By Teresa Ann Raffel-Kleist
CVT, VTS (Surgery), Madison Area Technical College,
"The outcome of a surgical procedure is often determined after a patient leaves the practice because most postoperative healing and recovery happen at home under the client's care. Thorough yet simple instructions are therefore essential to ensure a successful recovery. Clients may not be familiar with veterinary terminology, so explain at-home care in plain, easy-to-understand terms that match the written discharge instructions. Written instructions are important because the client may be overwhelmed by the postoperative care his or her pet will need and may not remember everything he or she was told.
Instructions that are difficult to understand may be performed incorrectly or not at all, which can complicate and extend patient recovery. Follow these 5 steps to ensure the client fully understands the care his or her pet needs:
1. Explain Every Medication
Clearly describe each medication type (eg, antibiotic, analgesic, anti-inflammatory) to help the client understand how the drug helps the patient. Explain when and how often each medication should be administered. One pill q12h is not the same as 2 pills q24h, so make sure the client understands the difference.
Always review each medication's common side effects (eg, soft stools from antibiotics, increased thirst and urination from corticosteroids) and the less common but more serious side effects (eg, facial swelling from aminoglycosides such as gentamicin sulface; vomiting, lethary, hypersalivation from almost any medication). Make sure the client knows which clinical signs require a phone call to the veterinarian or immediate medical attention. Consider demonstrating medication administration using dry kibble in place of a pill or water in place of a liquid preparation and letting the client practice to ensure he or she is comfortable.
2. Describe the Surgical Site
Show the client the surgical site, unless the wound is covered with a bandage. Discuss the wound color and appearance, including the number and type of stitches, and describe how the wound should appear while healing. If external stitches are in place, the client should schedule an appointment for stitch removal before leaving the practice. Explain that increased redness, discharge, or separation of the wound edges may indicate the incision is infected and the veterinarian should examine the patient as quickly as possible.
A patient will most likely lick the wound as part of normal bathing, but the client should know excessive licking must be prevented. Sprays or gels flavored with bitter apple or cherry or other deterrents, can be applied around the incision - not over - to help deter licking. Barrier devices such as an Elizabethan or BiteNot collars may be necessary if other distractions do not successfully deter the animal from excessively licking the incision. Taking photographs of the wound every few days or weekly can help the client monitor healing progress. The photographs can serve as a reference if healing slows or unexpected changes are noted in the incision's appearance.
3. Discuss the Importance of Bandage Care
If the patient has a bandage over the surgical site, explain the importance of the bandage and make sure the client understands how long it must stay in place. Demonstrate how to check if the bandage has slipped and how it can be repositioned. Explain how to keep the bandage clean and dry, and advise the client to smell the bandage at least daily to check for odor.
If a limb is bandaged, show the client how to check the toes for warmth, color, and swelling. (See Figure 1.) The patient may alert the client something is not right by licking or chewing at the bandage site - the client should contact the practice immediately to determine if a bandage check appointment is needed.
Figure 1 Clients should be shown how to check the pet's toes for warmth, color, and swelling when a limb is bandaged.
4. Review Exercise Restrictions
Review the recommendations or restrictions for patient exercise with the client. A patient with an abdominal wound should be prevented from jumping for at least 2 weeks to allow the abdominal wall to heal.
If walking is permitted, explicit instructions - not just leash walk only - should be shared verbally and included in the written discharge instructions. The client should walk the patient on a 5-foot leash - attaching the leash as a tether to a 50-foot line in the backyard is not leash walking.
If the veterinarian prescribed short, limited walks with a gradual progression to normal activity, give the client a specific timeline (eg, 5-minute walks for the first 2 days, 10-minute walks for the next 2 days, 15-minute walks for the subsequent 2 days, until the patient's normal activity level is reached). Demonstrate how to perform specific rehabilitation exercises the patient.
Delay bathing any surgical patient for at least 2 weeks to allow the wound to heal properly. Bathing must also be delayed following bandage removal until the sutures have also been removed.
5. Explain the Importance of the Right Diet
Recovery is not time for a patient to diet, but gaining extra weight can be counterproductive to healing. Explain the need for good nutrition - not excessive nutrition - and consider including specific nutritional recommendations in the written discharge instruction. For example, cats with urinary obstruction issues may be prescribed a diet specifically formulated to inhibit development of the crystals that caused the obstruction. Other patients with systemic issues (eg, hepatic, cardiac) can be given specially formulated food that will not stress those body systems while they recover.
A patient is likely to gain a few pounds during recovery because of a lower activity level, but weight gain can be kept to a minimum as long as treat are not substituted for love. Remind the client that time spent with the patient is more valuable than any treat.
Use simple, easy-to-understand terminology in all client communications. Clearly explain the purpose, dosage, and potential medication side effects to help ensure patients receive the medications needed to heal. Make sure clients are familiar with the wound site, which helps them better understand the healing process and know when to call the practice when something seems wrong. Discuss the importance of bandage care, exercise restrictions, and diet, and clearly explain the details in the written discharge instructions. Proper postoperative at-home care is essential for successful recovery, and the verbal and written instructions given to clients when patients are discharged are key."
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