Discussion
Severe pain is common in FATE patients and must be controlled effectively ( Appendix 5 , see page 55 ) [ 6 ] . Clinical signs of acute pain include an increased heart rate , open-mouthed breathing and a change in demeanour [ 14 ] . With this patient , care was taken to select analgesic drugs that provided appropriate pain relief and were suitable for cardiac-compromised patients . IV opioids present a lower risk to these patients compared with drugs such as ketamine , which may increase the heart rate . This could alter the patient ' s demeanour and subsequently affect its respiratory effort , which , in turn , could affect the cardiovascular state [ 16 ] .
Ideally , frequent pain scoring should be carried out by the same person using the same method , to ensure consistency and avoid subjective observations . In this case , it was not always possible for the same person to carry out the pain scoring , due to the busy nature of the large hospital . However , clear communication between staff ensured that any concerns about the patient ' s pain levels were promptly discussed with the veterinary surgeon . In this case , the CMPS-Feline pain scale was used [ 17 ] , but other fast , reliable methods of assessing pain are available , including the Feline Grimace Scale ( FGS ) [ 18 ] . Regardless of the pain-scoring method used , consistency , continuity and communication should be priorities within a patient-centred approach . In addition , clinical judgement is also important when considering pain , as well as taking into consideration external factors that may inhibit or disrupt the display of normal behaviours in a feline patient .
If pain is identified in a patient , a pain plan should be created promptly and monitored regularly to ensure pain control is sufficient . Methods of analgesic drug administration include the epidural , parenteral and transdermal routes [ 9 ] .
On arrival of the patient in this case , a priority was to stabilise his breathing . Acute management of his cardiac disease and concurrent congestive heart failure was managed with flow-by oxygen , analgesia ( methadone and then buprenorphine ) and diuretics ( furosemide ). There are recommendations that the use of topical nitroglycerine could help resolve the congestive state [ 14 ] , but this was not used in this case as the opioids administered achieved the desired outcome while also minimising any cardiovascular effects [ 16 ] .
Further details of the drugs prescribed in this case and the reasoning for their use can be found in Appendix 5 , Table 3 ( see page 55 ), along with recommendations for FATE therapy from Luis Fuentes [ 6 ] in Appendix 5 , Figure 5 ( see page 55 ).
The patient underwent hospitalisation and care in the ICU . A dog was recovering in the kennel below , due to lack of space in the ICU . This was not ideal and , although steps were put into place to minimise stress to the patient , such as a pheromone diffuser ( Feliway ) and covered doors , having a separate feline ICU would have been preferable .
To prevent further complications , the patient ' s haematology and biochemistry panels were reviewed frequently , which avoided issues such as hyperkalaemia from reperfusion syndrome caused by high potassium levels . Fluid therapy was closely monitored to avoid the build-up of toxins from ischaemia and maintain perfusion to the kidneys and the liver .
Conclusions
This case had a positive outcome , but patients with FATE are at a high risk of the condition recurring . Therefore , advice on medical management for preventative therapy is given in these cases and euthanasia is suggested if deterioration occurs .
Assessment of learning
1 . Which is a clinical sign of aortic thromboembolism ? a ) Cold limbs b ) Hindlimb paralysis c ) Absent femoral pulses d ) All of the above
2 . What nursing is required with suspected FATE ? a ) Frequent pain scoring b ) Nutritional management c ) Mannitol d ) Temperature stabilisation and monitoring
3 . Which pain scoring method was used in this case ?
a ) Glasgow Feline Composite Measure Pain Scale ( CMPS-Feline )
b ) Numerical Rating Scale ( NRS ) c ) Visual Analogue Scale ( VAS )
1 . d ) All of the above 2 . a ) Frequent pain scoring 3 . a ) Glasgow Feline Composite Measure Pain Scale ( CMPS-Feline )
Answers
54 Veterinary Nursing Journal