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Advanced Clinical Nursing Theory > Equine Ortho > Flashcards

Equine Ortho Flashcards

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1
Q

what are the main categories of equine orthopedic surgery?

A

elective
emergency

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2
Q

what sorts of elective surgery may be performed on horses?

A

arthroscopy/tenoscopy
angular limb deformities
soft tissue surgery

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3
Q

what elective soft tissue surgery may be performed on horses?

A

neurectomy
fasciectomy
desmotomy

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4
Q

what emergency surgery may be performed on horses?

A

arthroscopy - synovial sepsis and fracture repair
fracture repair
sequestrum removal

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5
Q

what fractures may be repaired using arthroscopy?

A

intra-articular

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6
Q

what is a common reason for elective arthroscopy?

A

OCD management

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7
Q

what is the aim of arthroscopy for OCD management?

A

stop further degeneration of developmental defects within the cartilage and bone of the joint

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8
Q

what is synovial sepsis?

A

bacterial infection leading to septic arthritis

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9
Q

what is the best method of treating synovial sepsis?

A

arthroscopy to flush joint
antibiotics

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10
Q

what can trauma resulting in damage to the periosteum lead to?

A

death of the bone in the region and then formation of a sequestrum

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11
Q

what is a sequestrum?

A

bone that has become necrotic due to trauma separates (sequesters) and becomes a foreign body which is often infected

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12
Q

what may indicate a horse has a sequestrum?

A

non healing wound
draining tract

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13
Q

how are sequestrum treated?

A

removed along with any active involucrum to allow wound and bone to heal

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14
Q

what is the involucrum?

A

bed of bone surrounding region sequestrum formed

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15
Q

what are angular limb deformities?

A

laterally or medially bent legs

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16
Q

in what animals are angular limb deformities seen?

A

foals under 18 months

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17
Q

what may cause angular limb deformity?

A

nutrition
incomplete ossification
tendon / ligament laxity

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18
Q

how can angular limb deformities be treated?

A

growth arresting techniques
growth accelerating techniques

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19
Q

what growth arresting techniques are available for angular limb deformities?

A

transphyseal screw in side that is overgrowing
plating

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20
Q

what growth accelerating techniques are available for angular limb deformities?

A

periosteal transection

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21
Q

what is the importance of treating angular limb deformities?

A

protection of joints from OA in the future

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22
Q

what are the challenges associated with fracture repair in horses?

A

size of horse and stress on repair
need to return to athletic ability
recovery from GA is dangerous
lack of soft tissue on distal limb

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23
Q

what is the issue with the lack of soft tissue on the equine distal limb in terms of fracture repair?

A

often open
contamination likely

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24
Q

what is the preferred method for fracture repair?

A

standing under sedation / LA

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25
Q

what may be needed prior to elective orthopedic surgery?

A

x ray
ultrasound

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26
Q

what must be checked prior to elective patient admission?

A

vaccine status (flu and tetenus)

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27
Q

what is involved in ortho patient prep?

A

pre-op exam
IV catheter
clip as much of site if possible

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28
Q

what is involved in prep of the emergency ortho patient?

A

clinical exam
ensure haemodynamically stable
sedate if necessary
IVC
wound care

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29
Q

what may be used to sedate horses with suspected fractures?

A

alpha 2
butorphanol

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30
Q

what does wound care depend on?

A

presentation of wound

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31
Q

what equipment may be needed for wound care?

A

clippers
swabs
hibi
warm water
sterile saline
needles
syringes

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32
Q

what medications may need to be given to ortho patients pre-op?

A

antibiotics
tetanus vaccine / antitoxin
analgesia

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33
Q

will imaging be needed prior to emergency ortho surgery?

A

depends on case
referring vet may have done already

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34
Q

if fracture is suspected what may be done before surgery?

A

limb support to stabilise

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35
Q

what are the goals of fracture stabilisation?

A

stabilise
reduce discomfort and distress
minimise futher trauma to bone ends, soft tissues and vasculature
prevent further contamination

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36
Q

what is the issue with too much padding round a fracture?

A

allows movement of bone fragments or slippage of splint

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37
Q

what areas of the body may be splinted?

A

proximal areas no
distally yes
site depends on location on leg

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38
Q

what type of splint can be used on the distal limb?

A

kimsey splint

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39
Q

where are Kimsey splints often used?

A

racehorses - distal fractures

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40
Q

what is a robert jones bandage made up of?

A

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

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41
Q

what diameter should a finished robert jones bandage be?

A

3x diameter of the limb

42
Q

what is the role of the nurse during ortho surgery?

A

scrub nurse
circulating nurse - run theatre

43
Q

what are the general equipment requirements for theatre?

A

clippers
scrub
fluids for IVFT and lavage
medication
U cath
anaesthetic machine
imaging needed and PPE
positioning aids
post op bandage or casting materials

44
Q

when will a u cath be placed?

A

all surgeries
sheath sutured closed in male horses

45
Q

should horses shoes be removed before entry to theatre?

A

if possible yes - unlikely in an emergency

46
Q

why is horse shoe removal before surgery preferred?

A

protection of equipment
reduction of trauma in recovery

47
Q

what is involved in equine patient prep?

A

cover feet and tail
clip
clean skin
disinfect skin

48
Q

where should clipping be performed?

A

outside theatre

49
Q

what size of clip should be performed?

A

10-15 cm outside surgical site

50
Q

what is used for skin prep in horses?

A

chlorhexidine
povidone iodine (round face)

51
Q

what is the benefit of chlorhexidine for scrub?

A

residual activity as binds to protein in skin
low toxicity

52
Q

why is chlorhexidine not suitable for open wounds?

A

toxic to fibroblasts found beneath the skin surface

53
Q

what are the issues with povidine iodine for skin prep?

A

inactivated in presence of organic debris

54
Q

when is alcohol commonly used for skin prep?

A

rinse after surgical scrub

55
Q

what are the downsides to using alcohol for skin prep?

A

only effective against bacteria
inactivated by organic debris
no residual activity

56
Q

how may horses be positioned for surgery?

A

ropes or support stands for legs
cushioning and padding essential

57
Q

what imaging equipment is used in equine ortho?

A

fluro (PPE)
arthroscopy tower

58
Q

what are the main considerations for positioning of horses in theatre?

A

surgeon comfort
access to surgical sites
horse comfort
myopathy / neuropathy risk

59
Q

what positioning aids may be used in theatre?

A

stands
ropes
padding
cushions
fluid bags

60
Q

what are the main risks associated with patient positioning in theatre?

A

myopathy / neuropathy from maintained pressure of the horses bodyweight on one area for an extended period

61
Q

what is vital if imaging will be used during ortho surgery?

A

PPE available

62
Q

what is critical about bandages placed after surgery?

A

need to be strong enough to withstand a dramatic recovery

63
Q

is casting material often used in equine ortho surgery?

A

uncommon

64
Q

what are the main options for equine recovery from GA?

A

unassisted
rope recovery
sling
pool

65
Q

what is involved in rope and sling recovery?

A

rope attaches to headcollar and tail to direct
sling works in a simular way but bodyweight can be supported

66
Q

what are the risks associated with pool recovery?

A

infection
pulmonary oedema

67
Q

what must be monitored in orthopedic post op care?

A

analgesia
antibiotics
TPR
assessing faecal output and consistency
appetite
IV catheter patency and health
bandage strike through or slipping

68
Q

why must faecal output be monitored post op?

A

impactions are common due to drugs and reduced movement

69
Q

what is involved in post op care for synovial sepsis?

A

antibiotics
repeat synoviocentesis
wound managment

70
Q

what route of antibiotics may be used for synovial sepsis?

A

systemic
intrasynovial
intravenous regional perfusion

71
Q

what is intravenous regional perfusion?

A

toniquet placed above the joint or wound
high dose antibiotics injected into vein below

72
Q

what parameters will be assessed in synoviocentesis?

A

WBC
TP
serum amyloid A

73
Q

what can be decided based on repeat synoviocentesis?

A

if second wound lavage is needed

74
Q

what are the main complications seen with orthopedic surgery?

A

post-op infections
incision breakdown
unacceptable pain
bandage sores
cast sores
supporting limb laminitis

75
Q

how can supporting limb laminitis be prevented?

A

frog support in opposite limb
deep bedding
rubber mats
bandage good leg
effective analgesia

76
Q

how is supporting limb laminitis caused?

A

laminae and vascular compression on opposing limb as it is taking most of the body weight
leading to inflammation and separation

77
Q

how can laminitis be detected?

A

bounding digital pulse

78
Q

when are bandage complications more common?

A

if the horse is hot/sweating
horse is moving a lot
bandage poorly applied (rare)
incorrect tension

79
Q

what may be done to reduce risk of bandage complications?

A

cross tie

80
Q

how often should casts be checked?

A

BID

81
Q

what are you monitoring with regards to casts?

A

sudden or gradual changes in comfort
fever
discharge or staining
wear on sole
cast breakage
heat
flies sitting on one area
smell in first few days

82
Q

what are the complications with fracture fixation?

A

postoperative infection
breakage of implants or implant failure
further limb fracture

83
Q

what fracture fixation complications are seen in recovery?

A

breakage of implants or implant failure
further limb fracture

84
Q

what is the impact of post op fracture fixation infection?

A

causes unstable fixation
results in pain and slowed healing

85
Q

what equipment is required for fracture fixation?

A

drill
plates and screws
general kit and drapes
bone reduction forceps
plate bender
fracture kit

86
Q

identify this instrument

A

drill

87
Q

identify this ortho equipment

A

plate

88
Q

identify this instrument

A

bone reduction forceps

89
Q

identify this instrument

A

plate bender

90
Q

what size fracture kit is used in equine ortho?

A

4.5mm
5.5mm

91
Q

identify this instrument

A

Mathieu retractor

92
Q

identify this instrument

A

Weitlaner retractor

93
Q

identify this instrument

A

synovial resector

94
Q

identify these instruments

A

trocar (top two)
cannula

95
Q

what must you do before induction of an arthroscopy case?

A

ensure equipment is working

96
Q

identify this instrument

A

bruns curette

97
Q

what is the Bruns curette used for?

A

atraumatic removal of fragments within the joint

98
Q

identify these instruments

A

Ferris Smith Rongeurs - straight or curved

99
Q

why are iodine compounds not used for skin prep?

A

staining
radiopaque
smell
only free iodine is bacteriocidal

100
Q

is free iodine used in skin prep?

A

only if diluted or combined with detergent

101
Q
A

Advanced Clinical Nursing Theory (36 decks)

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