Surgical Nursing Block 1

What is "-ectomy?"

To remove or excise

What is "-otomy?"

To cut into
-incision

What is "-ostomy?"

Surgical creation of an artificial opening

What is "-rrhaphy?"

Surgical repair by suturing

What is "-pexy?"

Surgical fixation

What is "-plasty?"

Surgical alteration of shape or form

What is hemostasis?

Stoppage of bleeding

What is an onchyectomy?

Declaw removal

What are two coagulation products used for hemostasis in surgery?

Gel foam and Bone wax

What is a ligation?

Tying off of a blood vessel or duct with sutures

What is a ligasure?

A vessel sealing by pressure/energy

What are the three phases of wound healing?

1. Inflammatory Phase
2. Repair Phase
3. Remodeling Phase

What is the body's initial response to both vascular and cellular injury?

Inflammation!!
- protects against foreign material and sets up tissue repair

What takes place during the inflammatory phase?

Vessels vasoconstrict to control hemorrhage, then vasodilation to allow antibodies, nutrients, and WBCs into damaged tissue

Approximately how much blood does a 4x4 gauze absorb?

5-10 mL [10mL]

Granulation tissue appears in what phase of wound healing?

Repair Phase

What occurs during the repair phase?

Capillaries begin growing into damaged tissue, and fibroblasts now can enter damaged tissue and begin producing collagen fibers
- Collagen fiber makes up scar tissue

What does the remodeling phase consist of?

Rearrangement of the collagen fibers in the skin for the final stage of wound healing

How long after injury does the remodeling phase start?

Starts 4 weeks after the initial injury

What are the three types of wound healing?

1st - Intention Healing (minimal tissue damage, debriding skin edges)
2nd - Intention Healing (scab)
3rd - Intention Healing (granulation bed, sutured closed)

What is the golden rule for laceration wounds?
(AKA-What's the longest a wound can stay open before it needs to be closed?)

Laceration should be closed within 6 HOURS of injury to get ideal healing and less chance of infection

What are the preanesthetic diagnostic tests you need to do?

1. Bloodwork
2. X-ray
3. EKG

What is asepsis?

Freedom from infection from bacteria, viruses, and microorganisms

True or False: Endogenous microorganisms cannot really be prevented.

True

What are endogenous microorganisms?

Microorganisms that originate from inside the patient

What are exogenous microorganisms?

Microorganisms that originate from the environment

Development of infection depends on what two thingS?

Balance of virulence of the organism and resistance of the patient

What can cause post surgical wound infections?

1. Poor tissue handling
2. Airborne bacteria on the skin

What is sterilization?

Complete destruction of all living organisms

What are types of sterilization?

1. Autoclave - steam
2. Dry Heat - glass objects
3. Gas Sterilization - Ethylene Oxide
4. Radiation Sterilization - Cobalt 60
5. Antiseptics
6. Disinfectants

What flammable and toxic gas is used for sterilization?

Ethylene Oxide

True or False: Ethylene oxide is safe on rubber and plastic

True

What temperature does an autoclave have to be set at for sterilization?

121 C for at least 15 mins

How often should sterile double wrapped materials be re-sterilized if unused?

Every 7 weeks

How often should sterile single wrapped materials be re-sterilized if unused?

Every 4 weeks

What disinfectant is used for cold sterilization?

Ceytylcide
(Soak for 10 mins)

What pH does scrubbing detergent need to be for surgical instruments?

Neutral pH to prevent corrosion and rusting - Alconox

Why shouldn't we use substances such as Chlorhexidine or Betadine for scrubbing surgical instruments?

Overtime they will cause corrosion

What is the purpose of draping?

To protect exposed tissues from contamination, from the surrounding skin

True or False: Chlorhex in contact with the eye can cause damage to the cornea

True

What is the purpose of an Ultrasonic?

Uses vibrations to break apart small particles of organic cells from instruments after surgery (5-10 mins)

What has better residual effect, Betadine (Povidone) or Chlorhexadine?

Chlorhexadine

What is the time period for an Ultrasonic?

5-10 mins

How long should surgical instruments be lubricated with milk after washing?

Lubricate after washing for 30 secs

How long should food/water be withheld before surgery?

Food withheld 12 hours before surgery.
Water withheld 3-4 hours before surgery.

How long should hands and arms be surgically scrubbed?

Scrub 5-10 mins; 3-5 mins after the first surgery

Where should you keep your hands after sterile scrubbing?

Keep hands elevated between waist and shoulder level

True or False: It's okay to pass in between the patient and the surgeon.

False; never pass between scrubbed personnel and the patient

What are 4 post-operative complications?

1. Hemorrhage
2. Seroma
3. Infection
4. Wound Dehiscence

What is wound dehiscence?

Reopening of a surgical incision
(First signs usually appear within 3-4 days post surgery)

How long until sutures should be removed after surgery?

10-14 days

What are the three ways to close an incision?

1. Skin sutures
2. Skin staples
3. Skin glue - Cyanoacrylate

What are signs of infection?

1. Pain
2. Swelling
3. Warm to touch
4. Erythema

True or False: Animals may be painful for up to 3 days after surgery.

True - 3 days is the average for pain to last

How long are sutures left in for?

10-14 days

What is evisceration?

Disembowelment

What is seroma?

The accumulation of serious fluid in dead space in the region of an incision

What is main cause of seroma?

Over activity

What is Hypothermia?

Body temperature less than 99 degrees Fahrenheit

What are some adverse affects of hypothermia?

1. Hypotension
2. Poor clotting or coagulation
3. Delayed healing and infection
4. Delays excretion of anesthesia agents and prolongs recovery

True or False: Hypothermia delays healing

True

What stage of anesthesia is known as the "excitatory phase?"

Stage II

What are some ways to prevent hypothermia?

1. Towels and blankets coverage
2. Bear Hugger
3. Heated surgical table
4. Warm water circulating blanket
5. Wrap their feet to avoid heat loss
6. Decrease oxygen flow rate
7. Warm IV lines or IV bags
8. Esophageal Warmer

Each additional minute of anesthesia time increases the risk of skin infection by \_____ % ??

0.5%

What are we preventing by stopping food 12 hours before surgery?

Aspiration pneumonia

What is surgical anesthesia fluid rate?

10 ml/kg/hr (Now *5 ml/kg/hr* in lab)

What does ASA stand for?

Anesthesia Society Association
-ASA Tables distinguish classifications of the patient's risk under anesthesia

What is analgesia?

Loss of sensation to pain

What is anesthesia?

Total loss of sensation to the body induced by drugs that depress the CNS

What is the difference between general anesthesia and surgical anesthesia?

Both are loss of sensation and consciousness, but only surgical anesthesia comes with muscle relaxation and analgesia

What is catalepsy?

State of unresponsiveness and rigid limbs

What is hypnosis?

Artificially induced sleep

What is dissociative anesthesia?

CNS state characterized by catalepsy and analgesia

What is narcosis?

Drug induced stupor or sedation

What is neuroleptanalgesia?

Hypnosis and analgesia

What is tranquilization?

State of calmness in which the patient is awake and unconcerned with its surrounding

What is sedation?

Mild degree of CNS depression which can be awaken by stimuli

MAP should never fall below what number during anesthesia?

No MAP below < 60 mmHg; lower anesthesia

Nystagmus eye position is a sign of what anesthesia plane?

Stage II and Stage III (Plane 1)

Ventral eye position is a sign of what anesthesia plane?

Stage II - Plane II

True or False: Central eye position indicated the patient is too deep under anesthesia.

True

What reflexes are present in Stage III - Plane II anesthesia?

Patellar, ear flick, palpebral, and corneal

Patients with low-grade heart murmurs and cardiac diseases are what class risk on the ASA table?

Class III Risk

How long does pain last for on average?

Pain lasts for 3 days

What are the two types of pain?

1. Somatic - pain arising from skin, muscle, bone, and joints
2. Visceral - Pain arising from internal organs

What are clinical signs of pain?

1. Vocalizing
2. Body Posture (hunching, shaking, stiff)
3. Activity
4. No appetite
5. No urination/defecation

What does multimodal analgesia do?

Interrupts pain pathway at various points

What is the transduction pain pathway?

Pain stimulus sensation to CNS
-Local Anesthesia

What is the transmission pain pathway?

Pain impulse to spinal cord
-Local Anesthesia

What is the modulation pain pathway?

Sorting of pain stimuli in spinal cord
-Opioids

What is the perception pain pathway?

Only in conscious patients, knowing pain is present and reacting as vocalization or withdrawal reflex
-Tranquilizers

True or False: Pain slows down recovery and healing.

True

What are some commonly used opioids?

1. Oxymorphone
2. Hydromophone
3. Fentanyl
4. Butorphenol
5. Buprenorphine
6. Morphine
7. Tramadol (not controlled)

What opioid is commonly used as epidural route and commonly sent home with cats?

Buprenorphine

True or False: Morphine causes vomiting.

True

True or False: It is okay to use Butorphanol with Fentanyl

False; It is NOT okay to use Butorphanol with Fentanyl. Butorphanol block the action of Fentanyl.

What opioid may be used as a transdermal patch, or administered in an IV drip?

Fentanyl

What are side effects of fentanyl?

1. Profound sedation
2. Bradycardia
3. Respiratory Distress
4. Hyperexcitation in cats

How long does a fentanyl patch last?

3-5 days

What is Trazadone and what does it do?

It is a serotonin antagonist reuptake inhibitor. It increases serotonin levels in the brain and inhibits perception of pain.