Sugery Lecture Exam 2

How should the patient be positioned when you begin clipping hair?

the same position the patient will be in for the procedure

What grip do we use for hair clippers?

pencil grip

What number blade should we use in the clippers?

#40

Should you use clippers against the grain or in the direction of the hair growth?

Both to get the closest shave

How much hair should you remove for a surgical procedure?

At least 2 clipper blade widths from the area of the proposed incision, preferably more to allow for changes during the surgical procedures.

If you are prepping an orthopedic procedure and are using the “hanging leg” technique, how will you remove the hair from the sirgical site?

circumferentially (circles going around the leg)

T or F: You should always clip and prep the patient in only your scrubs.

False, always wear a lab coat to prevent the tracking of hair into the surgical suite

Why do we use a #40 blade instead of a #10 blade?

#40 gives us a finer and closer cut

How should you hold the vacuum when removing hair?

With at least one finger over the suction hole so as not to grab at the skin and cause damage or irritation

Why is it important to make clean, crisp edges when clipping a patient?

Because this is the only part of the procedure that the client sees. We want to make it as professional-looking as possible

____ suture - applied around the anal opening to prevent leakage of fecal material during surgery.

purse-string suture

When would we use a purse-string suture?

perineal surgery or hind-limb orthopedic procedures

How often should clipper blades be brushed, disinfected, and lubricated?

After each use

T or F: Skin cannot be “sterilized” but is made “antiseptic” with the use of antiseptics.

True

What are the most commonly used antiseptics? (2)

• Chlorhexidine

• Providone-iodine

The skin is made antiseptic in two stages. What are they?

• “rough” prep

• “sterile” prep

Where is the rough prep performed?

in the surgical preparation area (induction)

Where is the sterile prep performed?

in the surgical suite

What are the desirable properties of antiseptics? (5)

• wide spectrum of antimicrobial activity

• low tissue toxicity

• inexpensive

• residual activity

• works well in the presence of organic activity

For abdominal surgeries where the prepuce will be “draped in,” the prepuce should be flushed with what?

dilute betadine

What type of gloves do we use for the intial scrub?

exam gloves

What type of gloves do we use for the final scrub?

sterile gloves

What technique should be used during the final scrub?

clean hand, dirty hand

How should you scrub a patient?

center out and in circular motions

T or F: Once the sponge has touched hair, you do not go back over the incision area; you should discard the sponge.

True

How long is the general contact time for a scrub solution?

5 minutes, or until the sponges come away clean with no residue or dirt

T or F: When using a huck towel to remove scrub solution, you should use circular motions and move from the center out.

False, huck towels should be used to pat dry; do not rub

T or F: You can use dry gauze to remove scrub solution.

True

When a surgeon “paints” the surgical site, what are they doing?

Usually a providone-iodine solution without detergent and slightly high concentration. It is allowed to dry on the skin and is usually applied with a spray bottle

T or F: You generally should not mix chlorhexidine and iodine products.

True

Which scrub solution has “okay” residual activity?

Iodine

Which scrub solution has low tissue toxicity everywhere?

Iodine

Which scrub solution has low tissue toxicity everywhere except mucous membranes?

chlorhexidine

Which scrub solution will stain clothing and fur?

Iodine

Which scrub solution will not stain clothing or fur?

Chlorhexidine

Which scrub solution is inactivated by inorganic debris?

Iodine

Which scrub solution has good activity in organic debris?

Chlorhexidine

How do you generally dilute Iodine?

50:50 with water

How do you generally dilute chlorhexidine?

60:40 with water

Which scrub solution more commonly produces an adverse reaction?

Iodine

Which rinsing agent is antibacterial and dries quickly?

alcohol

Why must we be careful when using alcohol as a rinsing agent?

we must be cautious when using cautery because alcohol is flammable

Which rinsing agent has no antimicrobial activity and is not flammable?

water

What position should the patient be in for an abdominal surgery?

dorsal

What position should the patient be in for a castration?

dorsal

What position should the patient be in for an orthopedic and extremity surgery?

lateral recumbency

What position should the patient be in for a tail and perianal surgery?

ventral recumbency

What position should the patient be in for a back surgery?

ventral recumbency and in a V trough

What position should the patient be in for a thoracic surgery?

lateral or dorsal recumbency depending on the surgeon’s intent

When is the hanging led technique most commonly used?

extremity orthopedic or soft tissue procedures

What is the advantage of the hanging leg technique?

Allows the entire extremity to be draped in and manipulated during surgery. Fatigue of muscles for fracture reduction

____ - the complete elimination of microbial viability

sterilization

____ - the destruction of most pathogenic organisms on inanimate objects

disinfection

____ - prevents growth or action of microorganisms on living tissue by inhibiting activity or killing them (not sterile)

antisepsis

____ - living organism too small to be seen with the unaided eye

microbe/microorganism

____ - microbe capable of causing disease

pathogen

____ - the detrimental result of invasion by pathogens

infection

____ - infection acquired during hospitalization or during attendance at any veterinary medical facility

nosocomial

What surgical preparations begin the day before surgery?

giving the animal a bath and withholding food and water

How long should solid food be withheld before surgery?

at least 6 hours

Why do we withhold food and water before surgery?

decrease the risk of regurgitation and aspiration while under anesthesia

What does NPO stand for?

nothing per os (by mouth)

What should be included in a pre-op exam?

• signalment

• history

• physical exam

• consent form

• weight

• BCS

• head and neck

• skin

• lungs

• heart

What should be included in the history?

• signalment

• reason for visit

• specific history of presenting complaint

• current medications

What should be included in the physical exam?

• weight, BCS, TPR

• head and neck

• abdomen and chest

• skin

• lymph nodes

• orthopedic exam

• neurological exam

What should be included in a consent form?

• identifies the patient

• specific procedures to be performed

• potential risks

• veterinarian’s name

• estimate

• signature of owner

• owner contact info

How should you record the weight of your patient pre-op?

in kg and the current weight for that day

On a 1-5 BCS, 1 means what? And 5 means what?

• 1 means emaciated

• 5 means obese

What do we test within the head and neck exam?

• PLR (pupillary light response)

• CRT (capillary refill time)

• Lymph nodes

• skin tent

• neck (flex for pain)

What are we checking for with a skin exam?

• alopecia

• coat quality

• palpation

• external parasites

How should we auscultate the lungs in a pre-op exam?

both sides: cranial, middle, and caudal areas over the ribs

Where should you auscultate the heart?

left cranial side below the elbow

A minimum database for a young healthy surgical candidate should include what?

• packed cell volume (PCV)

• total solids (TS)

• blood glucose (BG)

• blood urea nitrogen (BUN)

• alanine aminotransferase (ALT)

What are the four components of the pain pathway in order?

• Transduction - pain is recognized and sent to the CNS

• Transmission - impulses are sent toward the spinal cord

• Modulation - pain signals are processed in the spinal cord

• Perception - pain signals are recognized by the brain, and a reaction occurs

How do opioids manage pain?

opioids work at several locations along the pain pathway, affecting nociceptive signal transduction, modulating signals at the spinal level, and inhibiting perception of pain.

What receptors are involved with opioid pain management?

The Mu and Kappa receptors

How do NSAIDs provide pain relief?

They block COX1 and COX2 enzymes

How do Alpha2-Adrenergic Agonists provide pain relief?

by inhibiting transduction and transmission of nerve impulses and modifying the signals at the spinal cord

Which wound classification is this: Nontraumatic, uninfected, no break in aseptic technique, no inflammation encountered, elective, primary closed, no drains.

Clean

Which wound classification is this: Controlled entry into hollow viscus, minor break in aseptic technique.

Clean-contaminated

Which wound classification is this: Open, fresh traumatic wound, incision into a site with acute non-purulent inflammation, major breaks in aseptic technique.

Contaminated

Which wound classification is this: Pus encountered during surgery, perforated viscus found, traumatic wound with devitalized tissue, foreign material or fecal contamination, or of more than 4 hours duration, perforated viscus, acute bacterial infection with purulent exudates encountered during surgery.

Dirty

Which wound classification is this: surgically created wound, no hollow viscus opened, aseptic technique maintained, no infection encountered.

Clean

Which wound classification is this: surgical wounds that enter hollow viscus, minor break in technique occurs

Clean-contaminated

Which wound classification is this: major break in technique, hollow viscus is opened with gross spillage, traumatic wounds

Contaminated

Which wound classification is this: conatins purulent material, contains contents of perforated hollow viscus, more than 100,000 per gram of tissue.

Dirty or Infected

Primary wound closure is used for what kinds of wounds?

Clean and clean-contaminated

What kind of wound closure is this: the wound is left open for 2-5 days and is closed prior to granulation tissue formation. Permits repeated lavage and debridement to convert the wound to clean-contaminated status appropriate for closure.

delayed primary

How are contaminated wounds closed?

delayed primary

What kind of wound closure is this: granulation tissue is allowed to form in the wound prior to closure. Deep narrow wounds-direct apposition over granulation tissue

Secondary

How do we close dirty or infected wounds?

second intention closing

What kind of closure is this?

second intention

____ - taking steps to prevent disease

prophylaxis

____ - taking antibiotics after surgery

postoperative

____ - taking antibiotics just before and during surgery

perioperative

When do we need to give antibiotics?

• long surgery (more than 2 hours)

• Orthopedic implants

• break in asepsis

• entering GI tract

What is the best prevention of infection?

good surgical technique

When there is a gross contamination during surgery, what should you do?

lavage and repair the break is asepsis

When should you give perioperative antibiotics?

30 minutes before skin incision and every 90 minutes during surgery

____ - also known as bed sores or pressure sores.

decubital ulcers