Plus-Hex CLINICAL
Figure 6 . Ruby in her Help ' Em Up harness .
Figure 7 . Ruby in her Help ' Em Up harness .
Food and water were offered when Ruby was in sternal recumbency to help prevent aspiration . Before any attempt was made to offer food or water , her gag reflex was checked by applying external pressure to the hyoid bones to stimulate swallowing or by stimulating the pharynx with a finger to elicit a gag [ 1 ] . Initially , Ruby did not want to eat or drink . During this period , she received intravenous fluid therapy with crystalloids ( Hartmann ' s solution ) at 2 ml / kg / hour , to ensure her natural losses from breathing , urinating and defaecating were replaced and her fluid balance was maintained [ 11 ] . After 3 days she began to show neurological improvements and regained her appetite .
The correct balance should be found between nursing care and patient rest , but mental stimulation is often neglected with recumbent patients [ 12 ] , and it is important to consider the mental wellbeing of patients that do not have the physical ability to move . Therefore , time was spent with Ruby on activities such as grooming and bathing to ensure her hygiene needs were met , and carrying her outside to a garden where she could lie down and enjoy the scents and sounds of the outdoors ( Figure 8 ).
Ruby ' s owners visited regularly , spending time with her in a dedicated covered neurology garden area . This meant they were able to see her day-to-day progress , and the regular visits also helped them understand and process all the information being given to them by the veterinary team .
Additional nursing considerations
In addition to treatment and rehabilitation , it is important to consider the other needs of recumbent patients such as Ruby during their hospitalisation , and fundamental nursing care is crucial .
Ruby was housed in a kennel with a specialised orthopaedic mattress . This helped to prevent pressure sores , which commonly develop when patients are lying on bony prominences , such as their shoulders and hips , for long periods of time [ 11 ] .
Although Ruby was urinary continent , an indwelling Foley catheter was placed , with a closed system in the form of a collection bag , to help maintain cleanliness and prevent urine scalding . When Ruby was very recumbent , she was not able to move herself away from soiled bedding . The urinary catheter and collection system helped to ensure that she did not develop any sore areas on her skin from urine or subsequent regular bathing . It also helped to avoid any patient stress associated with bed soiling . The collection system also allowed Ruby ' s urine output to be measured to monitor her hydration status . Her normal urine output was expected to be in the range of 1 – 2 ml / kg / hour [ 11 ] .
Figure 8 . Ruby enjoying time outdoors on the grass .
Volume 40 ( 2 ) • April 2025
49