Patient Care and Nursing Skills in Practice

Patient Care and Nursing Skills in Practice

The externship is where classroom knowledge becomes hands-on competence. During this lesson block you will perform real patient care under supervision, document your work accurately, and demonstrate that you can work safely at the veterinary assistant level. Every action you take affects a living patient, so precision, communication, and respect for your scope of practice are non-negotiable.

Morning and Evening Rounds

Rounds are a structured check on every hospitalized patient at the start and end of each shift. Your job is to move through the ward systematically, collect objective data, and report anything abnormal without delay.

For each patient record:

• Temperature – use a rectal thermometer unless contraindicated; normal range varies by species (dogs and cats approximately 100–102.5 °F; confirm species-specific normals with your quick-reference handbook).
• Pulse – count for at least 15 seconds and multiply; note rate and quality (strong, weak, bounding).
• Respiration – count chest rises for 15–30 seconds; note effort (labored, shallow, normal).
• Pain score – apply the Colorado State University (CSU) Acute Pain Scale. The CSU scale uses behavioral and physiological indicators and produces a numeric score; document the exact score and the specific signs that drove it.
• Mucous membrane (MM) color – normal is pink and moist; pale, white, yellow (icteric), blue (cyanotic), or brick-red findings are abnormal.
• Capillary refill time (CRT) – press the gum firmly for one second and release; normal refill is less than two seconds.

Safety rule: Any abnormal vital sign, a pain score change of one point or more, abnormal MM color, or CRT outside normal must be reported to the supervising technician or veterinarian before you move to the next patient. Never decide on your own that an abnormal finding can wait.

Document in the medical record using the format your site requires. Accuracy in the record protects the patient and is a legal requirement.

Venipuncture and IV Catheter Placement

You are required to log a minimum of 15 documented attempts across this block. Common sites include the cephalic vein (dogs, cats), saphenous vein, and jugular vein; site selection depends on the patient condition and supervising staff direction.

For each attempt, record in your competency log: species, anatomic site, needle or catheter gauge, outcome (success or failure), and your supervisor's signature. Honest documentation of failures is expected and helps identify where you need more practice.

Key technique reminders:

• Occlude the vessel proximal to your insertion site to raise the vein.
• Enter at a low angle (approximately 15–30 degrees) with the bevel up.
• Confirm blood flash before advancing the catheter off the stylet.
• After catheter placement, flush gently to verify patency and check for perivascular swelling.
• Secure and label the catheter per site protocol; note date and time placed.

Patient safety: Use the smallest effective gauge for the intended therapy. If a patient shows signs of distress or you cannot achieve venous access after a reasonable number of attempts per your site's policy, stop and notify supervising staff. Never attempt a site or species you have not been trained on without direct supervision.

Surgical Preparation

You will participate in at least four surgical prep assignments. A proper prep directly affects the risk of surgical site infection, which is a significant patient safety concern.

Clip: Use a surgical clipper blade appropriate for the species and coat type. Clip an area larger than the anticipated incision. Clip against the direction of hair growth for a close cut. Remove loose hair before scrubbing.

Surgical scrub: Alternate between surgical scrub solution (commonly chlorhexidine or povidone-iodine based) and sterile saline or alcohol, moving in a circular pattern from the incision center outward. Never wipe back toward the center after moving outward. The number of scrub passes and the solution used will follow your site's protocol.

Positioning and draping: Position the patient as directed by the surgeon—improper positioning can cause nerve or soft tissue injury. Assist with draping by handing sterile drapes without contaminating them; if you break sterile technique, say so immediately.

Post-case debrief: After each surgical prep, ask your supervisor to identify one specific area to improve. Write this in your competency log. This reflection habit is central to professional growth.

Medication Administration Support

As a veterinary assistant, you support medication administration under the direction of a licensed veterinarian or credentialed technician. Always perform the "five rights" check: right patient, right drug, right dose, right route, right time. Confirm the patient's ID band before any procedure. If you have any doubt about a drug or dose, stop and ask—administering the wrong medication is never an acceptable risk.

Professionalism and the Competency Evaluation

Your Midpoint Supervisor Evaluation rates 20 competency items on a 1–4 scale. You need a minimum of 3 on each item and an overall mean of 3.0 or higher. A score of 3 represents consistent, safe, and appropriate performance with minimal prompting. Scores below 3 on any item mean you must seek additional practice and supervisor feedback before the evaluation closes. Treat every patient interaction as an evaluated performance—because patient safety depends on it.