THE hospitalised rabbit presents its own problems and challenges to nurses. For the rabbit, being a prey animal, just being in hospital can be enough to upset its stress levels, let alone when they are already compromised.
One of the most common presentations of the rabbit needing nursing care is that of the rabbit with gut stasis. This may be primary, due to either a diet or stress issue with resulting pain from gas build-up or secondary, due to pain and/or discomfort from dental issues, trauma, or an underlying disease process.
Even rabbit patients that come into hospital for routine procedures should be treated as if gut stasis is a concern. It is now relatively common for rabbits undergoing neutering, for instance, to have pre-emptive injections of gut mobility drugs, pre- and post-operative pain relief and fluid therapy to prevent post-operative complications.
The quicker the rabbit can start to be treated the better and hopefully clients are starting to realise that a rabbit not eating is an emergency to prevent a quick decline resulting in death. In hospital we need to try to minimise the stress that the rabbit will feel in a strange environment to the best of our ability.
If you are lucky enough to have a dedicated rabbit ward then congratulations! However, most of us can feel thankful for just having separate cat and dog wards with rabbits commonly being put in with the cats. This is marginally better than being with noisy dogs but still less than ideal for a prey species.
If you are able to utilise another area – we use our lab room – and set up a restriction cage, for instance, this can be a good compromise. Another benefit of a restriction cage is that they are bigger than a cat kennel – it is often overlooked how important exercise is in stimulating gut movement in the rabbit and a larger area makes this more possible.
Providing cardboard boxes for the bunny to hide in, jump on and run around, toilet rolls stuffed with hay and/or favourite veggies, litter trays with hay in for the bunny to scrabble and dig in – all this will provide an environment to help with the rabbit’s recovery. A heat pad may be indicated if the animal’s temperature is subnormal.
Pain relief is of the utmost importance in treating rabbits and any resulting gut stasis will not be resolved without addressing this. The use of NSAIDs in rabbits is well-tolerated – check the dose used as it can be used at a rate much higher than that in the dog.
Dehydration should be addressed before using a NSAID – buprenorphine can be used instead or in conjunction. Tramadol is also an effective pain relief in bunnies. Fluid therapy should be initiated with gut stasis cases whether dehydration is apparent or not as hydration of the guts is important.
Radiographs and blood glucose can also be very helpful in determining the severity of the case and any underlying causes. Gut mobility drugs such as metoclopramide and also ranitidine should also be given. Ranitidine also helps prevent gastric ulcers.
Feeding
Supportive nursing will mainly concern syringe feeding. I find that the syringes provided by Supreme Recovery are the best suited to the task. They hold a good amount of food and are ergonomic for the bunny and the shape of their mouth.
Science Supreme Recovery or Oxbow Critical Care (both powdered diets to be mixed with water) can be used for syringe feeding although Excel has recently introduced a diet called Dualcare, a pellet food which can have water added to make a mash or a syringable food.
In order to syringe-feed successfully, wrapping the bunny in a towel can help. Placing the syringe tip between the nasal philtrum and then gently moving to the side and inwards is the easiest way of getting the syringe in place rather than trying to get the rabbit to open its mouth voluntarily. I aim to feed 10-15ml of food each time with a target of 50ml/kg over a 24-hour period.
As well as syringe feeding, we should offer tasty foods to try to encourage them to eat independently – dandelion leaves, parsley, curly kale, spring greens and freshly picked grass are all foods I have had success with in the past. Good quality hay should always be available.
Offer sweet treats like apple and carrots with care as the sugar can exasperate the condition by increasing fermentation and gas build-up. This is why pineapple juice – although commonly used in the past – shouldn’t be used to try to break down hairballs.
Poo production should be monitored closely – the amount passed and the quality can tell us a lot as to how the rabbit is progressing. Are they uniform in shape? Do they have mucus around them? Are they a poo string? Any evidence of caecotrophs?
It always amuses me how much attention us nurses pay to faeces and with rabbits it can give a significant amount of information as to whether the treatment is helping, so don’t feel silly about counting those poos!
