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Applied Clinical Veterinary Nursing > Equine > Flashcards

Equine Flashcards

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1
Q

what are the 2 broad categories of equine orthopaedic surgery?

A

elective or emergency

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2
Q

what are the most common elective orthopaedic surgeries?

A

arthroscopy/tenoscopy

angular limb deformities

soft tissue surgery

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3
Q

why might elective arthroscopy/tenoscopy be carried out?

A

OCD lesions
tendon sheath disease

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4
Q

what are the elective soft tissue orthopaedic surgeries?

A

neurectomy/fasciotomy

desmotomy e.g. palmar annular ligament

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5
Q

why might an emergency arthroscopy/tenoscopy be performed?

A

synovial sepsis
intra-articular fracture repair

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6
Q

what emergency orthopaedic surgeries may be performed?

A

arthroscopy/tenoscopy

fracture repair

+/- sequestrum removal

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7
Q

what technique is used to treat osteochondritis dissecans?

A

elective arthroscopy

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8
Q

what is OCD?

A

osteochondritis dissecans

developments defects in cartilage and bone - results in chip fragments in the joint

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9
Q

what is the aim of arthroscopy for OCD?

A

stop further degeneration to the joint

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10
Q

what is synovial sepsis?

A

bacterial infection leading to septic arthritis

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11
Q

what is the treatment for synovial sepsis?

A

arthroscopy for extensive flushing of the joint

systemic abs

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12
Q

what is a sequestrum?

A

a ‘foreign body’ of necrotic bone which detaches due to trauma resulting in damage to the periosteum

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13
Q

why does a sequestrum require removal?

A

it is seen as a ‘foreign body’ - often infected

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14
Q

what signs might indicate presence of a sequestrum?

A

non-healing wounds and draining tracts

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15
Q

how is sequestrum treated?

A

removal of sequestrum and any active involucrum (bed of bone surrounding the region)

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16
Q

which horses are typically affected by angular limb deformities?

A

foals

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17
Q

which direction can angular limb deformities occur?

A

laterally or medially

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18
Q

why might angular limb deformities develop?

A

different factors - nutrition, incomplete ossification, tendon/ligament laxity

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19
Q

what surgical techniques are performed for angular limb deformities?

A

growth arresting techniques e.g. transphyseal screw, plating

growth accelerating techniques e.g. periosteal transection

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20
Q

what are the difficulties with post-op management of angular limb deformities?

A

issues surrounding age - not used to be stabled, handling etc.

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21
Q

what are the difficulties with performing fracture repairs in horses?

A

size - stress on repair

athletes - repair requires great strength

recovery from GA - flight animals

Lack of tissue on distal limb - potential contamination

cost - up to £6000

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22
Q

how do elective orthopaedic equine patients typically present?

A

should be otherwise healthy

likely going to be weight bearing on all 4 limbs

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23
Q

what might happen to the elective orthopaedic patient on presentation for surgery?

A

check vaccination status

may require additional imaging prior - radiographs, U/S

patient prep - pre-op exam, IV catheter, clip site while conscious if tolerant

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24
Q

how should we manage arrival of the emergency orthopaedic patient?

A

clinical exam - esp CVS stability, treat injury like fracture

sedation?

IV catheter placement

wound care

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25
Q

what sedation agents might be used to emergency patients on presentation?

A

a2 agonist (e.g. detomidine/ranitidine) and butorphanol

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26
Q

what equipment should prepared for wound care on an emergency patient?

A

clippers
clorhexidine, swabs
warm water
sterile isotonic fluids
needles/syringes

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27
Q

what medication might be required for an emergency orthopaedic patient?

A

antimicrobials
tetanus antitoxin
analgesia

check whether any of these have been given prior to referral

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28
Q

what imaging might be required prior to emergency orthopaedic surgery?

A

radiographs

u/s (musculoskeletal probe - linear)

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29
Q

what are the goals of fracture stabilisation?

A

stabilise the fracture

reduce discomfort and distress

minimise further trauma to bone ends, soft tissues and vasculature

prevent further contamination

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30
Q

why should care be taken when padding a splint bandage?

A

padding should be layered but too much padding allows movement of bone fragments or slippage of the splint

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31
Q

can stabilisation damage the limb further?

A

good stabilisation should not inflict additional damage to the limb

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32
Q

which part of the limb may be splinted?

A

distal parts - not proximally

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33
Q

why are the distal limbs splinted?

A

to prevent knuckling

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34
Q

what is a Kimsey splint?

A

purpose-built distal limb splint

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35
Q

what might a Kimsey splint be used for?

A

pastern and metacarpal fractures in racehorses

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36
Q

how is a robert jones bandage applied?

A

many layers of cotton, each held in place and tightened by elastic gauze

each layer is applied more tightly than the previous one

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37
Q

what should a robert jones bandage sound like when flicked?

A

a watermelon

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38
Q

what is the nurse’s role during ortho surgery?

A

scrub nurse - run table/anticipate next step during procedure

circulating

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39
Q

what are the general requirements for preparation of theatre for an ortho case?

A

clippers

antibacterial preparations

fluids

medications

urinary catheter

shoe removal?

anaesthetic machine, circuit etc.

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40
Q

what is the process of patient prep for ortho surgeries?

A

remove shoes?

cover feet and tail

clip hair - preferable outside operating theatre

two scrubs - first to clean and second to disinfect

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41
Q

how wide should the surgical clip be for ortho procedures?

A

10-15cm away from surgical site

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42
Q

what is the advantage of chlorhexidine usage?

A

good residual activity - binds to protein in skin

low toxicity

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43
Q

why shouldn’t chlorhexidine be used on mucous membranes?

A

can be toxic for fibroblasts

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44
Q

why are iodine compounds rarely used for ortho surgery prep?

A

stains, radiopaque, smells

only free iodine is bactericidal

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45
Q

how should povidone iodine be prepared for skin prep?

A

no free iodine unless diluted or combined with detergent

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46
Q

what is the advantage of using povidone iodine for surgical skin prep?

A

low toxicity

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47
Q

what is the disadvantage of using povidone iodine for surgical skin prep?

A

it is inactivated in the presence of organic debris

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48
Q

what can be used to improve the efficacy of povidone iodine?

A

synergistic effect with alcohol

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49
Q

why shouldn’t alcohol be used alone for surgical skin prep?

A

only effective against bacteria

inactivated by organic debris

no residual activity

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50
Q

what are the specific theatre considerations for ortho surgery?

A

patient position

instruments required

imaging equipment - radiography PPE, arthroscopy tower

post-op bandagin/casting materials

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51
Q

why do horses require lots of cushioning/padding during surgery?

A

prone to myopathies and neuropathies

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52
Q

what are the surgeon considerations in terms of patient positioning for ortho surgery?

A

comfort

accessibility of the surgical site

number of surgical sites - some conditions occur bilaterally

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53
Q

how can we aid the comfort of the surgeon/patient during ortho surgery?

A

support stands, ropes, padding, cushions, fluid bags

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54
Q

what are the recovery options for the patient post-surgery?

A

unassisted

rope recovery

sling recovery

pool recovery

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55
Q

what are risks with pool recovery?

A

infection risk

pulmonary oedema

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56
Q

what are the general considerations for post-op care after ortho surgery?

A

analgesia and antimicrobials

monitor parameters - TRP WNL

reasonable faecal output/consistency

reasonable appetite

IV catheter required/removed?

bandage care

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57
Q

why should we monitor pain levels closely post ortho op?

A

consider whether the pain is appropriate for the surgery performed - indicative of possible complications

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58
Q

why is it important to monitor faecal output after ortho surgery?

A

impactions common - especially if gone from pasture to stable/box rest

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59
Q

why should care be taken if leaving an IV catheter in post-op?

A

care if hay nets/bars - good table management important

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60
Q

what is involved in post-op care for synovial sepsis?

A

antimicrobials

repeated synoviocentesis

wound management

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61
Q

what types of antimicrobials might be given for synovial sepsis?

A

systemic

intrasynovial

intravenous regional perfusion (IVRP)

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62
Q

how is intravenous regional perfusion antimicrobial therapy performed?

A

tourniquet is placed proximally and high dose abs are injected distally

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63
Q

why might repeated synoviocentesis be performed after synovial sepsis?

A

monitoring WBC, TP, serum amyloid A

checking whether a second lavage is required

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64
Q

what are some post-op complications of orthopaedic surgery?

A

post-op infections

incision breakdown

unacceptable post-op pain

bandage sores

supporting limb laminitis

large intestinal impaction

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65
Q

how the risk of supporting limb laminitis be reduced after ortho surgery?

A

frog support, deep bedding, rubber matting in stable

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66
Q

what makes bandage complications more likely to occur?

A

horse sweating/hot

horse moving around a lot

poor application

incorrect tension

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67
Q

why is it important to monitor regularly for bandage complications?

A

severe lesions can develop in quite a short period of time

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68
Q

how can we monitor for cast complications?

A

twice daily

sudden or gradual changes in comfort

fever

discharge or staining

wear on sole

cast breakage

heat

flies sitting in one spot in summer

bad smell

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69
Q

what are the possible complications of fracture fixation?

A

post-op infection

breakage of implants/implant failure

further fracture of limb

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70
Q

why should post-op infection be avoided after ortho surgery?

A

causes unstable fixation

results in pain and reduced healing

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71
Q

what equipment is required for fracture fixation?

A

general kit and drapes
drill
plates and screws
bone reduction forceps
fracture kit (4.5 and 5.5)
plate bender

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72
Q

what additional instruments might be required for ortho/fracture fixation?

A

mathieu retractor

hohmann retractor

gelpi retractor

Weitlaner retractor

bruns curette

ferris smith rongeurs

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73
Q

what equipment is required for arthroscopy?

A

camera and screen
synovial resector
fluid line and pump
trocars and cannula
scope and light cable

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74
Q

how long does stage 1 of foaling last?

A

30-60mins

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75
Q

what happens during stage 1 of foaling?

A

cervix relaxation and uterine contractions

ends with water breaking (rupture of chorioallantois)

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76
Q

how long does stage 2 of foaling last?

A

5-30 mins

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77
Q

what happens during stage 2 of foaling?

A

delivery of foal

if this is delayed, needs assistance

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78
Q

how long does stage 3 of foaling last?

A

2-3hours

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79
Q

what occurs during stage 3 of foaling?

A

placenta expelled

if this is delayed, needs assistance

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80
Q

how long should it take a foal to stand after birth?

A

within 1 hour

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81
Q

how long should it take a foal to suckle after birth?

A

within 2 hours - may take some time to find udder

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82
Q

how long should it take for a foal to pass meconium after birth?

A

should pass within 3 hours

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83
Q

how long should it take for a foal to pass urine after birth?

A

8-12 hours - colts tend to be on faster side

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84
Q

how do foals sleep?

A

lying down, legs extended

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85
Q

what is indicated by a foal sleeping curled up?

A

indication that something might not be right

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86
Q

what should the resting heart rate of a foal be post-partum?

A

50-80bpm

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87
Q

what may be heard on auscultation of a foal immediately post-partum?

A

audible crackles - this is normal

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88
Q

what other respiratory signs might a foal have immediately post-partum?

A

mild nasal discharge - not concerning as long as starting to become more normal by 2-3 hours post-birth

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89
Q

what is the normal heart rate of a foal up to 7 days old?

A

HR 80-100bpm

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90
Q

what is the normal resp rate of a foal up to 7 days old?

A

30-40brpm

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91
Q

what is the normal temperature of a foal up to 7 days old?

A

37.5-39.5 C

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92
Q

what is the normal mm colour of a foal up to 7 days old?

A

pink and moist

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93
Q

what is the normal blood pressure of a foal up to 7 days old?

A

> 70mmHg MAP

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94
Q

how much colostrum do foals require?

A

about 1L in the first 12 hours

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95
Q

how much milk do foals require per day?

A

will drink 20-30% bodyweight in milk/day

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96
Q

how many calories do foals require?

A

100-160 kcal/kg/day

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97
Q

why is colostrum important for foals?

A

contains antibodies from the mare’s blood, which are absorbed by the foals gut in the first 12-24 hours of life (passive transfer)

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98
Q

what can go wrong with the foal during development/birth?

A

trauma during birth - rib fractures

congenital abnormalities

acquired abnormalities e.g. patient urachus

failure of passive transfer

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99
Q

what congenital abnormalities might develop in foals?

A

cleft palate

microphthalmia

limb deformities

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100
Q

what is the main sign of a cleft palate?

A

milk at nostrils when suckling

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101
Q

why does failure of passive transfer occur?

A

foal unable to drink enough
or
due to quality/quantity of mare colostrum

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102
Q

why does sepsis usually occur in foals?

A

failure of passive transfer
or
local infection which has spread systemically

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103
Q

what is sepsis?

A

inflammatory response to systemic bacterial infection

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104
Q

what are the clinical signs of sepsis?

A

pyrexia
petechiae
injected mms
dull/flat/unresponsive
recumbency

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105
Q

what other clinical signs may occur in foals due to sepsis?

A

uveitis
synovial sepsis (lameness/swollen joints)
diarrhoea
pneumonia
umbilical infection

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106
Q

what is one of the major parameters indicating sepsis in foals?

A

hypotension

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107
Q

how does neonatal isoerythrolysis occur?

A

mare produces antibodies against the foals RBCS - foal absorbs the colostrum and the foals RBCs are broken down by these antibodies

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108
Q

why does neonatal isoerythrolysis occur?

A

mare has antibodies because she has come into contact with the blood cells before - commonly happens due to previous foal with same sire

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109
Q

what are the signs of neonatal isoerythrolysis?

A

anaemia, icterus, weakness

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110
Q

how is neonatal isoerythrolysis treated?

A

cannot be treated directly - may require blood transfusion and supportive care until can generate own blood cells

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111
Q

what are the other names for neonatal maladujstment syndrome?

A

hypoxaemic ischaemic encephalopathy

perinatal asphyxia syndrome

dummy foal

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112
Q

what is the clinical presentation of neonatal maladujstment syndrome?

A

very variable -
poor suck relfex

failure to nurse - hyperaesthesia - obtundation/coma

neurological signs

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113
Q

when might signs of neonatal maladujstment syndrome appear?

A

may be abnormal from birth or may ‘crash’ at 24-48 hours

114
Q

what technique may help with neonatal maladujstment syndrome?

A

‘foal squeeze’ - pressure on thoracic cavity - helps in around 20% of cases but unsure why

115
Q

what is the cause of neonatal maladujstment syndrome?

A

cause unknown

116
Q

when is a foal considered premature?

A

<320 days gestation

117
Q

when is a foal considered dysmature?

A

normal gestation duration but appear premature

118
Q

what is the appearance of a dysmature foal?

A

silky coat, floppy ears, domed head

119
Q

what other physical signs do dysmature foals have?

A

other organs may be immature as well as the musculoskeletal system

incomplete ossification of cuboidal bones

120
Q

how can dysmaturity be diagnosed?

A

x-ray carpal/tarsal joints - last to mature in utero, joints will be abnormal for rest of life if born underdeveloped

121
Q

why might a foal have a ruptured bladder?

A

trauma within birthing canal

physical manipulation by humans around the abdomen

122
Q

when do clinical signs of a ruptured bladder begin to present?

A

at a few days old

123
Q

what are the clinical signs of a ruptured bladder?

A

colic
abdominal distension

124
Q

why is a ruptured bladder life-threatening?

A

due to electrolyte abnormalities, especially hyperkalaemia

increased potassium, low sodium, low chloride

125
Q

how can we avoid inducing bladder rupture in foals?

A

never lift/move a foal from their abdomen - use stifles/forelimbs

126
Q

what are the clinical signs of meconium impaction?

A

straining to defecate
mild colic

127
Q

how can we reduce risk of meconium impaction?

A

phosphate enemas

128
Q

is meconium impaction an emergency?

A

not usually an emergency, but may get referred for IVFT/management

129
Q

what are the roles of the NICU nurse?

A

patient care - responsible for all foals needs, don’t forget mare!

staying organised

keep foal unit clean and stocked

communication

130
Q

what are the general nursing care considerations for NICU foals?

A

maintain sternal recumbency - prone to atelectasis

assist to stand every 2 hours

weigh foal daily (unless recumbent)

careful examination - attention to detail important

131
Q

why should the NICU foal be turned every 2 hours?

A

important to prevent decubitus ulcers developing

132
Q

what should be involved in a NICU examination?

A

demeanour compared to last check

all systems - nose to tail approach

treatments - infusions, oxygen

nutrition

urine/faecal output

133
Q

how often should we examine a sick foal?

A

minimum every 4 hours, more often is very unwell/declining

134
Q

why/where should we check the mucous membranes in NICU foals?

A

good indicator of systemic health

check multiple locations - buccal muscosa, conjunctiva, ear pinnae, coronary bands

135
Q

what are the normal cardiac parameters for NICU foals?

A

normal HR = 80-100bpm
strong pulses
warm extremities

136
Q

why are sick foals reliant on a stable heart rate?

A

they cannot increase their stroke volume

(HR = CO x SV)

137
Q

why do sick foals have poor heart rate compensation?

A

due to immature sympathetic nervous system

138
Q

why do sick foals develop murmurs?

A

due to adaptation of foetal circulation to life ex-utero - should go by 4 days old

139
Q

what if a murmur does not disappear in a foal by 4 days old?

A

suspect congenital defect or endocarditis due to septic process

140
Q

how do we monitor function of the respiratory system in sick foals?

A

rate (30-40brpm) and rhythm, effort

louder bronchial sounds than adult
no wheezes/dullness/crackles after first few hours of life

nasal discharge?
rib fractures?

141
Q

what else can we monitor in sick foals which goods a good indication of respiration?

A

blood gas analysis - oxygenation

142
Q

why should we monitor the eyes in sick foals?

A

good indicator of systemic state

143
Q

how do the eyes show dehydration?

A

sunken, entropion

144
Q

how do the eyes show sepsis?

A

injected

hypopyon (fibrin and pus accumulation within anterior chamber of eye)

uveitis

145
Q

how do the eyes show trauma?

A

injected
swollen eyelids

146
Q

why are sick foals prone to developing corneal ulcers?

A

foals have reduced corneal sensitivity - ulcer formation may be less obvious

147
Q

what flexural deformities might develop in sick foals?

A

flexor/tendon laxity

contracture

148
Q

why might sick foals show signs of colic?

A

meconium impaction

ileus - will not tolerate enteral nutrition

149
Q

why might foals develop diarrhoea?

A

often secondary to sepsis if very young

can acquire infection diarrhoea

150
Q

what can be used to care for the umbilicus in young foals?

A

0.5% hibitane

151
Q

how often should umbilicus care be carried out?

A

twice daily hibitane dip if otherwise WNL

QID if patent urachus

152
Q

how can we provide support for the mare after birth?

A

TPR twice daily

check mares perineum

ensure adequate milk

encourage mare-foal bond

check placenta has been passed

153
Q

why are over-the-wire IV catheters preferred in horses?

A

less thrombogenic - polyurethane

154
Q

what is the disadvantage of over-the-wire IV catheters?

A

technically more difficult to place, requires 3 people

155
Q

what should be considered for catheter maintenance in horses?

A

check patency and vein integrity every 4 hours

care when administering drugs - sedimentation

extra vigilance when on parenteral nutrition

156
Q

how can we avoid drug sedimentation in IV catheters?

A

flush drug through adequately after administration of the next

157
Q

can venous samples be taken from an over-the-wire catheter?

A

yes

158
Q

which test can test for failure of passive transfer?

A

IgG SNAP test

159
Q

what are the appropriate IgG levels in a foal?

A

> 8.0g/L

160
Q

what can be done if the foal is <24hrs old with low IgG levels?

A

can supplement with colostrum via NG tube

161
Q

what can be done if the foal is >24hrs old with low IgG levels?

A

indicates failure of passive transfer - requires plasma transfusion

162
Q

where should an arterial blood gas sample be taken from?

A

lateral metatarsal artery

163
Q

what are the normal PaO2 values in a horse?

A

80-110 mmHg

164
Q

what are the normal PaCO2 values in a horse?

A

40-48mmHg

165
Q

how can recumbency affect blood gas?

A

lateral recumbency can reduce PaO2 by up to 30mmHg

166
Q

why might we obtain a venous blood gas sample?

A

to assess electrolytes

167
Q

why should we monitor glucose in sick foals?

A

hypoglycaemia common

likely have poor glycogen/fat reserves

168
Q

how can we combat hypoglycaemia in foals?

A

fluids supplemented with dextrose - monitor closely to ensure not too much

169
Q

why do we monitor lactate in foals?

A

good measurement of tissue perfusion

170
Q

what are normal lactate levels in foals?

A

<3-4mmol/L in neonates

<2mmol/L by 3 days old

171
Q

why might a foal have increased lactate levels?

A

insufficient oxygen supply to tissues - could be hypovolaemia, hypoxaemia, sepsis

172
Q

what does an increased lactate level mean for a sick foal?

A

worse prognosis

173
Q

what fluids should be used for fluid resuscitation in foals?

A

Hartmanns solution (warm)

174
Q

what solution can be used for ongoing fluid therapy in a sick foal?

A

Hartmanns + 5% dextrose

175
Q

what rate should be used for ongoing fluid therapy for foals?

A

3-5ml/kg/hr

176
Q

what else do we need to consider with fluid therapy in foals?

A

foals cannot tolerate high sodium concentrations in fluids - risk of subcut oedema

need to supplement potassium if not nursing

177
Q

where is a good place to take a NIBP measurement on a foal?

A

tail cuff

178
Q

how should you take an NIBP measurement on a foal?

A

tail cuff - ensure correct way round, try not to stimulate foal during placement

take an average of 3 readings

179
Q

what value is considered hypotension in the foal?

A

MAP <70mmHg

180
Q

how does sepsis cause hypotension?

A

suppresses myocardial contractility (reduced stroke volume)

inappropriate widespread vasodilation

181
Q

can hypotension caused by sepsis be treated with fluid therapy?

A

no - reduced cardiac contractility means the heart will not efficiently pump it round the body

182
Q

what medications can be used to treat hypotension caused by sepsis?

A

inotropes - increase force of cardiac contractions

vasopressors - constrict blood vessels

183
Q

what should the urine output of a foal be?

A

> 50-70% of fluid input OR >2ml/kg/hr

184
Q

how concentrated should foal urine be?

A

initially hypersthenuric, then quickly becomes hyposthenuric

USG <1.008

185
Q

how is intranasal oxygen given to the foal?

A

tubing inserted into nostril up to level of medial canthus of eye

taped to tongue depressor and run along the face

tubing runs through hole in neck wrap before connecting to oxygen

186
Q

how is intranasal oxygen made less cold/drying?

A

run through a humidifier filled with sterile water

187
Q

what flow rate should intranasal oxygen be started at?

A

5L/min then adjust accordingly

188
Q

what is involved in management of intranasal oxygen administration?

A

clean tubes daily and change at EOD

189
Q

what are the possible complications of intranasal oxygen administration?

A

nasal irritation
rhinitis
airway drying

190
Q

what is the advantage of nebulisation?

A

aids secretion removal

191
Q

how can nebulisation be made more effective?

A

manual coupage of the chest

192
Q

what can be administered via nebulisation?

A

sterile saline

bronchodilators

abs

193
Q

are foals commonly ventilated?

A

no, if requiring ventilation, foal is likely very sick and very unlikely to make it past that point

194
Q

what can result from prolonged seizure activity?

A

increased cerebral oxygen demand and neurone damage

195
Q

what is first line treatment/management of seizures?

A

5mg diazepam IV - can be repeated

196
Q

what can be done if seizure activity continues despite diazepam?

A

midazolam CRI

phenobarbital

levetiracetam

197
Q

how much nutrition do sick foals require?

A

approx 10ml/kg every 2 hours

198
Q

how can nutrition be delivered to a sick foal?

A

do not bottle feed - aspiration risk

NG tube - if healthy enough to receive enteral nutrition

TPN - short-term prevention of negative energy balance

199
Q

how often can a phosphate enema be giveN/

A

max twice in 24 hours

200
Q

what different types of enema are available for foals?

A

phosphate enema (fleet)

soapy water (200ml)

acetylcysteine retention enema

201
Q

how does an acetylcysteine retention enema work?

A

dissolves the meconium

usually requires sedation

202
Q

what are the most common emergency surgeries (non-ortho)?

A

colic
dystocia
trauma

203
Q

what is colic?

A

a broad term for abdominal discomfort in horses

204
Q

what body systems are involved in colic?

A

GI tract
urinary tract
reproductiv organs
liver

205
Q

how can we identify the body systems causing symptoms of colic?

A

performing a colic work-up

206
Q

what history should be obtained from the owner when performing a colic work-up?

A

how long was it been colicking for?

severity of signs shown so far

when were faeces last passed

breed/age/sex

previous occurrences of colic

any management changes e.g. stabling/turnout, worming, geographical region

207
Q

what information should be obtained from the referring vet during a colic work-up?

A

TPR on initial examination/subsequent exams

clinical findings so far (inc rectal/NGT findings)

any medications administered

suspected lesion based on exam

whether or not surgery is an option for the owner/insurance info

208
Q

what equipment is needed for a colic assessment?

A

drugs
clippers and sterile prep solution
catheter
blood tubes
lactate reader
NG tube
rectal gloves and lubricant
fluids (isotonic and hypertonic)
u/s machine

209
Q

what drug should be prepared for a colic assessment?

A

sedation (xylazine/detomidine/butorphanol)

NSAIDS (flunixin)

buscopan/buscopan compositum

210
Q

where is a colic workup usually done?

A

usually in stocks for restraint

sometimes unsafe to do so will move to knockdown box

211
Q

what is involved in the physical examination during a colic work-up?

A

demeanour, signs of pain, abrasions

TPR

GI borborygmi

CVS status (mm, pulses)

abdominal distension

rectal exam - may req sedation + buscopan

212
Q

how is buscopan useful during a rectal examination?

A

relaxes the anal sphincter

213
Q

when might we pass a NG tube during a colic work-up?

A

for gastric decompression - if high HR or significant pain

214
Q

what is indicated by the presence of reflux on NG intubation?

A

small intestinal obstruction

215
Q

how much reflux provides an indication that surgery may be required?

A

> 2L

216
Q

what bloods are useful during a colic work-up?

A

minimum database for colic
PCV, TP, lactate

217
Q

what imaging is useful during a colic work-up?

A

abdo u/s - FAST scan

abdominocentesis (aseptic prep) - TNCC, TP, lactate

218
Q

what can we check for during abdo u/s for colic work-up?

A

colon displacement
free fluid/oedema

219
Q

what is the aim of the initial colic work-up?

A

determine whether the case is surgical or medical

220
Q

what findings of the clinical exam indicate colic surgery?

A

congested mms, CRT >3s, HR >60-80bpm, poor pulse quality

uncontrollable pain

221
Q

what findings of the rectal exam indicate colic surgery?

A

distension or displacement of the small or large intestine

222
Q

what findings of the abdo u/s indicate colic surgery?

A

amotile, distended loops of small intestine

223
Q

what biochemistry findings indicate colic surgery?

A

high lactate in blood or peritoneal fluid

224
Q

what are the considerations for moving a colic horse to surgery?

A

ensure IVC present and patent

ensure stomach has been decompressed

begin clipping abdomen (if safe)

remove shoes (if safe)

225
Q

how big should the clip for colic surgery be?

A

20cm either side of the midline, over the whole ventral abdomen

226
Q

how should the theatre itself be prepared for colic surgery?

A

theatre bed - ready to receive horse in dorsal

anaesthetic machine and circuit

hoist - ready and working by knockdown

227
Q

what equipment should be prepared for colic surgery?

A

hose, clippers and surgical scrub

urinary catheter

warmed fluids

surgical kit x2

fresh gloves + gowns in case of contamination/enterotomy/resection

drapes (lots)

colon table and dump drum

carboxymethylcellulose

228
Q

what is a colon table/dump drum?

A

extra table attached to main table, dump drum to collect intestinal contents

229
Q

what is involved in colic surgery?

A

ventral midline incision (>20cm long)

all GUT is assessed for distension, thickening, viability, displacement

any non-viable intestine must be resected and anastomosed

230
Q

what equipment is required for intestinal resection?

A

buster drapes
doyen clamps (atraumatic)
suture material
fluids for lavage

231
Q

what happens to large intestinal displacements?

A

no dot require resection/anastomosis

232
Q

why do the contents of the pelvic flexure need to be removed before fixing lesions?

A

due to the weight of the contents

233
Q

how are the content of the pelvic flexure removed?

A

via enterotomy - colon table should be tilted down so contents run into the dump drum/away from the surgical field

234
Q

what 3 layers of the abdomen must be closed after colic surgery?

A

linea alba
subcut tissue
skin

235
Q

what suture materials should be used to closed the abdomen after colic surgery?

A

linea alba - vicryl 0 or 2
subcut tissues - usually PDS
skin - usually PDS (occasionally staples)

236
Q

what dressing materials can be used for the wound after colic surgery?

A

melolin
lap bandage as stent
adhesive spray

237
Q

why should surgeons avoid placing staples after colic surgery?

A

some poor person will have to remove them from a horse

238
Q

what should happen in the immediate post-op/recovery phase after colic surgery?

A

remove urinary catheter

bandage feet if shoes still on (to avoid trauma)

towel dry as much as possible (will be saturated due to scrub/lavage during surgery

belly bandage once standing

239
Q

what should be involved in post-op care for all colic cases?

A

IVFT +/- lidocaine CRI

analgesia

antimicrobials

incision care

240
Q

what analgesia will likely be given post-op after colic surgery?

A

NSAIDs despite GI risk - opioids are generally avoided because horse are already such a high risk for ileus

241
Q

when should refeeding begin after large intestinal displacements?

A

can gradually refeed once awake and alert

242
Q

when should refeeding begin after small intestinal resections/anastomosis?

A

no food for 48 hours usually - must weigh up incision breakdown vs ileus

243
Q

what should refeeding start with after colic surgery?

A

small amounts of fibre nuts +/- handfuls of grass

244
Q

what are some of the possible post -op complications after colic surgery?

A

endotoxaemia

ileus

colitis

jugular thrombophlebitis

peritonitis

incisional infection

245
Q

what is endotoxaemia?

A

endotoxins leaked into blood from gut

246
Q

how can endotoxaemia be treated?

A

IVFT
flunixin +/- polymixin B +/- hyperimmune plasma

247
Q

what can develop as a result of endotoxaemia? how can we prevent it?

A

laminitis - ice boots pre-emptively, deep bed, frog supports

248
Q

how can we treat ileus as a result of colic surgery?

A

NG intubation regularly - decompression

IVFT

nil by mouth

pro-motility drugs - lidocaine, erythromycin, metoclopramide

monitor by u/s

249
Q

what are the main signs of colitis after colic surgery?

A

usually become pyrexic and develop marked diarrhoea

250
Q

how can colitis be treated?

A

IVFT

isolation? (will shed salmonella)

gastroprotectants e.g. misoprostol, sucralfate

251
Q

how can jugular thrombophlebitis be treated?

A

remove catheter

local anti-inflammatory treatment

consider anti-thrombolytics

252
Q

how can peritonitis be diagnosed?

A

abdominocentesis

253
Q

how can peritonitis be treated?

A

broad spectrum antimicrobials

254
Q

what type of incisional complications can occur after colic surgery?

A

infection

often develop marked oedema/cellulitis

255
Q

how can incisional infection be treated?

A

antimicrobials if horse is systemically unwell

swab for culture and sensitivity before encouraging drainage

256
Q

how often should a patient be monitored post-colic surgery?

A

complete clinical exam every 2-4 hours

257
Q

what should be involved in post-op monitoring after colic surgery?

A

demeanour

GIR borborygmi, faecal output/consistency, appetite

jugular vein (heat/swelling/pain/patency)

feet (comfort and digital pulses)

incision (oedema, discharge)

ensure geldings are not urinating on belly bandage

258
Q

what fluid rate should a horse be on after colic surgery?

A

maintenance - 50ml/kg/hour

assess dehydration and ongoing losses e.g. reflux

259
Q

what should long-term aftercare/management look like after colic surgery?

A

gradual refeeding and reduction of analgesia

box rest 4-6 weeks, walks to grass

paddock rest 1 month

turn out 1 month

then gradual return to previous work

260
Q

how does time affect foal mortality during birth?

A

rate increases by 16% for every 10 mins > 30 mins

261
Q

what is a red bag delivery?

A

premature separation of the placenta

262
Q

what usually appears first at the vulva during foaling?

A

amnion - silvery white appearance

263
Q

what appears at the vulva during a red bag delivery?

A

chorioallantois - deep red colour

264
Q

what should happen if a red bag delivery is noticed?

A

chorioallantois must be ruptured immediately and assisted delivery of the foal should be performed

265
Q

what is the main reason for dystocia during foaling?

A

usually foal malposition

occasionally due to foal abnormalities e.g. limb deformities

266
Q

what is the key history that should be obtained for dystocia during foaling?

A

signalment

time of onset of stage II

gestation days

assistance attempted?

pertinent medical treatments and history

267
Q

what should we prepare if there is a dystocia case arriving?

A

preparation of knockdown box - warm water, lube, foal ropes, hoist

preparation for induction - anaesthetist present

preparation of theatre - dorsal recumbency

prep for where foal will be resuscitated

268
Q

what are the options for dystocia if a vaginal delivery is not possible?

A

c-section if foal is alive

foetotomy if foal is dead

269
Q

what are the options for dystocia if a vaginal delivery might be possible?

A

assisted birth if possible

controlled if assisted not productive after 5-15 mins - clip and prep abdomen in case needs c-section

270
Q

what is involved in equine caesarean?

A

ventral midline incision

uterine horn located and exteriorised

hysterotomy incision (35-40cm) - allow for feet and hocks

umbilical cord clamped and transected

foal lifted out and transferred to separate team

271
Q

how many nurses should be involved in care of the mare during c-section?

A

2 people scrubbed in
one circulating
one anaesthetist

272
Q

how many nurses should be involved in care of the foal after c-section?

A

2 min people to resuscitate foal

will likely need oxygen supplementations, IVC placement, umbilicus management

273
Q

how should the mar be recovered after c-section?

A

assisted whenever possible - increased risk of limb fractures, likely exhausted due to delivery attempts prior to c-section

274
Q

what is the survival rate of controlled vaginal delivery?

A

87-94%

275
Q

what are the survival rates of the foal and mare with c-section?

A

mare - 87-89%

foal 10-30%

276
Q

what are the specific post-op care considerations after c-section?

A

similar to colic

check for normal passing of placenta

uterine lavage

regular examination of mammary glands/teats

277
Q

what if the placenta is retained?

A

oxytocin every hour

278
Q

how is uterine lavage performed?

A

SID/BID?

5-10 litres isotonic fluid

279
Q

why must the mammary glands/teats be examined regularly?

A

check for development of toxic mastitis

280
Q

what are some of the complications of dystocia?

A

reproductie tract trauma - perineal lacerations, uterine rupture

retained placenta

delayed uterine involution

metritis and peritonitis

uterine/bladder prolapse

arterial haemorrhage (uterine artery)

281
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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