Jasper is a cocker spaniel with recurring ear problems and has been shaking his head for four days. He has started to whimper when Mrs Walker strokes his head. This type of case is appropriate to book in with a RVN where they can gather evidence to enable the veterinary surgeon to make a clinical assessment to diagnose and prescribe treatment.

The RVN sees Jasper and following the protocol makes an assessment of whether it is possible to examine his ears. Following a pain assessment, the RVN dispenses analgesia and arranges a recheck appointment 3 days later.

When Jasper returns, the RVN is able to examine his ears and visualise the tympanic membrane, which is intact. If the RVN could not visualise the tympanic membrane or could see that it was ruptured, they would refer the client to the veterinary surgeon.

The RVN takes a swab for cytology and cleans the ear, dispenses cleaning lotion and arrange to speak to the client once the results of the swab have been received. It is essential that clear clinical records are completed that allow the veterinary surgeon to make a clinical assessment on the patient.

The RVN performs the cytology and reports to the veterinary surgeon.

The veterinary surgeon and RVN discuss the results and prescribe steroid drops for treatment.

The RVN makes another appointment with Mrs Walker to explain the results, demonstrates how to apply the ear drops and dispenses the treatment to the client.

Toby is a 12-year-old, anxious, neutered male cat. He has once again lost a fight with his neighbour. Mr Thomas has noticed that the fur on his neck is wet and there is a horrid smell. Toby has not been eating as much food as normal. He has been booked in with the RVN.

During the consultation, the RVN gives Toby a full physical examination following the protocol and identifies a burst cat bite abscess on the left side of his neck. He is otherwise fit and healthy, although tender around the wound.

The RVN clips the area as Toby is comfortable with the process, they flush the site and clean the area. The RVN explains how to monitor the wound to the owner.

The RVN completes the clinical notes and the veterinary surgeon makes a clinical assessment, prescribing analgesics.

The RVN dispenses the analgesics to the owner, explaining how to administer them and books a review appointment.

RVNs can lead in the management of chronic cases based on protocols being developed that consider all scenarios for the patient. It is essential that the veterinary surgeon and RVN take a team-based approach to the development of the protocols, and identify when it is necessary for the veterinary surgeon to be involved or re-examine the patient.

Willow is a 15-year-old cat with chronic renal disease. She is due a review of her medication and therefore booked in with the RVN. The RVN checks the understanding of the client regarding kidney function and the impact of renal failure, how they are managing the medication and completes a physical examination. The RVN takes a history, takes a blood sample, weight, body condition score and blood pressure measurement. The owner has brought in a urine sample. The RVN explains why each of the parameters are monitored.

The RVN runs the blood tests according to the protocol and checks the urine sample. The results are put on to the clinical history and the RVN informs the veterinary surgeon of the results of the diagnostic tests and the results of the physical examination.

The veterinary surgeon makes a clinical assessment and prescribes a repeat prescription. The RVN dispenses the medication and discusses the benefits of feeding clinical renal diets to support the kidney function and schedules a recheck appointment.

The RVN adds value to the consultation by taking time to discuss Willow’s disease process and how it relates to the tests performed and medication given.

The veterinary surgeon has seen a healthy 2-year-old Labrador, Lily, with right hind limb lameness. She is booked in to have a series of x-rays.

The veterinary surgeon and RVN have a pre-induction meeting to discuss Lily’s procedure and devise a plan for her sedation, GA and recovery. The plan lists all predicted outcomes and complications with actions to be taken at each point including when to alert the veterinary surgeon of a deviation from the norm. As GA and radiographic positioning is taught during veterinary nursing training, the RVN will take the lead in the procedure.

According to the surgical safety checklist, they check that Lily has been starved for at least six hours and her water removed for a minimum of two hours. Her last toileting is noted and the results of her physical examination by the veterinary surgeon has been checked, and an ASA level is assigned.

An IV catheter has been placed and secured by the RVN.

The veterinary surgeon calculates the premedicant, induction agent and any other medications that may be required during the procedure.

The RVN draws up medications including the induction agent and administers the premedicant. The RVN induces anaesthesia according to Lily’s protocol, places the endotracheal tube and attaches her to the GA machine for anaesthesia to be maintained. Lily is monitored whilst being x-rayed by a second RVN and throughout the procedure.

The veterinary surgeon checks the x-ray images and confirms a diagnosis. Lily’s anaesthetic is unremarkable and she recovers well in her kennel.