Nursing Case Study - Rosie

@helen 
Hi Helen,
Yes these are some great considerations. It is really important to make sure we have somewhere (ideally quiet) ready to take Rosie for triaging and if the usual emergency area is unavailable that we have a plan B. 

Emergency medications are also key and a crash box or trolley is really helpful to have prepared for quick access to these. As we don't know what condition Rosie will be in when she arrives, it would also be a good idea to have medications for resuscitation available (e.g. adrenaline, atropine) and dosage charts.

Other items I would prepare include oxygen and methods to deliver these (e.g. mask/flow-by), monitoring equipment, items for catheter placement and blood collection (both under the direction of the veterinary surgeon) and an ultrasound scanner. Based on Rosie's signalment and description of signs, I would also be checking the blood product availability in the practice or locally, even if she doesn't need it once she has been assessed.

@f_leneyhotmail-com 
Hi Fran, great answers. The primary survey is key and allows us to establish what (if any) life-threatening signs Rosie has that need immediate intervention. You are then right about having to try and find a balance with caring for the patient and communicating with team members and the owner.

I like to try and reassure the owners when they arrive as much as possible and have found that introducing myself and briefly explaining what is going to happen (e.g. "“Hello Mrs Jones, my name is Laura, and I am a veterinary nurse. I am just going to take Rosie into our treatment area to perform a triage exam and check if there is anything we need to do right now to help her. Once this is complete, a vet will come and speak to you”) can really help with this.

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Rosie's nursing care is going to be very intensive initially to ensure she is responding to the treatment administered. Throughout this time we want to be monitoring her cardiovascular status (HR, pulses, NIBP, CRT) and her respiratory system. This is to monitor for both deterioration and improvement in her condition. 

As she is currently collapsed and recumbent, we need to use lots of padded bedding and turn her regularly (every 4 hr) plus monitor her bed for urine/faeces. Bear in mind she has received steroids plus fluid boluses and ongoing fluid therapy so may be producing more urine during this time. As we were expecting a relatively quick improvement with treatment, a urinary catheter was not deemed appropriate at this point, however if her recumbency was anticipated to be longer-term then this would have been considered.

Additional treatment options that may have been needed included adrenaline and vasopressor support if Rosie had not improved.