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What are some aspects of monitoring a patient as they recover from anesthesia?
-post op TPR (temp of 98 F is important)
-continue to monitor pulse ox, ECG, BP until they begin to wake up
-untie ET tube and deflate cuff so that it can be removed promptly when they swallow a couple times
When do you remove an ET tube? Why?
After they swallow 2-3 times to make sure the pharyngeal area has regained mobility and they can breathe on their own
What is an exception to removing an ET tube after 2-3 swallows?
Brachycephalic patients; we wait almost until they can lift their head because it sometimes takes longer for them to breathe on their own after anesthesia.
As a general rule, extubation of which of these dog breeds should be delayed until they are able to lift their head?
Pugs (brachycephalic breeds)
Shivering in a patient recovering indicates:
The patient's body is attempting to produce heat.
Rewarming should be considered when the temperature is:
< 97.6 F
Rewarming efforts should be decreased as the patient's body temperature returns to normal to avoid:
Rebound hyperthermia
What are some acceptable methods of warming a patient?
-fluid warmer
-microwave 1-2 L fluid bags and shake to avoid hot spots
-bair hugger
-water bottles
-warm water filled balloons/latex gloves
-uncooked rice or lentils
What are some unacceptable methods of warming a patient?
-electric heating blankets/pads
-any acceptable method that involves placing the heat source directly on the patient without a barrier like a towel or blanket
How can lung atelectasis be prevented?
-flip sides at regular interval
-put in sternal recumbency if possible
-copage (beating or pushing on the side to stimulate lung movement)
-walking in a sling can stimulate lung movement
How can bladder overflow be prevented?
-empty bladder at least 3 times per day
-diapers for a bladder that is constantly leaking
What is the reversal agent for opioids (morphine, fentanyl, etc.)?
Naloxone (butorphanol can partially reverse)
What is the reversal agent for diazepam and midazolam?
Flumenazil
What is the reversal agent for dexdomitor?
Antisedan
What is another name for pressure sores/bed sores?
Decubital ulcers
What is a decubital ulcer?
Reduced blood supply to skin when in the same position for an extended period of time; can be caused by laying on a boney prominence or dragging around a boney area
What are some likely spots for a decubital ulcer?
-hips
-elbows
-ischiatic tuberosity
-hock
Stage I Bed Sore
Red skin- can go away shortly after pressure is relieved
Stage II Bed Sore
Partial dermal skin loss; ulcer or blister but if treated promptly it can heal fairly quickly
Stage III Bed Sore
Full skin loss; creates a deep crater like wound
Stage IV Bed Sore
Large scale loss of skin with damage to muscle and bone may be exposed; most serious and can be lethal due to infection
Pinna
Ear tip
Tympanic Membrane
Ear Drum
AD (auris dextra)
Right Ear
AS (auris sinistra)
Left Ear
AU (auris utraque)
Both Ears
Aural Hematoma
Blood filled space between cartilage and skin of the pinna
How is an aural hematoma corrected?
Draining procedure or surgery
Where should the incision be placed for an aural hematoma?
An ‘S’ or linear incision on concave portion of the pinna
How long do bandages and sutures stay after aural hematoma draining?
Needs to stay wrapped for two weeks or more
What is the goal of aural hematoma surgery?
Alleviate hematoma and prevent recurrence
What are things to monitor post-op for ear canal surgery?
-watch for signs of facial nerve damage
-make sure bandage is in place and clean
-submit samples and cultures from surgery
-pain meds
-antibiotics
What indicates facial nerve damage?
Not being able to blink, different pupil sizes, lip dropping, eyelid dropping
Anisocoria
Pupils different sizes
OD (Oculus Dexter)
Right Eye
OS (Oculus Sinister)
Left Eye
OU (Oculus Uterque)
Both Eyes
Lacrimation
Tear Production
Blepharospasm
Squinting, Blinking excessively
Photophobia
Light Sensitivity
Enophthalmos
Pulling back eye, third eyelid protrusion
Conjunctivitis
Inflamed Conjunctiva
Keratitis
Inflamed Cornea
Entropion
Rolling in of eyelid
Ectropion
Rolling out of eyelid
What should never be used in or around the eye to prep for ophthalmic procedures?
Chlorhexidine
What is acceptable to use to prep the periocular area before surgery?
Diluted Betadine
What are some postop care notes for eyelid surgery?
-e collar
-pain meds
-ocular antibiotics (give all meds 5 minutes apart with liquids first and then ointments)
When should warm compresses be started after eyelid surgery?
2 days after surgery
When should a patient with eyelid surgery be seen for a recheck?
10-14 days
What types of eye masses do dogs usually get?
Usually benign, meibomian (sebaceous) adenoma (most common); malignant can occur it is just less common
What type of eye masses do cats usually get?
Usually malignant, squamous cell carcinoma (most common) especially on white or pink eyelids
How is the patient positioned for eye surgery?
Sternal or Lateral Recumbency
Cherry Eye
Prolapse of the 3rd eyelid from weakness of connective tissue or skin allergies
Diode Lasers
May contact tissue and may have more collateral tissue damage
CO2 Lasers
Do NOT contact tissue and the intensity is controlled by distance and length of exposure
What are some hazards associated with laser surgery?
-eye hazard without goggles
-skin hazard without gowns and gloves
-smoke plume hazard from inhaling smoke so wear and mask and keep the evacuator 1-2 inches from smoke
-fire hazards from drapes, oxygen, alcohol, or fur so place wet sponges around and use non-alcohol scrubs
What PPE is required in the OR when a laser is being used?
-specific wavelength goggles
-gown/gloves
-laser mask
What is an indication for a patient to undergo a Zepp procedure?
Chronic Ear Infection
Removal of the gland of the third eyelid can lead to:
Keratoconjunctivitis sicca
When using a laser surgical unit, exposure refers to:
How long the tissue is exposed to the laser
Laparoscopy
Minimally invasive abdominal surgery
Thoracoscopy
Chest Version of Laparoscopy
Arthroscopy
For Joints
Where should an endoscope be placed when not in use?
not coiled and hanging in a clean area
What are the steps to clean an endoscope after surgery?
-clean immediately after use
-insert the tip in a bowl of tap water, depress suction button for 5 sec and release, then repeat
-wipe under the sheath, move dials and buttons, inspect for damage or replacements needed
-use a cleaning brush, enzymatic cleaner, high level disinfection last, and hang to dry
What are the steps to prep for any type of endoscopy?
-hook up selected scope
-assure light source is working
-confirm flush solution
-check insulation and suction is working (in a bowl of water)
-accessory instruments (biopsy forceps, lubricant, oral speculum, and formalin cups or slides)
How long should a patient be fasted before a gastroscopy?
12-18 hours
How long should a patient be fasted before a colonoscopy?
24-36 hours
What other prep is needed for a colonoscopy?
-enemas or laxatives are needed so may need 12-24 hours of prep time
-need lavage to clean colon during the scope
Endoscopy
The use of a specialized endoscope to perform a minimally invasive examination of the abdomen and its viscera
Gastroscopy
Endoscopic examination of the stomach
Hypoxemia
Decreased oxygen in blood/tissues
Which of these is a patient-related cause of prolonged recovery from anesthesia?
Hypotension
List 3 things that contribute to hypothermia in a perisurgical patient.
-hair was clipped
-body cavity was opened
-if alcohol was used as prep and dries
List 3 clinical signs that may indicate postoperative internal bleeding.
-pale MM
-increased HR
-decreased blood pressure
-abdominal swelling
What is premature loss of sutures and opening of the surgical site?
Dehiscence; any of all layers can be serious/fatal and can cause infection (usually the result of self mutilation or playing, running, jumping, etc.)
What is a fluid filled pocket under the skin that can be dead space from surgery or can be caused by an overactive postop patient?
Seroma
What is a pocket filled fluid, bacteria, and neutrophils? It will have straw colored to light red fluid and draining purulent fluid.
Abscess
What type of surgical swelling is a pocket filled with blood?
Hematoma
What type of surgical swelling will give an empty aspiration, may contain intestines, and may be reducible?
Hernia
Signs of Infection
-redness
-swelling
-draining
-may have fever and can be painful
List three methods to prevent an animal from causing self-trauma to an incision post operatively.
-e collar
-bite not collar
-stainless steel sutures
The process of autotransfusion is administering:
Blood aseptically collected from a patient's body cavity back to the patient
What are important points to remember for client ed?
-talk TO the owner (not down or at them)
-take owner to a quiet room (not where animal is present)
-don't just read a paper to them
-can be done by a tech or a vet
How often should the client monitor the surgery incision after the patient is discharged?
Twice Daily
What is a simple way to help clients monitor for migration of a feeding tube?
Make a mark with a permanent marker; if that mark changes location than the tube has migrated
What should clients watch for with perianal surgery?
-straining/vocalizing when defecating
-posturing a lot without defecating
-defecating with no control
-diarrhea (may be too much fiber)
What should clients watch for after a caesarean section?
-aggression towards babies
-incision care
-signs of mastitis (red, swollen, painful nipples or ones that don't produce milk)
What should clients watch for after an orthopedic procedure?
signs of infection, implant failure, worsening lameness, etc. and any signs of incision/bandage issues
What should clients watch for after an onychectomy?
check toes for swelling, discharge, worsening or appearance of lameness (bleeding needs to be reported immediately)
What should clients watch for after a cystotomy?
-monitor for straining to urinate or trouble getting a good stream
-blood in urine is normal for up to 36 hours
-may need to urinate more often than normal so allow more frequent chances
What are some things clients should watch for with a gastrointestinal procedure?
signs of peritonitis: depression, lethargy, vomiting, swollen painful abdomen, increased bruising, fever
How often should bandages be checked?
Twice daily (for contamination/moisture)
A client called to ask about vaginal discharge from her bulldog that had a caesarean section 3 days ago. What would be considered normal discharge for this patient?
Bloody and mucousy
What are some at home care instructions for cesarean section?
-red to brown vaginal discharge is normal for a few days with no foul odor
-loose stools are normal
-weigh newborns once daily to make sure they are gaining
-feed mom high calorie food
What are some at home care instructions for orthopedic procedures?
-explain confinement throughly (what type, how long, and explain why)
-leash/sling walked and how to do that
-calorie restrictions during confinement
What are some at-home care recommendations for an onychectomy?
-no clay or clumping litter (until incisions are healed at 10-14 days)
-crate confined
What are some at-home care recommendations post perianal surgery?
May need high fiber diet (laxatives, fish oils)
What are some at home care recommendation for gi procedures?
-the earlier they are eating the better
-may need small meals or bland diet (depending on procedure)