Surgical Nursing Flashcards
List the 7 factors that would predispose a patient to a surgical site infection ?
Age and body condition, immunosupression/endocrinopathies, recent surgery, prior radiation at the site (more in humans), remote infection, skin disease, Peri-op temp.
Describe the 4 surgical classifications, and give examples for each
Clean = not entering GI, resp, urogenital or oropharyngeal. Non-traumatic surgery. Eg orthopaedics and castrate.
Clean-contaminated =as above but entering tract. FB removal from GI, no spillages
Contaminated: open wound, spillages of urine/gut contents. Gastric contents contaminates surgical area
Dirty: purulent wound, RTA wound overlaying area of interest. Faecal contamination.
What is the timeframe encompassed by the ‘Golden Period’ in terms of infection? What is the Golden period?
Time it takes for contaminated wound to establish infection, time for bacteria present to become pathogenic source of infection. It’s 6-8hrs
Describe the stages of a mares labour. When would you be concerned that intervention may be required?
Stage 1: relaxation of cervix and uterine contractions begin. Mare will be restless and panting
Stage 2: waters break, foal should be out within 15 minutes.
Stage 3: placenta, should be within 3 hours.
Concerned: no foal more than 15mins after waters break. Placenta not passed after 6 hours.
What is the normal RR and HR for a newborn foal? If it’s not breathing, what should you do?
RR-40-60
HR- 80-120
Within 40s of coming out, IV or irrational-tracheal adrenaline. Nose to mouth resuscitation, may need to intubation and ventilate. Is there a heart beat? Thoracic compressions at 100/min.
Discuss advantages and disadvantages of iodine compounds, chlorhex and alcohol for surgical skin prep (Evita)
Iodine: inactivated by organic matte, stains radio opaque, needs water or detergent to be effective, synergistic with alcohol, low toxicity.
Chlorhex: residual activity, low toxicity, but can be toxic to fibroblasts.
Alcohol : only effective against bacteria, inactivated by organic debris, no residual activity, commonly used as rinse for surgical scrub.
What is a cholesteatoma? How does it arise?
Epidermoid cyst containing keratin debris. Expansile lesion, can destroy local structures. Can be a primary condition or secondary to TECA-LBO. Surgeon has left epithelium in bulla and closed up, or due to incomplete removal of structures during op.
What is the difference between a TECA-LBO and a Subtotal TECA?
TECA-LBO (total ear canal ablation- lateral bull osteotomy) results in a floppy or lateralised ear, a problem in breeds where the ear sticks up. Subtotal TECA is the same surgery, but the incision is more ventral, and the proximal canal cartilage is preserved. Muscles also preserved. High ear as a result
What properties does a chest drain need to have to be fit for purpose?
Soft, non-irritant, radiopaque, stylet, fenestrated
Where would you clip and prep a patient, ready for the placement of a chest drain?
4th-11th rib.
What is a heimlich valve? When would it not be suitable for a patient ?
Unidirectional valve that passively drains pleural space. Uses the patients own respiration to push fluid or air from the chest tube. Only suitable in patients over 10kg, as pressure not enough in patient smaller than 10kg
What is the advantage of using statinsky or bull dog clamps over crile forceps?
All used in thoracic surgery. Crile forceps are haemostatic, permanently close vessel. Bull dog/statinsky clamps temporarily occlude vessels, pressure exerted on tissue is reduced.
What is the anatomical difference between a disc protrusion and a disc extrusion
Extrusion: disc nucleus erupts traumatically into the epidural space, through the annulus.
Protrusion: annulus builds over time and bulges into epidural space, but annulus is intact.
Discuss the 5 pathologies that spinal disease encompass to cause neurological signs?
Laceration (tearing, disc extrusions)
Compression (squashing, over time can damage axons)
Contusion (secondary to something primary. Inflammatory processes, increased calcium level in cells. Causes apoptosis. Free radicals released.)
Ischaemia (cell death)
Infiltration (less common, inflammatory issues, neoplasic causes, infectious cause)
What are the 2 pathologies of spinal disease that nurses can directly contribute to halting the progression of?
Laceration and ischaemia. Immobilise and preserve oxygenation of tissues
Why are spinal surgical patients prescribed physio ?
Prevents pressure sores, reduces pain, supports resp tract, improves vet team bond with patient, promotes motor recovery and development of new nervous pathways.
What are the 5 elements of nursing care for surgical spinal patients ?
Manage urinary incontinence, prevent pressure sores, detect and control pain, support and monitor resp tract, promote motor recovery
Discuss the benefits of passive range of motion for an orthopaedic patient. When might fill POM movements be a contraindication ?
Blood and lymph flow; keeping joints and ligaments supple, maintains muscle tone. Would only be able to do Sagital plane motions for patients recovering from luxations.
Describe the stages of wound healing
Post op- 24-48hrs. May see oedema, patient may be painful.
Regeneration: 5 days to 3weeks. New collagen fibres forming. If none is broken, bridging callus forms.
Remodelling: 6 weeks to 1 year. Alignment of cells and tissue, strengthened tissue, fibrous tissue develops. Maturation, metabolic rate drops to normal, vascularity returns to normal. If bone is healing, clinical union of bone.
What are the 5 steps taken in the first few hours of presentation of an animal with GDV?
1) restore and support Circulation
2) decompress the stomach
3) establish if it’s twisted or dilated
4) surgical correction of volvulus
5) prophylaxis to prevent repeat (environmental and surgical)
What would you be concerned about post operatively for a patient having received a thyroidectomy ? What signs might you look for?
Hypocalcaemia from removal of the parathyroid gland (iatrogenic). Seizures, muscle twitching. May take blood samples to monitor it.
When might an insulinoma be managed medically? What does this entail?
More frequent feeding to avoid hypos, glucocorticoid admin (not suitable long term due to side effects), diazoxide.
Might be chosen if owners reject surgical management, or if a patient has relapsed after surgical management
Describe the post op complications that could arise after surgery to correct and remove an insulinoma
Transient hyperglycaemia, persistent hypoglycaemia, pancreatitis
Why is it important to blood type a patient undergoing surgery on the biliary tract?
Vitamin k is a fat soluble vitamin, required for clotting and haemostasis. If biliary tract isn’t functioning properly, vitamin k not being absorbed properly and will be low. More likely to bleed and require transfusion. Also dissection near vessel rich area, could bleed.
Name the 4 flaps that can be used to close a defect, where only the subdermal plexus vascularises the tissue
Advancement flap, rotational flap, transposition flap, skin fold flaps
Name the 4 common axial pattern flaps used. What makes an actual pattern flap different from a regular flap technique?
Thoracodorsal, omocervical, caudal superficial epigastric, deep circumflex iliac. Involves cutaneous artery itself, not just sub dermal vascular bed.
Discuss the indications and contraindications for skin grafts
Indications: distal limb, primary closure not possible, healthy granulated tissue present
Contra-indications: wounds on head and trunk as can’t immobilise these areas, infection at site, incomplete granulation bed, debris at surgical site.
Define ataxia, paraparesis and paraplegia (sorrel)
Ataxia- pelvic limb incoordination
Paraparesis - neurological deficits but with motor function present
Paraplegia - neurological deficits with absent motor function
What do you need to have ready when an equine fracture comes in?
Drugs, bandage material, splints, cast material, catheter, fluids, turn radiology equipment on
What do you need to get ready when a colic comes in?
Medication (sedation, analgesia), stethoscope, clippers and sterile prep, catheter, NG tube and buckets, reveal sleeve and lubricant, ultrasound machine
What should you get ready for when a horse with a wound comes in?
Clippers and sterile prep, radiography equipment, catheter, fluids for lavage, medication, bandage cart, gloves, probe.
Describe the main elements of nursing care when nursing a neonate foal
Monitoring parameters (signs of deterioration can be subtle), fluid therapy, respiratory support, maintenance of body temp, nutritional support
What to the acronyms SPIRM and SAP stand for when doing an orthopaedic examination?
S= swelling P= pain I=instability R=range of motion M= manipulation
S=swelling
A= muscle atrophy
P=pain
Describe how you would carry out an arthrocentesis on an elbow joint
5ml syringe with 21/23G needle.
EDTA tubes prepped, cytology slides ready
Clip and prep area
Don sterile gloves
Insert needle into joint, draw back.
If no sample is obtained, release plunger and negative pressure before removing needle and repositioning.
Should get 0.05ml-0.3ml of viscous clear fluid. Can smear it on a slide or if enough, send for cytology in EDTA tube.
The aim of a TPLO is to reduce the angle of the tibial plateau to increase joint stability. What is the desired angle range the surgeon will be wanting to achieve after fitting the plate?
5-7 degrees
For which orthopaedic procedure would it be desirable for patients to return to exercise ASAP
FHNE. Maintain muscle mass, mobile pseudoarthrosis, and range of motion
List the 4 ways hip dysphasia can be corrected surgically
Juvenile symphysiodesis, femoral head and neck excision, triple/double pelvic osteotomy, Total hip replacement (cemented and uncemented)
What would be your general approach to a wound? Suspected to be contaminated.
stabilise and GA (major body assessment, catheter, IVFT, analgesia, full body assessment, minimum database) Clip around wound Lavage the wound Explore wound if deep (e.g. Bite) Surgical debridement C+S Broad spec ABs Close wound or leave open depending on wound.
