There are a number of considerations when nursing a recumbent foal , including the way the patient is moved and positioned ( Table 1 ).
Table 1 . Some considerations when nursing a recumbent foal .
Nursing care
Adjusting the position
Consideration
Never turn a foal on to its back and then flip its legs over to the other side . This can shock the sick neonate , with its lowermost lung unable to adjust to the sudden change .
During the transition , sit the foal in the sternal position for a few minutes to allow the lowermost lung to expand before completing the turn .
Lifting the recumbent neonate
The recumbent neonate will be weak and immobile , and will require frequent handling , turning and lifting . Newborn foals often weigh in excess of 50 kg and can be unwieldy to move due to their shifting centre of balance . Personnel involved in lifting foals will need to be familiar with industry standards on safe lifting practices , to minimise the risk of harming themselves .
Foals must never be lifted by their rib cage or have pressure exerted on their abdomen . The best way to raise a foal into a standing position is to first sit it in sternal recumbency ; then , with at least two people , lift the elbows and stifles with the legs positioned under the foal . The use of aids such as stretchers and wheeled trolleys can assist in moving foals around the clinic .
Thermoregulation
Positioning
Timing of adjustment
Encouraging standing
Skin hygiene
Supplemental oxygen therapy
Even when maintained in sternal recumbency , foals need to be repositioned with their hindlegs rotated from one lateral to the opposite lateral position .
When it is lying in lateral recumbency the foal must be turned every 2 hours , from one side to the other .
Assisting or encouraging recumbent foals to a standing position for short periods of time will stimulate them to awaken and will encourage normal foal behaviours .
Scrupulous attention should be paid to keeping the foal ' s delicate skin clean and dry , to prevent scalding and maceration .
When soiled , incontinence pads and other materials used to absorb urine and faeces must be changed immediately .
Frequent arterial blood gas analyses will determine whether measures to keep the foal in sternal recumbency are effective and will help to assess the need for supplemental oxygen therapy .
Sick neonates have an underdeveloped thermoregulatory system and are often unable to stabilise their body temperature . They are particularly susceptible to hypothermia , and lose significant heat through conduction when in contact with cold floors or housed in draughty stables .
Efforts must be made to keep the foal warm and dry . It should be housed in draught-free accommodation on a raised bed , with stable heaters ( wall-mounted or ceilingmounted heat lamps ). Foals with cool ears and distal limbs may have decreased peripheral perfusion , which should be confirmed and addressed .
Cooling is accelerated when the foal ' s skin is wet , due to the effects of evaporation , so keeping the foal dry is essential . Administering IV fluids cooler than the core body temperature will also contribute to heat loss . It is good practice to administer warmed IV fluids to try to maintain the body temperature .
Foil emergency blankets and self-warming blankets ( BARRIER EasyWarm , Mölnlycke Health Care Ltd ) are excellent single-use products that assist in warming patients in an emergency setting ( Figures 2 and 3 ). Forced-air warming blankets ( Bair Hugger Animal Health Blanket , 3M ) provide efficient and rapid warming . However , although they are superior in their instant convective warming abilities , the noise and appearance of these devices can cause alarm in the accompanying foal-proud mare , which may then require sedation .
Seizures in the sick neonate are common and are often associated with sepsis , neonatal encephalopathy , shock and trauma [ 1 ] . If seizures are not controlled , the foal can suffer significant hyperthermia as a result of repeated seizure activity . This affects respiration , causes blood gas imbalances and affects pulmonary function , increasing the possibility of further seizures .
30 Veterinary Nursing Journal