Daily Hospital Responsibilities

Daily Hospital Responsibilities

Hospital/Clinic Procedures

It is an unfortunate fact of life that the amount of money available for health care and veterinary medicine is often limited by the animal’s production value. Most farmers provide what they can for diagnosis and treatment of their livestock, but the monetary value of the animal may fall far short of what is required for its medical or surgical treatment. It is disheartening to tell a farmer that surgery for a cow’s broken leg is possible but may cost several thousand dollars, knowing that the realistic value of the cow may only be $800. In addition to maintaining the farm and the other animals on the farm, the farmer also must provide for his or her family, and at some point these economic considerations must enter the decision-making process.

The monetary value of horses usually is considerably more than that of production livestock (at least in the mind of the owner!). Emotional attachment often plays a role in the owner’s decision to finance a horse’s treatment. Also, many horses are accustomed to being handled and transported, making transportation to a hospital more practical than that of other large animals. Therefore, horses are generally more likely than livestock to be evaluated and treated at large animal clinics.

Because of cost and practicality, not all sick large animals have the luxury of going to a hospital or clinic. Large animals present unique circumstances and challenges for their examination and treatment. The size of these animals as well as herd management present some difficulty with their transportation, so most large animal work is performed on the farm. Many large animal clinics and hospitals are available nationwide, but special transportation in trailers or livestock vans is required to reach these “haul-in” facilities. Transportation of large animals may be problematic. Not all large animal owners have a trailer or livestock van, so transportation must be arranged through a friend or professional livestock transportation company. A significant amount of time may be required to arrange for an animal’s transportation, and in some parts of the country the nearest large animal hospital is several hours away. When dealing with an emergency case where assessment and treatment are urgent, the time delay related to finding transportation, loading, and driving the animal to the hospital can have devastating consequences.

Ambulatory practice, field service, or farm calls are types of large animal practices in which the veterinarian takes the necessary supplies and equipment to the farm and performs the diagnostic and treatment procedures there. Mobile veterinary units may be homemade or purchased from companies that specialize in their design. The unit may range from simple storage bins to large fiberglass units with refrigerators, running hot and cold water, and storage space for supplies and equipment. These units can be adapted to cars, vans, or trucks (Fig. 4-1).

Improvising examinations and treatments on the farm is often required and can present challenging situations, many of which can have completely successful outcomes. Accurate assessment of the facilities, personnel, and costs involved is important when planning to treat sick animals on the farm. These same factors also must be considered in the hospital environment.

The following principles of facility care and maintenance apply to large animal hospitals and clinics, but with a little imagination and planning most can be adapted to care for animals at their home farms.

Stall/Hospital Maintenance and Care

In a clinical setting, livestock are commonly housed in stalls. Stalls should be cleaned daily to remove manure and wet spots (urine). The two basic approaches to stall cleaning are to (1) remove only the soiled bedding and try to spare as much bedding as possible (picking) or (2) remove all bedding, soiled or not, down to the stall floor (stripping). Whether a stall is picked or stripped depends largely on the nature of the case and the habits of the animal. Some animals are very “neat,” defecating and urinating in particular spots; the stalls of these patients can be successfully picked for perhaps several days. At the other end of the spectrum are the extremely dirty animals of the world—they have no pattern to their defecations/urinations, and they may walk repeatedly through their eliminations, scattering feces and urine all over the stall. Picking for these cases will be difficult. Stalls of animals with diarrhea are also difficult to pick (Fig. 4-2).

For cases that lend themselves to picking, the stall should be checked at least twice daily and picked as necessary. Wet urine spots should be removed to the depth to which the urine has soaked. After removing the soiled bedding, replace as much bedding as was removed by picking. Animals that are active in their stalls may push bedding against the walls of the stall; be sure to spread this bedding back toward the center of the stall to create an even surface.

Stripping of bedding should occur at least every few days for any patient and more frequently if warranted by the nature of the case. After stripping the stall, the bedding must be completely replaced. This is obviously more expensive than picking and is more time consuming, so stripping should be done judiciously. Stripping should always be done after a patient is discharged to allow for thorough stall cleaning and/or disinfection between patients.

When cleaning stalls, do not overlook the walls and ceiling. Cobwebs are common on stall ceilings and walls and should be removed regularly because the presence of cobwebs, dust, and other particulate matter on these surfaces reflects poorly on hospital cleanliness.

Barn aisles should be swept at least once daily. Usually, two to three times daily is required to maintain cleanliness and a neat appearance of the facility.

Stall Flooring

The two common types of stall floors are cement (concrete) and dirt/packed clay. Some older barns have wood floors, but these are not often seen in a hospital setting. Each type of flooring has advantages and disadvantages.

Cement floors (and walls) are advantageous for hospital use because they can be disinfected and steam cleaned. Portable spray-type steam-cleaning machines can be taken from stall to stall to perform thorough cleansing of stalls between patients. This is especially valuable when the previous patient had a contagious disease. If steam cleaners are not used, disinfectants can be applied directly to the surface, scrubbed, and hosed. Dirt and wooden walls and floors are difficult to adequately disinfect with these procedures. The disadvantages of cement flooring are its expense to install; decreased patient comfort, especially for animals that lay down to sleep or are recumbent as a result of their disease; and sometimes compromised drainage. Proper contouring of the floor with a central drain is vital for drainage, and patient comfort can be improved with the appropriate amount of deep bedding for the case.

Rubber mats can be placed between the cement floor and the bedding layer. Some mats are solid rubber; others have a porous waffle-type construction that improves drainage. Because liquids cannot penetrate through solid mats for drainage, moisture control must be provided by absorption into the bedding material. Absorbent bedding material should be used with solid mats. Rubber mats can greatly increase patient comfort, but they are expensive and difficult to maintain and thoroughly disinfect.

Sand can be placed over the cement; however, the cement stalls cannot have drains. The major disadvantage to this type of flooring is the amount of time cleaning, removing, and replacing the sand between patients. However, it is extremely useful for lameness cases because of the cushioning effect of sand.

Dirt floors must be constructed properly to provide acceptable drainage. Dirt floors have the obvious disadvantage of poor disinfection properties. If a contagious case is housed on a dirt floor, the stall may have to be isolated for days or weeks following dismissal of the contagious animal before another patient can be housed safely in the stall.

Stall Bedding

Bedding material is placed on top of the stall floor to improve comfort and absorb urine and fecal liquids. The two most popular types of bedding material are wood shavings and grain (not pine) straw. Other types of bedding include sawdust, peat moss, and shredded paper. Each type of bedding has pros and cons.

Wood shavings are made from softwoods or hardwoods. Softwood shavings have good absorbency, often comparable to or better than straw. Shavings are generally less dusty than straw and usually are tolerated better by horses with respiratory allergies. Shavings may provide more of a cushion effect, which may benefit patients with sore feet or legs. However, wood shavings are more likely to get under bandages and casts and are more abrasive than straw. Wood bedding products are believed to harbor more gram-negative bacteria than straw, which may be an exposure concern for neonates. Therefore, straw is preferred for pregnant animals and neonates.

Sawdust is another wood product used for bedding. However, it can be unacceptably dusty, and the particles are small enough to be inhaled. Sawdust is poor bedding for pregnant animals, neonates, and any animal with respiratory problems. Recumbent patients and neonates may be more prone to scratching their corneas on the particles when lying on their sides. (Young foals do not sleep standing as many adults do.)

Wood products, whether shavings or sawdust, must be free of black walnut (Juglans nigra) content. Black walnut causes acute laminitis (founder) in horses, although the exact route of toxin entry into the horse is not yet understood. When purchasing wood product bedding, ask the distributor to identify the types of wood in the product. Black walnut produces shavings and sawdust that are dark; however, other safe types of wood can produce similar dark colors. If dark shavings/sawdust particles are visible, avoid using the product unless the contents are known to be free of black walnut. Many distributors are not aware of black walnut’s toxicity to horses.

Straw is usually oat or wheat. Oat straw is more absorbent than other straw types, although straw in general is not highly absorbent compared with other types of bedding. Straw is naturally dusty, and dustiness increases if the straw blades are chopped short. Straw is generally poor bedding for respiratory cases and gastrointestinal (GI) cases. Some animals will eat straw bedding; straw has little nutritional value but may increase the likelihood of digestive problems in the horse if it is eaten in large quantities.

Peat moss is highly absorbent, and horses will not eat it. Peat moss is unlikely to harbor fungi and is not considered likely to contribute to respiratory conditions. Peat moss is cushiony when applied deeply and, combined with its absorbency, may be excellent bedding for recumbent (“downer”) cases. Storage of peat moss should be in well-ventilated areas only.

Shredded paper products are highly absorbent bedding materials with little dust. Paper products usually are good products for respiratory allergies and other respiratory cases. Note, however, that newsprint can leave stains on the patient.

Daily Patient Care

Feeding Patients

Depending on the patient’s disease, special feeding may be required. If the animal has difficulty chewing or swallowing, the food may need to be moistened or even made into gruel. The clinician will prescribe any special diet necessary for the patient. Sick horses are seldom fed concentrates because of increased concerns for developing GI problems. Sometimes patients cannot be fed any food, and sometimes even water must be withheld for successful management of a particular disease. This is especially true with GI diseases. If these patients are depressed, they may not have an interest in food or water. Horses that are being withheld food and water will sometimes eat or chew anything they can—bedding, wooden doors/walls, buckets, etc. Managing these horses may require placing a muzzle on them. Muzzles are not always effective because some horses can find inventive ways to eat around them, and some can get them off. If it is vital that the horse take nothing by mouth (nil per os [NPO]). It is better to remove all bedding and use rubber mats or inedible bedding such as peat moss.

Although eating from the ground is common on farms, this procedure should not be allowed in a hospital setting. Manure and urine can contaminate the feed. Hay can be suspended in a hay net or placed in a hay rack. Hay nets and slat-type hay racks should be higher than shoulder level to prevent hooves from getting entangled in them if the animal paws with the front legs.

Animals should have access to supplemental salt and/or trace minerals, which can be provided in the form of loose salt or the more traditional block form (salt/mineral brick or “lick”). Giving each patient a full block is unnecessary; the blocks can be divided with a hammer or small saw for short-stay patients. Discard salt licks between patients as part of thorough stall cleaning.

Record the types and amount of feed offered to the animal as well as what the animal actually eats. Some animals may eat their hay but refuse their grain, or vice versa. Some may eat fresh grass if it is available but refuse hay. Some may eat only a portion of what is put in the stall. What the animal eats and does not eat can be important information for the clinician.

Watering Patients

Water provision is a vital part of animal care. Fresh water provided daily is an absolute necessity. Water can be provided in the stall with either manual or automatic methods. Manual watering involves filling a water container, usually a bucket, with a water hose. Automatic waterers are convenient for human caretakers but are not always helpful in a hospital setting. Most animals do not have access to these devices on their home farm and therefore do not know how to use them. The waterers make a noise when they refill, which repels many horses. Automatic systems are difficult to disassemble for thorough disinfection. Perhaps the biggest drawback in a hospital setting is the inability to accurately track a patient’s water intake. There is no convenient way to monitor the amount of water entering the bowl under normal circumstances.

Manual watering is preferable in the large animal hospital. Standard water buckets hold 5 gallons, so some animals may require two 5-gallon buckets in their stalls. Water containers should be checked more than once per day and filled as necessary. The amount of water consumed by an animal is important information and should be recorded at each “bucket check.” Animals may not drink adequate amounts of water in the hospital setting because of stress, illness, or a different taste of the water from what they are accustomed to on their home farm. Water consumption is particularly important to monitor in GI patients.

Because opinions vary on what a “full bucket” means, it is useful to standardize a full bucket by marking the fill level with tape or a nontoxic paint mark. This will provide consistency by having all caretakers fill the bucket to the same level. When estimating the amount of water consumed by the animal at each bucket check, do not assume that the amount of water missing from the bucket has actually been consumed by the horse. Some animals play with their water buckets (with their mouths or by pawing with the forelimbs) and spill large quantities of water on the floor. Animals may place their noses in their buckets and splash their water without actually drinking. Therefore, you should check the stall floor in the area of the bucket to see if most of the water has been spilled or if it has, in fact, been consumed by the horse. Record the approximate amount of water consumed, and refill the bucket to the fill line.

Some animals benefit from electrolyte water solutions. Electrolyte water is generally made by adding a commercially prepared electrolyte powder to a standard volume of water. Potassium chloride can be made with 6 to 10 g or electrolyte salt per liter of water. Many animals will drink electrolyte water during hot weather to replace losses through sweat evaporation (horses primarily), and some simply seem to enjoy the alternative to plain water. Horses with diarrhea may selectively drink electrolyte and bicarbonate solutions; bicarbonate water is made by adding 10 g of baking soda per liter of water. Electrolyte water should never be used as the sole water source. Instead, it should be provided as a supplement to plain, fresh water.

Water buckets should generally be placed at or above shoulder level so that the animal’s legs will not get caught in them. Rubber buckets are easy to disinfect and last longer than metal buckets, which have a tendency to get crushed and may rust. In cold weather, water sources may freeze, and the ice must either be physically broken and removed or ice formation prevented with commercially available electric water warming coils.

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Aug 11, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Daily Hospital Responsibilities

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