Theatre Practice Flashcards
Diathermy?
Diathermy?
.High frequency alternate polarity radio-wave electrical current to cut or coagulate tissue
during surgery.
What needs to be counted before and after surgery?
What needs to be counted before and after surgery?
.Swabs .Needles
.Sutures
Circulating nurse?
Circulating nurse?
.Assist with all non-sterile procedures.
Surgical knots?
Surgical knots?
.The basic surgical knot is a reef or square knot.
.A surgeon’s knot has an initial double throw, not a single throw.
.The suture loop should be loose otherwise it will compromise the vascular supply and delay healing and cause irritation to the patient.
Control haemorrhage by?
Control haemorrhage by?
.Using swabs to blot the bleed not wipe.
Post op?
Post op?
.Patient should not be left until conscious, sitting up and breathing normally.
.ET tube removed once the cough reflex returns and in cats just before to prevent laryngospasm.
Intubation?
Intubation?
.Provides a secure airway and protects it from saliva and liquids during dental work.
.Supplys oxygen and anaesthesia and reduces pollution from waste anaesthetic gases.
Laryngospasm after surgery?
Laryngospasm after surgery?
.Keep ET tube in place & get vet.
Haemorrhage after surgery?
Haemorrhage after surgery?
.Bandage
Hypothermia after surgery?
Hypothermia after surgery?
.Warm patient, set room to 21°c - 23°c and monitor temp every 10 mins.
.Give warm iv fluids, blankets, heat pads and bubble wrap.
Surgical pack shelf life?
Surgical pack shelf life?
.Repack and sterilise if not used within 6-8 weeks.
Surgery involves?
Surgery involves?
.Always involves the creation or treatment of wounds.
A wound?
A wound?
.Can be defined as an injury in which there is a forcible break in the continuity of the soft tissues.
.Wounds that are covered (moist) heal faster than open ones. Dressing should be applied to encourage moist healing.
Wound healing?
Wound healing?
1) Haemorrhage - inflammation and primary wound contraction. Haemorrhage occurs at the time of the injury. This then clots and forms a scab, which protects the wound from external contamination. Inflammation follows.
2) Proliferation - after 12 hours, epithelial proliferation starts. New cells are produced and slide over the surface of the wound. This occurs at a rate of up to 2mm per day if the wound is kept moist. After 36 hours, fibroblasts and new capillaries are produced, forming grandulation tissue. This is usually bright red and firm but is quite easily damaged.
3) Maturation - during epidermal growth new collagen is laid down and forms scar tissue. This is continually remodelled up to 2 years after the original incident.
Inflammation?
Inflammation?
.Is the reaction of normal tissue to injury and is part of the body’s natural defense mechanism.
.When cells are damaged, chemicals such as histamine and prostaglandins are released and these stimulate the inflammatory response.
.This is needed to start the healing process. Use of anti-inflammatory drugs will reduce healing in the early phases.
Factors affecting wound healing?
Factors affecting wound healing?
.Movement .Infection
.Tension .Self trauma
.Foreign material
Incised wound?
Incised wound?
.Clean straight cut with little damage to surrounding tissues, heals quickly, moderate haemorrhage e.g. scalpel, glass, tin.
.First aid - access and control haemorrhage, remove foreign bodies if safe, clip away hair, clean wound, apply sterile dressing/ bandage.
Puncture wound?
Puncture wound?
.Small external wound but may be deep and causes inflammation, swelling and possibly an abscess e.g. teeth, thorn or nail.
.First aid - access and control haemorrhage, remove foreign bodies if safe, clip away hair, clean wound, apply sterile dressing/ bandage.
Lacerated wound?
Lacerated wound?
.Large irregular opened wound with damage to the skin and tissues, minimal haemorrhage, slow healing e.g. dog fight, barbed wire, broken glass
.First aid - access and control haemorrhage, remove foreign bodies if safe, clip away hair, clean wound, apply sterile dressing/ bandage.
Abrasion?
Abrasion?
.Graze wound, painful due to exposure of nerves, the epidermis is grazed away and exposes the dermis.
.Caused by friction of the skin against a rough surface e.g. like rope or carpet.
.First aid - clip away hair, clean wound, apply a sterile dressing.
.Painful due to exposure of nerves in the dermis
Contusion wound ?
Contusion wound?
.Blood vessels rupture under the skin causing haemorrhage. The blood seeps into the tissues and eventually clots. Warm and discolouration of skin.
.Discolouration under the skin, swelling and warm
.First aid - apply cold compress
Avulsion wound?
Avulsion wound?
.A flap of skin with only one end attached to the body.
.Occurs where there is forcible separation of a tissue from its attachments e.g. dog fights
.Access and control haemorrhage, remove foreign bodies if safe, clip away hair, clean wound, apply sterile dressing/ bandage.
Degloving?
Degloving?
.Separation of a tissue from its attachments or damage to the blood supply e.g. tissue dies and sloughs away over a period of time e.g. road traffic accident.
Shear wound?
Shear wound?
.Removal of skin and damage to bones or joints
Haematoma wound?
Haematoma wound?
.Blood loss and a pocket of blood develops under the skin e.g. blunt trauma
Flushing a wound?
Flushing a wound?
.Use sterile hartmann’s solution or 0.9% saline.
Wet to dry dressing?
Wet to dry dressing?
.Swabs soaked in hartmann’s solution put on wound, when it drys out and is removed it takes with it any educate and debris.
.Change every 12 - 24 hours.
Dry to dry dressing?
Dry to dry dressing?
.Dry swabs are put on a wound so that debris and necrotic tissue adheres to the swabs and is pulled away when the dressing is changed.
.Is painful so not commonly used.
Bandages can help to?
Bandages can help to?
.Protect a wound from bacterial contamination.
.Debride a wound.
.Provide comfort and pain relief.
.Prevent patient interference.
.Support an area with a wound and reduce movement of the skin edges.
.Prevent desiccation of a wound.
.Reduce the development of swelling and oedema.
.Absorb any exudates.
.Provide a better appearance of the wound.
Bandage care?
Bandage care?
.Must not be allowed to get wet.
.Patient not to interfere with it e.g. buster collar, sprays.
.Check regularly for signs of damage, infection, healing.
Bandage layers?
Bandage layers?
.Primary or contact layer - this touches the wound and must be sterile.
.Secondary or intermediate layer - pudding, usually added for comfort or absorption
.Tertiary or protective layer - applied over the other layers to hold them in place, prevent interference and minimise contamination from the environment.
Drains?
Drains?
.Device that allows fluid or air to pass from a wound or body cavity to the surface e.g. abscesses, seromas.
.Most common drain - is a soft flexible tube known as the penrose drain.
Desiccation?
Desiccation?
.Having had all moisture removed.
Seroma?
Seroma?
.Fluid build up under the skin (serous fluid).
Purulent?
Purulent?
.Containing discharge or pus.
Reconstructive surgical techniques?
Reconstructive surgical techniques?
.Skin flaps - conserve the natural blood supply to the tissues partly removed.
.Skin grafts - completely removed epidermis and dermis, sometimes only parts of the dermis.
.Wound dehiscence - breakdown of a surgical wound e.g. insufficient debridement, poor local blood supply, movement of wound.
Wound infection?
Wound infection?
.Signs of a animal with an infected wound e.g. anorexic, lethargy and pyrexia. Site will be red and swollen, painful and have discharge.
Abscess?
Abscess?
.Is a localised collection of pus caused by bacteria entering a wound. Pus is tissue debris, dead and degenerating neutrophils and is usually cream or green.
.Usually contains pyogenic organisms, but can be sterile.
.Found in skin, muscle, bone, organs and brain.
.Signs - pain, swelling, reduced function of the area.
.Treatment - drain with fluids or 0.05% chlorhexidine for superficial abscess and surgery for deep ones.
Excision?
Excision?
.The removal of tissue using a scalpel.
Ulcers?
Ulcers?
.Loss of the epithelial surface of a tissue, usually skin or MM, leaving a raw area e.g. oral, pressure sores, corneal ulcers.
Fistula?
Fistula?
.Is a channel that passes from one MM to a second MM or the skin e.g. it passes from one epithelial surface to another.
Hernias and ruptures?
Hernias and ruptures?
.These are similar, since both case abdominal contents come to rest in an abnormal position through an opening in the muscular wall.
.Hernia - the opening in the abdominal wall is natural such as the umbilicus or inguinal ring.
.Rupture - there is a tear in the muscle wall that allows the abdominal contents to migrate through.
Types of hernias - umbilical, inguinal and perineal hernia.
.Diaphragmatic rupture - a rupture caused by trauma forcing the diaphragm to tear.
Tumours/ neoplasia?
Tumours/ neoplasia?
.Any abnormal new growth occurring in the body.
.Can occur anywhere in the body. Either benign (localised) or malignant (spreads)
.Metastases - secondary tumours that usually develop as small clumps of cells break away from the first tumour and enter circulation.
Benign tumours?
Benign tumours?
.Lipoma - composed of adipose tissue
.Fibroma - superficial tumour of the skin
.Adenoma - tumour of glandular tissue
.Papilloma - warty growths on the skin
.Melanoma - tumour of the melanocytes in the skin.
Malignant tumours?
Malignant tumours?
.Carcinoma - produced from epithelium
.Sarcoma - produced from medodermal/ connective tissue
.Melanocarcioma - tumour of the melanocytes in the skin
Causes of tumours?
Causes of tumours?
.Mutations- uncontrolled proliferation (increase) of mutated cells.
.Viruses - feline leukaemia virus and papillomavirus.
.Carcinogens - chemicals that induce mutations in the DNA e.g. smoking and benzene
.Ultraviolet light e.g. sunlight causes skin cancer
Tumour diagnosis?
Tumour diagnosis?
.Sample of tissue to see cell type and degree of malignancy.
.Radiography.
.Ultrasonography
.MRI
.CT scan
Tumour treatment?
Tumour treatment?
.Surgery to completely or partly remove it. Be gentle when preparing the tumour site for surgery or there is a possibility of increasing the tumour.
.Chemotherapy - the treatment of tumours using cytotoxic drugs. Used for tumours that have spread or those affecting the bone marrow or lymphatic system. Can be used as the sole treatment method for some tumours or in combination with surgery or radiation treatment.
.Radiation therapy - radiation damages rapidly diving cells and can cause chromosomal damage, thereby preventing them from diving further. Used by its self or with treatment.
Cytotoxic drugs?
Cytotoxic drugs?
.Care should be taken when handling e.g. PPE.
.When handling patient faeces and urine that may have the drugs in them.
Radiation side affects?
Radiation side affects?
.Erythema
.Alopecia
.Skin thickening
.Hair colour changes
Preoperative?
Preoperative?
.Last feeding time?
.Medications?
.In season?
.Last urination and defecation?
.Should be allowed water up until pre-medication .
.Once asleep start clipping and skin prep.
Operative stage?
Operative stage?
.Sterile nurse - passes instruments, swabbing the site and cutting sutures if scrubbed up first.
.Non-sterile nurse - monitors the condition of the patient and only this so their full attention is given.
Postoperative?
Postoperative?
.The op site should be gently cleaned before the patient starts to come round from the anaesthetic and any dressings applied.
.Then monitor recovery to ensure adequate respiration and return of the laryngeal reflexes.
.Should be kept warm and regularly check op site.
.After surgery check - vital signs, nutrition, pain, stress, bedding and surgery site.
Discharge/ post operative care?
Discharge/ post operative care?
.Medications
.When and what to feed
.Walking/ working
.Next appointment
.Problems to watch for
Aural haematoma?
Aural haematoma?
.Develops on the ear pinna from infection or foreign body within the ear.
.Signs - swollen, warm and blood filled caused by self trauma.
Total ear canal ablation (TECA)?
Total ear canal ablation (TECA)?
.Infection or tumour are very severe.
.Produre results in deafness.
Lateral wall resection (zepp’s procedure)?
Lateral wall resection (zepp’s procedure)?
.Chronic ear infection in which the vertical canal has become chronically inflamed and narrowed.
Proptosis?
Proptosis?
.Prolapse of the eyeball.
.An emergency and is one of the few situations where an animal must be taken to surgery asap.
.Signs - eye more bulbous than normal and blindness can be an affect of it.
.Prevent the eye from drying out by applying saline, ophthalmic ointment or water-soluble jelly and buster collar.
Corneal ulcer?
Corneal ulcer?
.Eye is very painful causes blepharospasm, increased fluid from eyes, may be infected causing discharge.
Enucleation (eye removal)?
Enucleation (eye removal)?
.Too damaged to save causing blindness and pain.
.Causes - trauma, panophthalmitis, neoplasia, glaucoma, prolapse, abscess.
Dilute povidone-iodine used for?
Dilute povidone-iodine used for?
.For cleaning site near eyes
Exenteration?
Exenteration?
.Eye and tissues removed.
Cataracts?
Cataracts?
.Is an increase in the opacity of the lens and in a true cataract is due to deposition of material within part of the eye lens.
.75% of dogs with diabetes mellitus develop cataracts and go blind.
Entropion?
Entropion?
.The eyelid rolls inwards.
.Causes tear overflow, irritation, blepharospasm and conjunctivitis
Ectropion?
Ectropion?
.Eyelid bags open exposing the conjunctiva.
.Causes conjunctivitis.
Ectopic cilia?
Ectopic cilia?
.One or two abnormally positioned eyelashes.
Distichiasis?
Distichiasis?
.Involves a row of extra eyelashes.
.Signs - epiphora, blepharospasm, conjunctivitis.
Foreign body and intestinal surgery?
Foreign body and intestinal surgery?
.Don’t use NSAIDS for post op.
Gastric dilation torsion?
Gastric dilation torsion?
.Signs depressed, salivate, vomit, abdominal swelling, deep purple MM.
.Stomach distends causing pressure on hepatic portal vein and vena cava and decreases venous return resulting in hypovolemic shock because blood is not being sent to tissues.
.After surgery blood pressure should be monitored to prevent endotoxic shock.
.Exercise animals before feeding.
Rectum and anus conditions?
Rectum and anus conditions?
.Neoplasia
.Polyps - growth within the colon
.Anal furunculosis - a deep pyoderma develops in the perineal tissue.
Ovariohysterectomy?
Ovariohysterectomy?
.The ovaries, uterine horns and uterine body are removed.
.Prevents pregnancy and false pregnancy
.Prevents mammary tumours
.Prevents and treats pyomertra
Ovariectomy?
Ovariectomy?
.Only the ovaries are removed.
.Complications from surgery are haemorrhage, abdominal swelling and leakage from op site.
Hysterectomy (caesarean section)?
Hysterectomy (caesarean section)?
.Opening of the uterus to remove fetuses if the animal is having problems giving birth alone e.g. large fetuses, abnormal position of fetuses, pelvic deformities and uterine inertia.
Urethral obstruction?
Urethral obstruction?
.Urinary calculi stuck
.Signs Urinary tenesmus, haematuria,lethargyand pain.
Urethral stricture?
Urethral stricture?
.Scarring that narrows the urethra.
.Stricture restricts the flow of urine.
Calculi (stones)?
Calculi (stones)?
.A concretion of material, usually mineral salts, that forms in an organ or duct.
Nebuliser?
Nebuliser?
.Face mask filled with air or drugs.
Chest drain?
Chest drain?
.Syringe and needle attached to a three-way tap to suck the air out of the chest.
Fractures?
Fractures?
.Minimise the movement of the fracture fragments
.Support with bandages for splints
.immobilise it - allows initial bone healing to occur more rapidly.
.Should heal in 4 to 6 weeks normally after surgery.
.Reduced exercise and good diet.
Fracture treatments?
Fracture treatments?
.Conservative - no surgery or fixation just confined, so bone can heal.
.External fixation - casts and splints. Casts are fully weight bearing after 30 mins.
.Internal fixation - surgery.
Fracture post op care?
Fracture post op care?
.Limited exercise for the first few weeks.
.Dogs - lead exercise 2-3 times a day for 10-15 mins each time is advocated.
.Cats - restrict to a large cage with occasional supervised excursions may be appropriate.
.No stairs, jumping or running in early stages.
Luxations and subluxations?
Luxations and subluxations?
.Luxations (dislocation) - is the persistent displacement of bones forming a joint.
.Subluxations (partial dislocation) - the bones are disturbed from their normal position but remain in contact.
.Causes - trauma or abnormalities from birth.
Burns?
Burns?
.Caused by fire, chemicals, hot water or surfaces.
.Reddened damaged skin, moist skin, heat, swelling, painful and alopecia, skin oozing.
.First aid - cool with sterile running water/ saline, maintain & monitor body temperature, apply lint free non adhesive dressing.
