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JJ > Surgical Nursing of Exotics > Flashcards

Surgical Nursing of Exotics Flashcards

1
Q

why is the pre-op assessment of small mammals so important?

A

as they hide signs of illness well and so an exam will highlight any potential complications

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2
Q

what is involved in small mammals pre-op check?

A

check respiratory system and CVS
record accurate weight
pre-anaesthetic bloods

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3
Q

why are pre-anaesthetic bloods not always performed in exotic species?

A

anaesthesia may be required to take the samples which defeats the object

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4
Q

how can you prepare for small animal surgery?

A

pre-empt any problems

clipping of surgical site

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5
Q

what problems must you pre-empt before anaesthetising your exotic patient?

A

blood loss - place catheter, prepare fluids
heat loss - hot hands and heat pads
apnoea - pre-oxygentaion

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6
Q

what method can be used to give fluids pre-operatively in exotics?

A

SC bolus

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7
Q

what area should be clipped for exotic surgery?

A

smallest area possible to reduce heat loss - damp down edges of fur around site

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8
Q

what must be avoided when prepping the patients skin?

A

alcohol as it will cool the patients body

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9
Q

how can heat loss be prevented under GA?

A 
bubble wrap
bear hugger
silver foil
heat mat
take care not to overheat (heat stroke is a risk)
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10
Q

what exotic small mammals are often intubated?

A

rabbits and ferrets

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11
Q

how can rabbits and ferrets be intubated?

A

visualise larynx using otoscope or use urinary catheter

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12
Q

how can you monitor small mammals under GA?

A

direct monitoring of heart and respiration
pulse ox
capnography
rectal thermometer

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13
Q

how can HR be monitored?

A

clip patch over heart and use doppler

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14
Q

in what animals is capnography especially useful?

A

tubed rabbits

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15
Q

how should small mammals be positioned for surgery?

A

raise chest to reduce the pressure of abdominal contents on lungs

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16
Q

what may be used to support small mammal ventilation?

A

mechanical ventilator

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17
Q

what are the main potential post-op complications for exotic small mammals?

A 
haemorrhage
hypothermia
pain
hypoglycaemia
gut stasis
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18
Q

how can post-op haemorrhage in exotic small mammals be monitored for and prevented?

A

monitor HR, MM and pulse quality for signs of shock
maintain IV access in case it is needed
monitor wounds for haemorrhage
try to ensure minimal haemorrhage during surgery

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19
Q

how can hypothermia be prevented post op in exotic patients?

A

maintain temperature in an incubator or on a heat pad as animal recovers
monitor rectal temperature

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20
Q

how can hyperthermia of exotic patients be prevented in the post op period?

A

transfur to cooler environment once temperature of the patient is normal to prevent over heating

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21
Q

how can pain be prevented post op in exotic patients?

A

give adequate pain relief and place local blocks during srugery

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22
Q

what drugs may be given for post-op pain relief in exotic small mammals?

A

opioids

NSAIDs

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23
Q

how can hypoglycaemia be prevented post op in exotic patients?

A

encourage to eat, if not responding check blood glucose

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24
Q

how can gut stasis be prevented post op in exotic small mammal patients?

A 
encourage to eat as soon as possible
syringe feed if not tempted by high value foods offered
prokinetics
analgesia
monitor for droppings
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25
Q

how long following surgery may it take for small exotic mammals to pass droppings?

A

up to 24hrs

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26
Q

what are the key things to remember during the post-op recovery period for exotic small mammals?

A

keep warm on recovery
move to a cooler environment once recovered to prevent heat stroke
analgesia at appropriate doses is very important (higher than dogs and cats)

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27
Q

how does surgery on exotics differ from that done on cats and dogs?

A

most can be extrapolated from cats and dogs
fine instruments may be used to make surgery easier
magnification can be used
good haemostasis is even more crucial

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28
Q

what magnification equipment may be used in exotic surgery?

A

loops

operating microscope

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29
Q

what equipment can be used to ensure good haemostasis in exotic surgery?

A

electro-cautery

radiosurgery

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30
Q

what are the best suture materials for exotics?

A

synthetic monofilament absorbable materials

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31
Q

give 2 examples of suture that is commonly used for exotics

A

Monocryl

Caprosyn

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32
Q

what suture material should be avoided in exotics?

A

catgut

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33
Q

why should catgut suture be avoided in exotics?

A

generates a pyo-hgranulomatous reaction as is dissolves which increases adhesions

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34
Q

what technique of skin sutures should be used for exotics?

A

buried - prevents chewing out

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35
Q

what may be used to secure skin wounds alongside sutures in exotics?

A

tissue glue

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36
Q

what makes wound dressing difficult in small exotic mammals?

A

difficulty keeping dressings in place and thin nature of skin in small mammals

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37
Q

what are the main aspects of wound care in small exotic mammals?

A

surgical closure with buried sutures and tissue glue is preferable
buster collars are useful if tolerated
clean dry bedding (e.g. incosheet or vet bed) is best and avoid hay or straw initially

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38
Q

in what species is radiography useful?

A

rabbits and ferrets

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39
Q

what may make interpretation of some radiographs in some small mammal species difficult?

A

small size

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40
Q

what types of radiographs are best for small mammals?

A

digital

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41
Q

why are digital radiographs best for small mammals?

A

they may be enlarged and manipulated to highlight changes

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42
Q

how many imaging views are needed when imaging small exotic mammals?

A

at least 2

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43
Q

what may affect radiographic contrast in the abdomen of some mammals?

A

presence of large amounts of fat

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44
Q

what makes ultrasound difficult in some rodents?

A

small size

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45
Q

what can ultrasound be used for in exotic small mammals?

A

imaging the bladder or looking at a mass

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46
Q

what is the issue with ultrasound in rabbits and guinea pigs?

A

gas within the bowel may limit the views available

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47
Q

what can be assessed by ultrasound in rabbits and guinea pigs?

A

GI motility
presence of free fluid
masses

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48
Q

what is CT used for in exotic small mammals?

A

teeth and jaws especially

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49
Q

how must small exotic mammals be restrained for CT?

A

GA or sedation

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50
Q

what are the common surgical procedures seen in exotic small animals?

A 
neutering (spay, castration or vasectomy in ferrets)
lump / abscess removal
dentistry
GI obstruction
enucleation
liver lobe torsion
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51
Q

what is key about castration in guinea pigs and rats?

A

vaginal tunic must be closed to prevent a hernia

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52
Q

during a ferret vasectomy how is the ductus defrens prevented from regrowing?

A

a section is removed rather than just cutting it and leaving it

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53
Q

what can make spaying more difficult in small exotic mammals?

A

broad ligament is fatty and so removal is difficult
rabbits have friable tissue that is easily torn
ferrets have corkscrew shaped uteruses and these can be hard to remove

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54
Q

what surgical procedure is common in rabbits?

A

lump / abscess removal

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55
Q

how is abscess removal performed in rabbits?

A

if in the jaw - cut around, leave and open crater. Anaerobic bacteria are unable to survive
anywhere else - complete removal

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56
Q

how may GI obstructions be surgically removed in small exotic mammals?

A

milk through to LI and allow to pass naturally if moveable

eneterotomy/ectomy if tissue is damaged or object will not pass through

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57
Q

what condition can make spaying of exotic mammals more easy?

A

pyometra as uterus is enlarged and so easier to visulaise

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58
Q

from what aspect should cystotomy be performed?

A

least vascular aspect

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59
Q

why must care be taken if performing enucleation in rabbits?

A

blood sinus located behind eye

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60
Q

what can occur as a result of liver lobe torsion?

A

necrosis

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61
Q

in what small exotic animals are dental problems common?

A

hystricomorph rodents (e.g. guinea pigs, chinchillas and degus) and rabbits

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62
Q

what teeth problems may other (non-hystricomorph) rodents get?

A

incisors

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63
Q

what is the key factor which contributes to molar and incisor and malocclusion?

A

diet

64
Q

how can diet cause molar and incisor malocclusion?

A

inadequate grass / hay means that teeth wear differently and overgrow with sharp edges formed
not enough fibre can lead to differnet chewing action
calcium in the diet may also affect bone quality and teeth formation

65
Q

what can have and effect on teeth due to overcrowding?

A

breeding leading to smaller heads

66
Q

what are the signs of dental issues found on clinical exam?

A

weight loss
ptyalism
swellings on ventral boarder of mandible

67
Q

what is ptyalism?

A

dribbling of saliva

68
Q

what equipment can be used to examine small mammals teeth?

A

otoscope

69
Q

what is used to assess rodents teeth and roots?

A

good radiogrpahs

70
Q

can malocclusion be cured?

A

no - can be managed with correction of diet to help

71
Q

what is needed to access the molar teeth of rodents?

A

appropriate dental gag

72
Q

how can spurs and tooth overgrowth be treated in small mammals?

A

spurs removed and crown height reduced

73
Q

what equipment is used to remove tooth spurs and reduce crown height?

A

molar burr with guard

74
Q

what can be used to reshape incisors?

A

dental burr or cutting disc

75
Q

what should not be used to cut incisors?

A

nail clippers

76
Q

can incisors be removed?

A

yes but is complex

77
Q

what dietary corrections may aid dental issues?

A

increased fibre

reduced carbohydrates

78
Q

what should be performed on exotics before anaesthesia?

A

thorough clinical exam and faecal and blood screens

79
Q

why is a through clinical exam of reptiles necessary before anaesthesia?

A

they effectively hide any signs of illness

80
Q

what is required to maintain a reptiles body temperature before and after the procedure?

A

facilities such as a vivarium which will maintain the correct POTZ

81
Q

is fasting needed before a reptiles operation?

A

no but maybe avoid feeding animals on the day of the procedure (reptiles only usually fed weekly or less)

82
Q

why do reptiles require respiratory support under GA?

A

they breathe via skeletal muscle movement as they have no diaphragm

83
Q

how may a reptiles respiration be supported under GA?

A

IPPV

ventilator (e.g. vetronics)

84
Q

how many breaths per minute do most reptiles need?

A

~4

85
Q

why is monitoring of reptiles under anaesthetic difficult?

A

at surgical depths few, if any reflexes are able to be monitored and respiration is usually controlled externally

86
Q

how can heart rates be monitored in reptiles under GA?

A

doppler probe can be used

87
Q

how fast are reptiles HR?

A

slow

88
Q

when are capnographs useful in monitoring reptiles under anaesthesia?

A

particularly useful on recovery as animal will not breathe if over oxygenated

89
Q

how are wound sites prepared for surgery in reptiles?

A

as for any surgery

90
Q

what solution is used to prep the skin of reptiles before surgery?

A

chlorhexadine or iodine

91
Q

why is alcohol not recommended to scrub reptiles skin before surgery?

A

it will lead to cooling and increase hypothermia risk

92
Q

what can be used to allow visualisation of a reptile while still ensuring sterility?

A

clear plastic drapes which adhere to the scales up to the incision site

93
Q

how should reptilian scales be prepped for surgery?

A

scrub solution allowed to soak into scales

brush may be used to ensure scrubbed area is clean

94
Q

what makes the positioning of reptiles for surgery so difficult?

A

varying shape of reptiles

95
Q

what has had to happen to surgical techniques in some species of reptile?

A

altered due to the reptiles shape e.g. coelotomy performed in lateral on chameleons and iguanas ventrally

96
Q

what can be used to position reptiles for surgery?

A

foam wedges and sand bags

97
Q

what must be done to minimise pressure on the lungs of reptiles during surgery?

A

elevate chest and use assisted ventilation

98
Q

what is breathing in reptiles stimulated by?

A

low O2 not high CO2 - unlike mammals

99
Q

what is involved in post-op recovery of reptiles?

A

gradually reduce RR on ventilator to stimulate spontaneous breathing
use capnography
keep animal at POTZ to speed up recovery

100
Q

what are the main areas of post-op care in reptiles?

A

wound management

analgesia

101
Q

what dressings can be used for wound management in reptiles?

A

opsite and primapore

something absorbent

102
Q

how should wounds be managed post op in reptiles?

A

clean wound regularly

ensure enclosure is clean as ventral abdomen is often in contact with floor/bedding and faecal material

103
Q

what analgesia is used for reptiles post op?

A

NSAIDs - meloxicam (metacam)

opioids - butorphanol

104
Q

where are surgical incisions made on reptiles?

A

between the scales to improve healing

105
Q

where are incisions often made in snakes skin during surgery?

A

between 1st and 2nd row of small scales

106
Q

what suture material are wounds closed with in reptiles?

A

monofilament

107
Q

what suture pattern is used to close reptiles skin?

A

everting pattern such as horizontal mattress sutures

108
Q

why are everting sutures needed to close reptiles skin?

A

prevents the natural inversion of skin below scales

109
Q

when are sutures removed from reptiles?

A

after 4-6 weeks as healing is slower

110
Q

why are removable sutures needed in reptiles?

A

absorbable material will eventually absorb but takes a very long time so skin sutures still need to be removed

111
Q

what sutures are avoided in reptiles?

A

catgut and polyfilament sutures

112
Q

why are polyfilament and catgut sutures to be avoided in reptiles?

A

create a lot of tissue reaction

113
Q

what can be used alongside sutures to aid wound opposition in reptiles?

A

tissue glue

114
Q

what is a coeliotomy?

A

entry into coelomic cavity

115
Q

how is a coeliotomy performed in lizards?

A

ventral midline approach

116
Q

what must be avoided when performing coeliotomy on lizards?

A

midline ventral abdominal vein

117
Q

how can the midline ventral abdominal vein be avoided in lizards when performing coeliotomy surgery?

A

entering the abdomen caudal to the xiphoid and cranial to the umbilicus or cranial to the pubis and less than a fourth of the distance to the umbilicus

118
Q

what happens if the midline ventral abdominal vein is damaged in lizards?

A

can be tied off without affecting the lizard

119
Q

how should the coelomic cavity be closed in lizards?

A

close coelomic membranes if possible and then the skin

120
Q

how can coeliotomy be performed in laterally compressed lizards?

A

right or left lateral approach just behind last rib extended along the curve of teh rib

121
Q

how is the coelom entered in snakes?

A

between the ribs and the ventral musculature

122
Q

how can the coelom of snakes be closed following surgery?

A

2 layer of muscle and skin

123
Q

what must be assessed about the incision site before operating on snakes?

A

exactly where the incision needs to be made as it is not possible to access all snakes organs through one incision

124
Q

how can the coelom be accessed in chelonia?

A

trapdoor in the plastron cut using an oscillating or circular saw

125
Q

how are the wounds in the chelonia’s plastron cut to ensure the shell can be replaced after surgery and not fall inwards?

A

with a 45 degree bevel

126
Q

how is the plastron separated from underlying muscle attachments in chelonia?

A

scalpel handle or periosteal elevator

127
Q

what must you be careful of when opening the plastron of chelonia?

A

not to damage the paired abdominal veins that run in the coelomic membrane

128
Q

how is the trapdoor in the plastron replaced after surgery?

A

glued back in place

129
Q

what is used to clean wounds in reptiles?

A

dilute iodine followed by wound fully rinsed

130
Q

what dressings can be used on chelonia?

A

adhesive dressings such as primapore or opsite

131
Q

what can be used to aid reptilian wound healing?

A

water based gels or hoeny

132
Q

why is diagnostic imaging particularly useful in reptiles?

A

often difficult to palpate abdominal structures (especially tortoises)

133
Q

do most exotic species require sedation for imaging?

A

no -their sedate nature makes imaging easier

134
Q

what views are often used in reptile imaging?

A

dorso-ventral
horizontal beam lateral
horizontal beam cranio-caudal

135
Q

why are vertical beam lateral images difficult in reptiles?

A

there is no diaphragm so little seperation between lungs and coelom

136
Q

why does ultrasonography work well in reptiles?

A

absence of fur means good contact

137
Q

what can improve ultrasound images in reptiles?

A

allowing gel to soak between the scales

138
Q

how may amphibious species be scanned with ultrasound?

A

immerse probe and the animal in water

139
Q

what is ultrasound good for imaging in reptiles?

A

heart
reproductive tract
GI
masses

140
Q

what species of reptiles are best for CT?

A

chelonia

141
Q

how long does CT imaging take?

A

15 seconds

142
Q

what tissue is CT good for imaging?

A

soft tissue

143
Q

what can be produced from CT images?

A

3D images

144
Q

how should animals be restrained for CT/imaging?

A

within a box to keep safe and reduce movement

145
Q

what are the most common surgical procedures in reptiles?

A

mass/abscess removal
ovariosalpingectomy
GI obstruction
hemipenile amputation

146
Q

what is the issue with mass removal in reptiles?

A

skin cannot be closed so the wound remains open

147
Q

why do abscesses have to be removed in reptiles?

A

they are solid so lancing and draining is not possible

148
Q

what is removed during an ovariosalpingectomy?

A

ovary and shell gland

149
Q

what is performed in lizards to remove reproductive organs?

A

ovarectomy

150
Q

what incision is needed to perform ovariosalpingectomy / ovarectomy?

A

midline incision

151
Q

what must you ensure has been removed when spaying reptiles?

A

all ovarian tissue to prevent regrowth

152
Q

when does GI obstruction often occur in reptiles?

A

lizards eating bedding or stones

153
Q

what surgery may be needed to correct GI obstruction?

A

enterotomy

coliotomy

154
Q

when does hemipenile amputation need to be performed?

A

if there is persistent prolapse

155
Q

how is hemipenile amputation performed?

A

clamp and ligation

156
Q

should wounds to scutes be closed with glue?

A

no - if unclean the wound will lead to abscess. Should be closed with tape

JJ (33 decks)

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