T1: Admissions and Scheduling Flashcards
What information should you gather from the client/provide to the client when discussing admissions over the phone?
- verify and record client and animal details
- phone number
- explain the procedure
- verify if any changes since the last examination
- explain the cost and the possibility of any other costs
- request food is withheld for at least 6 hours prior to anaesthesia, according to your clinic’s policy
- paediatric patients and diabetic patients have special considerations that will be covered
- there is no need to withhold food from small rodents and herbivores prior to surgery, and the owner should be advised to bring in food from home for these animals
- request that fluids are only given until a certain time unless age/condition preclude this
- bathe animals if necessary
- ask owner to confine animals (especially cats) so that they can be found and have no access to food
- request owners bring animals to the surgery using suitable restraints
- complete consent form in co-operation with the owner
- weigh the animal
- give the option of pre-anaesthetic bloods and IV fluids
- confirm the admission date and time
What should you talk to the client about when they arrive for surgery with their pet?
What forms need to be completed?
- Locate animal records
- Check to see if animal has had previous anaesthetic and how this went
- Any referral records
- CONSENT FORM!!! this is a legal document -implements vet duty of care
- explain surgical procedure incl. diagnostics, analgesia, IVFT, anaesthesia etc
- pre-care (did this occur?) and post care guidelines
- Pets appearence after surgery
- ESTIMATION OF COST and payment method
- ask if animal has special food, toy, likes/dislikes
- does animal require other services eg desex, nail clip etc
- surgery risks
What should an animals history include?
- date
- client details
- patient details
- presenting complaint or reason for admission
- immediate medical history of the problem
- patient’s past medical history
- patient’s environmental history, and
- herd or flock history (if applicable)
other than ‘normal’ patient history parameters, what other history should be obtained?
- Relevant medical history
- past illnesses, tx, outcome?
- vaccination status/parasite prevention
- allergies
- if on meds, has it had meds today?
- enviro history
- other pets?
- indoor or outdoor?
- exercise
- diet
How should you prepare and prioritise surgical schedules?
- write up each morning as cases arrive
- considerations incl:
- sterile or non sterile
- species
- body cavity entered?
- presence of infection
- surgeon availability
- emergencies
- have box next to name to tick for premed given
What does routine or elective surgery mean?
implies surgical procedures carried out on healthy animals, and normally involves minimal risk to the patients well-being.
These are procedures that are often carried out on a daily basis
What does non-routine and emergency surgery entail?
- has to be performed to either save the life or prevent deterioration of the animal
facilitating the surgery program involves?
- communicating with the veterinarian and other staff regarding the schedule
- working as a team
- preparing the theatre and equipment
- preparing the animal
What questions may you need to ask the veterinarian before setting up for a non-routine surgery?
and just considerations in general?
- determine specific equipment needed
- locate and display x-rays for reference
- clipping, prepping and positioning of patient
- confirm procedure with surgeon
- maintain integrity of sterile field
- select and apply wound dressings
- assist with resuscitation of patient during cardiac arrest or other life-threatening events in the operating room
- perform any other duties or procedures incident to the surgical procedure deemed necessary and as directed by the surgeon
- directing any junior nurses to help with procedures or prep
What are the special considerations for DIABETIC patients prior to surgery?
- do they need admitting day prior to procedure? -run blood glucose curve
- otherwise advise clients to administer half of normal insulin and no breakfast
- water must NOT be withheld as diabetics are often polydipsic
- blood glucose measured at time of premed
- place on Dextrose to stabilise before surgery
- measure BG at induction
- measure BG every 15mins in surgery
-
keep BG levels b/w 8-16mmol
*
What patients are considered geriatric?
those that have reached 75% of their normal expected lifespan
What are the increased risks for geriatric patients?
- loss of cardiovascular, renal, hepatic and respiratory systems
- so are more at risk of them not metabolising the drugs used efficiently.
- They also have the probability of underlying or concurrent disease so a thorough work up of these animals is required to give the best possible outcome
- always give fluids unless health contraindicates
- ensure water is not withheld for more than 30mins prior to surgery
Risks for geriatric patients UNDER ANAESTHESIA?
- hypoxaemia and hypercapnia
- dehydration, hypovolaemia, hypotension and poor tissue perfusion
- cardiac arrhythmias
- hypothermia
- prolonged drug action and delayed recovery from anaesthesia
- adverse drug reactions
- stress
General recommendations to reduce incidence of complications in geriatric patients?
- carry outpre-anaesthetic examination
- stablilise and/or optimise the patient’s condition prior to anaesthesia.
- keep anaesthetic time to a minimum
- reduce doses of all drugs because of the lower blood volume, increased plasma levels of active drug and the reduced requirement for all anaesthetic drugs
- keep patient warm
DRUG recommendations to reduce incidence of complications in geriatric patients?
use drugs that:
- result in minimal cardiac depression, e.g., benzodiazepines
- can be antagonised (reversed), e.g., benzodiazepines and opioids
- have a short duration of action, e.g., propofol.
- avoid very heavy sedation in elderly animals.
- do not use NSAIDs without checking renal and hepatic function and never use them concurrently with steroids. Consider alternative analgesic techniques, e.g., local anaesthetics.
- keep the patient warm.
