begin nursing
immediately after birth and then every one to two
hours. The mother licks their external genitalia
both to stimulate urination and defecation and to
clean them after every feeding. Normal puppies
and kittens are born without circulating antibodies
and rely on maternal antibodies received in
colostrum.
Hand-raising puppies and kittens may be required
if the mother is debilitated or the neonates are
orphaned. A suitable environment is needed, such
as a container with high enough sides so that
the animals cannot climb out and so drafts are
reduced. A hot water bottle covered with a blanket
or soft towel can be placed in the container to
provide warmth. Commercial milk replacers are
available for feeding of orphaned puppies and
kittens. (Figure 5.1)
Figure 5.1: Commercial milk replacers for feeding
orphaned or ill puppies and kittens.
The volume required is calculated based on the
weight of the animals. The formula is warmed to
body temperature and is fed in equal portions at
least four times a day. Puppies should gain 1 to
2 g/day/lb (2 to 4 g/day/kg) of anticipated adult
weight. Kittens should weigh 80 to 140 g at birth
(most weigh around 100 to 120 g) and gain 50 to
100 g weekly.
L e s s o n 5 | N u r s i n g P r i n c i p l e s o f S p e c i a l P o p u l a t i o n s 115

Feeding prepared formula to nursing-age puppies
and kittens can be accomplished with a dosing
syringe, feeding tube, or by nipple bottle designed
for puppies and kittens. (Figure 5.2) After each
feeding, swab the anogenital area with moistened
cotton or dry, soft tissue paper until reflex
elimination occurs.
LLC
Figure 5.2: bluedoor, Tube feeding method for critically ill
puppy.
© Geriatric Pet Care
Aging is a complex set of biological processes
that are affected by a number of factors. These
include the animal’s genetic background, overall
metabolic status, and environmental factors to
which the animal is exposed. Geriatric animals
have an increased susceptibility to disease. Care
of geriatric patients is focused on reducing the
normal progressive deterioration that occurs as the
animal ages.
The age at which an animal is considered geriatric
is variable. Smaller dogs are generally considered
geriatric at around 9 years of age while large
breeds would be considered geriatric at around 7
to 8 years of age. Most cat breeds are considered
geriatric at approximately 8 years of age. Geriatric
animals should be given a complete physical
examination on at least an annual basis. Diagnostic
testing is also performed regularly and includes
complete blood counts, urinalysis, a chemistry
profile, as well as checking for any blood parasites,
gastrointestinal parasites, or external parasites.
Vaccine boosters are given as needed. Additional
evaluations to detect common age-related
disorders of vision, hearing, and cognitive ability
may also be performed. Common conditions that
occur in aging pets are listed in Table 5.1.
Hospice care should be considered for pets that
are nearing the end of life. Administration of pain
medications may become necessary. Some aging
pets may also require regular fluid therapy or have
a feeding tube put in place. Special attention must
be paid to patients that are not ambulatory to
prevent the development of decubital ulcers and
urine scalding.
Table 5.1
Common Age-Related
Conditions of Dogs and Cats
Periodontal disease
Chronic valvular disorder
Chronic renal disease
Urinary incontinence
Bronchitis
Degenerative joint disease
Arthritis
Cognitive dysfunction
Hyperthyroidism
Diabetes mellitus
Hyperadrenocorticism
Nursing of Cancer Patients
Cancer is a primary cause of natural death in
geriatric patients and can develop in younger
patients as well. The decision to treat cancer in
pets requires careful consideration of the quality
of life of the pet. Pain medications are often
needed for cancer patients. Patients receiving
chemotherapy may develop nausea and vomiting.
Anti-emetics are sometimes administered in these

cases. Treatments can be surgical or radiation
or chemotherapy can be used. Combinations
of treatment methods are also possible. Safety
concerns related to administration of antineoplastic
agents must be discussed with the owner.
Technicians involved in caring for patients
receiving antineoplastic agents must adhere to
strict safety measures. Gloves are required when
handling these medications. Specially made
gloves for handling chemotherapeutic agents are
available. In the absence of chemotherapy-specific
gloves, double-gloving with powder-free gloves
is recommended. Thoroughly wash your hands
before donning gloves and immediately again
after they are removed. A disposable gown should
also be worn and the cuff of the gloves placed
over the cuff of the gown. It is ideal to prepare
medications for use in a Biologic Safety Cabinet
(BSC). (Figure 5.3) If a BSC is not available, wear a
respirator approved by the National Institute for
Occupational Safety and Health (NIOSH). Goggles
with a fitted nosepiece and side shields or a full
face shield and respirator will provide protection
when preparing chemotherapy agents.
Always administer chemotherapy in an area with
good ventilation. A designated sharps container
used only for chemotherapy and a chemotherapy
spill clean-up kit must be available. Patients
should be placed on non-absorbent pads. Verify
all dosages before administering any medications.
Chemotherapy agents can be administered IV, IM,
SC, intralesional, intracavitary, or orally. A butterfly
catheter or indwelling intravenous catheter can be
used for IV administration.
LLC
bluedoor, Figure 5.3: Preparing chemotherapeutic agents in
a biological safety cabinet.
information related to nursing principles of special
populations.
© L e s s o n 5 | N u r s i n g P r i n c i p l e s o f S p e c i a l P o p u l a t i o n s 117

Lesson 6
F luid Therapy and Advanced LLC
Monitoring
ESENTIAL SKILS
• Explain care of recumbent animal
• Determine/maintain fluid infusion rate
• Place intravenous catheters
• Monitor patient hydration status
• Develop familiarity with fluid delivery systems
• Describe physical therapy techniques
READING ASIGNMENTS
• Principles bluedoor, and Practice of Veterinary Technology,
© 3rd Edition, Sirois, Chapter 16, Chapter 19,
pages 506–509, 516, Chapter 24.
• Kirk & Bistner’s Handbook of Veterinary
Procedures and Emergency Treatment,
9th Edition, Ford & Mazzaferro, Section 1,
pages 32–44, pages 61–62, 65–69.
Fluid Therapy
Many hospitalized patients and most surgery
patients are likely candidates for fluid therapy.
Fluid therapy is one of the most commonly used
supportive measures in veterinary medicine and
is an important part of every hospitalized animal’s
care. Approximately 60% of the total body weight
is composed of water. This water is divided up
into three primary compartments: intracellular,
intravascular, and interstitial. The diffusion of water,
or osmosis, occurs when water moves across a cell
membrane from an area of higher concentration
to an area of lower concentration until the two
concentrations are equal. The concentration
difference creates what is called osmotic pressure.
The concentration of these osmotically active
particles in a solution is called osmolality and is
expressed as mOsm/kg. Normal plasma osmolality
in dogs and cats is approximately 300 mOsm/kg.
Patient Assessment
Assessment of animals with suspected fluid loss
should begin with a thorough medical history.
In most cases, the patient history will assist in
identifying the origin of the fluid loss. Dehydration
can occur with diarrhea, pu/pd, vomiting, draining
wounds, or lack of access to drinking water.
The client should be questioned regarding the
patient’s fluid intake volume, food intake, and
any unusual fluid outputs (diarrhea, vomiting,
excessive salivation, etc.). The initial assessment
should then proceed to evaluation of the vascular
system and acid-base balance. These evaluations
will provide an estimation of perfusion, which is
the ability of body fluids to reach the organs and
tissues to supply nutrients and oxygen. Physical
signs associated with hydration include mucous
membranes, skin turgor, body temperature,
decreased CRT, and changes in body weight.
Skin Turgor Test
Although this evaluation method is highly
subjective, it can provide an initial determination
of the extent of fluid loss in the patient. The test

should be performed with the animal in lateral
recumbency. The skin on the torso is lifted into
a fold and evaluated for the approximate time
required for the skin to return to its normal
position. If the skin stands in a fold, the patient is
probably severely dehydrated (~12%). If the skin
returns slowly to its normal position, the patient
is probably mildly dehydrated (~5%). Ideally, the
same individual should perform this test each time
using the same location on the patient’s body to
eliminate some of the subjectivity of the test.
Table 6.1 summarizes methods for evaluating
degree of dehydration.
LLC
Table 6.1: Evaluating percent dehydration.*
< bluedoor, 5% • Not detectable
< 5–6% • Slight loss of skin elasticity
• Definite loss of skin
elasticity
• Slight increase in CRT
< 6–8%
• Slight sinking of eyes into
orbit
• Slight dryness of oral
mucous membranes
• Tented skin stands in place
• Higher CRT
< 10–12%
• Eyes sunken in orbits
• Dry mucous membranes
• Possible signs of shock
• Signs of hypovolemic shock
< 12–15%
• Death
© * Based on percentage of body weight lost as fluid.
Capillary Refill Time (CRT)
This test provides an indication of peripheral
perfusion. To perform the test, apply pressure to
the mucosa of the gum or the inner lip and then
determine the time required for the blanched area
to return to pink. Normal CRT should be one to
two seconds. Prolonged refill time is suggestive of
impaired perfusion and shock.
Packed Cell Volume (PCV)
The PCV represents the ratio of the height of the
column of red blood cells relative to the total
volume in the capillary tube. Patients with a
PCV below 20% have reduced oxygen carrying
capacity.
Albumin and Total Protein
Albumin is the primary component responsible
for maintenance of intravascular oncotic pressure.
Total protein values below 3.5 g/dl and albumin
values below 1.5 g/dl results in inadequate
retention of intravascular water and subsequent
hypovolemia.
Types of Fluids
The choice of fluids used for replacement will
be determined by what type of dehydration is
occurring, where fluid replacement needs to be
directed and choices available.
Several types of basic fluid solutions are used.
The veterinarian will choose the fluid type based
on the patient’s physical status. Fluid solutions
are classified as either crystalloid or colloids and
can be further classified as hypotonic, isotonic,
or hypertonic. Lactated ringer’s solution is a
commonly used isotonic crystalloid. Another class
of fluid falls under the category of total parenteral
nutrition (TPN). TPN fluids contain electrolytes in
addition to nutritive materials such as vitamins,
minerals, and calorically dense materials. Patients
might be prescribed combinations of TPN and
standard fluid therapy.
Rehydration Volume
Essential to proper fluid delivery is the ability
to properly calculate fluid replacement rates,
including percent dehydration and on-going
losses. To determine the volumes needed, the
fluid deficit volume is added to the normal
maintenance volumes and any abnormal ongoing
fluid losses that may result from the patient’s
physical condition. Fluid deficit volumes can be
calculated using the PCV, urine specific gravity, and
CRT. The animal’s body weight (kg) is multiplied
by the deficit percentage to determine the initial
L e s s o n 6 | F l u i d T h e r a p y a n d A d v a n c e d M o n i t o r i n g 119

rehydration volume. Maintenance fluids of
40–60 mL/kg/day are added. Additional abnormal
fluid losses (i.e., vomiting, diarrhea) are estimated
and added to that initial volume.
Route and Rate of Administration
The route and rate of fluid administration depends
on the degree and severity of the fluid losses,
the volume that needs to be replaced, and
the type of fluid replacement selected by the
veterinarian in response to the patient’s physical
status and size. Fluids can be administered orally,
subcutaneously, intravenously, intraperitoneally,
and intraosseously. Patients are usually given
80% of the total rehydration volume in the first
24 hours of treatment and the remaining 20% in
the next 24 hours. Rapid or extensive fluid losses
are usually replaced quickly unless the patient has
cardiovascular compromise or pulmonary edema.
To determine the drops per minute, calculate
the total volume needed and divide this by the
number of minutes available to deliver the desired
volume. (Figure 6.1) If using a microdrip set, of 60
drops per mL, 0.48 mL is approximately 29 drops
per minute, or one drop every two seconds.
© bluedoor, LLC
Figure 6.1: Intravenous administration sets.
Fluid Therapy Calculations
Giving IV fluids is an extremely common procedure
in veterinary medicine. Simply stated, you can kill
a patient with too much IV fluid, and conversely,
patients can die of dehydration. The veterinarian
and technician are trained to assess a patient’s
hydration status, and determine what percentage
of body fluid has been lost. Using that percentage,
along with the weight of the animal and the
known metabolic need for fluids, we can calculate
a fluid rate, or the amount (in mL) of IV fluids to
be received each hour. IV infusions involve giving
a certain volume over a certain time. The IV fluid
rate is how many mL of fluid an animal receives
per hour (ex: 22 mL/hr IV). The maintenance rate
is how much fluid an animal’s body needs per day
to stay properly hydrated. Generally, cats and dogs
need 50 mL/kg/day.
Some of our patients are dehydrated, though, so a
maintenance rate will only maintain them in their
current state of dehydration. For these patients,
we must calculate a replacement volume to bring
them back to normal hydration. For example, if a
13-pound cat is 5% dehydrated:
• Find patient’s weight in kg 13/2.2 = 5.9 kg
• Find percent dehydration (0.05)
• Multiply 5.9 X 0.05 = 0.295L (295 mL). This is
the amount of fluid needed to replace this
cat’s fluid deficit.
You should give this over 4–6 hours, or just add
the 295 mL to the maintenance dose (5.9 X 50) and
give it over 24 hours.
If a patient is in shock, we give a “shock dose” of IV
fluids. Give it as quickly as possible, not worrying
about a rate—only the volume is important.
Dog shock volume = 90 mL/kg
Cat shock volume = 70 mL/kg
You should also make up for ongoing losses
of fluid (from vomiting, diarrhea, bleeding, or
ptyalism). Just estimate (or measure) the volume of
fluid lost and administer 1.5–2 times that amount
in IV fluids. You can add this into the daily amount
or give it as a bolus over an hour or two.

Fluid Administration
There are various ways to deliver IV fluids:
1. Microdrip set: microdrip chamber and tubing
with rate control device that is connected to
a fluid bag on one end and the patient’s IV
catheter on the other end. Each drop from the
chamber is 1/60 of a mL (60 drops/mL).
2. Macrodrip set: 10, 15, or 20 drops/mL.
3. Infusion pump: a fluid bag with extension set
(usually macrodrip) is used. The tubing of the
extension set is run through a pump that is set
LLC
to the desired rate/volume/time.
4. Syringe pump: like an infusion pump, but
instead of a fluid bag, a syringe with fluid is
connected to an extension set, which connects
to the patient’s IV catheter at its other end. The
pump slowly depresses the syringe’s plunger,
giving the fluid at a carefully controlled rate.
Your veterinarian will frequently ask you to add
solutions to an IV bag, or dilute a medication for a
patient. The amount of a medication to add to the
bag bluedoor, can be calculated using a proportion in the
following equation:
Vx C= Vx C1 1 2 2
• Vis the volume of the fluid bag being used
1 • Cis the desired concentration to give to the
1 patient
• Cis the concentration of the medication as
2 supplied
• Vwill be the variable to solve and provide the
2 © volume of the medication to add to the fluid
bag
For example, Dr. Longo tells you to give 350 mg
of Cefazolin (100 mg/mL) in a 500-mL bag of 0.9%
NaCl over 20 minutes. What rate should you set the
IV pump at to achieve this?
• Figure out volume of Cefazolin to give:
350 mg/100mg/mL = 3.5 mL
• Figure out what total volume of liquid is:
3.5 mL + 500 mL = 503.5 mL
• Figure out rate: 503.5 mL/20 minutes =
25 mL/minute or 25 X 60 minutes = 1,510 mL/
hour
Always be sure to properly label the fluid bag with
information on anything added to it.
Intravenous fluid therapy may also involve
constant (continuous) rate infusion (CRI). CRI
generally refers to administration of drugs rather
than IV fluids. Some drugs do not remain effective
in the body for very long. Their levels rise and fall
quickly, leaving the patient without an effective
level of drug during doses. To avoid this, a CRI
would be chosen rather than periodic bolus doses.
For example, a dog may be on 24 mL/hour of IV
fluids and a CRI of lidocaine. We usually express
CRIs as “# of mg over X minutes.” So, for the example
above, the dog may be receiving 10 mg every 30
minutes.
Intravenous Catheters
Catheters are available in a wide variety of lengths
and diameters. Types of catheters include winged
infusion needles (butterfly catheters), over-the-
needle catheters, and through-the-needle
catheters. Multi-lumen catheters are available as
either over-the-needle catheters or through-the-needle
type.
Winged infusion (butterfly) catheters are for
short-term use in patients that need numerous
IV infusions of medications, but not long-term
fluid therapy. These catheters are simple to insert
and cause the fewest local infections. However,
stabilization of the catheter can be difficult. The
catheter needle is attached to plastic “wings” that
are used to aid in placement and stabilization.
Over-the-needle peripheral catheters are the
most common type used in veterinary practice.
They can be placed relatively easily and quickly
and are generally atraumatic. They can be left
in place for up to 72 hours before changing to
another vessel. Longer maintenance times may
be possible with strict catheter care. Through-the-needle
catheters are longer than over-the-needle
catheters and are used primarily for central venous
access. Central venous catheters allow for the
administration of hypertonic solutions or irritating
drugs, direct monitoring of venous pressure, and
a port for blood sampling. Multi-lumen catheters
contain several lumens within a single catheter
and allow for simultaneous infusions of different

medications, even when the medications are
incompatible.
The length and diameter of the catheter affects
the rate of flow through a catheter. For rapid fluid
administration, the largest, shortest catheter
practical is the best. The maximal fluid flow rate
increases as the radius of the catheter lumen is
increased. Longer catheters are also more stable
in the vein and less likely to cause mechanical
irritation with resulting phlebitis. A short,
peripheral over-the-needle catheter may be
inserted distal to an area of flexion, such as in a
cephalic vein distal to the elbow. A central catheter
placed in a large vessel, such as the jugular vein,
is less likely to cause mechanical or chemical
irritation. For routine maintenance treatment, the
smallest gauge catheter that provides adequate
flow should be used. Consideration should also
be given to the size of the patient. Use of a large
catheter in a small diameter vein can disrupt
venous return.
Catheter Placement and Care Concerns
Intravenous catheter must be introduced and
maintained aseptically. The skin puncture site
is shaved of hair and prepared using standard
surgical scrub procedures. Careful attention to
detail is needed to avoid contamination of the
catheter and/or the venipuncture site. All catheters
must be secured with tape or sutures and covered
with a light bandage to protect the insertion site.
Winged infusion catheters require only taping.
Securing the catheter reduces movement of
the catheter in the vessel and can decrease the
likelihood of phlebitis.
Catheters not in constant use should be flushed
several times a day. When it is necessary to replace
a catheter, the new catheter should be in place
and patent before the old catheter is removed, in
case the animal has a cardiovascular crisis during
catheter placement.
The catheter bandage must be kept clean and
dry. The patient’s body temperature should be
measured at least once daily, the site proximal to
the catheter monitored for any signs of phlebitis
or subcutaneous fluid accumulation, and the
toes checked for swelling. The catheter should be
removed at the first sign of phlebitis, sepsis, or
catheter malfunction. Signs of phlebitis include
swelling at the catheter site, redness, pain,
thickening, or irritation of the vessel. Phlebitis can
be infectious or inflammatory in nature. Infectious
phlebitis may lead to septicemia and bacterial
endocarditis. Signs of septicemia and bacterial
endocarditis include cardiac arrhythmias, injected
mucous membranes, fever, and leukocytosis.
Thromboembolic disease can also result from IV
catheterization.
Should peripheral catheter placement be difficult,
a facilitative incision or full venous cutdown can
be performed. The facilitative incision reduces skin
tension and friction against the catheter and is
especially useful in patients with tough skin. A
0.5-mm incision is made through the dermis
directly over the blood vessel. A full venous
cutdown may be needed for very small patients
or when severe hypovolemia is present. The skin
should be infiltrated with local anesthetic and
a 1.0–2.0 cm incision made through the skin
alongside the blood vessel. The vessel is then
dissected away from the surrounding tissue and
the catheter inserted directly into the blood vessel.
Catheter placement can also be facilitated with
a guide wire. This method is used primarily for
insertion of a central venous line, in particular with
multi-lumen catheters.
Intraosseous (Intramedullary)
Catheterization
Adminstration of fluids and medications directly
into the bone marrow cavity provides absorption
equivalent to that of IV infusion. This is often the
preferred route of administration to neonatal
animals. Bones that are most readily accessible for
intramedullary administration are the proximal
shaft of the femur or humerus and the wing of the
ilium. Neonatal animals have soft enough bones
to allow placement of a standard hypodermic
needle into the marrow cavity. Intraosseous
infusion needles are available for this purpose, but
standard bone marrow needles used for diagnostic
collection of bone marrow also work well. There
is a small risk of creating bone infection by the
administration of fluids by this route. Bone marrow
© bluedoor, LLC

needles placed for intraosseous administration
of fluids and drugs can be left in place for
the same duration as IV catheters. They are
excellent methods of administering drugs during
cardiopulmonary resuscitation when it is difficult
to access peripheral veins for catheter placement.
Monitoring
Patients receiving fluid therapy are regularly
monitored and checked for signs of overhydration
or underhydration. Catheters must be regularly
evaluated for patency and signs of phlebitis.
The animal’s PCV, plasma protein, and body
weight are recorded. Renal function is monitored
in dehydrated animals by measuring or
approximating urine output volume. Normal
urine output volume is 2 mL/kg/hr. Measurement
of central venous pressure can also be used to
monitor fluid therapy patients.
Nursing Care of Critical Patients
The primary job of providing nursing is to attend
to the physical needs of the patient. Patients must
be kept clean, dry, and comfortable and in safe
and secure housing. Hospitalized patients are
companion animals used to having people with
and around them for a major portion of their day
and are not accustomed to sleeping alone in a
cage. Providing adequate nutrition to meet their
physical needs is also a vital component of nursing
care. After the initial assessment and stabilization,
the veterinarian may require additional testing,
such as blood work or diagnostic imaging studies,
to gain additional information on the patient’s
condition. The type of blood work requested will
depend on the availability of in-house testing
equipment, the condition of the patient, and
the individual veterinarian’s preferences. It is
recommended that blood be collected prior to
any treatments if at all possible. It is generally
recommended to collect 1 EDTA tube, 1 heparin
tube (plasma), and 1 red top tube (serum) from all
critical patients following initial assessment and
prior to initiation of treatment. This will usually
allow you to conduct a minimum database in
house.
Ongoing assessment involves regular monitoring
of vital signs, fluid intake, and urine production.
Specific types of regular testing, such as blood
pressure monitoring, ECG, pulse oximetry, etc.,
may be needed depending on the nature of the
patient’s illness or injury. Many of these procedures
are performed repeatedly to help identify any
trends in patient status and to aid the veterinarian
in revising the treatment plan as the patient status
changes. (Figure 6.2)
LLC
bluedoor, © Figure 6.2: This critical patient has an ECG pack for
continuous monitoring of cardiac function while in
the ICU.
Pain assessment is equally important when
evaluating a critical patient. Pain can be classified
as either acute or chronic and should be treated
as soon as it is identified. The individual character
and temperament of the animal further influences
its response. Assessment of pain may include vital

signs, such as heart rate, as well as behavioral
observations.
Much of nursing care centers on the administration
of medications and treatments. Ensuring that
these are administered effectively with minimal
amounts of stress to the patient is essential.
Knowing the pharmacokinetics of the medications
you are administering is important for not only
patient care, but also for anticipation of side
effects. Being able to efficiently and accurately
calculate drug dosages and administer them
safely is equally important. Medications that are
administered in incorrect amounts can either kill
the patient or not provide the correct therapeutic
level for the patient.
Some critical patients will be suffering from
contagious diseases. These patients will generally
be located within an isolation area (ward) of the
hospital. Ideally, the isolation ward has a single
entrance and exit. All equipment and supplies
used for animals in the isolation ward remain
in the ward and are not used on other animals.
The number of staff members with access to
the isolation ward should be limited in order to
minimize spread of disease to other areas of the
hospital.
Physical Therapy
Hospitalized patients should undergo regular
physical therapy. Physical therapy and
rehabilitation speeds recovery of patients.
Therapeutic techniques are categorized as thermal
therapy, passive exercise, and active exercise.
Combinations of multiple types of therapies
are common. Therapeutic ultrasound and laser
therapies are also being used for rehabilitation in
veterinary patients.
information related to fluid therapy and advanced
monitoring.
© bluedoor, LLC

LLC
Lesson 7
Dentistry
bluedoor, © L e s s o n 7 | D e n t i s t r y 125
ESENTIAL SKILLS
• Perform routine dental prophylaxis
• Explain dental home care to client
• Perform routine dental radiographs
• Educate clients regarding home dental care
READING ASSIGNMENTS
3rd Edition, Sirois, Chapter 18.
• Small Animal Surgical Nursing: Skills and
Concepts, 2nd Edition, Tear, pages 288–289,
Figures 11-2, 11-3.
• Veterinary Instruments and Equipment: A Pocket
Guide, Sonsthagen, Chapter 21.
OVERVIEW
Dentistry is one of the most technician-directed
area of the veterinary hospital’s operation. The
technician directs client education on home dental
care, helps perform the oral examination, cleans
the teeth, and charts the oral health findings. Oral
health is a major contributor to overall health in
animals. If the mouth is painful, animals do not
eat well. If the oral tissues are infected, bacteria
are spread throughout the body. Examination of
the oral cavity can reveal significant health issues:
mucous membrane color is indicative of circulatory
issues, breath odor can alert you to renal disease
or diabetes, lymph node palpation can reveal
enlargement due to neoplasia or inflammation,
etc.
Oral Anatomy and Terminology
Three skull types are recognized in canine and
feline patients: mesaticephalic, dolichocephalic,
and brachycephalic. The mesaticephalic skull is a
medium length and width, the dolichocephalic
is long and narrow, and the brachycephalic
skull is short and wide. Examples of breeds that
demonstrate certain skull types are found in Table
18-1 of your Sirois textbook. Common occlusal
abnormalities seen in small animal patients are
reviewed in Table 18-2 of the same text.
Teeth are divided into the crown (exposed portion
of tooth) and root (submerged portion) sections.
Enamel covers the crown, and cementum covers
the root. Underneath the enamel and cementum,
through the entire length of the tooth, is a layer of
dentin. Figure 18-2 in the Sirois textbook contains
a cross-section diagram of the components of
the tooth and surrounding tissues. Collectively,
the tissues and supporting structures around the
teeth are called the periodontium. This includes
the gingiva, cementum, periodontal ligament, and
the alveolar bone, or socket. The free edge of the
gingiva is typically not attached directly to the
tooth. A space between the tooth and the tissue is
known as the gingival sulcus, and will be assessed
for depth during routine dental examination. A
pulp cavity underlies the dentin. This area houses
the blood vessels, nerves, and connective tissues

that serve the tooth. The ridge of dental laminar
epithelium gives rise to the deciduous (primary)
and permanent (adult) teeth.
Dental formulas are a way to express the normal
number and arrangement of teeth in a particular
species. The formulas for canine and feline
deciduous and permanent dentition can be
located in Table 18-3 on page 485 of your Sirois
textbook.
Instruments and Equipment
The ultrasonic scaler is commonly used in
veterinary dentistry. This instrument will help
remove tartar or calculus from the teeth during
dental prophylaxis. Magnetostrictive scalers
use vibrations of metal stacks causing the tip
to vibrate. Piezoelectric scalers run an electrical
current through a quartz crystal to generate
vibrations. Heat is generated by the vibrations
of ultrasonic scalers, so a constant water flow is
necessary to keep the instrument cool.
Manual hand-scaling instruments include scalers
and curettes. Hand scalers can be used to scale
calculus off the crown of the tooth. Curettes can be
used to remove subgingival deposits from the root
surface and to debride the lining of the soft tissue.
Periodontal probes and explorers are other types
of manual dental instruments. The probe is marked
in millimeter increments, and can be introduced
into the gingival sulcus to determine the depth of
various pockets around a tooth.
The explorer is used to detect roughened areas,
resorptive lesions, or open canals in teeth. Scaling
the teeth to remove calculus buildup will roughen
their enamel surface. Polishing with a rotary
hand tool, micromotor unit, or the slow-speed
handpiece of an air-driven unit can be done to
produce a smooth surface on the tooth. Box 18-1
of your Sirois textbook contains a checklist for pre-dental
LLC
bluedoor, © preparation. In addition to the preparation
of dental equipment, veterinary technicians must
also set up to administer general anesthesia
and closely monitor patients during the dental
prophylaxis. Standard patient assessments and
stabilization should occur prior to anesthesia, and
photos should be taken of the mouth in order to
document the oral condition. Dental items that will
be necessary include:
• Absorbable suture and a surgical blade if the
DVM anticipates the need for gingival flaps
• Gauze and cotton-tipped applicators
• Prophy paste for polishing teeth after scaling
• Plaque disclosing liquid
• Fluoride gel or foam
• Water and chlorhexidine rinse
• OraVet®
• Patient chart and pen
Personal protective equipment is also necessary.
The technician should utilize gloves, splash
goggles or a face shield, and a mask. During dental
procedures, bacteria from the plaque and calculus
on teeth will be aerosolized, and personnel must
prevent themselves from breathing, ingesting, or
absorbing this bacteria.
Periodontal Disease
Periodontal disease often begins with mild
gingivitis, edema, and redness of the free
gingival margin. This is referred to as stage I
periodontal disease, and may be reversed with
appropriate therapy. Stage II periodontal disease is
demonstrated by increasing sulcus depth or up to
25% attachment loss. Stage III periodontal disease
shows pocket depths up to 9 mm in dogs (1.5 mm
in cats), and up to 50% attachment loss. Pocket
depth greater than 9 mm and 50% attachment
loss are characteristics of stage IV periodontal
disease. Table 18-5 in your Sirois textbook reviews
the stages and descriptions of periodontal disease.
Early stage, reversible gingivitis is often associated
with aerobic, gram-positive, nonmotile cocci.
Bacteria work their way into deeper tissue with
the progression of disease, and the proliferative
flora at that point is more likely anaerobic, gram-negative,
motile bacilli. Treating periodontal
disease has three primary goals: controlling
bacterial populations, minimizing pocket depth,
and maintaining healthy attached gingiva. Without
proper treatment, periodontal disease may
progress to affect the liver, kidneys, heart, lungs,
and nervous system.

© bluedoor, LLC
L e s s o n 7 | D e n t i s t r y 127
Dental Prophylaxis
Prophylaxis, by definition, means to prevent or
protect from disease. Dental prophylaxis is the
process during which the teeth are cleaned.
Removal of plaque and calculus from the teeth
protects veterinary patients from gingivitis, decay
of teeth and bone, and periodontal disease. A
systematic approach should always be used
to avoid missing any portion of the cleaning
process. Following the physical exam, equipment
preparation, and anesthetic protocol selection, the
patient should be induced to general anesthesia
and a comprehensive oral examination carried out.
Then the routine steps in dental prophylaxis can
be performed. These include ultrasonic scaling,
hand scaling, subgingival curetting, plaque
disclosing solution application and flushing, dental
probing/exploring, radiographs, extractions by
the veterinarian, polishing, and the application of
sealants. Figures 18-12 through 18-21 in your Sirois
textbook show photos of the steps in the dental
prophylaxis process.
Charting
Conditions in the patient’s mouth must be
accurately recorded in the hospital record.
Variations in tooth appearance, pocket depth,
and missing or retained teeth should all be
noted in a dental chart. Two charting systems
are commonly used in veterinary patients: the
triadan system and the alphanumeric system.
The triadan system uses a three-digit number to
correspond with each tooth. A different set of
numbers is used to denote primary or permanent
teeth. The mouth is divided into four quadrants
divided by maxilla and mandible, and right and
left. Quadrant one is the right maxilla, two is the
left maxilla, three is the left mandible, and four is
the right mandible. This quadrant number is the
first of the three digits in the triadan system. The
second number is the actual tooth designation.
Within each quadrant, teeth are numbered in
the same fashion: incisors, canine, premolars,
molars. All canine teeth are numbered 04 and all
first molars are numbered 09. Counting forward
or backward will allow the technician to number
all other teeth. Primary teeth have the same
tooth numbering system, but the quadrants will
be numbered five through eight (in the same
order as one through four). In the alphanumeric
system, abbreviations will be correlated to the
type of tooth being identified: incisors (I), canines
(C), premolars (PM), and molars (M). Quadrants
of the mouth are identified as in the triadan
system, but instead of being numbered, they will
be reflected in the position of the tooth number
relative to the tooth abbreviation. For example,
the right maxillary canine would be C1 and the
left maxillary canine would be 1C. Figure 18-23 in
your Sirois textbook is a reference combining the
triadan and alphanumeric systems, and identifies
normally missing teeth in adult canines and
felines. Charting methods in veterinary dentistry
may be computer- or paper-based. Symbols
and abbreviations are used to denote specific
problems in particular teeth, and can be qualified
with a number ranking of severity. Box 18-4 in your
Sirois textbook lists some symbols commonly used
to designate specific problems, and Table 18-7
contains a charting index to systematically grade
plaque, calculus, gingivitis, periodontal disease,
tooth mobility, furcation exposure, odontoclastic
resorptive lesions, fractures, and malocclusions.
Radiography
Dental radiology is indicated in cases with
increased gingival pocket size, facial swelling,
advanced periodontal disease, nasal discharge,
fractures of the teeth or jaw(s), oral growths,
malocclusion, or malformed teeth. Oral
radiographs may be performed with digital dental
radiographic units, or with standard radiographic
equipment and intraoral films. Intraoral film comes
in a variety of sizes; sizes 2 and 4 are the most
commonly used. These are nonscreened, double-emulsion
films encased in a paper sleeve with a
lead foil backing to reduce scattered radiations.
They can be taped to the lead end of a larger
film for developing in an automatic processor or
standard tanks or rapid developer and fixer can be
used in individual containers.
Patient positioning during dental radiology
is most often lateral recumbency for imaging
the mandibular premolars and molars, dorsal

recumbency for the mandibular incisors and
canines, and ventral recumbency for the maxillary
incisors, canines, premolars, and molars. Parallel
and bisecting angle techniques are both used
in small animal dental radiology. The parallel
technique can be used with mandibular premolars
and molars. The film (or digital receiver) is placed
intraorally, parallel to the teeth. The x-ray beam
is aimed perpendicular to the parallel items.
Because of the shape of the palate, this position
of the film or receiver is not possible throughout
the mouth. The bisecting angle technique is used
in areas where the film cannot be placed parallel
to the teeth. Film (or the receiver) is placed flat
in the mouth, parallel to the hard palate, below
the teeth of interest, and above the endotracheal
tube. The beam is positioned midway between
perpendicular to the long axis of the tooth and
perpendicular to the film. A dimple is present
on dental radiographic film and receivers, acting
as a permanent marker. Once films or images
are processed and being reviewed, this can be
useful in determining which side of the mouth is
being viewed. Table 18-8 and Figure 18-25 in your
Siroi textbook review dimple placement in the
mouth during oral radiology. Radiographic cone
placement to achieve the angles described above
is depicted in Table 18-9 of the text.
Home Dental Care
Veterinary technicians must be prepared to
educate clients on the importance of continued
oral care for their pet’s overall health. Many
products are available from the veterinary facility
as well as pet supply stores. Teeth can be cleaned
at home on a regular basis with toothbrushes,
finger brushes, gauze, and sponge applicators. The
most important thing an owner can do is find the
method that will be best tolerated by the pet, and
keep using it consistently. Toothpastes designed
for pets is recommended because fluoride and
detergent components aren’t safe for pets to
swallow (small animal patients aren’t likely to spit
out the toothpaste after clients brush their teeth).
Wipes, gels, and rinses are available for pets that
won’t tolerate the use of a toothbrush. These
methods all aim to remove plaque from the teeth
before it has a chance to calcify. Table 18-10 in
your Sirois textbook contains an overview of home
care products available on the market. These range
from the above mentioned pastes, gels, and wipes
to plaque prevention diets, treats, and toys.
Chapter 21 in the Sonsthagen text contains
photographs along with function and
characteristics of dental instruments, including
hand scalers, curettes, probes, explorers, dental
forceps, and other accessories used during dental
prophylaxis.
information related to dentistry.
© bluedoor, LLC

Vet Tech Essentials: Module 5

Recommended

Recommended

More Related Content

Recently uploaded

Recently uploaded (20)

Featured

Featured (20)

Vet Tech Essentials: Module 5