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Advanced EVPC Yr2 > Exam Revision ... > Flashcards

Exam Revision ... Flashcards

1
Q

What are the stages of the Nursing Process?

A
  1. Assessment
    (Assess px + what the nursing diagnosis is)
  2. Planning
    (Creating short-term nursing goals)
  3. Intervention
    (Decide what nursing interventions are req)
  4. Evaluation
    (Eval why those interventions are req)
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2
Q

In basic terms, What is the Nursing Diagnosis?

A

RVN identifying the Actual + Potential problems/patient needs

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3
Q

What are the 4 phases of Wound Healing?

A
  1. Haemostatis
  2. Inflammation
  3. Repair
  4. Maturation
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4
Q

Homeostasis is the 1st phase within wound repair, can you describe, in order, what happens at each stage?

A
  1. Initial bleeding flushes wound
  2. Vasoconstriction occrurs - lasting 5 - 10 mins
  3. Platelet plug formation is triggered by damaged BV wall
  4. Formation of fibrin plug + scab
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5
Q

Which of the following would cause a delay in wound healing?

A) Moist wound environment
B) Tissue oxygenation
C) Infection
D) Limited movement of the wound edges

A

C) Infection

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6
Q

2 ..

What type of wound is this?

A
  1. Open
  2. Burn
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7
Q

2. ..

What type of wound is this?

A
  1. Closed
  2. Contusion/bruise
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8
Q

Which type of dressing is best used on a superficial wound?

A) Low/non-adherent
B) Hydrocolloid
C) Anti-microbial
D) Film

A

D) Film

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9
Q

How many drops/ml does a Standard Giving Set deliver?

A

20 drops/ml

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10
Q

How many drops/ml does a Paediatric Giving Set deliver?

A

60 drops/ml

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11
Q

Name 3 catagories of Fluid used in the VP

A
  1. Crystalloid
  2. Colloid
  3. Blood/blood products
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12
Q

List 8 reasons a blood transfusion may be given to a px

A
  1. Haemorrhage
  2. Sx
  3. Trauma
  4. Hypovolaemia (due to haemorrhage)
  5. Anaemia
  6. Thrombocytopenia
  7. Blood clotting/factor deficiency
  8. Low protein/Albumin
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13
Q

7 …

What is the fluid rate of a 26kg dog that has V+ 2x today?

(Assuming the drop rate is 20 drops/ml)

A
  1. Maintenance = 50 ml x BW(kg)
    = 50 ml x 26kg
    = 1300 ml p/day
  2. Ongoing losses = 4 ml x BW (kg) x (No. of episodes of V+)
    = 4 ml x 26kg x 2
    = 208 ml/day
  3. Total fluid requirements = Maintenance + Ongoing losses
    = 1300ml + 208
    = 1508 ml/day
  4. P/hr = Total fluid / 24hr
    = 1508ml/24hr
    = 63 ml/hr
  5. P/min = P/24hr/60 min
    = 63ml/60min
    = 1.05ml/min
  6. Drops p/seconds = Drip factor x P/min
    = 20 x 1.05ml
    = 21 drops/min
  7. Drop p/1 second = 60 seconds/Drop p/seconds
    = = 60 sec/21 drops
    = 1 drop, every 2.8 seconds or (3 sec)
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14
Q

8 steps…

A 15kg Border Collie was admitted to the practice with a PCV of 50%

He has V+ 2x + D+ 2x in 24hrs

Calculate the fluids req in Drop per second

A
  1. Maintenance = 50 ml x BW(kg)
    = 50 ml x 15kg
    = 750 ml p/day
  2. Deficit = 10ml x BW (kg) x % of loss
    = 10ml x 15kg x 5%
    = 750 ml
  3. Ongoing losses = 4 ml x BW (kg) x (No. of episodes of V+)
    = 4ml x 15kg x 4 (2x D+, 2x V+)
    = 240ml
  4. Total 24hr fluid req = Maintenance + Deficit + Ongoing losses
    = 750 + 750 + 240
    = 1740 ml p/day
  5. P/hr = Total fluid / 24hr
    = 1740ml/24hr
    = 73 ml/hr
  6. P/min = P/24hr/60 min
    = 73ml/60min
    = 1.2ml/min
  7. Drops p/seconds = Drip factor x P/min
    = 20 x 1.2ml
    = 24 drops/min
  8. Drop p/1 second = 60 seconds/Drop p/seconds
    = 60 sec/24 drops
    1 drop, every 2.5 seconds or (3 sec)
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15
Q

List 10 nursing interventions can be carried out to help a cardiac px?

A
  1. Reduce stress
  2. Minimal handling
  3. Avoid restricting chest + neck
  4. Controlled exercise, only at px’s own pace
  5. Provide oxygenation
  6. Restricted sodium diet + but ensure palatable
  7. Support them to sleep + recieve adequate rest
  8. Ensure they have frequent opportunites for the toilet
  9. Make sure they recieve accurate medication (Communicate with VS)
  10. Ensure they stay at an appropriate temp + ensure they don’t become hypo or hyperthermic
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16
Q

State 8 possible problems that may arise when nursing a cardiac px

A
  1. Fluid overload - if on IVFT
  2. Dyspnoea
  3. Hypothermia
  4. Weight loss
  5. Cachexia
  6. Polyuria
  7. Dehydration
  8. Reduced activity/mobility
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17
Q

Give 8 methods by which to assess a respiratory px

A
  1. RR (Observation)
  2. Resp effort
  3. Resp noise (Ausculatation of chest)
  4. MM colour
  5. Pulse oximetery (> 94%)
  6. Arterial blood gasses
  7. Capnography
  8. X-ray
  9. Ultrasound
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18
Q

List 10 conditions that are candidates for O2 therapy

A
  1. Dyspnoea
  2. Airway obstruction
  3. Cardiac px
  4. Shock
  5. Severe anaemia
  6. Diaphragm rupture
  7. Feline asthma
  8. Pleural space disease
  9. Pneumonia
  10. Pulmonary oedema/Contusions
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19
Q

List 8 methods of providing O2 therapy

A
  1. Flow-by
  2. Mask
  3. Nasal prongs
  4. Nasal catheter
  5. Oxygen cage
  6. Incubator
  7. Oxygen collar
  8. Intubation
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20
Q

Give 4 disadvantages of placing an animal in an 02 cage

A
  1. Requires large volumes of oxygen
    2.Can take a long time to fill cage
    3.Hyperthermia
    4.Difficult to monitor px
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21
Q

4..

What are some advantages for Nasal Prongs in administering 02?

A
  1. Direct oxygen delivery
  2. Good for larger dogs
  3. Easy to monitor px
  4. Can carry out other tasks whilst they are inserted (Eating, drinking etc)
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22
Q

Identify 3 nursing interventions we can use to encourage an animal to increase their water intake?

A
  1. Fresh water ad-lib
  2. Salt-free broth
  3. Water fountain
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23
Q

What are some methods of encouragement that can be used to help an px eat?

A
  1. Warming food
  2. Hand-feeding
  3. Using strong-smelling food
  4. Putting food on paw or lips
  5. Little + often
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24
Q

Name 6 measures you could put in place to help an animal suffering with regurgitatoin

A
  1. Elevated feeding/feed from height
  2. Use soft foods
  3. Small meals (Little + Often)
  4. Keep animal upright after feeding
  5. Calorie dense foods
  6. No exercise before + after eating
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25
Q

8 steps…

A 5kg dog has had a FT placed today.

Work out a feeding plan based on their RER, feeding a Recovery diet of 1kcal/ml

A
  1. RER = (BW(kg) x 30) + 70
    = (5kg x 30) + 70
    = 220 kcal/day
  2. Day 1 = 33%
    = 33/100 x RER
    = 33/100 x 220
    = 73 kcal/day
  3. Day 2 = 66%
    = 66/100 x 220
    = 145 kcal/day
  4. Day 3 = 100%
    = 220 kcal/day
  5. IN MLS, must convert> Day 1 = Day 1 kcal/day /ml of diet
    = 73 kcal/1
    = 73 ml/day
  6. Day 2 = Day 2 kcal/day /ml of diet
    = 145kcal/1
    = 145 ml/day
  7. Day 3 = Day 3 kcal/day /ml of diet
    = 220 kcal/1
    = 220 ml/day
  8. Max Feeding volume = 10 mg/kg
    = Vol of max to feed at time x BW(kg)
    = 10 x 5
    = 50ml per feed
    ( 4 - 5 meals)
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26
Q

How would you instruct an owner to store + mix the Insulin for their diabetic cat?

A
  1. Store in fridge
  2. Don’t shake vial
  3. Gently invert/roll
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27
Q

Which condition affects the Endocrine system + an be treated by Radioactive Iodine?

A) Hypothyroidism
B) Hyperthyroidism
C) Hypoadrenocorticism (Addisons)
D) Hyperadrenocorticism (Cushings)

A

B) Hyperthyroidism

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28
Q

Identify 9 nursing intervention for a Neurological px

A
  1. Supportive bedding
  2. Supported walking
  3. Cage rest
  4. Decubitus ulcer prevention - Turn Q2-4 hrs
  5. Monitor urination + defecation
  6. Assisted feeding (Meet RER)
  7. Pain management
  8. Skin care
  9. Maintain body temp
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29
Q

State 7 pieces of PPE to be used when handling or administering Chemotherapy medication

A
  1. High-quality Nitrile gloves
  2. Full-Length long-sleeved gown
  3. Face shield
  4. Goggles
  5. Mask
  6. Respirator
  7. Shoe covers
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30
Q

What is the Deficit calculation?

A

Deficit = 10ml x BW (kg) x % body water loss

I.e ;10ml x 15kg x 5%
= 750 ml

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31
Q

What is the Ongoing losses calculation?

A

Ongoing losses = 4ml x BW (kg) x No/ of epsiodes (V+, D+)

  • REMEMBER = if a px has 3x V+, 2x D+ the total number = 5!

I.e; 4ml x 15kg x (2x V+, 2x D+ = 4)
= 240ml

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32
Q

What endocrine condition presents w/:
* High blood Glucose levels
* Due to disruption
or
* Effect of Insulin

A

Diabetes Mellitus

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33
Q

List 4 symptoms of DM

A
  1. PU
  2. PD
  3. Polyphagia
  4. Weight loss
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34
Q

What are DM at risk of developing?

A

Glaucoma

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35
Q

5 ..

What do Diabetic Clinics do?

A
  1. Support O’s of newly dx pets
  2. Encourage compliance
  3. Review records + monitor progress Q 3-6 mo
  4. Identify + Rectify problems
  5. Monitor px’s symptoms + condition
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36
Q

What is Caninsulin?

A

A prescription Insulin inj to tx DM in Dogs + Cats

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37
Q

10 ..

Explain how you would show a client how to admin an Insulin inj

A
  1. Use Insulin syringe or pen
  2. Demonstrate w/water + model to client
  3. Allow O to practice under supervision + teach several other family members
  4. Ensure eating prior to admin
  5. Check expiry + broach date
  6. Invert vial
    (Explain don’t shake, as cause different concentrations within the bottle, so could get a very high or very low - causing Hypoglycaemia!)
  7. Draw up correct dose + check
  8. Vary Inj site (Some req 2x inj)
  9. If in doubt, only inj once
  10. Dispose of sharps safely
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38
Q

8 ..

What would a Canine DM diet px consist of?

A
  1. High protein
  2. Normal fat + complex carbs
  3. No simple sugars (cause spike)
  4. High-fibre (Control obesity + reduce Glucose surge, slow digestion)
  5. Same diet, same ax - each day
  6. 2 meals p/day
  7. 1/2 w/each inj
    or
    8.1x full inj - if 8 - 10hrs later
  8. No titbits!
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39
Q

7/8 ..

What would a Feline DM diet px consist of?

A
  1. High protein
  2. Low carbs
  3. Fibre content not as important - still no simple sugars
  4. Allow to graze (if pref) but not before Insulin inj
  5. If meal fed - 1/3 of Daily req w/ inj - Rest @ nadir (lowest)
  6. Tins = ‘dilute’ carbs - feed dry if only eat that form
  7. Small portion of food 8hrs after Insulin inj

Diet important in remission - reduced weight results in reduced B cell destruction

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40
Q

4 ..

What should exercise look like for DM px?

A
  1. Regular
  2. Similar ax + same time of day + same length
  3. Full walk = dangerous = req greater levels of blood Glucose!
  4. Important as can help increase weight loss
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41
Q

10 ..

What are the different ways you can monitor a DM px?

A
  1. Csigns (Polyphagia, PUPD, Glaucoma)
  2. Periodic sx checks
  3. Diabetic clinics (Weigh food + calculators RER)
  4. Owner obs
  5. **Check for long-term effects **(Cataracts, Plantigrade stance)
  6. Blood test w/Glucometer
  7. Use cephalic, pinna or footpad prick
  8. Single test or BGC (Blood Glucose Curve)
  9. Intermittent or (CGMS) Continous Glucose Monitoring System
  10. Urinalysis (USG, Dipstick)
  11. Record - sheet, diary

Note - if use pinna or footpad, never change sites, stay with 1 or other to prevent variations in results - but obv vary sites

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42
Q

What 6 factors may contribute towards an unstable DM px?

A
  1. Insulin that was admin out of date
  2. Insulin damaged (Incorrect storage, handling)
  3. Ketodiastix damaged
  4. Glucometer not working
  5. O dosing incorrectly (Technique, dosage, timing)
  6. O feeding titbits or extra food

Refer to VS for dx + res-stabilisation

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43
Q

What 2 Emergency conditions may a DM px present with?

A
  1. Diabetic ketoacidosis (DKA)
  2. Hypoglycaemia
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44
Q

In basic terms…

How would you tx a DKA px, in an emergency?

3 …

A
  1. Maintain px airway
  2. IVFT - Hartmanns 0.9% Saline
  3. Rapid acting Insulin
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45
Q

What Type, % + Content of fluids should be given to a DKA px?

A
  1. Hartmanns
  2. 0.9%
  3. Saline
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46
Q

5 ..

How would you tx a Hypoglycaemic px, in an emergency?

A
  1. Feed immediately
  2. Give Glucose water
  3. Hypo-stop
  4. Rub Sugar/Syrup (Honey) solution on mm
  5. IV Glucose
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47
Q

A white small dog presents to the practice with the following symptoms:

  • PUPD
  • Polyphagia
  • Pot-belly
  • Panting
  • Bilateral alopecia on his flanks
  • Thin inelastic skin
  • Muscle atrophy
  • Weakness

What disease am I?

A

Hyperadrenocorticism!!
(Cushings)

..Pot-belly!!..

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48
Q

What are the 8 symptoms of Hypoadrenocorticism in Dogs?

A
  1. PUPD
  2. Polyphagia
  3. Pot-belly
  4. Panting
  5. Bilateral alopecia on his flanks
  6. Thin inelastic skin
  7. Muscle atrophy
  8. Weakness
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49
Q

What condition does this dog have?

A

Cushing’s!

(Hyperadrenocorticism)

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50
Q

Cushings..

How would you care for a px with Hyperadrenocoriticism?

9 ..

A
  1. Reduce stress levels
  2. Take care when handling
  3. Fat restricted diet (Generally overweight presentation - depending on concurrent conditions, as indicated by VS)
  4. Ensure nutrition maintained
  5. Monitor BCS, MCS + BW (Weigh Q morning)
  6. Monitor Csigns ( + O questionnaire)
  7. ACTH stim tests (Q 3 - 6 mo)
  8. Monitor skin integrity, infections + especially urinary infections
  9. Educate client!
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51
Q

A Canine px presents to the VP with the following symptoms:

  • Anorexia
  • Haemorrhagic V+
  • Nauseous
  • Malnourished
  • Haemorrhagic D+
  • Lethargy + Inappetence that wax and wanes..
  • Painful + sore abdomen

I’m tricky to dx, what could I be?

A

Hypoadrenocorticism..!!
(Addison’s)

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52
Q

7 Csigns..

What are the Clinical signs associated with Hypoadrenocorticism?
+
What species is it normally seen in?

A
  1. Commonly presented in Dogs
  2. Clinical signs are:
    * Anorexia
    * Haemorrhagic V+
    * Nauseous
    * Malnourished
    * Haemorrhagic D+
    * Lethargy + Inappetence that wax and wanes..
    * Painful + sore abdomen
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53
Q

What is Addison’s/Hypoadrenocoriticsm?
+
How is it usually caused?

A
  1. Reduction or inability to produce steroids in the adrenal glands
  2. Usually occurs as a result of Immune destruction of adrenal gland
    Or
  3. Consequence of tx Hyperadrenocorticism!
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54
Q

What is the term given to a px who is an emergency state of Hypoadrenocorticism?

A

Addisonian Crisis!

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55
Q

How do you handle + tx a patient in an Addisonian Crisis?

A
  1. Emergency IVFT @ shock rate of 0.9% NaCl
  2. Medical management
  3. Monitor:
  4. BP
  5. ECG
  6. Electrolytes
  7. Acid-base-balance
  8. Stabilise
  9. Reduce stress levels
  10. Don’t handle abdomen (painful)
  11. Monitor Csigns (O questionnaire)
  12. Monitor WBC counts + Na : K ratio!
  13. Educate client on tx, effects of stress + signs of Crisis!!
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56
Q

What type, % + content of emergency IVFT fluids should you use for a px in an Addisonian Crisis?

A

Emergency IVFT
1. Shock rate
1. 0.9%
1. NaCl

NaCl = Sodium Chloride

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57
Q

What 3 things should you educate a client, regarding an Addisonian Crisis?

A

Educate client on
1. How to admin tx
2. Effects of stress
3. Signs of Crisis!!

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58
Q

A Canine has been brought into the VP with the following Csigns..

  1. Lethargy
  2. Exercise intolerance
  3. Obesity
  4. Bradycardia
  5. Hypothermia
  6. Alopecia
  7. Seborrhoea
  8. Hyperpigmentation
  9. Pyoderma

What condition may they have?

A

Hypothyroidism!

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59
Q

In basic terms, what is Hypothyroidsim?

A
  • An underactive thyroid gland
  • Resulting in a decreased Metabolic rate
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60
Q

What is Seborrhoea?

A

Greasy skin

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61
Q

True or False.

Due to the Csigns that Hypothyroid Dog’s present with, they may be more susceptible to dermatological infections

A

True!

As they present with the following dermatological signs:
1. Alopecia
2. Seborrhoea
3. Hyperpigmentation
4. Pyoderma
These skin abnormalities disrupt the skin integrity + barrier function, thus, more susceptable to infection!

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62
Q

What levels are of most concern when monitoring Hypothyroid px’s?

A

T4 levels!
(Thyroxine in blood)

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63
Q

How long may it take for Hypothyroidism clinical signs to improve in px’s?

A) 5 - 6 weeks
B) 4 - 6 weeks
C) 3 - 8 weeks
D) 2 - 4 weeks

A

B) 4 - 6 weeks

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64
Q

If it may take 4 - 6 weeks for Hypothyroid px’s clinical signs to improve, how long may it take for the dermatological signs?

A) Years
B) Weeks > months
C) Days > weeks
D) Months > years

A

D) Months > years

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65
Q

This Cat is brought in to the practice.

It also presents with the folliowing Csigns..
* Polyphagia w/weight loss
* Emaciation
* Hyperactive
* Aggressive
* Heart murmur
* Tachycardia
* PUPD
* V+
* D+
* Depression
* Weakness
* Dehydration

Name this infamous condition!

A

Hyperthyroidism!!

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66
Q

12 …

List the Csigns of Hyperthyroidism

A
  1. Polyphagia w/weight loss
  2. Emaciation
  3. Hyperactive
  4. Aggressive
  5. Heart murmur (if long-term)
  6. Tachycardia
  7. PUPD
  8. V+
  9. D+
  10. Depression
  11. Weakness
  12. Dehydration
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67
Q

In basic terms, what is Hyperthyroidism?
+
How is it caused?

A
  1. Overactive thyroid gland
  2. Overproduction of T4 (Thyroxine) > increases metabolic rate
  3. Usually a results of benign hyperplasia
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68
Q

3 ..

How may Hyperthyroid px’s be treated?

(To include how can RVN assist, client education + diet)

A
  1. RVN assist w/:
    * Medical management
    * Dietary control
    * Radioactive Iodine
    * Thyroidectomy
  2. Client education:
    * Re importance of accurate dosing
    * Advise on tablet admin
    * If long-term - how to monitor Csigns
  3. Diet
    * Not guaranteed control
    * Precription only diet
    * Monitor T4 levels
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69
Q

What are 2 potential tx options for Hyperthyroidism in Cats

A
  1. Thyroidectomy
  2. Radioactive Iodine
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70
Q

What is the likely dx for this px?

A

Looks to be…

Hyperthryoidism!

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71
Q

What is of great importance to monitor post-Thyroidectomy?

A

CSigns of Hypocalcaemia

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72
Q

What is ‘131I’?

A

Radioactive Iodine

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73
Q

What type of tx is this feline px recieving?

A

Radioactive Iodine Therapy

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74
Q

What 3 ways can Radioactive Iodine normally administered in the VP?

A
  1. IV
  2. S/C
  3. Per os
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75
Q

How is Radioactive Iodine excreted in the body?

A

Through:
1. Urine
2. Faeces

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76
Q

Who can perform RIT?

Radioactive Iodine Therapy

A

Trained personnel ONLY

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77
Q

4 ..

What must you advise client’s re-px’s Radioactive Iodine Therapy?

A
  1. Minimise close contact
  2. Stay away from Immuno-comprimised people + animals
  3. Exercise in restricted area
  4. How to dispose of urine, faeces + litter ( < 3 weeks post discharge)
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78
Q

Define Cancer

A
  • Process of normal cells transformed to undergo
  • Excessive or restrained growth
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79
Q

Name the 4 types of Cancer

A
  1. Sarcoma
  2. Carcinoma
  3. Lymphoma
  4. Leukaemia
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80
Q

3 ..

What is a Sarcoma?

A
  1. Begin in tissue
  2. Connects, supports or surrounds other tissues + organs
  3. Muscle, bone + fibrous tissue
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81
Q

6 ..

What is a Carcinoma?

A
  1. Originate in tissues that:
    * Cover a body surface
    * Line a body cavity
    * Make up an organ
  2. Derive from glandular tissue
  3. Prefixed w/ ‘adeno’..
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82
Q

3 ..

What is a Lymphoma?

A
  1. Occur in cells that make up an important components of:
  2. Immune system
  3. Protect the body’s cells

Lymph cells + tissue

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83
Q

3 ..

What is a Leukaemia?

A
  1. Occur in blood
  2. Forming tissues
  3. Blood cells
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84
Q

12 ..

What is the role of the RVN in tx Cancer px?

A
  1. Assisting with diagnostics (CT, MRI, x-rays)
  2. Admin of tx
    * Chemotherapy
    * Reduction of side-effects
    * Pain management
  3. Meeting nursing care needs
  4. Monitor + manage side effects
  5. QOL assessments
  6. Client education
  7. Emotional support for O (Euthanasia)
  8. Palliative care
  9. Patient assessment + care plans
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85
Q

What are 3 major goals of treating Cancer px’s?

A
  1. Preserving QOL
  2. Tumour control
  3. Remission
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86
Q

What are the 5 main treatment options for Cancer px’s?

A
  1. Sx
  2. Chemotherapy
  3. Radiotherapy
  4. Biotherapy
  5. Complementary therapy
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87
Q

What are the 3 main surgical tx options for Cancer px’s?

A
  1. Curative
  2. Biopsy
  3. Debulking
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88
Q

Why might a px recieve Chemotherapy?

A

To tx systemic cancers

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89
Q

When is Radiotherapy more indicated with Cancer px’s?

A

More sensitive with rapidly dividing cells

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90
Q

True or False.

Radiotherapy can be used only in combination with other therapies

A

False

It can also be used independently

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91
Q

When is Biotherapy used in Cancer px’s?

A
  • To:
    1. Stop
    Or
    2. Suppress
  • The growth of a tumour
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92
Q

What type of therapy is..
* Likely to have little supportive data
* Potentially be used in conjunction to alleviate symptoms
* Could potentially cause harm if used as an alternative?

A

Complimentary therapies

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93
Q

Name a complimentary therapy used for Cancer px’s?

A

CBD

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94
Q

What tx may this px be recieving?

A

Chemotherapy

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95
Q

True or False.

Chemotherpy drugs can be used as:
* Sole agent
* In combo with others
* Before sx
* Before or after radiation therapy
* For Solid tumours

A

True!!

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96
Q

What type of tumours is Chemotherapy most inclined to tx?

A

Solid tumours!

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97
Q

Why is Chemotherapy more tolerated in Veterinary medicine?

A
  1. More palliative
  2. Used to minimize toxicity
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98
Q

3 ..

Why do typical Chemotherapy protocols require a rest period between treatments?

A

To allow healthy cells to
1. Repair
2. Regenerate
3. Minimise side effects

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99
Q

2 …

Despite typical Chemotherapy protocols consisting of having a rest period between treatments, allowing healthy cells to undergo repair, regeneration + minimise side effects.

What is the unforunate risk that can come from this?

A
  1. It allows the damaged tumour blood vessel’s to recover
    * 2. Thus lessens overal efficacy of the protocol
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100
Q

Name 7 disadvantages of Chemotherapy

A
  1. Expensive
  2. If using typical protocol of rest between tx’s, lets tumour BVs to recover + regenerate
  3. Cause unpleasant side effects
  4. Requires specific training
  5. Cytotoxic to handle - saftey risk
  6. No guaranteed effects
  7. Difficult to dispose of
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101
Q

What type of drug are Chemotherapy drugs?

A

Cytotoxic

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102
Q

List 4 potential effects of Cytotoxic drugs if ingested

A
  1. Tissue damage
  2. Liver damage
  3. Chronic headaches
  4. Reproductive problems
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103
Q

Identify 6 ways in which staff may come into contact with Cytotoxic drugs during Chemotherapy tx

A
  1. Need stick injury
  2. Inhalation
  3. Direct contact on skin
  4. Ingestion when preparing + administering
  5. Handling waste
  6. Contact with excretions
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104
Q

What class of person must not be around Cytotoxic drugs?

A

Pregnant women

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105
Q

Ideally, how should Cytotoxic/Chemotherapy drugs be prepared?

A

Within a fume cabinet

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106
Q

Why should you have closed adminstration systems when administering Cytotoxic drugs to px’s?

A

To prevent spillage

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107
Q

What type of PPE should you use for Chemotherapy?

A

Impervious!

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108
Q

How are Cytotoxic drugs disposed of in the VP?

A

In Cytotoxic waste (Purple bin)
(Which is Incinerated)

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109
Q

What 3 things should you never do around Cytotoxic drugs or during Chemotherapy?

A
  1. Eat
  2. Drink
  3. Touch face
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110
Q

Who should be removed from the area in which Chemotherapy takes place?

A

All non-essential personnel

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111
Q

What 8 essential details must Chemotherapy records include?

A
  1. Px’s BW
  2. Drug used
  3. Dosage given
  4. Route of admin
  5. Where/site of admin
  6. Who administered it
  7. Any sedation used
  8. Any adverse reactions
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112
Q

Depending on the drugs, what are the 3 methods in which Chemotherapy drugs are administered to px’s?

A
  1. Well-sited Indwelling catheter
  2. Orally
  3. IM
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113
Q

Why should you never given Chemotherapy drugs via IV?

A

Incase it spills!

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114
Q

What should you be familiar with before providing a px when Chemotherapy?

A
  1. Px treatment schedule
  2. Patient records prior to EACH admin
  3. Re-check dosage calculation
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115
Q

Should you change sites per each admin of Chemotherapy drugs?

A

Yes

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116
Q

What type of tx is this px recieving?

A

Chemotherapy

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117
Q

What type of sign must you have on the door, before performing Chemotherapy?

A
  1. Warning sign
  2. Stating “Chemotheraphy in progress, DO NOT ENTER”

(+ block the door if you need to, to prevent entering)

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118
Q

6 ..

List the PPE required for adminstering Chemotherapy

A
  1. Impervious full-length + sleeved. gown
  2. Glasses/goggles
  3. Chemo gloves or Double gloved
  4. Masks
  5. Shoe covers
  6. Hair nets
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119
Q

What must you consider about the floor when performing Chemo?

A
  1. That its washable
  2. You have a protective mat to prepare + admin
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120
Q

What type of saline should you use to flush the catheter pre + post admin of Chemo drugs?

A

Non-heparinised Saline

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121
Q

4 ..

How should you store Cytotoxic drugs?

A
  1. Well-labelled box + biohazard bag
  2. Locked away
  3. Labelled Cytotoxic + dangerous
  4. According to manafacture’s instructions
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122
Q

7 …

How should you decontaminate a spillage of a Cytotoxic drug?

A
  1. Contain the spill
  2. Prevent traffic
  3. Wear PPE
  4. Bleach area 3x times
  5. Use UV light
  6. Use Chemotherapy spill kit
  7. Waste disposal: Bedding in Infectious + hazardous (labelled as Cytotoxic) + Cytotoxic in purple bin
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123
Q

What are 4 nursing interventions for Chemotherapy px’s?

A
  1. Reduce V+ + nausea
  2. Admin of Gastroprotectants
  3. Pain management
  4. Nutritional/anorexia management
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124
Q

How can reduce V+ + nausea in Chemo px’s?

A
  1. Monitor V+ + nausea levels (Csigns etc)
  2. Anti-emetics
  3. Pre-emptive tx most effective
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125
Q

2 …

Why are Chemo px’s given Gastroprotectants?

A
  1. Because they are at risk of Gastric Ulceration due to medications
    Or
  2. Type of cancer
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126
Q

6 …

What must you consider when managing pain in Chemo px’s?

A
  1. Affects QOL
  2. Negative physical effects
  3. Tx side effects
  4. Occurance of secondary syndromes
  5. Effective assessments + re-assessments req
  6. Multi-modal approach is often req
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127
Q

What can effective nutritional management provide Chemo px’s?

A

Improves:
1. QOL
2. Survival time

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128
Q

What 6 nutrients should a Chemo px’s diet consist of?

A
  1. High BV protein
  2. High fat
  3. Omega-3 FAs
  4. Arginine
  5. Low carbs
  6. High fibre
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129
Q

How many days should a Chemo px’s diet be changed over to it’s new one?

A

Over 10 - 14 days

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130
Q

What are the 3 basic minimal requirements for a Chemo px’s diet?

A

Maintain:
1. Calorific intake
2. Body condition (BCS, MCS)
3. Avoid cachexia

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131
Q

What 2 types of feeding may be req for Chemo patient’s?

A
  1. Enteral
  2. Parenteral

(If V+ + naseous from chemo drugs)

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132
Q

What 4 things must be monitored in Chemo px’s daily?

A
  1. BW
  2. BCS
  3. MCS
  4. Hydration status
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133
Q

What 9 adverse effects must you inform the Client of, for pet’s that have undergone Chemo?

A
  1. Alopecia
  2. Neutropenia (7 - 10 days)
  3. Nausea
  4. D+ (2 - 7 days)
  5. V+ (2 - 7 days)
  6. Anorexia (2 - 7 days)
  7. Perivascular tissue damage
  8. Allergic reactions
  9. Myocardial damage
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134
Q

How many hrs post Chemo admin should an O avoid high-risk groups for?

A

24 - 72 hrs

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135
Q

How should clients dispose of Chemo waste at home?

A
  • Treat as hazardous
  • Provide :
    1. PPE
    2. Waste disposal equipment
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136
Q

Identify 10 potential Infectious diseases that require Barrier Nursing

A
  1. CPV
  2. KC
  3. CDV
  4. FURTD
  5. FeLV
  6. FIV
  7. Ringworm
  8. Campylobacteriosis
  9. Salmonellosis
  10. MRSA
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137
Q

6 …

Who are considered Immunocompromised in the VP?

A
  1. Any reduction in Neutrophil count
  2. Immunodeficiency disease
  3. Neonates (unvacced, only on colostrum)
    * Px’s treated w/:
  4. Immunosuppressive drugs (Glucocorticoids, Azathioprine, Cyclosporine)
  5. Chemotherapy
  6. Radiation tx
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138
Q

16 …

List some ideal principles of Isolation

A
  1. Own ventilation system
  2. SOPs (no visitors etc)
  3. Own equipment, PPE, cleaning chemicals, waste disposal, food, bedding, utensils, sink, lighting, heating system etc
  4. Good levels of hygiene (paper towels for hand dyring, WHO technique etc)
  5. Clear communication (whiteboard, records)
  6. Clear sinage
  7. Donning section prior entering
  8. Specific staffing (essential only, 1x RVN only)
  9. Wipeable surfaces
  10. Stainless steel materials etc where bac can’t live
  11. Colour coded system (red - re-usable, spec colour of Vetbeds)
  12. Glass windows for easy visualisation
  13. No visitors
  14. Disposable PPE, equipment (Like pulp food bowls)
  15. Autoclave or dispose of all resuable equip before using on another px
  16. Disinfectable - Radio, speaker system, toys, bordem breakers, TLC, bedding from home (Comfort)
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139
Q

Why should you not let a Parvo px toilet in a public area?

A

Because it stays in the environment for up to 2 years

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140
Q

Where should you walk Barrier nursed px’s?

A

Away from public areas

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141
Q

A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.

She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy

  • The O reports she has been drinking increased ax over the last few months.
  • She is on IVFT + also exhibiting signs of stress when hospitalized.
  1. Describe the nursing process for this px.
  2. List 5 possible nursing diagnoses.
A
  1. Needs support w/drinking adequate ax (Due to PD, Kenneling, use IV fluids)
  2. Needs support w/maintaining skin integrity (Aid of IV cannula)
  3. Needs support to urinate (Due to PU, use IV fluids + kenneling)
  4. Needs to support to eat adequate ax (Due to Nausea, use appropriate diet)
  5. Needs to support to maintain normal behaviours (Due to Stress, kenneling, req tx)
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142
Q

A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.

She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy

  • The O reports she has been drinking increased ax over the last few months.
  • She is on IVFT + also exhibiting signs of stress when hospitalized.
  1. Provide 5 nursing interventions
A
  1. Use gloves + aseptic technique when placing cannula
    * Flush w/sterile/heparinised saline Q24hrs to maintain catheter
    * Change dressing Q24hrs or as needed
    * Change catheters Q48-72hrs
  2. Provide access to fresh, clean water, bowl for px access.
    * Wash mouth with damp swab
  3. Provide litter tray with familiar little of non-absorbant litter (if VS requests urine testing)
    * Absorbent bedding (Vetbed) + kennel liners to provide comfort + draw any excretions away
  4. Supportive feeding - shallow, non-reflective bowl, aromatic, palatable, soft-foods
    * If ulcerated mouth, warm food
    * Refer to VS if signs of nausea
    * No tube if anorectic
  5. Provide calming environment seperate cat ward
    * No loud noises/barking
    * Calm background music
    * Pheromone plug in
    * Provide TLC
    * Sensitive handling
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143
Q

A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.

She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy

  • The O reports she has been drinking increased ax over the last few months.
  • She is on IVFT + also exhibiting signs of stress when hospitalized.
  1. Describe 6 methods of monitoring the patient during fluid administration
A
  1. Signs of hydration:
    * Skin turgor
    * CRT
    * Mm moistness
    * Nictating membrane position
    * HR
    * PR
    * BW
  2. Signs of overhydration:
    * Peripheral oedema
    * Soft, moist cough
    * Dyspnoea
    * Inc RR
    * Runny nose
    * Chemosis
  3. Urine output = 1-2 ml/kg/hr
  4. Central Venous Pressure
  5. Core v Peripheral temperature
    * Peripheral within 4 degrees celcius of core
  6. Check administration site for:
    * Swelling
    * Bruising
    * Pain
    * Perivascular fluid
    * Interference

Chemosis = swelling of conjunctiva

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144
Q

A 14 y/o, FN, DLH has been admitted into the VP for tx of CKD.

She exhibits the following clinical signs:
* Dehydration
* Dry mm
* Reduced skin elasiticity
* PU
* Inapetant
* Poor coat condition
* Lethargy

  • The O reports she has been drinking increased ax over the last few months.
  • She is on IVFT + also exhibiting signs of stress when hospitalized.
  1. Describe the discharge + home care instructions for the O of this px

5 …

A
  1. Appropriate diet:
    * Restricted phosphate
    * High BV protein
    * Ideally - wet diet
    * Encourage eating
    * Gradual change in diet to minimize anorexia + prevent food aversion
  2. Encourage:
    * Inc water intake
    * Fresh water ad lib
    * Water fountain
  3. Refer to renal nurse clinics:
    * Monitoring blood parameters + BP
  4. Monitor:
    * Food + fluid intake
    * BW
    * BCS
    * MCS
    * Severity of Csigns
  5. Admin prescribed medications + instruct on tableting cats
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145
Q

What 4 things does the Nursing Process provide?

A
  • Provide:
    1. Organized
    2. Structured
    3. Holistic
    4. Individualised
  • Px care
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146
Q

List these in order.

  • Evaluation
  • Assessment
  • Interventions
  • Nursing diagnosis
  • Planning
A
  1. Assessment
  2. Nursing diagnosis
  3. Planning
  4. Interventions
  5. Evaluation
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147
Q

How should you structure short/long-term goals?

A
  • Using SMART system
  • Subjective
  • Measurable
  • Achievable
  • Realistic
  • Time-bound
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148
Q

What does the Assessment stage of the Nursing Process?

A
  1. Clearly establishes individual needs
  2. Can only occur after following has been given:
    * Collected necessary info systematically from own obs, client, other team members
    * Reviewed collected info
    * Identified actual + potential problems
    * Identified priorities (among problems)
  3. Can ask O to fill out a questionnaire
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149
Q

What is the Nursing diagnosis stage of Nursing Process?

A
  1. Differs from medical dx, as it’s not concerned w/judgement about disease
  2. Identifies actual + potential problems
  3. Focused on providing the most appropriate nursing intervention
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150
Q

What is the Planning stage of the Nursing Process?

A

Making plans to overcome the identified nursing problems

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151
Q

What are the 6 Aims of the Planning stage, of the Nursing Diagnosis?

A
  1. Solve identified actual problems
  2. Prevent identified potential problems (from becoming actual)
  3. Alleviate any problems that cannot be solved
  4. Help px + client cope positively w/problems that cannot be solved or alleviated
  5. Prevent recurrence of treated problem
  6. Help make px as comfortable as poss, even when death is inevitable
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152
Q

What is the Interventions stage of Nursing Process?

A
  1. The do-ing stage of the process
  2. Carrying out Nursing Interventions
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153
Q

What is the Evaluation stage of Nursing Process?

A
  1. Reflection-part of the process
  2. Involves evaluating the care been given to the px:
    * Has it worked?
    * Has it not?
    * How can it be adapted?
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154
Q

During the Evaluation stage of the Nursing Process, if it is evident that the desired goals have not been met, what 8 questions should be considered?

A
  1. Has the goal set for the px been partially achieved?
  2. Is more info from VS or Client req to decide the next step in nursing care?
  3. Is a specific problem unchanged?
  4. Should the nursing intervention be changed or stopped?
  5. Is there a worsening of the problem?
  6. Should the goal + nursing intervention be reviewed?
  7. Was the goal set inappropriate or unrealistic?
  8. Does the goal req interventions from other members of the Vet team? (VS, Physio etc)
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155
Q

What stage of the Nursing Process is this?

  • Ben Jones is an 11 y/o MN Golden Retriever
  • Has been admitted for hospitilization by VS for investigation of:
    1. Lethargy
    1. PUPD
    1. He has had these for several days
  • VS requests he is kennelled for obs + prelimniary urine + blood tests are carried out
  • To investigate cause of problem
A

The collection of info from Client + VS, in the
Assessment stage

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156
Q

What stage of the Nursing Process is this?

  • It is already known from admitting VS that Ben has:
    1. Exercise Intolerance
    1. PUPD
  • However, if RVN had spoken to the O earlier
  • They would have ascertained that Ben is:
    1. Deaf in his L-ear
    1. Eats 1 meal p/day (In evening)
    1. Will only urinate + defecate on concrete - not grass
A

Assessment stage,
Had the RVN asked these questions, this would greatly improve Ben’s care

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157
Q

What stage of the Nursing Process is this?

  • The VS has made a dx of DM
  • Planning Ben’s care can now be carried out - using all info collected
  • The actual problems are:
    1. Exercise intolerance
    2. PUPD due to unstable DM
    3. Unilateral deafness due to age-related degeneration
  • The potential problems, if the actual problems are not solved, are:
    1. Weight loss
    2. Dehydration
    3. Hypoglycaemia
A

Planning stage!

(Identified actual problems + potential problems)

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158
Q

What stage of the Nursing Process is this?

  • Short-term goals for Ben while DM is being stabilized:

Problem = PD
* Short-term goal = Prevent dehydration
* Timing = At all times
* Nursing interventions = Provide measured volumes of fresh drinking water + record

Problem = PU
* Short-term goal = Ensure Ben has the opportunity to urinate regularly
* Timing = Q 1hr
* Nursing Interventions = Take Ben into an outside concrete run to allow him the opportunity to urinate + record

A

Planning stage!

(Identified actual problems + what nursing interventions can be put in place)

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159
Q

5 ..

What questions should you ask the O for ‘Eating adequate amounts’?

A
  1. What does the px normally eat?
  2. How much?
  3. How often?
  4. When?
  5. Does the px prefer any particular bowl?
160
Q

What is the rationale behind asking an O questions regarding eating?

A
  1. Get’s px back to eating normal food
  2. Allows calculation of RER or MER to maintain BW
  3. Bracycephalic cats (Persians) prefer flat bowls
  4. Cats generally prefer china or ceramic bowls, rather than plastic
161
Q

What questions should you ask the O for ‘Drinking adequate amounts’?

A
  1. How much do they normally drink?
  2. Do they often drink water from containers outside (collected rain water)?
162
Q

What is the rationale behind asking an O questions regarding drinking?

A
  1. Will vary from ax to ax
  2. May depend on whether the ax’s normal diet is wet or dry
  3. What type of water can be important
  4. Cats may drink from a dripping tap
  5. Rabbits + other SAs may drink from a bottle or bowl
163
Q

What questions should you ask the O for ‘Urinating normally’?

A
  1. Where do they urinate?
  2. Does the O use any commands?
  3. Do they have any problems urinating?
164
Q

What is the rationale behind asking an O questions regarding urinating?

A
  1. Diff px’s may show different preferences
  2. Inside or outside?
  3. Cats - use LT?
  4. What type of litter?
  5. Does dog urinate on walks?
  6. Always on grass or concrete?
  7. Commands for well-trained ax
  8. Do they have arthirtits? Joint stiffness can affect how the px urinates
165
Q

What questions should you ask the O for ‘Defecating normally’?

A
  1. How often?
  2. Where?
  3. On what?
166
Q

What is the rationale behind asking an O questions regarding defecating normally?

A
  1. How often - depends on diet provided
  2. Some dogs have preferences on where they urinate/defecate
  3. Cats may have a preference for type of litter
167
Q

What questions should you ask the O for ‘Breathing normally?

A
  1. Any problems?
  2. Do they snore?
168
Q

What is the rationale behind asking an O questions regarding breathing?

A
  1. Linked to exercise
  2. Indicate underlying disease
  3. Might be indicative of allergy
  4. Facial conformity may result in breathing difficulties (Persians, Pugs)
170
Q

What is the Dogs normal:

  1. HR
  2. RR
  3. Temp
  4. Urine output p/day
  5. Water intake p/day
A

Dogs

  1. HR = 70 - 140 bpm
  2. RR = 10 - 30 rpm
  3. Temp = 38.3 - 39.2 degree c
  4. Urine output = 1-2 ml/kg/hr or 24-48 ml/kg/day
  5. Water intake = 40 - 60 ml/kg/day
171
Q

What is the Cats normal:

  1. HR
  2. RR
  3. Temp
  4. Urine output p/day
  5. Water intake p/day
A

Cats

  1. HR = 100 - 200 bpm
  2. RR = 20 - 30 rpm
  3. Temp = 38.2 - 38.6 degrees c
  4. Urine output = 1-2 ml/kg/hr or 24-48 mnl/kg/day
  5. Water intake = 40 - 60 ml/kg/day
172
Q

What is the Rabbits normal:

  1. HR
  2. RR
  3. Temp
  4. Urine output p/day
  5. Water intake p/day
A

Rabbits
1. HR = 130 - 325 bpm
2. RR = 30 - 60 rpm
3. Temp = 38.5 - 40 degrees c
4. Urine output = 12 - 48 ml/kg/day (variable)
5. Water intake = 50 - 150 ml/kg/day (variable)

173
Q

What is the normal USG for a Dog?

A

1.015 - 1.045

30 difference!

174
Q

What is the normal USG for a Cat?

A

1.020 - 1.060

40 difference!

175
Q

What is the normal pulse oximetry reading for a Cat + Dog?

176
Q

What is the normal PCV of a Dog?

177
Q

What is the normal PCV of a Cat?

178
Q

Identify the 6 functions of the Skin

A
  1. Protection
    (Micorog, dehydration, UV light, mechanical damage)
  2. Sensation
    (Pain, temp, tough, deep pressure starts)
  3. Mobility
    (Smooth motion)
  4. Endocrine activity
    (Vit D prod, Ca absorp, bone metabolism)
  5. Exocrine activity
    (Release of water, urea, ammonia, sebum, sweat, pheromens, cytokines)
  6. Immunity
    (Pathogens)
  7. Thermoregulation
    (Conserving + releasing heat, maintain water + homeostatic balance)
179
Q

State the 3 layers of the skin in order

A
  1. Epidermis
  2. Dermis
  3. Hypodermis
180
Q

List the 5 layers of the Epidermis

A

Stratum…
1. Corneum
2. Lucideum
3. Granulosum
4. Spinosum
5. Basale

181
Q

Name the functions of these layeres of the skin:
1. Epidermis
2. Dermis
3. Hypodermis

A
  1. Epidermis:
    * Outermost
    * Waterproof
    * 3 types of cells: Squamous, Basal + Melanocytes
  2. Dermis
    * Middle layer
    * 2 layers: Papillary + Therectiular
    * Provides flexibility + strength
    * Contains: BVs, CT, Hair follicles, Lymph vessels, sweat glands
    * Held together by collagen
    * Contains pain + touch receptors
  3. Hypodermis
    * Deepest layer
    * Protects body from injury
    * Acts as shock absorber
    * Contains: Fat, CT + Collagen
182
Q

Name the 5 types of open wounds

A
  1. Incision
  2. Abrasion
  3. Avulsion
  4. Laceration
  5. Puncture
183
Q

Name the 2 types of closed wounds

A
  1. Contusion
  2. Crushing injury
184
Q

What’s the characteristics of a Incision wound?
+
Give 1 example

A
  1. Open
  2. Created by sharp tool
  3. Minimal tissue trauma
  4. Scalpel blade
185
Q

What’s the characteristics of a Abrasion wound?
+
Give 1 example

A
  1. Open
  2. Loss of Epidermis
  3. Loss of portion of Dermis
  4. Scuffed skin
186
Q

What’s the characteristics of a Avulsion wound?
+
Give 1 example

A
  1. Open
  2. Tearing of tissue away from:
    * Attachments
    * Underlying tissues
    * Underlying structures
  3. Dog bite
187
Q

What’s the characteristics of a Laceration wound?
+
Give 1 example

A
  1. Open
  2. Irregular
  3. Superficial damage underlying tissue
  4. Barbed wire injury
188
Q

What’s the characteristics of a Puncture wound?
+
Give 1 example

A
  1. Open
  2. Penetrating
  3. Created by sharp object
  4. Can introduce contaminates deep into tissue
  5. Resulting in high-risk infection
  6. Cat Bite
189
Q

What’s the characteristics of a Contusion wound?
+
Give 1 example

A
  1. Closed
  2. Blunt-force trauma
  3. Doesn’t break skin
  4. Causes damage to skin + underlying tissue
  5. Bruise
190
Q

What’s the characteristics of a Crushing injury wound?
+
Give 1 example

A
  1. Closed
  2. Force applied to tissue
  3. For long-period of time
  4. Fallen from height
191
Q

What is the duration of Contamination?

A
  • Time between:
    1. Infliction
    +
    1. Treatment
192
Q

What is a Class 1 contaminated wound?

A
  1. Clean wound
  2. Minimal contamination
  3. 0 - 6 hr duration
193
Q

What is a Class 2 contaminated wound?

A
  1. Significant contamination
    or
  2. 6 - 12 hr duration
194
Q

What is a Class 3 contaminated wound?

A
  1. Gross contamination
    or
  2. > 12hr duration
195
Q

What are the 4 classications given to Surgical wounds?

A
  1. Clean
  2. Clean-contaminated
  3. Contaminated
  4. Dirty
196
Q

List the 4 stages of wound healing

A
  1. Haemostasis
  2. Inflammation
  3. Repair
  4. Maturation
197
Q

How long does Haemostasis last for?

A
  1. Occurs immediately
  2. Lasts = varies
198
Q

How long does Inflammation last for?

A
  • Occurs within 6 hrs
  • Lasts = 3 - 6 days
199
Q

How long does Repair or Proliferation last for?

A

Occurs 3 - 7 days post injury

200
Q

How long does Maturation or Remodelling last for?

A
  1. Occurs 5 - 7 days post injury
  2. Lasts = Up to 2 years
201
Q

What intention is used for Clean wounds?

202
Q

What intention is used for Clean-Contaminated wounds?

A

Delayed primary

203
Q

What intention is used for Contaminated or Dirty wounds?

204
Q

What intention is used for Wounds with Extensive contamination or Devitalisation wounds?

A

Second Intention

205
Q

How are Clean wounds, under Primary Intention be managed?

A
  1. Immediate closure
  2. No tension
  3. Surgical sutures
206
Q

How are Clean-Contaminated wounds, under Delayed primary Intention be managed?

A
  1. Lavage
  2. Debridement
  3. Appropriate dressing
  4. Closure after 2 - 3 days
207
Q

How are Contaminared wounds, under Secondary Intention be managed?

A
  1. Lavage
  2. Debridement (Sedation)
  3. Closure after 5 - 7 days to allow granulation bed to form. (ONLY IF OPEN)
208
Q

How are Extensively Contaminated or Devitalised wounds, under Second Intention be managed?

A
  1. Unsuitable for sx closure
  2. DO NOT consider over joint (Blood flow restriction)
  3. Open wound management
  4. Lavage
  5. Debridement
  6. Appropriate dressing
  7. Allow to heal by self
  8. Only dressings + bandages
209
Q

If trauma has caused a wound, why should you wait?

A

To allow the wound to declare itself

210
Q

8 ..

How do you prepare a wound for Debridement?

A
  1. Sterile gloves + apron
  2. Adequate analgesia + had time to take effect
  3. GA (usually)
  4. Keep covered w/sterile, non-linting dressing (Guaze swabs) prior to prep
  5. Swab around wound bed for culture + sensitivity (Store in fridge)
  6. Insert Sterile water soluble Jelly into wound (Soaks hair)
  7. Clip around wound
    * Total injury visible
    * Clip passed unviable tissue
    * Provide 2cm margin
  8. Debridement
211
Q

10 ..

How do you perform a Lavage on an open wound?

A
  1. Sterile gloves + apron
  2. Use towel or liner to protect px from environment
  3. Ensure patient warm enough
  4. Lavage solution (Compatable w/tissues) Isotonic Sterile saline - Hartmann’s
  5. Dilute antiseptic scrub (DO NOT SCRUB as CYTOTOXIC) for contaminated
    * Chlorohexidine = 0.05%
    * Sterets Unisept sachets
    * Povidone Iodine 1% (NOT IN healing wounds)
  6. 20 ml syringe
  7. 19G needle
  8. Large vol = minimum of 100ml/cm
  9. Pressure = 8 - 12 psi
  10. Prevent cross-contamination
212
Q

3 …

Why are wounds Lavaged?

A
  1. Removes debris
  2. Reduces contamination
  3. Significantly reduces infection risk
213
Q

If a pressure greater than 12 psi is used to lavage a wound, what can this cause?

A

Drives pathogenic bacteria into wound + cells

214
Q

If a pressure lower than 8 psi is used to lavage a wound, what can this cause?

A

Has minimal to no affect

215
Q

Define Bioburden

A

No. of micro-organisms that the wound is contaminated with

216
Q

Define Biofilm

A
  1. Form of multispecies bacterial communities
  2. Organised onto a wound surface
  3. Forms extracellular matrix of:
    * Polysaccharides
    * Proteins
    * Nucleic acids
  4. To provide protection + ensure survival
217
Q

Name 3 forms of Debridement

A
  1. Autolytic
  2. Mechanical
  3. Surgical
218
Q

What does bioburden cause?

A
  1. Prolonged inflammation
  2. Healing delay
219
Q

What does a protein rich, devitalised wound tissue do?

A

Perfect environment for bacterial proliferation > Infection

220
Q

3 ..

When a Bioburden + Biofilm is removed, alongside a moist wound-healing technique, what can this do?

A
  1. Optimise cell proliferation
  2. Mainitain comfort
  3. Avoid Eschar formation
221
Q

What is Active debridement?

A

Use of soft-purpose-made brush
(Debrisoft)

222
Q

What is Biological Debridement?

A
  1. Use of medical maggots + leeches
  2. M + L grown in sterile environment
  3. Applied to wound bed
  4. Maggots can be applied w/pre-constructeed dressing or individually created dressing, to keep maggots secure in wound bed

Expensive..

223
Q

6 ..

Describe Autolytic Debridement

A
  1. Use of primary layer applications:
    * Alginates
    * Hydrocolloids
    * Hydrogels
    * Manuca Honey
    * Sugar
  2. Most selective form of debridement
  3. Spares healthy cells
  4. Maintain intact matrix of molecules
  5. While removing damaged cells
  6. With Microscopic precision
224
Q

6 ..

Describe Mechanical Debridement

A
  1. Physical removal
  2. Of tissue adheered to
  3. To a dried-on dressing
  4. Non-selective + non-desirable form of debridement
  5. Very painful
  6. Req GA/Analgesia
225
Q

4 …

Describe Surgical Debridement

A
  1. Gold-standard technique
  2. Tissue removed by VS
  3. According to:
    * Colour
    * Texture
    * Vascular supply
    * Temperature
  4. Selective form of debridement on a Macroscopic level
226
Q

Name 4 types of Closure techniques for wounds

A
  1. Sutures
  2. Staples
  3. Surgical Reconstruction (Flaps + Grafts)
  4. Drains (Active + Passive)
227
Q

List 2 disadvantages of Surgical Staples for wound closure

A
  1. Doesn’t go very deep
  2. Less reliable
228
Q

Identify 1 advantage of Surgical drains for wound closure

A

Minimises fluid build-up/oedema

229
Q

What is open wound management?

A
  1. Covering wound with appropriate dressing + bandage
  2. DOES NOT MEAN left open to environment
230
Q

What are the aims of Open wound management?

A
  1. Work syngeristically with cells
  2. Provide best environment possible
  3. Support healing process
231
Q

What is it called when a wound closes by itself?

A

Second Intention

232
Q

3 ..

When is Second Intention appropriate for Open wounds?

A
  1. Healing is progressing well
  2. Reconstructive sx is not required:
    * To prevent contracture or scarring
    * Might inhibit mnobility
    * Cosmetically unacceptable
  3. If px tolerates banadging
233
Q

What does normal Exudate look like?

A
  1. Clear
  2. Pink-tinged
234
Q

What does Infected Exudate look like?

A
  1. Cloudy
  2. Varied in colour
    * Yellow
    * Tan
    * Green
    * Reddish
    * Black
    * Milky
    * Thick
    * Viscous
235
Q

What is Exudate?
+
What does it contain?

A
  1. Exudate is:
    * Discharge from fluid
    * Plasma leaking from capillaries
  2. Contains:
    * Nutrients
    * Growth factors
236
Q

What is Exudates function for the body?

A

Provides a moist environment for cell viability

237
Q

When should Exudate normally reduce?

A
  1. Towards the end of the Inflammatory phase
  2. As granulation tissue + epitheliasation forms
238
Q

If Exudate is still present after the Inflammatory stage, what may this indicate?

A
  1. Increased bacterial burden
  2. Oedema
  3. Excess movement
  4. Patient interference
239
Q

What is Maceration?

A
  1. Wound with excessive production of Exudate
  2. Spilling onto adjacent healthy skin
  3. Inc susceptibility to infection
240
Q

What is Excortiation?

A
  1. Exudating wound
  2. Had contact with toxins from wound
  3. Causes damage to top layers of skin
241
Q

What is Granulation?

A
  1. Tissue build up by fibroblasts
  2. Secrete new extracellular matrix molecules (Collagen, Elastin) + Endothelial cells
  3. Which help build new BVs
242
Q

3 ..

What does healthy Granulation tissue look like?

A
  1. Bright red
  2. Moist
  3. Slightly un-even appearence

(Wound fluid levels depend on wound)

243
Q

3 …

What is Epithelialisation?

A
  1. Process of Epithelial cells migrate onto Granulation tissue
  2. Which provides:
    * Oxygen
    * Moisture
  3. Surface req for epithelial cells to:
    * Proliferate
    * Cross wound
    * Create new Epidermis
244
Q

How long would Wound Epithelialisation Process take for a 1mm wound?

245
Q

If it takes 10 days for a 1mm wound to undergo Epithelialisation, how long would a 10cm wound take?

A

Up to 500 days!

246
Q

Out of these 3 options, chose when you should change the dressing

A

Medium Exudate!

  1. Low = good ax of absorbancy left
  2. Perfect time
  3. Excess = Fully saturated, leads to Maceration of surrounding healthy tissue
247
Q

4 ..

What does Laser therapy do?

A
  1. Enhance wound healing times
  2. Reduce/prevent infection
  3. Inc blood flow + oxygenation
  4. Red inflammation + pain
248
Q

Identify 7 types of advanced dressings

A
  1. Hydrogels
  2. Hydrocolloids
  3. Polyurethane foam
  4. Polyhexamthylene biguanide (PHMB)
  5. Alginates
  6. Sodium chloride
  7. Super-absorbant
249
Q

What is a Hydrogel dressing?
+
When is it appropriate to use?

A
  1. They are:
    * Fluid donators for dry wounds
    * Donate + trap water
    * Hydrate necrotic material within wound
    * Absorb exudate
  2. Used for:
    * Wounds at risk of drying out
    * Necrotic wounds
    * Wounds within excess exudate
250
Q

What is a Hydrocolloids dressing?
+
When is it appropriate to use?

A
  1. They are:
    * Actively stimulate wound healing
    * Encourage debridement
    * Degrade on interaction with exudate
  2. Used for:
    * Dry > semi-dry wounds
    * Req additional moisture + natural debridement
251
Q

What is a Polyurethane foam dressing?
+
When is it appropriate to use?

A
  1. They are:
    * Foam
    * Highly absorbant
    * Act by drawing excess exudate away from wound
    * Maintain some moisture + humidity
    * Keeps wound moist
    * Now avaliable w/antimicrobial properties
  2. Used for:
    * Applied on top of other products (Hydrogels, Honey)
252
Q

What is a Polyhexamthylene biguanide (PHMB) dressing?
+
When is it appropriate to use?

A
  1. They are:
    * Protozoan
    * Antimicrobial agent
    * Broad spectrum of activity
    * Against bacteria + fungi
    * Breaks down bio-film
    * The PHMB attacks bacteria in wound exudate as it is absorbed
  2. Used for:
    * Staphylococci (Inc MRSA)
    * Pseudomonas
    * Proteus etc
253
Q

What is a Alginates dressing?
+
When is it appropriate to use?

A
  1. They are:
    * Fine
    * Fiborous
    * Absorb moisture
    * Dereived from Kelp
    * Wound exudate interacts w/Alginate to release cations that actively stimulate the wound
  2. Used for:
    * ??
254
Q

What is a Sodium Chloride dressing?
+
When is it appropriate to use?

A
  1. They are:
    * New
    * Guaze
    * Saturated w/20% Hypertonic saline solution
    * Promotes biological cleaning
    * Promotes autolytic debridement process
  2. Used for:
    * Non-infected
    * Highly exudating wounds
255
Q

What is a Super-absorbant dressing?
+
When is it appropriate to use?

A
  1. They are:
    * Cope w/high vol of exudate
    * Incoperated Polyacrylate crystals
    * Hi-tech silicone adhesives
  2. Used for:
    * Excessive exudate
    * Difficult to manage
256
Q

Name 2 types of Anti-microbial dressings
+
What they consist of?
+
When they are used?

A
  1. Manuka Honey
    * Excellent anti-microbial effects
    * Helps granulation bed form
  • Must be medical-grade
  • High-level filtering to remove debris
  • Effective against:
  • Pseudomonas spp
  • MRSA
  • E-Coli
  1. Silver dressings
    * Silver + salts have antispetic + antibacterial properties
    * Silver - ionises to release active silver ions into wound
  • Req activation prior to use
  • By moistening w/water for 10 sec
  • Effective against:
  • Pseudomonas spp
  • MRSA
  • E-Coli
  • Common yeasts + fungi (Candida)
257
Q

What is VAC?

A
  1. Vaccum Assisted Closure
  2. Use of negative pressure
  3. To encourage epitheliaisation + contraction of wound
  4. Through vaccum pump
  5. Sealed within plastic dressing
258
Q

Name 5 wound complications

A
  1. Devitalised tissue
  2. Large vol exudating wounds
  3. Infection
  4. Oedema
  5. Necrosis
259
Q

List 5 signs of wound infection

A
  1. Erythema
  2. Pain
  3. Oedema
  4. Localised heat
  5. Inflammation
260
Q

Name 4 types of Suture material

A
  1. Absorable
  2. Non-absorable
  3. Monofilament
  4. Natural or Synthetic
261
Q

Name 4 types of needle shapes

A
  1. Round bodied
  2. Straight
  3. Half-curved
  4. Curved
262
Q

What are the 3 types of main suture patterns?

A
  1. Apposing
  2. Everting
  3. Inverting
263
Q

Identify 7 suture patterns

A
  1. Simple interrupted
  2. Horizontal mattress
  3. Simple continous
  4. Ford interlocking
  5. Cruciate
  6. Vertical mattress
  7. Intradermal/Subcurticular
264
Q

Name the 3 main components of Surgical knots

A
  1. Loop
  2. Knot
  3. Ears
265
Q

List 4 types of Surgical knot

A
  1. Simple throw
  2. Surgeon’s knot
  3. Square knot
  4. Granny knot
266
Q

Name 7 techniques to overcome skin tension

A
  1. Px positioning
  2. Undermining
  3. Wound geometry
  4. Suture patterns
  5. Skin streching
  6. Tissue expanders
  7. Incisonal ‘‘plasty’’ techniques - V, Y, Z
267
Q

Identify 3 tension relieving techniques

A
  1. Subcuticular sutures
  2. Walking sutures
  3. Relaxing incisions (parrallel or multiple)
268
Q

Flaps..

Name 6 primary closures of large skin deficits

A
  1. Single pedicle advancement flap
  2. Bipedicle advancement flaps
  3. Rotation flaps
  4. Transposition flaps
  5. Axillary + Inguinal flaps (Trunk, Ventral, Thorax, Abdomen)
  6. Distant direct flaps (distal limbs)
269
Q

What are 5 complications of skin flaps

A
  1. Self-trauma
  2. Seroma
  3. Discharge
  4. Dehiscence
  5. Necrosis
270
Q

When do you use a drain?

A
  1. Repeated lavage of a space
  2. Repeated aspiration of fluid from a space (drain dead space)
  3. Prevention of seromas
271
Q

What is the most common Passive drain?

272
Q

When are passive drains used?

A
  1. Wounds w/dead space
  2. Where fluid accumilates
  3. Cat bite abscesses
273
Q

How do passive drains work?

A
  1. Gravity
  2. Capillary action
274
Q

When are passive drains contraindicated?

A
  1. Latex allergies
  2. Thoracic wounds
  3. Abdominal wounds
    * As will draw fluid into cavities - causing Pneumothorax or Peritonitis
275
Q

How are Passive drains removed?

A
  1. Trim 1 end to level of skin
  2. Pull
  3. But if 1 end exiting - cut top off before to not bring the outside through internally - compromising sterility
276
Q

What are Active drains?

A
  1. Rigid tube
  2. With a device that exerts constant gentle negative pressure
277
Q

What is the most common Active drain?

A

Jackon-Pratt

278
Q

How do Active drains work?

A
  1. Active suction
  2. Under negative pressure
  3. Using bulb/chamber
279
Q

When should Active drains be used?

A
  1. Body cavities
  2. Large dead spaces
  3. Following surgery
280
Q

What are the contraindications of Active drains?

A
  1. None!
  2. Generally wouldn’t use if small ax of fluid is expected
281
Q

How are Active drains removed?

A
  1. When fluid production decreases (2-5 days)
  2. Less than 2-4ml/kg/day
  3. Large surgery decficits (Can be up to 3 weeks of fluid production)
282
Q

What should you inspect of drains?

A
  1. Kinks
  2. Blockages
  3. SSI at stoma site
  4. Px interferance
283
Q

What should you apply around passive drain stoma sites?

A

Barrier creams

284
Q

How do you empty a closed drain?

A
  1. PPE
  2. Empty Q 4-6 hrs or when full
  3. BE AWARE - frequent emptying can inc chance for contamination + ascending infection
285
Q

True or False.

All px’s with open wounds should be barrier nursed

286
Q

What type of drain has a lesser risk of ascending infection?

A

Active drains

287
Q

What are passive drains commonly made of?

A

Rubber or Latex

288
Q

What is this?

A

Jackson Pratt, Active drain

289
Q

How long may it take for Jackson Pratt drains to work well?

A

3 - 5 days

290
Q

What ax of fluid indicates removal of a drain?

A

Fluid production < 2ml/kg/24hrs

291
Q

What is the expected ax of fluid production from a drain?

A

2 - 4ml/kg/24hrs

292
Q

When are Tracheostomy tubes used?

A
  1. Complete upper airway obstruction
  2. Req Airway protection
  3. Airway patency
  4. Mechanical ventilation
  5. Unable to intubate (BOAS)
  6. Laryngeal paralysis
293
Q

What are the complications that can occur from Tracheotomy tubes?

A
  1. Underlying disease
  2. Tube dislodgement
  3. Obstruction
  4. Aspiration pneumonia
  5. Infection
  6. Tracheal necrosis
  7. Tracheal stenosis
  8. Pneumothorax
  9. Pnuemomediastinum
294
Q

How do you remove secretions from Tracheotomy tube?

A
  1. Remove inner cannula Q 4-6 hrs minimum + disinfect
  2. Replace w/sterile cannula
  3. Single-lumen - entire tube needs replaced
295
Q

When is a Chest drain required?

A

In-dwellng catheter into pleural space to drain air or fluid

296
Q

If not trained when placing a chest drain, what can you cause?

A

Iatrogenic pneumothorax

297
Q

What is a Central Line?

A
  1. Long-stay catheters
  2. Used for long-term hospitilization
  • Allow for:
    1. Multiple blood draws
    2. Large vol or rates of IVFT
    3. High concentrations of medications at constant rate
298
Q

When are Oesophagostomy tubes used?

A
  1. Feeding longer than 7-10 days
  2. Functioning, unobstructed oesophagus + GI tract
    * Disorders of:
  3. Nasal passages
  4. Jaw bones
  5. Oral cavity
299
Q

Which are Insensible/Inevitable losses?

  1. Respiration
  2. Urine
  3. Faeces
  4. Skin
A
  1. Respiration
    +
  2. Skin
300
Q

Which are sensible losses?

  1. Respiration
  2. Urine
  3. Faeces
  4. Skin
A
  1. Urine
    +
  2. Faeces
301
Q

What is the maintence fluid calculation?

A

M = 50ml x BW(kg)

302
Q

What % of hydration causes:
1. Slight loss of skin elasiticity
2. Hair standing on end

303
Q

What % of hydration causes:
1. Dry mm
2. Slight dec skin elasitcity
3. Slight inc USG

304
Q

What % of hydration causes:
1. Marked loss of skin elasticity
2. Inc USG
3. Dec urine output
4. Sunken eyes
5. Tachycardia
6. Slightly prolonged CRT

305
Q

What % of hydration causes:
1. Skin tenting
2. Sunken eyes
3. 3rd eyelid protrusion/nictating membrane
4. Oliguria then anuria
5. Weak pulse
6. Prolonge CRT
7. Signs of shock
8. Lethargy

306
Q

What % of hydration causes:
1. Depression
2. Collapse
3. Shock
4. Moribund
5. Death

307
Q

What is general normal pH of Dogs + Cats?

A

7.35 - 7.45

308
Q

How can fluid therapy be admin?

A
  1. Orally
  2. IV
  3. SC
  4. IP
  5. IO
309
Q

What is a solute?

A
  • Solid
  • Liquid
  • Gas
  • Dissolved to make solution
310
Q

What is a solution?

A

A solute dissolved within a solvent

311
Q

What is a Solvent?

A

Liquid protion of solution

312
Q

What is an Isotonic solution?

A
  1. Concentration
  2. Equal to
  3. Plasma
313
Q

Name the 2 intracellular + 2 extracellular Electrolyte Cations

A
  • Intracellular
    1. Potassium
    2. Magnesium
  • Extracellular
    1. Sodium
    2. Calcium
314
Q

Name the 2 intracellular + 2 extracellular Electrolyte Anions

A
  • Intracellular
    1. Phosphate
    2. Proteins
  • Extracellular
    1. Chloride
    2. Bicarbonate
315
Q

What is the pH of blood dependent on?

A

Concentration of hydrogen ions (H+) dissolved within the blood

316
Q

What is Hypovolaemia?

A
  1. Inc concentration of blood
  2. Low plasma volume
317
Q

What is an Oedema?

A
  1. Dec plasma proteins
  2. Ineffective lymphatic drainage
318
Q

What 3 organs maintain Fluid balance?

A
  1. Brain
  2. Adrenal glands
  3. Kidneys
319
Q

What is lost in V+, despite water?

A

Stomach acid

320
Q

What is lost in D+, despite water?

A

Bicarbonate

321
Q

What is the difference between dehydration + hypovolemia?

A
  1. Dehydration = Lack of fluid in interstitial space
  2. Hypovolaemia = Lack of fluid in intravascular space
322
Q

What parameters are affected by Hypovolemia?

A
  1. CRT
  2. HR
  3. Pulse quality
  4. BP
323
Q

What are 3 main methods of assessing hydration?

A
  1. Clinical exam
  2. Urine testing
  3. Blood testing
324
Q

Identify 5 lab tests used to assess dehydration

A
  • All will rise:
    1. PCV (1% loss = fluid loss of 10mg/kg)
    2. Haemoglobin
    3. Total Plasma Protein (TPP)
    4. BUN + Creatinine
    5. USG
325
Q

What is the TP for a Dog?

A

54 - 71 g/dl

326
Q

What is the TP for a Cat?

A

54 - 78 g/dl

327
Q

Name the 4 primary acid-base distrubances

A
  1. Metabolic Acidosis
  2. Metabolic Alkalosis
  3. Respiratory Acidosis
  4. Respiratory Alkalosis
328
Q

When may Metabolic Acidosis occur?
+
What are the signs?

A
  1. Inc of acid in body
  2. Due to abnormal metabolic function
  3. Ingestion of acid substance
  4. Dec in Bicarbonate
  5. Compensatory dec in CO2
  • Csigns:
  • V+
  • D+
  • RF
  • Shock
329
Q

When may Metabolic Alkalosis occur?
+
What are the signs?

A
  1. Excessive loss of Sodium or Potassium
  2. Affects Kidney’s ability to control acid-base balance
  3. Inc is Bicarbonate
  4. Compensatory inc CO2
  • Csigns:
    1. V+ stomach contents only
    2. Over admin of Bicarbonate
330
Q

When may Respiratory Acidosis occur?
+
What are the signs?

A
  1. Resp system cannot excrete acid
  2. Lungs don’t expel Co2
  3. Inc Co2
  4. Compensatory inc Bicarbonate
  • Csigns:
    1. Resp obstruction
    2. Acute RF
    3. Hypoventilation - for any reason
    4. Anaesthetic problems
331
Q

When may Respiratory Alkalosis occur?
+
What are the signs?

A
  1. Excessive CO2 expelled from bloodstream
  2. Hyperventilation
  3. Dec Co2
  4. Compensatory dec in Bicarbonate
  • Csigns:
    1. Hyperventilation
    2. Pain
    3. Stress
    4. Hyperthermia
    5. Excessive IPPV
332
Q

What must you considere prioir to admin of Fluid Therapy?

A
  1. Type of dehydration
  2. pH of body
  3. Type req
  4. Ax req
333
Q

What is fluid vol req?

A

Maintenance vol + Deficit vol + Ongoing losses!

334
Q

What is a Crystalloid fluid?

A

Solution containing water + electrolytes

335
Q

What is a Colloid fluid?

A

Solution containing large molecules or plasma expanders

336
Q

How often should you change catheters?

A

Q 48 - 72hrs

337
Q

How often should you flush a catheter?

338
Q

11 ..

How should you monitor a px on IVFT?

A
  1. Check Csigns of hydration
  2. Use calculated vol
  3. Monitor TPR + MM
  4. Record urine output + USG
  5. Monitor PCV
  6. Monitor ongoing losses
  7. Central Venous Pressure
  8. Record all findings on fluid monitoring chart
  9. Review fluid therapy reg
  10. Monitor signs of overperfusion
  11. Weigh px daily
339
Q

Why is improtant to weight px’s on IVFT?

A

Because if they are dehydrated, they’ll weight less!

340
Q

IMPORTANT!!

What is Central Venous Pressure?

A
  1. Estimate of BP in Right Atrium
  2. Reflects ax of blood returning to heart
  3. Reflects heart’s ability to pump blood into arterial system
  4. Proportional to vol of blood in Anterior Vena Cava + Venous tone
    5.** Dec w/hypovolaemia or vasodilatio**n
  5. Inc by IVFT in critically ill px or w/cardiac disease
341
Q

List 9 Csigns of overperfusion

A
  1. Soft, moist cough
  2. Pulmonary oedema
  3. Dyspnoea
  4. Tachypnoea
  5. Tachycardia
  6. Lethargy
  7. Runny nose
  8. Dec PCV
  9. Inc urine output
342
Q

What are the 5 aims of Rehabilitation?

A
  1. Restore maximum:
    * Function
    * QOL
    * Independence
    * Following injury or illness
  2. Limit pain
  3. Return to normal functions (All activities)
  4. Build muscle
  5. Reduce recovery times
343
Q

List 4 types of Rehabilitation

A
  1. Physiotherapy
  2. Acupuncture
  3. Hydrotherapy
  4. Mctimoney
344
Q

What is Acupuncture?
+
When is it used?

A
  1. Insertion of needles into specific points on body to produce a healing response
  2. To:
    * Promote natural healing
    * Enhance blood circulation
    * Enhance oxygenation to BVs
    * Relax muscles
    * Relieve pain
    * Reduce swelling
    * Removal of waste products/toxins
    * Correcting energy imbalances within body
    * Stimulatese nervous system
345
Q

What is Hydroptherapy?
+
When is it used?

A
  1. Any healing or therapuetic water
  2. Controlled exercise in water
  3. Zero or low impact
  4. Non-weight baring in controlled weight bearing exercise
  5. Uses Buoyancy, Hydrostatic pressure, Cohsion + Turbulence
  6. To:
  • Relieve pain
  • Reduce swelling + stiffness
  • Circulatory benefits
  • Improved cardiovascular fitness
  • Inc mental stimulation
  • Improved gait pattern
  • Muscle strength
  • Joint mobilisation
346
Q

When is Hydrotherapy indicated?
+
Contraindicated?

A
  1. Indicated
    * Pre + Post orthopaedic sx
    * Pre + Post spinal sx
    * Muscle atrophy
    * Obesity management
    * Orthopdic conditions/disease
    * Neurological conditios
    * Performance, working or show dog conditioning
    * Behavioural issues
  2. Contraindicated
    * Cardiac dysfunction (overheat)
    * Respiratory dysfunction (hydrostatic pressure > inc effort)
    * Severe peripheral vascular disease (Damage BVs)
    * Infections (Spread)
    * Coagulopathies (Inc blood flow)
    * Unstable fractures (must be fully hx)
    * V+
    * D+
    * Precautionary conditions (Season, Epilepsy, Chemo, DM)
347
Q

What is Mctimoney?
+
When is it used?

A
  1. Physical manipulation using gentle hands to realign balance + muscoskeletal system
    * Precise + rapid adjustments of spine + pelvis by Chiropractor/VS referral
  2. Used:
    * Post-Ortho sx
    * Injurd/accident
    * Working or competing dogs
    * Mobility issues (Conformation defects, Obese)
    * Lameness
    * Exercise intolerance
    * Uneven gait
    * Stiff + pain post-exercise
    * Changes in performance, behaviour + temperament
    * Uneven muscle development
    * Signs of discomfort when back touchde
348
Q

What is Physiotherapy?
+
When is it used?

A
  1. Combo of techniques to create a tailor made rehabilitative program for an individual
    * Thermotherapy
    * Massage
    * Therapuetic exercises
    * Laser therapy
    * Electrial stimulation
    * Therapuetic ultrasound
    * Extracorporeeal shockwave therapy (ESWT)
  2. Used for:
    * Geratrics
    * Post-op recovery
    * Stable post-sx
349
Q

When is Physiotherapy contraindicated?

A
  1. Pyrexia (Inc blood flow = inc heat)
  2. Infection (Spread)
  3. Vascular compromise
  4. Coagulopathy
  5. New or Unstable fractures
  6. Spinal instability
350
Q

When do you use Thermotherapy?
+
When do you use Cyrotherapy?

A
  1. Thermotherapy
    * Chronic pain
    * Relax tense muscles
    * Aches
    * Arthiritis
  2. Cyrotherapy
    * Acute injury
    * After activity
    * Reduce swelling
    * Sprains
    * Bruises
    * Pain
351
Q

Name the 4 types of massage techniques

A
  1. Stroking
    (Long, slow gliding strokes)
  2. Effleurage
    (Firm stroking movements towards lymph nodes)
  3. Petrissage
    (Kneading, picking up, rolling + compressions)
  4. Frictions
    (Deep transverse massage w/fingertips)
352
Q

Give 1 indication of each of these Massage techniques:
1. Stroking
2. Effleurage
3. Petrissage
4. Frictions

A
  1. Stroking
    (Long, slow gliding strokes)
    * Aids circulation
    * Inc lymph flow
    * Stimulates sensation
  2. Effleurage
    (Firm stroking movements towards lymph nodes)
    * Inc lymph flow
    * Reduces oedema
  3. Petrissage
    (Kneading, picking up, rolling + compressions)
    * Mobilises soft-tissue
    * Enhances deeper circulation
    * Aids toxin removal
  4. Frictions
    (Deep transverse massage w/fingertips)
    * Breaks down adhesions
    * Improves fibre alignment
353
Q

What is ROM or PROM?

A

Range Of Movement
Or
Passive Range Of Movement

354
Q

Identify nursing care for suspect Spinal/Non-ambulatory px

A
  1. Massage - Effleurage in UPWARDS DIRECTION
  2. Standing
  3. Toothbrush
  4. ROM
  5. Turning
  6. Urinary catheter care +/- Manual bladder emptying
  7. Grooming
  8. Feeding
  9. Wound interferance
  10. Nursing Care Plan
355
Q

What is Shock?

A

Acute circulatory failure resulting in inadequate tissue prefusion + energy production

356
Q

What is Stage 1 shock?

A
  • Compensatory shock
  • Attempt to reduce effects of shock
  1. Baroreceptors detect reduc cardiac output
  2. Stimulate adrenaline + noradrenaline
  3. Causes inc HR + contractility
  4. Hypoxia of tissues > metabolic acidosis
  5. Inc Ventilation - to address acid-base balance
  6. **Hypoperfusion of kidney **activates RAA system
  7. Aldosterone acts on collecting ducts to retain Na + H20
  8. Causes peripheral vasconstriction
357
Q

What is Stage 2 shock?

A
  • Decompensatory
  • No longer able to compensate
  • When shock is not treated
  1. Fluid + proteins leak from circulation > tissues - due to peripheral vasodilation
    3.** Inc blood viscosity**
  2. Acidosis inc
  3. Gut becomes Ischaemic
  4. Bac enter blood stream
  5. Inc stuporous of comatose
358
Q

What is Stage 3 shock?

A
  • Irreversible
  • Too much cell death - non-reversable
  1. Systemic Inflammatory Response Syndrome (SIRS)
    * Inflammatory injury to 1 organ systems
    * Causes knock-on effect
    * Infectious or non-infectious cause
  2. Disseminated Intravascular Coagulation (DIC)
    * DEATH IS COMING
    * Activiation of haemostatic mechanisms
    * Induces prothrombotic state
    * Leads > bleeding tendencies (can’t clot)
  3. Multi-Organ Dysfunction (MOD)
    * SIRS + Septic shock > MODs
    * Every organ + system is affected
  4. Death

  1. SIRS
  2. DIC
  3. MOD
359
Q

List 3 stages of shock

A
  1. Compensatory
  2. Decompensatory
  3. Irreversible
360
Q

Name 4 types of shock

A
  1. Hypovolaemic
  2. Septic/Distributive
  3. Cardiogenic
  4. Obstructive
361
Q

What happens in Hypovolaemic shock?

A
  1. Heart pumps well
  2. But dec circulating vol
  3. Due to blood, fluid or plasma loss
  4. Results in Hypoperfusion
362
Q

What happens in Septic/Distrubitive shock?

A
  1. Distrubitive due to hypotension
  2. Heart pumps well
  3. But peripheral vasodilation
  4. Gram-ve bac infection
  5. Endotoxins released from ruptured bac cells
  6. Toxins > circulation inc capillary permeability - causing uneven fluid distrubution
363
Q

What happens in Cardiogenic shock?

A
  1. Reduc in cardiac efficacy
  2. Heart loses ability to pump effectively
  3. Leads to reduc in cardiac output
  4. Results in congestion in Liver + Lungs
  5. Causes oedema
364
Q

What happens in Obstructive shock?

A
  1. Obstruction of normal blood flow
  2. Heart pumps well
  3. Outflow obstructed
  4. Causesed by pulmonary thromboembolism or pericardial effusion
  5. Pericardial effusion - blood unable to fill ventricles > cardiac output is red
  6. Removal of obs will resolve signs
365
Q

What is the Isotonic fluid shock rate for a Dog?

366
Q

What is the Isotonic fluid shock rate for a Cat?

367
Q

What is the Hypertonic fluid shock rate for a Dog?

A

4 - 5 ml/kg

368
Q

What is the Hypertonic fluid shock rate for a Cat?

A

2 - 4 ml/kg

369
Q

What is the Hydroxyetyl starches fluid shock rate for a Dog?

A
  • Up to 20ml/kg
  • Divide into 5ml/kg boluses + reassess
370
Q

What is the Hydroxyetyl starches fluid shock rate for a Cat?

A
  • Upe to 10 ml/kg
  • Divide into 2.5 - 3 ml/kg boluses + reassess
371
Q

What is the Crystalloid or Colloid fluid shock rate for a Dog?

A
  1. Crystalloid = 4 - 45 ml/kg
  2. Colloid = 5 - 10ml/kg
372
Q

What is the Crystalloid or Colloid fluid shock rate for a Cat?

A
  1. Crystalloid = 25 - 27 ml/kg
  2. Colloid = 1 - 5 ml/kg
373
Q

How much blood can Cats + Dogs donate?

A

20%

Max in Dogs = 18ml/kg
Max in Cats = 11ml/kg

374
Q

What is the formula for finding out correct total blood volume required for a transfusion?

A

Vol of donor blood req (ml) x BW(kg) x Desired change in PCV

ALL DIVIDED BY

PCV of transfused blood

375
Q

Give calculation of how much blood volume to be transfused in mls to a px

A

k = Constant rate, 70 for dogs, 60 for cats

k x BW(kg) x req PCV - Recipient PCV
Divided by (only req PCV&raquo_space;)
PCV of red cell product

376
Q

How many mls of PCV does it take to raise a PCV by 1%?

A

1 ml/kg of PCV
OR
2ml/kg Whole blood

377
Q

Collate a list of questions you would ask an owner on a care plan

A
  1. What is Fluffy’s normal routine? When does she normally eat, go to the toilet and sleep?
  2. How much/what type of exercise does Fluffy get? What type, for long how?
  3. What does Fluffy eat, how much, how many meals? Does she have any treats, if so, what are they? What type of bowl does she use?
  4. How much does Fluffy drink + How is she given water?
  5. What are her normal activities behaviours? Does Fluffy have any stress triggers?
  6. Where does Fluffy normally go to the toilet? What are her normal toileting behaviours? Type of area? How often does she pass urine/stools?
  7. How do you normally groom Fluffy?
378
Q

Collate a list of questions you would ask an VS on a care plan

A
  1. Were there any complications during surgery or GA?
  2. What is the volume, strength, frequency + time due for Fluffy’s medications?
  3. Is Fluffy NPO (nil per os) or what/when can she have food/water?
  4. Is Fluffy on strict cage rest? If no cage rest - Can Fluffy be allowed out for toileting/exercise?
  5. What are the bladder considerations?
  6. Does Fluffy have a buster collar on?
  7. Any specific wound care considerations?
  8. What’s the plan?
  9. How long might the ESF be inplace for?
  10. Is there any specific monitoring information required by the VS?
379
Q

How would you provide adequate nutrition for a Cardiac patient?

A
  1. Palatable diet
  2. Maintain calorie intake
  3. Provide high-quality BV protein
  4. Restricted sodium diet
  5. No high-salt treats
380
Q

How would you provide maintain hydration for a Cardiac patient?

A
  1. Ensure accurate fluid plan in place + followed
  2. Check for overperefusion
  3. Provide oral fluids
381
Q

How would you ensure a Cardiac patient is able to defecate normally?

A
  1. Maintain hydration
  2. Low intensity exercise, if possible to stimulate persistaltic contractionss
  3. Oral lubricants with food - if palatable
382
Q

How would you ensure a Cardiac patient is able to urinate normally?

A
  1. Allow frequent toilet trips - if able to mobilse
  2. Indwelling catheter
  3. Kennel liners
383
Q

How would you provide maintain oxygenation for a Cardiac patient?

A
  1. Provide 02; oxygen cage, flow-by + nasal cannula
  2. Limited handling - reduce stress, care around neck + chest regions
  3. Peripheral catheter inserted as precaustion if no fluids
  4. Crash cart avaliable if required
  5. Weight management
384
Q

How would you provide maintain body temperature for a Cardiac patient?

A
  1. Insultate to ensure peripheral circulation is maintained
  2. Normal environmental temp/fan to ensure no overheating
385
Q

How would you provide maintain skin + coat conidtion for a Cardiac patient?

A
  1. Maintain skin integrity - skin care, bathing if soiled, keep skin dry
  2. Assist with - grooming, eye + oral hygiene (Particulary if not drinking + panting)
386
Q

How would you provide mobilise adequately for a Cardiac patient?

A
  1. Cage rest - where appropriate
  2. Low Intensity exercise - care with steps + inclines
  3. Use harness, instead of collar
  4. PROM exercises
387
Q

How would you provide maintain adequate sleep + rest for a Cardiac patient?

A
  1. Minimal procedures + handling
  2. Group together observations, nursing interventions + medications
  3. Periods with reduced lighting
388
Q

How would you ensure a Cardiac patient is able to Express normal behaviours?

A
  1. Stress-free handling - minimal contact, no scruffing, avoid neck area
  2. Provide hide - care with monitoring
  3. Reduce environmental noise - away from noisy patients, domestic noises, radio etc
389
Q

15 ..

What nursing interventions may you use for nursing Neurological patients?

A
  1. Supportive bedding
  2. Care handling
  3. No leads or collars
  4. Sternal recumbency + Turn Q2 hrs
  5. Coupage
  6. Nebulisation if required
  7. Supported walking or cage rest
  8. Decubitus uclers - check + prevent
  9. Monitor urination + defecation
  10. Manual expression or urinary catheterisation
  11. Assisted feeding - care to protect airways, tube feeding if required
  12. Ensure meet RER
  13. Pain management
  14. Skin care + grooming
  15. Maintain body temperature (Q15 mins until within normal ranges)
390
Q

What may a Neurological + Assessment + Plan involve?

A
  1. Results from Neurological assessment
  2. Urination + Defecation function assessment
  3. Mobility
  4. Independent feeding
  5. Rehabilitation plan
391
Q

When may this be used?

A

To perform a Neurological assessment

392
Q

What nursing care is involved in the Immediate Post-op rehabilitation period for Neurological patients?

A
  1. Pain control
    * Buprenorphine, Methadone etc
    * Pre + Post-op
  2. Massage
    * 20 mins
    * 2-3 x day
    * Warms the muscles
  3. Cyrotherapy
    * 10-15 mins
    * 2-4 x day
    * Reduce inflammation, pain, heat
    * 3 days for post-Orthopeadic-surgery
393
Q

What nursing care is involved in the Early Post-op rehabilitation period for Neurological patients?

A
  1. Massage
  2. Passive ROM exercises
    * 10-15 cycles
    * 2-3 x day
  3. Thermotherapy
    * 10-20 mins
    * 2-3 x day
    * Depends on weight
    * 3-post surgery
    * Chronic conditions
  4. Alternative therapies
    * Ultrasound
    * TENS
394
Q

What nursing care is involved in the Late Post-op rehabilitation period for Neurological patients?

A
  1. Exercise
    * Active
    * Active-assisted
    * Active-resisted
  2. Walkers/wheelchairs
  3. Low-level light therapy
395
Q

What may a Opthalmic + Assessment + Plan involve?

A
  1. Attempt to evaluate level of sight
  2. Ability to cope w/unfamiliar environments (will bring stress)
  3. Level of stress
396
Q

9 …

What possible Nursing Interventions would you use for Opthalmic patients?

A
  1. Use voice to make patient aware of approach
    * Call name, make presence known
  2. Reassurance, particulary when moving/carrying out procedures
  3. Reduces stress + excitement
    * Quiet ward
    * Reduced light
    * Blanket over kennels
    * Pheremones
  4. Careful handling
    * Opthalmic pain is extreamly painful
  5. Be aware of aggresive tendencies
  6. Keep routine for feeding + bowls
    * Ask O for familiar items + scent
  7. Prevent self-trauma
    * E-collar
    * Don’t let them rub their eye, will if sutured, may be in for 10+ days, as will req another op if so!
    8.Occular hygiene + lubrication
    * Use gentle, clean, cotton guaze
    * Lubricating eye drops
    * Remove secretions + blood etc
  8. Accurate + Careful medication
  9. Dim lights

Advanced EVPC Yr2 (28 decks)

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