Perioperative nursing (SA15) Flashcards
What is the purpose of post op management?
- Recover patient from anaesthesia
- Prevent/manage post-op complications
- Identify new problems rapidly
- Ensure patient welfare
Why does the procedure performed need to be included in a handover?
- Recovery nurse can understand possible complications and considerations
- Considerations and requirements written on patient records
When do most anaesthetic deaths occur and what is important to manage and reduce this?
- Recovery period
- Important to record progression of recovery
- Report concerns quickly
What does the recovery nurse need to ensure in preparation for removing an ET tube?
- Check cuff is deflated
- Tie removed
When should the ET tube be removed in dogs?
- When gag/cough reflex returns
- When dog first swallows
When should the ET tube be removed in cats and rabbits? Why?
- Just before gag/cough reflex returns
- Reduce risk of laryngospasm
- When ear twitch reflex returns on cats
How should patients be positioned during recovery?
- Does not restrict airway or breathing
- Lateral recumbency with head and neck extended
- Some need sternal recumbency to aid breathing and prevent atelectasis
- Brachycephalics in sternal with chin elevated
- Can tolerate ETT in place until awake to reduce risk of respiratory obstruction
How long should patients have close and continuous observations during recovery?
- Until lifting head
- Responds to verbal stimulation
How long should patients have frequent monitoring?
- Until fully recovered
When should vital signs be monitored and recorded during recovery?
- Immediately after handover
- At 15 minute intervals until patient is fully recovered
- If concerns arise, can record more frequently
Which vital signs should be monitored and recorded during recovery?
- Extubation time
- Temperature
- MM colour, CRT
- Peripheral pulse quality
- Pulse/HR
- RR
- BP if hypo/hypertensive during surgery
- Demeanour
Why should significant parameter changes be reported to the veterinary surgeon?
- Complications may be occuring
- Can be life threatening, highest risk in recovery
Why must multiple parameters be monitored and recorded throughout recovery?
- Increase information obtained
- Monitor trends
- Limited from single, one off measurements
- Miss indications until problem progressed
What may decreasing blood pressure with increasing heart rate indicate?
Hypovolaemia
What may increasing heart rate, respiration rate and blood pressure signify?
Pain
What is a common complication following general anaesthesia?
- Hypothermia
- Active warming may be necessary
- Heat pads, warm air blankets, extra bedding, bubble wrap
What is the risk of using hot hands?
- Risk of thermal injuries if bursts or are too hot
What are the complications of prolonged hypothermia?
- Surgical site infections
- Nosocomial infections
- Prolonged action of drugs
- Delayed recovery
- Shivering
How does shivering affect the patients oxygen demand?
- Increased oxygen demand up to 300%
What treatment instructions should be included in the hand over?
- New medications
- Changes to current medications
- Medication times/frequency
- Medication given during procedure
- Pain management (score/analgesia)
- Care for bandages
- Catheter, tube, drain instructions
- IVFT requirements/changes
What common post op complication is caused by patients and how can this be prevented?
- Wound, catheter, tube, drain interference
- Elizabethan collar, pet medical shirt
What is the difference between the IVFT requirements for a healthy routine procedure vs. significant haemorrhage?
- Healthy, routine, normotensive may discontinue IVFT post op
- Significant haemorrhage during surgery will have more complex IVFT and monitoring requirements
What things can indicate pain?
- Do not move when urinating in kennel
- Inappetence
- Uncharacteristic aggression
- Changes in behaviour
- Crying out in pain
Where should rabbits be recovered and why?
- Prey species
- Prep room may be shared with predator species
- Can cause extreme stress, detrimental for recovery
- Recover somewhere quiet
- Exotics ward, portable carrier in quiet area
Why shouldn’t shavings be used as bedding post op? What should be used instead?
- May stick to surgical wounds
- Increase likelihood of surgical site infections
- Use towels or blankets until healed
Why should electric heat pads not be used while the recovering patient is left unattended?
- May chew cables
How should patients with fracture repairs or procedures restricting mobility be recovered?
- In small kennels
- Can’t move around too much during disorientation in recovery
How should old and arthritic patients be recovered?
- Reduced fat and mobility
- Padded bed/orthopaedic mattress
- More likely to suffer from hypothermia
- Prepare active warming before handover
How should patients be recovered?
- Bowls/litter trays removed until recovered
- Warm soft bedding
- Vet bed wicks away liquid to prevent sores
- Ambient temperature 22-24C
What PPE should be worn during a dental procedure and why?
- Goggles, Gloves, Face Masks
- Protect all staff from debris, aerosol and splatter
What pieces of furniture are important for dental procedures and why?
- Adjustable table for appropriate working position to avoid injury
- Operating light can be positioned for better visualisation
How should a patient be positioned during a dental procedure?
- Comfortable for the patient and vet or nurse
- Likely they will require turning to access all areas of mouth and positioning for dental x-ray
- Ionising Radiation Regulations 2017 must be adhered to
How should dental equipment be prepared?
- Avoiding clutter
- Facilitating easy access
- Avoiding contamination of unused equipment
- 2 metre radius of spray (bacteria)
- Size of patient and species will change equipment needed
What is a dental probe?
- Sharp pointed instrument
- Used to explore the mouth and feel for tooth abnormalities
- Can be double ended and include a periodontal probe (explorer probe)
What is a periodontal probe?
- Explorer probe
- Measure depth between gingival margin and gingival attachment to tooth and gingival recession
- Blunt tip avoids soft tissue and tooth surface trauma
What are dental mirrors used for?
- Aid visualisation of all tooth sides without moving the patient
What care should be taken with dental mouth gags?
- Prolonged retraction of cat jaws can cause blindness
- Removed periodically
- Jaw opened and closed several times before replacing it
What are dental elevators?
- Aid removal of teeth
- Apply downwards force to wedge tip between marginal bone and tooth root
- Come in different sizes and degrees of concave and angle
What is a dental luxator?
- Finer and sharper than elevators
- Fit in periodontal ligament space to cut ligament
- Do not use to apply rotational force as can damage instrument
What are dental extraction forceps?
- Complete loosening of tooth and remove it from socket
- Extreme care used to not break tooth with excessive or improper force
What are dental tartar forceps?
- Remove bulky deposits of tartar before ultrasonic scaling
What are dental periosteal elevators?
- Raise soft tissue when performing flap to achieve surgical excision
What is a dental ultrasonic scaler?
- Remove tartar from tooth
- Side of scaler contacts tooth
- NOT TIP
- Constantly move
What is a dental air driven drill?
- Used to section crown of multi-rooted teeth to aid removal
- Variety of burrs available
What is a dental air driven polisher?
- Polish teeth and remove stains
- Disposable rubber cups
- Apply vet dental polish to crown of teeth
- Avoid contact with gum and soft tissue
What is an epulis and how can they be removed?
- Gingiva mass
- Often benign
- Can cause difficulty if become large
- Often removed at same time as dental
- Monopolar (cutting) diathermy can aid removal
What is a maxillectomy/mandibulectomy?
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What are the properties of cast materials?
- Comfortable
- Easy to apply
- Strong/hard wearing
- Radiolucent
- Lightweight, not bulky
- Easy to remove
- Water resistant, breathable
- Economical
