Patient outcome
One week after being admitted to hospital , and after showing improvement in her clinical signs , Ruby ' s appetite returned and she regained the ability to urinate and defaecate independently . Following discussion , it was decided that her owners could continue Ruby ' s nursing care and physiotherapy exercises at home , in more relaxing and familiar surroundings , without the distractions of the hospital environment .
Ruby was able to walk with assistance while in her Help ' Em Up harness . Her owners were given instructions on how to support her in sternal recumbency to provide safe access to food and water , to reduce the risk of aspiration due to the pharyngeal and oesophageal dysfunction often seen in patients with lower motor neuron diseases [ 1 ] . They were also given instructions on how to perform her physiotherapy exercises .
After 3 weeks , Ruby returned to see the rehabilitation team so her progress could be assessed ( Figure 9 ). She is now fully ambulatory and continues to make progress towards being her normal self .
Acknowledgements
The author would like to thank the neurology and rehabilitation departments at Langford Vets Small Animal Referral Hospital , where this case was based .
Assessment of learning
1 . How do clinical signs progress in dogs with polyradiculoneuritis ?
a ) Ascend ( caudal to cranial ) b ) Descend ( cranial to caudal ) c ) Stay the same d ) No clinical signs
2 . What nursing consideration needs to be made with dogs that have polyradiculoneuritis ?
a ) Gag reflex checks b ) Respiratory rate and effort c ) Regular turning to prevent pressure sores d ) All of the above
3 . How should patients with polyradiculoneuritis be offered food and water ?
a ) In whatever position they are comfortable b ) Sternal recumbency c ) Food and water should be withheld
4 . What medical condition can be ruled out to assist with diagnosis ?
a ) Eye ulcers
Figure 9 . Ruby being assessed by a member of the rehabilitation team during a follow-up appointment . b ) Megaoesophagus c ) Osteoarthritis
Conclusions
Patients with neuromuscular conditions such as polyradiculoneuritis can be challenging to nurse , due to the high level of care they require in the form of nutrition , hygiene , mental stimulation and rehabiliation , as well as addressing comorbidities such as aspiration .
However , because they require intensive nursing , these patients can also be extremely rewarding . Such cases demonstrate the vital role of VNs and support staff in patient recovery .
1 . a ) Ascend ( caudal to cranial ) 2 . d ) All of the above 3 . b ) Sternal recumbency 4 . b ) Megaoesophagus
Answers
50 Veterinary Nursing Journal