Post operative nursing needs Flashcards
What are some nursing considerations for post operative care?
- stress reduction
- life stage
- nutrition
- surgery type
- infection control
- wound care
Why should a nurse consider stress reduction for a patient?
Stress greatly increases healing time.
There should be separate wards for different species. Consider use of a hormone spray such as feliway or pet remedy. The ward should be kept quiet and dimmed if possible - photoperiod should be observed.
Rabbits specifically should have a friend brought with them
Why should a nurse consider life stage for a patient?
Particularly old or arthritic animals will large beds and bottom kennels. Neonates will need to be kept warmer as they cannot thermoregulate. Life stage may also affect things like IVFT
Why should a nurse consider a patient’s nutrition?
Neonates will require higher calories and more regular meals. Rabbits should not be starved to prevent ileus. No new diets should be started to prevent the Garcia effect
Why should a nurse consider the type of surgery a patient has had?
Type of surgery will affect positioning and handling e.g. ophthalmic patients should not have slip leads
Define an OTOMY
A temporary opening. It denotes a procedure for cutting open tissue during surgery
What are some examples of ‘otomies’?
Rhinotomy, tracheotomy, thoracotomy, gastrotomy, enterotomy, urethotomy, cystotomy, , myotomy
What is a rhinotomy?
A surgical procedure that involves making an incision in the nose for a variety of purposes
What is a tracheotomy?
A surgical procedure that creates an opening in the neck into the trachea
What is a thoracotomy?
A surgical procedure that allows access to the chest cavity and organs, such as the heart, lungs, oesophagus, aorta or spine
What is a myotomy?
A surgical procedure that involves cutting muscle to relieve constriction. Often performed in the gastrointestinal or urological system
What is an enterotomy?
A surgical procedure that involves making an incision in to the intestine
What is a gastrotomy?
A surgical procedure that involves making an incision into the stomach wall to access the stomach. Common to remove foreign objects from the stomach, or to take gastric biopsies
What is a cystotomy?
A surgical procedure that creates an opening in the bladder to drain urine
What is a urethrotomy?
A surgical procedure that involves cutting a stricture in the urethra to improve urine flow and relieve blockages
Define an OSTOMY
A maintained opening. It is an opening which communicates with the outside through the skin
What are some examples of ‘ostomies’?
Pharyngostomy, tracheostomy, gastrostomy, jejunostomy
What is a pharyngostomy?
A small rubber tube that allows food to bypass the mouth and be delivered to the stomach. It is inserted through a small incision in the side of the neck and enters the oesophagus through the pharynx
What is a tracheostomy?
A surgical procedure that creates an opening in the neck to insert a tube into the trachea
What is a jejunostomy?
A surgical procedure that creates an opening in the abdomen and the jejunum to allow for a feeding tube to be inserted
What is a gastrostomy?
A surgical procedure that creates an opening in the abdomen that allows a feeding tube to be inserted into the stomach
Define an ECTOMY
Surgical removal of part or all of a structure
What are some examples of ‘ectomies’?
Lung lobectomy, pancreatectomy, cholecystectomy, colectomy, nephrectomy, orchidectomy, ovariohysterectomy, splenectomy, ostectomy,
What is a pancreatectomy?
As surgical procedure to remove part or all of the pancreas. Often performed to treat pancreatic cancer, or severe chronic pancreatitis
What is a cholecystectomy?
A surgical procedure to remove the gall bladder
What is a lung lobectomy?
A surgical procedure to remove the lobe of a lung
What is a colectomy?
A surgical procedure to remove part or all of the colon
What is a nephrectomy?
A surgical procedure to remove part or all of a kidney
What is an orchidectomy?
A surgical procedure to remove one or both testicles
What is an ovariohysterectomy?
A surgical procedure to remove the ovaries and the uterus
What are some particular nursing needs for abdominal surgery patients?
- regular pain scoring
- INVFT
- warming to prevent hypothermia
- the wound may require a dressing
- appropriate nutrition
- may require catheterisation due to reduced movement
What is a splenectomy?
A surgical procedure to remove the spleen, either partially or fully
What are some examples of abdominal surgeries?
Ex laps, ovariectomy/ovariohystectomy, splenectomy, cholecystectomy, enterectomy/enterotomy, laparotomy, c-section, diaphragmatic hernia repair
What is an ostectomy?
A surgical procedure that removes part or all of a bone
What is an effective method of warming abdominal surgery patients when under GA?
Fluid warmers can be used to warm fluids that will be used to lavage the abdomen
What is open peritoneal drainage?
The abdomen is not fully closed, and it is lavaged again during abdominal surgery
Which of the plasma proteins is most likely to be lost by patients undergoing abdominal surgery?
Albumin
Define LAVAGE
To wash out an area with sterile fluid
What type of drape should be used when lavaging?
A waterproof one, to prevent hypothermia
What is the technique for abdominal lavage?
- take abdominal fluid for sensitivity and culture if needed
- use sterile isotonic fluids at body temperature
- repeat until the fluids come out clear
- remove all fluids when finished
- use omentum to cover any potential sites of leakage
- when redraping - place new drapes over the top of contaminated ones
- do not use topical antibiotics or antiseptics
Define OMENTUM
The peritoneal folds
What are some examples of orthopaedic surgery?
Fracture repair, lateral suture, TPLO, TTA, femoral head and neck excision, CCWO, amputation
What are some specific nursing needs for orthopaedic patients?
- strong and frequent analgesia
- antibiosis
- management of a cast/dressing/fixture
- increase protein in the diet
- controlled and restricted exercise
- physiotherapy
- urinary catheter, especially if non ambulatory
What dietary change is often beneficial in orthopaedic patients?
Increased protein to assist muscle regrowth and bone healing
What are some examples of spinal surgeries?
Discectomy, laminectomy, spinal fracture repair
What is a discectomy?
Removal of a full or part of a herniated spinal disc
What is a laminectomy?
The removal of bone spurs and tissues associated with things like arthritis to remove the pressure on the spine
Spinal surgery candidates are at particular risk from what?
- pneumonia (hypostatic changes)
- decubitus ulcers
- dermatitis
- limb oedema
- muscle wastage due to lack of movement
- cauda equina - affects the lower back, bladder and bowel function
- UTI from repeated catheterisation
What are some specific nursing considerations for spinal patients?
- Urinary catheter placement
- analgesia, and regular pain scoring
- regular turning (q2 hours) to prevent decubitus ulcers
- regular reflex checks to monitor function
- mental stimulation
What are some examples of respiratory tract surgeries?
- laryngeal paralysis surgery
- rhinotomy
- oronasal fistula repair
- tracheostomy
- thoracotomy
What is laryngeal paralysis surgery?
A ‘tie back’ procedure involving the arytenoid cartilage. It is approached via the neck. Care should be taken with the MM as they can swell and cause the throat to close
What is BOAS?
Brachycephalic obstructive airway syndrome
What is an oronasal fistula?
A fistula is a connected tunnel between two parts of anatomy.
What is a tracheostomy?
A permanent opening in the trachea - involves an oxygen delivery tube and a trach tube, which are the same size
What are key points to remember during a tracheostomy?
- the ventral area of the neck should be clipped and prepped
- suction may be required
- constant one to one monitoring is required for the first 12-24 hours after placement
- tube should be suctioned every hour
- the tube should be nebulised every hour using 2-10ml of sterile saline
- a new trach tube should be placed every 2-6 hours, depending on the level of exudate
What is a thoracotomy?
A temporary opening of the thorax; may be done to remove a foreign body, for lung lobectomies, pyothorax etc
Define a THROMBOEMBOLISM
A condition in which a thrombus (blood clot) breaks of from its original site and travels through the bloodstream (as an embolus_ to obstruct a blood vessel, causing tissue ischaemia, and organ damage. It is important to get bigger dogs moving quickly following thoracotomies to prevent this
What are some ophthalmic conditions that could require surgery?
Entropion, ectropion, distichiasis, tumour removal, prolapse of the Hardarian gland, cataract repair, foreign body removal
What is ectropion?
Eversion of the eyelids, the opposite of entropion. Can cause irritation, eye dryness and excessive lacrimation
What is entropion?
A condition in which the eyelid turns towards the eye. It is inverted, and the eyelashes rub against the eye causing irritation
What is distichiasis?
A condition that results in extra eyelashes, or them growing where they shouldn’t, and causing irritation
What are some nursing considerations for ophthalmic patients?
- reduce intraocular pressure -
Why is it important to reduce intraocular pressure in ophthalmic patients?
It can affect recovery and cause pain - elevate head on recovery, reduce stress, keep BP normal, avoid collars, and slip leads, and jugular blood samples. Avoid anaesthetic drugs that increase intraocular pressure, such as ketamine
Why is consideration of environment important for ophthalmic patients?
What is some important post operative care for ophthalmic patients?
What are some examples of elective surgery?
What is the technique for an orchidectomy in cats?
What is the technique for an orchidectomy in dogs?
What is a scrotal ablation?
What is the technique for orchidectomy in rabbits?
Why might castration be performed?
What is an ovariohysterectomy?
What is pseudocyesis?
What is an ovariectomy?
What different types of hernias are common?
What is an umbilical hernia?
What is an inguinal hernia?
What is a perineal hernia?
Define ONCOLOGY
What are some examples of benign tumours?
What is a lipoma?
What is a papilloma?
What is a melanoma?
Where may malignant melanomas present?
What is an adenoma?
What are some examples of malignant tumours?
What is a carcinoma?
What is a sarcoma?
What is an adenocarcinoma?
What is the importance of tumour staging?
Define METASTISED
What is a common site for biopsy of bone marrow?
What type of needle is used for biopsy of bone marrow?
What are some examples of minor surgery that an RVN can perform?
Where are absorbable sutures generally used?
Where are non-absorbable sutures generally used?
What is the risk to the patient if sutures are placed too tightly?
Why might wounds be dressed?
What are some factors that should be monitored during wound healing?
What are some complications that can arise from surgical wounds?
What are the two types of fracture healing?
Describe indirect fracture healing
Describe direct fracture healing
What is the expected length of time for fracture healing?
What are some complications that can arise during fracture healing?
Define NON UNION
Define DELAYED UNION
Define MALUNION
Define OSTEOMYELITIS
Define IMPLANT FAILURE
How should a cast be applied?
What is the risk if a cast has too much padding?
What is the risk if a cast has too little padding?
What is some equipment required for applying a cast?
What is the technique for applying a cast to a patient?
What are ring doughnuts used for during casting?
What are some key points for post operative care of casts and splints?
What is internal fixation?
What are some key points for post operative care of internal fixation?
What is external fixation?
What are some key points for post operative care of external fixation?
What are bone grafts?
What is an autograft?
What is an allograft?
What is the most common site for harvesting for bone grafts?
