that any patient admitted to the hospital with a history of seizures should have a seizure plan in place from the outset . In a busy hospital , there is a low likelihood of a VS being immediately available to prescribe antiepileptic medications . Therefore , clear communication and delegation from the VS in charge allows VNs to act without a VS present . Creating treatment plans such as a seizure plan can truly maximise the role of a VN , while still following the RCVS CoPCVN . Changes in veterinary culture are important to encourage the full use and empowerment of VNs , especially when their knowledge and skills can be a vital contribution to a patient ' s care .
Preparation for how critical a patient may become could also be improved . A resuscitation status should be discussed on the admission of all patients , regardless of their condition or procedure , to ensure the owner ' s wishes are followed accurately , that is , whether they want their pet to be resuscitated in the event that the need arises . The location of the patient ' s kennel in relation to where emergency cases are handled or where crash equipment is stored should also be considered . Alternatively , keeping emergency equipment near to the patient can enhance the efficiency of care if the patient experiences CPA .
Calculating in advance the doses of emergency medication specific to the patient will also improve the response time and quality of care . Emergency cases are infrequent in most practices , so staff confidence in handling them may be low . Having the necessary equipment ready and a clear plan in place can reduce stress and boost confidence .
Ensuring staff participate in regular training exercises will help them approach an emergency patient with greater confidence . VNs can have extensive knowledge gained from years of experience , and possibly extra related certificates and qualifications , so it is important to maximise these skills to help train and lead others .
Conclusions
The patient was able to leave the hospital 4 days after his initial presentation . He remained on calcium and vitamin D supplementation after discharge to help maintain the blood calcium concentration . The patient is still doing well a year after admission and treatment .
It was clear that the VNs played a vital role in this patient ' s care . Close monitoring was necessary during treatment and the VNs ' knowledge allowed them to advocate for the patient when it was important .
Critical patients , such as the one in this case report , can be a challenge , but regular monitoring to track their response to treatment can help guide their care . Regular epoc measurements were taken while the patient was hospitalised to evaluate the success of the calcium supplementation , and this approach is recommended [ 16 , 27 ] .
Arbaugh et al . [ 28 ] monitored iCa every 4 – 5 hours , which supports the actions taken by the team in this case . It can therefore be concluded that the team administered emergency and oral calcium supplementation appropriately considering the available literature .
Assessment of learning
1 . What should be tested to determine whether a patient is hypocalcaemic ?
a ) Total calcium b ) Ionised calcium c ) Total and ionised calcium d ) None of the above
2 . What value of iCa is associated with severe hypocalcaemia ?
a ) > 1.2 mmol / l b ) > 0.9 mmol / l c ) < 0.8 mmol / l d ) < 1.2 mmol / l
3 . What is a known complication of calcium supplementation ?
a ) Panting b ) Bradycardia c ) Hyperthermia d ) Ventricular premature complexes
4 . What changes can be seen on an ECG due to hypocalcaemia ?
a ) Deep T waves b ) Prolonged QT intervals c ) Prolonged ST intervals d ) All of the above
5 . What should a VN do for a patient that is a seizure risk ?
a ) Create a seizure plan with the VS in charge b ) Decide the medication needed yourself c ) Wait until the animal seizures to decide its treatment
d ) Put the patient in a kennel that is out of the way to avoid stimulation
28 Veterinary Nursing Journal