In a survey , 50 % of respondents indicated a need for a specific validated composite pain scale for rabbits [ 11 ] . As 50 % of participants recognised the VN ' s role in pain management [ 4 ] , and as myiasis is such a painful condition [ 12 ] , it is paramount that VNs are confident in recognising pain , monitoring the clinical signs and providing pain relief under veterinary supervision [ 13 ] .
VNs are currently lacking proficient literature on pain management for rabbits , which can affect their confidence as professionals . Considerations may include introducing rabbit-specific courses in veterinary nursing education or creating CPD courses that are readily accessible in practice . Increasing veterinary professionals ' knowledge of and confidence in dealing with rabbit emergencies will lead to more efficient and effective veterinary practices .
Turner et al . [ 1 ] identified that the majority of myiasis cases were secondary to other conditions , such as lameness , urine scalding or paralysis . Grant et al . [ 14 ] state that these conditions were frequently missed by owners , resulting in poor healthcare for domestic rabbits . Furthermore , Dalley et al . [ 15 ] state that only 36.4 % of owners in a survey checked their rabbit ' s perineal area , and another study found that many owners had little confidence in handling their rabbit [ 16 ] .
As some patients will be more predisposed than others to the condition [ 4 ] , it is important for VNs to understand the immediate and primary care needed for critical myiasis patients . If clients do not confidently understand rabbit management then the health and welfare of their animals may suffer . Therefore , it is important for veterinary professionals to have a clear understanding of rabbit healthcare , in order to provide the appropriate guidance to clients , especially relating to critical rabbits .
Pain measurement is an important part of effective pain management [ 17 ] but , currently , there is no multidimensional composite scale for rabbits [ 18 ] . The Rabbit Grimace Pain Scale ( RbtGS ) is used to measure pain in rabbits [ 19 ] but it can be difficult to differentiate pain from stress in this species . Foote [ 20 ] highlighted that rabbits often hide their pain in the veterinary practice , due to stress , making pain assessment more difficult for the assessor . This can be dangerous , as stress increases blood pressure and cardiac output , which can result in rapid deterioration of the patient [ 21 ] . This confirms the need for a pain scale that considers signs of stress and ways to reduce it in a veterinary setting .
Ileus is another critical emergency in rabbits , for which fluid therapy is essential to recovery . In severe cases , hospitalisation for intravenous fluid therapy is needed [ 10 ] . Fluid therapy often includes electrolytes to regulate fluid balance , muscle function , blood pH and rehydration [ 22 ] . In cats presenting with shock following trauma , aggressive fluid therapy is needed [ 23 ] to replace lost fluids , prevent dehydration , increase cardiac output and correct hypoperfusion [ 24 ] . Carrasco [ 25 ] states that myiasisinfested rabbits show signs of dehydration , shock and lethargy , which confirms the need to use intravenous fluid therapy in rabbits presenting with myiasis .
With this in mind , this article aims to understand the implications of nursing care when considering pain assessment and fluid therapy for the critical myiasis rabbit . The article will also examine the limitations of veterinary medicine for rabbits in relation to the previous aim . These aims will be met through a thorough review of the existing literature for rabbits with myiasis , followed by an exploration of what the literature implies for the treatment of the condition by veterinary professionals . Within that exploration , further research requirements within the field will be highlighted . Gibbs ' s Reflective Cycle [ 26 ] , discussed by Fontaine [ 27 ] ( Figure 1 ), will be used throughout the article to effectively review the literature about the myiasis rabbit .
Action plan If it happened again , what would you do ?
Conclusion What else could you have done ?
Ethical approval
Ethical approval was not required for this article [ 28 ] .
Discussion
Description What happened ?
Analysis What sense can you make of the event ?
Figure 1 . Gibbs ' s Reflective Cycle ( 1988 ). Reproduced from Fontaine [ 27 ] .
Feelings What were you feeling & thinking ?
Evaluation What was good & bad about the experience ?
An increase in owned rabbits ( 13 %) over the past 3 years [ 29 ] has resulted in a higher demand for routine procedures such as neutering and preventative treatment [ 30 ] . This includes myiasis , which is a preventable dermatological disorder and is usually secondary to faecal and urine scalding around the perineal area [ 12 ] . Dalley et al . [ 15 ] stated that only 36.4 % of owners check their rabbit ' s perineal area for daily hygiene purposes , which should be monitored in particular in rabbits that cannot groom due to arthritis or obesity [ 12 ] . In a study by O ' Neill et al . [ 4 ] , with a sample
20 Veterinary Nursing Journal