Midterm Examination Demonstration

Physical Examination of Dog

1. SIGNALMENT AND HISTORY

Complete information about the owner and the animal or pet
History: chief primary complaint

2. OBSERVE FROM A DISTANCE

3. MAKE FRIENDS. Put patient at ease for them to relax well.

4. RECORD GENERAL CONDITION. Level of consciousness, posture and gait, and

hydration status.

Activity level: ASSESSMENT OF LEVEL OF CONSCIOUSNESS

Signs LOC
Fully concsious, alert, engaged, and interested in the BAR (bright, alert, and
environment responsive)
Fully conscious and alert but not engaged, owing to fear, QAR (quiet, alert,
pain, illness, or any other cause. Subdued or quiet. responsive)
Mildly depressed. Aware of surroundings.Can be aroused Lethargic
with minimal difficulty (verbal or tactile stimulus)
Very depressed. Uninterested in surroundings. Responds Obtunded
to but cannot be fully aroused by a verbal or tactile
stimulus.
A sleeplike state. Non responsive to a verbal stimulus. Stuporous
Can be aroused only by a painful stimulus
Sleeplike state. Cannot be aroused by any means Comatose

Degree of Dehydration Clinical Signs

<5% Not clinically detectable
5% to 6% Subtle loss of skin elasticity
6% to 8% Obvious delay in return of tented skin to normal position
Slightly prolonged capillary refill time (CRT= <2 seconds)
Eyes possibly sunken in orbits
Possibly dry mucous membranes
10% to 12% Skin remains tented
Very prolonged capillary refill time
Eyes sunken in orbits
Dry mucous membranes
Possible signs of shock (tachycardia; cool extremities; rapid,
weak pulse)
12% to 15% Obvious signs of shock
Death imminent

5. VITAL SIGNS: Body weight and body condition score, Normal temp: 37-39 degrees
celsius, Normal heart/pulse rate: large dogs = 60-100; medium sized dogs = 80-120;
small sized dogs = 90-140 (evaluate at femoral artery), Normal respiratory rate: 10-30
bpm; Color of the mucous membrane must be checked and be noted, normal color =
pink,pale or bright. Take the CRT= <2 seconds

Body Condition Scores

Too Thin Ribs, spine, and pelvic bones easily visble on short haired cats
Very narrow waist
BCS
Small amount of muscle
1
No palpable fat on the rib cage
Severe abdominal tuck
Ribs easily visible on short haired cats
Very narrow waist
BCS
Lost of muscle mass
2
No palpable fat on the rib cage
Very pronounced abdominal tuck
BCS Ribs visible on short haired cats

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 Obvious waist
3 Very small amount of fat
Marked abdominal tuck
Ribs not visible but easily palpable\
BCS
Obvious waist
4
Minimal amount of abdominal fat
Ideal Well proportioned; Ribs not visible but easily palpable
BCS Obvious waist
5 Small amount of abdominal fat
Slight abdominal tuck
Ribs not visible but palpable
BCS
Overweight Waist not clearly dedined when seen from above
6
Very slight abdominal tuck
Ribs difficult to palpate under fat
BCS Waist barely visible
7 No abdominal tuck
Rounding of abdomen with moderate abdominal pad
Ribs not palpable under fat
BCS
Too heavy Waist not visible
8
Slight abdominal distension
Ribs not palpablle under a thick layer of fat
BCS Waist absent
9 Obvious abdominal distension
Extensive abdominal fat deposits

6. NERVOUS. Presence or absence of head tilt, tremors: evalutaion of pupillary light

reflex and triceps, patellar, and gastrocnemius reflexes

7. EYES. Make sure that the eyes are clear and free of any deformity and abnormality
and how the irises respond to the light (pupillary light reflex)

8. EARS. Use otoscope to look at the ear canal making sure there are no presence of
mites and infection.

9. MOUTH. Look at the teeth at both sides, to see any evidence of infection and
calculus. Dental health is important both in cats and dogs. Untreated dental disease can
cause kidney failure and liver disease.

10. INTEGUMENTARY. Hydration status, condition of hair coat, alopecia, parasites,

lumps, wounds, and rashes.

11. MUSCULOSKELETAL. Presence or absence of swelling; gait, limping, guarding,

tenderness, and overall musculature.

12. LYMPHATIC. Palpate the submandibular lymph nodes, salivary glands (normally
palpable) and, larynx and thyroid gland (not normally palpable)

13. CARDIOVASCULAR AND RESPIRATORY. Listen by using a stethoscope. Two things

to auscultate well is the heart pumping at a reasonable rate and also, its pulse quality
good and solid, regular, and normal heart rhythm. Other issue is the lungs, are the
lungs clear and healthy? Observe if there are any abnormal sounds such as wheezing,
rasping, and any congestion. If the lungs are clear and heart is sounding good move on
to the next exam.

a) Cardiac auscultation
 Palpate area between 4th and 6th intercostal spaces on both sides of the
thorax for point of maximum intesity (PMI) of the heartbeat and any
cardiac thrills
 Evaluate heart rate and rhythm (count beats and multiply by 4)
 Normal heart sounds: lub dub - should be a short time gap between heart
sounds
 S1 - loud, long, low pitch (closure of AV valves); S2 - closure of semilunar
valves
 Abnormal heart sounds:

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  Arryhtmia - three or four sounds instead of two
 Murmur - prolonged series of audible vibrations during normally silent
part of cardiac cycle; soft and swooshing sound
 Muffled heart sounds - presence of fluid
 Auscult the heart in multiple locations: right and left side of the chest
 Locations to auscult specific heart valves:
 Left 4th-6th - (PMI) mitral valves
 Left 2nd - 4th - pulmonic valve
 Left 3rd - 55th - aortic valve
 Right 3rd - 5th - triscupid valve

b) Respiratory auscultation
 Respiratory rate - breaths/min
 Depth/Effort - normal, shallow, deep
 Character - note for any diffculty on inspiration and/or expiration
 Normal respiratory sounds - vesicular/ bronchial
 Abnormal lung sounds:
 Wheezes - continuous high pitched hissing which is heard
more on expiration
 Rales/crackles - course to fine which is heard more on
inspiration
 Rhonchi - musical sounds
 Dull - indicate pneumonia or consolidation
 Absence - pleural space disease

14. GASTROINTESTIINAL. Inspect for distention, deformity, displacemetn, symmetry,

and bruising. Auscultate to deetct intestinal hypermotility or hypomitility. Palpate the
abdomen by using 1 or 2 hands, begin at the spine and move ventrally, allowing the
abdominal viscera to slip through the fingers. Rpeat throughout abdomen, noting organ
size and location and the presence of fluid, gas, fetuses, masses or feces. Note any pain
or guarding of the abdomen.

15. EXTERNAL GENITALIA/ GENITOURINARY. Always verify sex and reproductive status.
Inspect perianal area for hair mats, hernias, feces, masses, and evidence of discharge.
 Male - inspect prepuce and penis (note: discharge, inflammation, and tumors)
 Female - palpate and visually assess mammary glands forr tumor, cysts,
swelling, heat or discharge and inspect vulva

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Oral and Parenteral Administration of Drugs
A. Parenteral (needle required)
 Intradermal
 Subcutaneous
 Intramuscular
 Intravenous

How to decide which route is best?

1. Patient factors
- health condition (symptoms present)
- Absorption rate of the drug required
- systemic vs local effect desired
- temperament
- ease of administration for client

2. Drug Factors
- formulation of drug dose
Formula = (body weight x dosage )/ concentration
- cost

3. Other factors
- special precaution to be followed during administration
- potential side effects
- pain at injection site
- can it be combined with other prescribed medicine?

Comparison of common parenteral routes:

IM = 90 degrees
SC = 45 degrees
IV = 25 degrees
ID = 10-15 degress

1) Before the injection: gather the supplies needed - needles, syringe, medication to be
injected, and proficient person to restrain the animal
- for venipuncture: cotton ball and hydrogen peroxide (optional)

2) Needles
 Gauge is usually determined by:
 Consistency of drug
 Route of administration
 Patient size
 At least two needles are required:
 One to draw up the medication
 One to administer the medication
- avoid contamination and to keep the sterility of the medication

Process for changing needles:

 Draw up exact amount of drug (can use smallest needle available)
 Aspirate all drug into the syringe (out of the needle)
 Remove needle and replace with appropriate needle
 Carefully ensure all air is out of the syringe by slowly depressing the plunger

3) Injectable drugs
 Supplied as: sterilized solutions and powders must be reconstituted with sterile
solution
 May be stored in: vials, ampules, fluid bags

4) Intradermal
 Common use:
 desensitize skin
 allergy skin testing
 Skin is usually shaved before performing an ID injection

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  Drug is not disposed throughout the body

Procedure:
1. A fold is skin is lifted or skin is pulled taught and a 25 to 27 gauge needle attached
to a syringe is inserted with the bevel up (allows for smooth piercing of the skin
and induction of the medication into the dermis)
2. Allergy testing: a 0.1mL volume of allergen is injected
3. Locally anesthetizing: dose of drug
4. Performed correctly: injection site will look like a translucent lump

5) Subcutaneous injections
 Easiest route
 Common use:
 Vaccine administration
 Fluid administration
 Pain medications, antibiotic injections, insulin
 Absorption rate = slow compared to other routes and is slower in obese animals
 Injection sites:
 Preferred site: dorsolateral region from the neck to the hips
 Avoid dorsal region of the neck and back

Procedure:
1. Fold of skin is tented, and insert needle at base of tent
2. Aspirate (important to ensure that needle ti is at its desired location)
3. After injection, briefly massage skin to facilitate drug distribution

6) Intramuscular injections
 Appropriate route for injection of small volumes of medication
 Common uses:
 Anesthetics/ sedatives - convenient routes for fractious animals
 Pain medications
 Heartworm treatment
 More painful
 Sites:
 Epaxial muscle
 Quadriceps muscle
 Triceps muscle
 Semimembranosus and semitendinosus
 Deep IM injections in the 3rd- 5th lumbar region of the back are used to
administer adulticide heartworm treatment (immiticide)

Procedure:
1. Isolate the muscle between the fingers and thumb
2. 22-25 gauge needle attached to a syringe is embedded in the muscle of a 90 degree
angle
3. Aspirate
4. Once in the muscle, inject the medication slowly
5. Massage the site

Complications:
 Tissue trauma
 Pain
 Nerve damage

7) Intravenous
 Drugs and fluids may be injected directly into a vein or through an IV catheter
 IV route produce can immediate response and is usually should be given slowly
 Requires new needle for administration
 Sites:
 Cephalic
 Saphenous
 Femoral
 Jugular - uses catheter

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  Common use:
 Inducing anesthesia
 Chemotherapeutic agents
 Anticonvulsant drugs
 Irritating drugs
 Emergency/resuscitation drugs
 Large amounts of fluid needed

Procedure:
1. Expel air bubbles from the syringe prior to inserting into the vein
2. Restrainer should occlude the vessel with the digital pressure or use a tourniquet
3. Grasp the extremity and pull the skin, taut in a distal direction
4. Swab the skin and hair with alcohol soaked cotton ball
5. Insert a 20-25 gauge needle, beveled-up into the vein
6. Usually blood enters the hub of the needle at penetration of the vvein (flash), but
placement is conformed by aspirating
7. Once hit, restrainer should release pressure from the vein
8. Inject medication into the vein
9. Communicate with restrainer and remove needle
10. Apply firm pressure to the injection site until hemostasis/coagulation occurs

Complications:
 Injecting drugs outside the vein
 Hematoma
 Intra arterial injection
 Hitting a nerve
 Air embolus
 Phlebitis
 Septicemia

B. Oral

a. Tablets, Capsules, Pills, Pastes

1. Open the patient’s mouth by sliding the thumb of the non-dominant hand
behind the upper canine tooth and onto the hard palate while simultaneously
extending the head.
2. Place the thumb or other finger of the dominant hand on the lower mandible at
the incisor area to further open the mouth
3. Place the tablet or capsule as far caudally, over the base of tongue, as possible
with two fingers of the hand, while maintaining pressure on the mandible
4. Once the tablet or capsule is over the base of the tongue, close the animal’s
mouth, keeping the control of the extended head until it swallows. It is possible
to encourage swallowing by massaging or rubbing the throat/ or blowing in the
nose.
5. Administer at least 3-6mls of water after oral capsules or tablets to ensure the
patient swallows and aid in transit of the medication
6. It the patient is a potential biter, fold the upper lips over the upper arcade of
teeth, push down on the mandible at the incisor region and push the tablet or
capsule as far back in mouth as possible.

b. Liquid
1. Grasp the muzzle and slightly extend the neck
2. Use the fingers of the hand on the muzzle to make a small pouch at the
commissure of the lips
3. Place the syringe with the desired material at the commissure if the lips, behind
the last upper molar, and give the liquid slowly until the animal “begins to
swallow”
4. Give small amounts slowly until finished
5. If coughing occurs stop the administration of the liquid

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