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Surgical Nursing > Advanced spinal surgical nursing > Flashcards

Advanced spinal surgical nursing Flashcards

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1
Q

List the nine conditions that can be seen in the spinal patient

A 
degenerative 
developmental 
anomalous (cysts)
neoplastic 
nutritional 
inflammatory (discospondylitis/empyema)
trauma fractures/luxations 
vascular
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2
Q

List the four types of degenerative spinal disease and what the characteristics of each

A

Disc extrusion
Small breeds, annulus tears and degenerative nucleus squirts out
Disc protrusion
Large breeds, annulus bulges compressing the cord
Cervical spondylomyelotpathy
canal stenosis, facet hypertrophy, disc protrusion, flaval ligament hypertrophy-compress the cord (rotties)
Lumbosacral disease
disc protrusion, facet hyperplasia, soft tissue proliferation possible subluxation
impinge on cauda equine/nerve roots directly affecting the blood supply (labs GSD)

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3
Q

List the types of neoplasia that can occur in the spine

A

Primary (from neurological tissues)
Secondary (from surrounding neurological tissues )
Tertiary metastasised

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4
Q

What are anomalous cysts?

A

Sub arachnoid diverticula
an abnormal adhesion between layers of meninges which causes a collection of csf that compresses the cord or inflammation/odema in the cord

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5
Q

What is disconsponylitis?

A

Infection of the intervertebral discs and the end plates of the surrounding vertebra
compresses cord lead to instability with a compressive /dynamic disease component

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6
Q

What pathological actions can cause spinal cord damage?

A 
laceration 
compression 
contusion 
ischaemia 
inflammation
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7
Q 
How do i medically manage the 
laceration 
compression 
contusion 
ischeamia 
infiltration and dysfunction
A 
Laceration 
not solvable but preventable, immobilise area, maintain blood supply
Compression 
no medical management 
contusion 
not solvable 
ischaemia (BP, HR, SV, CO, hypoxaemia) 
Infiltraion/ dysfunction 
treated with drugs or radiation
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8
Q

How do you immobilise a laceration spinal patient?

A

Spinal board
bandaging materials
spinal brace

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9
Q

When a primary spinal patient presents what do i need to control?

A

Ischaemia
ensure ventilating
appropriate blood supply
ensure CO is sufficient (arrythmias, shock)
Ensure blood volume and blood pressure is appropriate

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10
Q

what clinical parameters should be monitored in a spinal patient?

A 
Resp rate and effort 
HR, PQ
Pulse oximeter
blood gas
blood pressure 
fluid volume status
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11
Q

What is a dorsal laminectomy?

A

Removal of the laminae of the dorsal vertebral arch +/- the spinous process (access to dorsal spinal column)
CSM, lumbar sacral disease, SAD, disc diseases

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12
Q

What is a facectectomy?

A

Removal of the articular facet

lumbar sacral disease CSM

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13
Q

What is a Foraminotomy?

A

Enlargement of an intervertebral foramen to relive pressure on a nerve root
Lumbosacral disease

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14
Q

What is a hemilaminectomy?

A

Removal of one half of the lateral vertebral arch ( includes pedical and facets)
allows access to lateral and partial access to the ventral or dorsal spinal column
Tumours SAD

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15
Q

What is a corpecomty?

A

Lateral approach with removal of part of the vertebral body and endplates either side of the IVD
Allows for removal of compression from the ventral cord in thoracic and lumbar cord without going through the thorax or abdomen
dangerous in the cervical cord do not use at the lumbosacral junction

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16
Q

What is a ventral slot?

A

Slot like opening from a ventral approach in endplates of the vertebral body and removal of part of the disc in the cervical spine
access to ventral aspect of the spinal column

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17
Q

What is stabilisation of the spine and what is it used for?

A

removing the motion between adjacent vertebrae using implants and boe grafts
consider distraction-fusion for CSM and LS

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18
Q

List the retractors that are useful in spinal surgery

A

Gelpis and odd legs

mckee retrators

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19
Q

List the equipment useful for bone and soft tissue removal in the spinal surgery

A 
Spinal burr 
Kerrisons rongeurs 
Bone punch forceps 
Friedman microrongeurs 
compound action spinal rongeurs
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20
Q

List the equipment useful in tissue, periosteal or tissue retraction

A 
freer periosteal elevatro 
dandy nerve hook 
sheas curette 
Rosen mobiliser 
younger scaler 
jaquette scaler 
Adsons nerve hook
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21
Q

List the equipment useful for haemostasis in spinal surgery

A 
Bone wax 
srugicell 
spongistan 
surgisnow 
PVA
Duragen 
Codman surgical patties
22
Q

Areas to implement nursing specific to the spinal patient

A

Manage urinary incontinence
prevent pressure sores
detect and control pain support and monitor the resp rate
promote motor recovery

23
Q

What is important in physical therapy of the spinal patient?

A 
Prevent pressure sores 
maintain motor fuction 
reduces pain 
supports the respiratory tract 
improves bond
24
Q

Why is it important to carry out physical therapy?

A

plasticity of cells changing the way that they work
Nervous system re-learning movements only possibly whilst generating the movement
START EARLY

25
Q

What does physical therapy do?

A 
improves lymph and venous drainage 
promotes motor function 
improves bond 
relaxes patient 
Pain relief
26
Q

What does physical therapy do for the motor system?

A

Maintains joint health
limits muscle wastage
prevents limb muscles spasticity/contracture/ flaccidity
Retrains gait patterns

27
Q

What does physical therapy do for the sensory system?

A

improve core stability
retrain gait patterns
stimulates proprioception

28
Q

What actions do we perform for physical therapy?

A 
Massage
Passive range of motion 
Active assisted exercises 
Active exercises
proprioceptive exercises
29
Q

What is massage important for?

A 
Lymph and venous return 
minimises pain 
limits muscle spaciticy 
Dermal stimulation 
Warms up muscles
30
Q

What is passive range of motion important for?

A

joint health
flexibility/elasticity
gait patterning

31
Q

What are active assisted exercises?

A 
assistance during muscular contraction 
assisted walking
walking with a sling 
physio-rolls 
water treadmill
32
Q

what are active exercises?

A 
Unassisted movement of a joint
static exercises (standing on one leg) 
walking (straight line,figure of 8)
specific exercises (sit to stand)
33
Q

What are proprioceptive exercises?

A 
Body recognition of limb position
standing 
wobble board
uneven surfaces 
walking over poles 
weaving through cones
34
Q

What other modalities can be use in physical thearpy?

A

Cold therapy
Hot therapy
Neuromuscular electrical stimulation
laser therapy

35
Q

What do you need to consider when making a physical therapy plan?

A 
Previous activity 
environment 
temperament 
client expectations
client involvement 
physical examination 
neuro exam 
disease process 
concurrent orthopaedic conditions
36
Q

What physical therapy should be included in the firs 48-72 hours post-surgery?

A

Massage
full body light massage
cold compress

37
Q

What physical therapy should be included when the dog is able to support weight with no limb movements?

A 
Massage limb muscles 
Light full body massage 
Passive range of motion (15 cycles of each joint) 
Standing exercises 
Weight shifting exercies
38
Q

What physical therapy should be included when the dog has initial limb movement?

A 
Passive range of motion 
standing exercise
weight shifting 
assisted walking 
hydrotherapy
39
Q

What physical therapy should be included when the dog has good limb movements?

A 
Sit to stand 
circles and figures of 8 
wobble board 
walking over poles 
hydrotherapy
40
Q

Why is skin and wound management important?

A

infection
pain
poor quality of life

41
Q

Why does skin disease occur?

A 
Boredom 
sensory dysfunction (neuropathic pain)
recumbencey 
bladder/faecal dysfunction
42
Q

How do pressure sores develop?

A 
Lack of movement lead to mechanical load in one area 
ischaemia 
reduced pulsatile blood flow 
reduced venous return 
reperfusion tissue injury 
blood pressure abnormalities 
Deep tissue first then skin
43
Q

What are the pressure points where pressure sores are most likely to form?

A

Ischial tuberosities
lateral condyles of the humerus
perianal

44
Q

What are the risk factors of pressure sores?

A 
Dogs with long fur 
diarrhoea 
weather
age 
concurrent ortho condition 
heating of the floor
45
Q

How are pressure sores prevented?

A 
Turn every 2 to 4 hours 
Appropriate bedding 
sling bed 
porous bedding 
non-slippery floor 
absorbent pads 
use of lower cages
Physical therapy to promote circulation 
Skin inspection once a day 
Drying the skin (waterproof barrier cream)
Manage bladder 
Avoid unnecessary dressing 
care with tape on skin
46
Q

How do you treat pressure sores?

A

Clean
debride
antibiotics
bandaging

47
Q

If a spinal patient is unable to urinate what can this lead to?

A

UTI
Bladder distension (lead to atony)
Distension of the ureters
predisposition to skin sores

48
Q

How can you manage the bladder in the spinal patient?

A

Manual expression (3x daily)
Intermittent catheterisation
Indwelling catheter
drug therapy

49
Q

What can lack of pain management lead to?

A

Self mutilation

reduced rate of rehab

50
Q

What are the types of pain?

A

Inflammatory-tissue damage
Neuropathic- dysfuction in transmission of noiciception
Acute- sudden onset localised
chronic- intense and unrelenting and persists

51
Q

Why should the respiratory tract be managed in spinal patients?

A 
prone to hypoventilation 
atelectasis 
pneumonia
Monitor respiratory parameters
Turn regularly 
Physical therapy 
propping into sternal 
appropriate drug and o2 therapy

Surgical Nursing (24 decks)

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