How to help your patients with clinics: 5 cases I've nursed and how I did it
Do you want to do more to help your patients with chronic diseases, but you’re not sure where to start?
Or maybe you know exactly what you want to offer, but you’re worried you might not know the answers to the questions you’ll be asked.
A lot of the time, the fear of not knowing how to answer questions, or feeling like you don’t know enough, can stop you from starting all together. Don’t let that happen - because, the truth is, you’ll learn the answers to those questions as you go, and you don’t need to know everything about a disease to help care for a patient with it.
Embrace action and trust that things don’t have to be perfect in order for you to help your patients and your clients!
There are so many patients with different diseases we can help as veterinary nurses. In fact, I’m going to go so far as to say that every disease can benefit from a medical nurse clinic!
In today’s post, I’m walking you through 5 real patients I’ve cared for and supported with clinics. They’ve got a variety of different diseases - and quite a few of them I’m sure you wouldn’t think about offering clinics for, but the truth is, we can really help them!
If you want to learn more about setting up and running medical nurse clinics, join me next week for a free challenge on all things confident consulting. There’s still time to grab your spot, and I’ll share more on that at the end of this post!
#1: Badger, a 15-year-old MN Border Terrier with Diabetes
If you attended my endocrine nursing workshop, you’ll already be familiar with Badger. He is one of my absolute favourite patients, and our nursing team sees him fortnightly for diabetic clinics.
Badger is a 15-year-old male neutered border terrier, with diabetes mellitus (which has been very difficult to stabilise) and hypothyroidism, along with a few other conditions (a hepatopathy, chronic pancreatitis and osteoarthritis). A really sweet boy with a huge list of conditions we can make a big difference to with good nursing support.
We see Badger every 2 weeks to check him over, weigh him to ensure he isn’t losing weight, and apply new continuous glucose monitoring sensors. We also check his bloods regularly to ensure his thyroid medication doses are appropriate, check his liver values and just generally make sure our favourite gent is in good shape.
He is also on a ton of medications, so repeats are needed very often, and nutrition is a big consideration for him, since we are having to balance his pancreatitis and diabetes with maintaining a normal body condition score, preventing weight and muscle loss, and encouraging normal food intake.
Comfort, mobility and quality of life are also really important considerations for this gorgeous boy, so we also chat regularly about helping to keep him comfortable at home.
We’ve been seeing this sweet boy for nurse clinics for over a year now, and the fact that his family also know all the nurses well is really helpful - as we all work together to give Badger the best possible care.
#2: Pudding, a 3-year-old MN Pug with Hypoadrenocorticism
Pudding pug is another gorgeous lad those of you who attended the endocrine nursing workshop will be familiar with. Pudding was 3 when he was diagnosed with Addison’s disease, having presented to us as an emergency in an Addisonian crisis.
We stabilised him, transitioned him on to long-term treatment with prednisolone and desoxycorticosterone pivalate (Zycortal), and then arranged for him to come back regularly to see the medicine nurses.
Pudding’s rechecks were all about monitoring how he was doing at home, helping him return to normal life, and supporting his family as they adjusted to life with an addisonian dog. Collecting a thorough history, evaluating him for any signs of prednisolone side effects, and taking regular blood samples to check his electrolyte levels were our main considerations.
We paid particular attention to his appetite, water intake, toileting habits, exercise and activity levels, and chatted to his family regularly about whether there were any stressful events coming up which we may need to adjust his medication doses for.
We saw Pudding twice a month for the first few months after his diagnosis, until we had got him back to normal on a stable dose of medication. Our nurses then taught Pudding’s family how to administer his Zycortal injections at home, which they continue to do, bringing him back to the vets for blood tests a few times a year. Pudding lives a very normal and happy life, and his visits absolutely put a smile on the face of every nurse who saw him.
#3: Dexter, a 6-year-old MN Doberman with Mediastinal Lymphoma
Dexy was absolutely one of my favourite patients and his visits to see us each week were the real highlight of my week in the clinic.
He was one of those patients who just made you understand why you became a veterinary nurse. It was impossible to see him and not have a massive smile on your face.
I saw Dexter for weekly cancer clinics and to administer chemotherapy under the direction of the veterinary surgeon. For him, this was a modified CHOP protocol (rotating chemotherapy between cyclophosphamide, epirubicin, vincristine alongside prednisolone - for those of you interested, we substituted doxorubicin for epirubicin because of the potential cardiotoxicity and the fact Dexy was a doberman and at increased risk of DCM).
Dexter loved seeing familiar faces every week and for us it was vital his chemotherapy visits were as positive as possible, since weekly visits for blood tests and IV injections are not the most fun! Luckily, his love for treats far outweighed his care for needles - in fact, he very quickly used to run through reception to the door, and would take great delight in pulling me around the hospital to get up to the chemotherapy room, because that’s where all the good treats were!
For us, maintaining quality of life were our main considerations in Dexter’s appointments, so our focus was on comfort, controlling side effects of medications, maintaining normal appetite, mobility, toileting and generally just keeping Dexter as happy as possible.
#4: Minx, a 5-year-old FN DSH with IMHA
Minx was referred to us as an emergency for management of anaemia, lethargy, weakness, hyporexia and pica. After stabilising her and diagnosing her with IMHA, we began her on a long-term treatment plan with immunosuppressive medications. Her plan changed a few times, and we switched her from prednisolone, to ciclosporin, to chlorambucil.
She saw our medicine nurse team for regular clinics where we performed a thorough clinical examination, weighed her, monitored for steroid side effects, and collected bloods for haematology and packed cell volume, and examined a blood smear.
Minx lived up to her name and developed a very specific way she would allow us to examine her and collect her samples - medial saphenous samples only, thank you very much, and if you tried to examine her before her blood test you wouldn’t get one afterwards!
So we very quickly learned what worked best for Minx and adapted our clinics to suit her - which just goes to show the importance of having a team familiar with their patients and their specific needs!
Getting updated histories regularly from Minx’s family was also really important, as Minx had one very specific trait which indicated a relapse of her anaemia - pica. Minx would lick the patio when her anaemia worsened - so this was something we used to monitor her response to treatment.
Minx is a wonderful, cheeky cat who knew exactly what she wanted - and what she didn't! She spoke to my cat lady heart and is a great example of the need for continuity and to tailor your approach to each individual patient.
#5: Genghis, a 5-year-old MN Sphynx with Asthma
I can’t tell you how much love I have for this gorgeous boy. Genny is a total dude, one of those cats who just owns the room and loves all the attention!
Genghis was referred to us for respiratory investigations and we diagnosed him with feline lower airway disease. After his diagnosis, he began seeing the medicine nurses for respiratory clinics, to introduce him to his new inhaler - which is really important to do gradually, especially in cats, using positive rewards so they accept it without stress.
We also were monitoring Genny’s weight closely and keeping him at as healthy a weight as possible, to avoid any impact of this on his respiration, and adapting his environment as required to reduce things like allergens, fragrances and chemicals which would irritate his airways.
Genghis absolutely loved coming to see us and he is a great example of how much nurses can do with conditions like respiratory disease, where people wouldn’t necessarily think of using nurse clinics to support these patients! He continues to do really well and barely needs his inhaler any more!
So I hope these patients have shown you just how much we can do to support our medical patients with clinics - even in patients with diseases that wouldn’t normally see nurses!
Now you’ve seen the types of patients I have seen for clinics, it’s time to think about the clinics you’d like to perform in your practice! And if you want some help getting these started, I’m running a free challenge to do just that next week - to learn more and save your spot, simply drop your email address below!
