JEN the RVN

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JEN the RVN

Hints and tips for the Veterinary Nursing community. Creating a learning environment for all levels. Hi! I'm Jenny RVN Cert VN ECC. I qualified in 2007.

I have been on the ground in practice since 2003. I started my journey from work experience in school, which led to a job as an evening kennel maid in a local practice. From there, I started my training in Veterinary Nursing. Since then, I have worked in general practice ranging from busy 24 hour hospitals to branch practices, gained my Cert VN ECC in 2012, did a short stint in teaching student nu

rses in college and been a Head Nurse on and off throughout my career. Right now and for the foreseeable future, I am a locum RVN. I am a bit of a jack of all trades with 20 years on the ground experience in Veterinary Nursing. I now want to share hints and tips to help others, going back to basics, covering as many aspects of day to day practice as possible.

11/09/2024

I’ll tell you it’s been a disgusting morning and I haven’t even got to work yet!

1) Stepped in dog s**t….ok admittedly in my own garden so I only have myself to blame for that one!

2) Spent 5 minutes trying to chase this little s**t around the park who looked almighty pleased with himself running around with what appeared to be a white cotton string hanging out his mouth. Followed by another 5 minutes of wrestling…yes you guessed it….a huge tampon out of his mouth 🤢

3) He then proceeded to roll in dog s**t 💩

It’s a bloody good job he’s cute to make up for it 😍😇

10/09/2024

Wow! What an incredible day at VN Spark 2.0. Felt rather starstruck seeing my favourite nursing gurus up on the stage delivering their wisdom. Were you there? For those that weren’t, here are a few of my personal take homes from the day from each session:

🌟From rolling up towels to support those frog legs for those older patients in dorsal recumbency for surgery. Also MAGIC MIKE! Something I regularly do (under vet direction). 1mcg/kg medetomidine for those “huffy” patients where other analgesia has been provided and for those stormy recoveries. I’m definately going to get the Magic Mike term spread across practices I work with 🤣

🌟 From update on the new RECOVER guidelines. Scrap that high dose adrenaline. Remember that if you have reversed all analgesia in a crash situation and the patient survives, don’t forget they might be in pain and need further analgesia. Plus, if your patient crashes on the op table and the abdomen is open, consider cardiac compressions through the diaphragm.

🌟From a great refresh of feline blood transfusions. Incorrectly warming your blood will increase your chances of a transfusion reaction. It’s better to give cold blood and warm your patient than risk a reaction. Also need to look at AVHTH algorithm as it will help determine the type of transfusion reaction and correct steps to take following this.

🌟From looking at the 5 pillars of a healthy feline environment to use as a base for feline first aid behavioural advice. Lots of useful everyday case studies used which will definately help in my nurse consults.

🌟From consider early introduction of wound intervention aids with elective and planned surgeries to help patients adapt before it’s needed.

🌟From I will never forget which way round stertor and strider goes after those fabulous and hilarious impressions! Those brachycephalics are likely to have increased PCV and bloods gases will show higher C02 and lactate. Turn them slowly and in stages when moving under GA - they have increased vagal tone so turning suddenly could induce a cardiac arrest.

15/03/2024

If there is one thing this job brings, it’s definitely variety. This week I have been doing:
Anaesthesia,
Dentals,
Nursing inpatients such as IMPA, blocked toms, cholangiohepatitis, gastric-intestinal disorders,
Assisted with scopes, X-rays and ultrasound scans,
Assisted with unblocking urethral obstructions, joint taps and enemas
Discharged medical patients to their awaiting and grateful families, and eaten the lovely treats they bring in for us,
Laboratory work,
And to top it all off a 6pm Friday ex-lap on a silly sausage who decided to swallow a tennis ball whole.
I’ve been covered in every bodily fluid going.
My legs and feet ache.
My back and shoulders hurt.
I’m knackered.
But I’ve LOVED every minute of it.
Not just because of the job itself, but where I am locuming at the moment is a very busy hospital with the most organised, hardworking and amazing team who all stayed past the end of their shift to help get theatre clean and kits done so it wasn’t all left to me.

There have been countless times over the last 20 years where I’ve genuinely wanted to pack it all in. I’ve been there with the stress and the burnout and the compassion fatigue. But I’m so glad I fought through it, because it’s weeks like these that make me feel so incredibly proud and honoured to do this job 🥰

14/03/2024

This week, I was assisting with the diagnostics on a patient with suspected immune-mediated polyarthritis. If this is not something you have come across before, here is a little bit of info on the condition, along with what you need to prep for joint taps

13/03/2024

Remember that not all your kitty inpatients are used to using a litter tray. If you have noticed they appear to be holding onto their urine, try adding outside material such as soil and leaves to their tray to encourage them to go (assuming it’s appropriate from an infection control point of view).

06/03/2024

I don’t know about you, but I find it so cool when you instantly see expected changes in patient parameters when certain drugs are administered.

This is a BP trace from a healthy dog under GA for dental work. The patient had a 5mcg/kg medetomidine and 0.3mg/kg methadone premed. Alfaxan induction and maintenance on sevoflurane.

It was just one of those awkward anaesthetics. The patient just didn’t want to maintain a happy plane of anaesthesia and even when nothing painful was occurring, palpebral reflexes and jaw tone kept returning. Despite local nerve blocks and additional analgesia and increasing the sevoflurane %, we still struggled. So we administered an additional 5mcg/kg medetomidine intravenously to see if it helped.

Medetomidine is an alpha2-agonist. Within a couple of minutes following iv administration, you will see an increase in blood pressure caused by peripheral vasoconstriction. As a reflex response, you will also see a decrease in heart rate and reduced cardiac output.
Medetomidine produces a biphasic effect on blood pressure, so after that initial increase, you will see a return to normal or slightly low BP. The decrease in cardiac output is of minimal significance in healthy animals with normal cardiovascular function. It is also a potent analgesic offering roughly 1 hour analgesia.

29/02/2024

I had dealt with many crash situations in my career but this was a new one on me.
This ECG shows sinus tachycardia with ST depression. The patient presented for its first cardiac ultrasound. He appeared clinically stable. Upon placing him in right lateral recumbancy for the scan, in the space of 5 seconds, he became cyanotic and went into immediate cardiac arrest.
I was in a tiny practice as the sole nurse and as this was what I thought to be a routine conscious scan, we did not have anything prepared for this rare and unfortunate event. We were able to administer BLS and get some adrenaline in. He responded immediately and proceeded to sit up and resist intubation. We were then able to quickly scan his heart and he had a significant pericardial effusion.
We performed a pericardial centesis and stabilised him until he was transferred to a 24hr hospital.
This just goes to show how quickly a “routine” procedure can turn, and I will now ensure that even if they are not undergoing any sedation or GA, I will always be prepared for this eventuality!

26/02/2024

Feline hyperthyroidism.
A very common condition we see in practice. We may even be the first to pick up on the possibility of the disease based upon our history taking and physical examination in a nurse clinic.
How confident do you feel about chatting to owners about this disease? A valuable use of our expertise and skills would be to deliver the diagnosis made by the vet, and discuss the different treatment options that the vet has authorised, with the owner. Doing so can help raise public awareness and perception of the RVN role. It can also empower us individually as we have much more involvement with helping a patient and their owner navigate their way through a potential life-long condition. We can help them to understand whats happening to their pet and why they are seeing the symptoms they are seeing. We can talk them through the likely diagnostic tests that will be run. And once a diagnosis is made, we can talk them through all their options of how to manage the disease.
Here is a very brief overview of feline hyperthyroidism to help you gain that confidence.
References: Small Animal Internal Medicine for Veterinary Technicians and Nurses - Edited by Linda Merrill

23/02/2024

Pulse ox probe placement doesn’t have to be limited to the tongue 👅. For dental procedures in particular they can really get in the way. Anywhere you can find a nice pink bit of tissue can work. In this patient, I got a lovely reading from between the toes. Other areas you can consider are the ear pinna, v***a, prepuce and pads.
Where is your go-to for pulse ox probes?

19/02/2024

Happy Monday! If you can remember just one thing today….lube those eyes!! And not just under GA. For the complete peri-operative period. Plus any in-patient receiving opioids or Ketamine or are in an oxygen cage.

Are you regularly checking your patients for ulcers whilst they stay with you and also in post-op checks?

From a QI point of view, the product used and frequency of application should be recorded. Ulcers that have developed during or following a stay at the practice should be logged - just like post-op wound complications would be. This will then provide a good evidence base for you to adapt your eye lubrication protocol as needed.

What’s your current protocol? And if you don’t have one, don’t worry it won’t take long. You just need to include your product of choice, a list of situations it must be used and the minimal frequency of application.

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