Communication in our profession

With a recent focus on travelling pets, we must also continue to consider the animals who do not travel outside of the UK. This time of year is especially significant with the warmer temperatures having finally arrived. We should now be striving to educate owners on the prevalence of ticks. VNs are ideally placed to do this, through nurse consultations, preparing materials for the practice waiting room and using social media. With approximately 2000 to 3000 new cases of Lyme disease being diagnosed annually in England and Wales according to the NHS, this is clearly an area of importance. We have the ability to have a positive impact on the health of both humans and their companion animals.

Just 5 minutes will give horses a healthier future

Remember to participate in the National Equine Health Survey during 18–25 May 2015, and encourage your horse-owning clients and colleagues to do so too, says Gemma Taylor, Education Officer at Blue Cross.

Comparison of oesophageal, rectal and tympanic membrane temperature in anaesthetised client-owned cats

Objectives:To determine the agreement between a veterinary-specific tympanic membrane thermometer and measurement of core oesophageal and rectal temperature in client-owned anaesthetised cats.Methods:A prospective study was performed using 20 cats that were scheduled to undergo general anaesthesia. For each cat, five consecutive temperature recordings were taken from an oesophageal temperature probe (OT), rectal thermometer (RT) and a veterinary-specific tympanic membrane thermometer (TT) prior to surgery. The temperatures were compared using Bland-Altman analysis.Results:Mean differences for the TT compared with OT and RT were -0.86°C (SD = 0.62°C, 95% CI [-2.39°C, 0.67°C]) and -0.93°C (SD = 0.57°C, 95% CI [-2.27, 0.44]) respectively; both greater than the accepted maximal clinical tolerance of 0.20°C. The mean difference for the RT compared with the OT was 0.06°C (SD = 0.28°C, 95% CI [-0.56, 0.67]).Clinical significance:The TT does not accurately represent core body temperature in cats under general anaesthesia and should not be used interchangeably with oesophageal thermometers. Rectal temperatures can be used to reliably approximate core temperature in anaesthetised cats.

Guidelines for recognition, assessment and treatment of pain

Use of this documentThis document is designed to provide the user with easy-to-implement, core fundamentals on the successful recognition and treatment of pain in the day-to-day small animal clinical practice setting. While not intended to be an exhaustive treatise on the subject matter, the text does provide an extensive reference list and there is additional material on the World Small Animal Veterinary Association (WSAVA) website (www.wsava.org) designed to provide resources for those wanting to further their knowledge of this subject matter based on the current literature.There are no geographic limitations to the occurrence of pain, nor to the ability to diagnose it. The only limiting factors are awareness, education, and a commitment to include pain assessment in every physical examination. As such, the pain assessment guidelines herein should be easily implemented regardless of practice setting and/or location.In contrast, there are real regional differences in the availability of the various classes of analgesics, specific analgesic products, and the regulatory environment that governs their use. This represents a significant hurdle to the ideal management of pain in various regions of the world, irrespective of the ability to diagnose. In the treatment section of these guidelines (not included here), these issues are taken into account by the provision of ‘tiered’ management guidelines beginning with comprehensive pain management modalities that represent the current ‘state of the art’ followed by alternative protocols that may be considered where regulatory restrictions on analgesic products prevent ideal case management. Owing to space limitations, tiered management cannot be listed for all situations, but the analgesics available can be selected from the recommended management. It should also be recognised that in some situations, whether due to a etiology or available analgesics, euthanasia may be the only moral or ethical (hence viable) treatment option available. Humane methods are presented.Sections are given on the various product and procedure modalities including pharmacology, mechanism of action, indications, contraindications, dosing, and practical clinical notes to help guide the reader in tailoring the therapeutic protocol to the needs of the individual patient.Recognise this document as providing guidelines only, with each situation unique and requiring the individual assessment and therapeutic recommendations that only a licensed veterinarian can provide. There are a number of statements that are the collective opinion of the authors, based on their cumulative experience with pain management gained within their respective fields but not yet evidenced via published data. It is the view of the group that providing this guidance is important in areas where to date there is little published work to underpin clinical pain treatment in dogs and cats.The contents should also be put into context of the following pain assessment and management tenets:• Pain is an illness, experienced by all mammals, and can be recognised and effectively managed in most cases• Pain assessment should accompany every patient assessment• Treat predictable pain — pain associated with surgery is 100% predictable• Pain assessment is key to determining the degree and duration of pain treatment but should not replace the adage of treating predictable pain• Perioperative pain extends beyond 24 hours and should be managed accordingly• Practice preventive (preemptive) pain management — initiate appropriate treatment before a procedure to prevent the onset of pain, and continue this to prevent occurrence of pain for the duration of time commonly recommended for the problem or which the patient requires• Response to appropriate treatment is the gold standard to measure the presence and degree of pain.We can't always know that our patient does hurt, but we can do our best to ensure that it doesn't hurt

Canine leishmaniosis: an update

Canine leishmaniosis caused by the protozoan parasite Leishmania infantum has entered the UK. Entry appears linked to pet dogs accompanying their owners (on vacation) to the Mediterranean basin where this vector-borne canine disease is prevalent. The parasite resides in the superficial dermis of infected dogs, either within macrophages or free in host tissue. L. infantum is transmitted naturally through sandfly bites. Sandflies are not currently present in the UK. Vertical transmission from infected bitches to puppies and transmission through blood transfusion have been confirmed, while sharing of hypodermics have only been proven experimentally. Some infected dogs remain asymptomatic with this resistance to disease development being associated with a strong cell-mediated immune response. Diseased dogs present with varied symptoms including generalised enlargement of lymph nodes, scaly dermatitis, anaemia, anterior uveitis and renal dysfunction. Clinically suspect dogs should be tested by fine needle aspiration of lymph nodes and/or bone marrow to perform cytology and polymerase chain reaction (PCR). Blood PCR lacks a certain degree of sensitivity. Indirect diagnosis through serology while routine is problematic in interpreting results and antibody titres. The recommended treatment protocol is a combination of the antimoniate N-metilglucamine subcutaneously, and allopurinol orally. Direct parasite transmission from dogs to humans has not been demonstrated. A commercial vaccine has emerged that offers options for prevention, which is useful for pets travelling to areas where the infection is endemic, particularly if they are staying for an extended period during the season when sandflies are active. Practitioners need to evaluate each individual case, based on client compliance, response to treatment and follow-up evaluation before deciding whether or not to consider euthanasia.

Anaesthesia of the head trauma patient

Head trauma or traumatic brain injury is commonly encountered following polytrauma, such as road traffic collisions and high rise falls, and it presents specific anaesthetic challenges. The brain is extremely sensitive to changes in volume which can be the consequence of haemorrhage, oedema or compressive fractures. Understanding the interplay between intracranial factors (such as intracranial pressure and cerebral blood flow), physiological factors (such as blood pressure and ventilatory status) and pharmacological factors is important in order to come up with an appropriate anaesthetic plan. This article outlines some of the theory and evidence that surrounds this complicated subject and suggests some nursing and anaesthetic strategies which can be implemented when managing these complex cases.

How to conduct a nurse-led senior clinic part 1 — preparation and planning

The current economic climate means the modern veterinary practice has to work hard to attract new clients, retain satisfied, committed clients and promote its services, as well as using the staff and facilities as cost effectively as possible. Increasing veterinary knowledge and changes in professional attitudes towards preventative care and client bonding mean that veterinary nurses have an ideal opportunity to expand their roles within the practice, becoming more involved in the preventative care and management of patients and owner education. The first of this two-part article will focus on the level of planning required in order to implement a nurse-led senior clinic in a veterinary practice.

Using the ability model to design and implement a patient care plan

The introduction of models of nursing and holistic care concepts into the veterinary nursing literature is enabling veterinary nurses to develop their patient care skills and advance their professional role. In line with recently published literature, the primary author's experience of designing and implementing a nursing care plan for a hospitalised patient strengthened the bond between all those involved with the patient and provided an individually tailored plan of veterinary nursing care. The process did highlight some complications associated with nursing care plans, such as excessive documentation but it was found that overall, the introduction of a nursing care plan improved patient care and provided improved structure to the nursing process. It is suggested that the veterinary nursing team should collaborate to adapt the nursing care plan in order to improve its efficiency within the practice. By introducing further continued professional development on models of care, the veterinary profession can utilise the holistic benefits of care plans to enhance patient care and empower veterinary nurses in their day to day routine.

Critical care of the guinea pig: a veterinary nurse's guide part 2

The popularity of guinea pigs as pets potentially results in veterinary nurses encountering these stoic species relatively frequently, and it is advisable to acknowledge the species’ anatomical and behaviour traits prior to handling and treatments. Veterinary nurses should be encouraged to be involved in patient assessment and nursing care planning to facilitate efficient and appropriate treatment administration and, in particular, confident responses to patients requiring critical and emergency action. This article aims to address some successful nursing initiatives and skills that can facilitate the critical care, emergency response and recovery of pet guinea pigs.

Readers’ letters

The March issue of The Veterinary Nurse included an article titled ‘The Pet Travel Scheme (PETS) and parasite protection for the travelling pet’ (Stokes and Wright (2015) The Veterinary Nurse 6(2): 60–70). The Veterinary Nurse received the following correspondence in response.