Head to Tail Health Check – Skin

Animal’s skin should look just like ours when it’s healthy – pink, smooth and warm. It is easy to tell when there is a problem as it’s hard to notice any animal scratching, biting and rubbing at itself.

The most common thing I booked appointments for was for excessively itchy dogs and cats! There can be many reasons for an itchy pet and these are:

• Environmental Factors – Dogs that like to run through tall grass, and bushes.
• Nutritional Factors - Food allergies i.e. wheat intolerance
• Parasitic Factors – Fleas and ticks etc.

Things to look for:

Hot spots – These are often seen in long haired dogs such as Golden Retrievers. This can also been known as Moist Eczema and is caused by moisture building deep in the fur and causing skin lesions which can easily become infected as a hot spot is the perfect breeding ground for Bacteria. Aggressive treatment with topical antibiotics is often needed as these can spread quickly.

Tip: If you find a hotspot developing, clip the fur off the patch and cleaned with an antibacterial scrub such as Hibiscrub, this will prevent the moisture building up and deprive the bacteria of their preferred environment.

Parasites – Flea allergic dermatitis is seen commonly in practice and clients are very sceptical when they are told the diagnosis as they often can’t see any fleas on their pet. But in actual fact all it takes is one bite from one flea for the animal’s skin to become red, sore and irritated.

Tip: A cool bath can often sooth the skin of animals with flea allergic dermatitis, shampoo such as epi-soothe are often prescribed as it puts moisture back into dry skin.

Infectious Dermatitis – This is when the skin is red and salvia stained as its is often so irritating that the animal will lick at the infected area continuously. After a while skin lesions can develop and eventual puss will be seen. Treatment for this would be to clip the infected area to allow the skin to dry out and to again use a topical soothing agent to relieve the itching, oral antibiotics are also given to kill the microorganisms invading the skin.

As a veterinary nurse, your job would be to administered medication the vet has prescribe and note the day to day changes in the condition to see whether the treatment is working. Having basic background knowledge is important! 

Head to Tail Health Check – Hydration Status

Breakdown of Fluid Losses in a 24hour period:

Inevitable losses (Respiratory Losses) – 20mg/kg/24hrs

Faecal losses (Normal faeces) – 10-20mg/kg/24hrs

Urinary losses – 20ml/kg/24hrs

*It is thought that each time an animal vomits they lose 4ml/kg/24hrs*

An animal becomes dehydrated when they lose more than the normal amount of fluid for their bodyweight. This can be caused by vomiting, diarrhoea, and pyrexia, failure to consume food and water and overexposure to heat. Left untreated dehydration cause organ failure and death.

There are several ways dehydration can be detected, these are:

•  Lack of skin elasticity (the skin doesn’t ping back as quickly as it should when pulled)
• Dry, tacky gums
• Sunken eyes
• Oliguria
• Lethargy
•  Delayed CRT

By combining the above symptoms we can score how severely dehydrated the dog is on a 1-10% scale. 1% being adequate and no treatment needed 7-10% needs immediate medical attention as death is probable. Anything in between 2-6% would require fluid therapy.

Head to Tail Health Check - Mentation and Demeanour

I totally forgot about this and its one of the first things you should do before you even approach the animal.

Mentation and Demeanour are important factors to consider as they can hint to how an animal is feeling I.e. if they are in pain, uncomfortable, scared.

Mentation – This is the level of consciousness the animal has at the time of the health check.

Demeanour – This is how the animal is presenting itself to you during its health check.

An animal’s mentation can firstly be assessed by calling the animals name from a distance and seeing it jumps up and comes running towards you or if it just sits there or if it even responses to you at all. If you get no response walk closer doing the same thing, repeat this until you get a response. Once you have reached the animal and you still have had no response, stroking it and stimulating it can also be done to see if the animal is just too weak to respond to you or if it is unconscious.

Mentation can also be assessed by doing a neurological exam and testing the Pupillary Light Reflex and the animal’s reaction times. But I have never seen a Veterinary Nurse do these.

Once you have established an animal’s mentation and you can note their demeanour, are they bright and active, sad and depressed, or aggressive and fearful.

NEVER APPROACH An AGGRESSIVE DOG BY YOURSELF! ALWAYS HAVE SOMEONE ELSE WITH YOU AND A MUZZLE AND SLIP READY FOR RESTRAINT IF NEEDED.

Common abbreviations used when describing mentation and demeanour:

BAR – Bright, Alert and Responsive (Responsive to external stimuli and not acting ill)

QAR – Quiet, Alert and Responsive (Not as active but responsive)  

Gums

The colour of an animal’s gums can tell you a lot about its condition, whether they are healthy, in shock or even if they have been poisoned. The main colours to look out for are:

• Salmon Pink – Healthy
• Yellow – Jaundice (Likely to be a problem with the Liver)
• Brick Red – Possible Gas poisoning (Carbon Dioxide poisoning presents this sign)
• White/Grey – Anaemic or in established shock – IMMEDIATE VETERINARY ATTENTION NEEDED.
• Blue/Dark Grey – Lack of circulating Oxygen (Usually Dyspnoeic) – IMMEDIATE VETERINARY ATTENTION NEEDED.

The animals Capillary Refill Time (CRT) should also be checked to ensure that blood is circulating well. In a healthy animal it should turn from white when pressed to pink in less than two seconds. Anything significantly longer than that could suggest that the animal is about to go into shock that they are hemorrhaging from somewhere.

Breath

The smell of an animal’s breath can also give you an indication to what their condition is like.

• Animals with sweet smelling breath (ketones) – Possibility of diabetes (distinctive pear drops smell)
• Animals with Stale Urine smelling breath – Possible Renal Failure, more common in cats than dogs (Once you smell this you will never forget it trust me!)
• Animals with combination of dental disease and bad breath – IN NEED OF A DENTAL!

Teeth

It doesn’t take a rocket scientist to know if a patient is in serious need of a dental, The most common clinical signs that are seen (or smelt!) are: Bad breath, Reluctance to eat normal food, Plaque build-up on teeth and Broken or cracked teeth.

Rabbits and other small rodents – Their teeth grow continuously, therefore educating owners on this and what food is the best for them to prevent the need for dentals every six weeks is very important.   

Head to Tail Health Check - Nose

A healthy nose should be clear of discharge and both nostrils should be fully open and clear.

There are several types of discharge from the nose that can be present, these are:

• Clear Discharge - Commonly caused by Allergies (present with other symptoms)
• Yellow Discharge - Is a symptom of Distemper
• Green Discharge 
• Smelly Discharge

Generally, clear discharge coming from the nose is nothing to worry about unless it is coming from just one nostril, has a foul odor or if it is always present. Any of the other types of discharge being present would suggest an infection or trauma.

*NASAL DISCHARGE from just ONE nostril could suggest a blockage in that nostril, such as a grass seed. Other clinical signs that could be seen with a blockage are nose bleeds, sneezing and pawing at the Nose*

Other Symptoms that are associated with a Nasal infection are: Nose bleeds, Coughing and Choking due to a postnasal drip and a foul odor.

Polyps (overgrown Mucus producing glands) and Tumors can also be observed in all animals. Clinical signs of this would be Noisy breathing, a bulge on the side of the nose and purulent and bloody discharge. These need Veterinary Attention.