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Unit 4 Objectives

Care of the Hospitalized Equine Patient Monitoring and Lab tests

technicians are responsible for the care of equine patients in the hospital setting some of these duties include IV fluid administration, signs of discomfort, heart rate, respiratory rate, hydration status, CRT, abdominal pain, respiratory distress, shock, laminitis and gastrointestinal motility.
an increased heart rate in the equine patient is a rate of 60 beats per minute or greater and is an indication of pain
patient monitoring forms are useful for designed to identify trends in physical signs
patient treatment forms coordinate treatment periods when several individuals may be responsible for administering medications
monitoring and treatment forms are considered a permanent part of the medical record, which represents a legal document or record of all events during the patients hospitalization
horses that are contagious should be hospitalized in isolation facilities
some of the common contagious disease in horses are colitis (salmonellosis), strangles (S. equi equi), and neurologic form of equine herpesvirus (EHV-1)
technicians responsible for the care of patients in isolation setting should take the following precausions wear boots, disposable gloves and body suits which should be disposed of upon leaving the isolation area. a disinfectant foot dip should be used when entering and leaving the area
the most common problems resulting in recumbency in horses are neurologic and musculoskeletal diseases
recumbent horses and foals can develop pressure sores over what areas pelvis, elbows and head
as a result of pressure and decreased circulation what can become damaged muscle and underlying bony structures
to prevent fecal impaction horses should be offered fresh grass to facilitate fecal evacuation and those unable to defecate need to have fecal material removed twice a day
what can be done to reduce the possibility of pressure sores? deeply bedded on straw, placed on a padded mat or placed on a mattress, rotated every 6 hours
recumbent adult horses can be managed for a period of 1-2 weeks without the development of complications such as pneumonia, colic
a component of the cell wall of gram-negative bacteria are called endotoxin
endotoxemia refers to the group of clinical signs caused by endotoxin circulating through the bloodstream
the signs of endotoxemia include fever, tachycardia, hyperemic mucous membranes, leukopenia, laminitis and depression
the most common cause of endotoxemia is gastrointestinal disease that compromises the intestinal wall such as diarrhea or colic, allowing translocation of bacteria across the intestinal wall and into the blood stream
other causes of endotoxemia can include retained placenta, metritis (uterine infection), pneumonia, peritonitis and large wounds
the best course of treatment for endotoxemia is the removal of the source
nutrition is important in hospitalized patients and can range in the following based on the patients disease and needs bran mash, pellets, water-soaked hay, parenteral IV nutrition.
care needs to be taken when parenteral nutrition is provided because the risk for septic thrombophlebitis can occur. a dedicated line and aseptic technique are recommended
IV catheters can be useful in horses to administer medications, fluids and nutrition the catheter should be checked for the following infection at the catheter site whether in the SQ tissue or the vein
infection at the catheter site in the vein is called septic thrombophlebitis and can be life threatening
ideal antimicrobial is characterized by its effectiveness against a wide range of bacterial organisms, easy to administer, and nontoxic
Penicillin is good for treating Gram-positive pathogens (streptococcus zooepidemicus, S. equi equi ex procaine penicillin) and frequently administered IM or IV (potassium penicillin)
aminoglycoside antimicrobials are efficacious against gram-negative pathogens administered IM and IV ex. gentamicin, amikacin sulfate
aminoglycoside antimicrobials sometimes affect renal function
trimethoprim-sulfa antimicrobials have a moderate effect against gram-positive negative pathogens
the medication to treat anaerobic bacterial infections include metronidazole
other antimicrobials are not widely used because of the risk of antimicrobial-induced colitis
some of the analgesic medications used for horses include phenylbutazone, flunixin meglumine, firocoxib, are NSAIDS to treat mild to moderate pain
medication most effective for the treatment of musculoskeletal pain is phenylbutazone
a medication that may combat the effects of endotoxemia in horses with gastrointestinal tract disease is flunixin meglumine
sedatives that also provide analgesia include lidocaine (some anti-inflammatory effects) xylazine and detomidine
depending on the needed duration of analgesia may determine the appropriate sedative xylazine provides up to 20 minutes of sedation, where detomidine provides up to 1 hour.
a narcotic agonist that provides up to 1 hour of sedation and analgesia for moderate to severe pain is butorphanol
corticosteroids have potent anti-inflammatory properties and are administered for allergic airway disease, allergic skin conditions, immune-mediated disease and joint inflammation
corticosteroids can be administered orally, topically, parenterally (IV/IM) and intra-articularly
adverse affects of corticosteroids include immunosupression, polyuria or polydipsia, poor hair coat, muscle wasting, poor wound healing, laminitis, and progression of degenerative joint disease
an anti-inflammatory drug that is used occationally in horses to relieve swelling and edema associated with CNS trauma, traumatic musculoskeletal injuries, laminitis and myositis is DMSO
because the veterinary technician plays a central role in the day to day monitoring and care of hospitalized patients they must be able to be observant and to perform a through physical examination
Laboratory Studies clinicopathologic testing provides information to identify impairment of an organ system, confirm a clinical diagnosis, assess patient response to therapy and formulate a prognosis
hematology a complete blood count (CBC)
CBC provides information pertaining to RBC count, WBC count, RBC morphology, WBC differential (including neutrophils, lymphocytes, eosinophils and monocytes), WBC morphology and fibrinogen concentration
RBCs are most easily estimated using the PCV pack cell volume which is normal between 32% and 45%
Low PCV less than 30% is indicative of anemia
What happens to the PCV after excitement and exercise it can be elevated by as much as 50%
what happens to the protein levels in response to massive blood loss it will decrease while lactate levels will increase
to identify the presence of infection what needs to be evaluated the total and differential WBC count will be elevated along with the fibrinogen concentrations
a profoundly low WBC count (leukopenia) characterized by low neutrophil count (neutropenia) and immature band neutrophils is indicative of gram-negative septicemia (endotoxins released from the cell walls of GN bacteria) or gastrointestinal disease, with inflammation allowing mucosal absorption of gram-negative bacteria.
high eosinophil counts (eosinophilia) are indicative of massive parasite ingestation or allergic disease
low lymphocyte counts (lymphopenia) may be observed with early viral infection
serum chemistry panels provide specific information pertaining to the liver, kidney, muscle, and serum electrolyte concentration.
the normal color of a horses serum is yellow as a result of increased serum bilirubin levels because horses do not have gall bladders
low serum ALB levels are consistent with liver compromise in most species, horses maintain ALB levels even with marked impairment of the liver function
reliable indicators of liver dysfunction in horses are high Y-glutamyltransferase (GGT), high serum sorbitol dehydrogenase (SDH), high bile acid concentrations, low BUN and increased ammonia levels
chronic renal failure in most species would indicate a low Ca high phosphorus, horses are considered obligate calcium exterters, with increased Ca concentration
reliable indicators of renal failure in horses include high CREA and BUN and electrolyte abnormalities (decreased Na, Cl, K)
diarrhea in horses can often be detected in advance because the large colon in horses exchanges large amount of electrolytes and fluids on a daily basis, with low electrolyte levels indicating water loss into the lumen of the colon thus resulting in diarrhea
an indicator of muscle damage in all species is noted with an increase in creatine phosphokinase CK.
Because horses have large muscle mass, or exercise in an unconditioned horse, transport, rolling from abdominal pain you can expect CK levels to be elevated, it is a concern when the level is 200 times normal values
the enzyme found in muscle tissue following muscle trauma, disease or liver disease is asparatate aminotransferase (AST) elevated
a by product produced by cells underggoing anaerobic metabolism owing to lack of oxygen is lactic acid or lactate; levels increased when conditions of decreased oxygen delivery to tissues
The most common cause of elevated lactate levels (hyperlactatemia) is hypovalemia (decrease in volume of blood plasma) seen mainly with colic and diarrhea
lactate levels in venous blood can provide an objective measurement of the magnitude of hypovolemia and can help in monitoring the response to fluid therapy
other causes of increased blood lactate levels include anemia, cardiac disease and respiratory disease
in colic cases comparing the lactate level in peripheral blood with an abdominal fluid sample can be useful in determining the viability of the intestine; in colic cases where blood supply is compromised such as large colon volvulus or a strangulating small intestinal lesion result in an elevated lactate level
blood gas analysis provides information on the oxygen and carbon dioxide content, pH, base deficit and bicarbonate levels of a patient
arterial samples are indicated to evaluate patients with respiratory disease
venous samples are indicated in patients with diseases affecting metabolic acid-base status such as diarrhea and kidney disease
urinalysis is essential for evaluation of primary renal disease
normal urine in horses contains calcium carbonate crystals and is usually alkaline pH 7-9, which would lead to a false positive in protein readings
because of mucous glands located within the renal pelvis urine may appear thick and mucoid
red urine can be caused for many different reasons primary urinary tract infection, hemolytic anemia, or myoglbin/myositis
specific gravity indicates the ability of the kidney to concentrate urine in horses no greater than 1.030
urinary electrolyte excretion ratios indicate the ability of the kidney to conserve electrolytes
WBC and the presence of bacteria are indicative of primary urinary tract infection
the presence of protein, glucose and casts is indicative renal disease
evaluation of body fluids (CSF, joint, abdominal) provides important information pertaining to inflammation, infection or neoplasia within that particular body cavity
boy fluids can be analyzed for these products total protein, total cell count, differential cell count, bacterial culture and testing for specific infectious diseases
abnormalities in protein and cell counts can identify an inflammatory, infection, neoplastic process
CSF tap can detect several antibodies for neurologic diseases including equine protozoal myelitis, herpes myeloencephalopathy, enquine encephalomyelitis
clinical signs making abdominocentesis necessary are abdominal pain, abnormal rectal exam, abdominal distention, idiopathic fever
cocmplications of abdominocentesis include tramatic bowel rupture, bowel rupture, trav
techs play an important role in bacterial testing of specimens collected from patients with infectious disese from bodily fluid, feces, urine, wound exudate
a laboratory technique that identifies and amplifies a specific segment of genetic meaterial from bacteria, viruses, or animals polymerase chain reaction PCR
PCR allows for very sensitive and specific diagnostic testing for bacterial and viral pathogens, genetic disease because the DNA sample are unique to each organism
PCR can be used to diagnose genetic disorders by identifying the segment of DNA specific to the disease
fasting hyperbilirubinemia a normal response to serum bilirubin concentrations when feed is withheld for 24 hours in horses
capitalization of veterinary technician skills in food animal practice can help with meeting client and patient needs and can improve practice productivity, efficiency and revenue
Created by: tnewhouse