Advanced medical nursing

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This chapter provides information on medical nursing at a level beyond that expected of the newly qualified veterinary nurse. The nursing process is emphasized throughout this chapter. This approach is particularly useful for patients with medical conditions which are multifactorial. It is necessary for veterinary nurses to accurately evaluate the stability of new admissions and existing patients in their care. A triage examination briefly reviews each body system in order of importance to highlight abnormal signs and devise a treatment plan. This chapter looks into Nursing the patient with non-specific clinical signs; Nursing the patient with cardiovascular disease; Nursing the patient with respiratory disease; Nursing the patient with gastrointestinal disease; Nursing the patient with neuromuscular disease; Nursing the patient with musculoskeletal disease; Nursing the patient with urogenital disease; Nursing the patient with disorders of the maemopoietic system; Nursing the patient with skin disease; Nursing the patient with ophthalmic disease; Nursing the patient with endocrine disease; and Nursing the patient with cancer.

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Image of Standard positioning for a diagnostic ECG. The dog is restrained in right lateral recumbency with the limbs extended.
Standard positioning for a diagnostic ECG. The dog is restrained in right lateral recumbency with the limbs extended. Standard positioning for a diagnostic ECG. The dog is restrained in right lateral recumbency with the limbs extended.
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2.5 Examples of a normal and three abnormal ECG traces. Normal ECG. Note the synchronous P waves and QRS complexes. Note also the consistency between complexes. Third-degree atrioventricular block. Note the asynchrony between the P waves and QRS complexes. Note also the abnormal broad appearance of the QRS complexes. Supraventricular tachycardia starts half-way along the trace. Note the rapid heart rate with normal QRS complex appearance. Ventricular tachycardia after two sinus beats. Note the rapid heart rate with abnormal broad QRS complexes.
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2.6 A Holter monitor attached to a Boxer with intermittent syncope. This dog is wearing an analogue monitor; these have been largely replaced by more compact digital units.
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2.7 Doppler measurement of blood pressure in a cat. Cuff suitable for oscillometric measurement of blood pressure.
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2.14 A patient positioned for a nasal flush biopsy.
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2.16 Oesophageal diseases. The lateral thoracic radiograph is of a standing conscious Great Dane with megaoesophagus. Dorsal and ventral borders of the dilated oesophagus are indicated by red and yellow arrows, respectively.
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2.18 A dog with abdominal pain adopting the ‘praying stance’.
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2.19 A veterinary nurse performing a buccal mucosal bleeding time test. Note the upper lip is everted by a bandage; filter paper is used to absorb excess blood without disturbing the primary clot.
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2.20 Nursing considerations for gastrointestinal disease. The photograph shows a dog with megaoesophagus being fed in an upright position by a veterinary nurse. Elevation of the head and thorax encourages passage of food into the stomach.
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2.23 A French Bulldog demonstrating marked head tilt due to vestibular syndrome.
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2.24 A dog adopting an opisthotonic posture due to immune-mediated meningitis. This dog is conscious though minimally responsive; the dog was ambulatory only 12 hours earlier.
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2.27 Examples of different bone biopsy devices. Top: Bone marrow needle. Middle: Michel trephine. Bottom: Jamshidi needle.
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2.32 Diagnostic flow chart for investigation of skin disease.
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2.34 Performing the Schirmer tear test in a dog. (© D Gould)
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2.35 Fluorescein staining of a shallow corneal ulcer. (© D Gould)
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2.36 Using the Schiøtz tonometer to measure intraocular pressure. (© D Gould)
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2.38 Ear prick blood collection for monitoring blood glucose levels in a cat.
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2.39 Blood glucose curve showing persistent hyperglycaemia due to inadequate insulin or insulin resistance.
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2.40 Blood glucose curve showing a rapid decrease in blood glucose levels, causing hypoglycaemia, due to an insulin overdose.
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2.41 Blood glucose curve showing good stabilization.
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2.42 Lateral thoracic radiograph of a dog with pulmonary metastases from a malignant oral tumour.
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2.43 Oral squamous cell carcinoma in a cat.
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2.44 Glove box isolator used for the preparation of drugs required for chemotherapy.
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2.45 Items found in a chemotherapy ‘spill kit’. Note the aerosol-proof facemask with eye protection. Other items include a water-impervious long-sleeved gown, nitrile rubber gloves and a self-sealing cytotoxic waste and absorbent wipe bag.

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