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Veterinary Nursing VN09 > Post operative nursing requirements > Flashcards

Post operative nursing requirements Flashcards

1
Q

Define SHOCK

A

A life threatening condition characterised by hypoperfusion. There are several different types, including distributive, hypovolaemic, obstructive and cardiogenic

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2
Q

Define HYPOVOLAEMIA

A

A lack of circulating blood volume

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3
Q

Define HYPOTHERMIA

A

Low body temperature

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4
Q

Define HYPOXIA

A

Reduced levels of oxygen

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5
Q

Define HYPOXAEMIA

A

Reduced levels of oxygen in the blood

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6
Q

Define HAEMORRHAGE

A

General bleeding; may be more specific and be primary, secondary, reactionary, open, closed etc

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7
Q

Define APNOEA

A

Lack of breathing

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8
Q

Define DYSPNOEA

A

Difficulty breathing

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9
Q

Define OEDEMA

A

Fluid retention; may be in limbs (particularly distal) or positional (e.g. related o hypostatic changes in the lungs)

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10
Q

Define ISCHAEMIA

A

Lack of perfusion and blood flow to tissue in the body

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11
Q

Define NECROSIS

A

Tissue death

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12
Q

Define ANURIA

A

Lack of urination

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13
Q

Define OLIGURIA

A

Low urine output

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14
Q

Define PARAPLEGIA

A

Hind limb paralysis

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15
Q

Define TETRAPLEGIA

A

Complete paralysis of all four limbs. Also called quadriplegia

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16
Q

Define HEMIPLEGIA

A

Paralysis of one side of the body e.g. left or right

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17
Q

Define SEPSIS

A

Blood poisoning, in which the immune system overreacts and starts to attack itself. The tissues and the organs eventually shut down and it can lead to septicaemia

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18
Q

What is urine output indicative of?

A

It indicates kidney function and perfusion

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19
Q

What is the formula to calculate urine output?

A

1–2ml/kg/hour

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20
Q

How often should patients under anaesthesia be checked?

A

At least every 5-10 minutes, and the check recorded on the anaesthetic sheet

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21
Q

What parameters should be checked whilst an animal is under anaesthetic?

A

Heart rate, respiratory rate, blood pressure, reflexes, temperature, mucous membrane colour, capillary refill time, ETC02 etc

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22
Q

What is ideal for the recovery area?

A

The area should be quiet, warm, dark, well ventilated, and large enough to accommodate all patients. It should have basic equipment such as blankets, beds, incontinence sheets and heating and cooling sources etc, but also emergency equipment such as oxygen, crash/intubation kits, and monitoring equipment including pulse ox, BP machine and ECG (ideally multiparameter)

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23
Q

What is the ideal temperature for the wards?

A

18-23 degrees Celsius

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24
Q

What drugs should a crash kit ideally contain?

A

Adrenaline, atropine, lidocaine, naloxone etc

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25
Q

What is the risk if a patient has a full bladder in recovery?

A

It can cause discomfort, panic, anxiety and pain, especially if the patient has had abdominal surgery. These will all contribute to a poor recovery for the patient

26
Q

How can a patient’s bladder be emptied?

A

Usually it can be manually expressed by pressing on the caudal abdomen of the patient prior to recovery - the patient will become more tense as they gain consciousness in recovery.
A rigid urinary catheter may also be passed

27
Q

How should patients be positioned in recovery?

A

On padded and absorbent bedding in sternal recumbency (although not if thoracic surgery has been performed). Avoid laying patients directly on their surgical incisions

28
Q

Define ATELECTASIS

A

Partial or complete collapse of a lung or part of a lung

29
Q

For how long can lacrimation be reduced following drug administration?

A

Up to 36 hours

30
Q

What are some recovery complications that may arise?

A

Shock, excitement, pain,

31
Q

What are the different types of shock?

A

Hypovolaemic, cardiogenic, distributive, obstructive

32
Q

Describe hypovolaemic shock

A

Involves the loss of circulating blood volume. Leads to hypoperfusion, then ischaemia, then necrosis and often death if not resolved.

33
Q

Describe cardiogenic shock

A

Usually combined with existing underlying heart disease. The shock may be a result of a myocardial infarction. Care should be taken when giving IVFT to these patients, both the amount and the type. Secondary oedemas may arise, and arrythmias may develop

34
Q

Describe distributive shock

A

Poor perfusion due to the loss of vasomotor tone. The animal has lost its ability to dilate vessels. Presents as tachycardia with increase capillary refill time. Can be caused by anaphylaxis, severe burns, pyometra, sepsis etc

35
Q

Describe obstructive shock

A

Involves a physical block to blood flow, usually affecting the veins. Blood is then trapped, and there is a reduction in blood flow, especially to the peripheries. Pressure builds on the right side of the heart. Can be seen more often in GDV patients, who may also suffer arrhythmias due to the intensity of the surgery

36
Q

What are the clinical signs of shock?

A

Tachycardia, increased CRT, pale MM, hypokinetic pulses, pulse deficits

37
Q

What is the rate for shock fluids for dogs?

A

60-90ml/kg

38
Q

What is the rate for shock fluids for cats?

A

40-60ml/kg

39
Q

What are cats susceptible to when giving shock rate fluids?

A

Hypoperfusion, or volume overload. No more than 10ml should be given to cats as a bolus

40
Q

What is the bolus limit for cats IV?

A

10ml

41
Q

What is the risk for active warming shock patients?

A

Patients who are in shock should not be actively warmed, as it can draw heat away from vital organs, putting strain on them and resulting in organ failure. Blood is distributed to the peripheries instead, which are comparatively unimportant

42
Q

What is the risk of emergence excitement for recovery patients?

A

Not only can the animal injure itself as it thrashes around in its cage but the noise may agitate other patients too. Excitement may be drug induced and a side effect of drugs like ketamine, or it may be pain related, highlighting the importance of strong, multimodal analgesia.

43
Q

What are common signs of pain for recovery patients?

A
  • vocalisation
  • depression
  • positioning
  • facial expression
  • reactivity
  • high pain scores
44
Q

What are two types of wound drains?

A

Passive and active drains. Passive drains are usually open. Active drains are usually closed

45
Q

What are the circumstances that drains are used?

A
  • to prevent a fluid build up in the wound
  • repeated aspiration of a particular area
  • repeated lavaging of a particular area
46
Q

Define SEROMA

A

A seroma is a collection of fluid that builds up under the surface of your skin.

47
Q

How do passive drains work?

A

They are for superficial areas only. Common for dog bites. They rely on gravity and capillary action for drainage. They must be placed at the bottom of a wound, facing down, to achieve this. The exudate wicks around the drain and out of the patient. They are sutured in place with purse string sutures.
Main type is a penrose drain

48
Q

Which suture type is used to secure wound drains in place?

A

Purse string sutures

49
Q

In what circumstance would a passive drain not be used?

A

For thoracic draining - they would allow air into the thoracic cavity and increase the risk of pneumothorax and lung collapse

50
Q

What is the main type of passive drain?

A

A penrose drain

51
Q

What are some disadvantages to passive wound drains?

A
  • the drain is always open, so the risk of infection is high
  • free draining aspect means contamination of pet’s environment i.e. clients house
  • can be a lengthy process until it stops draining
  • drained amount cannot be measured
  • cannot be bandaged in, so risk of self trauma is high
52
Q

Describe active wound drains

A

Usually solid walled, with a stylet and most have a radiopaque line down the side of them to help with placement. They are sutured in the same way as passive drains. They can be attached to a vacuum pump or syringe, and can be used in thoracic areas or indeed in other cavities of the body.

53
Q

What is a key rule for active wound drains?

A

They have to be manually emptied - this means that the exudate can be measured, and there is less risk of mess, but it should not be left to overfill and cause pain

54
Q

What is a Heimlich drain (valve)

A

Only used with solid walled, active drains. They are one way valves that sit on the end of a drain at all times to act as a safety mechanism. They have within them unidirectional valves

55
Q

What are the two types of vacuum drain pumps?

A

Grenade style, and concertina/accordion style. Both are single use only

56
Q

Describe a grenade style vacuum drain pump

A

They rely on a vacuum to suck out exudate/blood/fluid from a wound. They mechanism is squeezed then attached to an active drain. It visibly fills, and shows when it must be drained or removed. They can be used for cavities

57
Q

Describe a concertina/accordion style vacuum drain pump

A

They rely on a vacuum to suck out exudate/blood/fluid from a wound. They mechanism is squeezed then attached to an active drain. It visibly fills, and shows when it must be drained or removed.

58
Q

What are some advantages of closed drains?

A
  • prevents infection
  • reduced risk of self trauma to the patient, as they are bandaged in
  • prevents pneumothorax
  • volume of exudate can be measured and monitored
  • reduced risk of secondary infections such as dermatitis
59
Q

What are some disadvantages of closed drains?

A

Can get blocked if drainage is not frequent enough. Nursing interventions must be frequent and are very involved

60
Q

What are some key points when caring for drains?

A

All drains should be handled in an aseptic manner. The following should be adhered to:

  • prophylactic, broad spectrum antibiotic is recommended
  • barrier cream is recommended at the exit site of the drain, especially for passive drains, to prevent secondary dermatitis
  • purse string sutures are used for quick closure
  • regular checks are required whether it is open or closed
  • animal will quickly reject the drain as a foreign object - vitals should be closely, regularly monitored. If it is fully rejected it will need to be removed
  • condition of skin around the stoma site should be closely monitored
  • consider the colour of the exudate being removed as it will indicate infection

Veterinary Nursing VN09 (2 decks)

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