pre/intra/post-op + complications

Question 1

What advice should be given to the owner several days prior to procedure?

Answer 1

• fast patient from 10pm night before or whatever is practice policy (depends when op is scheduled for the next day)
• bathe patient day before
• take patient for walk and toilet in the morning before op
• water available until admit
• make sure O understands procedure (go over GA, estimate, op details, pros and cons, informed consent)
• make O aware of pre-op bloods
• advise O to make arrangements for collection as patient unlikely to be able to walk far, public transport not recommended

Question 2

Describe patient skin prep for bitch spay

Answer 2

• Clipped neatly around incision site (ensure clippers clean, oiled and working beforehand)
• wear gloves
• use lint free swabs and dilute chlorhexidine
• start scrubbing from incision site outwards
• Once skin/fur border met discard swab and start from middle again until whole area is clean
• transfer patient to theatre using trolley
• position in dorsal recumbency (secure legs with ties and use trough or sandbags)
• carry out final prep using fresh gloves, swabs and hibi solution
• finally spray site with surgical spirit

Question 3

Describe patient skin prep for eye surgery

Answer 3

• soluble gel put into eye
• should have minimal clip with fine blades
• irrigated with sterile saline to remove loose hair
• dilute Povidone Iodine should be used (0.1-0.2%)
• Use sterile cotton buds soaked in Povidone Iodine to clean inside of eye lids
• Povidine Iodine also used to clean area around site
• Position in lateral recumbency with sand bags
• Should use sterile clear adherent drape.

Question 4

Describe how to drape for a bitch spay

Answer 4

• 4 rectangular drapes used to create a window ‘fenestration’ for surgical site
• Can be created any size
• First drape placed closest side of patient, then furthest away then over both ends then secured in place towel clips
• Or use disposable and cut a hole in it.

Question 5

Describe 4 methods of monitoring a small furry under GA

Answer 5

• Temperature using a thermometer for core temp
• Heart rate using oesophageal/normal stethoscope/dopplr taped over heart
• Respiratory rate by observation by counting chest movements or watching reservoir bag. Can attach capnograph which also gives ETCO2.
• Mm colour
• Pulse oximeter measures SP02 (oxygen saturation) by attaching probe to ear tip or pedal.
• Check cranial nerves manually by checking blink and eye position, jaw tone.

Question 6

How would you maintain the temperature of a G.pig under GA?

Answer 6

• Bair hugger, heat pads, hot hands
• bubble wrap
• heated table
• Warm sub-cut fluids
• Warmer environmental temperature
• Monitor using thermometer for core temp/feel for peripheral temp
• Remove excess fluid which may be on patient from scrubbing and don’t use as much in first place

Question 7

How to remove ET tube for dog

Answer 7

• Monitor vital signs closely for return of blink
• Untie and uncuff tube just before extubation to protect airways
• When swallow reflex returns, remove tube slowly and gently downwards arc shape

Question 8

When should an ET tube be removed in a cat?

Answer 8

Before the swallow reflex returns

Question 9

What information should be communicated from anaesthesia nurse to recovery nurse?

Answer 9

• Patient name, age, sex, procedure
• name of surgeon, and if they want to do a recheck and what time
• Anaesthetic and pre-med agents
• any reactions or complications
• Any other medication given and if need continues
• Fluid rate
• TPR’s
• Going home instructions from Operating surgeon

Question 10

Describe some indicators that an animal is in pain

Answer 10

• Vocalisation
• unusually quiet/dull
• Increased pulse and respiratory rate
• Guarding op site
• patient interference
• Restlessness
• Aggression
• Hunched posture

Question 11

7 signs of mild hypovolaemic shock

Answer 11

• HR= 120-150bpm
• Femoral Pulse= Bounding/Snappy
• Dorsal Pedal Pulse= Readily Palpable
• MM Colour= Normal/pinker
• CRT= >1sec
• Mentation= Usually Normal
• Extremities= Usually Normal

Question 12

7 signs of moderate hypovolaemic shock

Answer 12

• HR= 150-170bpm
• Femoral Pulse= weak
• Dorsal Pedal Pulse= Just Palpable
• MM Colour= pale pink
• CRT= 1 - 2 sec
• Mentation= Depressed
• Extremities= Cool/Normal

Question 13

7 signs of severe hypovolaemic shock

Answer 13

• HR= 170 - 220 bpm
• Femoral Pulse= very weak/thready
• Dorsal Pedal Pulse= Not Palpable
• MM Colour= pale pink/ white
• CRT= >2 sec if detectable
• Mentation= Severely Depressed
• Extremities= Cold

Question 14

What care should a patient receive once returned to recovery?

Answer 14

• Administer analgesia at vets instruction
• monitor TPR
• monitor pain
• monitor wound
• keep warm/comfy/quiet
• feed/water ASAP