Table 3 . Areas of palpation for pain assessment
Assessment of pain
Palpation of the head , assessing the temporal muscle and the mandible as well as the patient ' s ability to open its mouth
Palpation of the neck , full spine and surrounding muscles to assess for diffuse spinal pain
Palpation of the ribs , reaction to which can indicate thoracic and cervical vertebral pain
Palpation of the abdomen can be used throughout the patient ' s assessment ; increased tension in the abdomen can be a subtle sign of pain in the area being manipulated
Oral care – this is important for these patients as they are often unable to eat and drink . The patient should have the tongue , gums and oral cavity moistened regularly , as this maintains healthy mucous membranes and inhibits the overgrowth of bacteria , as well as providing comfort for the patient [ 1 ] . If there is a potential reduction in the patient ' s ability to swallow , a damp swab is sufficient and safer .
Figure 2 . Forelimb range-of-movement stretching .
Ocular care – these patients may be unable to blink , may require oxygen therapy and will be receiving opioid analgesia [ 1 ] . Ocular care should include regular lubrication of the eyes , every 1 – 4 hours depending on the patient ' s presentation and breed . The eye area , face and skin folds should also be cleaned and dried regularly .
Rehabilitation
Rehabilitation is important for recumbent patients ' long-term function and quality of life [ 10 ] . Hypotrophy of muscles occurs rapidly from disuse and immobilisation . Ambulation and weight-bearing exercises should therefore be encouraged , as and when the patient is able . Deterioration of other soft tissue can occur , as well as contractures , scar formation and deterioration of joint health [ 2 ] .
Passive range-of-motion exercises can be used to increase mobility , maintain range of motion and support joint health ( Figures 2 – 4 ). Massage techniques can be used to manipulate the soft tissue , through rubbing , kneading and tapping [ 2 ] . Effleurage , petrissage and skin rolling techniques can all be of benefit to these patients . Massage can also serve as pain relief , by reducing joint stiffness , muscle spasms and pressure [ 6 ] ( Figures 5 , 6 ).
Rehabilitation exercises can also reduce the risk of the patient developing decubitus ulcers while recumbent or immobile . Further measures include avoiding clipping fur over bony prominences , providing padding under the intravenous catheter port , and providing mattresses and padded bedding [ 10 ] .
Figure 3 . Square lay position .
26 Veterinary Nursing Journal