Plus-Hex CLINICAL
ABSTRACT This case study and nursing care analysis explores the treatment and nursing interventions for a hospitalised dog that showed signs of significant stress .
The patient was admitted for a computed tomography scan , followed by an anal sacculectomy the following day . The patient did not exhibit signs of stress during the initial consultation , nor was it identified as a potential problem by the owners . However , the patient quickly showed signs of stress on admission .
The veterinary nurses , veterinary surgeon , anaesthetist and other team members worked together to develop , implement and adapt a stress management plan to support the patient while in hospital . The case is evaluated and additional learnings shared .
Keywords stress , management , nursing , canine , dog , in-patient , hospitalisation
Patient signalment
Species Breed Age
Dog Labrador 8 years Sex Male ( neutered ) Weight
34.6 kg
Arrival and admission
On admission , the patient ( not pictured ) – which was admitted for a computed tomography ( CT ) scan and anal sacculectomy – arrived with his owners and was friendly and calm in their presence . He had a positive demeanour during the clinical examination and on arrival at the surgical ward where he was to be hospitalised for the procedures . The patient was placed in a walk-in kennel with a glass door , orthopaedic mattress , vet bed and bowl of water .
The patient began to show initial signs of stress by panting , barking and standing up once the kennel door was closed behind him . The ward was calm and quiet and there were no obvious triggers that might have initiated this stress . When given attention , the patient would attempt to barge out of the kennel but was obedient and manageable , and recognised commands such as ‘ sit ’, ‘ stay ’ and ‘ lie down ’. He would comply with commands for a few seconds but his stress levels were too high for him to relax .
A veterinary nurse ( VN ) took the patient from his kennel and took him into the preparation area to place an intravenous ( IV ) line . Here , two VNs were required to keep the patient seated while another VN placed the IV catheter . He continued to pant throughout this procedure but was amenable . Owing to the age of the patient , it is possible that he had osteoarthritis , so he may have found this restraint uncomfortable . Pain scoring could have been conducted beforehand – to identify whether the patient would have benefited from analgesia before the IV catheter was placed – and the results discussed with the veterinary surgeon ( VS ) before going ahead . The first IV placement was successful and the patient was taken back to his kennel , but his stress levels continued to rise .
A neckerchief and blanket were sprayed with Pet Remedy , with the neckerchief then secured around the patient ' s neck and the blanket left in his kennel . Pet Remedy is a clinically proven natural remedy used to promote calm and emotional wellbeing , with two sprays lasting 2 – 6 hours [ 1 ] . Unfortunately , the patient did not respond to Pet Remedy . Another product , Adaptil – a spray containing fast-acting synthetic pheromones , with effects lasting 4 – 5 hours [ 2 ] – could have been tried with this patient , but it was not in stock at the time .
Initial procedure
The patient was taken for his CT scan , where he was given 0.2 mg / kg butorphanol and 5 μg / kg medetomidine for sedation , which worked well . To support a slower , calmer recovery , the patient was not given a reversal agent .
As the patient would be hospitalised overnight to have surgery for an anal sacculectomy the following day , the in-house stress score guide ( Appendix 1 , pages 44 and 45 ) was used to determine the next steps , and a stress management plan was obtained from the VS . The VS advised that , when recovered , the patient could be given 10 mg / kg trazodone ( administered as two 150 mg tablets ) to assist with his stress levels .
Recovery and overnight care
On recovery , the patient urinated in his kennel . The bladder should ideally be expressed before the patient wakes up to prevent such incidents . A stress recovery plan had been discussed with the VS , allowing 1 μg / kg medetomidine to be given intravenously , if required . This is an alpha-2 adrenoceptor agonist , which acts as a sedative to minimise recovery stress and reduce the risk of self-injury . As medetomidine can increase urinary output , patients should have more frequent walks and have their kennels checked regularly for signs of urine [ 3 ] .
When fully awake , the patient was taken for a walk to see if this alleviated any stress , and enrichment was provided in the kennel , including a Kong toy , a soft toy and a Dentastix chew provided by his owners on admission .
Volume 39 ( 6 ) • December 2024
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