minimal restraint and calm , reassuring handling , it is generally possible to position patients for long enough for the ultrasonographer to achieve the images necessary for diagnosis .
Diagnostic images can generally be obtained whether the patient is in lateral or sternal recumbency or standing [ 6 ] , so patients which are unable to be positioned laterally due to stress or compromised respiration should not be scanned in this position .
The patient ' s respiratory rate and effort should be carefully monitored throughout any procedures . Any signs of deterioration should be raised with the veterinary surgeon and may necessitate a short break for the patient in the oxygen kennel . Flow-by oxygen can be provided , but face masks should be avoided as these can increase patient stress .
Generally , veterinary nurses ( VNs ) will perform radiography in practice , and the same considerations apply to the handling of patients , whether radiography is performed consciously or with mild sedation .
Initial outcome
Overnight , the patient responded well to the furosemide CRI . His respiratory rate decreased to 36 breaths / min with minimal respiratory effort . Heart rate was 160 bpm , MMs were pink and CRT was < 2 s . Oxygen therapy was stopped and the patient ' s SpO 2 was recorded as 98 %.
Parenteral furosemide was changed to the oral route at a dose of 2 mg / kg . Transient ischaemic dilation and respiratory rate and effort were monitored hourly to ensure that there was no deterioration in the patient ' s condition following this change .
Clopidogrel was added to his treatment at 18.75 mg PO SID , based on the finding of spontaneous echo contrast , which is associated with blood stasis , indicating a prothrombotic state and increasing the risk of aortic thromboembolism ( ATE ).
Clopidogrel is indicated for use in cats with or at risk of developing intracardiac thrombi . It is a thienopyridine antithrombotic drug which binds to the adenosine diphosphate receptor on platelets , preventing platelet aggregation and thrombosis . The FAT CAT study [ 7 ] found that administering clopidogrel ( versus aspirin ) provided a significant improvement in time to a repeat ATE , with an improved median survival time of 251 days .
It can be difficult to administer clopidogrel due to its bitterness , which may lead to hypersalivation or anorexia . If this occurs it can generally be resolved by giving the drug inside plain gelatine capsules . Flavoured tablets or emulsions are also available , which may improve patient compliance .
Blood sampling was repeated to assess renal parameters , which revealed a moderate increase in urea and creatinine , and mild hypokalaemia and hypochloraemia . This is common secondary to diuretic treatment and was expected to improve as the dose was lowered . Blood glucose was within normal limits .
The patient was discharged that evening , with a recheck appointment arranged for a week later .
Nursing care at discharge
Feline cardiac patients should ideally be discharged as soon as they are able to maintain oxygenation and can be medicated orally , as hospitalisation will frequently increase patient stress , which can worsen their condition .
The VN can help to improve patient outcomes by educating the owner at discharge . It is essential that owners understand why medications have been prescribed , what they do , and how and when to give them . Compiling a discharge sheet or medication table may be useful for reference once the patient is at home .
Cats are notoriously difficult to medicate , so it is important to discuss methods of administration , such as the use of pill putty , treats , tools ( such as pill givers ) and administering directly into the mouth . Some medications are available in a variety of flavours or formulations ( e . g . liquid and tablet ), and owners should be made aware that options are available if they do struggle . Having the VN as a point of contact for advice can prove vital in encouraging owner compliance [ 8 ] .
It is also helpful to advise owners on how to monitor their cat ' s respiratory rate and effort at home , as well as being aware of what is normal for their cat . Changes in respiratory rate or effort are often the first sign of a condition worsening in these patients , so owners who are aware of how to monitor these accurately may be able to identify patient deterioration more promptly . Monitoring can be demonstrated by the VN in practice and clients should then be encouraged to demonstrate the technique to the VN to confirm their understanding . Some owners may also need reassurance that they are correctly counting rates when monitoring at home , so it can be helpful to provide them with an email address to which they can send videos for assessment by a VN .
Respiratory rate should always be monitored when the patient is sleeping or resting quietly , with no external stress factors and not immediately following excitement or exercise . Techniques such as the use of apps ( e . g . the ‘ Cardalis ’ app ) or filming the patient ' s breathing and watching the video can be useful for acquiring accurate results with minimal patient interference . Respiratory rate should be under 30 breaths / min and breathing effort should not be easily visible from a distance . If the patient is purring it may appear as respiratory effort so this should be taken into account .
46 Veterinary Nursing Journal