Written by Roxanne Murray RVN, Ward Nurse
As a Referral Ward Nurse at Swift Referrals, the most rewarding part of my role is providing patient care. My aim is to ensure patients feel calm, relaxed and pain free throughout their stay at Swift Referrals.
I have always had a keen interest in pain management and how physiotherapy can help patients gain strength, stability, and confidence.
My interest in drug free pain management therapy has evolved over the course of my career. Each patient is different and responds to treatment in their own way. Early on in my career, I began providing cryotherapy to patients and I started to notice the reduction in swelling and bruising around surgical sites which evidently alleviated pain.
My current role allows me to focus solely on caring for post-surgical and medical patients for example, those who have undergone TPLO, hemilectomy, pelvic fracture repairs, soft tissue surgery and critical care patients that required pain management. Providing individualised care and support to patients is the most fulfilling part of my role. Ensuring patients’ pain is managed appropriately results in patients being less stressed, calmer and aides their recovery ultimately helping them to return to their families sooner.
The condition, age, breed, and size of our patients are all factors which must be considered before we start rehabilitation. We need to have the patient laid in lateral recumbency, as some patients may be unable to stand due to quadriplegia for example - this is usually present in patients who have surgical or non-surgical cervical spine injuries.
In most cases, we require the hoist if a patient is too big to hold up. The age of the patient is always an important consideration as our elderly patients may already have osteoarthritis in other joints. They may also have age related dementia and the whole process of a rehabilitation program may be difficult for them to process. In these cases, taking our time is important to ensure we do not stress the patient.
We see a range of breeds that require rehabilitation from Dachshund to Great Danes. All patients require a tailor-made rehabilitation program that meets their condition, breed, and temperament.
A patient we saw at Swift Referrals recently was a female, German Shepherd with chronic osteoarthritis. The patient was referred to Swift Referrals, as she went off her backend.
She was sedated and an MRI was performed which revealed a disc extrusion at the level of Lumbar 1-2. Surgery was performed to remove the extruded disc material and allow the spinal cord to lie in her normal position. Andrea, our orthopaedic surgeon, performed a procedure called a hemilaminectomy.
When our patient returned to the ward to recover, she was now in the care of the ward nurses. It is the team’s duty to ensure that her time with us was spent comfortably, pain-free and stress free.
During the first 12 hours post op, our rehabilitation goal was to manage her pain. By using the Glasgow Composite Measure Pain Scale, nurses pain scored the patient frequently, and administer opioids as required. The next stage of the patient’s recovery was to improve her range of motion. We understood that she was recovering from hemilaminectomy but we also knew from her clinical history that she had severe osteoarthritis in her hips, stifles, elbows and shoulders.
In most cases and within the first 72 hours, cryotherapy is performed on the operation site every 6 hours to reduce swelling. Every 4 hours, ward nurses then begin to provide heat therapy and massage on all joints. In addition, to help soothe arthritic joints, ward nurses do this by gently placing a warm pad on each muscle area for around 5-10 mins dependent on the patient.
Once the joints have been warmed up, ward nurses then gently massage all muscles. This helps to relax the tense muscles, increase oxygenation of the blood, improves flexibility, and reduces discomfort. Ward nurses will then move on to improving muscle length by gently stretching the limbs, in some cases this can prove difficult. For our female German Shepherd this was challenging due to her severe osteoarthritis, especially in her hips and stifles. But with heat, massage, and passive range of motion, we were able to slowly loosen the stifle and hip joints. This meant that we could improve her muscle strength and limb rotation throughout her stay at Swift Referrals.
Spinal patients require both physical and mental stimulation. When carrying out tailored rehabilitation, we praise patients and provide them with toys and treats. Ideally, taking the patient outside helps with their wellbeing and independent toileting if possible.
We also must consider in recumbent patients their basic hygiene, this can range from cleaning waxy ears, to preventing or managing faecal and urine scolds. Our female German Shepherd did have a urinary catheter in place for the first 48 hours while she recovered, but this was removed as soon as possible to prevent urinary tract infections and to monitor if
she was able to pass urine herself and how easily she expressed. Doing this helps the team to create an individualised care plan for upon discharge.
We understand how worrying and concerning a pet’s recovery can be. We therefore support all pet owners by demonstrating how to do basic massage, passive range of motion and stretch on their pets to help aide their pet’s recovery while at home.
In addition, we advise pet owners on basic hygiene, for example, how to clean waxy ears. This is important as the patient may not be able to groom themselves. We also provide advice on preventing and managing faecal or urine scolds and demonstrate to owners how to express their pet’s bladder.
At Swift Referrals we pride ourselves on providing exceptional care – we provide care and support around-the-clock and our phone lines are always open to offer a supportive and lending hand.