Plus-Hex CLINICAL
Introduction
This case study and patient care proposal will explore the treatment options and potential nursing interventions for a seizuring canine patient with aspiration pneumonia . It will focus on the role of the veterinary nurse ( VN ) in providing nursing care to address the patient ' s initial needs of respiratory support , neurological monitoring and fluid therapy .
Patient signalment
Species Breed Age
Dog French bulldog 4 years Sex Male ( neutered ) Weight
7.8 kg
Patient presentation
The patient presented in status epilepticus having been seizuring for approximately 15 minutes . On arrival , he was given a single 10 mg dose of diazepam rectally , which resolved the seizures . An intravenous ( IV ) catheter was placed in the left cephalic vein to allow IV administration of fluid therapy and further antiepileptic medication if required .
A summary of the patient ' s initial assessment follows . Cardiovascular system
The patient ' s heart rate was 168 beats per minute with good-quality synchronous pulses . Mucous membranes were pink with a capillary refill time of 1 second . Systolic blood pressure was 174 mmHg .
Respiratory system
The patient was panting continuously . It was difficult to auscultate the thorax due to excessive upper respiratory noise .
Neurological system
The patient was obtunded following drug administration .
Temperature The patient ' s temperature was recorded at 41 ° C . Other The patient was noted to be hypersalivating .
Patient admission and diagnosis
The patient was slowly cooled using tepid water , applied using a shower head over a sink , until his temperature was 38.5 ° C . IV fluid therapy was initiated with Hartmann ' s solution at 4 ml / kg / hour .
A blood sample was taken for minimum database biochemistry , packed cell volume ( PCV ) and total protein ( TP ) measurement . These analyses revealed a lactate of 4.8 mmol / l ( reference range 0.5 – 2.0 mmol / l ) and a blood glucose of 10.7 mmol / l ( reference range 3.6 – 6.2 mmol / l ). The partial pressure of carbon dioxide in arterial blood ( PaCO 2
) was 28 mmHg ( reference range 32 – 43 mmHg ) and pH was 7.50 ( reference range 7.35 – 7.46 ) [ 1 ] . All other parameters were unremarkable .
Following admission , the patient had three more generalised tonic-clonic seizures over the next 6 hours . Each one was treated with 0.5 mg / kg diazepam intravenously and he was given incremental doses of phenobarbital up to a total loading dose of 16 mg / kg .
There was no history of previous seizures or trauma , and the client reported that the patient had no access to toxins . The patient was scheduled for further investigations , comprising MRI and a cerebrospinal fluid tap , once he was in a more stable condition .
The patient was admitted to the hospital for ongoing care . He remained obtunded following the administration of antiepileptic drugs , with a normal pupillary light reflex and menace response bilaterally .
After 24 hours , an increase in respiratory rate and effort was noted , and ultrasonography of the thorax revealed B-lines bilaterally . Thoracic radiography showed an interstitial pattern in the right cranial and middle lung lobes . Aspiration pneumonia was diagnosed .
Aetiology and pathophysiology
Aspiration pneumonia refers to inflammation and bacterial infection caused by the inhalation of foreign material [ 2 ] . Exposure to acidic gastric fluid results in pulmonary damage , which triggers an inflammatory response and predisposes the tissue to secondary bacterial infection [ 3 ] . The severity of the response depends on the aspirate ' s volume and composition [ 4 ] .
Inflammatory mediators cause increased endothelial permeability , resulting in the accumulation of protein and fluid in the alveoli [ 4 ] . The resulting loss of surface area inhibits gas exchange , leading to ventilation – perfusion mismatch and hypoxia [ 5 ] . Aspiration can also cause bronchoconstriction ; the increased airway resistance increases the patient ' s breathing effort . These changes cause the clinical signs typically seen , including tachypnoea , increased respiratory effort , harsh lung sounds and crackles on auscultation .
Volume 39 ( 6 ) • December 2024
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