The Revision Guide for Student Nurses (Part I)

Clinical Exam - Practical Task


  1. RESTRAINT A nervous stray may well require a muzzle as a safety precaution. A large dog is probably best examined on the floor, while a smaller breed should be carefully lifted onto the examination table.
  2. MAKE FRIENDS Introduce yourself before handling the dog and gently reassure him or her. It is sensible to sex the animal so that you can say "good boy" or "good girl" without looking like a fool later when you come to examine the genitals! In the stray scenario, the dog's name will not be known, but if you are given a task in which a client presents the dog - ask its name.
  3. VITAL SIGNS Unless advised otherwise, check the dog's vital signs before proceeding with a more thorough examination. Checking for ear mites is not a priority in a dog suffering from shock! A stray may be malnourished, dehydrated or injured, and with no history available from the owner - it is essential to investigate all avenues. Having established that the dog does not require emergency treatment from the veterinary surgeon, you are now ready to begin but first a quick recap on the signs of shock and dehydration and pain.

    • Depressed demeanour.
    • Pallor.
    • Dry mucous membranes.
    • Prolonged capillary refill time (> 2 secs).
    • Rapid feeble pulse.
    • Tachypnoea.
    • Tachycardia.
    • Cold extremities.
    • Hypothermia.
    • Collapse/convulsions.

    • Skin tenting.
    • Dry mucous membranes.
    • Pallor.
    • Prolonged CRT.
    • Dull, sunken eyes.
    • Staring, spiky coat.

    • Depression.
    • Inappetance.
    • Vocalising.
    • Panting.
    • Tachycardia.
    • Tachypnoea.
    • Pyrexia.
    • Lameness.
    • Aggression.
    • Unusual stance such as "the praying position".
    The eyes should be bright and alert. Check the palprebal reflex. Abnormalities include foreign bodies, third eyelids drawn across, entropion/ectropion, cataracts, excessive lacrimation and ocular discharge. The ears should be clean and free from odour. Look for excessive hair, wax and purulent discharge. Any or all of these signs may indicate otitis or otodectes cyanosis (ear mites). The mucous membranes of the mouth should be moist and pink in colour. Check the teeth for tartar, and the gums for stomatitis and gingivitis. Excessive salivation or panting could be indicative of a problem. A nasal discharge may well indicate a respiratory infection, which would pose a risk to other patients.
    Body weight is extremely important. A stray is more likely to be malnourished than obese. Perhaps the ribs are very visible and there is a significant skin tent indicating dehydration. The coat should be shiny and smooth. Methodically check for signs of parasitic infection. Fleas and ticks are clearly visible. A very scurfy coat could be evidence of malassezia, while areas of skin inflammation may be as a result of an allergic reaction or a mite infestation. Areas of hair-loss could be a manifestation of a hormonal condition such as Cushing's disease. The whole body should be carefully examined for injuries, masses and bald spots. A dog that is particularly itchy during examination is likely to be host to some form of external parasite, even if visible signs are not in evidence. A stray should be routinely treated with an effective insecticide prior to admission. Anthelmintics are also advisable.
    Ask an assistant to walk the dog up and down. Observe for lameness. An old dog may suffer from osteoarthritis. Check each limb in turn, and examine the pads. Look for interdigital foreign bodies, overgrown claws and fractured or scuffed nails. Scuffed nails are a prime sign of a road accident.
    The tail should be held high. A nervous dog will probably skulk with it between its legs, but a flaccid tail is often a sign of pelvic or spinal injury and warrants further investigation. The anus should be clean; look for signs of diarrhoea, haemorrhage and parasitic worms. Next check the genitalia. Sex the dog, noting for abnormalities in the male such as cryptorcidism. Look for bloody or purulent discharges particularly in a female. In a female, be especially vigilant in looking for signs of pyometra or a season.
    In practice, remember there is little point in performing a thorough clinical examination without noting the details. Ensure that scrupulous records are kept in order to advise other personnel as to the animal's requirements. If throughout the course of the examination there are any aspects, which give cause for concern - always seek the advice of a veterinary surgeon.