All pads and blankets require frequent attention , repositioning and immediate change once wet ( Falloon et al ., 2018 ). The use of fans to improve ventilation can help reduce sweating induced by the sling and extra padding ( Figure 3 , previous page ). Frequent application of talcum powder can absorb moisture from the skin .
Depending on the horse ' s comfort levels , the rear panel often takes more weight than the chest panel , particularly in laminitic patients , which frequently stand in a saw-horse position or sit into the sling in a dog-sitting position . Immobility is a leading cause of decubitus ulceration as the patient is unable to relieve pressure on painful areas ( Anders et al ., 2010 ). To avoid this problem , depending on the horse ' s temperament and clinical condition , it may be possible to remove the horse completely from the sling for a few hours during the day . Alternatively , it may be possible to remove the rear panel , under supervision , to allow the skin to aerate and dry . Daily grooming will help maintain skin hygiene and integrity , while providing positive mental stimulation for the patient ( Ryan et al ., 2020 ).
Nutrition
The horse in a sling should be maintained on a high plane of nutrition in order to avoid excessive weight loss ( Floyd & Taylor , 2017 ). However , over time , disuse muscle atrophy will occur regardless of the patient ’ s nutritional status , due to lack of exercise . Food and water should be offered hourly to the patient and positioned for ease of access ( Figure 4 ), for example , at shoulder height if necessary ( Floyd & Taylor , 2017 ).
Where indicated , a forage-based diet should be supplemented with a feedstuff low in non-structural carbohydrates , to minimise the onset or progression of laminitis . Further supplementation with an omega-3-rich oil will increase calorie intake ( Harris , 2017 ).
Weight loss in recumbent or debilitated patients has been shown to greatly increase the risk of decubitus ulcer formation ( Anders et al ., 2010 ). Anorexic horses should be encouraged regularly to eat and drink as much as possible , using treats such as apples and carrots , or warming the food to a warm mash to improve palatability ( Ryan et al ., 2020 ). For horses that are unwilling to drink , the provision of a ‘ water buffet ’ of sweet- , electrolyte- and non-flavoured water , as well as placing chopped apples in the water , can help to encourage water intake ( Dunkell , 2008 ; McKenzie , 2008 ). Food and water intake should be carefully measured and recorded on the patient ' s chart to facilitate monitoring .
Further nursing care
As with all intensive-care patients , it is important to carefully monitor and record the patient ' s clinical parameters and progress several times daily
( Floyd & Taylor , 2017 ). Monitoring charts , such as the Colorado Pain Scale ( Blossom et al ., 2007 ), can be used to subjectively record the patient ' s demeanour and attitude while in the sling ( Ryan et al ., 2020 ).
Reduced locomotion results in decreased intestinal motility , which can result in impaction and colic ( Floyd & Taylor 2017 ). Faeces and urine should be monitored for consistency and quantity ( Ryan et al ., 2020 ). Nasogastric fluid therapy may be required in patients that have inadequate fluid intake ( Dunkell , 2008 ).
Other indicators that the horse is not tolerating the sling well include signs of respiratory distress such as increased repiratory rate , nostril flare and abdominal effort ( Furr , 2008 ; Montgomery et al ., 2019 ).
Casts , bandages and foot supports should be checked regularly and monitored closely for signs of damage , slippage , strike-through , swelling or foul smells . Lower limb oedema caused by reduced mobility can be minimised by the application of supportive stable bandages ( Floyd & Taylor , 2017 ). Iodine tincture should be used to maintain hoof integrity and hygiene ( Floyd & Taylor , 2017 ).
Positive mental stimulation for these patients , such as physical contact , grooming , good lighting , stable toys , food and salt licks , can improve their outcome and quality of life ( Ryan et al ., 2020 ). Application of fly spray is also beneficial to avoid fly annoyance to the patient ( Ryan et al ., 2020 ).
Conclusion
Nursing an equine patient in a sling can be both physically and emotionally demanding for the horseowner , patient and caregivers alike . It requires highly intensive 24-hour care . The equine nurse plays a crucial role in the veterinary care of the equine patient in a sling .
Successful management of an equine patient in a sling depends largely on the animal ' s tolerance of the sling – both physically ( in terms of the incidence of complications such as the development of pressure sores ) and mentally ( in terms of the patient ’ s general behaviour and attitude towards the sling ).
Several ethical considerations factor into decisions on maintaining an equine patient in a sling for a prolonged period of time – primarily the long-term prognosis and the primary underlying condition for which the horse is being treated . Attentive nursing care will have a significant positive impact on the outcome of these cases , and on the patient ' s quality of life .
38 Veterinary Nursing Journal