JEN the RVN

15/03/2024

If there is one thing this job brings, it’s definitely variety. This week I have been doing:
Anaesthesia,
Dentals,
Nursing inpatients such as IMPA, blocked toms, cholangiohepatitis, gastric-intestinal disorders,
Assisted with scopes, X-rays and ultrasound scans,
Assisted with unblocking urethral obstructions, joint taps and enemas
Discharged medical patients to their awaiting and grateful families, and eaten the lovely treats they bring in for us,
Laboratory work,
And to top it all off a 6pm Friday ex-lap on a silly sausage who decided to swallow a tennis ball whole.
I’ve been covered in every bodily fluid going.
My legs and feet ache.
My back and shoulders hurt.
I’m knackered.
But I’ve LOVED every minute of it.
Not just because of the job itself, but where I am locuming at the moment is a very busy hospital with the most organised, hardworking and amazing team who all stayed past the end of their shift to help get theatre clean and kits done so it wasn’t all left to me.

There have been countless times over the last 20 years where I’ve genuinely wanted to pack it all in. I’ve been there with the stress and the burnout and the compassion fatigue. But I’m so glad I fought through it, because it’s weeks like these that make me feel so incredibly proud and honoured to do this job 🥰

14/03/2024

This week, I was assisting with the diagnostics on a patient with suspected immune-mediated polyarthritis. If this is not something you have come across before, here is a little bit of info on the condition, along with what you need to prep for joint taps

13/03/2024

Remember that not all your kitty inpatients are used to using a litter tray. If you have noticed they appear to be holding onto their urine, try adding outside material such as soil and leaves to their tray to encourage them to go (assuming it’s appropriate from an infection control point of view).

06/03/2024

I don’t know about you, but I find it so cool when you instantly see expected changes in patient parameters when certain drugs are administered.

This is a BP trace from a healthy dog under GA for dental work. The patient had a 5mcg/kg medetomidine and 0.3mg/kg methadone premed. Alfaxan induction and maintenance on sevoflurane.

It was just one of those awkward anaesthetics. The patient just didn’t want to maintain a happy plane of anaesthesia and even when nothing painful was occurring, palpebral reflexes and jaw tone kept returning. Despite local nerve blocks and additional analgesia and increasing the sevoflurane %, we still struggled. So we administered an additional 5mcg/kg medetomidine intravenously to see if it helped.

Medetomidine is an alpha2-agonist. Within a couple of minutes following iv administration, you will see an increase in blood pressure caused by peripheral vasoconstriction. As a reflex response, you will also see a decrease in heart rate and reduced cardiac output.
Medetomidine produces a biphasic effect on blood pressure, so after that initial increase, you will see a return to normal or slightly low BP. The decrease in cardiac output is of minimal significance in healthy animals with normal cardiovascular function. It is also a potent analgesic offering roughly 1 hour analgesia.

29/02/2024

I had dealt with many crash situations in my career but this was a new one on me.
This ECG shows sinus tachycardia with ST depression. The patient presented for its first cardiac ultrasound. He appeared clinically stable. Upon placing him in right lateral recumbancy for the scan, in the space of 5 seconds, he became cyanotic and went into immediate cardiac arrest.
I was in a tiny practice as the sole nurse and as this was what I thought to be a routine conscious scan, we did not have anything prepared for this rare and unfortunate event. We were able to administer BLS and get some adrenaline in. He responded immediately and proceeded to sit up and resist intubation. We were then able to quickly scan his heart and he had a significant pericardial effusion.
We performed a pericardial centesis and stabilised him until he was transferred to a 24hr hospital.
This just goes to show how quickly a “routine” procedure can turn, and I will now ensure that even if they are not undergoing any sedation or GA, I will always be prepared for this eventuality!

26/02/2024

Feline hyperthyroidism.
A very common condition we see in practice. We may even be the first to pick up on the possibility of the disease based upon our history taking and physical examination in a nurse clinic.
How confident do you feel about chatting to owners about this disease? A valuable use of our expertise and skills would be to deliver the diagnosis made by the vet, and discuss the different treatment options that the vet has authorised, with the owner. Doing so can help raise public awareness and perception of the RVN role. It can also empower us individually as we have much more involvement with helping a patient and their owner navigate their way through a potential life-long condition. We can help them to understand whats happening to their pet and why they are seeing the symptoms they are seeing. We can talk them through the likely diagnostic tests that will be run. And once a diagnosis is made, we can talk them through all their options of how to manage the disease.
Here is a very brief overview of feline hyperthyroidism to help you gain that confidence.
References: Small Animal Internal Medicine for Veterinary Technicians and Nurses - Edited by Linda Merrill

23/02/2024

Pulse ox probe placement doesn’t have to be limited to the tongue 👅. For dental procedures in particular they can really get in the way. Anywhere you can find a nice pink bit of tissue can work. In this patient, I got a lovely reading from between the toes. Other areas you can consider are the ear pinna, v***a, prepuce and pads.
Where is your go-to for pulse ox probes?

19/02/2024

Happy Monday! If you can remember just one thing today….lube those eyes!! And not just under GA. For the complete peri-operative period. Plus any in-patient receiving opioids or Ketamine or are in an oxygen cage.

Are you regularly checking your patients for ulcers whilst they stay with you and also in post-op checks?

From a QI point of view, the product used and frequency of application should be recorded. Ulcers that have developed during or following a stay at the practice should be logged - just like post-op wound complications would be. This will then provide a good evidence base for you to adapt your eye lubrication protocol as needed.

What’s your current protocol? And if you don’t have one, don’t worry it won’t take long. You just need to include your product of choice, a list of situations it must be used and the minimal frequency of application.

13/02/2024

If you’re doing a dematt or large clip, remember to regularly check your clipper blades are not getting too hot. Rotate regularly throughout and to speed up the cooling process, putting them in the fridge works a treat!

07/02/2024

04/02/2024

Do you often hear your vets talk about azotemia when discussing acute kidney injuries? Do you ever wonder what they mean when they refer to azotemia being prerenal, renal or postrenal? Here is a little bit of info to help you understand.

02/02/2024

Morning all! Hope you have a “cracking” Friday 😜🦷

31/01/2024

**O2 flow rate cheat sheet for T-piece and Mini Lack**

Blimey this one took a while! I thought these could be helpful for a variety of reasons.

Mainly, I want to highlight what I see vastly under-used in practice. The mini-lack circuit.

Now some of you may be working with a Humphrey ADE system, which is fab, but not everyone has them.

So why am I banging on about the mini lack?

As you will see on the charts, it requires much lower O2 flow rates. Oxygen from a cylinder is COLD! Lower O2 flow rates can be one of many measures to prevent anaesthesia induced hypothermia. It is also more economical and causes less atmospheric pollution.

T-pieces still very much have their place. For patients requiring long term IPPV, the T-piece would be your circuit of choice for smaller patients as the mini lack is not suitable for this purpose. You will also find that the mini lack flow rates can be

29/01/2024

Today’s top tip is about using skin tenting as a method of assessing dehydration.

Subcutaneous fat provides greater lubrication than lean tissue. Therefore, patients that are geriatric or have a low body condition score will have less subcutaneous fat.

This means that those patients may have a prolonged skin tent in the commonly used scruff area even if they are not dehydrated.

So where should we assess skin tenting in these patients?

The cranium and axillary region may provide more information about hydration status in these patients.

26/01/2024

Calculating CRI's is a valuable tool to get familiar with. Using a syringe driver is preferable, but this may not be a luxury you have. So if you need to dilute down and administer via a fluid pump, here is a working example to help guide you. For this example, I am going to use Ketamine as it has the added step of needing to convert from mcg to mg. This is a 10kg patient needing Ketamine at a dose of 5mcg/kg/min.

You will need to know the following:
Patient weight
Drug and dose rate
Rate of infusion (as requested by the VS)
Likely length of time infusion is required (this will help determine the fluid bag size you choose to dilute the drug in)

CRI's should ideally be run separately to other fluid therapy, so that fluid therapy adjustments can be made without affecting your CRI.

Remember to take into account the additional fluid therapy you are providing with the CRI. So if a patient is on 10ml/hr CRI, you may need to reduce their ongoing fluid therapy by the same amount.

Some medications will also require a loading dose prior to starting the CRI.

And last but not least - ALWAYS get your calculations triple checked!!

23/01/2024

How amazing is this?! 👏 Veterinary Early Warning Score (VEWS)
With credit to RCVS Knowledge and Belinda Andrews-Jones VTS (ECC) Dip AVN (Surg) CMgr RVN PG Dip Vet Ed MInstLM FCMI FHEA.
RCVS Knowledge and Andrews-Jones (2023). Veterinary Early Warning Score. [Online] Available at rcvsknowledge.org/VEWS

22/01/2024

"HELP! My pets having a seizure!!"
When you pick up that phone and hear this on the other end, it's easy to panic and draw a blank on what to say or do. In fact, I think the first time this happened to me, I simply threw the on call phone to the vet as I had no idea where to even start. Seizures are a complex subject and one which I could go into a complete tangent on. But let's start at the beginning, with how to handle the phone call. Your job is to provide first aid advice, and take enough relevant history so that a decision can be made as to how quickly we need to see the patient. It will also help determine what equipment and materials we should prepare for. I cannot stress enough that every scenario is different, so this framework should be used as a guidance only. Advice should always be sought by the VS.

20/01/2024

Woop woop 🙌 just secured my ticket for VN Spark with - cannot wait!

18/01/2024

We all need to recognise areas we aren’t so confident in and take measures to improve. Cytology if definitely one of those areas for me! So as I had a bit of time today, I thought I would do a bit of practice.
I had a look, got frustrated and walked away, then took a deep breath and got the textbooks out for some help!

So - what are your thoughts on my guesses? I’m probably wrong on some so please let me know!

Feline blood smear. Stained with Difquik .4yrs old, presented with severe dental disease with osteomyelitis. Also recent history of fleas.

16/01/2024

If you have a patient anaesthetised that is either obese or has a distended abdomen for some other reason, try to elevate the thorax slightly to ease the pressure on the thoracic cavity, thus improving tidal volume.

14/01/2024

We all know about pain scoring our patients, but have you considered regular phlebitis scoring?
Download yours from
https://knowledge.rcvs.org.uk/document-library/peripheral-catheter-care-and-phlebitis-score/peripheral-cannula-list-and-phlebitis-score-autosaved-.pdf

12/01/2024

Feline oral resorptive lesions.

These can be picked up on in your routine nurse clinic. Whilst we legally cannot diagnose this, we can flag this to a veterinary surgeon and recommend dental treatment.

So what is a resorptive lesion and what causes it?

Resorption is caused by odontoclasts—cells that are responsible for normal remodelling of tooth structure. These cells are activated, but then do not down-regulate, ultimately resulting in tooth destruction, the process of which is very painful to the patient.

Dental x-rays will confirm diagnosis and extraction of the affected tooth is the recommended treatment.

Never underestimate the nurses role here, a simple oral check on an otherwise healthy patient can lead to the diagnosis and treatment of a very painful condition. Once anaesthetised, we can also chart, scale and polish, perform dental X-rays and suture the gum post-extraction

12/01/2024

Troubleshooting an abnormal capnography reading? After other factors have been ruled out, you might consider changing your sampling line. But how would you know that it hasn’t already been done by someone else the previous day? A simple label with the date might help, particularly when working in busy hospitals with multiple staff.

11/01/2024

If you’re finding the pulse ox probe is compressing the capillary bed too much, try wedging it open with a needle cap to release some pressure.

10/01/2024

Do you ever panic when you see a rabbit health check on your nurse consult list? Are you confident in knowing what to discuss and examine? If not, here is a very short reminder of the basics 🐰

08/01/2024

Let’s hope no one needs to do this today!
Just a snippet of info about how to adjust your method of cardiac compressions based on patient size.
Remember for larger breeds you’re aiming for the widest bore part of the thorax.
Why?
The alterations in intra-thoracic pressure will aid in moving blood around the body.

07/01/2024

Nurse consults can feel pretty scary at times. But sticking with a structure that's easy to remember and follow can help give you focus and keep you in control of your consult. Take a peek at my SHEEP acronym to see if it helps you :)

07/01/2024

Are you really a Vet Nurse if you don't look like this underneath that uniform?!

Found on Google from pinterest.com