Analysis of the nursing care
On presentation, the patient was very fearful, hissing and trying to escape. This may have been exacerbated by pain, discomfort from being in the cat carrier, an unfamiliar environment, and the unpredictability of the procedures and handling [ 26 ]. For staff safety, a cat mask was fitted and he was wrapped in a towel for IV catheter placement. However, this can cause distress through immobilisation and restricting sensory perception [ 20 ].
It may have been beneficial to apply a topical anaesthetic ointment such as EMLA cream prior to IV catheter placement [ 17 ]. Another technique to reduce stress could have been to play calm music, to hide sounds made by machines and other patients [ 27 ]. However, this patient was extremely stressed, in pain and in need of urgent treatment. It was felt, therefore, that the more rapid approach was in the best interests of the patient.
Once medications were given and the urinary catheter was in situ, the patient was calmer. Following this, a‘ less is more’ approach was used for collecting blood samples from the medial saphenous vein, which was well tolerated. A small volume of blood was taken, to reduce the risk of bruising, every 12 hours [ 17 ]. Another consideration would be placing a central venous catheter during the same sedation as the placement of the urinary catheter, to allow for easy blood sampling [ 4 ].
In the quiet cat ward following the unblocking procedure, partially covering the patient ' s kennel door with a towel can help the cat feel secure. It also offers a surface for facial rubbing, facilitating the release of the F3 pheromone, which reassures them they are in their own domain [ 27 ].
The use of Feliway spray before the procedure, along with analgesia, may have improved the ease of handling the patient. Feliway spray has also been proven to be effective in increasing food and water intake, reducing stress and making handling easier [ 28 ].
The owner was given specific visiting times in the mornings and evenings, giving the patient a routine, which also helps to reduce stress [ 17 ]. During these visits, the patient was relaxed and benefited from having time without the Elizabethan collar and being groomed, reducing his stress and helping him tolerate the collar [ 17 ].
Minimising patient stress also helps to promote appetence [ 17 ], so it was important to maintain a calm environment and good analgesia. Additionally, a variety of foods was offered, but the patient showed no interest in eating, and so mirtazapine was administered, which did help the patient to eat.
Had the patient still not eaten, a feeding tube might have been required [ 17 ]. A naso-oesophageal or nasogastric tube could have been placed while the patient was sedated for the urethral unblocking procedure. These tubes are well tolerated and minimally invasive, although they can be associated with complications such as rhinitis, epistaxis and inadvertent tracheal intubation [ 29 ].
The patient should be weighed daily to help monitor nutrition [ 17 ] and hydration status. This was done three times daily, as per the VS ' s instructions. The patient ' s weight remained static throughout hospitalisation.
The practice policy for assessing pain in feline patients is to use the Colorado State University Feline Acute Pain Scale [ 2 ]. This pain scale is convenient to use, but it is not validated [ 21 ]. A better option is the validated Glasgow Feline Composite Measure Pain Scale, which is also easily accessible and reduces subjectivity [ 6 ]. However, the patient remained comfortable after the procedure, so the pain scale used was effective with this patient.
Conclusions
Standard operating protocols were followed, but the patient ' s care was individualised to suit his needs. After initial triage, the patient was quickly diagnosed with feline urethral obstruction following the blood work, which confirmed hyperkalaemia.
Hydration and analgesia were carefully managed, as was catheter care. Recognising the patient ' s level of stress and the risks associated with the condition were important in determining the best actions to take. Owner education was also important to ensure the patient ' s ongoing wellbeing.
This patient remained on a prescription urinary diet and had had no further urethral obstruction 12 months following discharge.
REFERENCES
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2 Hellyer PW, Uhrig SR, Robinson NG. Feline Acute Pain Scale. Colorado State University. 2006. Available from: https:// vetmedbiosci. colostate. edu / vth / wp-content / uploads / sites / 7 / 2020 / 12 / feline-pain-scale. pdf [ Accessed 21 January 2025 ].
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4 Mistry K, O ' Byrne E. Nursing a patient with feline urethral obstruction. The Veterinary Nurse. 2024; 15( 1): 23 – 28. Available from: https:// www. theveterinarynurse. com / content / clinical / nursing-a-patient-withfeline-urethral-obstruction / [ Accessed 25 September 2025 ].
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