PART 1: A Day in the Life of a Registered Veterinary Nurse at Bay Vets

My morning started at 7:30am, the Night RVN informed me that there were four inpatients from the previous night: Millie, Pickle, Humphrey and Roxy.

Millie (2-year-old labrador) and Pickle (3-year-old domestic cat) had been stable and would likely go home today.

Millie was recovering from a bleed intra-operatively and we had kept her for observations overnight.

Pickle had been referred to us from a local practice after he was involved in a traffic collision and obtained a fractured femur and dislocated hip. The surgeons had operated after he was stabilised, and Pickle had recovered well.

I was informed that Humphrey (6-year-old domestic cat), who was hospitalised for urethral obstruction the day prior so had been catheterised to resolve this was now having his urine output monitored through an indwelling urinary catheter (IUC). It was reported that he seemed comfortable and was eating and drinking as expected however his urine output was only 0.8ml/kg/hr, lower than expected and an indication that his kidney function may be in decline.

Roxy (4-year-old chihuahua), who was receiving a constant rate infusion of calcium for eclampsia, was beginning to show signs of bradycardia so her infusion would need to be altered and constant monitoring required to prevent her deterioration. I connected the ECG to her to monitor heart rate and for cardiac abnormalities and adjusted the rate of her transfusion to the lowest prescribed dose that the vet had already specified; 3.8ml/hr. Within 10 minutes, Roxy’s heart rate increased from 96 to 128, where it had been consistently through the night. Signs of eclampsia (panting, hypersalivation, muscle tremors, vomiting) remained absent which indicated the treatment was having the desired effect.

The inpatient vet arrived at 8am, I informed her of the above. They requested I ran a manual PCV then held Millie for an abdominal ultrasound to aid identification as to whether anaemia was present and if the haemorrhage had successfully been addressed in surgery and through the prescription and administration of tranexamic acid since she woke from the anaesthetic. I took a cephalic sample with the help of an auxiliary nurse, then asked them to centrifuge the blood in a capillary tube and use the Hawksley scale to interpret what percentage red blood cells were present compared to the whole blood. The result was 45% - well within the normal range.

I set up a comfy bed on the exam table and input the appropriate details and settings into the ultrasound machine then settled Millie on the table and held her steady while the vet confirmed there was no free fluid in her abdomen so Millie could indeed go home, and I was asked to arrange that appointment with the owner then see Millie out, explaining all aftercare to the owners.

Pickle was to have his wound dressing changed, and as long as his parameters were normal, I could also arrange a discharge appointment for him. His heart rate was 180, respiration rate 38, temperature 38.8 C and pain score 2/16 – all as expected and nothing of concern. I removed his dressing from yesterday, observed the wound was showing normal signs of early-stage healing so replaced a thin breathable dressing and an Elizabethan collar to prevent him interfering with this when he goes home.

I called the owners of Millie and Pickle while the vet re-examined Roxy, I informed the owners of the positive updates and arranged times for them to come to the surgery to receive home care plans and collect their respective animal.

I was then asked to run a calcium blood test on Roxy so we could determine whether the infusion had resolved the issue and could therefore stop intravenous treatment and arrange oral supplementation of calcium for her to go home with. The auxiliary nurse restrained Roxy for me while I took a jugular sample, then I used the centrifuge to separate the plasma from the cells and set-up the biochemistry analyser with calcium testing slides. I set the sample and test to run then returned to check on Humphrey.

Humphrey’s parameters indicated slight to moderate dehydration, and the vet advised his IVFT rate could be increased from maintenance to twice that, so I calculated this (17ml/hr) and calibrated the drip pump to deliver this for the next few hours. I removed the dressing from the intravenous cannula, examining the skin and palpating area to ensure there were no signs of phlebitis. I cleaned the skin with diluted chlorhexidine, dried it and reapplied a loose dressing to keep the site clean. I flushed the cannula and was satisfied it was functional and comfortable for Humphrey.

Roxy’s calcium results came in within the normal range, so the infusion was to be stopped and observations to continue to ensure the clinical signs of eclampsia did not return.

I called Humphrey’s owner and informed them we were monitoring his hydration status and urine output, supplementing his intake with further IVFT and would be in touch with them again later that day. It may be necessary for us to run blood analysis which would provide insight as to his renal function. They asked if they could drop off some of his favourite treats and visit him, which I arranged for the afternoon.

I also called Roxy’s owner and provisionally booked them in with the inpatient vet as a discharge appointment so ongoing management and prevention of recurrence could be discussed. If there were any changes in Roxy’s conditions throughout the day, she would have to stay with us but otherwise they were prepared to come and collect. I groomed Roxy after this and took her on her harness and lead out to the garden for enrichment and toilet opportunities.

After Roxy, I took Millie out to the garden and sat with her outside for 15 minutes so she could stretch her legs and enjoy one-to-one attention away from the wards. When we came back inside, I held her while another RVN removed her IVC and placed a pressure dressing, then put her back to her bed with some brunch in a slow feeder.

At 11am, Pickle was due some medication. The vet had requested the injectable drugs were swapped to oral formulations, so I noted the prescribed dose and dispensed antibiotics and anti-inflammatory analgesia, having one of my RVN colleagues check and countersign this. I fussed Pickle and convinced him to eat some tuna in which I had hidden his meds and swapped his unused litter tray for a shallower option in case his avoidance was due to his reduced mobility following his surgery. I was about to perform some passive physiotherapy as the surgeon had directed post-surgery when one of the consulting vets came into the prep area and asked for assistance with a dog who had been presented to consultation after being seen ingest a bagel containing raisins 30 minutes ago.

Mr Bagel (real name Monty) was to have emesis induced via apomorphine injection. The vet had weighed Mr Bagel and asked me to draw up and subcutaneously inject 2.5ml of the drug, which I did then held a tray by him and caught the consequences, ensuring the naughty labrador didn’t help himself to a second round. Once his stomach was empty, I returned Mr Bagel to his owner, advised them that he might seem dysphoric, and vomiting could recur for a few hours. I cleaned up the mess just in time for me to see Millie out as her owners had arrived for their discharge appointment.

I spoke to them about post-operative care including diet, exercise and wound care then answered their questions about what had caused the bleed during an otherwise routine spay procedure. I advised them of signs to look out for of pain and internal bleeding in case there was any repeats and reassured them of our out-of-hours service should they be concerned outside of surgery hours. I explained the analgesia liquid prescribed and showed them how to accurately dose and gave them advice on how to best get the tranexamic acid capsules into her when she was difficult to convince to eat medicines. Finally, I booked them a follow-up appointment in 2 days’ time.

Back in wards, I performed parameter checks on Roxy and Humphrey again; they were both stable, so I went for my lunch.

 To be continued.