VNSA15 + 16 Flashcards
When admitting animals what needs to be included?
-handover from o
-checking when animal was last fed + if water was withheld
-Animals possessions
-what meds has been given and when
-consent (age over 18) and checking they understand procedure
-consider economics
-contact details
-providing o a time to call for progress if not heard
-create nursing record
-record any changes (behaviour, eating and drinking etc)
-allergies
-update records (numbers and weights)
Starvation periods
Puppies and kittens = 3hrs
Dogs and cats = min 6hrs
Ferrets = max 4hrs (ideal time 1-2hrs)
Rabbits = not starved
Define elective/non-urgent procedures
Routine pre-anaesthetic prep, healthy animal discharged same day.
Eg neutering
Define necessary/urgent procedures
Condition isn’t immediately life threatening
Patient to be discharged in next few days (progress dependent)
Procedure can be delayed short term to allow time for necessary patient prep
Eg - RATA, Boas surgery, grass seed removal
Define emergency/life threatening procedures
Despite increased surgical risks prep time is limited
Patient expected to be hospitalised for some time post op
Immediate surgical procedure necessary
Eg - pyo, ex lap, foreign body, RTA, c-section, blocked bladder, GDV
What is a hernia ?
Where the body part protrudes abnormally through a tear or opening in an adjacent part.
Diaphragmatic = keep head and chest slightly higher. Closely monitor cardiovascular and respiratory system.
Umbilical/inguinal = can be incarcerated. Nursing dependable.
Perineal = a swelling by anus due to breakdown of muscle forming pelvic diaphragm. Check bladder not affected.
Management of orthopaedic procedures
Analgesia
Assessment of other body systems
Keep animal mobile if poss
Weight control
Nutrition for healing
Exercise and physio
Treatment of any skin infections
Recognition of early signs of complications (osteomyelitis, inc pain, reduced limb use, depression, pyrexia)
Advantages and disadvantages of casts (fracture management)
Used in relatively stable fractures (green stick, simple oblique or spiral) or post op support.
Adv: non-invasive, stability and relives pain, prevents displacement
Dis: limb swelling, decubitus ulcers, cast loosens, prolonged immobilisation, joint laxity, re-fracture on removal.
Advantages and disadvantages of internal fixation (fracture management)
Adv: Can be used with any fracture but open fractures with extensive soft tissue injury may not be suitable. Can be used in any bone, allows accurate reduction and rigid fixation. Limb has full function
Dis: expensive, time consuming, technically demanding, risks of surgery
Advantages and disadvantages of external fixation (fracture management)
Used in long bone fractures, comminuted, open and infected, delayed unions and non-unions, mandibular
Adv: minimal instrumentation required, clamps and bars reusable, minimal disruption of soft tissue, open wound management is easy, easy to combine with other implants, adjustable ridgity/alignment, easy to rem
Dis: soft tissue problems, application process requires technique, premature pin loosening, difficult to apply to proximal limb, x-rays difficult.
Monitor signs in post-op nursing
Body temp
Monitor faecal and urinary output (is catheter needed)
Osteomyelitis (pyrexia, depression, reduction of limb use, pain)
IVFT
Wound/bandage management and interference
Nutrition
Monitor body condition
Kennel size
Bedding material
Cold compress
Supported exercise
Enrichment
Spinal procedures
Problems = pain, paresis, paralysis, loss of bladder function, deep pain perception
Surgery often involves relieving pressure on the spinal cord.
Provide analgesia (NSAID’s, opioids)
Urinary monitoring and assistance
Padded kennel/mattress, regular turning (4-6hrs) of recumbent patients to reduce hypostatic pneumonia and decubitus ulcers. More lifting assistance with larger breeds. Keeping them clean and dry.
Thoracic procedures
Often life threatening procedures. Check for obstructions, SPO2 levels, heart failure etc.
nursing symptoms: inc RR, oxygen therapy, reducing stress.
During thoracotomy IPPV needed continuously
Extubated as late as poss
Chest drains
Dressings changed
Monitor temp and fluid loss
Post op - monitor vital signs, ensure air take is sufficient, careful patient handling, O2 supplementation, IVFT.
GDV (Gastric Dilation and Volvulus)
Fatal due to hypovolaemia and toxic shock.
Commonly seen in large deep chested breeded dogs.
Stomach twists causing a one-way valve effect at the gastro-oesophageal junction allowing swallowed air to enter but not leave. Gas accumulation may result from CO2 producing bacteria and gastric acid and bicarbonate can also lead to CO2 production.
Pre-op: aggressive IVFT needed to restore circulatory volume, acid-base balance and electrolytes. Stomach needs to be decompressed using oro-gastric tube or percutaneous. Analgesia, fluids, antibiotics etc also needed.
X-rays to confirm stomach position.
A gastrostomy tube is often placed.
Post-op: focus on cardiac output, tissue perfusion, ischaemia-reperfusion injury (IRI). Analgesia, IVFT, blood analysis, urinary output and ECG required.
What are the 2 aims of ophthalmic procedures
Preserve sight if poss and reduce pain.
Dental and oral procedures
Dirty procedures so must be done last or in a dedicated theatre.
Hand scaling: removes calculus from the supragingival area. Used in the direction of the gingiva to tip of the crown. A curette is used to remove calculus from subgingival area and moved in a circular motion around gingival margin.
Mechanical scaling and polishing: use of a scaler (ultrasonic or sonic units) uses electrical currents and the scaler tip vibrates and breaks up the calculus. Remove large areas with calculus forceps first to protect equipment. Constant supply is needed as a supply of heat is generated, should not be used for than 8secs per tooth at a time.
Patient care - tubed and cuffed, throat pack, keep warm, head lower than body so fluid drains out mouth, watch for choking or coughing
What information needs to be handed over post-op?
-IVFT amounts, rate etc
-operation performed
-wound (location, management, dressings)
-GA length and stability
-stitches out and any post-op care
-whether had additional treatments (nail clip or anal glands)
-vital signs
-sedation given
-analgesia, reversal med and time given and meds to go home
-patient temperament
-extubated time
-any complications
Name some immediate post-op aims
-reduce mortality and promote recovery
-improve wound healing
-provide analgesia
-ensure a rapid and complete return to normal function
-avoid infection development
-meet the patients nutritional demands
-reduce post-op complications
-reduce morbidity
What is shock?
Acute circulatory collapse. Circulation is unable to transport sufficient oxygen for the tissues needs.
What is blood pressure dependant on?
Blood pressure = cardiac output X systemic vascular resistance.
What are implications of inadequate tissue perfusion?
Cell hypoxia -> energy deficit causing lactic acid accumulation and drop in pH leading to anaerobic metabolism.
Can cause metabolic acidosis leading to vasoconstriction, failure of pre-capillary sphincters and peripheral pooling of blood.
This can lead to destruction, dysfunction and cell death
What do cells require to remain healthy?
Oxygen, nutrients and waste removal.
What are the 4 types of shock?
- Hypovolaemic
- Distributive (septic, toxic, anaphylactic)
- Cardiogenic
- Obstructive
Hypovolemic shock
Caused by reduction in circulating intravascular volume. (Fluid losses -severe dehydration, haemorrhage, V+ and D+ or loss of fluid in a body cavity)
Clinical signs - tachycardia, prolonged CRT, pale mm, poor pulse quality, low bp)
Distributive shock.
Where an animal suffers an abnormal blood volume distribution due to generalised and excessive dilation of the blood vessels.
Caused by - sepsis, severe pancreatitis, major tissue trauma, GDV, burns
Clinical signs: dark pink/red mm and rapid then slow CRT, tachycardia, poor pulse quality.
Neurogenic - results from CNS trauma causing acute vasodilation
Anaphylactic shock - caused by an allergic reaction to a substance results in peripheral resistance and vasodilation
Endotoxic shock - septic - toxins are released from bacteria causing a disturbance in blood distribution.
Cardiogenic shock
Occurs when the heart is unable to pump blood adequately around the body.
Consider - cardiomyopathy, heart and valve disease, severe arrhythmias
Clinical signs: heart murmur, irregular pulses, tachycardia or bradycardia.
Care with IVFT as inc blood volume makes the heart work harder.
Obstructive shock
Caused by an obstruction of the blood flow through the heart or back to the heart.
Consider - pericardial effusion or cardiac tamponade, constructive pericarditis, pulmonary thromboembolism
Clinical signs - tachycardia/bradycardia, heart murmurs and irregular pulses. Can be seen in conjunction with hypovolaemic shock.
What are crystalloids?
Electrolyte solutions that can pass freely out of the blood stream via the capillary membrane into the interstitial fluid.
When are isotonic, hypertonic and hypotonic crystalloids used?
Isotonic crystalloids- as replacement or maintenance fluids
Hypertonic fluids- Expands plasma volume by drawing fluid out of cells into extracellular space.
used in large hypovolaemic patients when isotonic fluids cant be administered at a high enough rate. Must follow with isotonic crystalloids.
Hypotonic fluids are rarely indicated.
What are colloids?
Contains molecules with a large molecular weight meaning they cant leave the vascular system.
They inc osmotic pressure of the blood, pulling fluid from the extracellular space into the vasculature.
Uses - hypovolaemic or hypoproteinaemia patients
What colour is arterial haemorrhage ?
Bright red, spurting in nature
What colour is venous haemorrhage?
Dark red, continuous in nature
What colour is capillary haemorrhage?
Bright red, continuous in nature
Define primary haemorrhage
Occurs at the time of injury, trauma or surgery
Define secondary haemorrhage
Occurs 7-14 days after trauma or surgery.
Cause - induction and sloughing away of blood vessels
Define reactionary haemorrhage
Occurs 24-48hrs following trauma or surgery.
Causes - slipping away of ligatures, dislodgement of clots, cessation of reflex vasospasm, normalisaition of bp
Define hypoperfusion
No improvement of the symptoms of shock.
Could be related to inc losses or inadequate volumes of fluid.
Define hyperfusion
The volume of fluid administered is greater than can be excreted.
Symptoms - dyspnoea, tachypnoea, fluid on chest, polyuria, heart failure, abnormal hr, oedema, lethargy
Actions - diuretics, take off fluids/reduce rate, O2 support
Define hydrostatic pressure
Pressure exerted by a fluid at a given point, due to the weight of the fluid above it.
Define hydraulic pressure
The pressure that results from the heart pushing blood through the vessels
What are the main cations and anions in extracellular fluid
Cations = Sodium, calcium
Anions = chloride bicarbonate
What are the main cations and anions in Intracellular fluid?
Cations = potassium, magnesium
Anions = phosphate
Fluid requirements
Adult large dogs - 1.5ml/kg/hr
Very small dogs - 4ml/kg/hr
Adult cats - 2-3ml/kg/hr
Kittens - up to 6ml/kg/hr
Note - obese animals calculated on a reduced bw. Pyrexia increases fluid requirements by 3ml/kg/degrees above normal temp
How does the body control water loss?
-Communicates w hypothalamus causing thirst
-osmoreceptors release ADH and stimulate reabsorption of water.
-released of renin: angiotensin = vasoconstriction and aldosterone = inc sodium retention = inc water reabsorption.
What is primary water loss?
Water lost from the extracellular fluid first causing a move from the Intracellular -> extracellular to maintain a balance.
(Osmotic equilibrium)
Eg - lack of water available, excessive panting, fever, diabetes insipidus
What is mixed water and electrolyte loss?
This occurs due to abnormal losses.
Water and electrolytes move from the extracellular fluid and there is no movement from the Intracellular fluid to balance
(maintain osmotic equilibrium)
Eg - haemorrhage, V+ and D+
Acid base balance
Hydrogen ions are produced as a result of normal metabolism, the body’s acid base balance is a measure of the hydrogen ion concentration within its tissues.
Hydrogen ions are measure according to the pH scale (ranging from 1-14)
Neutral pH = 7.35-7.45
What are the 3 principle means of balancing pH?
Buffers - such as bicarbonate - used to soak up the hydrogen ions, preventing acidosis.
Respiration - chemoreceptors monitor hydrogen ions and alter respiration accordingly, increasing ventilation inc the carbon dioxide expired and reduces acidosis.
Renal system - hydrogen ions are excreted into the urine, reducing acidosis.
What happens in acidosis
Metabolic acidosis drops due to bicarbonate buffers
Respiratory acidosis inc due to carbonic acid
What happens in alkalosis?
Metabolic alkalosis inc due to bicarbonate buffers.
Respiratory alkalosis decreases due to carbonic acid
Clinical signs for under 5% dehydrated
Not detectable.
Hx suggests a deficit is present. Inc in urine concentration.
Clinical signs for 5-6% dehydrated
Subtle loss of skin elasticity
Clinical signs for 6-8% dehydrated
Marked loss of skin elasticity
Slight prolonged CRT
Slightly sunken eyes
Dry MM
Clinical signs for 10-12% dehydrated?
Tented skin that stands in place
Proglonged CRT (>2 secs)
Sunken eyes protruded 3rd eyelid
Dry MM
Progressive signs of shock
How do you calculate fluid deficit by using % dehydration
% dehydration X body weight (kg) x 10
Fluid therapy for hypovolaemic shock.
(Isotonic crystalloid)
Isotonic crystalloid (Hartmans) should be used.
Mild hypovolaemia; Dog 5-10ml/kg and cat 3-5ml/kg
Moderate hypovolaemia; Dog 10-20ml/kg and cat 5-10ml/kg
Severe hypovolaemia; Dog 20-40ml/kg and cat 10-15ml/kg
Rabbits; 10-15ml/kg
Colloid therapy for severe hypovolaemia
Initial bolus = Dog 5-10ml/kg and cat 2-5ml/kg
Total bolus = Dog 20ml/kg and cat 10ml/kg
What records need to be kept when using IVFT?
Site of IV and gauge
Date of insertion
When and what it was flushed
Bandage checks
Any complications \
IVFT rate and running
List some complications of fluid therapy
Hypovolaemia - no improvement on IVFT
Hypervolaemia - too much fluid given
Tissue oedema
Cardiac disease
Renal insufficiency
Inc intracranial pressure - head trauma, intracranial masses ands seizure patients
