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ACVN - EQUINE NURSING > Equine Orthopaedic Surgery and Perioperative Care > Flashcards

Equine Orthopaedic Surgery and Perioperative Care Flashcards

1
Q

what elective surgery can be done?

A

– Arthroscopy/tenoscopy
- osteochondritis dissecans lesions
- Tendon sheath disease
– Angular limb deformities
(foals)
– Soft tissue surgery
- Neurectomy / fasciotomy
- Desmotomy e.g. palmar annular ligament

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2
Q

what emergency surgery might be done?

A
  • Arthroscopy/tenoscopy
  • Synovial sepsis
  • Intra-articular fracture repair
  • Fracture repair
  • +/- sequestrum removal
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3
Q

what would an arthroscopy/tenoscopy be done for?

A

intra-articular fracture repair, osteochondritis dissecans, synovial sepsis

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4
Q

what is synovial sepsis?

A

– Bacterial infection leading to septic arthritis

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5
Q

what is Osteochondritis dissecans (OCD)?

A

–Development defects in cartilage and bone

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6
Q

why is sequestrum removal indicated?

A

Trauma resulting in damage to the periosteum can result in death of the bone in
this region and necrotic bone separates (sequesters)
and becomes a “foreign body” so the sequestrum is often infected

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7
Q

what are angular limb deformities?

A

bendy legs - lateral or medial bend

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8
Q

who often gets angular limb deformitites?

A

foals

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9
Q

what are the different factors for angular limb deformity?

A

nutrition, incomplete ossification, tendon/ligament laxity

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10
Q

what sugical techniques can fix angular limb deformities/

A

– Growth arresting techniques e.g. transphyseal screw, plating
– Growth accelerating techniques e.g. periosteal transection

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11
Q

what are the considerations for fracture repair?

A
  • average weight of a horse is 500kg so lots of stress on fracture
  • athletes need repair to be strong
  • recovery from GA, flight animal
  • lack of soft tissue on distallimb so potential for contamination
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12
Q

what are the considerations for the emergency patient?

A
  • Clinical examination
    – When in doubt, treat like a fracture…
    – Is the patient stable?
  • Sedation?
    – a2 agonist e.g. detomidine and butorphanol
  • IV catheter
  • Wound care
    – Clippers, swabs, chlorhexidine, warm water, sterile isotonic fluids, needles/syringes
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13
Q

what pre-op considerations are there for the emergency patient?

A

– Medications e.g. antimicrobial drugs, tetanus
antitoxin, analgesia
- Have these been given prior to referral?
- Is limb support required? - Do we suspect a
fracture?

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14
Q

what are the goals for fracture stabilisation?

A

– Stabilize fracture
– Reduce discomfort and distress
– Minimize further trauma to bone ends, soft tissues and vasculature
– Prevent further contamination

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15
Q

what is the nurses role during surgery?

A
  • Scrub nurse – run table/anticipate next step during procedure
  • Orchestrate – run the room
    – This starts pre-operatively
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16
Q

how do you prep theatre for surgery??

A
  • Clippers
  • Antibacterial preparations
  • Fluids
  • Medication
  • Urinary catheter
  • Shoe removal?
  • Anaesthetic machine, circuit etc
17
Q

howdo you repare the patient for surgery?

A
  • Patient is primary source of
    pathogens
  • Cover feet and tail
  • Clip hair Preferably outside operating theatre
  • At least 10-15 cm away from
    intended surgical site
  • 1st Clean skin
  • 2nd Disinfect skin
18
Q

how can you prepare the skin for surgery?

A
  • Chlorhexidine
    – Residual activity (binds to protein in skin)
    – Low toxicity (but can be toxic for fibroblasts)
  • Iodine compounds
    – Stains, radiopaque, smells.
    – Only free iodine is bactericidal
  • Povidone iodine:
    – No free iodine unless diluted or combined with detergent
    – Low toxicity (individual sensitivity reported) – Inactivated in presence of organic debris
  • Synergistic effect with alcohol
19
Q

what are the uses for alcohol as a skin prep?

A
  • Only effective against bacteria
  • Inactivated by organic debris
  • No residual activity
  • Commonly used as rinse after surgical scrub
20
Q

what specific requirements are there for preparing the theatre?

A
  • ropes/support stands, cushioning/padding for positioning
  • instruments required?
  • imaging equipment required?
  • post-op bandaging/casting materials
21
Q

what surgeon considerations are there for positioning of the patient?

A

– Comfort
– How accessible is the surgical site?
– Is there more than one surgical site?

22
Q

what positioning considerations are there for the horse?

A

– Comfort
– Myopathy/neuropathy risk

23
Q

what types of recovery can you do for horses?

A
  • Unassisted
  • Rope recovery
  • Sling recovery
  • Pool recovery
24
Q

what are the risks with pool recovery?

A

infection/ pulmonary oedema

25
Q

what post-op care should you provide?

A
  • Analgesia
  • Antimicrobials?
  • Normal parameters:
    – TPR within normal limits
  • Reasonable faecal output / consistency
    – Impactions common!
  • Reasonable appetite
  • IV catheter required / removed?
  • Bandage care - strike through, slipping, comfort
  • Monitoring
26
Q

what post-op care should you provde for synovial sepsis?

A
  • Antimicrobials
    (– Systemic
    – Intrasynovial
    – Intravenous regional perfusion)
  • Repeated synoviocentesis?
    (– WBC, TP, SAA
    – Is a second lavage required?)
  • Wound management
27
Q

what are the complications associated with orthopaedic surgery?

A
  • Post-operative infections
  • Incision breakdown
  • Unacceptable pain post-operatively
  • Bandage sores
  • Cast sores
  • Supporting limb laminitis
    – Frog support opposite limb
28
Q

why might bandage complications arise?

A

– Horse sweating / hot
– Horse moving around a lot
– Poor application
– Incorrect tension

29
Q

how can you monitor casts?

A
  • Twice daily
  • Sudden or gradual changes in comfort
  • Fever
  • Discharge or staining
  • Wear on sole
  • Cast breakage
  • Heat
  • Flies sitting one spot (in summer)
  • smell
30
Q

what are the complications associated with fracture fixation?

A
  • post-op infection
  • breakage of implants/implant failure
  • further fracture of limb
31
Q

what equipment do you need for fracture fixation?

A
  • drill
  • plates and screws
  • bone reduction forceps
  • general kit and drapes
  • fracture kit (4.5mm set and screws, 5.5mm set and screws)
  • plate benders
32
Q

what equipment do you need for arthroscopy?

A
  • camera
  • synovial resector
  • trochars
  • cannula
  • fluid line
  • screen
  • scope
  • light cable
  • fluid pump
  • arthroscopy tower
33
Q

what is a tenoscopy?

A

Arthroscope to look in tendon sheaths instead of joints

34
Q

why might a patient develop arthritis after arthroscope?

A

if chip fragments are left inside the joint

35
Q

what is rope recovery?

A

rope on head collar and tail, guiding the horse up when they are ready, would leave in ET tube or NO tube

ACVN - EQUINE NURSING (3 decks)

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