Nursing Care in the Treatment of Parvovirus
Dorothy Joan Kendall
This article is written to offer my
experience with Parvo Virus as a help to anyone in similar circumstances.
Canine Parvo Virus (CPV) is a killer of young dogs, and we were exposed
taking an older dog to a Veterinarian for teeth cleaning. Since symptoms
appear 3 or 4 days after infection, we unknowingly exposed all of our dogs
during this initial period ... of course, as soon as the tests were run
confirming CPV, we gave everyone booster shots - even the older dogs; but
by then, it was too late. From the time of exposure, Dec. 5, to Dec. 18th,
we were taking dogs to our Vet Clinic - the youngest died, but we saved
two that were older puppies. All had the same shots, so we can only think
that some had stronger immune responses than others did. I will say that
a pregnant bitch had no problems, whelped puppies normally, and the puppies
received a first shot of Proguard V at 5 weeks of age - came through unscathed.
Dottie was the last to exhibit symptoms
on the 18th, when she was rushed to the Clinic and put on IV (intravenous)
care immediately. Dottie at 7 months of age weighed about 13 pounds, was
in excellent health and condition at the time she went to the Vet. Our
Vets are very good, one of the few hospitals where there is 24 hour care,
either from one of the 5 doctors, or U of P students.
What I want to talk about here is Intensive
Care Nursing. First, once the CPV ravages the Gastrointestinal tract, the
dog must be on IV fluids to fight dehydration, shock and lack of food.
Nine to five nursing care just won’t do it; it must be on a round the clock
24 hour a day schedule, and 90% of our Veterinarians just are not prepared
to deal with this. Costs are prohibitive, and skilled technicians hard
to find ... we aren’t blaming our Vets for not running an ICU (intensive
care unit) like this; I just wish they had told us immediately how critical
this was, and either encouraged us to take over Dottie to a place that
was equipped, or take on this care at home, where we could be equipped
to deal with the problem ourselves.
I realize not all people would even
want to do this themselves, or would a sane Veterinarian even recommend
this to everyone ... but to keep a dog like Dottie, and not use strenuous
support, was condemning her to a sure death. I was not satisfied with what
I saw of their nursing care, and told them so; eliciting a very defensive
response. It was only then that they told us she was probably going to
die, and we could take her someplace else with better nursingcare if we
weren’t satisfied. As a result, we lost many precious hours that could
have effected an earlier recovery.
Human medicine is further advanced
than Veterinarian teaching, and the average Vet can’t begin to avail himself
of the all the new and very expensive equipment needed for specialized
cases; but just good nursing is something we all can do. Another very important
point is the psychology of the sick dog ... they need to be in familiar
surroundings, with people they know and trust to stimulate the will to
live. Having knowledgeable friends is also something we all don’t have
access to, but the information is out there if we want to learn and equip
ourselves to take on home care nursing.
We brought Dottie home on Christmas
Eve, knowing that she would probably die. Our Vet had put in a very good
IV line on Dottie (this is very tricky, and should be done only by a professional,
where a small, plastic tube is inserted into the main vein on the front
leg to admit fluids and medication), well taped and hard for her to get
at. Very sick dogs won’t bother this, believe me. When we told the Vet
we wanted to take Dottie home, she provided the medication she had been
using, and instructions on how to use it. But that wasn’t enough! Since
it obviously wasn’t working, we knew something else had to be changed,
so we called a friend (Medical Doctor versed in emergency room medicine).
She was horrified that the fluids and medications (see article on fluid
and electrolyte treatment) being used was not consistent with what she
knew of canine physiology. Ann, being an Operating Room Nurse was inclined
to trust the Vets, but bowed to the Doctor’s advice.
The Vets were treating this problem
much too conservatively, with plain lactated Ringers solution (comes in
a 1,000 ml plastic bag with a hanger on the top), and no potassium. This
was changed! We used a liter of 5% dextrose and Ringers Lactate solution,
with 20 mil equivalents of potassium chloride added. Veterinarians are
hesitant to use potassium for fear of side effects, but this was a real
emergency. Ann was knowledgeable about administering fluids, so she showed
me how the IV worked.
Next, I had to be instructed on how
to check on the dog’s condition; this involved taking the pulse (inside
of the thigh muscle next to the bone) and keeping a written record ...
should have been about 90 beats per minute on older dogs, up to 120 bpm
for puppies. Dottie’s was 168! This meant the fluid was being administered
too slowly from the IV (faster pulse rate means less fluid circulating
in the body), so that had to be adjusted, and a constant monitoring of
the pulse and IV was necessary to correct any significant changes. I also
had to keep a record of oral fluid intake, vomiting or diarrhea every hour
during the day, and every two hours through the night. Respiration (breathing)
was also watched to see if it was excessively fast or slow.
Potassium infusion rate was reduced
day by day as pulse rate dropped and fluid intake slowed accordingly. We
had to know how the kidneys were working, so any urination was also closely
watched - for amount, color and frequency. During this time, the bedroom
had to kept draft free and warm, with a heating pad in one side of the
sick bed (2 x 3 playpen, with floor elevated to mid-level, and draped with
a sheet), underpads covering the rest with a soft bed of towels or small
blankets for her to lay on. Lay she did, hardly moving, still having some
diarrhea ... this had to be gently sponged off as necessary.
This went on for two days, with barely
perceptible improvement, a step backward, two steps forward - not knowing
from one day to the next if she would live. On the day after Christmas,
Dottie woke me up whining to tell me her bed was dirty and wet - she was
sitting up, and wagged her tail when she saw me. Even though she was still
critically ill, I now had hope that she might pull through! She began taking
a little chicken broth by mouth, and I offered her this every hour, coaxing
her to drink. Her pulse was now down to 134, so the fluids were slowed
down accordingly. She got a partial bath in a small basin, and was dried
with the hair dryer on low - she didn’t usually want to be on the heating
pad, but she went to it after the bath as she was still probably slightly
damp.
The next day she had her first solid
food, finely chopped chicken breast with more broth, and seemed to be hungry.
Although she vomited some of this, most of it stayed down; we’d fixed a
big Ham for Christmas, and she would eat small amounts of this, even though
it was definitely not recommended. I gave her whatever she would eat, baby
cereal, chopped egg yolk, chicken, broth and finally scraped ground sirloin
the next day. (This is done by freezing lean beef slightly, and scraping
against the grain with a wide knife.)
What an ordeal for all of us, but I
can say without reservation that Dottie would have died at the Vet’s if
we hadn’t brought her home. She would have died without the professional
human medical knowledge necessary to resolve the electrolyte imbalance.
She would have died without the nursing, record keeping, and loving handling
during her critical care time. The lesson here is to expect certain standards
of care from your Vet, and to ask intelligent questions about what will
be done to help your dog. Time is of the essence in critical care, so if
you’re not sure about the course of treatment, get help from someone who
does know - and don’t be afraid to tackle the problem |