Physical Assessment

The doctor relies on the medical volunteer/staff's observations and assessments while determining their treatment plan. Your judgments and medical notes are critical for the doctor, patients, fellow volunteers and integrity of the parvo program. The following assessments are documented at the top of each patients medical chart during every shift.

The following criteria will be noted by medical volunteers/staff on the Treatment Sheet in the "Physical Exam" and "Intake and Output" sections.

Attitude

The following abbreviations and categories are used to denote attitude/mentation during the shift:

• BAR (Bright Alert and Responsive) - patient is aware of their surroundings, often barking, excited to see you and acting like a normal puppy

• QAR (Quiet, Alert and Responsive) - patient is aware of their surroundings but seem more quiet and reserved than your average puppy.

• Lethargic - patient is incredibly tired and/or weak, is not paying attention to surroundings, sometimes laying lateral (on their side) and not getting up

• Semi-Comatose - patient is unresponsive to your presence and to stimulation (pushing or tapping on them). 

  • This is absolutely an emergency situation - begin the 'Crashing Puppy Protocol' and notify the veterinarian.

Assess aggression. If a small dog, such as a chihuahua, is defensively aggressive, you can try to wrap dog with blanket from behind. Try to at least administer injectible antibiotics. If on oral medications, hide pills in food.

Gum Color

Also referred to as mucous membrane, the color of the gums indicate blood circulation, blood loss or shock. Includes pink, pale pink, grey, & white. You can press on the gums and release to note the capillary reaction time (CRT) by timing how long it takes for the color to come back. CRT should be less than 2 seconds.

• Pink - Bubble-gum pink is a healthy color for gums. CRT is typically <2 seconds for healthy gums.

• Pale Pink - most sick patients have lowered blood flow which can be observed by pale gums and a CRT >2seconds. 

• Grey - patient is most likely in shock - notify the doctor immediately- refer to the 'Crashing Puppy Protocol'.

• White - patient has had a significant amount of blood loss - notify the doctor immediately - refer to the 'Crashing Puppy Protocol'.

Pale pink gums

Temperature

The temperature of the extremities (paws) can also indicate blood flow and circulation. Paws should be warm (internally). Patients should always have blankets, and smaller/sicker patients need a heating pad placed under their blankets to help their body maintain the proper temperature. 

We do not regularly check temperatures in the ICU however, if a puppy feels too warm/hot or cold always check their temperature. 

Cold paws on a lethargic puppy is BAD NEWS - notify the on-call doctor immediately, and the Crashing Puppy Protocol may be necessary.

A healthy dog's temperature is between 99.5 and 102.5 degrees Fahrenheit. As the body is fighting off infection, the immune system will intentionally increase the core body temperature to aid in fighting off bacteria and viruses which function ideally at normal body temperature. Minor fever is good, and ice packs are not necessary. We start to worry about sepsis when temperatures start to reach 104 degrees Fahrenheit - alert the veterinarian on-call. It is likely that they may increase the CRI or otherwise change the treatment protocol. A temp under 98 degrees Fahrenheit will require an external heat source. Anything under 97 degrees could be an indication of crashing and appropriate steps must be taken. 

Fluid Absorption

Hydration of the patient can be determined from a skin tent test. Lightly pull the skin/scruff up and let go. Observe as the skin re-positions - if it snaps back, the dog is well hydrated. If the skin stays tented and/or slowly re-positions, the dog is dehydrated. For a more detailed assessment of hydration, see the Dehydration Assessment chart (optional)

• SQ medication and fluids: for patients on SQ treatment, check under the neck, below the chest and front arms for a "pouch" of fluids. If the patient is not absorbing its medication, gravity will pull the fluid down to these locations. Alert the doctor, as the treatment plan will change if a dog is not absorbing its SQ fluids.

• IV medication and fluids: always check the IV catheter site for swelling. If there is swelling, the catheter is most likely not in the vein and the dog is not getting its medications and fluids. Medications given IV can be very harmful if exposed under the skin.

  • Swelling above the catheter: indicates the the vein may have ruptured, or blown, and the patient needs a new catheter

    • A blown vein will leak blood and/or fluids in the surrounding area, causing swelling 

    • Swelling from a blown vein is generally above the catheter site due to direction of blood and IV fluid flow

    • A blown vein will clot on its own when its able to "rest" after the IV fluids and catheter have been removed.

    • A different vein/arm must be used for a new catheter.

    • The swelling can be painful depending on severity. A special bandage may be needed to prevent infection.

  • Swelling below the catheter: commonly called "mega paw" indicates the tape or vet wrap is too tight and needs to be loosened at minimum

Consumption and Excretion

This includes what the patient it eating/drinking and whether they are vomiting or having diarrhea. Always note everything on the patient's medical chart, as this is essential information for determining the treatment needed and severity of the patient.

• Force Feeding - dogs not eating normal amounts of food need to be force fed. This will be done using a syringe filled with blended wet food, critical care food, or baby food. 

• Food offered - Can be dry food, wet food, turkey slices, chicken sticks, baby food or anything else to get a puppy to eat. We value quantity or quality in parvo patients. Always offer a very small amount first. Don't leave food in the cage of a puppy who is nauseous/vomiting. See Feeding Guidelines for more info.

• Food eaten - indicate if the dog ate all, some, none

• Water offered - In a bowl, or mixed with some food (to provide some protein). See Feeding Guidelines for more info.

• Feces - Note if any bowel movement was solid, semi-solid/soft, loose, diarrhea (water), bloody, mucousy, and any abnormal color (yellow, green). Alert the doctor if diarrhea is excessive. See Fecal Scoring System.

• Once the patient has had two solid bowel movements, they are ready to be tested again (for discharge)

• Vomit - Note whether there is vomit, and if so if it was a small or large amount and whether it was food, bile, blood or anything abnormal. Alert the doctor if vomit is excessive.

Other

Always make sure to critically observe your patient for any developments, whether they are improving or declining, or if you see any additional symptoms appear. Remember, you as volunteers are spending more time with these patients than anyone else, so you are the doctor's eyes while they aren't here, and the puppie's voice (if they're in pain, have abscesses forming, etc). Make a note on the patients chart if you notice anything abnormal, AND/or notify the doctor if it is an urgent situation. This may include, but is not limited to:

• Excessive/start of bloody diarrhea

• URI symptoms

• Skin symptoms

• Neurological symptoms, including twitching, abnormal eye movement, seizures

• Swelling anywhere on body, including the face

Watch for secondary issues and complications - examples include:

• Swollen joints - may occur from sepsis and can be very painful. If swollen joints noted, notify the doctor on-call. The patient may need extra pain meds

• Intussusception - is when the part of the intestines "telescopes" on itself and causes moderate to severe pain. Abdominal pain, lethargy, no appetite, and vomiting after the normal time-course of parvovirus might indicate intussusception. 

• Upper Respiratory Infections (URIs) 

• Intestinal Parasites- may be seen in stool

• Hair loss - may indicate mange, is itchy, and can be infectious to humans!

More information on 'Other Diseases' will be covered later in the curriculum.

"Pepper" the puppy with swollen carpal joints (above the paw)