Instructing and preparing clients for home care is essential for patient healing and return to well-being. This includes verbal and written discharge instructions as well as hands-on demonstrations of wound care, medication, and rehabilitation. Patient care, however, does not end when the animal walks out of the door. Following-up with clients within a few days of discharge provides an opportunity to monitor the patient’s condition, answer clients’ questions, assure compliance, and allay concerns. Clients must receive home care instruction to provide their pet with the optimal healing experience. Communication is essential to patient care. Verbal instructions are important, but as with preparing for surgery, visual aids are helpful along with written instructions. Engaged clients retain and understand more information. While clients are anxious to be reunited with their pet, talking to them without this distraction is beneficial. Bringing a client to a quiet area such as an exam room eliminates other distractions and provides a private setting for a conversation. While providing oral instructions, it is beneficial to emphasize important points in the written instructions. Using a highlighting marker to stress certain aspects of the discharge underscores their importance for the client. When providing instructions for medications, asking the client to repeat the dosing schedule assures their understanding. It is important to provide information on when the next dose of medication is due after the patient is discharged. Many studies, in human medicine, compare the appropriate reading grade level for discharge instruction comprehension and the actual reading level created (Bukata 2012). Studies indicate that the appropriate level of instructions be at the level of sixth grade reading (Somes 2003). While using medical terms is common knowledge for veterinary professionals, the general public may not understand them. Defining terms provides client education and understanding. For example, using the term “medial patella luxation or MPL” in a sentence is clear to the veterinarian and technician; however, a client may not recognize these words. Explaining this in layperson terms states this condition to be “the kneecap dislocates or moves to the inside of the knee.” Use of acronyms, “MPL” in the above example, is also confusing and in need of explanation. Discharge instructions must be clear, concise, and free of errors. Creating a defined format for all clinic personnel provides consistency. When using a template, assure all pertinent information is correct for the individual patient. Include the following information: Using a larger font size (14 pt.) aids in readability. Break down the instructions into short paragraphs and bullet points for clarification. Providing extra space allows the client to make notes. Printing on a special color paper may help the client to find the discharge instructions when needed (Day 2012). Not all clients are proficient in or knowledgeable about medicating their pet. Providing a demonstration is important for client compliance. Asking the clients to also perform the task helps them to perfect their technique. Empty gel caps for oral medication and saline-filled syringes are great teaching aids. When bandaging is required at home, it is imperative to explain all steps and materials to the client as well as have them practice. Figure 8.1 shows a patient requiring slight compression on a neck incision. Using stretch stockinette as a “hood and shirt” allows the client to replace the gauze covering the wound. Figure 8.1 Patients may go home with a stockinette bandage, like this Yorkshire terrier following neck surgery. The bandage requires monitoring and changing by the client. Providing photos or videos helps clients who are visual learners. Anatomical models, electronic images, and hard copy books are additional aids to enhance client learning and understanding. Offer clients images of scoping procedures and radiographs. Explaining the images to clients enhances their experience. Reviewing charges with the client gives them a perception of all aspects of the surgery and its related costs. Through all stages of the discharge process, encourage and provide the client an opportunity to ask questions. Patients may require special diets following their procedure. Short- or long-term needs are explained to the client. This information includes details of how to handle situations immediately after going home when food may need to be restricted to avoid vomiting due to anesthesia or pain medication–induced nausea. Patients are returned to their normal diet as soon as possible to avoid gastrointestinal upset. Some animals benefit from moistening dry kibble to be more palatable. Crushing the kibble prior to soaking in water hastens its water uptake. Patients reluctant to eat need coaxing with special foods such as commercially available canned pet food, baby food, boiled hamburger or chicken, water based tuna, and so on but not a high fat content food. Long-term needs may include diet changes to comply with a specific medical condition, for example liver and kidney disease, degenerative joint disease as well as obesity. Pet obesity is on the rise in the United States. Recent studies indicate veterinarians classify 53% of dogs and 55% of cats as overweight (Association for Pet Obesity Prevention 2012). This study also shows that most pet owners are unaware of their pet’s obesity. Providing clients information on weight-related conditions is imperative. These include kidney disease, breathing difficulties, hypertension, osteoarthritis, and type 2 diabetes. Showing and providing a body condition score and chart gives clients a visual aid in determining their pet’s current and optimal fitness (Figures 8.2 and 8.3). Figure 8.2 Canine body condition system scoring chart. (Courtesy of Nestle-Purina Petcare Company.) Figure 8.3 Feline body condition system scoring chart. (Courtesy of Nestle-Purina Petcare Company.) Clients need instruction on measuring food intake, determining calorie content, and finding healthy treat alternatives such as raw vegetables. Advice is given on adverse foods not to be given as treats including products containing the artificial sweetener Xylitol, grapes and raisins, chocolate, avocados, garlic, onions, and macadamia nuts (Vetlearn 2011). The stress of hospitalization alone may cause gastrointestinal upset. Clients are warned to watch for vomiting, anorexia, constipation, and diarrhea and to contact the veterinarian or technician if these occur. This is especially true for patients prescribed narcotics and non-steroidal anti-inflammatory drugs (NSAIDs). Patients deprived from food in the perioperative period and receiving narcotics are less likely to produce bowel movements (Papich 2011) on a regular basis for a short period after discharge. This is generally not a medical concern. Providing clients with this information allays their concerns. However, patients that are unable to urinate require special attention. Often following spinal surgery, patients cannot voluntarily urinate. Carefully explaining the need to monitor urination and demonstrating bladder expression is essential in these patients. When clients are unable to express their pet’s bladder, it may be advisable to continue hospitalization for expression or catheterization. Alternatively, repeat visits to the clinic may be required. Non-steroidal anti-inflammatory medications may cause vomiting and diarrhea. Clients are warned to contact the clinic if these occur, as it is imperative to stop the NSAID before the gastrointestinal condition worsens.
Chapter 8
Aftercare and Home Care
Client instructions
Written instructions
Hands-on demonstrations
Feeding instructions
Elimination
Exercise
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