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after anesthesia we perform
initial postop TPR
pulse ox, ecg, bp if necessary
untie endotracheal tube
deflate endotracheal cuff
remove et tube when patient is awake
start postop pain
in what situations would we leave the et tube cuff inflated before removing
regurgitation
dental procedures
palatal or nasal procedures
when do we remove the endotracheal tube
when the animal is blinking and has swallowed 2-3 times
which patients do we wait as long as possible before extubating
brachycephalic patients
hypoxemia
decreased oxygen in blood/tissues
hypotension
low blood pressure
hypothermia
mild hypothermia (96-99)
below 93 is a concern
hyperthermia
temp of >103.5
temp >106 is at risk of cellular damage and death
emergence delirium
exaggerated uncontrolled movement
cardiac arrythmias
abnormal ecg reading
hemorrhage
uncontrolled bleeding either superficial or internal
uncontrolled pain
analgesia not effective
fluid warming
heating units for lavage and IV
microwave 1 L for about 2-3 minutes
shake to avoid hot spots
should be 98-99 F
test on wrist
surface warming
water circulating heating blankets
warm air (Bair Hugger)
water bottles
water filled balloons for latex gloves
uncooked rice or lentils
seroma
fluid filled pocket under the skin
overactive patient postop
deadspace from surgery
can delay healing and lead to infection
keep patient quiet, warm pack several times a day and bandage
abscess
fluid with bacteria and neutrophils
straw-colored light red fluid
draining purulent fluid
hematoma
filled with blood
hernia
aspiration will be empty or fat filled with omentum
may be reducible
naloxone, butorphanol reverse
opioids such as hydromorphone, fentanyl, morphine
flumazenil reverses
diazepam, midazolam
antisedan reverses
dexdomitor or dexmedetomidine
stage I decubital ulcers
red skin
can go away shortly after pressure is relieved
stage II decubital ulcers
partial dermal skin loss
ulcer or blister
if treated promptly can heal fairly quickly
stage III decubital ulcers
full skin loss
deep crater like wound
stage IV decubital ulcers
large scale loss of skin with damage to muscle, bone may be exposed
most serious
can be lethal due to infection
lung atelactasis prevention in recumbent patients
lung collapses
can’t oxygenate well
takes-6-12 hours to reinflate, or longer
can occur in a few hours
flip sides, sternal, listen, copage, “walk”
urine scalding prevention in recumbent patients
empty bladder at least 3 times a day to avoid overflow
wear diapers if lower motor neuron bladder
urinary catheter
bathe frequently
spot clean
powder
constipation prevention in recumbent patients
may need to “walk” for posturing
2-3 days is fine for dogs
pumpkin
wet canned food
fiber supplements
fish oils
fecal incontinence prevention in recumbent patients
diaper
keep clean for risk of UTI
high quality, low waste food
“walk” outside after eating meals
fiber
what constitutes the recovery period of anesthesia?
cessation of anesthesia to the time the patients vital signs and level of consciousness return to normal
as a general rule, extubation of which dog breed should be delayed until they are able to lift their head?
pug
shivering in a patient recovering from anesthesia indicates
the patient’s body is attempting to produce heat
rewarming should be considered when the body temperature is
<97.6
rewarming efforts should be decreased as the patient body temperature returns to normal to avoid
rebound hyperthermia
which of these is a patient-related cause of prolonged recovery from anesthesia
hypotension
which breed of dog is more likely to have postoperative bleeding related to von Willebrand disease
Doberman Pinscher
the process of autotransfusion is administering
blood aseptically collected from a patient’s body cavity back to the patient
premature loss of sutures that allows the surgical site to open
Dehinscence
the forceful rinsing of a wound is called
lavage
which material is an example of occlusive dressing
natural cellulose
if a patient’s wound is left open for 2 days and protected with a dressing then surgically closed, what type of wound closure was performed
delayed primary
the primary layer of a bandage is also known as
contact layer
a catheter placed in which vein allows monitoring of central venous pressure
jugular
ear tip is called
the pinna
ear drum
tympanic membrane
right ear
AD auris dextra
left ear
AS auris sinistra
both ears
AU auris utraque
what are aural hematomas
hematoma within the auricular cartilage
forms from head shaking, scratching, fighting
otitis, foreign body, atopy, ear mites
how do we treat aural hematomas
treat underlying disease
trocharization/needle decompression
local steroid injection
must wrap for >/= 2 weeks
surgery
ear clipped and prepped (flush like prepuce)
S or linear incision in concave surface of pinna
remove cot and scar tissue
suture and bandage
how long to sutures and bandage stay in place after an aural hematoma surgery
3 weeks
post op monitoring for ear canal surgery
bandage in place and clean
submit samples and cultures
pain meds
antibiotics
ability to know what facial nerve damage looks like
inability to blink
pupil sizes different
lip drooping
eyelid drooping
right eye
OD oculus dexter
left eye
OS oculus sinister
both eyes
OU oculus uterque
lacrimation
tear production
blepherospasm
squinting, blinking excessively
photophobia
light sensitive
enophthalmos
pulling back eye, third eyelid protrusion
conjunctivitis
inflamed conjunctiva
keratitis
inflamed cornea
entropion
rolling in of eyelid
ectropion
rolling out of eyelid
anisocoria
pupils are different sizes
never use what in or around the eye when prepping
Chlorhexidine
what is acceptable to use when cleaning the periocular area before surgery
betadine
post op care for eyelid surgery
e-collar
pain meds
ocular antibiotics
warm compresses started 2 days after surgery
recheck in 10-14 days
in dogs eyelid masses are usually
benign
meibomian (sebaceous) adenoma most common
malignant can also occur
in cats eyelid masses are usually
malignant
squamous cell carcinoma most common
white or pink eyelids
entropion surgery
to relieve ocular pain and irritation
treat underlying conjunctivitis first for spasmatic entropion
developmental/conformational entropion is permanent without surgery
cherry eye
prolapse of third eyelid gland
nictitating membrane makes 30% of tears
seen in puppies due to weakness in connective tissue
seen in older dogs with skin allergies
CO2 laser surgery
do not contact tissue
intensity controlled by distance and length of exposure
diode laser surgery
may contact tissue
may have more collateral tissue damage
what are some workplace hazards associated with laser surgery
eye hazard
wear specific wavelength goggles
skin hazard
wear gloves and gown
smoke plume hazard
wear laser mask
keep evacuator within 1-2 inches of smoke’s origin
fire hazard
place wet sponges around surgical area
use non-alcoholic scrub
check et tube for o2 leaks
place wet sponge in rectum to avoid methane
PPE required to be in an OR when lasers are being used
specific wavelength goggles
wear gown and gloves
wear laser mask
how to clean the endoscope
use a cleaning brush to remove debris from air/water and biopsy channel
enzymatic cleaner
breaks down organic debris and bacteria
high-level disinfection last
cidex for 40-60 minutes
rinse with sterile saline or tap water followed by 70% alcohol
where should endoscopes be placed when not in use
should not be coiled
should be on special wall mounts
always hold it by the control section and protect the tip
gastroscopy procedure
fast for 12-18 hours
angulus = margo plicatus
foreign body removal
biopsies
brush cultures
feeding tube placement
ulcer diagnosis
need to pinch esophagus closed to insufflate
colonoscopy procedure
fast for 24-36 hours before procedure
can use enemas or laxatives as part of prep
need to pinch anus to properly insufflate
need lavage to clean colon during scope
insufflation is often released as biopsy samples are taken
a circulating nurse can do which duty during a surgery suite
open packs
balfour retractors are used to
hold open the abdomen for better visualization
separation of all layers of an incision is called
dehiscence
evisceration puncture of the abdomen to obtain fluid is called
abdominocentesis
what is a sign of intestinal viability
vascular pulses
which patient is more likely to develop gastric dilation volvulus
doberman pinscher
the primary reason for performing an ovariohysterectomy is
sterilization
what is considered to be the most painful part of the ovariohysterectomy
plucking the suspensory ligament
which drug is used to stimulate respirations for resuscitation of newborns after a c-section
doxapram
how is the incision closed during a feline ovariohysterectomy
there is no closure, it heals by second intention
what is the primary indication for a cystotomy
Cystic calculi
what is an indication for a patient to undergo a Zepp procedure
chronic ear infection
what should be used to aseptically prepare a patient for ophthalmic surgeries
dilute povidone-iodine solution
what is the medical term for rolling in of the eyelid
entropion
removal of the gland of the third eyelid can lead to
keratoconjunctivitis sicca
which of the procedures would be considered an elective orthopedic procedure
correction of medial luxating patella
an example of external coaptation would be placement of a
modified robert jones bandage
salter-harris fractures always involve the
physis
an external fixator would be contraindicated in the treatment of a fracture of the?
ileum
Which type of fixation device can be adjusted throughout the healing period?
external fixator
splints should only be employed for fractures distal to the
stifle and elbow