L2 – L3 , which was localised to the left side . A left-side L2 – L3 hemilaminectomy was performed by the VS . The patient received an intravenous dose of meloxicam ( a non-steroidal anti-inflammatory drug ( NSAID )) and an amoxicillin dose during surgery . A large amount of disc material was removed before routinely closing . The surgery and general anaesthetic went well .
Nursing interventions
Intervertebral disc disease is the most common spinal problem in dogs , particularly in breeds such as the dachshund , due to their long spines . The prognosis of a patient ’ s recovery is different in each patient and widely discussed in the literature . Various studies , including Ellapen et al . ( 2018 ), have found that recovery times are dependent on the first clinical signs and DP . Recovery to normal function can take weeks to months and can depend on the post-surgery nursing care provided . The variation in localisation of spinal cord problems means each spinal patient will present with different clinical signs and will need a tailored nursing care plan . The plan , which can be very rewarding to deliver , should consider wound management , nutrition , pain management and rehabilitation .
Pain management
Regular pain assessment is needed to successfully manage a patient ’ s post-operative pain . Each patient ’ s pain response depends on the severity of the spinal problem and the procedure performed . Pain determines alterations throughout the body – including the cardiovascular , respiratory and gastrointestinal systems – and is known to impair mental processing , leading to depression , anxiety and aggression ( Crook , 2014 ).
IVDE causes neuropathic and inflammatory pain , so Giudice et al . ( 2017 ) recommend the use of multimodal analgesia – for example , gabapentin alongside an NSAID or paracetamol if NSAIDs cannot be given . A study by Hurlburt ( 2000 ) found that steroids are no longer considered beneficial and are contraindicated in the management of IVDE , due to the drugs ’ weak efficiency and impact .
To prevent pain , it is important to handle these patients with care and ensure their environment is comfortable . In this case , a large duvet provided comfort but the patient ’ s limited mobility meant it struggled to move around on the duvet . To avoid this happening in future , I would use a vet bed instead , which is smaller and grips the floor , providing comfort while also making it easier for the patient to mobilise . A mattress could be used to provide comfort and prevent unwanted mobility .
Many studies , including Giudice et al . ( 2017 ), approve the use of the Glasgow Pain Scale ( GPS ) to measure a patient ’ s pain level . This patient was assessed using the
GPS every 4 hours , to ensure the level of analgesia was adequate . The GPS includes six categories , including vocalisation , attention to wound , mobility and response to touch . It did offer an idea of the patient ’ s pain but it was hard to get a definitive score in some categories . This was due to the patient being non-ambulatory , so it was not possible to assess its mobility correctly . Although the GPS allows you to score pain felt by the patient , it can be challenging to decipher between the pain felt and the score given . For example , in this case , the patient scored high due to being recumbent but was comfortable on palpation .
In addition to monitoring the patient ’ s post-surgery pain , other factors should be considered in analgesia . These include a patient ' s age , other health conditions ( e . g . arthritis ) or chronic illnesses ( e . g . pancreatitis ), as well as other considerations ( e . g . an indwelling catheter ) ( Crook , 2014 ).
The patient should also be assessed for other problems that could cause pain , and these should be reassessed regularly . In this case , the patient had suffered from pancreatitis in the past so it was kept on a low-fat diet and regularly checked for abdominal pain .
Bladder management
Bladder management is important in neurological patients . According to Daniels ( 2010 ), there is the possibility of a compressed nerve supply to the bladder , which can cause abnormal urination . The patient may not be able to urinate on its own , due to compression of the nerves , and there is a higher risk of urinary tract infections ( UTIs ) if the bladder does not void completely . Patients are also susceptible to storage disorders , such as overflow , where the bladder leaks .
It is important to thoroughly check all aspects of the bladder every few hours to prevent disorders and keep the patient comfortable . In this case , I felt the bladder every 4 hours to confirm approximate bladder size and softness , and patient comfort . An ultrasound scanner was also used to measure the size of the bladder every 4 hours , which allowed me to determine whether it needed expressing . Notes were taken for future use .
Due to the high risk of bladder disorders , nursing care is key to minimising complications . These include urine scalding , bladder distention and atony , and UTI . There are several methods of bladder management , with advantages and disadvantages of each , dependent on the patient . Bladder expression is known to be the most advantageous as it is non-invasive and inexpensive .
McKee ( 2000 ) suggests that post-operative care for IVDE patients should include bladder management at least three times per day , with manual expression being the preferred option .
Volume 37 ( 5 ) • November 2022
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