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Advanced Clinical Nursing Theory > Equine Ortho > Flashcards

Equine Ortho Flashcards

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
what may be needed prior to elective orthopedic surgery?
x ray ultrasound
26
what must be checked prior to elective patient admission?
vaccine status (flu and tetenus)
27
what is involved in ortho patient prep?
pre-op exam IV catheter clip as much of site if possible
28
what is involved in prep of the emergency ortho patient?
clinical exam ensure haemodynamically stable sedate if necessary IVC wound care
29
what may be used to sedate horses with suspected fractures?
alpha 2 butorphanol
30
what does wound care depend on?
presentation of wound
31
what equipment may be needed for wound care?
clippers swabs hibi warm water sterile saline needles syringes
32
what medications may need to be given to ortho patients pre-op?
antibiotics tetanus vaccine / antitoxin analgesia
33
will imaging be needed prior to emergency ortho surgery?
depends on case referring vet may have done already
34
if fracture is suspected what may be done before surgery?
limb support to stabilise
35
what are the goals of fracture stabilisation?
stabilise reduce discomfort and distress minimise futher trauma to bone ends, soft tissues and vasculature prevent further contamination
36
what is the issue with too much padding round a fracture?
allows movement of bone fragments or slippage of splint
37
what areas of the body may be splinted?
proximal areas no distally yes site depends on location on leg
38
what type of splint can be used on the distal limb?
kimsey splint
39
where are Kimsey splints often used?
racehorses - distal fractures
40
what is a robert jones bandage made up of?
many layers of cotton held in place and tightened by elastic gauze
41
what diameter should a finished robert jones bandage be?
3x diameter of the limb
42
what is the role of the nurse during ortho surgery?
scrub nurse circulating nurse - run theatre
43
what are the general equipment requirements for theatre?
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
when will a u cath be placed?
all surgeries sheath sutured closed in male horses
45
should horses shoes be removed before entry to theatre?
if possible yes - unlikely in an emergency
46
why is horse shoe removal before surgery preferred?
protection of equipment reduction of trauma in recovery
47
what is involved in equine patient prep?
cover feet and tail clip clean skin disinfect skin
48
where should clipping be performed?
outside theatre
49
what size of clip should be performed?
10-15 cm outside surgical site
50
what is used for skin prep in horses?
chlorhexidine povidone iodine (round face)
51
what is the benefit of chlorhexidine for scrub?
residual activity as binds to protein in skin low toxicity
52
why is chlorhexidine not suitable for open wounds?
toxic to fibroblasts found beneath the skin surface
53
what are the issues with povidine iodine for skin prep?
inactivated in presence of organic debris
54
when is alcohol commonly used for skin prep?
rinse after surgical scrub
55
what are the downsides to using alcohol for skin prep?
only effective against bacteria inactivated by organic debris no residual activity
56
how may horses be positioned for surgery?
ropes or support stands for legs cushioning and padding essential
57
what imaging equipment is used in equine ortho?
fluro (PPE) arthroscopy tower
58
what are the main considerations for positioning of horses in theatre?
surgeon comfort access to surgical sites horse comfort myopathy / neuropathy risk
59
what positioning aids may be used in theatre?
stands ropes padding cushions fluid bags
60
what are the main risks associated with patient positioning in theatre?
myopathy / neuropathy from maintained pressure of the horses bodyweight on one area for an extended period
61
what is vital if imaging will be used during ortho surgery?
PPE available
62
what is critical about bandages placed after surgery?
need to be strong enough to withstand a dramatic recovery
63
is casting material often used in equine ortho surgery?
uncommon
64
what are the main options for equine recovery from GA?
unassisted rope recovery sling pool
65
what is involved in rope and sling recovery?
rope attaches to headcollar and tail to direct sling works in a simular way but bodyweight can be supported
66
what are the risks associated with pool recovery?
infection pulmonary oedema
67
what must be monitored in orthopedic post op care?
analgesia antibiotics TPR assessing faecal output and consistency appetite IV catheter patency and health bandage strike through or slipping
68
why must faecal output be monitored post op?
impactions are common due to drugs and reduced movement
69
what is involved in post op care for synovial sepsis?
antibiotics repeat synoviocentesis wound managment
70
what route of antibiotics may be used for synovial sepsis?
systemic intrasynovial intravenous regional perfusion
71
what is intravenous regional perfusion?
toniquet placed above the joint or wound high dose antibiotics injected into vein below
72
what parameters will be assessed in synoviocentesis?
WBC TP serum amyloid A
73
what can be decided based on repeat synoviocentesis?
if second wound lavage is needed
74
what are the main complications seen with orthopedic surgery?
post-op infections incision breakdown unacceptable pain bandage sores cast sores supporting limb laminitis
75
how can supporting limb laminitis be prevented?
frog support in opposite limb deep bedding rubber mats bandage good leg effective analgesia
76
how is supporting limb laminitis caused?
laminae and vascular compression on opposing limb as it is taking most of the body weight leading to inflammation and separation
77
how can laminitis be detected?
bounding digital pulse
78
when are bandage complications more common?
if the horse is hot/sweating horse is moving a lot bandage poorly applied (rare) incorrect tension
79
what may be done to reduce risk of bandage complications?
cross tie
80
how often should casts be checked?
BID
81
what are you monitoring with regards to casts?
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
what are the complications with fracture fixation?
postoperative infection breakage of implants or implant failure further limb fracture
83
what fracture fixation complications are seen in recovery?
breakage of implants or implant failure further limb fracture
84
what is the impact of post op fracture fixation infection?
causes unstable fixation results in pain and slowed healing
85
what equipment is required for fracture fixation?
drill plates and screws general kit and drapes bone reduction forceps plate bender fracture kit
86
identify this instrument
drill
87
identify this ortho equipment
plate
88
identify this instrument
bone reduction forceps
89
identify this instrument
plate bender
90
what size fracture kit is used in equine ortho?
4.5mm 5.5mm
91
identify this instrument
Mathieu retractor
92
identify this instrument
Weitlaner retractor
93
identify this instrument
synovial resector
94
identify these instruments
trocar (top two) cannula
95
what must you do before induction of an arthroscopy case?
ensure equipment is working
96
identify this instrument
bruns curette
97
what is the Bruns curette used for?
atraumatic removal of fragments within the joint
98
identify these instruments
Ferris Smith Rongeurs - straight or curved
99
why are iodine compounds not used for skin prep?
staining radiopaque smell only free iodine is bacteriocidal
100
is free iodine used in skin prep?
only if diluted or combined with detergent
101

Advanced Clinical Nursing Theory (36 decks)

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