Surgical Nursing of Exotics COPY Flashcards
why is the pre-op assessment of small mammals so important?
as they hide signs of illness well and so an exam will highlight any potential complications
what is involved in small mammals pre-op check?
check respiratory system and CVS
record accurate weight
pre-anaesthetic bloods
why are pre-anaesthetic bloods not always performed in exotic species?
anaesthesia may be required to take the samples which defeats the object
how can you prepare for small animal surgery?
pre-empt any problems
clipping of surgical site
what problems must you pre-empt before anaesthetising your exotic patient?
blood loss - place catheter, prepare fluids
heat loss - hot hands and heat pads
apnoea - pre-oxygentaion
what method can be used to give fluids pre-operatively in exotics?
SC bolus
what area should be clipped for exotic surgery?
smallest area possible to reduce heat loss - damp down edges of fur around site
what must be avoided when prepping the patients skin?
alcohol as it will cool the patients body
how can heat loss be prevented under GA?
bubble wrap bear hugger silver foil heat mat take care not to overheat (heat stroke is a risk)
what exotic small mammals are often intubated?
rabbits and ferrets
how can rabbits and ferrets be intubated?
visualise larynx using otoscope or use urinary catheter
how can you monitor small mammals under GA?
direct monitoring of heart and respiration
pulse ox
capnography
rectal thermometer
how can HR be monitored?
clip patch over heart and use doppler
in what animals is capnography especially useful?
tubed rabbits
how should small mammals be positioned for surgery?
raise chest to reduce the pressure of abdominal contents on lungs
what may be used to support small mammal ventilation?
mechanical ventilator
what are the main potential post-op complications for exotic small mammals?
haemorrhage hypothermia pain hypoglycaemia gut stasis
how can post-op haemorrhage in exotic small mammals be monitored for and prevented?
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
how can hypothermia be prevented post op in exotic patients?
maintain temperature in an incubator or on a heat pad as animal recovers
monitor rectal temperature
how can hyperthermia of exotic patients be prevented in the post op period?
transfur to cooler environment once temperature of the patient is normal to prevent over heating
how can pain be prevented post op in exotic patients?
give adequate pain relief and place local blocks during srugery
what drugs may be given for post-op pain relief in exotic small mammals?
opioids
NSAIDs
how can hypoglycaemia be prevented post op in exotic patients?
encourage to eat, if not responding check blood glucose
how can gut stasis be prevented post op in exotic small mammal patients?
encourage to eat as soon as possible syringe feed if not tempted by high value foods offered prokinetics analgesia monitor for droppings
how long following surgery may it take for small exotic mammals to pass droppings?
up to 24hrs
what are the key things to remember during the post-op recovery period for exotic small mammals?
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)
how does surgery on exotics differ from that done on cats and dogs?
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
what magnification equipment may be used in exotic surgery?
loops
operating microscope
what equipment can be used to ensure good haemostasis in exotic surgery?
electro-cautery
radiosurgery
what are the best suture materials for exotics?
synthetic monofilament absorbable materials
give 2 examples of suture that is commonly used for exotics
Monocryl
Caprosyn
what suture material should be avoided in exotics?
catgut
why should catgut suture be avoided in exotics?
generates a pyo-hgranulomatous reaction as is dissolves which increases adhesions
what technique of skin sutures should be used for exotics?
buried - prevents chewing out
what may be used to secure skin wounds alongside sutures in exotics?
tissue glue
what makes wound dressing difficult in small exotic mammals?
difficulty keeping dressings in place and thin nature of skin in small mammals
what are the main aspects of wound care in small exotic mammals?
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
in what species is radiography useful?
rabbits and ferrets
what may make interpretation of some radiographs in some small mammal species difficult?
small size
what types of radiographs are best for small mammals?
digital
why are digital radiographs best for small mammals?
they may be enlarged and manipulated to highlight changes
how many imaging views are needed when imaging small exotic mammals?
at least 2
what may affect radiographic contrast in the abdomen of some mammals?
presence of large amounts of fat
what makes ultrasound difficult in some rodents?
small size
what can ultrasound be used for in exotic small mammals?
imaging the bladder or looking at a mass
what is the issue with ultrasound in rabbits and guinea pigs?
gas within the bowel may limit the views available
what can be assessed by ultrasound in rabbits and guinea pigs?
GI motility
presence of free fluid
masses
what is CT used for in exotic small mammals?
teeth and jaws especially
how must small exotic mammals be restrained for CT?
GA or sedation
what are the common surgical procedures seen in exotic small animals?
neutering (spay, castration or vasectomy in ferrets) lump / abscess removal dentistry GI obstruction enucleation liver lobe torsion
what is key about castration in guinea pigs and rats?
vaginal tunic must be closed to prevent a hernia
during a ferret vasectomy how is the ductus defrens prevented from regrowing?
a section is removed rather than just cutting it and leaving it
what can make spaying more difficult in small exotic mammals?
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
what surgical procedure is common in rabbits?
lump / abscess removal
how is abscess removal performed in rabbits?
if in the jaw - cut around, leave and open crater. Anaerobic bacteria are unable to survive
anywhere else - complete removal
how may GI obstructions be surgically removed in small exotic mammals?
milk through to LI and allow to pass naturally if moveable
eneterotomy/ectomy if tissue is damaged or object will not pass through
what condition can make spaying of exotic mammals more easy?
pyometra as uterus is enlarged and so easier to visulaise
from what aspect should cystotomy be performed?
least vascular aspect
why must care be taken if performing enucleation in rabbits?
blood sinus located behind eye
what can occur as a result of liver lobe torsion?
necrosis
in what small exotic animals are dental problems common?
hystricomorph rodents (e.g. guinea pigs, chinchillas and degus) and rabbits
what teeth problems may other (non-hystricomorph) rodents get?
incisors
what is the key factor which contributes to molar and incisor and malocclusion?
diet
how can diet cause molar and incisor malocclusion?
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
what can have and effect on teeth due to overcrowding?
breeding leading to smaller heads
what are the signs of dental issues found on clinical exam?
weight loss
ptyalism
swellings on ventral boarder of mandible
what is ptyalism?
dribbling of saliva
what equipment can be used to examine small mammals teeth?
otoscope
what is used to assess rodents teeth and roots?
good radiogrpahs
can malocclusion be cured?
no - can be managed with correction of diet to help
what is needed to access the molar teeth of rodents?
appropriate dental gag
how can spurs and tooth overgrowth be treated in small mammals?
spurs removed and crown height reduced
what equipment is used to remove tooth spurs and reduce crown height?
molar burr with guard
what can be used to reshape incisors?
dental burr or cutting disc
what should not be used to cut incisors?
nail clippers
can incisors be removed?
yes but is complex
what dietary corrections may aid dental issues?
increased fibre
reduced carbohydrates
what should be performed on exotics before anaesthesia?
thorough clinical exam and faecal and blood screens
why is a through clinical exam of reptiles necessary before anaesthesia?
they effectively hide any signs of illness
what is required to maintain a reptiles body temperature before and after the procedure?
facilities such as a vivarium which will maintain the correct POTZ
is fasting needed before a reptiles operation?
no but maybe avoid feeding animals on the day of the procedure (reptiles only usually fed weekly or less)
why do reptiles require respiratory support under GA?
they breathe via skeletal muscle movement as they have no diaphragm
how may a reptiles respiration be supported under GA?
IPPV
ventilator (e.g. vetronics)
how many breaths per minute do most reptiles need?
~4
why is monitoring of reptiles under anaesthetic difficult?
at surgical depths few, if any reflexes are able to be monitored and respiration is usually controlled externally
how can heart rates be monitored in reptiles under GA?
doppler probe can be used
how fast are reptiles HR?
slow
when are capnographs useful in monitoring reptiles under anaesthesia?
particularly useful on recovery as animal will not breathe if over oxygenated
how are wound sites prepared for surgery in reptiles?
as for any surgery
what solution is used to prep the skin of reptiles before surgery?
chlorhexadine or iodine
why is alcohol not recommended to scrub reptiles skin before surgery?
it will lead to cooling and increase hypothermia risk
what can be used to allow visualisation of a reptile while still ensuring sterility?
clear plastic drapes which adhere to the scales up to the incision site
how should reptilian scales be prepped for surgery?
scrub solution allowed to soak into scales
brush may be used to ensure scrubbed area is clean
what makes the positioning of reptiles for surgery so difficult?
varying shape of reptiles
what has had to happen to surgical techniques in some species of reptile?
altered due to the reptiles shape e.g. coelotomy performed in lateral on chameleons and iguanas ventrally
what can be used to position reptiles for surgery?
foam wedges and sand bags
what must be done to minimise pressure on the lungs of reptiles during surgery?
elevate chest and use assisted ventilation
what is breathing in reptiles stimulated by?
low O2 not high CO2 - unlike mammals
what is involved in post-op recovery of reptiles?
gradually reduce RR on ventilator to stimulate spontaneous breathing
use capnography
keep animal at POTZ to speed up recovery
what are the main areas of post-op care in reptiles?
wound management
analgesia
what dressings can be used for wound management in reptiles?
opsite and primapore
something absorbent
how should wounds be managed post op in reptiles?
clean wound regularly
ensure enclosure is clean as ventral abdomen is often in contact with floor/bedding and faecal material
what analgesia is used for reptiles post op?
NSAIDs - meloxicam (metacam)
opioids - butorphanol
where are surgical incisions made on reptiles?
between the scales to improve healing
where are incisions often made in snakes skin during surgery?
between 1st and 2nd row of small scales
what suture material are wounds closed with in reptiles?
monofilament
what suture pattern is used to close reptiles skin?
everting pattern such as horizontal mattress sutures
why are everting sutures needed to close reptiles skin?
prevents the natural inversion of skin below scales
when are sutures removed from reptiles?
after 4-6 weeks as healing is slower
why are removable sutures needed in reptiles?
absorbable material will eventually absorb but takes a very long time so skin sutures still need to be removed
what sutures are avoided in reptiles?
catgut and polyfilament sutures
why are polyfilament and catgut sutures to be avoided in reptiles?
create a lot of tissue reaction
what can be used alongside sutures to aid wound opposition in reptiles?
tissue glue
what is a coeliotomy?
entry into coelomic cavity
how is a coeliotomy performed in lizards?
ventral midline approach
what must be avoided when performing coeliotomy on lizards?
midline ventral abdominal vein
how can the midline ventral abdominal vein be avoided in lizards when performing coeliotomy surgery?
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
what happens if the midline ventral abdominal vein is damaged in lizards?
can be tied off without affecting the lizard
how should the coelomic cavity be closed in lizards?
close coelomic membranes if possible and then the skin
how can coeliotomy be performed in laterally compressed lizards?
right or left lateral approach just behind last rib extended along the curve of teh rib
how is the coelom entered in snakes?
between the ribs and the ventral musculature
how can the coelom of snakes be closed following surgery?
2 layer of muscle and skin
what must be assessed about the incision site before operating on snakes?
exactly where the incision needs to be made as it is not possible to access all snakes organs through one incision
how can the coelom be accessed in chelonia?
trapdoor in the plastron cut using an oscillating or circular saw
how are the wounds in the chelonia’s plastron cut to ensure the shell can be replaced after surgery and not fall inwards?
with a 45 degree bevel
how is the plastron separated from underlying muscle attachments in chelonia?
scalpel handle or periosteal elevator
what must you be careful of when opening the plastron of chelonia?
not to damage the paired abdominal veins that run in the coelomic membrane
how is the trapdoor in the plastron replaced after surgery?
glued back in place
what is used to clean wounds in reptiles?
dilute iodine followed by wound fully rinsed
what dressings can be used on chelonia?
adhesive dressings such as primapore or opsite
what can be used to aid reptilian wound healing?
water based gels or hoeny
why is diagnostic imaging particularly useful in reptiles?
often difficult to palpate abdominal structures (especially tortoises)
do most exotic species require sedation for imaging?
no -their sedate nature makes imaging easier
what views are often used in reptile imaging?
dorso-ventral
horizontal beam lateral
horizontal beam cranio-caudal
why are vertical beam lateral images difficult in reptiles?
there is no diaphragm so little seperation between lungs and coelom
why does ultrasonography work well in reptiles?
absence of fur means good contact
what can improve ultrasound images in reptiles?
allowing gel to soak between the scales
how may amphibious species be scanned with ultrasound?
immerse probe and the animal in water
what is ultrasound good for imaging in reptiles?
heart
reproductive tract
GI
masses
what species of reptiles are best for CT?
chelonia
how long does CT imaging take?
15 seconds
what tissue is CT good for imaging?
soft tissue
what can be produced from CT images?
3D images
how should animals be restrained for CT/imaging?
within a box to keep safe and reduce movement
what are the most common surgical procedures in reptiles?
mass/abscess removal
ovariosalpingectomy
GI obstruction
hemipenile amputation
what is the issue with mass removal in reptiles?
skin cannot be closed so the wound remains open
why do abscesses have to be removed in reptiles?
they are solid so lancing and draining is not possible
what is removed during an ovariosalpingectomy?
ovary and shell gland
what is performed in lizards to remove reproductive organs?
ovarectomy
what incision is needed to perform ovariosalpingectomy / ovarectomy?
midline incision
what must you ensure has been removed when spaying reptiles?
all ovarian tissue to prevent regrowth
when does GI obstruction often occur in reptiles?
lizards eating bedding or stones
what surgery may be needed to correct GI obstruction?
enterotomy
coliotomy
when does hemipenile amputation need to be performed?
if there is persistent prolapse
how is hemipenile amputation performed?
clamp and ligation
should wounds to scutes be closed with glue?
no - if unclean the wound will lead to abscess. Should be closed with tape
