Medical Nursing Week 10

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Medical Nursing Week 10
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2012-11-02 12:00:08
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Medical Nursing Vaccines Fluids Blood Transfusion EKG
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Medical Nursing Week 10
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  1. Vaccines
    Principles of vaccines
    • Vaccines are given to Prevent disease by stimulating antiboties to a specifc Antigen (parvovirus)
    • Vaccines are not 100% fool proof at preventing disease
    •      Some do not prevent disease infection, only lesson clinical symptoms.
    • Polyvalent vaccines contain many antigens
    •    DHLLP
    •    FeRCP
    • Monovalent vaccines contain only one antigen
    •     Rabies
    •    FELV
  2. Vaccines
    Types
    Modified Live (Attenuated)
    • Microorganisms are altered so they no longer virulent to cause disease, yet retains their anigenic properties to induce a immune response.
    • Produces a stronger and more durable immune response than likked vaccines
    • Side effects
    •   Can induce immunosuppression
    • Can cause vaccine induced disease
  3. Vaccines
    Types
    Killed (inactivated) Has more than one agent in it
    • Cannot replicate, so they are safer
    • Requires large anitgenic dose and multiple injections
    • Produces weaker immune response with shorter duration
    • Subunit Vaccine
    •   not infectious
    • Does not contain complete organism, rather components to produce immune response
    • Example: Equine Strangle
  4. Vaccines
    Types
    Bacterins- Has to be killed
    • Killed bacteria
    • less effective than viral vaccines
    • Short lived immunity
    • Example: Bordatella

    Vaccine against viruses work better
  5. Vaccines
    Types
    Live Vaccine
    • Adjuvant- drug-enhancing agent: a drug or agent added to another drug or agent to enhance its medical effectiveness. Keeps in the system longer
    • Live vaccine
    • prepared from live organism
    • Live vaccines require few doses
    • No adjuvents or preservative
    • Side effects
    •    Expensive
    • Contamination
    • Can give disease to person administering
    • Causes disease to animal being vaccinated due to residual virulence
    • Ex: Brucella abortus strain 19
  6. Vaccines
    Types
    Toxoid- to prevent it
    • Vaccine that produces immunity to a toxin rather than to a virus or bacteria
    • Proviede protection for 1 year
    • Ex. Tetanus toxoid- Clostridium tetani
  7. Vaccines
    Types
    Antiserum- Antibodies against infectious agent
    • Serum containing specific antibidies from a hyperimmunized animal that has been effected by the specific microorganism
    • Produces immediated action to kill live infectious antigens
    • Do not vaccinate for at least 21 days after giving antiserum
    • Ex. E-Coli in swin or cattle
  8. Vaccines
    Types
    Antitoxin- Antibodies against toxin
    • Antiserum aimed against specific toxin
    • Obtained from hyperimmunized horse which is then extracted from its serum
    • Antitoxins neutralize toxin when administered to patients with clinical disease
    • Produced immediate passive immunity for 7-14 days
    • Side effects
    • Allergic reaction
    • Ex. Tetanus antitoxin
  9. Vaccines
    Proper Use
    • vaccine are made to be given in a specific route, if not followed then they may not produce immunity.
    • Lyophilized (powder) should be used immediately after reconstitution
    • Improper storage and heat will inactivate vaccine
    • especially MLV
  10. Vaccines
    Maternal Antibodies
    • Passive immunity from colostrom
    • Maternal antibodies cause vaccine failure by inhibiting an immune response.
    • For this reason, multiple boosters are needed at a young age
    •   1. up to 22 weeks for puppies
    •   2. Up to 16 weeks for kittens
    • There is a 2-5 week window of vulnerability when an animal can be infected with virus but cannot be successfully immunized.
    • Heterotypic immunity- canine
    •   Immune response to one microorganism by immunizing with a different but antigenically related microorganism
    • Measles virus (MV) to protect against cainie distemper
  11. Vaccines
    Vaccinations- age
    • Start at 6, 8, 10 weeks of age, then repeat at 2-3 week intervals until 6 months of age. (especially for Rots, pits and doberman)
    • Many different protocols
    • New theory (vaccine titers)
    • Yearly boosters are scientifically invalid
    • No tru immunological reason for annual vaccine
    • Vaccineate puppies and kittens as before, but then no boosters are needed unless blood titer levels indicated immune toter is to low (vaccone titers)
    •    Vaccine generally keep immunity for 3 years duration in adult animals
    • Take vaccine titers before vaccination.
    • Over vaccination causing vaccine induced feline sarcoma (cancers) and immune mediated diseases at ITP and IMHA.
    • ITP- Idiopathic thrombocytopedic purpura
    • IMHA- Immune mediated hemolytic anemia
  12. Vaccines
    Core Vaccines (recommended)
    • Canine vaccines
    •    Parvovirus (MLV)
    •    Canine distemper (MLV)
    •    Canine adenovirus-2 (MLV)
    •    Rabies (killed)
    • Feline vaccines
    •     Feline panleukopenia (MLV)
    •     Feline viral rhinotacheitis- FHV (MLV)
    •     Feline calicivirus- FCV (MLV)
    •     Rabies (killed)
    •     Feline Leukemia virus (killed)
  13. Vaccines
    non core vaccines
    Canine Vaccines
    • Parainfluenza virus (MLV)
    • Bordatella bronchiseptica (killed)
    • Lyme(killed)
    • Canine coronavirus (MLV)
    • Leptospirosis (killed)
    • Rattlesnake (toxoid)
  14. Vaccines
    non core vaccines
    Feline Vaccines
    • Chlamydia psittaci (MLV)
    • FIP (MLV)
    • Bordatella(MLV)
  15. vaccine
    New Vaccines- Recombinant Vaccines
    • Vaccines are created utilizing bacteria or yeast products to form large amounts of a Single viral or bacterial protein antigen.
    • This recombinant protein is made into a vaccine and injected into the patient, and the patients immune system makes antibodies to the specific disease agents protein. (canine distemper)
    • Advantages of recombinant vaccines
    •    No symptoms of the disease vaccinated for since only a single protein of the antigen agent.
    • No adjuvant needed- lsee side effect reations
    • Produce strong cell mediated and humoral immune response.
    • Recombinant vaccines
    • Canine distemper
    • FELV
    • Lyme- Borrelia burgdorferi
    • Merial PUREVAC-FELV vaccine
    •    Recombinant vaccine
    •    Uses needles injection to prevent feline sarcoma
    • Given with VET JET transdermal vaccination system that injects antigen with air force into the dermis
  16. Vaccines
    Canine Vaccines
    DHLPP-C
    • Distemper
    • Hepatitis (CAV1 and CAV2)
    • Leptospirosis (L. Canicola and L. icterohemmorrhagica)
    • Parainfluenza
    • Parvo
    • Coronavirus
  17. Vaccines
    Canine Vaccines
    Bordetella
    • Bordatella bronchiseptica
    • Routes are either SQ or intranasal
    •        Intranasal is passive immunity
    • start at 8-12 weeks, of age then yearly booster 4-6 months
  18. Vaccines
    Canine Vaccines
    Lyme Disease
    • Borrelia burgdorferi
    • Start about 9-12 weeks of age, 4 months
    • Two vaccine series with shots given 2 weeks apart and booster once annually
  19. Vaccines
    Canine Vaccines
    Rabies
    • Begin at 4 months of age
    • Booster annually
    • Booster annually after 1 year of age
    •     after 1 year age, booster good for 3 years

    Rattlesnake (Toxoid)
  20. Vaccines
    Feline Vaccines
    FVRC-P
    • FVR- Feline Viral Rhinopnuemonitis
    • FVC- Feline calicivirus
    • FP- Feline Panluekopenia
    • P- Pnuemonitis (Chlamydia psittaci)
  21. Vaccines
    Feline Vaccines
    FELV
    • Start as early as 6 weeks
    • 2 vaccine series
    •   give second injection 2-4 weeks apart, then booster annually
  22. Vaccines
    Feline Vaccines
    FIP
    • 2 dose series
    •   second dose given 2-4 weeeks apart,
    • Intranasal
    • Does not prevent infection, only lessons clinical signs
  23. Vaccines
    Feline Vaccines
    Rabies
    same as dogs
  24. Vaccines
    Vaccine reactions
    • Reactions to any fraction of the vaccine: Rabies, leptospirosis
    •        Immune respons to antigen vaccine
    • Angioedema, hives, vomiting and diarrhea
    • Anaphylaxis
    • Pain at injection site
    • Fibrosarcoma in cats- neoplasia
    • Allergic reactions many times caused by adjuvants and preservatives.
    •         1. Adjuvant- agent used to carry antigen to enhance the immune response
    •      Alluminum hydroxide, phosphate and potassium
    •         2. Preservatives
    •                    Agents added to prevent growth of microorganisms
    •                    Penicillins, streptomycin and fungistatic agents
    • Generally treated as allergic reaction with Diphenhydramine (Benadryl) and corticosteroids. (Dexamethasone)
    •             1. Epinephrine and Iv fluid if anaphylaxis
  25. Equine Vaccine
    Core Vaccines
    • Tetanus
    • Equine encephalitis
    • Rhinopneumonitis (EHV) Equine Herpes
    • Influenza
    • West Nile Virus
  26. Equine Vaccine
    Tetanus (TT)- Core
    • Clostrideum tetani
    • Infection is characterized by muscle rigidity, which may result in death from respiratory arrest or convulsions.
  27. Equine Vaccine
    Equine encephalitis vaccines (EEE, WEE, VEE)
    • Eastern, western and Venezuelan strains
    • Combination trivalent vaccine for all three
    • Infection is characterized by a viral nuerological disease that can be minor as pyrexia and anorexia to convulsions and death
    • Transmitted by biting insects
  28. Equine Vaccine
    Equine Influenza (A1, A2)
    • Primarily infected by strains A1 and A2
    • Infection is characterized by fever, depression, anorexia, coughing and muscle pain
    • Transmitted by contact from horse to horse
  29. Equine Vaccine
    Equine Strangle
    • Streptococcus equi
    • Highly contagious respiratory disease characterized by fever and upper respiratory pus nasal discharge, followed by abscess formation of the submandibular, submaxillary and retropharyngeal lymph nodes
    • Subunit vaccine
    • May cause injection site abscess
  30. Equine Vaccine
    Equine Viral Arteritis (EVA)
    • RNA Virus
    • Infection is characterized by fever, depression, nasal discharge, caughing and limb swelling.
  31. Equine vaccines
    • Potomic horse fever
    • Rabies
    • Anthrax
  32. Sites of vaccine administration
    Page 123
    Dog
    • Giardia- left shoulder
    • DHPPC- right shoulder
    • microchip- back
    • Rabies- back
    • Lyme disease- back left leg
    • Rattlesnake- right rear leg
  33. Sites of vaccination Administration
    Cat
    • Giardia- front left shoulder
    • Microchip- same as dog
    • FVRCPP- front right shoulder
    • FeLV- left rear leg
    • Rabies- right rear leg
  34. Fluids for Therapy
    Animals water Weight On average 55-67% of weight
    How to access dehydration
    History of animal

    • Vomiting
    • Diarrhea
    • not drinking or eating
  35. Fluids for Therapy
    Animals water Weight On average 55-67% of weight
    How to assess dehydration
    • Skin fold 4,6,8
    • 4% dehydration- not evident clinically
    •   Not eating or drinking for 1-3 days
    •   Vomiting and diarrhea- fluid loss
    • 6% dehydration- moderate
    • Skin sluggish to return to position
    • Eyes are dull and dry
    • 8% dehydration- severe
    • Skin stays in tented position
    • Eyes are sunken
    • 12-15% dehydration- extremeel sever
    • Death is soon
  36. Fluids for Therapy
    Animals water Weight On average 55-67% of weight
    How to assess dehydration
    • PCV+ TP = dehydration
    • Fluid loss will increase Pack Cell Volume + Total protein
    • Increased BUN Blood urea Nitrogen
    • Increased urine specific gravity >1.040
  37. Fluids for Therapy
    Hydration
    Fluid rate guidlines and calculations
    • Administration of lfuids depends on the condition of the animal.
    •   No more than 1/4 total volume is given in the first hour
    • Daily maintenance calculation
    • 45mls * body weight
    • Fluid loss calculation
    •   Body weight kg and % dehydration
    • 1 liter (1000 mls per L) = total ml
  38. Fluids for Therapy
    Hydration
    Fluid rate guidelines and calculations
    • Drip rate calculation 
    • 15 drops/ml= macro (white)
    • 60 drops/ml = micro (green)
    • Drops/min= type of drip set (drops/ml) * volume hour
    •  Example :
    • Drops/min= 15 drops/ml * 250 ml=3750 drops/ml Or 3750 drops/ml x1 hr/60min= 60-65 drops/min or 1 drop/sec
  39. Fluids for Therapy
    Hydration
    Methods of Rehydration
    • Oral
    • Subcutaneous Fluids (SQ) fluids
    • Intravenous (IV) fluids
    •    fluids with addisitve of Potassium Chloride (K+) and calcium (Ca) are given slowly.
    • Intraperitoneal (IP) fluids in the abdomen
    • Intraosseous (IO) fluids usually reptile
    • Parental nutrition- feeding tubes PEG tube

    Jejunostomy tube, naso-gastro tube (NG)
  40. Fluids for Therapy
    Hydration
    Fluid Types
    Introduction
    • Most fluid is lost through the extracellular fluid
    • Normal plasma osmolarity is 300 MOsm
    • Blood Ph=7.4
    • Urine output 20-45 ml/kg/day
  41. Fluids for Therapy
    Hydration
    Types of fluids
    Crystalloids
    Introduction
    • Balanced electrolyte fluids with water
    • Sodium based electrolyte solutions that are commonly used replace fluids loss.
    • Their composition is similar to plasma
    • Crystalloids are classified into categories by their tonocoty as isotonic, hypotonic, hypertonic
  42. Fluids for Therapy
    Hydration
    Types of fluids
    Crystalloids
    Isotonic fluids
    • Electrolyte balance is similar to plasma
    • Lactated ringers solution (LRS), 0.9% sodium chloride (Nacl), 0.45% Nacl + 2.5% dextrose, Plamalyte, Normosol
    • Can be given at any rate
  43. Fluids for Therapy
    Hydration
    Types of fluids
    Crystalloids
    Hypertonic Fluids- Head Trauma
    • More electrolytes than plasm
    • 50% dextrose, 9% NACL (Hypertonic saline)
    • Cannot be given SQ
  44. Fluids for Therapy
    Hydration
    Types of fluids
    Crystalloids
    Hypotonic Fluids
    • Less electrolytes than plasma
    • Sterile water, 5% Dextrose and water (D5W)
    • Not used except to constitute drugs
  45. Fluids for Therapy
    Hydration
    Types of fluids
    Colloids
    • Large macromolecules restricted to plasma compartment that enhances the oncotic force of blood causing fluid to move into the vascular space.
    • Colloids are used to treat shock and hypoproteinemia
    • Natural colloids
    •    Plasma and Fresh whole blood
    • Synthetic colloids
    •   Hetastarch and Dextran 70
    •    Oxyhemoglobin (synthetic blood transfusion)
  46. Fluids for Therapy
    Hydration
    Types of fluids
    Blood Products
    • Whole Blood
    • Plasma
    • PRBC
  47. Blood Transfusions
    Transfusion Therapy
    • Transfusions are given not only for red blood cells, but also for other blood components as plasma and coagulation factors
    • Fresh whole blood can be separated into four components
    • Red cells
    • Platelet rich plasma
    • Fresh frozen plasma
    • Cryoprecipitate- factor VIII, Von Willondbrands
    • Transfusions may be indicated for the flollowing

    • Anemia
    • Coagulopathy
    • Thrombocytopenia- give plasma
    • Hypoproteinemic- give plasma
  48. Blood Transfusions
    Blood Types
    • Blood types are genetic markers on the red cell that are antigenic and specific for each  species.
    • These alloantibodies are the cause of transfusion reactions and neonatal isoerythrolysis.
    • Canine blood types
    •   Dogs system known as DEA (Dog Erythrocyte Antigen)
    •   Blood types can be positive and negative
    • Ideal Blood donor- DEA 1.1 negative (greyhounds)
    • Types
    •     DEA 1
    •            DEA 1.1 (A1)
    •            DEA 1.2 (A2)
    •    DEA 3B
    •    DEA 4 C
    •    DEA 5D
    •    DEA 7tr
  49. Blood Transfusions
    Feline Blood Types
    • Cats have three blood types: A, B, AB
    • Type A is the most dominant, while AB is rare
    • A/A or A/B are both type A
    • Only B/B is type B
  50. Blood Transfusions
    Crossmatching
    • Blood crossmatching test the serological incompatibility and compatibility between the donor and recipient.
    • Crossmatching test for alloantibodies, but does not determine blood type.
    • Dogs have naturally occuring alloantibodies, thus crossmatch should show compatibility
    • Cats have naturally occuring alloantibodies
    • Incompatibility of crossmatch show hemolysis or agglutination.
  51. Blood Transfusions
    Blood Sources
    Blood donors
    • donor criteria
    • PCV>40% in dog
    • PCV>35% in cats
    • Disease free and current vaccines
    • Weight at least 25kg. Dogs and 4kg for cats
    • Should not donate blood sooner than 4 weeks after blood donation
    • Maximal volume to be donated
    •     Dog 20ml/kg or 450mls
    •      Cat 10ml/kg or 50mls
    • Anticoagulent used Citrate-phosphate-dextrose-adenine (CPD-A)
  52. Blood Transfusions
    Blood Sources
    Storage
    • Whole blood- 4 degree C for 1 month
    • Packed red blood cells- 4 degree C 1 month
    • Platelet rich plasma - 24 hours
    • Fresh frozen plasma- <20 degree C up to 1 year
  53. Blood Transfusions
    Blood Sources
    Before Administering Blood
    • Warm to room temperature
    • At 50 degree C fibrinogen precipitates
    • At 45 degree C RBC will agglutinate
    • Filter needed when administering cell products to prevent thrombosis.
  54. Blood Transfusions
    Transfusion Administration
    • Warm to room temperature before administration
    • Rate depends on disease and patients status
    •    Always start blood transfusion slowly initially and give over 4 hours
    • Rate guide lines
    •    10 ml/kg hr to 22ml/kg/hr
    •    1 lm/lb of weight increase PCV by 1%
    • Calculations
    • Volume to be given =  PCV desired- PCV recipient
    • 2.2 * recipients Weight (kg) * (30 dog or 40 cat) x PCV of donor in anticoagulent
  55. Transfusion Reactions
    • Most common is fever, followed by vomiting and diarrhea.
    • Monitor temperature every 5 minutes- first symptom of transfusion reaction will be an increase in body temperature, then panting.
    • Phase 1 (anaphylaxis)
    •       Hypotension and bradycardia
    •       Vomiting and diarrhea
    •       Lethargy, seizure and nystagmus
    • Phase 2 (Hemolytic)
    •       Hemolysis, hemoglobinemia, bilirubinuria
    •       Tachycardia, DIC, Death
  56. Dexamethasone
    corticosteroid, is similar to a natural hormone produced by your adrenal glands. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Dexamethasone is also used to treat certain types of cancer.
  57. Blood Transfusions
    • Only NaCL .9% can be used when flushing lines before and after a blood product transfusion. Calcium will precipitate if you use LRS
    • Lactated Ringer's solution) is a liquid solution of electrolytes in water.
  58. Blood Sources
    • Blood banks offer different types of blood products. Usually relieable)
    • Autotransfusion from clean traumatic hemorrhage in body cavities
    • Blood donors- Donor criteria
    •  PCV >40% dog > 35% cat
    • Disease free and current on vaccines
  59. Electrocardiogram
    Basic Principles of Cardiac Vectors
    • Forces moving towards a positive electrode cause upward deflection on the dog.
    • forces moving away from a positive electrode cause a downward deflection on the ECG
    • ECG records the difference in electrical activity between the two electrodes
  60. Electrocardiogram
    Leads and lead colors
    • Leads detect electreical activity in different planes through the body are called I,II, III, Avr, Avl, and Avf
    •  Black lead- Front left leg
    • White lead- Front right leg
    • Green lead- right rear leg
    • Red lead- left rear leg
  61. Electrocardiogram
    Lead System
    Bipolar standard Leads
    • Lead I: right arm (-) and left arm (+)
    • Lead II: right arm (-) and left leg (+)
    • Lead III: left arm (-) and left leg (+)
  62. Electrocardiogram
    Augmented unipolar limb leads
    • Uses same electrodes as standard leads, but now connects them in different combinations.
    • Allow heart to be studies from three new angles.
    • Lead Avr: Right arm (+) compared with left arm and left leg (-)
    • Lead Avl: Left are (+) compared with right are and left leg (-)
    • Lead Avf: Left leg (+) compared with right and left arms (-)
  63. Performing an EKG
    • Animal in right lateral recumbency on non- metallic surface
    • Forelimbs- black on white like a newspaper
    • Hindlegs- Red over green like a stoplight
    • 6 lead axis strips at 25 mm/sec
    •   Lead I
    • Lead II
    • Lead III
    • Lead Avr
    • Lead Avl
    • Lead Avf
    • Lead II rythm strip at 50mm/sec for about 15-30 sec
    • Record the standard, usually 1cm = 1mv, write the strip speed, identify patient
  64. Indications for ECG
    • ECG may detect enlargement for cardiac chambers
    • ECG is used to diagnose cardia arrythmias
    • It detects electrolyte imbalances
    • It monitors response to therapy
    •        Digitals for CHF- Atrial arrythmias
    •        Antiarrythmic therapy
    • It is useful in the diagnosis of nonspecific diseases.
    •        Myocarditis
    •        Endocarditis
    •        Neoplasia
    • It helps to establish prognosis
    •        Changes or improvements
  65. EKG complexes
    • Definition: Depolarization- contraction (systole)
    •   Repolarization- filling  (diastole)
    • "P" wave
    •     Depoloarization of the atria
    •      Impulse from SA node to AV node
    • "P-R" interval
    •    Impulse from SA node to ventricles
    • QRS complex
    •    Depolarization of ventricles
    • "T" wave
    • repolarization of ventricles
  66. Page 142
    EKG in cardiac disease
    • Left cardiac enlargement
    •       Left axis deviation
    •      QRS complexes wide
    •      Tall "R" wave
  67. EKG in cardiac disease
    Right ventricular enlargement
    • Right ventricular Enlargement
    • Right axis deviation
    • Large "S" wave
  68. EKG measurements
    • Normal Speed is 25 mm/sec
    •        50mm/sec at the end of the strip
    • Calculation of heart rate from ECG
    •         Measures R to R interval in 3 seconds and multiply by 20 at speed 50mm/sec
    •       Measure R to R interval in 3 seconds and multiply by 10 speed 25mm/sec

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