Discharge advice

Re: Discharge advice

kaz84 — Tue, 21 Dec 2010 03:48:32 GMT

all the advice as above. we do a follow up call the following day to see how they are going. we also dispense Nsaids for another 3 days, so explain this aswell. we get alot of RN's and Dr's who think they should remove the stitches.

A few weeks ago i had one client say that was the best post op advice they have ever received, even more info and detail then when she had surgery :)

Re: Discharge advice

Geniverger — Mon, 20 Dec 2010 22:07:28 GMT

We have a post-op sheet with all the info on taking a pet home after sx to give to the client which we go through with them before they even see their animal. It goes like this;

Go over again what the procedure was, what it entailed and sometimes what was removed!
How the pet may react at home after a GA/sedation (sleepy, wobbly, disoriented, inappetent, or sometimes excited)
What to feed and when (we send our patients home with Royal Canin Sens control and give advice on reintroducing their pet's normal food)
Advice about shaved areas - Front legs and around wound site - and not to worry, it will grow back!
Possible cough from the ET tube, what to listen for (a lot of clients don't know what a dog cough sounds like and will call up thinking they have something stuck in their throat.
If there are stitches or staples we go through house/cage rest and lead walk restrictions, and give an estimated time of wound healing depending on the procedure (e.g. ~10 days for a castration, longer for say, an infected, cleaned-up and sutured cut pad) and tips on how to calm excited puppies or keep house-bound outdoor cats happy.
What to look for around the wound site (redness, swelling, discharge, pain, heat) and in the animal (changed demeanour, appetite change, interfering with the wound) which could indicate pain, infection or pulled sutures.
What pain-relief the patient has already had and take-home medication, whether it's abs, NSAIDs, topical medication, other pain relief etc, what it's for, when to give it and any special precautions.
When to bring the patient back for a POC and why it is so important - Many clients think that if their pet looks ok, they are ok. I explain that the vet needs to listen to the heart and lungs post-GA and assess the surgical site to make sure it's healing at the rate they would like, that there's no wound breakdown, and any pain or swelling is managed etc. It's surprising how many clients underestimate how important it is.
Any bandage care if relevant; what to look for, how to protect the dressing and when to come back for a bandage change.

That's about it. The vet will usually go through bits such as expected time for lab results, any clinical findings (from xrays or exlaps for example) and whether any further treatment is required.

Re: Discharge advice

Emma Townson VN Cert IV MBVNA — Mon, 20 Dec 2010 18:54:54 GMT

Because I was busy in surgery still, the vet asked her to discharge...

I stepped out quickly to lend an ear (becaue I dont trust her)...and I then had to step in an tell her...

the vet is normally so on the ball with this stuff and i was just a bit gob smacked that she said nothing :o

Re: Discharge advice

Steph Phillips — Sun, 19 Dec 2010 21:00:58 GMT

[quote user="Stuart McQueen RVN MBVNA"]

[quote user="SmegSlayer"]I sometimes wonder if 14 days is long enough for stitches to stay in for. my very first emergency call on nights as an SVN was at 6:45am- a female labrador who had been spayed 2 weeks before had been clipped on the back end by a van- the wound burst open to the muscle layer, the dog had to under go 3 days in hospital, full peritoneal lavage and the clients where lumbered with a huge OOH bill[/quote]

this has happened to me too... it was an exlap - ROS 14days. the woman phoned to say that that she'd just got the dog home and there was a bit of tissue poking through the wound... we said bring him straight back down, I was mortified, she rang back 2 minutes later to say she would need a visit as he was dragging him abdo contents across her kitchen floor, my heart just sank, i went out on the visit with the vet and was so apologetic to the client, she was so ok about it, it was unreal. she was like "it's not your problem, it was his time for his sutures to come out, he just hasn't healed" thankfully we sedated the dog and took him to the hospital (he has started to have a lick around his abdo - why? i'll never know)... hense the sedation... anyways we got him to the hospital and straight to theatre, flushed about 10 litres of saline into him, there was grit and hair and all sorts in there! he was on ivft for 2 days and went home on day 3 - sutured with pds which we took out after a month! that was 3 years ago, and i still get a christmas card from them!

[/quote]

I'd say it depended on the type of surgery and the vets opinion as to how long the stitches stay in for.. we removed a huge mammary tumour that involved a skin flap procedure (not sure what the exact term for it is!) - anyway, those stitches were in place for about a month - then removing a few stitches & buttons (buttons to take the tension) at a time over a period of 2wks!

Re: Discharge advice

Stuart McQueen RVN MBVNA — Sun, 19 Dec 2010 20:32:19 GMT

Re: Discharge advice

SmegSlayer — Sun, 19 Dec 2010 20:02:24 GMT

I sometimes wonder if 14 days is long enough for stitches to stay in for. my very first emergency call on nights as an SVN was at 6:45am- a female labrador who had been spayed 2 weeks before had been clipped on the back end by a van- the wound burst open to the muscle layer, the dog had to under go 3 days in hospital, full peritoneal lavage and the clients where lumbered with a huge OOH bill

Re: Discharge advice

Steph Worsley — Sun, 19 Dec 2010 19:19:27 GMT

you "caught" her? surely someone must have asked her to discharge the patient, I would actually rather her say nothing than give completely wrong advice.

It should have been down to the person who asked her to discharge to make sure she knew what info she should be giving to the client

Re: Discharge advice

Steph Phillips — Sun, 19 Dec 2010 19:12:12 GMT

We say all the above too:

rec bland diet that evening - little & often rather than one big meal - (rcw sensitivity), wound check 3days, stitches out 14 days.. see before if worried. Lead exercise after 2days for about 15mins, but I stress to keep on lead incase stiches gets caught on twigs or something .. I warn they might have a cough from et tube, and also point out the shaved area on leg (some clients question why we shave the leg) .. we also advice on what to look out for (swelling etc.. ) and come down if worried.

Re: Discharge advice

Honeybadger — Sun, 19 Dec 2010 19:06:05 GMT

Before I was nursing I had my rats discharged to me by the receptionist at the vets that I took them to. Never had any post op info, what had been done, what drugs had been given, what to look out for etc. I think communication is key between us and the clients to give the best patient care.

Re: Discharge advice

Honeybadger — Sun, 19 Dec 2010 19:04:13 GMT

All of the above - but I also show them the wound so they know where it is and how it should look. And I explain that they might have a slight cough from ET tube.

Re: Discharge advice

SmegSlayer — Sun, 19 Dec 2010 18:36:49 GMT

as above but i also say that if the animal suddenly goes off its food or goes a bit lethargic after being fine for a few days to come back BEFORE the scheduled appointment- some clients can be completely dumb so best to ensure everything is covered

Re: Discharge advice

shelly jefferies — Sun, 19 Dec 2010 18:19:05 GMT

we recommend poc 3 days and ros 10-14 days, explain importance of lead exercise until sutures removed, what to check for with regards to the wound, feeding, why use buster collar etc. We explain all this in detail but also have a printed copy which we give the owners, we have it saved on a word document so just change the animals details and can modify exercise of post op details. Also space on there to put about medications.

we also have at the bottom of our post op care sheets that the post op check and removal of suture are fOC unless any further meds or dressings etc are required as we had lots of people thinking everything was included in the first cost!

By giving people the paper copy it gives them something to refer to at home as normally not listening fully when telling them as more interested in getting pet home.

As well a post op home sheet, we also have a bandage care form which all dressings get given!

Re: Discharge advice

Stuart McQueen RVN MBVNA — Sun, 19 Dec 2010 17:04:14 GMT

POC 2 days

ROS 10-14 days

ABs and NSAIDs given under Ga last about 24 hours so no need for any meds to go home with.

Check for redness, swelling or weeping from the wound, contact if worried.

Can eat a LD later this evening, chicken, fish etc etc or can offer a tin of Royal Canin tin of sens if they want.

Dogs are usually left in kennel while I discharge so owners focus is on what I tell them.

I get them to go to reception to make at least the POC appointment while I get the dog.

I have a bit of a script that I go into when I get started, all that changes is the animals name and him or her! haha