Plus-Hex CLINICAL
Obtunded patients are at increased risk of developing hypothermia ; they are inactive , so are not producing heat through muscle movement , and may have impaired thermoregulation . Pyrexia is commonly seen in dogs with aspiration pneumonia [ 3 ] , but , as it involves an increase in the thermoregulatory set point of the hypothalamus , cooling methods are generally considered ineffective unless the pyrexia is severe .
Additional nursing interventions are needed for the obtunded patient . The VN should provide padded bedding , and change the patient ' s position every 4 hours to prevent decubitus ulcers and lung atelectasis . Coupage can be considered when turning the patient to help mobilise lung secretions . The bladder should be expressed regularly . Alternatively , urinary catheterisation would prevent urine scalding and allow monitoring of urine output ; however , this method carries a risk of urinary tract infection .
If the patient cannot blink , a lubricant gel should be applied to the eyes every 2 hours to prevent them drying out or developing corneal ulcers , especially as there is a higher incidence of keratoconjunctivitis sicca and corneal ulcers in brachycephalic patients [ 27 , 36 ] .
Fluid therapy
Treatment for aspiration pneumonia should include IV fluid therapy to address deficiencies in hydration and perfusion . Although this patient was normotensive on presentation , aspiration pneumonia can result in
hypotension through the activation of the inflammatory response [ 4 ] . Additionally , Dear [ 20 ] suggests that hydration is important to aid the clearance of airway secretions . Part of the VN ' s role is the calculation and provision of fluid therapy , as shown in Figure 1 .
The VN is instrumental in providing and monitoring fluid therapy . Initially , the VN should address hypovolaemia by administering crystalloids , such as Hartmann ' s solution , which are prescribed by the attending VS ; shock doses of fluids are typically prescribed . Once the patient is normovolaemic , the VN can estimate dehydration . Chronic fluid therapy is based on a combination of rehydration , maintenance fluid requirements and the replacement of any ongoing losses [ 17 ] .
In aspiration pneumonia patients , overhydration can worsen fluid extravasation into the pulmonary parenchyma [ 4 ] . The VN should therefore monitor the patient ' s hydration status and adjust the fluid rate as necessary . Hydration parameters include :
• respiratory rate , effort and noise
• mucous membrane moisture
• skin turgor
• bodyweight [ 37 ] .
Changes in these parameters or the presence of serous nasal discharge or peripheral oedema may indicate fluid overload .
Figure 1 . Calculations for a dog receiving intravenous fluid therapy .
Volume 39 ( 6 ) • December 2024
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