Plus-Hex CLINICAL
The patient was ventilated during the surgery to maintain end-tidal carbon dioxide and prevent irregular breathing, which could prolong the surgery time. In accordance with the hospital protocol, as the patient was young, his blood glucose( BG) was monitored every hour. This is because young animals have a high metabolic rate and are therefore at risk of hypoglycaemia when they are not regularly ingesting food. The patient ' s BG was stable throughout and he did not require glucose supplementation.
The foreign material was removed from the jejunum. The patient ' s recovery phase was uneventful.
Post surgery
A set volume of water was placed in the patient ' s kennel to allow his water intake to be measured. Urination was monitored for changes in the urine stream, odour, colour and volume. Dehydration is indicated when the urine is dark yellow [ 13 ]. The patient ' s hydration status was also monitored using the tent technique and identifying physical indications such as sunken eyes, which would indicate a 10 – 12 % loss of bodyweight due to dehydration [ 10 ]. Thomas et al. [ 7 ] suggest that sunken eyes have a diagnostic sensitivity of 62 %, meaning this is quite a reliable tool when establishing hydration status.
Constable et al. [ 8 ] state that loss of fluid from the interstitial and intracellular compartments leads to diminished skin elasticity, dryness of the skin and mucous membranes, and enophthalmos resulting from decreased post-orbital fat volume. This is relevant to this case, as the patient was showing weakness in the extremities, which supports the bloodwork findings indicative of dehydration; he also had tacky oral mucous membranes, another sensitive indicator of dehydration [ 7 ].
Hydration status can also be evaluated subjectively by checking the dryness of the oral cavity, and objectively by measuring urine specific gravity( USG) [ 13 ]. If the USG reading on the refractometer is higher than 1.030 it is considered pathological; this would have been a good method of checking the patient ' s hydration. Constable et al. [ 8 ] also explain that reduced circulating blood volume contributes to the mental depression of dehydrated patients.
An awareness of risk factors for dehydration, such as vomiting, diarrhoea, inappetence, temperature and disease processes, can help when providing holistic care, maximising the effectiveness of patient monitoring, meeting patient needs and ensuring a good recovery.
As with all in-patients, the patient ' s faecal excretions were documented to assess his faecal output. Preoperatively, it was unclear whether he had passed faeces since the onset of illness. Following removal of the foreign body, the passage of faeces was regarded as a positive indicator, suggesting successful alleviation of the gastrointestinal tract obstruction. The lack of urine production, despite the patient being on intravenous fluids, was not a surprise due to his level of dehydration.
Patient care plan
The patient ' s care plan was as follows:
• Monitor BG every hour until the patient is eating; if BG is < 2.5 mmol / l, offer food. If food is refused, apply glycerol on the gums. The patient ate 3 hours after recovering from anaesthesia so did not require hourly monitoring of BG for long.
• Continue the lidocaine constant-rate infusion( CRI) until finished. Four hours after the lidocaine is finished, start giving paracetamol IV at 10 mg / kg every 8 hours.
• Give an IV dose of meloxicam 0.2 mg / kg at 11 am on the day after surgery if the patient has eaten well.
• Continue cefuroxime every 8 hours overnight at 22 mg / kg. Switch the patient to oral amoxicillin trihydrate and clavulanic acid( Synulox, Zoetis) the morning after surgery( 12.5 – 20 mg / kg PO BID for 5 days).
• Continue to provide IVFT of Hartmann ' s solution with 20 mmol potassium at 4 ml / kg / hour until the patient is eating well.
• Offer the patient a palatable gastrointestinal low-fat( GILF) diet postoperatively. GILF is palatable, easily digested by the gut and is less likely to cause gastric upset than other diets.
• Veterinary care assistants to provide short walks on the lead and harness, to prevent rapid increases in blood pressure, which could result in bleeding or surgical site complications such as tears / irritation caused by excessive movement.
Evaluation of patient care
When handling the patient, care was always taken to ensure he had a positive experience. When he first entered the consulting room, he was approached slowly, with caution; a hand was offered for the patient to sniff in order for him to become familiar with the veterinary team. The patient was allowed to sniff the stethoscope before its use, to reduce stress associated with unfamiliar objects.
On admission, the patient was gently moved on to an orthopaedic mattress to optimise his comfort. This provided a positive experience for the patient and enabled treatments to be given with minimum stress.
Volume 40( 6) • December 2025
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