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JJ > Post Op Care COPY > Flashcards

Post Op Care COPY Flashcards

1
Q

define pre-operative

A

before surgery

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2
Q

what is involved in the pre-operative period?

A

any prior preparation, premedication up until the point of induction of general anaesthesia

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3
Q

what is involved in the peri operative period?

A

operative period from the start of genera anaesthesia until the patient wakes up form inhaled anaesthesia or anaesthesia is antagonised

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4
Q

what is the post operative period?

A

return to normal after general anaesthesia and surgery, during which the patient must be monitored closely

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5
Q

when does the recovery period end?

A

when a full level of consciousness is present and physiological values have been normailised

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6
Q

why is the post op period so important?

A

period of greatest risk during anaesthesia

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7
Q

what is a major contributory factor to mortality of animals in the recovery period?

A

a lack of continuous monitoring

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8
Q

where should the patient be transferred to for recovery?

A

clean, dry, comfy and quiet kennel

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9
Q

why must the recovery area be safe?

A

in case of thrashing, dysphoria or aggression

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10
Q

when can close monitoring of the recovering patient end?

A

until the animal is able to remain in sternal recumbancy unaided

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11
Q

when should the ET tube be removed in dogs?

A

when the animal is starting to swallow or move the tongue

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12
Q

when must cats be extubated?

A

earlier than dogs - when blink reflex returns as they are prone to laryngeal spasm - fatal

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13
Q

what should you do following extubation to ensure the airway remains patent?

A

extend the neck and head, pull the tongue forwards

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14
Q

what is different about extubating brachycephallic breeds?

A

may benefit from tube remaining in place until in sternal recumbancy to aid breathing

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15
Q

what will slow a patients recovery?

A

low temperature

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16
Q

what can be placed in the kennel in order to warm the patient?

A

hot hands
hot water bottles
heat pads

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17
Q

what parameters should be monitored in the recovering patient?

A

TPR
MM
lung auscultation
CRT

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18
Q

what is monitoring of the recovering patient looking for?

A

signs of haemorrhage or other complicatiosn

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19
Q

when may blood pressure be monitored in the recovering patient?

A

digital pulses or using doppler in a patient who you are concerned about - should have an idea of BP and its trend from peri-operative monitoring

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20
Q

does IVFT always need to continue post operatively?

A

only if animal is at risk - most cna come off

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21
Q

what animals are likely to need to stay on IVFT through recovery?

A

animals at risk of kidney injury or CKD
sick animals (e.g. pyometra)
low perioperative BP

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22
Q

what makes pain assessment in the post op period difficult?

A

determining dysphoria vs pain
animals level of sedation (unable to respond normally)
species differences (e.g. cats and rabbits)

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23
Q

what can we use to assess pain?

A

GPS
CMPS - Feline
Rabbit grimace scale

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24
Q

when should water be made available to patients?

A

as soon as the animals is able to hold themselves in sternal

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25
Q

what will be fed following most routine operations?

A

soft bland food

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26
Q

when will most animals be fed following routine surgery?

A

soon after they have fully regained consciousness and seem capable of eating

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27
Q

what is different about feeding cats in hospital?

A

some cats will be reluctant to eat in hospital which is not necessarily a concern

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28
Q

why is it a priority to get rabbits eating ASAP following surgery?

A

to prevent gut stasis

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29
Q

when should rabbits be syringe fed if they are not eating by themselves?

A

within 2 hours of surgery

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30
Q

what will wounds be covered with?

A

mostly surgical wounds will be covered with a dressing e.g. primapore

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31
Q

why is a buster collar usually necessary as soon as the patient is transfurred to the kennel?

A

to prevenet interference

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32
Q

what cna be used as an alternative to the buster collar?

A

medical vest

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33
Q

when should dogs be walked following surgery?

A

when able to stand and move comfortably

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34
Q

is defecation expected soon after surgery?

A

no - some animals may have diarrhoea which should be monitored

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35
Q

when should special attention be paid to urination?

A

following any surgery involving the urogenital tract (e.g. bitch spay) in case of complication

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36
Q

why should rabbits droppings be monitored?

A

as an indication of gut motility / stasis

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37
Q

how can gut stasis in rabbits be prevented?

A

lowering of stress
provide fresh hay, pellets and favorite foods at all times
syringe feed if not eating

38
Q

how can you lower rabbits stress while in practice?

A

ensure quiet ward away from predators (including smell of them if possible!)
bring the other half of their bonded pair with them
ensure hiding places available

39
Q

how can you ensure that you are monitoring the recovering rabbits faeces?

A

set up a partition in kennel so that rabbits can see each other but you are able to see individual rabbits droppings seperately

40
Q

why should eye lube be continued post operatively in rabbits?

A

as they are more likely to end up with eye ulcers due to mask use

41
Q

what medication may be given to rabbits to reduce gut stasis risk?

A

pro-kinetics

42
Q

how should pain be recognised?

A 
pain scales
facial expression
behaviour
inappaetance
reluctance to move
43
Q

how is pain managed?

A

pain relief

44
Q

how is post op haemorrhage recognised?

A 
slow CRT
pale MM
low BP
tachycardia
lethargy
dull behavour
45
Q

how will post op haemorrhage be managed?

A

likely to require surgical management and exploration

46
Q

how can aspiration pneumonia be recognised?

A

fluid from nose (esp. cats)
crackles on lung auscultation
dyspnoea

47
Q

what patients are more at risk from aspiration pneumonia?

A

dentals
vomiting / regurgitating
brachycephallic breeds
long surgeries

48
Q

how should aspiration pneumonia be managed?

A

need close monitoring (TPR) and oxygen
care with IVFT so that the problem is not made worse
vet may prescribe antibiotics and diuretics to help clear the lungs of fluid

49
Q

how should a patient that is taking a while to recover be managed?

A

ensure adequate temperature
consider antagonising any drugs still acting
monitor closely

50
Q

how is gut stasis recognised?

A

lack of faeces production and inappetance

no borborygmi sounds (unreliable)

51
Q

what patients can gut stasis be seen in?

A

possible in any patients post op but most likely in abdominal patients and rabbits

52
Q

how should gut stasis be managed?

A

manage complicating factors (e.g. pain)
promotility agents
IVFT
careful monitoring

53
Q

how is wound breakdown (dehiscence) recognised?

A

strike through dressing material

sutures may be disrupted

54
Q

how can wound breakdown (dehiscence) be managed?

A

may require surgery

55
Q

how should aggressive / dysphoric animals in recovery be managed?

A

anticipate before waking from GA - replace muzzle, buster collar or vest on, ensure secure IV

56
Q

how can a crashing patient be recognised?

A

bradycardia
apnoea
non-responsive

57
Q

how should a crashing in the recovery period be managed?

A

initiate CPR
get help
ALS

58
Q

what are the 4 most common medications given in the post op period?

A

pain relief
anti emetics
antibiotics
probiotics/kaolin

59
Q

when is opioid analgesia frequently used?

A

in routine surgeries

60
Q

what level of pain is methadone used for?

A

severe

61
Q

what are the routes of administration for methadone?

A

IV
IM
SC

62
Q

what is the duration of action of methadone?

A

4 hrs

63
Q

what level of pain is buprenorphine used for?

A

moderate

64
Q

what are the routes of administration for buprenorphine?

A

IV
IM
SC
sublingual (cats

65
Q

what is the duration of action of buprenorphine?

A

6-12 hours

66
Q

what level of pain is fentanyl used for?

A

severe

67
Q

what are the routes of administration of fentanyl?

A

IV or dural patch

68
Q

how long can a fentanyl patch take to reach full onset?

A

24 hours

69
Q

why must animal not lick or chew a fentanyl patch?

A

risk of overdose

70
Q

what are the main side effects of opioids?

A 
all should be transient - 
respiratory depression
bradycardia
panting
salivation
vocalisation
urination
defication
71
Q

how long do NSAID injections usually last?

A

24 hours

72
Q

what is the route of most NSAID injections?

A

SC

73
Q

what must be checked if giving NSAIDs post op?

A

ensure adequate BP to avoid renal damage

74
Q

when are NSAIDs most often given?

A

peri-operatively

75
Q

what are 2 examples of NSAIDs?

A

metacam

carprofen

76
Q

what are the main side effects of NSAIDs?

A

mostly transient GI effects (vomiting or diarrhoea)
lethargy
renal failure
vary rarely more serious e.g. gastric ulcers

77
Q

are anti emetics always used?

A

not usually but will be used if signs of nausea present

78
Q

what are the main examples of anti-emetics?

A

maropitant (Cerinia)
raniridine
metaclopramide

79
Q

what are the routes of administration of Maropitant (Cerinia)?

A

SC
IV
PO

80
Q

what anti emetics are also pro-mobility agents?

A

Ranitidine

Metaclopramide

81
Q

what are the signs of nausea?

A

lip licking
hypersalivation
crouched positon
inappetance

82
Q

what are the side effects of Cerenia?

A

pain on SC injection

83
Q

what are the side effects of ranitidine?

A

hyotension
weakness
cardiac arrhythmia (IV administration)

84
Q

what are the side effects of metoclopramide?

A

rare - behavioural changes, sedation

85
Q

when are antibiotics most commonly used post operatively?

A

orthopedic procedures
sick patients
surgeries lasting over 2 hours
dental disease or wound infection where they form part of treatment plan (most likely PO)

86
Q

what are the main IV antibiotics?

A

synuclav
cephalosporin
metronidazole

87
Q

what are the side effects of metronidazole?

A

vomiting and neuro side effects (e.g. seizures)

88
Q

what are the side effects of amoxy-clav?

A

nausea
diarrhoea
skin rashes

89
Q

are probiotics/kaolin routinely used post op?

A

not unless diarrhoea in the post op period

90
Q

what is the role of probiotics / kaolin?

A

binds faeces and puts good bacteria back into gut

91
Q

what animals are probiotics / kaolin good for before and after surgery?

A

rabbits

JJ (33 decks)

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