advanced vet patient care 🫀

Question 1

what are the stages for the nursing process

Answer 1

Assessment
Planning
implementation
Evaluation

Question 2

what are the sources of information required to effectively assess a px

Answer 2

The pet owner to provide information regarding normal activities
Nurse’s observations and clinical examination
Vet’s diagnosis and treatment plan
Patient history and records

Question 3

what is the nursing model

Answer 3

A system that can be used to provide a structure for assessing the patient and standardising the nursing care planned.

Question 4

what is a nursing diagnosis

Answer 4

The nurse identifying the patient’s actual and potential problems/patient needs.

Question 5

list the names of the 5 types of open wound

Answer 5

1. incision
2. abrasion
3. avulsion
4. laceration
5. puncture

Question 6

describe incision

Answer 6

a clean, sharp cut created by a sharp object- scalpel

Question 7

describe abrasion

Answer 7

damage with loss of epidermis/ dermis

Question 8

describe avulsion

Answer 8

tearing of tissue away from attachments, underlying tissue and structures

Question 9

describe laceration

Answer 9

irregular wound with damage to superficial and underlying tissue

Question 10

describe puncture

Answer 10

a penetrating wound created by a sharp object- tooth

Question 11

list the 2 types of closed wound

Answer 11

1. contusion
2. crushing

Question 12

describe contusion

Answer 12

blunt force trauma which doesnt break skin but causes damage to skin and underlying tissues

Question 13

describe crushing

Answer 13

force applied to the tissue for a period of time

Question 14

what are the degree

Answer 14

class 1: clean wound with minimal contamination- 0-6hr duration

class 2: wound with significant contamination 6-12hr duration

class 3: wound with gross contamination 12+ hr duration

Question 15

what are the phases of healing

Answer 15

haemostasis which occurs immediately after injury

inflammation which occurs within 6hrs, lasts 3-5days

proliferation which is the repair stage, occurs 3-7days post injury

maturation which is the remodelling phase- occurs 5-7 days post injury and lasts up to 2yrs or more

Question 16

explain haemmostasis

Answer 16

Haemostasis – Blood and lymph flows from the damaged blood vessels and lymphatics to fill the wound and cleanse the wound surface. Almost immediately the blood vessels undergo a reflex constriction, and endothelial damage activates the platelet with subsequent formation of the platelet plug. Vasoconstriction only lasts 5-10 minutes until the blood clot has formed. The blood vessels then dilate, and intravascular cells and fluid pass through the vessel walls into the extravascular space. Vasodilation is mediated but histamine released from local mast cells activated by tissue damage. A combination of activated platelets, red blood cells, fluid and fibrin forms the firbin plug within the wound defect.

Question 17

explain inflammation

Answer 17

The inflammatory and debridement phase typically lasts 3 to 5 days after the wound has occurred.
Blood vessels then dilate, increasing blood flow and bringing transudates into the wound, causing the heat, redness, and swelling of inflammation.
White blood cells in the exudate initiate debridement.
Neutrophils help break down bacteria and debris while stimulating monocytes.
Monocytes convert to macrophages, which continue to phagocytize debris and release growth factors that aid in tissue repair

Question 18

explain proliferation

Answer 18

The repair phase (Proliferative), which typically occurs from days 4 through 12, is characterized by replacement of lost tissue with normal, functioning cells of the same type. Only tissue or organs that maintain a cell population – such as epithelia, bone or liver – and are capable of undergoing mitosis are able to heal in this way.
Angiogenesis begins as capillaries grow into the wound from the surrounding healthy vasculature.
Growth factors allow for migration of fibroblasts, which leads to creation of collagen (which provides wound strength) and myofibroblasts (which cause wound contraction).
Granulation tissue begins to form (4-7 days) , followed by epithelialization and wound contraction.
Epithelialisation may take weeks to months to fully stratify, may be incomplete or be thin and delicate
Wound contraction (5-7 days), area of wound reduces, surrounding skin stretches

Question 19

explain maturation

Answer 19

The maturation (remodelling) phase begins when collagen fibres begin to orient along lines of stress, and can continue for years.
Wound edges meet, epithelialisation is completed
Redness reduces
The ultimate strength of the skin will be about 10% at 14 days, 25% by 4 weeks, and up to about 80% at several months

Question 20

what factors promote healing

Answer 20

• moist warm environment
• good nutrition
• tissue oxygenation
• limited movement of wound edges
• clean wound with good immune system

Question 21

what factors delay healing

Answer 21

• excessively dry or exudating wound
• poor circulation- shock, concurrent conditions, age, recumbency
• lack of essential nutrients- anorexia, poor perfusion, respiratory problems, lack of mobility
• excessive wound edge tension, patient interference, damage at dressing changes, if deficit when skin has been lost there can be tension on the stitches which results in wound tension, infection

Question 22

what is exudate

Answer 22

serosanguineaous in appearance
has a pink tingue to it
fluid that comes from wound

Question 23

what does exudate contain

Answer 23

oxygen, nutrients, cytokines, growth factors, chemotactic factors, WBC, enzymes

Question 24

where is exudate derived from

Answer 24

derived from plasma leaking from the cappillaries that leaks into the wound during inflammatory phase

Question 25

what is exudate

Answer 25

exudate consists of wound fluid plus liquified necrotic tissue created by WBC’s via the autolytic debridement and oedema caused by inflammation.

exudate levels are proportionate to the amount of contamination, infection and tissue damage in a wound and should subside as the wound transitions from the inflammatory/ debridement phase to the repair stage.

good bandaging and antibiotics will help wound healing

Question 26

if exudate is clear and pink tinged what does this tell you

Answer 26

its normal

Question 27

if exudate is cloudy and varied in colour what does this tell you

Answer 27

its infected

Question 28

what is the aim of wound management

Answer 28

provide a functional and cosmetic repair, relief of pain and distress to the animal, economic and time efficient procedures and prompt decision making in the event of signs of delayed healing

Question 29

what do you need to assess in wounds

Answer 29

• assess the whole px initially and stabilise
• time since injury
• what caused the wound
• degree of contamination
• degree of trauma at the site
• necrosis
• concurrent disease/medication
• is treatment / cost a viable option for the px?
• euthanasia

Question 30

what is the first type of wound closure called

Answer 30

PRIMARY CLOSURE
- healing by first intention
- this is the immediate closure of a wound after injury. this process can be used to close clean or clean-contaminated wounds with surgery
- classification- clean
- management- immediate closure no tension

Question 31

what is the 2nd type of wound closure called

Answer 31

DELAYED PRIMARY CLOSURE
- this type of closure occurs 2-5days after injury, before granulation tissue is formed. this process can be used to close clean-contaminated or contaminated wounds.
- classification- clean-contaminated or contaminated. questionable tissue viability
- management- lavage + debridement until healthy. appropriate dressing, closure after 2-3 days

Question 32

what is the 3rd wound closure called

Answer 32

SECONDARY CLOSURE
- this type of closure occurs at least 5 days after injury and after healthy granulation tissue has formed. this process can be used to close contaminated or dirty wounds.
- classification- contaminated or dirty
- management- lavage + debridement , appropriate dressing, closure after 5-7 days, granulation bed has begun to form

Question 33

what is the 4th wound closure called

Answer 33

HEALING BY SECONDARY INTENTION
- this type of closure occurs when a wound heals on its own by forming granulation tissue, epitheliasing and contracting.
- second intention is not selected for areas such as a limb on which the wound involves 2/3 or more of the limb because the risk that wound contraction will cause decreased mobility and or a tourniquet effect.
- classification- unsuitable for surgical closure. extensive contamination and devitalisation
- management- open wound management. lavage and debridement. appropriate dressing. allowed to heal.

Question 34

what are 3 important things to remember with wound healing

Answer 34

1. contaminated wounds should never be closed primarily. if in doubt treat as infected.
2. don’t manage an open wound for an excessive period.
3. if trauma caused the wound, let wound declare itself to give it time to disclose what tissue is viable or not.

Question 35

what is involved in wound prep

Answer 35

1. wear gloves
2. ensure adequate analgesia is provided and had time to take effect
3. GA usually required
4. keep covered with sterile, non-lining dressing prior to prep
5. swab wound bed for culture and sensitivity
6. insert sterile water soluble jelly into wound
7. clip around wound- total injury should be visible, clip passed unviable tissue and provide a 2cm margin
8. debridement

Question 36

what is the purpose of a lavage

Answer 36

helps to remove debris, reducing contamination and significantly reduces infection risk

Question 37

what is the pressure amount for a lavage to be effective

Answer 37

8-12psi

Question 38

what ml syringe is needed for lavage

Answer 38

20ml syringe

Question 39

what size needle is needed for lavage

Answer 39

19G needle

Question 40

how does debridement of a wound help

Answer 40

debridement prepares the wound bed by removing debris, contamination and necrotic tissue remaining after lavage. Debriding will reduce the risk of infection and promote healing

Question 41

what is bioburden

Answer 41

the number of microorganisms that the wound is contaminated with

Question 42

what is biofilm

Answer 42

forms when multispecies bacterial communities organise onto a wound surface and form an extracellular matrix of polysaccharides, proteins and nucleic acids to provide protection and ensure survival.

Question 43

what does bioburden cause

Answer 43

prolonged inflammation and healing delay

Question 44

what are the 3 forms of debridement

Answer 44

autolytic

mechanical

surgical

Question 45

what is autolytic debridement

Answer 45

Use of primary layer applications such as alginates, hydrocolloids, hydrogels, honey, or sugar. This form of debridement is the most selective because it spares healthy cells and intact matrix molecules while removing damaged cells and matrix with microscopic precision.

Question 46

what is mechanical debridement

Answer 46

Physical removal of tissue adhered to a dried-on
dressing; nonselective and, thus, the least desirable
form of debridement. Also, very painful so requires
anaesthetic and analgesia.

Question 47

what is surgical debridement

Answer 47

Gold standard technique. Tissue removed by surgeon
according to characteristics, such as color, texture,
vascular supply, and temperature; selective on a
macroscopic level.

Question 48

what is biological debridement

Answer 48

sterile environment and are applied to the wound bed. Maggots
may be applied with custom pre-constructed dressings or
Individually created dressing to keep the maggots securely In the
wound bed.

Question 49

what is active debridement

Answer 49

Using a soft purpose made scrubbing brush such as Debrisoft

Question 50

what are acemannan

Answer 50

Acemannan: Derived from aloevera and used on burns, dermal ulcers, lacerations, and radiation therapy wounds.11

Question 51

what is alginates

Answer 51

Derived from kelp and used in the inflammatory and repair stages. Absorb fluid from the wound, convert to a gel, and thus should not be used on dry wounds.

Question 52

what are bioactive dressings

Answer 52

Derived from living tissue and used in the inflammatory and repair stages. Provide a matrix for cell migration.

Question 53

what is biotherapy

Answer 53

Living organisms such as leeches or maggots. Leeches decrease edema and venous congestion. Maggots debride necrotic tissue, and their
secretions provide antimicrobial benefits.

Question 54

why use honey

Answer 54

Nonpasteurized honey (e.g., Manuka) provides antibacterial benefits, reduces edema, hastens sloughing of devitalized tissue, and promotes
granulation tissue formation.

Question 55

what are hydrocolloids

Answer 55

Composed of hydrophilic polymers. Used during the repair stage on low-exudate to medium-exudate wounds. As exudate from the wound is
absorbed, the hydrocolloid liquefies to form a gel. These dressings are usually used in wounds that require additional moisture and natural debridement. Hydrocolloids actively stimulate wound healing and encourage debridement as they degrade on interaction with wound exudate. They are best used in dry to semi-dry wounds, requiring maintenance in an optimal moist environment. Dressings are left in place for several days and provide a near-ideal wound healing environment.

Question 56

what are hydrogels

Answer 56

Hydrogels are used in wounds thought to be at risk of drying out. The main role of hydrogels is as a fluid donator for dry wounds. Hydrogels can both donate and trap water; therefore, they are useful for absorbing wound exudate, as well as hydrating and debriding necrotic material within the wound. A secondary dressing is required for hydrogels to work efficiently – this should ideally be a foam dressing with a semi-permeable film backing to maintain humidity and a moist wound environment.

Question 57

why use sugar

Answer 57

Reduces edema and bacterial proliferation and promotes granulation tissue formation.1 Application should be at least 1 cm thick

Question 58

list 4 closure techniques

Answer 58

sutures

surgical staples

surgical reconstruction- skin flaps or skin grafts

surgical drains - active or passive

Question 59

what does open wound management include

Answer 59

covering the wound with an appropriate dressing and bandage; it doesnotmean the wound is left open to the environment.

Question 60

what is the goal of open wound management

Answer 60

to work synergistically with the cells, providing the best environment possible to support the body’s wound healing process.

Question 61

when is second intention healing appropriate

Answer 61

Healing is progressing well
Reconstructive surgery isnotneeded to prevent contracture or scarring that might inhibit mobility or be cosmetically unacceptable
The patient tolerates bandaging.

Question 62

list the 2 types of periwound tissue damage

Answer 62

maceration- excessive production of exudate spilling onto adjacent healthy skin increasing susceptibility to infection

excoriation- contact with toxins from the wound causing damage to top layers of skin

Question 63

how would you reduce maceration and excoriation from occurring

Answer 63

-Check underlying cause
-Re-evaluate the best dressing for appropriate absorbency
-Change the dressings more frequently
-Protect peri-wound tissue with barrier cream
-Ensure thorough cleaning at bandage changes

Question 64

how is granulation built

Answer 64

Granulation tissue is built by fibroblasts, which secrete new extracellular matrix molecules (eg, collagen, elastin) and endothelial cells, which build new blood vessels

Question 65

what colour is healthy granulation

Answer 65

bright red and moist. it has a slightly uneven appearance.

Question 66

what is epithelialisation

Answer 66

Process when Epithelial cells on the skin edge migrate onto the granulation tissue, which provides the oxygen, moisture, and surface required for epithelial cells to proliferate, cross the wound, and create a new epidermis.

Question 67

what is the rate of which epithelialisation occurs

Answer 67

1mm/ 10 days - 10cm wound takes 500days to completely epithelialise.

Question 68

at what point would you change a dressing that has exudate and why

Answer 68

medium exudate as low exudate still has absorbency and excess exudate allows the dressing to become fully saturated which will lead to maceration of the surrounding healthy tissues

Question 69

what does appropriate dressing selection rely on

Answer 69

-Effective wound assessment
-Good knowledge of stages of wound healing and how dressings create optimal wound environment
-Location of the wound site
-Consideration of the cost of dressings

Question 70

what is a polyurethane foam dressing

Answer 70

These foams are highly absorbent and act by drawing excess exudate away from the wound, maintaining some moisture through humidity, which keeps the wound moist. They are commonly applied on top of other products – for example, hydrogels or honey. Foam dressings are now available with antimicrobial properties.

Question 71

what is a polyhexamethylene biguanide

Answer 71

PHMB is as an antimicrobial agent exhibiting broad spectrum activity against bacteria and fungi. This PHMB within the dressing attacks bacteria in wound exudate as it is absorbed. This type of foam dressing is effective against Staphylococci (including MRSA), Pseudomonas, Proteus etc.

Question 72

what do sodium chloride dressings do

Answer 72

A relative newcomer to the veterinary dressings market, this is a gauze dressing saturated in a 20 per cent hypertonic saline solution. This dressing promotes biological cleaning and the autolytic debridement process in non-infected and highly exuding wounds.

Question 73

what do super absorbent dressings do

Answer 73

Wounds that produce vast quantities of exudate can be very difficult to manage. New dressings have been designed to cope with very high volumes of exudate by incorporating polyacrylate crystals into the dressings in combination with hi-tech silicone adhesives to make them very “wearable”.

Question 74

what do silver dressings do

Answer 74

Silver and its salts have antiseptic and antibacterial properties. The silver in the dressings ionises to release active silver ions into the wound. The dressings require activation prior to use, by moistening with water for 10 seconds. Effective against Pseudomonas species, MRSA, E coli and common yeasts and fungi, including Candida.

Question 75

why is laser therapy useful

Answer 75

-Use of low level laser waves to enhance wound healing and reduce/prevent infection
-Increases blood flow and oxygenation
-Reduces inflammation and pain
-Speeds up wound healing

Question 76

why would you use a vacuums assisted closure

Answer 76

Use of negative pressure to encourage epithelialisation and contraction of the wound through the use of a vacuum pump sealed within a plastic dressing

Question 77

list 3 wound complications

Answer 77

1. devitalised tissue
2. exuding wounds
3. infection

Question 78

list characteristics of devitalised tissue

Answer 78

-Provide optimum conditions for growth of bacteria
-Delays the inflammatory phase
-Reduces the viability of the wound bed

-Many causes; localised to wound vs systemic issues
Requires debridement

Question 79

list characteristics of infection

Answer 79

Development – contamination, colonisation, critical colonisation, infection
-Signs – erythema, pain, oedema, localised heat
-Biofilm – protective coating produced by bacteria. Causes folding in of skin edges
-Causes damage or deterioration of the wound delaying healing, may cause systemic illness. Care AMR infection
-Check wound is properly debrided and cleaned, exudate level is managed, antimicrobial dressings (consider removal of debris and endotoxins from wound bed), systemic antimicrobials where indicated (culture & sensitivity)

Question 80

how do you treat an infected wound

Answer 80

Environment: Dedicated/Isolated room. Incontinence pads & ventilation

PPE: Gown, gloves, face mask
Vet & Nurse discuss options & plan. Vet would carry out any debridement required.

Aseptic Technique

Swab wound for culture & sensitivity to allow approp antibiotic treatment

Lavage Solution: PHMB breaks down biofilm. If unavailable active

8-12psi – bag of fluids/giving set/3 wat tap/20ml syringe/18-20G needle. (Wound irrigation systems are now available)

debridement & isotonic solution

Amount lavage 100ml/cm2

Dressings: Antimicrobial e.g. PHMB, silver or honey. Good control of exudate

Redress according to exudate volume -2-3 days maximum

Waste – Non-hazardous non-infectious Vs Hazardous Infectious

Question 81

why are drains used in practice

Answer 81

1. Remove exudate and fluid from surgical sites especially where the surgery has caused dead space
2. Allow monitoring of the surgical site ie abdominal surgeries- monitor free fluid composition and amount and replace loses
3. Aid wound healing and reduce the risk of dehiscence

Question 82

list characteristics of passive drains

Answer 82

-Use capillary flow
-Gravity
-Penrose drains
-Made of rubber latex
-Wider= more effective drainage
-Increased risk of infection of both the site and surrounding areas
-Can cause irritation of the skin when in place of from fluid
Sometimes the end is covered in absorbent material to absorb exudate
-Cheap and often used in GP or for minor infected wounds such as bite wounds

Question 83

list characteristics of active drains

Answer 83

-Closed System, collects fluid into a reservoir
-Apply an artificial pressure gradient to pull fluid or gas from a wound or body cavity
-Less risk of ascending infection
-Higher efficacy
-Can be positioned in any position as not relying on gravity
-More expensive
-Continuous or Intermittent Negative Pressure

Question 84

what is the Jackson Pratt drain

Answer 84

Active suction drains
Fenestrated drain attached to tubing that is then attached to a grenade
Air is removed from the grenade to create the negative pressure
When full or if there is an issue with the drain positive pressure will be present
Reduce dead space, remove air and fluid
Used for abdominal surgeries or larger wounds such as STS removal
Stay in until become non productive usually 3-5 days

Question 85

what is the Redon / Red O pack drain

Answer 85

Same as Jackson pratt
Not used as to empty they have to be disconnected from the close circuit tubing unlike Jackson Pratt drains that have a separate area for emptying

Question 86

what is the redovac drains

Answer 86

Completely closed active suction drains
Same as above the drain has fenestrated holes
Tubing to the reservoir bottle
This bottle is already primed as a vacuum DO NOT REMOVE THE CLAMP
A seal must be formed usually 4-6hrs post surgery then the clamp can be released allowing the drain to function
The reservoir has numbers to allow for recording volumes
They are bulky and not well tolerated in smaller species
Can be secured using surgical vests or cardio- vests

Question 87

what is the fluid production for a drain removal

Answer 87

2-4ml/kg/24hrs

Question 88

when are drains removed

Answer 88

when the fluid production is less than 2ml/kg/24hrs

Question 89

what is the standard operating procedure for handling drains

Answer 89

-Barrier nurse
-Excellent hygiene
-Minimum PPE of gloves
-Passive- Clean regularly to prevent irritation and infection, ensure environment clean
-Active- Empty when +ve pressure, DO NOT EMPTY Q4hrs just because the hospital sheet says drain, check if +ve pressure, empty if –ve pressure, check connections and mark on –ve pressure no requirement to drain
-If reservoir/canister is full, they must be replaced not emptied and reused
-Every time they are emptied, fluid/air volume must be recorded if concerned check sample
-Prevent patient interference

Question 90

how would you protect and cover a drain

Answer 90

• tubular elastic net dressing size 10
  -pet suit

Question 91

when are tracheostomy tubes used

Answer 91

Where complete upper airway obstruction has occured

Question 92

why are tracheostomy tubes used

Answer 92

• they provide Airway protection
• Airway patency
• Mechanical ventilation
• If unable to intubate ie UAO
• Laryngeal paralysis sometimes requires a longer term trach stoma

Question 93

what is the complication of aspiration pneumonia when using tracheotomy tubes

Answer 93

The net result of lung exposure to fluid, solid matter and bacteria can be minor, with a temporary physical reduction of the number of alveoli available for gas exchange while the immune system removes the problem. Alternatively, such exposure may lead to local or widespread pulmonary inflammation or infection – termed aspiration pneumonia, acute lung injury or acute respiratory distress syndrome. This complication has serious implications

Question 94

what are the complications of ongoing URT obstruction and regurgitation when using tracheotomy tubes

Answer 94

If the tracheostomy tube is too small, or partially or fully obstructed, the patient will still breathe with increased respiratory effort. The resulting negative intrathoracic pressure during inspiration will continue to predispose the animal to gastro-oesophageal reflux and, if the patient’s head moves below the level of the oesophagus, regurgitation may occur. This phenomenon is a risk in tracheostomy patients, as regurgitation does not involve a coordinated sequence of events causing the pharynx and larynx to protect the airway (as occurs during vomiting). Inhalation of fluid is therefore more likely, and the decreased effectiveness of the cough reflex and mucociliary escalator means the lungs are at greater risk of exposure to fluid, food and bacteria.

Question 95

what is the complication of inflamed/ infected focus within the tracheal wall when using tracheotomy tubes

Answer 95

Wound exudate from the tracheostomy site flows down the trachea, thus increasing lung exposure to fluid and bacteria.

Question 96

what is the complication of particle filtration is reduced when using tracheotomy tubes

Answer 96

More particulate matter is introduced to the respiratory tract;

Question 97

what is the complication of no effective cough reflex when using tracheotomy tubes

Answer 97

Pressure can no longer build up behind a closed glottis, so fluid or solid matter within the airway can no longer be ejected effectively and will accumulate within the airway or flow (under gravity) to the lungs;

Question 98

what is the complication of inspired air is not warm, humid or with laminar flow when using tracheotomy tubes

Answer 98

This causes inflammation of the respiratory epithelium, leading to increased mucus production, which, in turn, dries, causing thicker secretions or solid plugs. The mucociliary escalator no longer functions normally as the cilia are affected by the adverse conditions, particularly in the region of the tip of the tracheostomy tube;

Question 99

when do you start nursing care for a tracheostomy tube

Answer 99

immediately.

Question 100

explain the nursing care of an tracheostomy tube when using humidification

Answer 100

Humidification filters that can be attached to the end of the tube are one of the simplest ways to humidify inspired air for these patients. These are disposable. If the filters are unavailable, there are several alternative techniques which can be employed to provide humidification. One of these is the instillation of sterile isotonic saline (Burkitt Creedon and Davis, 2012). In order to provide proper humidification, 0.5–3 mls of sterile isotonic saline should be instilled into the tracheostomy tube hourly. Prior to instillation, the outside areas of the tracheostomy tube should be cleaned with chlorhexidine solution and sterile gauze. After cleaning and drawing up the sterile saline into a sterile syringe, the needle must be removed quickly and saline should be squirted into the tube without touching the sides. Nebulisation is another alternative method. Nebulising sterile saline for 10–15 minutes every 4–6 hours

Question 101

explain the nursing care of an tracheostomy tube when using aseptic wound care

Answer 101

Good wound care is vital for all tracheostomy tube placements, as these sites become prime locations for bacterial growth. Hands should be washed and gloves worn prior to handling the tracheostomy tube or area surrounding it. Sterile gloves should be used when cleaning the wound. The area should be cleaned around the incision and under the tube with chlorhexidine solution-soaked sterile gauze. Chlorhexidine solution should be diluted to 0.05% concentration for cleaning the wound (Burkitt Creedon and Davis, 2012). The gauze must not be dripping as the solution should not be allowed to get inside the incision. The nurse can begin working at the wound edges and work outward, away from the incision. No ointments should be used in the incision and wound area. Sterile cotton-tipped applicators may also be used instead of sterile gauze squares. Dry gauze pads can be placed around the tracheostomy tube after cleaning to aid in the absorption of exudate. The gauze pads should not be cut as the small fi bres that will be loosened by the cutting action could be inhaled by the patient. Instead, the gauze should be simply folded as needed to fi t around the tube. The tube ties should be checked each time the wound is cleaned, to ensure the tube is secure, and should be changed whenever they become soiled.

Question 102

explain the nursing care of an tracheostomy tube when using suctioning

Answer 102

Suctioning Patients with tracheostomy tubes produce various amounts of secretions. Regular suctioning is required but must be done very carefully as complications can occur. The patient should be pre-oxygenated for several minutes prior to suctioning. Aseptic technique must be followed (Fudge, 2009). A sterile, soft, long catheter that is pliable with fenestrations should be used. Silicone catheters are often preferred, but even a red rubber catheter may be used. The suction unit should not be turned on until the catheter is in place. Suction should be intermittent and light while moving the catheter in a circular motion to withdraw it. This process should take less than 15 seconds. Oxygen should be supplied and the patient given a break before repeating the process. Suctioning should be discontinued if there is a vagal response, cough, gag reflex, or any other adverse effects (Figure 5). This procedure should be practiced in advance of performing it (Figure 6). Veterinary nurses should use an alcohol based hand solution or disinfectant scrub to cleans hands and fingernails prior to the procedure. Ideally gloves should be worn in addition to proper hand sanitisation protocols.

Question 103

explain the nursing care of an tracheostomy tube when using removal of secretions

Answer 103

The inner cannula of the tracheostomy tube should be removed every 4–6 hours at minimum and replaced with a new sterile inner cannula. The original cannula can then be cleaned and soaked in a chlorhexidine solution to be used for the next exchange. Additional saline may be infused into the outer lumen if copious secretions are noted. If single-lumen tubes are used, the entire tube requires replacement. Care should be taken not to do this too often as it will irritate the wound. Therefore, tubes with inner cannulas are preferred to single-lumen tubes. Coupage and changing the posture of the patient may also facilitate removal of respiratory secretions, especially if done immediately after nebulisation. While care of a patient with a tracheostomy tube is intensive and involved, when the outcome is a healthy patient returning home, this in itself is a reward. Veterinary nurses must remember to start care immediately once a tube has been placed, and to always be on the watch for complications such as dislodgment, obstruction, or occlusion of the tube. They must also be diligent about preventing secretions from building up and blocking the tube, providing aseptic wound care, and providing humidifi cation of air.

Question 104

why is a thoracosotmy tube needed (chest drain)

Answer 104

A Thoracostomy drain is an in-dwelling catheter into the pleural space to drain air or fluid.
Accumulation of fluid or air in the pleural space separates the lungs from the chest wall thereby applying pressure and creating difficultly for the lungs to expand and fill with air, consequently causing clinical signs of dyspnoea, tachypnoea and hypoxia

Question 105

what is the nursing care for a chest drain

Answer 105

All staff must be properly trained or could cause life-threatening iatrogenic pneumothorax
WHO handwash & aseptic technique
The clamp must be compressed with a metal C clamp, and sealed with an adaptor and capped with a 3 way tap
Record volume of air and fluid separately
Frequency – Q4hrs for the first several hours then redice as volume decrease and clinical symptoms improve.
A maximum 3–5ml of negative pressure should be applied to the drain to avoid trauma to the pleura and occlusion of the tube by mediastinal or pleural tissue
Entry site can be cleaned with dilute chlorohexidine
The drain should be. The drain site dressing must be removed and replaced twice daily using a sterile
Monitor tube for clamps becoming disconnected
Monitor Patients Respiratory rate, effort and pattern, mm colour and SPO2 (tissue perfusion) ECG monitoring (cardiac impact)

Question 106

why are central lines used

Answer 106

-These are long stay catehters for use in patients that will
Be hospitlised for longer periods.
-They allow multiple blood draws from the line
-Allow larger volumes or rates of fluid therapy
-Allow higher concentrations of medications in constant rate
infusions that may be more irritant to perivascular tissue.
-Monitor central venous pressures

Question 107

what are the contraindications when using central lines

Answer 107

coagulopathy, raised intracranial pressure, thrombosis,
or a contaminated site/skin condition over the vessel

Question 108

what is the nursing care for central lines

Answer 108

-Aseptic Tehcnique
-Who handwash & Open glove
-Remove bandage material and examine site Q12hrs e.g. phlebitis, haematoma, kinking, dislodgement
-Clean site with dilute chlorohexidine & apply new dressing
-Bandage in place. Any exposed ports should be secured in body stocking
-Alcohol disinfecting caps should be applied over the needle free ports when not in use and should be changed each time the port is flushed
-Swab each port with alcohol prior to use
-Ensure that the catheter gate clamps are CLOSED whilst needle free valve is activated to prevent air embolism!
-All ports not in use must be flushed every 4 hours with heparinised saline. (use patient labelled bag of saline replace Q24hrs)
-If port becomes occluded – change needle free port for a red closed cap to prevent use & label DO NOT USE
-Dogs – walk on harness to avoid lead on jugular region

Question 109

when would you use an oesophagostomy tube

Answer 109

The use of oesophagostomy tubes is indicated when feeding is required for more than 7–10 days in patients with a functioning, unobstructed oesophagus and healthy gastrointestinal tract.
In patients with disorders of the nasal passages, jaw bones, oral cavity or pharynx oesophagostomy tubes bypass the injured site and enable enteral feeding.

Question 110

what are the complications of an oesophagostomy tube

Answer 110

Kinking, Blocking, Vomiting & Tube dislodgement

Question 111

what is the nursing care when using a oesophagostomy tube

Answer 111

Oesophagostomy tube dressings should be changed and the stoma site cleaned daily at the minimum as infection can occur

Question 112

what is the % of water in ECF

Answer 112

33%

Question 113

what is the % of water in ICF

Answer 113

66%

Question 114

what is the % of water in plasma

Answer 114

25%

Question 115

what is the % of water in interstitial fluid

Answer 115

75%

Question 116

list ways of the body water intake

Answer 116

drinking

food

metabolism

Question 117

list ways of the body water output

Answer 117

respiration

urine

faeces

skin

Question 118

what is an insensible loss

Answer 118

Insensible losses are where the body cannot adjust the losses. They will sometimes increase the amount it loses (e.g. with infection), but not decrease.

Question 119

what are sensible losses

Answer 119

Sensible losses are where the body can adjust the fluid loss to conserve or get rid of fluid.

Question 120

what is the ml/kg/day for insensible losses

Answer 120

10-20ml/kg/day

Question 121

what is the ml/kg/day for sensible losses

Answer 121

30-40ml/kg/day

Question 122

what is a solution

Answer 122

a solute dissolved within a solvent

Question 123

what is a solute

Answer 123

a solid, liquid or gas dissolved to make a solution

Question 124

what is a solvent

Answer 124

the liquid portion of a solution

Question 125

what does isotonic mean

Answer 125

concentration equal to plasma

Question 126

what does hypertonic mean

Answer 126

concentration higher than plasma

Question 127

what does hypotonic mean

Answer 127

concentration lower than plasma

Question 128

what is an electrolyte

Answer 128

a substance that dissolves in water and becomes ions which are charged particles. is conducts an electric current when dissolved / melted in water

Question 129

what are cations

Answer 129

positively charged ions

Question 130

what are anions

Answer 130

negatively charged ions

Question 131

why does normal pH need to be maintained

Answer 131

for cell function to occur

Question 132

how are the levels of hydrogen ions in the blood determined

Answer 132

by the amount of bicarbonate and carbon dioxide

Question 133

what form of carbon dioxide is carried in the blood

Answer 133

carbonic acid

Question 134

what does a change in pH do

Answer 134

decrease or increase in hydrogen or bicarbonate

Question 135

what is osmosis

Answer 135

the movement of water from an area of low conc to an area of high conc through a semi-permeable membrane until concs are equal

Question 136

what is osmotic pressure

Answer 136

the pressure with which water molecules are drawn across the semi-permeable membrane

Question 137

what is hydrostatic pressure

Answer 137

the force excreted by a fluid against a wall which causes movement of fluid between compartments

Question 138

what is the water movement across the capillaries determined by

Answer 138

the balance between hydrostatic pressure generated by the heart and the oncotic pressure generated by the proteins present in plasma

Question 139

describe the movement of water in capillaries

Answer 139

In capillaries, hydrostatic pressure (also known as capillary blood pressure) is higher than the opposing “colloid osmotic pressure” in blood—a “constant” pressure primarily produced by circulating albumin—at the arteriolar end of the capillary . This pressure forces plasma and nutrients out of the capillaries and into surrounding tissues. Fluid and the cellular wastes in the tissues enter the capillaries at the venule end, where the hydrostatic pressure is less than the osmotic pressure in the vessel. Filtration pressure squeezes fluid from the plasma in the blood to the IF surrounding the tissue cells.

Question 140

describe the water movement in cells

Answer 140

ECF and cytoplasm conc needs balanced so the osmotic pressure within the cell prevents excess fluid absorption. the fluid and nutrients move into cells from ECF. the fluid and waste is pushed out of cells to ECf. the fluid that is not absorbed into capillaries is then taken to the lymphatic system.

Question 141

what does a decrease in plasma proteins or ineffective lymphatic drainage cause

Answer 141

oedema

Question 142

what does homeostasis mean

Answer 142

any self-regulating process by which an organism tends to maintain stability despite external factors

Question 143

what is ECF essential for

Answer 143

ECF is essential for normal cellular functions, and its composition is tightly regulated by homeostatic mechanisms. These mechanisms ensure that variables like pH, electrolyte concentrations, and fluid volume remain within optimal ranges, allowing our bodies to function effectively

Question 144

what are the 3 organs in the body that regulate fluid balance

Answer 144

brain, adrenal glands and kidneys

Question 145

what is the composition of ECF

Answer 145

The main component of ECF isinterstitial fluid, which surrounds cells.
Blood plasma is another significant component of ECF, especially in animals with a circulatory system.
Lymph constitutes a small percentage of interstitial fluid.
Transcellular fluid accounts for about 2.5% of ECF1.

Question 146

how is osmolality controlled

Answer 146

Osmolality is controlled by hypothalamic osmoreceptors that stimulate thirst and the release of antidiuretic hormone (ADH) from the posterior pituitary gland. If net water loss from the body exceeds net water gain, plasma osmolality will rise and hypothalamic osmoreceptors then stimulate thirst and release of ADH. The augmented water intake and increased reabsorption of water by the kidney combine to decrease plasma osmolality towards normal.

Question 147

how does the RAAS - renin angiotensin aldosterone system work

Answer 147

a drop in blood pressure or in fluid volume causes the kidney to release renin

angiotensin is release from the liver

renin acts on angiotensin to from angiotensin 1

the angiotensin converting enzyme is released from the lungs and it acts on angiotensin 1 to form angiontensin 2.

angiotensin 2 also acts directly on blood vessels stimulating vastcontriction but it also acts on the adrenal gland to stimulate the release of aldosterone.

aldosterone acts on the kidneys to stimulate reabsorption of salt and water.

Question 148

what is a isotonic loss

Answer 148

loss of fluid that has similar osmolarity to plasma. e.g. vomiting and diarrhoea

Question 149

what is hypotonic loss

Answer 149

loss of fluid that has a lower conc of water than plasma e.g diabetes insipid and panting

Question 150

what is a hypertonic loss

Answer 150

a loss of fluid that has a higher conc of water than plasma e.g. hypoadrenocorticism

Question 151

list the 4 types of losses

Answer 151

water, water and electrolytes, blood, plasma

Question 152

what is the pathophysiology of the loss of water

Answer 152

plasma become hypertonic. fluid moves from ICF to ECF by osmosis

Question 153

what is the pathophysiology of the loss of water and electrolytes

Answer 153

loss hypotonic, isotonic or hypertonic. movement depends on tonicity of fluid. hypertonic dehydration as water only loss.
hypotonic dehydration - fluid moves from ECF to ICF by osmosis
isotonic dehydration- no fluid movement

Question 154

what is the pathophysiology of the loss of blood

Answer 154

most serious
isotonic loss therefore no fluid movement

Question 155

what is the pathophysiology of the loss of plasma

Answer 155

increased PCV, loss of plasma proteins
proteins must be replaced

Question 156

what are examples of the loss of water only

Answer 156

cannot drink e.g. injury
cannot concentrate urine e.g. diabetes insipidus

Question 157

what are examples of the loss of water and electrolytes

Answer 157

vomiting and diarrhoea
metabolic disorders

Question 158

what are examples of the loss of blood

Answer 158

trauma
surgery
warfarin posioning

Question 159

what are examples of the loss of plasma

Answer 159

burns
scalds

Question 160

what is dehydration

Answer 160

a lack of fluid in the interstitial compartment

Question 161

what is hypovolemia

Answer 161

a lock of fluid in the intravascular compartment

Question 162

what are parameters affected by dehydration

Answer 162

Mucous membrane moisture
Skin turgor
Eye position within orbit

Question 163

what are parameters affected by hopvolaemia

Answer 163

Capillary refill time
Heart Rate
Pulse Quality
Blood Pressure

Question 164

what tests can help estimate fluid loss

Answer 164

1. Packed Cell Volume Test (PCV) – inexpensive and quite revealing. For each 1% increase in PCV a fluid loss of 10 ml/kg has occurred. This can be unreliable where there is preexisting anaemia.
2. Haemoglobin – dehydration results in an increase in haemoglobin values due to loss of plasma water, but care should be taken when interpreting results from an anaemic animal.
3. Total Plasma Protein (TPP) – dehydration causes a rise in values. This can be measured from either a biochemistry test or from your refractometer. Measuring the total plasma protein is done in the same way as measuring the specific gravity of urine.
4. Blood urea & creatinine – parameters will rise in the dehydrated patient but will also be high in an animal with renal disease.
5. The specific gravity of urine – can also be an indicator of dehydration. If urine is highly concentrated this can be a sign of dehydration.

Question 165

what is the normal rate of urine output

Answer 165

1-2ml/kg/hr

Question 166

what is the rate for oliguria

Answer 166

under 0.5ml/kg/hr

Question 167

what is the specific gravity for a dog

Answer 167

1.015- 1.045

Question 168

what is the specific gravity for a cat

Answer 168

1.020-1.060

Question 169

what is a normal cats PCV

Answer 169

24-45%

Question 170

what is a normal dogs PCV

Answer 170

37-55%

Question 171

when will PCV decrease

Answer 171

anaemia

Question 172

when will PCV increase

Answer 172

dehydration

Question 173

what is total solids/ total protein

Answer 173

is a measure of the amount of plasma proteins in the blood; these include albumin, globulins and fibrinogen. Due to effect of osmosis during dehydration, TS will become elevated

Question 174

what is the normal TP for a dog

Answer 174

54-71g/dl

Question 175

what is the normal TP for a cat

Answer 175

54-78g/dl

Question 176

what happens when breathing is inadequate

Answer 176

When breathing is inadequate, carbon dioxide
(CO2, a respiratory acid) accumulates in the body, contributing to an acid state. The lungs can quite rapidly expel large quantities of carbon dioxide to reduce the quantity of acid in an effort to restore balance

Question 177

explain kidney regulation

Answer 177

The kidneys can also excrete more acid in their waste products, and retain more bicarbonate (HCO3−, a base or alkaline chemical), which is an important buffer employed within the body to help resolve or compensate for increased acid accumulation. If alkaline, the kidneys attempt to retain more acid and eliminate more bicarbonate (base substance) in an effort to maintain balance

Question 178

what are aboral acid-base balances indicative for

Answer 178

clinical disease processes and
can aid the clinician in identifying underlying causes of illness in the patient.

Question 179

what does the acidity or alkalinity of a soltution depend upon

Answer 179

how many hydrogen ions or molecules of C02 are present

Question 180

explain acidity

Answer 180

Hydrogen ions (H+) are a product of metabolism of protein and phospholipids. Carbon dioxide (CO2) is a byproduct of the metabolism of fat and carbohydrates. CO2 combines with H2O in the presence of carbonic anhydrase (enzyme/catalyst) to form carbonic acid.

Question 181

explain alkalinity

Answer 181

The body contains several mechanisms in order to maintain the desired “normal”, pH level, which is called buffering. A buffer is a compound that can accept or donate protons (H+) and minimize a change in pH

Question 182

what is metabolic acidosis

Answer 182

Metabolic acidosis occurs when there is an increase in the amount of acid in the body. This can be due to abnormal metabolic function, or ingestion of an acid or substance that is metabolized into an acid. There is a decrease in HCO3 and a compensatory decrease in CO2.

Question 183

what are examples for metabolic acidosis

Answer 183

vomiting
diarrhoea
renal failure
shock

Question 184

what is metabolic alkalosis

Answer 184

Metabolic alkalosis occurs when an excessive loss of sodium or potassium affects the kidney’s ability to control the blood’s acid‐base balance. There is an
increase in HC03 and compensatory increase in C02.

Question 185

what are examples of metabolic alkalosis

Answer 185

vomiting stomach contents only
over administration of bicarbonate

Question 186

what is respiratory acidosis

Answer 186

Where an acid state in the body occurs when respiratory system cannot excrete acid. Respiratory acidosis occurs when the lungs do not expel CO2 adequately. There is an increase in CO2, accompanied by a compensatory increase in HCO3−.

Question 187

give examples of respiratory acidosis

Answer 187

Respiratory obstruction
Acute respiratory failure
Hypoventilation for any reason
Anaesthetic problems

Question 188

what is respiratory alkalosis

Answer 188

Respiratory alkalosis occurs when too much CO2 is expelled from the bloodstream (typically from hyperventilation). There is a decrease in CO2 with a compensatory decrease in HCO3−.

Question 189

what are examples of respiratory alkalosis

Answer 189

Hyperventilation
Pain, stress
Hyperthermia
Excessive IPPV

Question 190

what is the volume of administration equation

Answer 190

fluid volume required= Maintenance volume + Deficit volume +
Ongoing Losses

Question 191

what is the maintenance rate

Answer 191

50ml/kg/day

Question 192

what is the deficit volume rate

Answer 192

10ml x % dehydration or % PCV increase

Question 193

what is the volume of ongoing loss

Answer 193

4ml/kg x vomit or diarrhoea or %burns

Question 194

how do you calculate the fluid administer rate

Answer 194

fluid volume / 24hr
fluid volume / 60 mins
fluid volume / 20
fluid volume/ 60secs

Question 195

what are the 3 categories of fluid

Answer 195

crystalloids
colloids
blood/ blood products

Question 196

what is a crystalloid

Answer 196

solution containing water and electrolytes. the electrolytes move easily across the endothelium into the interstitial space. can be classed as isotonic, hypotonic, and hypertonic

Question 197

what is a colloid

Answer 197

solution containing large molecules; plasma expanders. they remain in intravascular space longer than crystalloids.

Question 198

what is oxyglobin

Answer 198

a plasma expander with 02 carrying abilities

Question 199

when would you use oxyglobin

Answer 199

r dogs with anaemia, Oxyglobin acts as an immediate oxygen bridge to stabilise anaemic dogs until the underlying condition can be controlled and the animal’s body can produce its own new red blood cells. The treatment, which is now available in an individual 60ml transfusion bag, as well as a 125ml bag, maintains tissue oxygenation even when there is severe stenosis of blood vessels. It has a viscosity which is more than water but less than blood for ease of flow through vessels and also increases circulatory volume

Question 200

what do you take from blood/ blood products

Answer 200

whole blood- haemorrhage, anaemia, haemolysis

plasma - burns, hypovolaemia

packed red cells- anaemia

cryoprecipitate- clotting/ bleeding disorders

Question 201

what are the routes of administartion

Answer 201

oral
subcutaneous
intravenous
intraperitoneal
intraosseous

Question 202

what is the management of a drip line

Answer 202

Use unopened, sterile materials
Check bag is correct fluid, in date and clear
Prepare aseptically
Insert catheter up to the hilt
Ensure catheter is taped in dry
Change catheters ~ every 48-72hrs and dressings as needed if appropriate.
Flush catheter every 6hrs. DO NOT use fluids from drip bag
Check for signs of Phlebitis. Use Phlebitis Score system. (swelling, bruising, pain and perivascular fluid)
Check line regularly for kinks, blockages and interference
Prevent patient interference
Standard Operating Procedure (SOP) for Care

Question 203

what ways can you monitor a px

Answer 203

Check clinical signs for hydration level
Use calculated volumes
Monitor TPR and mucous membranes
Record urine output and SG
Monitor PCV
Monitor ongoing losses
(Central venous pressure)
Record all findings on fluid monitoring chart/ hospitalisation sheet
Review fluid therapy plan regularly
Monitor for signs of overperfusion
Weigh patient daily

Question 204

what is central venous pressure

Answer 204

Central venous pressure (CVP) is an estimate of the blood pressure in the right atrium. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. CVP is directly proportional to the volume of blood in the anterior vena cava and venous tone. This pressure is decreased by hypovolaemia or vasodilation and is increased by fluid therapy or vasoconstriction. It can be used to guide fluid therapy administration in critically ill patients, or in patients with cardiac disease to help prevent volume overload

Question 205

what is over perfusion

Answer 205

This is when the patient receives too much fluid. This is quite common in small mammals, cats and small dogs, which is why fluids must be carefully monitored.
Fluid overload can lead to peripheral oedema, which can lead more seriously to pulmonary oedema and can lead to respiratory distress and death.
Excessive administration of colloids can lead to right sided heart failure, and congestive heart failure. Crystalloid overload, in the early stages causes diuresis – the animal may produce lots of very dilute urine resulting in an increased risk of peripheral oedema and then pulmonary oedema, and death

Question 206

what is shock

Answer 206

shock is an acute circulatory failure resulting in inadequate tissue perfusion and energy production. as shock develops, pxs deteriorate rapidly

Question 207

what does normal tissue perfusion rely on

Answer 207

Cardiac output
Circulating volume
Peripheral vascular resistance

Question 208

what does a reduction of any parameters result in with normal tissue perfusion

Answer 208

Inadequate perfusion
Triggers compensatory mechanisms
Altered efficacy of all systems

Question 209

what is compensatory shock

Answer 209

when the compensatory mechanisms can fix the underlying problem

Question 210

what are mechanisms to reduce compensatory shock

Answer 210

Baroreceptors detect reduced cardiac output, stimulating adrenaline and noradrenaline release - causing increased heart rate and contractility

Hypoxia of tissues results in metabolic acidosis. Ventilation increases to address acid – base balance.

Hypoperfusion of kidney activating the RAA system. Aldosterone acts on the collecting ducts to retain Na and H2O. Also causes peripheral vasoconstriction.

Question 211

what are mechanisms to reduce decompensatory shock

Answer 211

Where shock is not treated, compensatory mechanism start to fail
Fluid and proteins leak from circulation into the tissues due to peripheral vasodilation. Viscosity of blood increases.
Acidosis increases
As gut becomes ischaemic, bacteria enters the blood stream – toxic
Increasingly stuporous or comatose

Question 212

what is irreversible shock

Answer 212

to much cell death that cannot be reversed

Question 213

what can irreversible shock lead to

Answer 213

Systemic Inflammatory Response Sydrome (SIRS)
Inflammtory Injury to one organ system that can cause damage to others. Can have infectious or non-infectious causes
Disseminated Intravascular Coagulation (DIC)
Activation of haemostatic mechanisms inducing a prothrombotic state leading to bleeding tendancies
Multi-Organ Dysfunction (MOD)
SIRS & Septic Shock can lead to MODS. Every organ and system within the body can be affected
Death

Question 214

what are the types of shock

Answer 214

Hypovolaemic
Septic/ Distributive
Cardiogenic
Obstructive

Question 215

what’s hypovolaemic shock

Answer 215

The heart pumps well but Decreased, inadequate circulating volume
Most common type of shock
Occurs due to loss of blood, fluid or plasma
Results in a severe tissue hypoperfusion
E.g. trauma, ruptured abdominal organs, surgery, V &/or D, burns

Question 216

what are clinical signs of hypovolaemic shock

Answer 216

Clinical Signs:
* Tachycardia
* Reduced pulse quality
* Absent peripheral pulses
* Prolonged CRT
* Changes in mm colour
* Reduced urine output
* Obtundation

Signs depend on phase of compensation/decompensation

Question 217

what is septic/ distributive shock

Answer 217

Also classed as a Distributive shock due to hypotension
Heart pumps well but there is peripheral vasodilation
Gram –ve (and occasionally +ve) bacterial infection
Endotoxins released from ruptured bacterial cells
Toxins in the circulation increase capillary permeability, causing uneven fluid distribution
E.g. peritonitis, pyometra, intestinal strangulation, gastric haemorrhage

Question 218

what are clinical signs of septic/ distributive shock

Answer 218

• Brick red mucous membranes
• Tachycardia
• Rapid CRT
• Bounding pulses
• Neurological signs
  o Depressed
  o Collapsed

Question 219

what are the 2 types of distributive shock

Answer 219

Hyperdynamic:
Increased cardiac output to improve tissue perfusion
Patient is compensating
Clinical Intervention – fluid therapy
Hypodynamic
Myocardial dysfunction
Patient is decompensating
Prognosis is poor

Question 220

what is cardiogenic shock

Answer 220

Reduction in cardiac efficacy
Heart loses its ability to pump effectively, leading to a reduction in cardiac output
Resulting congestion in liver and lungs, and oedema
Not a common type
E.g. cardiomyopathies, pericarditis, congenital defects, arrythmias

Question 221

what are clinical signs of cardiogenic shock

Answer 221

• Dyspnoea
• Presence of a heart murmur
• Rhythm abnormality
• History of heart problems
• Very high HR (>220bpm in dogs)
• Ascites

Question 222

what is obstructive shock

Answer 222

Obstruction of the normal blood flow
The heart pumps well but outflow is obstructed
Causes of obstructive shock include pericardial effusion and pulmonary thromboembolism
Due to pericardial effusion, blood is unable to fill the ventricles and hence cardiac output is reduced
Removal of the obstruction will cause resolution of the signs of shock

Question 223

what are clinical signs for obstructive shock

Answer 223

• Pale mucous membranes
• Tachycardic
• Slow capillary refill time

Question 224

what are clinical signs of general shock

Answer 224

Tachycardia
Hypotension
Tachypnoea
Pale mms
Prolonged CRT
Hypothermia + cold extremities
Weakness/depression
Reduced urine output
As progresses, dilated pupils and coma
Different types of shock can display other signs e.g septic shock causes congestion of the mms and an increased CRT

Question 225

how do you evaluate shock

Answer 225

History
Physical examination
MM colour, CRT, hydration
Heart rate
Blood pressure
Pulse rate and quality – peripheral pulse
Temperature – core and periphery
Blood tests – Hb, PCV/ TS, Total protein, glucose, BUN, lactate measurement

Question 226

what is the diagnosis for shock

Answer 226

Lactate – a byproduct of anaerobic respiration. Therefore a direct indicator of inadequate cell perfusion.

In one study of dogs requiring intravenous fluid therapy, those with lactate concentrations higher than the reference interval 6 hours after presentation were more likely to die (Stevenson et al., 2007).

Question 227

how to manage shock

Answer 227

Identify and rectify cause
Establish adequate ventilation and oxygenation
Restore optimum intravascular volume
Maintain adequate cardiac output and renal perfusion
Maintain optimum internal metabolic environment

Question 228

how to treat shock

Answer 228

Oxygenate; resuscitation where required
Provide analgesia
Control haemorrhage
IVFT, increase circulating volume + restore perfusion
Bicarbonate to address metabolic acidosis/ Hartmanns
(Antibiotics)
Maintain body temperature

Question 229

what are the shock rate fluids

Answer 229

Isotonic Fluid
Dose Dogs: 90ml/kg (full blood volume)
Cats: 50ml/kg
As the patient won’t have lost its full blood volume, it is advised to administer 25% of this and then re-assess cardiovascular parameters. Continue until parameters returned to normal

Hypertonic Fluid
Dose Dogs: 4 to 5 mL/kg
Cats: 2 to 4 mL/kg
Administered over approximately 10 minutes. Infusion rates greater than 1 mL/kg/min may cause a vagally mediated bradycardia, vasodilation, and bronchoconstriction

Hydroxyethyl Starches
Dose Dogs: up to 20 mL/kg (divide into 5ml/kg boluses & reassess)
Cats: up to 10 mL/kg (divide into 2.5-3ml/kg boluses & reassess)
Titrate to effect

Crystalloid & Colloid
Dose Dogs: Colloid @ 5-10ml/kg + Crystalloid @ 4-45ml/kg
Cats: Colloids @ 1-5ml/kg + Crystalloid @ 25-27ml/kg
(equivalent to approx. half the shock dose)
Titrate to effect and continually reassess clinical parameters to adjust type and rate of fluids

Question 230

what is the nursing care for the shocked px

Answer 230

Carry out first aid
Select method of oxygen delivery
Organise fluid administration, IV, jugular, bilateral?, central line, intraosseous, lactated ringers / colloids / blood / Oxyglobin
Analgesia – under the direction of the veterinary surgeon
Dressings – haemorrhage control
Warming patient
Stress reduction measures
Constant monitoring vital signs and records
Liaise with owners

Question 231

what parameters would you monitor shock pxs

Answer 231

• heart rate
• blood pressure
• mm
• temperature
• respiration (visual)
• repeat bloods- PCV

re evaluating px

Question 232

what is blood transfusion

Answer 232

Blood collection
Storage of blood and blood products
Blood types and cross-matching
Blood administration

Question 233

when do we use blood transfusion

Answer 233

Indications for Transfusion:
Anaemia- Due to blood loss (regenerative – haemorrhage, haemolysis
Due to failure of production (non-regenerative)
Coagulopathy
Thrombocytopaenia

Packed Red Blood Cells indicated for patients:
showing hypoxia as a result of anaemia (PCV 12-15%=hypoxia)
In acute blood loss due to haemorrhage

Plasma indicated for patients:
Coagulopathy when there is active bleeding
For patients with Von Willebrand’s Disease undergoing surgical procedure

Question 234

what are sources of blood

Answer 234

Must be species specific
Donors must meet certain requirements

Methods of acquiring blood or blood products
Practice register of donors
Staff pets
Blood collection organisations
National donor register
Practice protocol for blood transfusion

Question 235

what are the donor requirements

Answer 235

Fully vaccinated & reg wormed
Health, fit adult (1 – 8yrs)
Dogs>25kg, cats>4kg, BCS 4-6/9
Normal PCV & blood tests
Not have travelled abroad
No infectious disease, cats, –ve FIV, FeLV, FIP, toxoplasma, Mycoplasma haemofelis
No sub-clinical renal disease
Not on medication
Good temperament
Blood typed (or typed on collection)

Question 236

what % can dogs and cat donate their blood volume

Answer 236

20%

Question 237

what is the maximum a cat can give

Answer 237

11ml/kg

Question 238

what is the maximum a dog can give

Answer 238

18ml/kg

Question 239

what Is the formula to calculate the total volume of blood

Answer 239

Volume of donor blood req (ml)

= 80(dog) x BW(kg) x Desired change in PCV
divided by

PCV of transfused blood

Question 240

what is autogenous

Answer 240

taken from animal to use later on same animal

Question 241

what is heteroenous

Answer 241

blood taken from one animal to give to another animal

Question 242

what equipment needs set up

Answer 242

Attire
Clean Scrub Top
2 Pairs of Examination Gloves

Equipment
Clippers/ cat clippers
Comfortable table/location
Local Anaesthetic Cream
Diluted warm chlorhexidine or equivalent and sterile swabs
Surgical Spirit
Collection Equipment (450ml single collection bag with CPDA-1/CPD or syringe primed with anti-coagulant for cats)
Electronic Scales weighing in grams
Metal line clamps (optional – used by pet blood blank)/Guarded Haemostat
Dressing Material for neck bandage
Scissors
Sedation drugs
Eye lubricant
IVFT 100ml crystalloid(for cats/small dogs)

Question 243

what is the process of a blood collection in a dog

Answer 243

2 people lift onto table and get comfortable
Lie in left lateral recumbency, chin pulled forwards and front legs pulled caudally
Put on gloves, wipe away local anaesthetic cream, and perform surgical scrub.
Change gloves
Place the collection bag below the patient and place on scales.
Assistant should raise the jugular vein
Phlebotomist should insert the needle bevel up in a caudal direction (cranial can be performed)
Once in the vein, the assistant can remove the clamp on the collection set
Blood should flow easily. Normal rate is 50ml/min so you can collect the full unit in under 10 minutes.
Mix the anti-coagulant with the incoming blood with a gentle rocking motion at 15 second intervals.
Assistant in charge of the collection bag should monitor the weight for the desired volume.
Once full inform the phlebotomist and clamps the line
Place a sterile swab over venipuncture site, remove the needle and have the assistant apply direct digital pressure for 2 minutes.
Strip the blood from the collection line into the collection bag. leaving 5cm in the line from the bag.
Place clamps on the line (can use knots but less secure and doesn’t prevent contamination)
Fresh whole blood should be stored at room temperature and must be used within 4-6 hours from collection
If transfusion is delayed blood can be refrigerated 4-6C, although platelet activity will be reduced.

Question 244

how to monitor the dog donor

Answer 244

check and record the donors demeanour, pulse rate and pulse quality and mm colour

allow them to sit up slowly an lift them onto the floor

continue to monitor for 10-15mins and offer them a drink of water and a small meal of food

lead walk only for 24hrs. use a harness instead of collar / lead

Question 245

what is the blood collection process for a cat

Answer 245

Cats quite often sedated depending on temperament – if so, lubricate eyes and provide oxygen
A ratio of 1ml citrate based anti-coagulant to 7ml whole blood
Gently restrain in sternal recumbency with neck extended, using minimal restraint.
Disinfect venipuncture site
Change gloves
System of primed butterfly catheter, line clamped with haemostat and syringe. Keeping vein raised throughout.
Flow rate should be a rate of 5ml/minute or greater
Rock the syringe throughout to mix blood and anti-coagulant
Clamp and turn off 3 way tap before removing
Apply digital pressure to venipuncture site for 5 minutes

Question 246

how do you monitor the cat

Answer 246

monitor the pxs vitals and bp for hypotension whilst In a warm kennel

donations of 10ml/kg or more will require IVFT. This should be administered post donation via i/v catheter at a rate of double the volume collected over 60-120 minutes

once awake can be offered water and light meal

outdoor cats should be kept indoors overnight

Question 247

what’s involved with blood post collection

Answer 247

Bag clamped and blood removed from tubing
Blood bags should be labelled with donor name, collection date and time, blood group and quantity of blood donated, name of phlebotomist
Collected blood may be
Given directly to patient
Stored for future use
Separated to use RBC’s, plasma, platelets and clotting factors
Must be collected and stored in anti-coagulant
Heparin – for immediate use
Citrate phosphate dextrose (CPD)
Acid citrate dextrose (ACD)

Question 248

that blood products are taken in canines

Answer 248

Whole blood
Packed red blood cells
Plasma
Fresh frozen plasma (FFP)
Frozen plasma (FP)
Plasma products
Cryoprecipitate (CP) – Factor VIII, vWf, fibrinogen
Cryosupernatant (CS) – albumin, globulin, antithrombin, Proteins S and C, Factors II, VII, IX, X, XI and XII
Platelet products
Platelet rich plasma (PRP)
Other platelet products not currently available in UK

Question 249

how to store blood

Answer 249

If not used immediately blood should be stored at 4°C in a temperature controlled fridge
Longer storage,
Plasma may be frozen within one hour at -18°c for under one year (FFP)
Plasma frozen for over a year – frozen plasma (FP)
Cells can be refrigerated for three months

Blood banks process and store blood and blood products to ensure maximum longevity

Question 250

what are the blood types

Answer 250

Dogs have DEA (dog erythrocyte antigen). Only DEA 1 can be typed, +ve or -ve
Cats have three blood types (A, B, AB)
60% dogs are universal matches FIRST TIME
Risk of reaction increases at each transfusion
Higher risk of transfusion reaction in cats
Best practice to identify blood type in either species; always determine blood type of cats before blood transfusion and any animal previously transfused
Test kits available to identify if DEA +ve or –ve – Alvedia, Rapid Vet-H, DMEVet, Diamed G

Question 251

in cross matching what is major

Answer 251

donor RBCs and recipient plasma

Question 252

in cross matching what are minors

Answer 252

donor plasma and recipient RBCS

Question 253

what is the equation to calculate how much product to administer

Answer 253

blood volume to be transferred mls=

k (70 for c, 60 for f) x weight x required PCV recipient PCV divided by PCV of red cell product

Question 254

how to administer blood

Answer 254

Check blood bag for damage
Ensure it is correct blood type and/or is cross-matched
Warm in water bath to 37°C (max) or room temperature
Gently invert/mix whole blood
MUST Use blood administration set – reduce risk of microclots
MUST use appropriate infusion pump
Administer slowly at start (0.5-1.0ml/kg/hr) and monitor for signs of transfusion reaction
Increase rate (5-10ml/kg/hr) after 30mins if no signs
Continue monitoring
Stop once calculated volume been administered

Question 255

how to set up a transfusion

Answer 255

Any blood product must be administered through a 170-260 μm filter to reduce the risk of microclots or debris and set up in an aseptic manner using non-sterile gloves to reduce the risk of iatrogenic bacteraemia. Avoiding disconnection of the transfusion once connected also reduces this risk. A giving set can be inserted into the unit or it can be drawn out into syringes if smaller volumes or rates are required.

The blood product must be administered via an appropriate infusion pump as some may damage red blood cells (Kisielewicz & Self, 2014). A plasma warmer, such as the SAHARA©, is usually used for defrosting the plasma but can be used to gently warm the pRBCs to combat hypothermia, especially if multiple blood product transfusions are to be given, patients are small or particularly young, if the patient is under general anaesthesia or is already hypothermic (Kisielewicz & Self, 2014; Prittie, 2003).

Question 256

what are the transfusion reactions

Answer 256

Acute or delayed
Acute signs – immediate
Intravascular haemolysis – fever, tachycardia, dyspnoea, vomiting, shock, DIC, collapse, haemoglobinaemia
Extravascular haemolysis – milder signs, hyperbilirubinaemia (large amount of bilirubin)
Allery – urticarial type reaction, facial swelling
Delayed signs – 24-48hrs to 21 days
Ineffective transfusion, reducing PCV, fever, anorexia, jaundice

Question 257

how to monitor a transfusion

Answer 257

Monitor closely dedicated team member
Obtain baseline parameters prior to transfusion
Check and record all parameters on monitoring sheet
Rate of transfusion: set by vet
0.5-1ml/kg/hr for the first 15-30 minutes
If no reaction- then can administer the remaining over 4 hours
Monitoring intervals: Continuous for the first 30 minutes. Record every 5 minutes. Then can monitor every 15 minutes till end of transfusion
Signs of Reaction:
Tachycardia
Urticaria (facial swelling)
Hypotension
Vomiting or
Diarrhoea,
Dyspnoea/tachypnoea
Pyrexia
Haemoglobinuria.
Transfusion reactions require treatment with glucocorticoids, antihistamines and/or adrenalin may be considered. Antipyretics may be required.
If circulatory overload has resulted in pulmonary oedema, diuretic treatment and oxygen support
may be required.

Question 258

what factors influence the timescale for evaluation of each nursing intervention

Answer 258

The severity of the patient’s condition
The age of the patient
The normal frequency of the activity
The timescale of each goal/aim

Question 259

What information may be required in order to effectively evaluate the efficacy of the nursing intervention?

Answer 259

The goals set in the planning stage to identify if they are met
Nursing observations and clinical examination
Vet information

Question 260

How is the information from the evaluation used?

Answer 260

It identifies which nursing interventions have been successful, and by how much. This is then used to decide whether to change the intervention, alter the frequency, adapt it or stop it completely. Therefore revising the care plan.

Question 261

what are the SMART goals

Answer 261

specific – describe the outcome in a focused way. Use an objective view. the outcome should be related to a number, a percentage, fraction or frequency
Measurable - some form of measurable outcome so that a judgment can be made using a numerical element
Achievable – Is the goal set achievable? Has it been done before? Are there any contraindications to doing it?
Realistic - patient-specific factors should be taken into account to assess whether the goal is actually appropriate for the patient in question
Timing - goals should include a date or time by which they will be accomplished or completed.

Question 262

how to assess a cardiax px

Answer 262

client info- symptoms seen at home? normal routine for dog, medication,
history - any symptoms?
clinical examination- as we are staying with the px the whole time, we need to know whats normal so when doing the re evaluation is it better or worse
diagnostic tests
assessment of px need and potential problems

Question 263

what are pxs like with cardaic problems

Answer 263

fragile, open mouth, panting, a lot of movement in abdomen ( increased effort in breathing) - not just in chest, abdominal muscles are working hard as well. increased movement of chest resulting in reduced movement in lungs possibly due to a mass or fluid resulting in harder breathing

Question 264

what should you do with a px with cardiac distress

Answer 264

analyse breathing pattern
any history of breathing problems
reduce stress
place in a quiet area
give 02
provide rest or sedation
open mouth breathing in cats
don’t handle animal - stress- death

Question 265

what do you see in an ultrasound in pxs with cardiac distress

Answer 265

thickened mitral valve and tricuspid valve.
you won’t see as much contraction of the muscle around the ventricle

possible fluid around the heart

enlarged heart- cardiomegaly

on the x-ray there should be distinct areas of organs - there shouldn’t be all white or all black

Question 266

what should be assessed in the clinical examination

Answer 266

pulse rate- (femoral and sublingual come from the aorta) by using tarsal and metacarpal -peripheral pulse, the pulse might be different to indicate the heart - weak or binding or absent or irregular), rhythm and quality

compare pulse and heart rate- pulse deficit
blood pressure- detects low or high bp, vasoconstriction of blood vessels will maintain bp, if low, the blood can’t get where it needs to go. may have to wait until the animal is calm.

use stethoscope, listen to heart. muffled if fluid in heart, rate, rhythm, quality

capillary refill time- indicated blood is getting to peripheries, delayed or compensatory phase.

mm colour- pale if loss of blood volume

resting respiratory rate

crackling noises in lungs- fluid

engaging abdominal muscles?

is animal sitting up with head and neck extended for lung maximum extension or are they lying on their chest

pulse oximetor- device which is placed on a pulse point which tells the level of 02 in blood- you want it to be above 95, if below they have low 02

abdominal fluid wave- if abdominal is full of fluid- ascites, if one hand is on one side of abdomen and other is tapping the other side of abdomen, you will feel a thrush of fluid

Question 267

what diagostic tests will the vet use

Answer 267

radiography- radiogrpah of chest can tell size of heart. the heart takes 3 rib spaces, measure from apex- bottom. can also tell if any mass or fluid in pleural cavity

ECG- electrical activity of heart. is electrical impulses travelling through the heart normally?

echocardiography- ultrasound, can do cross section of heart, measure vessel walls, look at valves, gives accurate presentation of a mass or blot clot.

blood pressure

Question 268

ways of doing an ECG

Answer 268

special attachment - halter or telemetry- this goes onto the animal and they go home with it. it takes a continuous ECG of the animal. animal is more relaxed at home therefore beneficial doing it this way.

ECG performed in practice- only seeing what happens in heart in that time. they might be stressed from being in the vet

Question 269

how to do a ECG

Answer 269

need a machine
carry out in quiet, stress free environment
place animal in R lateral recumbency with gentle restraint- if too stressful, can do sitting ( may affect ECG if panting) or use sedation however this could affect the ECG.
needs to have a contact medium- ultrasound gel or surgical spirit.
has a sticky pad or crocodile clip
machines will have 3-4 leads that attach under the armpit and groin
clip legs and swab with spirit

Question 270

what colour are ECG cables

Answer 270

red- R foreleg
yellow- L foreleg
green- L hind leg
black- R hindleg

Question 271

what is the burst speed for ECG

Answer 271

30sec burst

Question 272

what will the ECG pattern look like

Answer 272

shoudl be a P for every QRS
should be a T for every QRS
regular pattern

Question 273

what does the echocardiography (ultrasound) scan look like

Answer 273

will show
- heart structure. should see each atria and ventricle

Question 274

what does an echocardiography show

Answer 274

function and blood flow

Question 275

what sound does the heart make

Answer 275

lub dub
lub - closing of the AV valves
dub- closing of aortic and pulomoric valves

systole- time inbetween lub and dub

Question 276

what does a murmur sound like

Answer 276

whooshing sounds, like a drum, very abnormal

Question 277

how to monitor blood pressure

Answer 277

cuff around leg 40% of leg/tail circumference

Question 278

why does a cuff inflate

Answer 278

to stop blood flowing through vessels

Question 279

what is the normal rate for a dog for bp

Answer 279

133mmHg systolic

Question 280

what is the normal rate for a cat for bp

Answer 280

124mmHg systolic

Question 281

what is a direct method of measuring bp

Answer 281

invasive technique using arterial catheters

Question 282

what is an indirect method of measuring bp

Answer 282

non- invasive using external cuff

Question 283

what veins can you use for measuring bp with a cuff

Answer 283

cerphalic or tail
clip hair
apply surgical spirit
apply ultrasound gel

Question 284

what needs and potential problems are there for a cardiac px

Answer 284

urinating and defecating- may not have control as so stressed. animal will use up all of 02 reserves if being taken out

eating as animal too stressed to eat

body temp- as animal is stressed, we need to maintain temp as they will get very hot

give animal 02 - compromised breathing

prepare IV access

place animal in quiet dark room, minimal staff, minimal handling

may be showing abnormal behaviours as so stressed. can become aggressive as they are panicked.

pain relief

Question 285

what are the nursing interventions for a cardiac px

Answer 285

stress free environment
minimal handling, reduces stress and avoid restriction of chest/neck, harness, care with restraint technique
controlled exercise- own pace, observe impact, care against syncope. provided minimum activity in advanced disease, use harness instead of collar.
provide oxygenation, lung care
IV access.
warm food as increases palatability.
frequent opportunity for urination, monitor fluid intake and weight (if loosing weight -not eating, dehydrated).
restrict sodium- pulls fluid into areas of a body
maintain body temp- environment temo- window, thermostat, radiator, fans, cool mat, cold towels placed beside them or underneath. DONT place on top as stops evaporation.
support rest or sleep - comfy bed, no lights, don’t have someone coming in all the time
give accurate medication

Question 286

how to provide home care

Answer 286

educate the owner on what to do so they have realistic expectations
ensure owner knows how to provide meds- if has side effects, tell owner.
exercise in moderation - reduce walk time by half.
cardiac diet- healthy treat options ( grain free)
no smoking in household
give boosters as don’t want to get kennel cough

Question 287

what are common signs of respiratory diseases

Answer 287

nasal discharge
sneezing
stertor
stridor
cough
dyspnoea
tachypnoea

Question 288

what will the lungs sound like with respiratory pxs

Answer 288

wheeze
crackles
stridor- HIGH pitched sound created as air passes through a narrowed airway during breathing. may be present during inspiration and expiration.
stertor- LOW pitches sounds (gasp or snore like) heard during inspiration. generally of pharyngeal origin

Question 289

what is eupnoea

Answer 289

normal breathing

Question 290

what is orthopnoea

Answer 290

adopting an upright or standing or sitting position due to difficulty breathing

Question 291

how to assess a respiratory px

Answer 291

Initial Observation
Assess Respiratory Rate, Effort and externally audible noise.
Signs of trauma or abdominal distension
Lung Auscultation
Increased Lung Sounds e.g. crackles, wheezes, harsh lung sounds
Are associated with lower airway and pulmonary parenchymal disease
Decreased Lund Sounds are associated with pleural space disease
Heart Auscultation
Listen for any heart murmur or irregularities in heart rhythm that could indicate underlying heart disease

Question 292

what oxygenation parameters do you assess

Answer 292

mm colour for signs of cyanosis

pulse oximetry measures the % of haemoglobin that is saturated with 02

capnography- measures c02 in expired gas and assess partial pressure of c02 in arterial blood. it also assess ventilation.

arterial blood gases- best assessment for ventilation and oxygenation

ultrasonography and radiography

Question 293

what pxs may get respiratory issues

Answer 293

any px with dyspnoea

airway obstruction

pleural space disease

pulmonary oedema

pulmonary contusions

pneumonia

feline asthma

pulmonary thromboembolism

diaphragmatic rupture- need the diaphragm to breathe

severe anaemia

cardiac px

shock cases

Question 294

what are the aims for respiratory therapy

Answer 294

increase 02 saturation of the blood and tissues and decrease respirator effect. minimise stress, maintain optimum temperature, minimal handling

Question 295

what are other methods of providing 02

Answer 295

flow by oxygen - hold tube with 02 coming out of tube
face mask- needs a close seal
nasal prongs- cant have a high flow rate as damages nares
nasal canula
oxygen cage
oxygen tent- cling film around kennel and apply 02
incubator - control temp, humidity, can feed 02
intubation +/- ventilator
tracheostomy/ transtracheal catheterisation

Question 296

what is the rate of flow of 02

Answer 296

2-3L/min

Question 297

what % of 02 does the flow by provide

Answer 297

25-30%

Question 298

what % of 02 does the face mask provide

Answer 298

50-60%

Question 299

what % of 02 does the nasal prongs provide

Answer 299

30-50%, rates higher than 4% can be uncomfortable

Question 300

what % of 02 does the 02 tent provide

Answer 300

30-80%

Question 301

what are potential complications of o2 therapy

Answer 301

Decrease of O2 saturation to vital tissues due to stress and handling

Increased dyspnoea – keep sternal/lateral recumbency, NOT dorsal, do not lean on patient

Drying of nasal mucosa – oxygenation longer than 2hrs, delivered directly into the respiratory tract or at rates of over 4L/min, requires a humidifier

Oxygen toxicity - >50% O2 for over 12hrs. Start 100% then reduce to lowest level that provides effect

Atelectasis – due to alveoli filling with fluid. Low intensity mobilisation, turning the patient, nebulisation and coupage, pain management

Question 302

how would you evaluate 02

Answer 302

Maintain blood oxygen levels above 95%
Maintain normal mucous membrane colour
Decrease respiratory rate and effort, reduction of paradoxical breathing
Monitor frequently to assess effect of interventions, review plan and identify complications

Question 303

what is an oesteoblast

Answer 303

cell which is involved with bone formation

Question 304

what is an oestoclast

Answer 304

a type of bone cell that breaks down bone tissue

Question 305

what is an oestocyte

Answer 305

ceel found in mature bone

Question 306

what is cortical bone

Answer 306

hard outer shell of bone

Question 307

what is cancellous bone

Answer 307

porous inner part of bone

Question 308

what is a fracture

Answer 308

a complete or incomplete break of the bone continuity with or without displacement of the resulting fragments. this is often accompanied by other injuries

Question 309

are fractures life threatening?

Answer 309

no, less priority. you would need to establish px for bleeding, stabilise heart or any life threatening injury

Question 310

how do you suspect a fracture

Answer 310

2 radiography views to specifcally diagnose

Question 311

what causes a fracture

Answer 311

a force to the bone

Question 312

what is tensile force

Answer 312

act to lengthen the bone

Question 313

what is compressive bone

Answer 313

shortening of bone

Question 314

what is shearing forces

Answer 314

typically parallel or tangential to the bone

Question 315

what is bending forces

Answer 315

create a convex aide of the bone and a concave side

Question 316

what are bending forces reffered to

Answer 316

moments

Question 317

How would you assess a patient that has arrived at the surgery with a fracture?

Answer 317

ABCs

breathing-
panting? open mouth breathing? respiration rate, pattern, effort greater on inspiration or expiration, any noise, stridor or starter? dyspnoea?

pulse-
check heart rate with stethoscope, mm refill time and colour, feel the femoral pulse and peripheral pulse, do they match up?

temperature-
ear thermometer or rectal thermometer.

if collapsed, assess airway

shock-
check bp , blood test if PCV is normal, total solids, lactate test- measure whether there is cell respiration occurring with the presence of 02. of cells don’t have 02, circulation isn’t going to tissues. if lactate is above 2.5, there is anaerobic respiration (lactate buildup).

check for IV

Question 318

How would you stabilise the patient?

Answer 318

Check and stabilize vitals (temperature, pulse quality and heart rate, respiration rate, blood pressure, pulse oximetry), if needed.

Perform thorough physical, orthopaedic, and neurologic examinations.

Pursue initial diagnostics, including blood analysis, thoracic and abdominal radiographs, and an AFAST ultrasound.

Resolve any life-threatening issues, which means that surgery may need to be delayed for several days due to conditions, such as pulmonary contusions or hypovolemia.

Administer proper analgesiaas soon as possible

ALWAYS SUPPLEMENT WITH 02

Question 319

what are the 2 types of fracture healing

Answer 319

direct and indirect

Question 320

what is direct fracture healing

Answer 320

Required rigid internal fixation. Occurs via a combination of contact and gap healing.
Contact Direct Healing occurs when the surfaces of the fracture are in direct contact. The fracture is stable, and there is no compression applied to the fragments.
Gap Direct Healing occurs when an interfragmentary gap of < 1 mm is present.

Direct – bone edges so close together that callus doesn’t form and the bone forms without the interim stage of fibrous tissue and cartilage– usually require surgical fixing asap after trauma.

Question 321

what is indirect fracture healing

Answer 321

The most common ‘natural’ healing process, whereby the fracture ends are placed close to each other (but not apposed), with intervening haematoma and variable displacement and/or angulation.

Question 322

what is the healing process of fractures

Answer 322

The process for normal fracture healing starts immediately at the time of the fracture with formation of a haematoma.
Inflammation:This phase traditionally lasts 3 to 4 days or longer, and is characterized by a fibrin-rich clot at the fracture site. This clot releases growth factors to simulate bone healing and potentially acts as a scaffold for migration of inflammatory and reparative cells.
Repair:During this phase, the clot is slowly replaced by granulation tissue, which adds slight mechanical strength. As collagen fibers become more abundant, granulation tissue is replaced by connective tissue and, after formation of connective tissue at the fracture site, resident mesenchymal cells differentiate into chondrocytes to form cartilage. With the help of growth factors, such as bone morphogenic proteins, the cartilage begins mineralizing to form woven bone.
Remodeling:This phase is characterized by a slow adaption of the bone to regain its original function and strength. It is a very slow process (up to 6–9 years in humans) that represents 70% of the fracture’s total healing time. The action of osteoclastic resorption and osteoblastic deposition is guided by Wolff’s law.

Question 323

what are the conditions for normal healing

Answer 323

For normal fracture healing to occur a number of requirements must be met:
viability of fragments (i.e. intact blood supply, if they dont they will die off and wont heal)

mechanical rest: this can be achieved by not moving and external immobilisation, e.g. cast or internal fixation.

absence of infection

Question 324

what are the 3 types of process of healing

Answer 324

spontaneous (indirect/secondary) healing
contact (angiogenic/primary) healing
gap healing

Question 325

wha are the influencing factors on healing times

Answer 325

Immature animals –
Improved vascularisation of callus in juvenile increasing rate of healing

Geriatric –
Reduced vascularisation of callus so prolonged healing compared to young and adult

Debilitation -
Hormone/kidney failure

Osteomyelitis –
Inflammation +/-Infection that interferes with healing

Cancellous vs Cortical-
Fractures in cancellous bone heal faster than cortical bone

Fracture sight -
Bone with good muscle coverage will have a good blood supply which will improve fracture healing ability

Type of fracture-
Oblique fractures have a larger surface area than a transverse fracture, improving contact to promote tissue regrowth

Poor reduction/fixation-
Good reduction to allow ‘Direct Healing’ will heal better. Poor reduction will have increased gap and callus formation and increased risk of malunion

Movement-
Movement to the fracture site will delay healing and increase risk of malunion

Question 326

what are the complications of fracture healing

Answer 326

Non-union – Complete failure of fractured bone ends to unite

Delayed union – Healing progresses slowly. Clinical union might occur but not achieved within expected time.

Malunion – Healing occurs in an abnormal position

Shortened limb – a form of malunion where the fracture hasn’t been reduced. Might be seen in cases that didn’t have veterinary intervention e.g. stray dogs

Osteomyelitis – Inflammation of the bone characterised by progressive inflammatory destruction of new bone. Bacterial Osteomyelitis = Infection

Fracture disease – A syndrome of muscle wastage and inability to flex joints in a limb after repair. Can occur due to scar formation.

Sequestrum – piece of devitalised bone separated from bone not incorporated into repair.

Implant failure – implants are foreign material and the body’s immune system may reject the implant. Can also occur due to poor choice of implant so it’s not compatible with the bone size/shape, and patient overactivity.

Question 327

what are types of fractures

Answer 327

normal, transverse- directly across, oblique- diagonal , spiral, comminuted- numerous fragments, segmental, one segmented part, avulsed, pulling of part of bone, impacted- pressure, torus- compression with a bulge, greenstick- fracture but not all the way through the bone

Question 328

what are the principles of fracture repair

Answer 328

Restoring the continuity of the bone

Restoring length

Restoring functional shape

Maintaining soft tissue function of blood vessels, muscles and nerve supply.

Question 329

what are the 3 fixation techniques

Answer 329

External coaptation
Internal fixation
External

Question 330

what factors affect repair choice

Answer 330

Classification of fracture
Age
Size
Temperament
Underlying diseases
Cost
Expectation of owner

Question 331

what is the aim of external coaptation

Answer 331

To limit motion at a fracture sight but immobilizing the joint above and below the fracture.

Question 332

what are the methods for external coaptation

Answer 332

casts, splints, and extension splints

rubbing may occur resulting in additional issues- pressure sores

relying on natural healing

only used on stable fractures such as greenstick

Question 333

what are the ADV of external coaptation

Answer 333

Technically simpler
Economical
Non-invasive

Question 334

what are the DISADV of external coaptation

Answer 334

Limited applications
Not sufficient stabilisation
Decubital ulcers
Slow healing rate and greater callus formation
Fracture disease
Owner Compliance

if cant go above or below the external coaptation isn’t suitable

Question 335

what are the nursing considerations for coaptation

Answer 335

Aftercare advice sheets incorporating a care plan to address basic needs

Providing protective cover for example with splint covered with bandage as can get wet. examples include empty drip bags, poo bags, carrier bags, medical pet shirts /anti-chew device such as bitter spray, collar.

Monitor for swelling if too tight/chafing/staining/smell if wound being infected/slipping/collapse

Medications (Analgesia, NSAID’s, Sedatives) may chew bandage if it’s uncomfortable.

Exercise - what is temperament of animal, will need mental stimulation. to limit exercise you cant walk them. only take them out in the garden on a lead. dont let cat out. limit pet on sofa, bed, stairs. keep at crate rest or restrict to one room, puppy pen, if multiplet household, take away other animals. you have to explain the result if they don’t do this e.g. splint falling off, fracture getting worse.

Mental Stimulation- snuffle pads, slow feeder, sit with the dog, radio, toys, activities

Post-op checks

dont have px with you when discussing after care as owner wont listen properly

Question 336

what is an internal fixation

Answer 336

something that goes into the bone such as a pin, wire, plate, screw

Question 337

what are the ADV of internal fixation

Answer 337

Any closed fracture, any bone

Accurate reduction

Rigid fixation

Early return to full function – minimal risk of fracture disease

Question 338

what are the DISADV of internal fixation

Answer 338

Expensive/time consuming
Surgical Skill
Equipment
Surgery risks
Not suitable for open fractures

Question 339

what are the nursing considerations of internal fixation

Answer 339

Immobilisation if deemed appropriate- carrying?

Coaptation as protection

Surgical Site Infections (SSI’s), smell, colour of exudate (green yellow or milky purulent), necrotic tissue, inflammation with heat, swelling, temp

Ability to mobilise
sling, vet beds, memory foam mattress, manually lift the dog up to stand with 2-3 people. use rubber matts on floor, carpet to stop slipping. put on lead, does dog pee on or off lead/ certain substrate/ command to toilet?

Ability to access 5 freedoms
Patient Interference
Monitor for complications

Question 340

what is the suggested protocol for surgical site infection

Answer 340

Train staff appropriately on protocols

Protocol for cleaning, disinfection, and sterilization of Ortho Equip

Swab patient skin prior to surgery

Pre-operative surgical site preparation e.g. sterile gloves/sterile scrub materials/Chloroprep (remains on skin for 4 days after surgery) /contact time

Peri-operative measures – surgeon double gloves/facemask/cap

Post-operative surgical site care e.g. aseptically clean with sterile gloves & sterile swabs/apply dressing in theatre/residual effect Chloroprep 48hrs

Monitoring & Document Infections that do occur

Swab wound when infections occur

Antimicrobial therapies for prevention of SSI should be based on the risk of SSI

Question 341

what are the indications for external fixations

Answer 341

If there is an open contaminated fracture. Where the wound needs to be treated as a open wound and/or needs bandage changes.
If there is a concern that placing internal fixation will increase the risk of osteomyelitis or infection.

Question 342

what are the ADV of external fixations

Answer 342

Minimal instrumentation/reuseable
Minimal disruption to soft tissues/foreign materials
Can manage open wounds
Complements other techniques
Adjustable/easy to assess
Easy to remove

Question 343

what are the DISADV for external fixations

Answer 343

Soft tissue issues
Skill/difficult to apply to proximal limbs
Xrays can be hard to view
Premature pin loosening

Question 344

what are the nursing considerations for external fixations

Answer 344

Open wound care
Compression bandages for 2-3days, daily change
Cover the pins!
Air
Cage rest/lead walks
Scab formation – leave
Excess exudate – clean and see VS
Wound interference
Written instruction – what’s next?
Contact information

Question 345

what are the aims of rehabilitation

Answer 345

restoring maximum function, quality of life and independence following injury or disease.

to limit pain

build muscle

return the animal to normal function where possible- all activities of daily living

reduce recovery time

Question 346

what are the types of rehabilitation

Answer 346

physiotherapy

acupuncture

hydrotherapy

mctimoney

Question 347

who in the team are involved with rehabilitation

Answer 347

all members of the team including multi-disciplinary teams

Question 348

what types of pain are there

Answer 348

inflammatory response
articular cartilage damage
increased joint stress
muscle atrophy less ROM
decrease in exercise

Question 349

what is the aim of acupuncture

Answer 349

to promote natural body healing

Question 350

what is the method os acupuncture

Answer 350

insertion of a special needle into acupoints which are rich in nerve endings and blood vessels

Question 351

what are the effects of acupuncture

Answer 351

enhances blood circulation and tissue blood flow/ oxygenation and removal of waste products/ toxins

stimulate nervous system

reduces swelling

relives pain

encourages healing by correcting energy imbalances in the body

relaxes muscles

Question 352

what is the aim of hydrotherapy

Answer 352

take the weight off joints and enable flexion and extension

Question 353

why is a thermal effect of hydrotherapy good

Answer 353

aids muscle relaxation for exercise

Question 354

what are benefits of hydrotherapy

Answer 354

relives pain

reduction of swelling and stiffness

circulatory benefits

improved cardiovascular fitness

muscle strength

joint mobilisation

increased mental stimulation

improve gait pattern

Question 355

list some conditions hydrotherapy can be used for

Answer 355

orthopaedics
spinal
neurological
muscle atrophy
obesity
show dog conditioning
behaviour issues by relieving excess energy and promoting focus

Question 356

what is mctimoney

Answer 356

animal manipulation that’s hands on adjustments

Question 357

what does the RVN need to asses in a px

Answer 357

Assess your patient – nose to tail health check with some enhancements –
physio assessment – which includes….
Static Assessment: Posture (head, spine, tail) Conformation (spine, limbs, joint angle) Limb placement (cow hocked, wide, narrow)

Dynamic Assessment Watch in walk and trot - Spinal Movement, Posture/Tail,Limb Placement, Weight Baring, Lameness, Swing Phase, Sit to Stand

BCS!!!

Lameness scoring -which scale? Force plates/gait analysis

Measurements – pros and cons

Question 358

what are considerations for pxs

Answer 358

Companion/working
Multi animal/children
Floor
Stairs
Bedding
Exercise
Previous therapy
Aversion to water/touch/noises…

Question 359

why is hot heat useful for

Answer 359

chronic pain
relaxes tense muscle
aches
arthiritis

Question 360

what is cold heat useful for

Answer 360

acute injury
after surgery
reduces swelling
sprains
bruises
pain

Question 361

list methods to maintain temperature regulation

Answer 361

Heat pad
Bear Hugger
Bubble Wrap
Blankets
Hot Water Bottle/Microwave heated pads
Thermal socks/bubble wrap on feet
Humidifiers attached to GA circuit- warm air so preserved body temp

Question 362

what can hypothermia impact

Answer 362

recovery and depth of anaesthesia

Question 363

temperature can be affected as soon as …

Answer 363

presumed drugs administered

Question 364

what are types of physio techniques

Answer 364

Thermotherapy
Assisted standing
PROM
Massage
Turning 2-4 hourly

However, physiotherapy and rehabilitation after orthopaedic surgery can aid recovery by increasing muscle strength and reducing pain, swelling and inflammation (Connell and Monk, 2010).

Restrict blood flow – reduce swelling – reduce pain - Ice packs are wrapped in a towel to prevent damage to the skin, and then placed on the area for 10–20 minutes (Connell and Monk, 2010; Drum et al, 2015) repeatedly throughout the day. The use of ice packs on cats can be difficult because of their reluctance to lie still for long periods of time (Drum et al, 2015), and can be painful on application. However, this may be easier during the recovery period when the patient is drowsy. ice cubes

Slings/towels

If the patient was recumbent for 2 hours, they were turned onto a different recumbency to aid patient comfort, prevent decubitus ulcers and hypostatic pneumonia (Murrell and Ford-Fennah, 2011).

Question 365

what is the role of the scrubbed nurse

Answer 365

Works directly with VS within sterile field

Ensures sterility maintained and liases with
Circulating nurse

Organises sterile instruments and passes sterile
Equip to vet

Question 366

what is the role of the circulating nurse

Answer 366

Tasks performed outside sterile field
Organises nursing care with rest of team
Tasks could include –
passing instruments in sterile manner to scrubbed nurse
Organising equipment
Monitoring and recording
Consumables

Question 367

how do you prepare a theatre

Answer 367

Area checked and clean
All theatres damp dusted at start of day
Spot cleaned after each procedure
Room set appropriately for procedure
Correct equipment and instruments
Checking sterilised equipment
Equipment
Patient checked
Check lists!!!!!
Planning is key!!

Question 368

what are the pre and postoperative nursing considerations

Answer 368

Surgical preparation of skin
Positioning of patient- bratty- elevated so less chance of regurgitation. nerve damage. breed. surgery.
Equipment
Drapes – “strike-through”
Monitor patient for hypothermia and dehydration
Swabs counted and weighed for blood loss calculations
Post op bedding/environment
Post op analgesia and close observations
Wound interference
Drains – dressings
Factors that promote/delay healing

Question 369

what are the nursing considerations in a theatre

Answer 369

Aftercare advice sheets

Providing protective cover/anti-chew device

Monitor for swelling/chafing/staining/smell/slipping/collapse

Medications

Exercise

Post-op checks

Question 369

what are some anti- lick/ chew devices

Answer 369

Buster collar
Soft
Inflat
Stocking
T-shirt/underwear
Covers

Question 370

what questions should you ask the owner

Answer 370

Cats – what litter type and can they get into the tray? Lids/inco sheets
How do they drink
Decrease stress – pheromones/calming aids/things from home (label!!)
Normal behaviour? Breed type

what is the usual bedding at home
what does the animal eat
what does the animal eat out of
is there any allergies or dislikes
is the animal on meds
does the animal have any previous history
is the animal fully vaccinated
how often does the animal toilet
how active is the animal
does the animal have any preferences of males or females
what is the animals normal behaviour
does the animal have a preference of where or how they toilet
does the dog have high or low stress levels
is there any mobility issues
is there any command words
Is there a food release word
is there any grooming issues, like matts
any health conditions
has the dog had any vomiting or diarrhoea in the past 2-3 days
is there any aggressions
does the dog have issues with dogs or cats
does he react okay around strangers
when did he last eat and how much
when was the last time he defecated or urinated
any issues with respiration
why does he take any medications
how much water does he drink normally
is there any toys he gets when he is anxious
has he destroyed any bedding
has he ever been away from owner
any treats he prefers or gets after a walk etc
how fast does he eat
raw fed?

Question 371

what questions should you ask the vet

Answer 371

how did surgery go
any complications
open sutures?
how long do you want sutures in for and when do you want them removal
any medication to be given and how much
how did anaesthetics go
hypo/hyperthermic?
have you phoned owner to let them know how surgery went
any restrictions for the dog
happy for nurse to discharge px
how long do you need px to rest before toileting
how your going to manage the medical case
any particular diet
how slow/fast to give IVFT
when do they start meds
any side effects of meds
can I use ice packs
do you need me to apply a bandage such as Robert jones
how often do you need drain emptied and managed
do you tell owner or shall VN tell owner for open drain or closed drain
how do you want external fixation managed
how long should animal rest
how long should animal exercise for
is it on fluids
rate for fluids
is it needing blood work
how often is blood work needed
pain score?
does VN have to administer any med
do they need to come in for post op checks
is it allowed to jump

Question 372

what are the clinical symptoms of acute renal px

Answer 372

Sudden-onset anorexia, lethargy and depression.
Oliguria and anuria, followed by polyuria.
Vomiting and diarrhoea.
Polydipsia.
Dehydration.
Uraemic breath.
Abdominal pain.

Question 373

what is the clinical symptoms of chronic renal failure

Answer 373

Polyuria/nocturia (as the kidney loses its ability to concentrate the urine).
Polydipsia.
Uraemia – anorexia, vomiting, lethargy and depression.
Weight loss.
Dehydration.
Oral ulceration and halitosis.
Non-regenerative anaemia (due to lack of erythropoietin production by the kidney).
Hypertension.
Rubber jaw (renal hyperparathyroidism)

Question 374

what is cystitis

Answer 374

inflammation of the bladder

Question 375

what are the causes of cystitis?

Answer 375

Idiopathic
Feline lower urinary tract disease (see ‘Feline lower urinary tract disease (FLUTD)’ below)
Trauma
Urolithiasis (see ‘Urolithiasis (urinary calculi)’ below)
Neoplasia
Primary bacterial infection – often ascending, common in female dogs
Bacterial infection secondary to other diseases (e.g. diabetes mellitus, hyperadrenocorticism (Cushing’s disease), immunosuppressive infection such as FIV and FeLV).

Question 376

what are the clinical symptoms of cystitis

Answer 376

Pollakiuria = Abnormally frequent urination
Urinary tenesmus.
Haematuria.
Stranguria.
Incontinence.
Dysuria.
Inappropriate urination.
Excessive grooming.

Question 377

what are the clinical symptoms of urinary incontience

Answer 377

Loss of control over urination
Passing of urine when lying down or walking.
Urine around perineum which can cause urine scalding.

Question 378

what are the clinical signs for urolithiasis

Answer 378

Pollakiuria.
Urinary tenesmus= feeling of incomplete emptying of bladder after urination
Haematuria.
Dysuria.
Distended bladder.

Question 379

what are the clinical symptoms of feline lower urinary tract disease

Answer 379

Distress – vocalizing and signs of abdominal pain
Anuria
Distended hard bladder
Clinical signs of renal damage
Anorexia and vomiting
Lethargy and depression
Dehydration
Collapse and death if untreated.
Hyperkalaemia- high K+ levels
kidney damage

Question 380

what are the nursing interventions for urinary pxs

Answer 380

Record abnormal output, appearance, dipstix/SG results, micturition posture and frequency- collecting urine and comparing what’s normal, volume, appearance
Express bladder/catheterise where indicated
Use aseptic techniques
Take steps to reduce trauma
Regularly check bladder size- not commonly used now a days as bladder may burst, catheter siting etc. Flush if required
Empty bag every 4hrs, measuring output where required
Check lines are not kinked or blocked, bag not full. urine will go on animal if not closed catheter.
Prevent self-mutilation
Keep patient and kennel clean and dry, use kennel liners under vet bed
Clip perineum and apply barrier cream where risk of scalding
Provide accurate medication

Question 381

what equipment and prep is needed of a catheter

Answer 381

Equipment
Analgesia
Sedate/GA
Gloves
Catheter
3 way tap
Closed urinary system
Sterile lubricant
Syringe
Kidney dish
Saline flush
Suture material & instrument

Preparation
Bloods
GA
Clean site

Question 382

what additional care is needed for a catheterisation

Answer 382

Maintain fluid therapy, observe for fluid overload & care if potassium added!
Monitor fluid ins+outs
Assisted feeding
Palatable diets, warming food
Soft diets
Hand feeding
Pain management
Feeding tubes
Maintain body temperature
Stress reduction

Question 383

how do you evaluate a catheterisation

Answer 383

Monitoring urine output (1-2ml/kg/hr)
Washable litter
Weighing newspaper/kennel liner
Catheter attached to closed system - collection bag
Output, appearance, dipstix/SG results, micturition posture and frequency, signs of UTI infection
Monitor body weight, condition and muscle mass
Monitor hydration status
Monitor water intake
Pain levels and vital signs

Question 384

what is SG used for

Answer 384

evaluate kidney function

Question 385

what is the SG for dogs

Answer 385

1.001-1.060

Question 386

what is the SG for cats

Answer 386

1.005-1.080

Question 387

In animals with dehydration and normal renal function, urine specific gravity should be..?

Answer 387

> 1.030 in dogs and >1.035 in cats.

Question 388

what are some further care to provide for urinary pxs

Answer 388

Appropriate diet (restricted protein and phosphate for CRF, restricted minerals for urolithiasis), ideally wet diet

Encourage increased water intake
Fresh water ad lib
Broth (salt-free)
Water fountain

Renal nurse clinics
Monitor food and fluid intake, BW, BCS & MCS
Blood sampling, signs of deterioration and IRIS staging
BP monitoring