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PART
III- NURSING CARE
I. Nursing Care
Supportive care for sick cats is extremely important. Good nursing
care can help prevent complications and speed recovery from acute illness.
In the Sick Room of the shelter, every effort is made to promote comfort
and reduce stress. The bedding should be extra comfortable and the cages
meticulously clean. Food and water need to be available at all times.
Nutritional support is essential. Tempting, nutritious food should
be provided to help maintain the appetite and help prevent dehydration.
The appetite can be stimulated often by offering wet foods with strong
smells such as fish flavors. Some cats have preferences for certain
textures of food when they are sick, so offer flaked style if the cat does
not eat soft, ground food or vice-versa. Trying a variety of flavors and
textures with the sick cat will usually result in finding something they
will eat. Cats with sores or ulcers in the mouth may need very soft bland
food such as Hill's A/D or chicken baby food, which may even have to be
further softened by mixing a small amount of water with the food. Heating
the wet food for a short time in the microwave may help make the food more
tempting. Be sure it is not hot so the cat does not burn their mouth.
Force feeding may be needed if the cat cannot be tempted to eat.
Force feeding must be done with great care to prevent choking or
aspiration.
10. Frequently Encountered Problems
The health problems
and illnesses we see most often in the shelter
are various respiratory infections, gastrointestinal problems, and skin
problems. Also common in our shelter are dental concerns, internal and
external parasites, injuries, and urinary tract problems.
Other illnesses that have occurred here are Diabetes, Hepatitis,
Pancreatitis, Renal Failure, Eye Injuries, Toxoplasmosis, FIP,
Hyperthyroidism, Seizures, and heart problems. We have encountered high
fevers, severe anorexia, dehydration, and depression, which can accompany
the other illnesses.
Recognizing the potential for any of these and numerous other
potentially serious illnesses to occur at any time is vital.
A. Anorexia
Newly admitted cats at times show very poor appetites until they
start adjusting to the new environment. Try to provide tempting varieties
of nutritious food for them and extra TLC. They may be traumatized by the
experience and will need extra comforting and support. When their previous
diet is known, try to provide that type of food as something familiar may
help their adjustment. They can gradually be transitioned to our standard
fare.
Anorexia often accompanies illness. Use A/D, chicken baby food,
cat tuna, or other more enticing selections. Sick cats need to eat. We
have Nutri-cal paste and kitten food which can always be offered.
Assess any cat showing depressed appetite for oral or dental
lesions, fever, dehydration, or any other symptom of illness. Any cat who
does not eat for more than a full day, will need to be gently force fed.
If this becomes necessary, they will also need to be seen by a
Veterinarian. If subcutaneous fluids are given, select Lactated Ringer's
solution for calories.
B. Constipation
Constipation is difficult to accurately assess as virtually every
cat has access to community litter pans at some point during the day.
Additionally, the daily checklist may not be accurate if it is completed
before the cats have eaten or used their boxes.
Whenever there is concern that a cat has not had a stool for more
than one to two days, they should be monitored while they are out of the
cage. True cases of constipation rarely occur in the shelter.
When it is certain that a cat is not moving their bowels regularly,
assess for any other sign of illness. Be sure they are both eating and
drinking. Check for any abdominal distension or tenderness. Listen for
active bowel sounds. If any sign of obstruction occurs, have them seen by
a Veterinarian. If there is no indication of obstruction or any other
symptom, Laxatore or a similar product, can be given. Always be sure the
cat has access to fresh drinking water and adequate exercise.
C. Dehydration
Dehydration occurs easily in any cat who is sick, febrile,
debilitated in any way, is elderly, or has a depressed appetite.
Dehydration can contribute to fever and may become life threatening rapidly
when not corrected.
Be sure fresh water is available. Tempt with high moisture content
food such as A/D, chicken baby food or any preferred wet food with extra
water added for additional moisture. Warm in microwave if necessary. Be
sure the food is not hot when served.
If there is no respiratory or GI distress present, cool water can
be given orally by dropper or syringe. Give as much as can be safely
administered. Do not force a struggling cat to take water. There is
always a threat of aspiration.
Subcutaneous fluids should be given when needed to correct
dehydration. Normal saline is used for hydration alone. Lactated Ringer's
also provides calories for the anorexic.
If dehydration is ongoing, the cat should be assessed by a Veterinarian.
D. Diarrhea
A frequent occurrence in the shelter, diarrhea can be difficult to
assess. An episode or two is easily precipitated by any stress. It is
most often self-limited. Common causes can include: parasites, diet
change, incorrect feeding, or antibiotic use. Ongoing diarrhea is a sign
of another problem and can easily lead to dehydration or malnutrition.
Eating other cats food, treats, or ingestion of catnip should be
ruled out initially. Parasites can be determined by fecal exam. Incorrect
feeding may be detected in some cases.
Each case must be individually assessed. Be sure feeding is
correct and monitor the cat for consumption of other cats foods. Be sure
they have fresh water to drink as they need to replace lost fluids.
Assess for abdominal symptoms or other signs of illness. If the
stool is soft but formed, monitor the cat. If the stool is unformed,
monitor closely for dehydration or other symptoms.
When diarrhea occurs for more than one to two days and no other
symptoms are found, send fecal sample to Veterinarian's office for exam
including check for Coccidia. If the diarrhea is severe, provide water but
withhold solid food for at least 12 hours. Provide fluids subcutaneously
for dehydration if needed.
If diarrhea persists for more than one to two days and fecal exam
is normal, refer to Veterinarian.
If withholding solid food results in no further diarrhea, slowly
start re-feeding, using small portion, dry food initially. If tolerated,
advance slowly and monitor.
For additional dietary control, add one teaspoon plain yogurt daily
to wet food. Baby rice cereal can be mixed with wet food also.
If Veterinarian prescribes Metronidazole or Flagyl, this drug can
be diffiuclt to administer. Coat each dose with small among of Nutri-cal
or Laxatone to facilitate the process. If necessary, tablet can be crushed
to powder and inserted into small empty gelatin capsules which are
available in the shelter.
1) Complications - Sometimes, diarrhea can indicate a
number of other problems including a cat's inability to tolerate the stress
of confinement in our environment.
Illness related to the Gastrointestinal System can
cause acute or chronic diarrhea. Any of these situations will require
Veterinary assessment and intervention. Ongoing chronic or intermittent
diarrhea and complicated diarrhea calls for Veterinary referral.
Cats can develop Inflammatory Bowel Disease or
infections of digestive organs and system. Mucus or blood in stool, fever,
dehydration and vomiting can complicate the situation, and in some cases,
can be much more of a threat to the cat's health than simple diarrhea.
Testing and treatment with medication may be needed.
E. Vomiting
Vomiting is another very frequent occurrence in the shelter. It is
usually an isolated incident that can occur as a result of eating too much,
too quickly, incorrect diet, hairball, or stress. If there are not other
symptoms of illness, it is usually safe to simply monitor cats with
occasional episodes of vomiting. Try to establish if one of the above
factors is the cause. Treat hairballs with Laxatone, feed small volumes of
food per serving.
Always monitor and thoroughly assess cats with repeated or frequent
vomiting. If vomiting is recurrent for several hours and there are no
other symptoms, withhold all food and water and monitor. When the vomiting
has stopped for several hours, offer small amounts of water at hourly
intervals. After 8 to 12 hours with no further vomiting, offer small
serving of bland, soft food such as chicken baby food. If this is
tolerated for one to two days, advance slowly to regular diet. If
vomiting continues, provide subcutaneous fluids, with hold oral intake and
consult Veterinarian.
Any sign of more serious illness requires Veterinary evaluation.
Monitor for bleeding, abdominal tenderness or distension, abnormal or
absent bowel sounds, jaundice, or fever. Monitor for behavioral changes.
Chronic vomiting may be the result of disorder or infection of
gastrointestinal organs or many other organs, systems, and illnesses.
F. Urinary Tract Infections (UTI)
Urinary Tract Infections and other problems of the urinary system
are seen regularly in our cats. When abnormalities in normal urination are
reported, monitor closely. Intervention is usually needed.
If no urinary output is noted for a full day, the cat should be
confined and assessed. All areas of the cage should be inspected for wet
or dried urine including bedding and floor of cage beneath grate. The cat
may not have used the litter box. They may also have used another cat's
box or community litter. Check for bladder distension or tenderness of the
lower abdomen or pelvis. Be sure there is no external physical obstruction
such as dried litter on urinary meatus. Be sure the cat has been drinking
and provide fresh clean water. Provide fresh litter and clean litter box.
If there are no other symptoms, no bladder distension, no straining
behavior, be sure cat is hydrated, keep confined and monitor. Often it is
found that there is no problem.
Straining to urinate is always a problem and can indicate an acute
emergency situation, especially in male cats. If straining is seen and no
urine is produced, consult with Veterinarian immediately. This can become
rapidly life threatening for male cats who may have an internal
obstruction.
For males or females who strain to urinate but are able to pass
urine even if bloody or concentrated, obtain urine specimen and use
dipstick for urinalysis. If urine is being passed, the cat is not in
immediate danger, but it is an acute situation and requires intervention.
Confine cat, provide water to drink. When urine is obtained and tested,
consult Veterinarian.
Bloody urine without straining can occur. Collect and test urine
and consult Vet.
Polyuria, or excess urine, may be found. It is often a simple
matter of insufficient quantity of litter. Monitor for pattern of
polyuria and if found, obtain and test urine. Consult Veterinarian. After
dipstick, save remaining urine specimen for more accurate specific gravity
testing by Veterinarian. Polyuria can indicate systemic disease such as
Renal Failure or Diabetes. Monitor cat for other symptoms such as changes
in appetite or behavior. Note changes in appearance or weight. Monitor
for vomiting, diarrhea, fever, and other symptoms.
Chronic Urinary Tract Infections with bloody urine or straining
require ongoing monitoring and intervention. Prescription diets are
usually recommended as well as treatment of acute infection.
All cats with history of UTI's should have urinary behavior
monitored and periodic dipstick urinalysis. Urine pH should be maintained
in range below 6.5 by dipstick.
G. Skin Problems
We have seen a range of skin problems from those related to allergy
or diet to infections. Attention to each individual's skin and hair coat
provides a great deal of information on the cat's general health and is
often the first sign of a problem that requires intervention.
Alopecia, loss of hair, thinning or breakage, can be caused by
trauma, inflammation, infection, external parasites, immune system issues,
or other systemic disease. Each case must be evaluated.
Visual examination of the area may reveal obvious trauma, change in
skin surface, or breakage of hairs. There can be multiple different causes
of each of these findings. Regardless of what is initially seen, follow
visual exam with a Wood's Lamp exam before other interventions are
initiated. Ringworm is frequently found in the shelter, and disruption of
skin or hair coat, for any reason, can make a cat more vulnerable to
invasion by this fungus.
Wood's Lamp examination may reveal immediately if Ringworm is
present whether as the primary cause of the initial problem, or secondary
to the primary cause. The Wood's Lamp exam is not a reliable single tool
unless it is distinctly positive, for green fluorescence of skin or hair
shafts. A negative Wood's Lamp exam does not rule out Ringworm.
If Wood's Lamp exam is definitely positive for the bright green
fluorescence of Ringworm, follow-up with Vet referral for treatment. Local
or systemic treatment may be chosen by Vet. Twice daily cleansing with
chlorhexidine solution should also be initiated, and the cat isolated.
If Wood's Lamp exam is negative and visual exam reveals no other
obvious lesion, follow with DTM culture. Initiate twice daily cleaning
with chlorhexidine Solution. If culture is negative on day 14, continue
cleanings. If area does not improve or if it worsens, consult
Veterinarians.
If obvious trauma is present, such as a bite or scratch, attempt to
determine if the cat was fighting. If this cannot be determined or can be
ruled out, the lesion could be self-induced. Obtain DTM culture as
Ringworm may cause itching. Begin chlorhexidine washes twice daily and
monitor. If not resolving, refer to Vet. If fleas are present, they
require treatment. If near the ears, examine for signs of ear mites and
treat if present.
Occasionally, subcutaneous vaccine injections sites develop
inflammation or alopecia which is self limited. Since vaccination also
results in temporary immune suppression to some degree, leaving the cat
vulnerable to infections, obtain culture and initiate twice daily
chlorhexidine wash.
Feline acne, flea allergy, dermatitis, food or environmental
contacts, and infections also occur. Allergic determatitis often causes
roughened, dry, bumpy skin texture and should be evaluated by a
Veterinarian. Infections should be evaluated by a Veterinarian.
11. Injuries
The range of feline injuries encountered in the shelter covers the
spectrum from scratches to fractures, dislocations, and eye injuries.
Obviously, simple minor wounds can be cleaned and monitored.
Simple superficial scratches close to the eyes should be treated twice
daily with Triple Antibiotic Eye Ointment to help prevent secondary eye
infection. Any other eye injuries or significant injuries should be
evaluated by a Vet. Always monitor for swelling, redness, drainage, or
fever which indicate infection and refer to Vet if they occur.
Emergency Veterinary referral needs to be made for any serious injury.
12. Emergencies
The following situations require immediate emergency visit to a
Veterinarian:
A. Severe respiratory distress;
B. Unresponsive cat who has not been sedated or anesthetized;
C. Seizure activity;
D. Bleeding that cannot be stopped with pressure application;
E. Fractures;
F. Fever 106 degrees F, or higher;
G. Male cat straining to urinate but unable to pass urine.
13. Rabies Quarantine
In dealing with this issue, we adhere to state law. As the
potential risk to human health is very significant, we take extra
precautions and make all decisions in this matter with a directed effort
always to minimize risk, choosing safe, conservative actions in all cases
without deviation.
All cats with wounds of unknown origin are quarantined immediately
unless they have proof of current Rabies vaccination. The wound does not
have to be an obvious bite or scratch, nor does it have to appear to have
been clearly inflicted by an animal. If the origin of a wound is not
known, it is treated as a quarantine issue. All cats with wounds also need
to be seen for Veterinary examination.
The Quarantine Period is six full months. After five full months
have elapsed, the cat is examined by our Veterinarians. If they determine
that there is no evidence of Rabies, a Rabies vaccination is administered.
The cat is quarantined for a further 30-day period, then is re-examined by
the Veterinarian. If there remains no evidence of Rabies infection in the
cat, the Veterinarian alone may release the cat from continuing quarantine.
During the entire quarantine period, the cat is monitored for any
abnormality in health or behavior that could potentially be a sign of
Rabies infection. If there is any sign of such an abnormality even
potentially developing, the cat must be evaluated by a Veterinarian. This
includes any change in behavior or neurological symptom and any other
development that could even possibly indicate Rabies infection.
Only staff and volunteers who have received pre-exposure Rabies
Vaccinations are ever permitted to enter the Quarantine Area or have any
contact with any cat who is in quarantine for Rabies. No unvaccinated
persons may enter this area or have any contact with cats in quarantine at
any time for any reason. There are no exceptions.
If cats in quarantine for Rabies have contact with each other, a
risk is undertaken for each involved cat. If Rabies were to develop in any
of these cats, every cat exposed is also at risk. No food, water, or
dishes should be shared. For this reason, each cat should have exercise
and play time out of their cage separately.
14. Bite Wounds
Any new cat with current Rabies vaccination who is admitted with a
bite wound should receive close monitoring in the shelter for a ten-day
period.
Any human who is bitten by a shelter cat should immediately wash
the bite very thoroughly with antibacterial soap and hot running water,
then flush the area repeatedly with Hydrogen Peroxide Solution available in
the shelter. The area should be carefully monitored for any sign of
infection. Should any sign of infection or any other problem occur, the
affected person should contact their health care provider immediately to
obtain medical care.
Any cat in the shelter who bites a human must be monitored in the
shelter for a ten-day period. If the cat has not received a Rabies
vaccination, it should be delayed until the ten-day monitoring period has
elapsed. Any suspicious sign should be evaluated by a Vet.
15. Parasites
Internal and external parasites are common in the shelter.
Worms. All new cats are routinely given medication for worms.
Following label directions or specific Vet recommendation, Drontal is used
initially. A second dose may be needed. Drontal tablets must be rapidly
administered, placing the dose as far back toward cat's throat as possible.
Voluminous frothy salivation can occur if the tablet is in the cat's mouth
for more than a few seconds. Getting a second chance, if the first attempt
fails, may not always be possible. For Roundworms, Strong-T (generic) is
used when Drontal cannot be given, at a dose of 1 ml. per 10 lb. body
weight. Repeat in 10-14 days. For Tapeworms, Droncit is used according to
package directions.
Other parasites have been found on fecal exams and treatment is
recommended by Veterinarian in specific situation.
Coccidia has been a problem at times. It must be diagnosed by
fecal exam. Treatment will be recommended by Veterinarian.
Fleas frequently arrive with new cats. Flea powder can be used on
cats and bedding. Follow label directions carefully. Flea baths can be
given when willing staff or volunteers are able. Follow label directions
for flea shampoo. Flea combs should be used to remove remaining fleas and
eggs.
Advantage is available in the shelter. It is routinely used
monthly in the Quarantine Room where fleas have been a chronic problem and
the cats are more closely confined. Wherever there are fleas, expect to
see tapeworms, also.
When using any product to kill or control parasites, use caution.
Follow label directions. Never mix different products. All of these
substances are highly toxic and must be respected.
Ear Mites are very common in the shelter. Ears should be gently
and thoroughly cleaned. A variety of products are available for treatment
in the shelter. We have had the most success using Tresaderm, often on a
long-term basis in chronic or resistant cases. Tresaderm must be
refrigerated. The routine we have found most effective over time has been
to administer three to four drops in each affected ear twice daily for one
to two weeks depending on severity. Then, once daily for another one to
two weeks for total of at least 21 days. Clean ears as needed before and
between treatments. Monitor ears periodically, for several weeks,
following treatment. In chronic or recurrent cases, other products can be
used. We have found that what works best in long term situations and is
best tolerated by the cats is to use Tresaderm, three times weekly for
longer periods after initially attempting the previous, more intensive
regimen. The three-times weekly treatment usually works in one to three
months but may need to be periodically repeated.
Other products we have used include Mita Clear which has been both
poorly tolerated and less effective, and Ivomec 10% Solution. Both are
available in the shelter.
Invomec 10% Solution is potentially neurotoxic and caution must be
used. Ivomec concentrate must be mixed with Propylene Glycol to make 10%
Solution. Mix very carefully. Add 1 ml. Ivomec concentrate to 9 ml.
Propylene Glycol. Shake well before each use to be certain soltion is
evenly mixed. Use 1 ml. in eaach ear one time. May be repeated after 21
days have elapsed if mites return. Store all Ivomec Solution is dark glass
containers. Never repeat dose without checking with a Vet. Ivomec is not
always tolerated by the cats. It appears to cause more discomfort than the
other products.
Be aware that cats often shake their heads rapidly and forcefully
when produts are instilled in their ears. Be very cautious to avoid
getting the products into the eyes of cats or humans when they are shaking.
16. Additional Information
A. Disinfectants
Although we have used other products, the disinfectant we find most
effective has been Chlorhexidine Solution. Chlorhexidine is effective
against the Ringworm fungus, and additinoally, when we added it to other
measures in place to reduce incidence of URI, appears to have contributed
significantly toward this objective.
Chlorhexidine is less potentially toxic than bleach, the most
effective Ringworm disinfectant. Bleach solutions are hazardous to felines
and humans and the risks of using bleach in our imperfectly ventilated
facility outweigh the benefits, except in very limited circumstances.
Chlorhexidine can be used for wound cleansing, treating feline
acne, and local skin cleansing. It is a good treatment for localized mild
skin infections.
Any disinfectant, including cholorohexidine Solution msut be used
properly and with cautious respect. Label directions must be stringently
followed at all times. Solutions improperly mixed are not safe. If too
dilute, the solution is ineffective. If too strong, it is potentially
toxic. The solution should never be ingested.
B. Subcutaneous Fluids
When using subcutaneous fluids to prevent or correct hydration or
to provide extra fluids or calories for sick, anorexic, or febrile felines,
proper use of equipment is essential. Only sterile equipment intended for
parenteral use is acceptable.
Use the smallest available quantity of sterile solution. 500 ml.
bags are preferable to 1000 ml. bags, to avoid both waste and increased
risk of contamination in this setting.
Tubing should be changed after 48 hours if using Lactated Ringer's
Solution or toher solutions that contain dextrose or glucose. For Normal
Saline Solution, the tubing can be used for five to seven days; if used
aseptically to minimize risk of contamination.
Use a new needle for each fluid administration. Always cap the
needle, or the open end of the tubing with sterile caps if tubing is stored
between uses without the needle. Do not leave any part of the system open
to contamination of room air.
If equipment can be safely stored with needle attached, it is good
practice to apply a new needle after each fluid administration to reduce
risk of contamination by backflow.
If backflow is ever observed, do not use the tubing or solution for
more than one cat.
C. Lab Work
Urine: To collect urine, use clean litter box containing a small
amount of non-absorbant styrofoam packing peanuts. Avoid cellulose or
cornstarch as they tend to dissolve and can alter test results. If the cat
refuses to use this litter, try an empty box which also works somethimes.
As a last resort, remove all bedding and litter pans, line bottom of cage
with litter boxes until the cat urinates. This is uncomfortable for the
cat and is avoided when possible. Use sterile syringe without needle, or
large sterile dropper to remove specimen from box and send to Vet's Lab or
test with dipstick in the shelter.
For more accurate specific gravity or microscopic exam, specimen
must be sent ot the Vet's Lab. Urine culture is done entirely by the Vet.
Routine Dipstick Urinalysis can easily be done in the shelter.
Always observe timing according to product label. We find the "Leukocyte"
test shows positive result even when microscopic Vet exam does not reveal
leukocytes. Protein reading often shows trace positive result which can be
due to feline high protein diet alone and is not necessarily abnormal.
With abnormal results, save the specimen and consult Veterinarian.
Fecals: Collect small amount fresh stool in small plastic bag
pre-marked with permanent "sharpie" type penw ith cat name, Vet ID #,
date,
and test to be performed. For diarrhea, always include Coccidia. Tapeworm
is not usually found this way but many other common parasites will be
detected.
Blood Tests: All blood work is done by Veterinarians.
Results: When possible for cultures and blood work, obtain copy of
result for MRFRS and attach to health record. If Vet does not notify
shelter of results, call to obtain them.
DTM culture for Ringworm: we perform this test at the shelter. If
this is not possible, request that it be done at Vet's office, using our
culture bottle. In the shelter, follow label directions provided with the
Dermatophyte Test Medium (DTM) culture bottles. Disinfect forcepts with
chlorhexidine Solution after use. Label specimen using permanent marker
with cat name and date of culture. Monitor result every two to three days.
After the 14th day, the result is no longer accurate. The culture must
receive final reading on Day 14. Positive results may be seen much sooner.
Discard after reading on 14th day. If unsure of result at any time,
consult Veterinarian.
17. Kittens
Due to the immature immune system of kittens and high
concentraitons of potentially harmful microorganisms in the shelter,
kittens reside in foster homes. When fully vaccinated and at least four
months of age, some kittens who have not been adopted from the foster
program are occasionally placed in the shelter. All kittens are at
significantly increased risk of illness in the shelter environment, so this
is avoided whenever possible.
18. Adoption
Your goal in adoption is to provide each of your felines with a
permanent, loving home. Toward this end, it is vital to be entirely honest
with adoptive families with regard to any and all known health and
behavioral history. This helps facilitate the most appropriate permanent
placement. All known health, behavioral, or social special needs and
concerns must be honestly and clearly disclosed so that the family can best
determine their ability to meet those needs. Any cat who cannot be kept by
their family after adoption for any reason should be returned to the
shelter. The shelter should willingly accept lifetime responsibility for
its animals.