Surgery Final

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

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