Plus-Hex CLINICAL
elbows. A short period in sternal recumbency between turning from one side to the other can be beneficial, and this can conveniently coincide with offering food and water and ensuring the patient is clean and dry. Brief periods in this position also support the patient ' s mental wellbeing by allowing improved environmental engagement and reducing the stress associated with prolonged lateral recumbency.
Nutritional support is another important aspect of nursing care, particularly for recumbent patients that are unable to access food or water independently. Taking the time to hand-feed or encourage these patients to eat and drink, both within and outside the kennel environment, supports adequate nutrition and hydration while also offering valuable mental stimulation and contributing to holistic patient care [ 8 ].
The incorporation of interactive feeding tools such as puzzle feeders, lick mats and Kongs can further enhance patient wellbeing. These methods promote cognitive engagement and facilitate self-soothing behaviours through the release of endorphins associated with repetitive licking actions [ 9 ]. Adding a section to the hospital sheet to remind the nursing team to offer water regularly( every 2 – 4 hours) will mean that this is not missed for those patients that are unable to move to access their water bowl independently due to either recumbency or pain on initial presentation. Intravenous fluid therapy can be started and maintained if deemed appropriate by the VS.
Patients with spinal conditions may also experience a loss of bladder function, particularly when the hindlimbs are affected. Both the severity of spinal cord compression and the degree of neurological disruption influence the neural pathways supplying the bladder, which will determine the pattern of dysfunction observed. Recognising whether a patient presents with an upper motor neuron( UMN) or lower motor neuron( LMN) lesion is essential for appropriate bladder management.
In a UMN lesion, voluntary control is lost but reflex activity is preserved. The bladder typically becomes large, firm and difficult to express due to increased urethral sphincter tone, and patients may leak small amounts of urine secondary to overflow. In LMN bladder dysfunction, both voluntary control and reflex detrusor function are impaired. The bladder is usually large, flaccid and easy to express, with reduced urethral sphincter tone. Continuous dribbling of urine is common, and these patients are at increased risk of urine scalding and ascending urinary tract infections. Understanding these patterns provides a clear rationale for tailored bladder management plans, including manual expression, catheterisation and appropriate skin care.
Manual expression of the bladder is often the goto management technique. Aseptic placement of a urinary catheter( either temporary or indwelling) should be considered in patients where manual expression is not tolerated [ 8 ]. The equipment needed for this procedure is shown in Figure 5.
Exercise should be kept to a minimum; however, dogs may be taken out for short, assisted walks if it is safe to do so, using a lead and harness. This allows them the opportunity to toilet independently, where possible, and provides mental stimulation. Walking aids such as a sling or rear-support harness( Figure 4) should be used for paraparetic or paraplegic patients, plus an additional front sling or appropriate, fully supportive front harness for tetraparetic or tetraplegic patients [ 8 ]. All walking aids should be of an appropriate length to ensure the handler can manoeuvre the patient safely without overreaching, and the handler should always be able to maintain a straight back to protect their own posture.
Figure 5. Equipment for the placement of a sterile urinary catheter: gloves, dilute iodine and swabs for cleaning; sterile gloves; sterile lubrication; sterile, appropriately sized urinary catheter; three-way tap and syringe; collection dish.
Figure 4. A dog with a harness to assist with walking.
Manual expression should be performed a minimum of once a day, but ideally two or three times daily to prevent bladder overdistension [ 10 ], or more frequently if a patient is leaking urine in between these times. Intermittent use of ultrasound scanning to monitor urinary bladder size is informative and well tolerated, and is particularly beneficial in patients where manual palpation is challenging, such as those that are overweight or whose temperament limits handling [ 10 ].
Volume 41( 3) • June 2026
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