Environmental Considerations for Hospitalised Patients
No matter of the length of stay or medical condition non-routine in-patients have, it is essential that these long-term hospitalised patients receive gold standard nursing care. The aim is to address both their physical and mental healthcare requirements, encouraging optimal recovery whilst ensuring that patient welfare is at the heart of everything you do. Veterinary Nurses are at the forefront of this care and are the patient's advocate.
Nursing care plans
Several styles of nursing care plans are now commonly used in veterinary practices. For long-term patients, these can prove invaluable, ensuring the whole of the veterinary team is kept up-to-date with the patients changing requirements. Upon admit, ask owners about their pet's routine relating to feeding, sleeping, exercise, bedding, commands for urination and defecation etc. It is helpful to keep the animal's stay as normal as possible throughout their hospitalisation, which can help to calm and settle the patient.
Nutrition
Correct nutrition is essential and long term hospitalised patients are likely to need some form of assisted feeding. Some animals may require encouragement with hand-feeding to get them to eat. Others may require tube feeding; Polyurethane Feeding Tubes are radiopaque feeding tubes for medium-term use (up to four weeks). Total Parenteral Nutrition (TPN) is likely to be required for patients who are unable to eat for themselves and for whom tube feeding is not suitable. The patient will likely be on a formulated diet to meet their medical requirements; however, caution should be taken when introducing a medical diet in a hospitalised environment to ensure food aversion does not occur. For this reason, some patients may not be started on prescription diets whilst in a hospital environment. Patients should be weighed at least twice daily and have their calorific requirements recalculated if any weight loss has occurred.
How Much Should You Feed A Hospitalised Animal?
Dogs: 84 kcal/kg0.75/day
Cats: 200–250 kcal daily
Most hospitalised dogs and cats exercise very little, and therefore, their needs are expected to most closely approximate resting fed metabolic rate (RFMR). The use of illness factors is no longer recommended as caloric excess has been suggested to worsen outcome in hospitalised humans.
Bedding
Bedding must always be kept clean and dry. Familiar bedding bought in by the owner may help comfort some animals with a familiar scent upon it. However, consideration for cross-contamination from introducing vectors from outside the clinic must be a consideration. The bedding used must be fit for the animal's medical condition. Recumbent animals will require deep bedding to help prevent decubitus ulcers.
An orthopaedic memory foam mattress helps prevent bedsores. It moulds perfectly to the shape of the patient and helps with arthritis, hip, joint and muscular pain. It is ideal for obese or overweight animals, and the anatomical and orthopaedic support provided by such bedding can enhance and promote good circulation. Turn recumbent patients regularly to help prevent hypostatic pneumonia; the use of massage and coupage is also beneficial. Underweight animals or those with little body fat, such as greyhounds, also need deep bedding to prevent pressure on bony prominences.
Fleece type bedding is generally suitable for most patients who are mobile and able to move around. Absorbent cage liners should ideally be used underneath the bedding to help wick urine away from incontinent or recumbent animals.
Cats frequently appreciate doughnut beds being made for them by rolling towels up to create a raised wall around their bed. Many cats also like a place to hide, so an enclosed bed or box where they can go to sleep or hideaway is welcome by many cats, especially long term hospitalised patients.
Temperature
All patients must be kept warm. Adequate ventilation is required, and wards should be within the range of 18-20 degrees Celsius. It is important to exclude draughts.
Depending upon the medical condition and health status of the animal, additional warmth may be required. Preventing hypothermia is crucial, using including blankets, foil blankets, bubble wrap, warm air blowers, applying socks to the feet or an incubator preemptively ensures the best possible nursing care for patients.
Extreme care is required if using heat sources, especially direct heat, in the way of heat pads or mats. Never position recumbent patients in direct contact with heat which they cannot readily get away from. Part of their nursing care plan should also include regular temperature checks to evaluate for hypo or hyperthermia – ranges of 38-39 degrees Celsius are considered normal for both cats and dogs.
Lighting
Appropriate lighting is especially important in 24-hour clinics where the lights in the kennels may never be switched off! Try and ensure you switch lights off when it is not necessary to have them on, especially at night, to allow animals to sleep in the dark, which is a natural for both dogs and cats. If possible, try and dim lights a little during the day or partly cover the kennel with a towel to block some of the light out.
Hygiene
High standards of hygiene, not only in the kennel environment but also of the animal, are imperative not only for the animal's welfare but also to prevent the spread of any possible contaminants. Many long term patients are unable to groom themselves effectively. Most animals appreciate having their mouth, eyes and nose cleaned twice daily or more frequently to remove any discharge. Cotton wool dampened with warm water is sufficient for this purpose. Often providing such primary nursing care is easily overlooked in a busy hospital environment. Still, it is a task that is quick and easy to achieve and will make a massive difference to the patient's demeanour.
Any faeces, urine, vomit or blood must be removed immediately from the animal's kennel. If medically able, dogs should be walked to toilet at least every couple of hours and cats provided with a litter tray which should be changed as soon as it is soiled.
Mental stimulation
Providing opportunities for mental stimulation is vitally important with long term hospitalised patients. Spending time stroking them, talking to them, hand feeding and showing affection will help to aid recovery. Some animals may also appreciate the background noise of a radio or television. Owners may also wish to visit. Spending time with their owners can aid some patients but should be evaluated on a case by case basis, as some animals may become distressed when their owner leaves. In such situations, visits from the owner may have to be discouraged.
Kennels areas can be noisy and busy, and for long term hospitalised patients, this may cause distress. Organise your kennels such that long term patients are in the quietest area, so they are not exposed to the hustle and bustle every day.
Conclusion
We must take a holistic approach and consider all aspects of our patients needs when nursing long term hospitalised animals. We need to take into account their medical condition, as well as their requirements for situationally appropriate nutrition, bedding, warmth, mental stimulation and comfort to nurse and care for them effectively to help ensure a successful outcome.