Surgery Final Exam Study Points and Questions

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)