Plus-Hex CLINICAL
Figure 1 . An ECG trace taken from the patient soon after admission , showing pronounced , high T waves .
of contact [ 18 , 19 ] but an increased level of comfort for the patient [ 20 ] . Research into other stress-free techniques for acquiring an ECG , to include textile electrodes , could change future practice [ 17 ] .
Severe hypocalcaemia can cause cardiopulmonary arrest ( CPA ) in a small number of patients [ 21 ] , especially those with an iCa of less than 0.5 – 0.6 mmol / l [ 2 ] . Luschini et al . [ 21 ] demonstrated a statistically significant association ( p = 0.002 ) between the severity of hypocalcaemia and the morbidity of the patients in their study . When calcium supplementation has begun , bradycardia or arrhythmias can further develop , which can predispose the patient to CPA [ 2 ] . On reflection , although the team deemed the patient in this case to be critical , and delivered intense monitoring and nursing care , preparation for CPA could have been improved to include calculating emergency drug doses , collecting equipment nearby and staff readiness [ 22 , 23 ] . It was later noted that a resuscitation code had not been discussed with the owner to give them the opportunity to opt into or out of resuscitation . It is important that VNs , as veterinary professionals , act in the best interest of the patient and owners while gaining informed consent [ 14 ] . It is therefore recommended to gain a resuscitation code for all patients attending the practice . The practice in this case has since changed its policy , and on admission of patients it now requires owners to give written authority to resuscitate or not resuscitate on the consent forms .
Management of seizures
The patient had already had partial and full seizure episodes at home , so preparation for a possible seizure in the hospital was essential [ 24 ] . However , a seizure management plan was not established at the time of the patient ' s admission . As a result , when the patient first experienced a seizure in the hospital , the nursing team had not been pre-authorised to administer specific medications to control it . However , the team was still able to respond promptly and administer the necessary medications under veterinary supervision and prescription . The literature recommends the discussion of a seizure plan for the hospitalised patient so medications can be administered if the VS is not available [ 24 ] . In accordance with the RCVS CoPCVN , VNs are not allowed to prescribe medication but are able to administer medication under the direction of the VS [ 14 ] . The team created a seizure plan after the first seizure , which was implemented in response to the second seizure in the hospital . It was clear that the VNs understood the evidence-based standard of care for this patient [ 24 , 25 ] , evaluated the evidence and improved their approach to the patient ' s treatment , which is vital in critical patients .
During the patient ' s hospital stay , care was provided by a large team of VNs , who used both written and verbal communication to ensure optimal care . Given the severity of the patient ' s condition , precise communication and meticulous record-keeping were essential to prevent treatment errors and to closely monitor the patient ' s status and response to interventions [ 15 ] . The VNs used visual aids on the kennel to ensure all staff were aware the patient was to be carefully watched due to seizure activity . Signs were also placed on the doors into the kennel area to prevent heavy foot traffic through this area , so the patient was not over-stimulated [ 26 ] .
Future recommendations
Having reflected on the care provided in this case , the author recognises that the VNs delivered evidence-based nursing care within the legal scope of the VN ' s role . However , there are a few aspects of the management of a hypocalcaemic patient that could be improved on in future practice , such as ensuring the discussion of a seizure plan on admission . The author recommends
Volume 40 ( 1 ) • February 2025
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