Plus-Hex CLINICAL should be monitored throughout the treatment process to ensure the patient shows signs of improvement rather than deterioration .
As with all patients , cardiac auscultation is essential . Heart rate and rhythm can change depending on varying factors . For example , a patient with increased blood potassium needs to be monitored , in particular , for signs of bradycardia . The auscultated heart rate and rhythm should always be compared with the pulse rate and rhythm to assess for pulse deficits indicating cardiac arrhythmias such as atrial fibrillation ( Haskey , 2015 ). Any pulse deficits noticed should be confirmed with an ECG .
Adequate nutrition for the DKA patient is crucial to the recovery process but may prove challenging to maintain . Patients with DKA are often anorexic on presentation , with appetite not usually returning until ketoacidosis is controlled ( Boag , 2012 ). Where possible , it would be recommended to maintain at least the resting energy requirements ( RER ) of the patient . This can be done through any means , from hand-feeding to tube-feeding ( Haskey , 2015 ).
Fluid therapy should be monitored and maintained to ensure the patient is receiving the correct volume of fluids , as fluid overload in particular can be a complication of therapy . Hydration status can be monitored by evaluating the factors laid out in Table 3 . Haskey ( 2015 ) states that with regards to fluids , ‘ ins ’ should match ‘ outs ’. The veterinary nurse can perform 4- to 8-hourly urine measurements to ensure the patient is not being over- or under-hydrated . The urine can be measured from a urine collection bag if a urinary catheter is in place or by simply weighing the urine production on bedding , incontinence pads or in litter . Regular weighing of the patient is a useful tool for indication that the fluids are meeting the patient ' s requirements . The fasted pet can expect to lose 0.5 – 1.0 % of body weight per day . Abnormal weight gain indicates over-hydration and will need to be monitored closely alongside urine output . The nursing of the critical DKA patient can be intensive and challenging , but following the four-step nursing process will ensure thorough monitoring , and intervention as required , ensuring the highest standard of care for the patient . surgeon relies on the nurse to be able to monitor closely and report changes as necessary . The care of the DKA patient is often extensive and requires intensive care from the team involved . Nursing care is invaluable to patient recovery and is a good opportunity for RVNs and SVNs to apply the knowledge gained through study and to see a clinical difference being made throughout the treatment process .
REFERENCES
Aldridge , P . & O ’ Dwyer , L . ( 2013 ) Practical Emergency and Critical Care Veterinary nursing . 1st ed . Chichester , Wiley-Blackwell .
Battaglia , A . & Steele , A . ( 2016 ) Small Animal Emergency and Critical Care for Veterinary Technicians . 3rd ed . St . Louis , Elsevier .
Boag , A . & Nichols , K . ( 2011 ) Small Animal First Aid and Emergencies . In : Cooper , B ., Mullineaux , E ., Turner , L . & Greet , T . ( eds .) BSAVA Textbook of Veterinary Nursing . Gloucester , BSAVA , pp . 614 – 615 .
Boag , A . ( 2012 ) Ketoacidosis . In : Mooney , C . T . & Peterson , M . E . ( eds .) BSAVA Manual of Canine and Feline Endocrinology . 4th ed . Gloucester , BSAVA , pp . 251 – 258 .
Gear , R . & Mathie , H . ( 2011 ) Medical disorders of the dogs and cats and their nursing . In : Cooper , B ., Mullineaux , E ., Turner , L . & Greet , T . ( eds .) BSAVA Textbook of Veterinary Nursing . Gloucester , BSAVA , pp . 537 – 589 .
Irwin-Porter , J . ( 2011 ) Laboratory diagnostic aids . In : Cooper , B . Mullineaux , E ., Turner , L . & Greet , T . ( eds .) BSAVA Textbook of Veterinary Nursing . 5th ed . Gloucester , BSAVA , pp 508 – 536 .
Skelly , B . ( 2018 ) Endocrine emergencies . In : King , L . & Boag , A . ( eds .) BSAVA Manual of Canine and Feline Emergency and Critical Care . 3rd ed . Gloucester , BSAVA , pp . 264 – 275 .
VetsNow ( 2013 ) Supporting the Emergency Patient ; Unit 4 , Outcome 2 . Endocrine disorders .
Reflective professional development notes . To access hyperlinks to the references , scan the QR code on page 3 .
Conclusion
Boag ( 2012 ) states that prognosis for the DKA patient is guarded , with a study showing that long-term (> 2 months ) survival was only 12 %. With that in mind , and the first 24 hours being the most critical stage , it is crucial for the veterinary nurse to monitor the patient for signs of deterioration and clinical symptoms associated with ketoacidosis , to actively participate in the care and changing treatment plans . The veterinary
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