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Intermediate Nursing - class notes > Ch 32 - Preoperative , surgery occurrences book notes > Flashcards

Ch 32 - Preoperative , surgery occurrences book notes Flashcards

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1
Q

What is included in a complete preoperative assessment?

A
  • know the primary problem
  • eating, drinking, urination, and defecation habits of animal
  • ask if client ate or drank anything before anesthesia and surgery
  • what medications the animal is taking or has taken
  • history of previous medical problems and surgical procedures - let surgeon know
  • vaccine status
  • TPR, quality and character, CRT, muscous membrane, color, weight, and demeanor
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2
Q

The animal should not have food for a least ___ hours before antsthesia?

A

12 hours

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3
Q

Why is it important to know what medications the animal has taken the day of the surgery?

A

could affect what medications are administered before and after surgery

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4
Q

A young puppy or kitten is best vaccinated at least ___ weeks before surgery rather than on the day of sugery, Why?

A

2 weeks
- because the immune system can be suppressed by anesthesia and surgery, making the patient less responsive to immunization.

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5
Q

Diagnostics might include?

A
  • blood work such as packed cell volume (PCV)
  • total plasma protein (TP) concentration
  • blood urea nitrogen (BUN)
  • blood glucose concentration
  • complete blood count (CBC)
  • complete biochemical analysis, and the heart worm test
  • blood gas analysis
  • electrocardiogram (ECG)
  • radographs
  • ultrasound and fine-needle mass aspiration
  • fecal analysis; and/or urinalysis
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6
Q

It is the vet tech’s responsibility to inquire about the ____ procedure to be performed and what ____will be required.

A

surgical

instrumentation

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7
Q

A ___ ___ water blanket should be placed on the operatng table, turned on, and covered with a towel so it is warm when needed.

A

heated circulating

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8
Q

Clean surgical hair ____ and skin ____ solutions should be made available for use.

A

clippers

cleansing

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9
Q

The _____ cage should be made ready wit warming equipment turned on.

A

postoperative

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10
Q

Warm- ____ blankets should be nearby to cover the patient if needed.

A

air

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11
Q

Inadequate animal preparation for surgery can?

A

hinder surgical technique, increase the risk for surgical infection, result in wasted time spent correcting deficiencies, and result in prolonged anesthesia

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12
Q

_____ antibiotics are used to decrease the risk for infection in clean or clean-contaminated surgeries.

A

prophylactic

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13
Q

Antibiotics should never be given _____ to animals undergoing surgery.

A

indiscriminately

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14
Q

What are some indications for prophylactic antibiotics?

A
  • operative is longer than 90 min.
  • the patient may be immunosuppressed
  • a hollow viscus is to be entered (i.e., GI tract)
  • the incision is to involve an area that is difficult to aseptically prepare (toe, or ear)
  • orthopedic implants are placed
  • joint procedures that are long and aggressive and require multiple entrances into the joint
  • if the consequences of infection cold be devastating to the surgical outcome (hip replacement)
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15
Q

Prophylactic antibiotics are not recommended for?

A

short, clean surgical procedures, such as simple mass removal, OHE, castration etc.

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16
Q

What would cause the antibiotics to not be effective during surgery?

A

therapeutic drug levels are not present in the wound fluid (serum and interstitial tissues)

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17
Q

How much time is needed to make sure that the antibiotics are at a therapeutic level?

A

20 mins. before surgical incision is made

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18
Q

Antibiotics given 3 or more hours before the procedure?

A

select for resistant bacteria

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19
Q

Prophylactic antibiotics given more than 3 to 5 hours after the surgical incision has been made will?

A

likely not be effective in preventing infection

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20
Q

No advantage is associated with continuing antibiotics after surgery unless?

A

it is necessary to treat an active infection, or a break in sterile technique occurred during surgery.

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21
Q

Anesthesia and surgery can result in several potential problems?

A
  • blood loss
  • hypothermia
  • pain
  • cardiac and respiratory problems
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22
Q

What is normothermic?

A

normal body temperature

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23
Q

The postoperative phase is a critical transition period from?

A

general anesthesia to consciousness

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24
Q

After surgery, continual monitoring should be provided until the animal is?

A

safely extubated, normothermic, and in sternal recumbency

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25
Q

As long as the animal is hospitalized, what should be monitored?

A

vial signs, behavior, appetite, and the surgical incision should be evaluated

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26
Q

A ____ abnormal vital sign does not necessarily identify a significant ___.

A

single

problem

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27
Q

All indicators ___, ___ respiration, mucous membranes should be evaluated serially to detect a trend in an animals condition.

A

TPR, pulse

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28
Q

It is a trend that will determine the ____ of the postoperative problem and will dictate appropriate ____.

A

severity

treatment

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29
Q

___ and ___ should always be assess before surgery to obtain a baseline value and postoperative if substantial blood was lost during surgery (a few hours after).

A

PCV and TP
Packed cell volume
Total plasma protein

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30
Q

It is not unusual for PCV and TP to drop up to ___ % as a result of anesthesia and surgery, even when no major blood was lost.

A

10

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31
Q

What are the vital signs that should be checked/examined periodically during and after surgery?

A

temperature, heart rate, pulse quality, respiration, and character of mucous membranes

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32
Q

Animals with substantial blood loss could experience?

A

continued hypothermia or a drop in body temperature, rapid heart rate, and pale or white mucous membranes

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33
Q

What are some treatment strategies for a hemorrhage?

A
  • crystalloid fluid bolus
  • colloidal fluid administration
  • blood transfusion
  • oxygen carrier fluid administration
  • pressure bandages
  • reoperation
34
Q

When dealing with treating a hemorrhage, treatment choice depends on the ____ ____and ability to maintain a ____condition.

A

animal’s status

stable

35
Q

What is hypothermia?

A

a subnormal body temperature

36
Q

Does an animal’s body temperature increases, drops or stay the same when they are anesthesized?

A

drops

37
Q

When should you monitor body temperature?

A

throughout general anesthesia and during recovery

38
Q

What are some mechanisms to maintain body temperature during surgery

A
  • placing animal on a heated circulating water blanket
  • wrapping paws and the body in plastic wrap
  • wrapping warm water bottles (or gloves fill with warm water) with a towel - place next to animal
  • cover areas not involved in the surgical procedure with an insulated blanket
  • using actively warmed cages and surgery tables
  • use a warm-air blanket
39
Q

What devices are not good to use to warm an animal?

A

Heat lamps - can cause thermal burns - an anesthetized animal cannot respond to painful - concentrated heat
Electric heating pads - concentrated heat can cause thermal burns

40
Q

A warm-water bath for only small dogs and cats is made by?

A
  • filling a large, deep pan- big enough to place the entire animal in - 3/4 full with warm water, place a thick garbage bag over the pan and water, then place a towel over the garbage bag where the animal is to be placed.
41
Q

When should heating sources be discontinued?

A

when the animal’s body’s temperature approaches 100 degrees F
- animal should be kept covered and temperature monitored to make sure it returns to normal

42
Q

What indicates that an animal is in pain during surgery?

A
  • increases in HR, RR, BP and lightening of the anesthetic plane
43
Q

Is an increase HR alone during surgery mean the animal is in pain?

A

No. Trends and a combination of factors should be used to determine what problem is actually present.

44
Q

Increased HR during surgery can also occur with?

A

hypotension (low blood pressure)

45
Q

A drop in blood pressure may indicate a need to turn the patient’s anesthesia ____?

A

down

46
Q

An increased HR with other parameters of pain or awakening may indicate the need to ____ anesthesia.

A

increase

47
Q

During recovery, animals may do what to show they are in pain?

A
  • vocalize
  • have elevated Heart and RR
  • thrash, bit or chew at the surgery site
  • become aggressive
  • disinterest in environment
  • crying upon manipulation of the painful area
  • insomnia
  • lack of appetite
48
Q

Changes in vital signs can mean numerous things, and the animal should be carefully ____ by the technician and the surgeon before ____ administration.

A

evaluated

drug

49
Q

It is best not to let the animal experience ___ before pain medication is given.

A

pain

50
Q

As a side effect from anesthesia an animal may ____ or ____.

A

vocalize or pant

51
Q

To help the veterinary team, the use of a ___ scale that assesses a combination for parameters such as ___ signs, ____, mobility, and sensitivity to touching incision or painful site.

A

pain
vital
behavior

52
Q

Pain treatment is accomplished in several ways to determine what regimen is use, what are they?

A
  • the animal
  • the availability of pain medications
  • the type of procedure that was performed
53
Q

Most soft tissue surgical pain will last how many days?

A

4 to 5 days after surgery

54
Q

Bone and joint procedures pain will last how many days?

A

8 to 10 days after surgery

55
Q

Pain medication should be administered when?

A

before surgery in premedicants, and they should be continued throughout the surgical procedure and into the postoperative period according to dosing regimen for the particular drug used.

56
Q

An appropriately managed surgical patient will likely sleep for ___ hours after surgery and what else?

A

several

  • should be comfortable when manipulated
  • should be alert and interested in its environment when aroused
  • will often be willing to eat or drink depending on the problem being treated
57
Q

The animal should not be allowed to experience ___ before medication is given. Pain medication should be administered at dosing ____ appropriate for the medication- not as needed.

A

pain

intervals

58
Q

The surgical incision is usually left uncovered after surgery, but can be covered with an ____ or a ____ bandage for the first few ____ after surgery.

A

adhesive
wrap
days

59
Q

Why would a wound be covered?

A

to keep incision clean, prevent contact with the hospital environment and to absorb seepage

60
Q

T or F

Ointments and creams (even antibiotic topicals should be placed on the incision.

A

F

should not because this can cause irritation, and components of the ointment can delay wound healing

61
Q

What are some abnormalities that can occur in the early postoperative period (1 to 3 days)?

A
  • redness
  • swelling
  • drainage
  • dehiscence (wound breakdown)
62
Q

T or F

Some surgeries produce some redness and swelling with no drainage.

A

T - such as OHE and castration

63
Q

T or F
If a wound that was contaminated or surgical exposure was extensive, the incision is expected to be somewhat swollen, reddened, and hot to the touch and mild to moderate drainage in the first 24 to 48 hours postoperative.

A

F - warm to touch

64
Q

Swelling secondary to surgical trauma will usually resolve within ___ to ___ days after surgery.

A

3 to 7

65
Q

____ (serum accumulation under the incision) and ____ (blood accumulation under the incision) may persist for ____.

A

seromas
hematomas
weeks

66
Q

T or F

Most animals will not lick or chew at the surgical incision.

A

T

67
Q

T or F

Animals usually lick or chew at the incision only if the character of the incision is irritating.

A

T

68
Q

What are some contributors to incision irriation?

A
  • sutures placed too tight
  • traumatic tissue handling
  • suture reaction
  • tension on the suture line
  • clipper burn
  • prepping irritation (clipper burn and solution reaction)
  • incision infection
  • seroma formation
69
Q

What can an animal wear to stop the animal from traumatizing the incision and protect the wound?

A
  • Elizabethan collar
  • bandage
  • neck brace
  • T-shirt
  • chemical restraint
70
Q

Seromas can form if?

A
  • extensive surgical dissection occurred beneath the incision
  • tissue planes could not be or were not adequately closed
  • excessive motion occurs at the incision site
71
Q

T or F

Seromas usually resolve without treatment in a few weeks.

A

T

72
Q

What can aid in resolution of seromas?

A
  • warm compresses,
  • hydrotherapy
  • bandaging
73
Q

Seromas are usually not drained because?

A

there is an increased chance of infection and self-resolution

74
Q

When is drainage of a seroma warranted?

A

when its very large and/or is causing impairment

75
Q

Drainage should be performed ___, and an ____, ____ drain should be placed.

A

aseptically

active, closed

76
Q

What is cellulitis?

A

infection along tissue planes

77
Q

What are signs of cellulitis?

A

if swelling occurs 4 to 6 days postoperatively, is warm to the touch, is associated with an elevated body temperature, or is reddened and/or draining

78
Q

Abscess/infection must be treated by?

A

drainage, warm compresses, and systemic antibiotics

79
Q

What is wound dehiscence?

A

the separation of the layers of an incision or wound

80
Q

Dehiscense is most often due to?

A

technical error in suture technique, but incision complications can play a role

81
Q

What contributes to wound dehiscence?

A

use of inappropriate suture to close a wound, inappropriate suturing technique, tension on the incision line, incision infection, seroma formation, and disease and/or drug therapy leading to delayed wound healing

Intermediate Nursing - class notes (16 decks)

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