Perioperative nursing (SA15) Flashcards

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1
Q

What is the purpose of post op management?

A
  • Recover patient from anaesthesia
  • Prevent/manage post-op complications
  • Identify new problems rapidly
  • Ensure patient welfare
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2
Q

Why does the procedure performed need to be included in a handover?

A
  • Recovery nurse can understand possible complications and considerations
  • Considerations and requirements written on patient records
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3
Q

When do most anaesthetic deaths occur and what is important to manage and reduce this?

A
  • Recovery period
  • Important to record progression of recovery
  • Report concerns quickly
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4
Q

What does the recovery nurse need to ensure in preparation for removing an ET tube?

A
  • Check cuff in deflated
  • Tie removed
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5
Q

When should the ET tube be removed in dogs?

A
  • When gag/cough reflex returns
  • When dog first swallows
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6
Q

When should the ET tube be removed in cats and rabbits? Why?

A
  • Just before gag/cough reflex returns
  • Reduce risk of laryngospasm
  • When ear twitch reflex returns on cats
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7
Q

How should patients be positioned during recovery?

A
  • Does not restrict airway or breathing
  • Lateral recumbency with head and neck extended
  • Some need sternal recumbency to aid breathing and prevent atelectasis
  • Brachycephalics in sternal with chin elevated
  • Can tolerate ETT in place until awake to reduce risk of respiratory obstruction
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8
Q

How long should patients have close and continuous observations during recovery?

A
  • Until lifting head
  • Responds to verbal stimulation
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9
Q

How long should patients have frequent monitoring?

A
  • Until fully recovered
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10
Q

When should vital signs be monitored and recorded during recovery?

A
  • Immediately after handover
  • At 15 minute intervals until patient is fully recovered
  • If concerns arise, can record more frequently
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11
Q

Which vital signs should be monitored and recorded during recovery?

A
  • Extubation time
  • Temperature
  • MM colour, CRT
  • Peripheral pulse quality
  • Pulse/HR
  • RR
  • BP if hypo/hypertensive during surgery
  • Demeanour
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12
Q

Why should significant parameter changes be reported to the veterinary surgeon?

A
  • Complications may be occuring
  • Can be life threatening, highest risk in recovery
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13
Q

Why must multiple parameters be monitored and recorded throughout recovery?

A
  • Increase information obtained
  • Monitor trends
  • Limited from single, one off measurements
  • Miss indications until problem progressed
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14
Q

What may decreasing blood pressure with increasing heart rate indicate?

A

Hypovolaemia

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15
Q

What may increasing heart rate, respiration rate and blood pressure signify?

A

Pain

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16
Q

What is a common complication following general anaesthesia?

A
  • Hypothermia
  • Active warming may be necessary
  • Heat pads, warm air blankets, extra bedding, bubble wrap
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17
Q

What is the risk of using hot hands?

A
  • Risk of thermal injuries if bursts or are too hot
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18
Q

What are the complications of prolonged hypothermia?

A
  • Surgical site infections
  • Nosocomial infections
  • Prolonged action of drugs
  • Delayed recovery
  • Shivering
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19
Q

How does shivering affect the patients oxygen demand?

A
  • Increased oxygen demand up to 300%
20
Q

What treatment instructions should be included in the hand over?

A
  • New medications
  • Changes to current medications
  • Medication times/frequency
  • Medication given during procedure
  • Pain management (score/analgesia)
  • Care for bandages
  • Catheter, tube, drain instructions
  • IVFT requirements/changes
21
Q

What common post op complication is caused by patients and how can this be prevented?

A
  • Wound, catheter, tube, drain interference
  • Elizabethan collar, pet medical shirt
22
Q

What is the difference between the IVFT requirements for a healthy routine procedure vs. significant haemorrhage?

A
  • Healthy, routine, normotensive may discontinue IVFT post op
  • Significant haemorrhage during surgery will have more complex IVFT and monitoring requirements
23
Q

What things can indicate pain?

A
  • Do not move when urinating in kennel
  • Inappetence
  • Uncharacteristic aggression
  • Changes in behaviour
  • Crying out in pain
24
Q

Where should rabbits be recovered and why?

A
  • Prey species
  • Prep room may be shared with predator species
  • Can cause extreme stress, detrimental for recovery
  • Recover somewhere quiet
  • Exotics ward, portable carrier in quiet area
25
Q

Why shouldn’t shavings be used as bedding post op? What should be used instead?

A
  • May stick to surgical wounds
  • Increase likelihood of surgical site infections
  • Use towels or blankets until healed
26
Q

Why should electric heat pads not be used while the recovering patient is left unattended?

A
  • May chew cables
27
Q

How should patients with fracture repairs or procedures restricting mobility be recovered?

A
  • In small kennels
  • Can’t move around too much during disorientation in recovery
28
Q

How should old and arthritic patients be recovered?

A
  • Reduced fat and mobility
  • Padded bed/orthopaedic mattress
  • More likely to suffer from hypothermia
  • Prepare active warming before handover
29
Q

How should patients be recovered?

A
  • Bowls/litter trays removed until recovered
  • Warm soft bedding
  • Vet bed wicks away liquid to prevent sores
  • Ambient temperature 22-24C
30
Q

What PPE should be worn during a dental procedure and why?

A
  • Goggles, Gloves, Face Masks
  • Protect all staff from debris, aerosol and splatter
31
Q

What pieces of furniture are important for dental procedures and why?

A
  • Adjustable table for appropriate working position to avoid injury
  • Operating light can be positioned for better visualisation
32
Q

How should a patient be positioned during a dental procedure?

A
  • Comfortable for the patient and vet or nurse
  • Likely they will require turning to access all areas of mouth and positioning for dental x-ray
  • Ionising Radiation Regulations 2017 must be adhered to
33
Q

How should dental equipment be prepared?

A
  • Avoiding clutter
  • Facilitating easy access
  • Avoiding contamination of unused equipment
  • 2 metre radius of spray (bacteria)
  • Size of patient and species will change equipment needed
34
Q

What is a dental probe?

A
  • Sharp pointed instrument
  • Used to explore the mouth and feel for tooth abnormalities
  • Can be double ended and include a periodontal probe (explorer probe)
35
Q

What is a periodontal probe?

A
  • Explorer probe
  • Measure depth between gingival margin and gingival attachment to tooth and gingival recession
  • Blunt tip avoids soft tissue and tooth surface trauma
36
Q

What are dental mirrors used for?

A
  • Aid visualisation of all tooth sides without moving the patient
37
Q

What care should be taken with dental mouth gags?

A
  • Prolonged retraction of cat jaws can cause blindness
  • Removed periodically
  • Jaw opened and closed several times before replacing it
38
Q

What are dental elevators?

A
  • Aid removal of teeth
  • Apply downwards force to wedge tip between marginal bone and tooth root
  • Come in different sizes and degrees of concave and angle
39
Q

What is a dental luxator?

A
  • Finer and sharper than elevators
  • Fit in periodontal ligament space to cut ligament
  • Do not use to apply rotational force as can damage instrument
40
Q

What are dental extraction forceps?

A
  • Complete loosening of tooth and remove it from socket
  • Extreme care used to not break tooth with excessive or improper force
41
Q

What are dental tartar forceps?

A
  • Remove bulky deposits of tartar before ultrasonic scaling
42
Q

What are dental periosteal elevators?

A
  • Raise soft tissue when performing flap to achieve surgical excision
43
Q

What is a dental ultrasonic scaler?

A
  • Remove tartar from tooth
  • Side of scaler contacts tooth
  • NOT TIP
  • Constantly move
44
Q

What is a dental air driven drill?

A
  • Used to section crown of multi-rooted teeth to aid removal
  • Variety of burrs available
45
Q

What is a dental air driven polisher?

A
  • Polish teeth and remove stains
  • Disposable rubber cups
  • Apply vet dental polish to crown of teeth
  • Avoid contact with gum and soft tissue
46
Q

What is an epulis and how can they be removed?

A
  • Gingiva mass
  • Often benign
  • Can cause difficulty if become large
  • Often removed at same time as dental
  • Monopolar (cutting) diathermy can aid removal
47
Q

What is a maxillectomy/mandibulectomy?

A

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