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1
Q

What are the stages of the Nursing Process?

A
  1. Assessment
    (Assess px + what the nursing diagnosis is)
  2. Planning
    (Creating short-term nursing goals)
  3. Intervention
    (Decide what nursing interventions are req)
  4. Evaluation
    (Eval why those interventions are req)
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2
Q

In basic terms, What is the Nursing Diagnosis?

A

RVN identifying the Actual + Potential problems/patient needs

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3
Q

What are the 4 phases of Wound Healing?

A
  1. Haemostatis
  2. Inflammation
  3. Repair
  4. Maturation
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4
Q

Homeostasis is the 1st phase within wound repair, can you describe, in order, what happens at each stage?

A
  1. Initial bleeding flushes wound
  2. Vasoconstriction occrurs - lasting 5 - 10 mins
  3. Platelet plug formation is triggered by damaged BV wall
  4. Formation of fibrin plug + scab
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5
Q

Which of the following would cause a delay in wound healing?

A) Moist wound environment
B) Tissue oxygenation
C) Infection
D) Limited movement of the wound edges

A

C) Infection

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6
Q

2 ..

What type of wound is this?

A
  1. Open
  2. Burn
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7
Q

2. ..

What type of wound is this?

A
  1. Closed
  2. Contusion/bruise
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8
Q

Which type of dressing is best used on a superficial wound?

A) Low/non-adherent
B) Hydrocolloid
C) Anti-microbial
D) Film

A

D) Film

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9
Q

How many drops/ml does a Standard Giving Set deliver?

A

20 drops/ml

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10
Q

How many drops/ml does a Paediatric Giving Set deliver?

A

60 drops/ml

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11
Q

Name 3 catagories of Fluid used in the VP

A
  1. Crystalloid
  2. Colloid
  3. Blood/blood products
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12
Q

List 8 reasons a blood transfusion may be given to a px

A
  1. Haemorrhage
  2. Sx
  3. Trauma
  4. Hypovolaemia (due to haemorrhage)
  5. Anaemia
  6. Thrombocytopenia
  7. Blood clotting/factor deficiency
  8. Low protein/Albumin
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13
Q

7 …

What is the fluid rate of a 26kg dog that has V+ 2x today?

(Assuming the drop rate is 20 drops/ml)

A
  1. Maintenance = 50 ml x BW(kg)
    = 50 ml x 26kg
    = 1300 ml p/day
  2. Ongoing losses = 4 ml x BW (kg) x (No. of episodes of V+)
    = 4 ml x 26kg x 2
    = 208 ml/day
  3. Total fluid requirements = Maintenance + Ongoing losses
    = 1300ml + 208
    = 1508 ml/day
  4. P/hr = Total fluid / 24hr
    = 1508ml/24hr
    = 63 ml/hr
  5. P/min = P/24hr/60 min
    = 63ml/60min
    = 1.05ml/min
  6. Drops p/seconds = Drip factor x P/min
    = 20 x 1.05ml
    = 21 drops/min
  7. Drop p/1 second = 60 seconds/Drop p/seconds
    = = 60 sec/21 drops
    = 1 drop, every 2.8 seconds or (3 sec)
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14
Q

8 steps…

A 15kg Border Collie was admitted to the practice with a PCV of 50%

He has V+ 2x + D+ 2x in 24hrs

Calculate the fluids req in Drop per second

A
  1. Maintenance = 50 ml x BW(kg)
    = 50 ml x 15kg
    = 750 ml p/day
  2. Deficit = 10ml x BW (kg) x % of loss
    = 10ml x 15kg x 5%
    = 750 ml
  3. Ongoing losses = 4 ml x BW (kg) x (No. of episodes of V+)
    = 4ml x 15kg x 4 (2x D+, 2x V+)
    = 240ml
  4. Total 24hr fluid req = Maintenance + Deficit + Ongoing losses
    = 750 + 750 + 240
    = 1740 ml p/day
  5. P/hr = Total fluid / 24hr
    = 1740ml/24hr
    = 73 ml/hr
  6. P/min = P/24hr/60 min
    = 73ml/60min
    = 1.2ml/min
  7. Drops p/seconds = Drip factor x P/min
    = 20 x 1.2ml
    = 24 drops/min
  8. Drop p/1 second = 60 seconds/Drop p/seconds
    = 60 sec/24 drops
    1 drop, every 2.5 seconds or (3 sec)
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15
Q

List 10 nursing interventions can be carried out to help a cardiac px?

A
  1. Reduce stress
  2. Minimal handling
  3. Avoid restricting chest + neck
  4. Controlled exercise, only at px’s own pace
  5. Provide oxygenation
  6. Restricted sodium diet + but ensure palatable
  7. Support them to sleep + recieve adequate rest
  8. Ensure they have frequent opportunites for the toilet
  9. Make sure they recieve accurate medication (Communicate with VS)
  10. Ensure they stay at an appropriate temp + ensure they don’t become hypo or hyperthermic
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16
Q

State 8 possible problems that may arise when nursing a cardiac px

A
  1. Fluid overload - if on IVFT
  2. Dyspnoea
  3. Hypothermia
  4. Weight loss
  5. Cachexia
  6. Polyuria
  7. Dehydration
  8. Reduced activity/mobility
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17
Q

Give 8 methods by which to assess a respiratory px

A
  1. RR (Observation)
  2. Resp effort
  3. Resp noise (Ausculatation of chest)
  4. MM colour
  5. Pulse oximetery (> 94%)
  6. Arterial blood gasses
  7. Capnography
  8. X-ray
  9. Ultrasound
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18
Q

List 10 conditions that are candidates for O2 therapy

A
  1. Dyspnoea
  2. Airway obstruction
  3. Cardiac px
  4. Shock
  5. Severe anaemia
  6. Diaphragm rupture
  7. Feline asthma
  8. Pleural space disease
  9. Pneumonia
  10. Pulmonary oedema/Contusions
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19
Q

List 8 methods of providing O2 therapy

A
  1. Flow-by
  2. Mask
  3. Nasal prongs
  4. Nasal catheter
  5. Oxygen cage
  6. Incubator
  7. Oxygen collar
  8. Intubation
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20
Q

Give 4 disadvantages of placing an animal in an 02 cage

A
  1. Requires large volumes of oxygen
    2.Can take a long time to fill cage
    3.Hyperthermia
    4.Difficult to monitor px
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21
Q

4..

What are some advantages for Nasal Prongs in administering 02?

A
  1. Direct oxygen delivery
  2. Good for larger dogs
  3. Easy to monitor px
  4. Can carry out other tasks whilst they are inserted (Eating, drinking etc)
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22
Q

Identify 3 nursing interventions we can use to encourage an animal to increase their water intake?

A
  1. Fresh water ad-lib
  2. Salt-free broth
  3. Water fountain
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23
Q

What are some methods of encouragement that can be used to help an px eat?

A
  1. Warming food
  2. Hand-feeding
  3. Using strong-smelling food
  4. Putting food on paw or lips
  5. Little + often
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24
Q

Name 6 measures you could put in place to help an animal suffering with regurgitatoin

A
  1. Elevated feeding/feed from height
  2. Use soft foods
  3. Small meals (Little + Often)
  4. Keep animal upright after feeding
  5. Calorie dense foods
  6. No exercise before + after eating
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25
# 8 steps... A **5kg** dog has had a **FT** placed today. Work out a **feeding plan** based on their **RER**, feeding a **Recovery diet** of **1kcal/ml**
1. **RER** = (BW(kg) x 30) + 70 = (5kg x 30) + 70 = 220 kcal/day 2. **Day 1 = 33%** = **33/100 x RER** = 33/100 x 220 = 73 kcal/day 3. **Day 2 = 66%** = **66/100 x 220** = 145 kcal/day 4. **Day 3 = 100%** = 220 kcal/day 5. **IN MLS, must convert**> **Day 1 = Day 1 kcal/day /ml of diet** = 73 kcal/1 = 73 ml/day 6. **Day 2 = Day 2 kcal/day /ml of diet** = 145kcal/1 = 145 ml/day 7. **Day 3 = Day 3 kcal/day /ml of diet** = 220 kcal/1 = 220 ml/day 8. **Max Feeding volume = 10 mg/kg** = **Vol of max to feed at time x BW(kg)** = 10 x 5 = **50ml per feed ( 4 - 5 meals)**
26
How would you instruct an owner to store + mix the Insulin for their diabetic cat?
1. Store in fridge 2. **Don't shake** vial 3. **Gently invert/roll**
27
Which condition affects the **Endocrine** system + an be treated by **Radioactive Iodine**? A) Hypothyroidism B) Hyperthyroidism C) Hypoadrenocorticism (Addisons) D) Hyperadrenocorticism (Cushings)
B) Hyperthyroidism
28
Identify 9 nursing intervention for a Neurological px
1. **Supportive bedding** 2. Supported walking 3. Cage rest 4. **Decubitus ulcer prevention - Turn Q2-4 hrs** 5. Monitor urination + defecation 6. **Assisted feeding (Meet RER)** 7. Pain management 8. **Skin care** 9. **Maintain body temp**
29
State 7 pieces of **PPE** to be used when handling or **administering Chemotherapy** medication
1. **High-quality Nitrile gloves** 2. **Full-Length long-sleeved gown** 3. **Face shield** 4. Goggles 5. Mask 6. **Respirator** 7. **Shoe covers**
30
What is the **Deficit** calculation?
Deficit = **10ml x BW (kg) x % body water loss** I.e ;10ml x 15kg x 5% = 750 ml
31
What is the **Ongoing losses** calculation?
Ongoing losses = **4ml x BW (kg) x No/ of epsiodes (V+, D+)** * **REMEMBER** = if a px has 3x V+, 2x D+ the total number = 5! I.e; 4ml x 15kg x (2x V+, 2x D+ = 4) = 240ml
32
What endocrine condition presents w/: * High blood Glucose levels * Due to disruption or * Effect of Insulin
Diabetes Mellitus
33
List 4 symptoms of DM
1. PU 2. PD 3. Polyphagia 4. Weight loss
34
What are DM at risk of developing?
Glaucoma
35
# 5 .. What do Diabetic Clinics do?
1. Support O's of newly dx pets 2. Encourage compliance 3. Review records + monitor progress Q 3-6 mo 4. Identify + Rectify problems 5. Monitor px's symptoms + condition
36
What is Caninsulin?
A prescription Insulin inj to tx DM in Dogs + Cats
37
# 10 .. Explain how you would **show a client** how to admin an Insulin inj
1. Use Insulin **syringe or pen** 2. **Demonstrate w/water + model to client** 3. Allow O to **practice under supervision** + teach several other family members 4. **Ensure eating prior to admin** 5. **Check expiry + broach date** 6. **Invert** vial ***(Explain don't shake, as cause different concentrations within the bottle, so could get a very high or very low - causing Hypoglycaemia!)*** 7. **Draw up** correct dose + **check** 8. **Vary Inj site** (Some req 2x inj) 9. **If in doubt, only inj once** 10. Dispose of sharps safely
38
# 8 .. What would a **Canine** DM diet px consist of?
1. High protein 2. Normal fat + complex carbs 3. **No simple sugars (cause spike)** 4. **High-fibre (Control obesity + reduce Glucose surge, slow digestion)** 5. Same diet, same ax - each day 6. **2 meals p/day** 7. **1/2 w/each inj** or 8.**1x full inj - if 8 - 10hrs later** 9. **No titbits!**
39
# 7/8 .. What would a **Feline** DM diet px consist of?
1. High protein 2. **Low carbs** 3. Fibre content not as important - still **no simple sugars** 4. Allow to **graze** (if pref) but **not before Insulin inj** 5. **If meal fed - 1/3 of Daily req w/ inj - Rest @ nadir (lowest)** 6. **Tins = 'dilute' carbs** - **feed dry if only eat that form** 7. **Small portion** of food **8hrs after Insulin inj** **Diet important in remission - reduced weight results in reduced B cell destruction**
40
# 4 .. What should exercise look like for DM px?
1. Regular 2. Similar **ax** + **same** time of **day** + same **length** 3. **Full walk = dangerous = req greater levels of blood Glucose!** 3. Important as can help increase weight loss
41
# 10 .. What are the different ways you can monitor a DM px?
1. **Csigns** (Polyphagia, PUPD, Glaucoma) 2. Periodic **sx checks** 2. **Diabetic clinics** (Weigh food + calculators RER) 3. **Owner obs** 4. **Check for long-term effects **(Cataracts, Plantigrade stance) 5. **Blood test w/Glucometer** 6. Use cephalic, pinna or footpad prick 7. **Single test** or **BGC** (Blood Glucose Curve) 8. **Intermittent** or (CGMS) **Continous Glucose Monitoring System** 9. **Urinalysis** (USG, Dipstick) 10. **Record** - sheet, diary ## Footnote Note - if use pinna or footpad, never change sites, stay with 1 or other to prevent variations in results - but obv vary sites
42
What 6 factors may contribute towards an unstable DM px?
1. **Insulin** that was admin **out of date** 2. Insulin **damaged** (Incorrect storage, handling) 3. **Ketodiastix damaged** 4. **Glucometer not working** 5. **O dosing incorrectly** (**Technique, dosage, timing**) 6. **O feeding titbits** or extra food Refer to VS for dx + res-stabilisation
43
What 2 Emergency conditions may a DM px present with?
1. Diabetic ketoacidosis (**DKA**) 2. **Hypoglycaemia**
44
# In basic terms... How would you tx a **DKA** px, in an emergency? ## Footnote 3 ...
1. Maintain px airway 2. IVFT - Hartmanns 0.9% Saline 3. Rapid acting Insulin
45
What **Type**, **%** + **Content** of fluids should be given to a DKA px?
1. Hartmanns 2. 0.9% 3. Saline
46
# 5 .. How would you tx a **Hypoglycaemic** px, in an emergency?
1. **Feed immediately** 2. Give Glucose water 3. Hypo-stop 4. **Rub Sugar/Syrup (Honey) solution on mm** 5. **IV Glucose**
47
A **white small dog** presents to the practice with the following symptoms: * PUPD * **Polyphagia** * **Pot-belly** * Panting * **Bilateral alopecia on his flanks** * Thin inelastic skin * Muscle atrophy * Weakness What disease am I?
Hyperadrenocorticism!! (Cushings) ..Pot-belly!!..
48
What are the 8 symptoms of Hypoadrenocorticism in Dogs?
1. PUPD 1. **Polyphagia** 1. **Pot-belly** 1. Panting 1. **Bilateral alopecia on his flanks** 1. Thin inelastic skin 1. Muscle atrophy 1. Weakness
49
What condition does this dog have?
Cushing's! (Hyperadrenocorticism)
50
# Cushings.. How would you care for a px with Hyperadrenocoriticism? ## Footnote 9 ..
1. **Reduce stress levels** 2. Take care when handling 3. **Fat restricted diet** (Generally overweight presentation - depending on concurrent conditions, as indicated by VS) 4. **Ensure nutrition maintained** 5. **Monitor BCS, MCS + BW** (Weigh Q morning) 6. Monitor Csigns ( + O questionnaire) 7. **ACTH stim tests (Q 3 - 6 mo)** 8. **Monitor skin integrity, infections + especially urinary infections** 9. Educate client!
51
A **Canine** px presents to the VP with the following symptoms: * Anorexia * Haemorrhagic V+ * Nauseous * **Malnourished** * Haemorrhagic D+ * **Lethargy + Inappetence that wax and wanes..** * **Painful + sore abdomen** I'm tricky to dx, what could I be?
**Hypo**adrenocorticism..!! (Addison's)
52
# 7 Csigns.. What are the Clinical signs associated with Hypoadrenocorticism? + What species is it normally seen in?
1. Commonly presented in Dogs 2. Clinical signs are: * Anorexia * Haemorrhagic V+ * Nauseous * **Malnourished** * Haemorrhagic D+ * **Lethargy + Inappetence that wax and wanes..** * **Painful + sore abdomen**
53
What is Addison's/Hypoadrenocoriticsm? + How is it usually caused?
1. **Reduction** or **inability** to produce **steroids** in the **adrenal glands** 2. Usually occurs as a result of **Immune destruction** of adrenal gland Or 3. Consequence of **tx Hyperadrenocorticism**!
54
What is the term given to a px who is an **emergency** state of Hypoadrenocorticism?
**Addisonian Crisis**!
55
How do you handle + tx a patient in an **Addisonian Crisis**?
1. **Emergency IVFT @ shock rate of 0.9% NaCl** 2. Medical management 3. Monitor: 4. **BP** 5. **ECG** 6. **Electrolytes** 7. **Acid-base-balance** 8. Stabilise 9. R**educe stress** levels 10. **Don't handle abdomen** (painful) 11. Monitor Csigns (O questionnaire) 12. **Monitor WBC counts** + **Na : K ratio**! 13. Educate client on tx, effects of stress + signs of Crisis!!
56
What **type**, **%** + **content** of emergency IVFT fluids should you use for a px in an **Addisonian Crisis**?
Emergency IVFT 1. **Shock rate** 1. **0.9%** 1. **NaCl** ## Footnote NaCl = Sodium Chloride
57
What 3 things should you educate a client, regarding an Addisonian Crisis?
Educate client on 1. How to admin tx 2. Effects of stress 3. **Signs of Crisis**!!
58
A Canine has been brought into the VP with the following Csigns.. 1. **Lethargy** 2. Exercise intolerance 3. **Obesity** 4. **Bradycardia** 5. **Hypothermia** 6. **Alopecia** 7. **Seborrhoea** 8. Hyperpigmentation 9. Pyoderma What condition may they have?
Hypothyroidism!
59
In basic terms, what is Hypothyroidsim?
* An **underactive** **thyroid** gland * Resulting in a **decreased Metabolic rate**
60
What is Seborrhoea?
Greasy skin
61
True or False. Due to the Csigns that Hypothyroid Dog's present with, they may be more susceptible to dermatological infections
True! As they present with the following dermatological signs: 1. Alopecia 2. Seborrhoea 3. Hyperpigmentation 4. Pyoderma These skin abnormalities disrupt the skin integrity + barrier function, thus, more susceptable to infection!
62
What levels are of most concern when monitoring Hypothyroid px's?
**T4** levels! (Thyroxine in blood)
63
How long may it take for Hypothyroidism clinical signs to improve in px's? A) 5 - 6 weeks B) 4 - 6 weeks C) 3 - 8 weeks D) 2 - 4 weeks
B) 4 - 6 weeks
64
If it may take 4 - 6 weeks for Hypothyroid px's clinical signs to improve, how long may it take for the dermatological signs? A) Years B) Weeks > months C) Days > weeks D) Months > years
D) Months > years
65
This Cat is brought in to the practice. It also presents with the folliowing Csigns.. * **Polyphagia w/weight loss** * Emaciation * **Hyperactive** * Aggressive * **Heart murmur** * Tachycardia * **PUPD** * V+ * D+ * **Depression** * Weakness * Dehydration Name this infamous condition!
Hyperthyroidism!!
66
# 12 ... List the Csigns of Hyperthyroidism
1. **Polyphagia w/weight loss** 1. Emaciation 1. **Hyperactive** 1. Aggressive 1. **Heart murmur** (if long-term) 1. Tachycardia 1. **PUPD** 1. V+ 1. D+ 1. **Depression** 1. Weakness 2. Dehydration
67
In basic terms, what is Hyperthyroidism? + How is it caused?
1. **Overactive** thyroid gland 2. **Overproduction of T4 (Thyroxine) > increases metabolic rate** 2. Usually a results of **benign hyperplasia**
68
# 3 .. How may Hyperthyroid px's be treated? | *(To include how can RVN assist, client education + diet)*
1. RVN assist w/: * Medical management * Dietary control * **Radioactive Iodine** * **Thyroidectomy** 1. Client education: * **Re importance of accurate dosing** * **Advise on tablet admin** * If long-term - how to monitor Csigns 1. Diet * Not guaranteed control * **Precription only diet** * Monitor **T4 levels**
69
What are 2 potential tx options for Hyperthyroidism in Cats
1. Thyroidectomy 2. Radioactive Iodine
70
What is the likely dx for this px?
Looks to be... Hyperthryoidism!
71
What is of great importance to monitor post-Thyroidectomy?
CSigns of Hypocalcaemia
72
What is '131I'?
Radioactive Iodine
73
What type of tx is this feline px recieving?
Radioactive Iodine Therapy
74
What 3 ways can Radioactive Iodine normally administered in the VP?
1. IV 2. S/C 3. Per os
75
How is Radioactive Iodine excreted in the body?
Through: 1. Urine 2. Faeces
76
Who can perform RIT? | Radioactive Iodine Therapy
Trained personnel ONLY
77
# 4 .. What must you advise client's re-px's Radioactive Iodine Therapy?
1. **Minimise close contact** 2. **Stay away from Immuno-comprimised** people + animals 3. **Exercise in restricted area** 4. **How to dispose of urine, faeces + litter** ( **< 3 weeks post discharge**)
78
Define Cancer
* Process of normal cells **transformed** to undergo * Excessive or **restrained growth**
79
Name the 4 types of Cancer
1. **Sarcoma** 2. **Carcinoma** 3. Lymphoma 4. Leukaemia
80
# 3 .. What is a Sarcoma?
1. **Begin in tissue** 1. **Connects**, **supports** or **surrounds** other tissues + **organs** 1. **Muscle**, **bone** + **fibrous** tissue
81
# 6 .. What is a Carcinoma?
1. **Originate in tissues** that: * **Cover** a body **surface** * **Line** a body **cavity** * **Make up** an **organ** 2. Derive **from glandular tissue** 3. Prefixed w/ '**adeno**'..
82
# 3 .. What is a Lymphoma?
1. Occur in **cells** that make up an important components of: 2. **Immune system** 3. Protect the body's cells | **Lymph cells + tissue**
83
# 3 .. What is a Leukaemia?
1. **Occur in blood** 2. Forming **tissues** 3. **Blood cells**
84
# 12 .. What is the role of the RVN in tx Cancer px?
1. Assisting with **diagnostics** (CT, MRI, x-rays) 2. Admin of **tx** * **Chemotherapy** * **Reduction of side-effects** * **Pain management** 3. Meeting nursing care needs 4. Monitor + **manage side effects** 5. **QOL assessments** 6. Client education 7. **Emotional support for O** (Euthanasia) 8. **Palliative** care 9. Patient assessment + care plans
85
What are 3 major goals of treating Cancer px's?
1. **Preserving QOL** 2. Tumour control 3. **Remission**
86
What are the 5 main treatment options for Cancer px's?
1. Sx 2. Chemotherapy 3. Radiotherapy 4. **Biotherapy** 5. **Complementary therapy**
87
What are the 3 main surgical tx options for Cancer px's?
1. Curative 2. **Biopsy** 3. **Debulking**
88
Why might a px recieve Chemotherapy?
To tx **systemic** cancers
89
When is **Radiotherapy** more indicated with Cancer px's?
More sensitive with rapidly dividing cells
90
True or False. Radiotherapy can be used only in combination with other therapies
False It can also be used independently
91
When is Biotherapy used in Cancer px's?
* To: 1. **Stop** Or 2. **Suppress** * The **growth** of a tumour
92
What type of therapy is.. * Likely to have little supportive data * Potentially be used in conjunction to alleviate symptoms * Could potentially cause harm if used as an alternative?
Complimentary therapies
93
Name a complimentary therapy used for Cancer px's?
CBD
94
What tx may this px be recieving?
Chemotherapy
95
True or False. Chemotherpy drugs can be used as: * Sole agent * In combo with others * Before sx * Before or after radiation therapy * For Solid tumours
True!!
96
What type of tumours is Chemotherapy most inclined to tx?
**Solid** tumours!
97
Why is Chemotherapy more tolerated in Veterinary medicine?
1. More **palliative** 2. Used to **minimize toxicity**
98
# 3 .. Why do typical Chemotherapy protocols r**equire a rest period between treatments**?
To allow healthy cells to 1. Repair 2. Regenerate 3. Minimise side effects
99
# 2 ... Despite typical Chemotherapy protocols consisting of having a **rest period between treatments**, allowing healthy cells to undergo repair, regeneration + minimise side effects. What is the **unforunate risk** that can come from this?
1. It **allows the damaged tumour blood vessel's to recover** * 2. Thus **lessens overal efficacy** of the protocol
100
Name 7 disadvantages of Chemotherapy
1. Expensive 2. **If using typical protocol of rest between tx's, lets tumour BVs to recover + regenerate** 3. Cause unpleasant side effects 4. **Requires specific training** 5. Cytotoxic to handle - saftey risk 6. **No guaranteed effects** 7. Difficult to dispose of
101
What type of drug are Chemotherapy drugs?
Cytotoxic
102
List 4 potential effects of Cytotoxic drugs if **ingested**
1. Tissue damage 2. Liver damage 3. Chronic headaches 4. Reproductive problems
103
Identify 6 ways in which staff may come into **contact** with **Cytotoxic drugs** during **Chemotherapy** tx
1. **Need stick injury** 2. **Inhalation** 3. Direct contact on skin 4. Ingestion when preparing + administering 5. Handling waste 6. **Contact with excretions**
104
What class of person must not be around Cytotoxic drugs?
Pregnant women
105
Ideally, **how** should Cytotoxic/Chemotherapy drugs be **prepared**?
**Within** a **fume cabinet**
106
Why should you have **closed** adminstration systems when administering Cytotoxic drugs to px's?
To prevent spillage
107
What type of PPE should you use for Chemotherapy?
**Impervious**!
108
How are Cytotoxic drugs disposed of in the VP?
In Cytotoxic waste (Purple bin) (Which is Incinerated)
109
What 3 things should you never do around Cytotoxic drugs or during Chemotherapy?
1. Eat 2. Drink 3. Touch face
110
Who should be removed from the area in which Chemotherapy takes place?
All non-essential personnel
111
What 8 essential details must Chemotherapy records include?
1. Px's **BW** 2. **Drug** used 3. **Dosage** given 4. **Route** of admin 5. **Where/site of admin** 6. **Who administered** it 6. Any **sedation** used 7. Any **adverse reactions**
112
Depending on the drugs, what are the 3 methods in which Chemotherapy drugs are administered to px's?
1. Well-sited Indwelling catheter 2. Orally 3. IM
113
Why should you never given Chemotherapy drugs via IV?
Incase it spills!
114
What should you be familiar with before providing a px when Chemotherapy?
1. Px **treatment schedule** 2. Patient records **prior to EACH admin** 3. Re-check dosage calculation
115
Should you change sites per each admin of Chemotherapy drugs?
Yes
116
What type of tx is this px recieving?
Chemotherapy
117
What type of sign must you have on the door, before performing Chemotherapy?
1. **Warning** sign 2. Stating "**Chemotheraphy in progress, DO NOT ENTER**" (+ block the door if you need to, to prevent entering)
118
# 6 .. List the PPE required for adminstering Chemotherapy
1. **Impervious** full-length + sleeved. gown 2. Glasses/goggles 3. Chemo gloves or **Double gloved** 4. Masks 5. Shoe covers 6. Hair nets
119
What must you consider about the floor when performing Chemo?
1. That its **washable** 2. You have a **protective mat** to prepare + admin
120
What **type of saline** should you use to flush the catheter pre + post admin of Chemo drugs?
**Non-heparinised** Saline
121
# 4 .. How should you store Cytotoxic drugs?
1. **Well-labelled box** + **biohazard bag** 2. **Locked** away 3. **Labelled** Cytotoxic + dangerous 4. According to manafacture's instructions
122
# 7 ... How should you decontaminate a spillage of a Cytotoxic drug?
1. **Contain the spill** 2. **Prevent traffic** 3. Wear PPE 4. **Bleach area 3x times** 5. Use **UV light** 6. Use **Chemotherapy spill kit** 7. Waste disposal: **Bedding in Infectious + hazardous (labelled as Cytotoxic)** + Cytotoxic in purple bin
123
What are 4 nursing interventions for Chemotherapy px's?
1. Reduce V+ + nausea 2. Admin of **Gastroprotectants** 3. Pain management 4. **Nutritional/anorexia management**
124
How can reduce V+ + nausea in Chemo px's?
1. Monitor V+ + nausea levels (Csigns etc) 2. **Anti-emetics** 3. Pre-emptive tx most effective
125
# 2 ... Why are Chemo px's given Gastroprotectants?
1. Because they are at **risk of Gastric Ulceration due to medications** Or 1. **Type** of cancer
126
# 6 ... What must you consider when managing pain in Chemo px's?
1. **Affects QOL** 2. Negative physical effects 3. Tx side effects 4. **Occurance of secondary syndromes** 5. **Effective assessments + re-assessments req** 6. Multi-modal approach is often req
127
What can effective nutritional management provide Chemo px's?
Improves: 1. QOL 2. Survival time
128
What 6 nutrients should a Chemo px's diet consist of?
1. High BV protein 2. High fat 3. **Omega-3 FAs** 4. **Arginine** 5. **Low carbs** 6. High fibre
129
How many days should a Chemo px's diet be changed over to it's new one?
Over 10 - 14 days
130
What are the 3 basic minimal requirements for a Chemo px's diet?
Maintain: 1. **Calorific intake** 2. **Body condition** (BCS, MCS) 3. Avoid **cachexia**
131
What 2 types of feeding may be req for Chemo patient's?
1. Enteral 2. Parenteral (If V+ + naseous from chemo drugs)
132
What 4 things must be monitored in Chemo px's **daily**?
1. BW 2. BCS 3. MCS 4. Hydration status
133
What 9 **adverse effects** must you inform the Client of, for pet's that have undergone Chemo?
1. **Alopecia** 2. **Neutropenia (7 - 10 days)** 3. Nausea 4. D+ (2 - 7 days) 5. V+ (2 - 7 days) 6. Anorexia (2 - 7 days) 7. **Perivascular tissue damage** 8. **Allergic reactions** 9. **Myocardial damage**
134
How many hrs post Chemo admin should an O avoid high-risk groups for?
24 - 72 hrs
135
How should clients dispose of Chemo waste at home?
* Treat as hazardous * Provide : 1. PPE 2. Waste disposal equipment
136
Identify 10 potential Infectious diseases that require Barrier Nursing
1. CPV 2. KC 3. **CDV** 4. **FURTD** 5. **FeLV** 6. FIV 7. **Ringworm** 8. **Campylobacteriosis** 9. Salmonellosis 10. MRSA
137
# 6 ... Who are considered Immunocompromised in the VP?
1. **Any reduction in Neutrophil count** 2. Immunodeficiency disease 3. **Neonates** (unvacced, only on colostrum) * Px's treated w/: 4. Immunosuppressive drugs (**Glucocorticoids**, **Azathioprine**, **Cyclosporine**) 5. Chemotherapy 6. Radiation tx
138
# 16 ... List some ideal principles of Isolation
1. **Own ventilation system** 2. SOPs (no visitors etc) 3. Own equipment, PPE, cleaning chemicals, waste disposal, food, bedding, utensils, sink, lighting, heating system etc 4. Good levels of hygiene (**paper towels for hand dyring**, WHO technique etc) 5. Clear communication (whiteboard, records) 6. Clear sinage 7. **Donning section prior entering** 8. Specific staffing (essential only, **1x RVN only**) 9. Wipeable surfaces 10. Stainless steel materials etc where bac can't live 11. **Colour coded system (red - re-usable, spec colour of Vetbeds)** 12. **Glass windows for easy visualisation** 13. No visitors 14. Disposable PPE, equipment (Like **pulp food bowls**) 15. **Autoclave or dispose of all resuable equip before using on another px** 16. **Disinfectable - Radio, speaker system, toys, bordem breakers, TLC, bedding from home (Comfort)**
139
Why should you not let a Parvo px toilet in a public area?
Because it stays in the environment for **up to 2 years**
140
Where should you walk Barrier nursed px's?
Away from public areas
141
A **14 y/o**, **FN**, **DLH** has been admitted into the VP for tx of **CKD**. She exhibits the following clinical signs: * Dehydration * Dry mm * Reduced skin elasiticity * PU * Inapetant * Poor coat condition * Lethargy * The O reports she has been drinking increased ax over the last few months. * She is on IVFT + also exhibiting signs of stress when hospitalized. 1. **Describe the nursing process for this px.** 2. **List 5 possible nursing diagnoses.**
1. **Needs support w/****drinking adequate ax** (Due to PD, Kenneling, use IV fluids) 2. Needs support w/**maintaining skin integrity** (Aid of IV cannula) 3. Needs support **to urinate** (Due to PU, use IV fluids + kenneling) 4. Needs to support **to eat adequate ax** (Due to Nausea, use appropriate diet) 5. Needs to support to **maintain normal behaviours** (Due to Stress, kenneling, req tx)
142
A **14 y/o**, **FN**, **DLH** has been admitted into the VP for tx of **CKD**. She exhibits the following clinical signs: * Dehydration * Dry mm * Reduced skin elasiticity * PU * Inapetant * Poor coat condition * Lethargy * The O reports she has been drinking increased ax over the last few months. * She is on IVFT + also exhibiting signs of stress when hospitalized. 1. **Provide 5 nursing interventions**
1. Use **gloves + aseptic technique when placing cannula** * **Flush w/sterile/heparinised saline Q24hrs** to maintain catheter * **Change dressing Q24hrs** or as needed * **Change catheters Q48-72hrs** 2. Provide access to fresh, clean water, bowl for px access. * **Wash mouth with damp swab** 3. **Provide litter tray with familiar little of non-absorbant litter** (if VS requests **urine testing**) * Absorbent bedding (Vetbed) + kennel liners to **provide comfort** + **draw any excretions away** 4. Supportive feeding - **shallow**, **non-reflective bowl**, aromatic, palatable, **soft**-foods * **If ulcerated** mouth, **warm** food * Refer to VS if signs of nausea * **No tube if anorectic** 5. Provide calming environment seperate cat ward * No loud noises/barking * Calm background music * Pheromone plug in * Provide TLC * **Sensitive handling**
143
A **14 y/o**, **FN**, **DLH** has been admitted into the VP for tx of **CKD**. She exhibits the following clinical signs: * Dehydration * Dry mm * Reduced skin elasiticity * PU * Inapetant * Poor coat condition * Lethargy * The O reports she has been drinking increased ax over the last few months. * She is on IVFT + also exhibiting signs of stress when hospitalized. 1. **Describe 6 methods of monitoring the patient during fluid administration**
1. **Signs of hydration**: * Skin turgor * CRT * Mm moistness * **Nictating membrane position** * HR * PR * BW 2. Signs of **overhydration**: * Peripheral oedema * **Soft, moist cough** * Dyspnoea * Inc RR * **Runny nose** * **Chemosis** 3. **Urine output = 1-2 ml/kg/hr** 4. **Central Venous Pressure** 5. **Core v Peripheral temperature** * ***Peripheral within 4 degrees celcius of core*** 6. **Check administration site** for: * Swelling * Bruising * Pain * **Perivascular fluid** * Interference ## Footnote Chemosis = swelling of conjunctiva
144
A **14 y/o**, **FN**, **DLH** has been admitted into the VP for tx of **CKD**. She exhibits the following clinical signs: * Dehydration * Dry mm * Reduced skin elasiticity * PU * Inapetant * Poor coat condition * Lethargy * The O reports she has been drinking increased ax over the last few months. * She is on IVFT + also exhibiting signs of stress when hospitalized. 1. **Describe the discharge + home care instructions for the O of this px** ## Footnote 5 ...
1. **Appropriate diet**: * **Restricted phosphate** * High BV protein * Ideally - wet diet * Encourage eating * **Gradual change in diet to minimize anorexia + prevent food aversion** 2. **Encourage**: * Inc water intake * **Fresh water ad lib** * Water fountain 3. **Refer to renal nurse clinics**: * Monitoring **blood parameters** + **BP** 4. **Monitor**: * Food + fluid intake * BW * BCS * **MCS** * Severity of Csigns 5. **Admin prescribed medications** + instruct on **tableting cats**
145
What 4 things does the Nursing Process provide?
* Provide: 1. **Organized** 2. **Structured** 3. **Holistic** 4. Individualised * Px care
146
List these in order. * Evaluation * Assessment * Interventions * Nursing diagnosis * Planning
1. Assessment 2. Nursing diagnosis 3. Planning 4. Interventions 5. Evaluation
147
How should you structure short/long-term goals?
* Using SMART system * **S**ubjective * **M**easurable * **A**chievable * **R**ealistic * **T**ime-bound
148
What does the **Assessment** stage of the Nursing Process?
1. **Clearly establishes individual needs** 2. Can **only occur after** following has been given: * **Collected necessary** info systematically from own obs, **client**, other team members * **Reviewed** collected info * **Identified actual + potential problems** * Identified **priorities** (among problems) 3. Can ask O to fill out a questionnaire
149
What is the **Nursing diagnosis** stage of Nursing Process?
1. **Differs from medical dx, as it's not concerned w/judgement about disease** 2. Identifies **actual + potential problems** 3. Focused on **providing the most appropriate nursing intervention**
150
What is the **Planning** stage of the Nursing Process?
Making plans to **overcome** the **identified nursing problems**
151
What are the **6 Aims** of the **Planning** stage, of the Nursing Diagnosis?
1. **Solve identified actual problems** 2. **Prevent** identified **potential problems** (from becoming actual) 3. **Alleviate** any problems that **cannot be solved** 4. **Help px + client cope positively** w/problems that **cannot be solved or alleviated** 5. **Prevent recurrence** of treated problem 6. Help **make px as comfortable as poss**, even when **death is inevitable**
152
What is the **Interventions** stage of Nursing Process?
1. The do-ing stage of the process 2. **Carrying out Nursing Interventions**
153
What is the **Evaluation** stage of Nursing Process?
1. **Reflection-part** of the process 2. Involves evaluating the care been given to the px: * Has it worked? * Has it not? * How can it be **adapted**?
154
During the **Evaluation** stage of the Nursing Process, if it is **evident** that **the desired goals have not been met**, **what 8 questions** should be **considered**?
1. Has the goal set for the px been **partially achieved**? 2. Is **more info** from **VS** or **Client** **req** to **decide the next step** in nursing care? 3. Is a specific **problem unchanged**? 4. Should the nursing intervention be **changed** or **stopped**? 5. Is there a **worsening** of the problem? 6. Should the **goal** + **nursing intervention be reviewed**? 7. Was the **goal set inappropriate** or **unrealistic**? 8. Does the **goal req interventions** from **other members** of the Vet **team**? (VS, Physio etc)
155
What stage of the Nursing Process is this? * Ben Jones is an 11 y/o MN Golden Retriever * Has been admitted for hospitilization by VS for investigation of: 1. Lethargy 1. PUPD 1. He has had these for several days * VS requests he is kennelled for obs + prelimniary urine + blood tests are carried out * To investigate cause of problem
The collection of info from Client + VS, in the Assessment stage
156
What stage of the Nursing Process is this? * It is already known from admitting VS that Ben has: 1. Exercise Intolerance 1. PUPD * However, if RVN had spoken to the O earlier * They would have ascertained that Ben is: 1. Deaf in his L-ear 1. Eats 1 meal p/day (In evening) 1. Will only urinate + defecate on concrete - not grass
Assessment stage, Had the RVN asked these questions, this would greatly improve Ben's care
157
What stage of the Nursing Process is this? * The VS has made a dx of DM * Planning Ben's care can now be carried out - using all info collected * The actual problems are: 1. Exercise intolerance 2. PUPD due to unstable DM 3. Unilateral deafness due to age-related degeneration * The potential problems, if the actual problems are not solved, are: 1. Weight loss 2. Dehydration 3. Hypoglycaemia
Planning stage! (Identified actual problems + potential problems)
158
What stage of the Nursing Process is this? * Short-term goals for Ben while DM is being stabilized: Problem = **PD** * Short-term goal = **Prevent dehydration** * Timing = **At all times** * Nursing interventions = **Provide measured volumes of fresh drinking water + record** Problem = **PU** * Short-term goal = **Ensure Ben has the opportunity to urinate regularly** * Timing = **Q 1hr** * Nursing Interventions = **Take Ben into an outside concrete run to allow him the opportunity to urinate + record**
Planning stage! (Identified actual problems + what nursing interventions can be put in place)
159
# 5 .. What **questions** should you ask the O for '**Eating adequate amounts**'?
1. **What** does the px normally eat? 2. **How much**? 3. **How often**? 4. **When**? 3. Does the px prefer any **particular bowl**?
160
What is the rationale behind asking an O questions regarding **eating**?
1. **Get's px back to eating normal food** 2. **Allows calculation** of **RER** or **MER** to **maintain BW** 3. **Bracycephalic cats** (**Persians**) prefer **flat** bowls 4. **Cats** generally prefer **china** or **ceramic** bowls, rather than plastic
161
What **questions** should you ask the O for '**Drinking adequate amounts**'?
1. **How much** do they normally drink? 2. Do they often **drink** water **from containers outside** (collected **rain water**)?
162
What is the rationale behind asking an O questions regarding **drinking**?
1. **Will vary** from ax to ax 2. May **depend** on whether the ax's normal **diet** is **wet** or **dry** 3. What **type** of water can be important 4. **Cats** may drink from a **dripping tap** 5. **Rabbits** + **other SAs** may drink from a **bottle** or **bowl**
163
What **questions** should you ask the O for '**Urinating normally**'?
1. **Where** do they urinate? 2. Does the O use any **commands**? 3. Do they have any **problems** urinating?
164
What is the rationale behind asking an O questions regarding **urinating**?
1. Diff px's may show **different preferences** 2. **Inside** or **outside**? 3. **Cats** - use **LT**? 4. What **type** of **litter**? 5. Does **dog** **urinate** on **walks**? 6. Always on **grass** or **concrete**? 7. Commands for well-trained ax 8. Do they have **arthirtits**? **Joint stiffness can affect how** the px **urinates**
165
What **questions** should you ask the O for '**Defecating normally**'?
1. How **often**? 2. **Where**? 3. **On what**?
166
What is the rationale behind asking an O questions regarding **defecating normally**?
1. How **often** - **depends on diet provided** 2. Some **dogs** have **preferences** on **where** they urinate/defecate 3. **Cats** may have a preference for **type of litter**
167
What **questions** should you ask the O for '**Breathing normally**?
1. Any **problems**? 2. Do they **snore**?
168
What is the rationale behind asking an O questions regarding **breathing**?
1. Linked to **exercise** 2. Indicate **underlying disease** 3. Might be indicative of **allergy** 4. **Facial conformity** may result in breathing difficulties (**Persians**, **Pugs**)
169
170
What is the **Dogs** normal: 1. HR 2. RR 3. Temp 4. Urine output p/day 5. Water intake p/day
Dogs 1. HR = 70 - 140 bpm 2. RR = 10 - 30 rpm 3. Temp = **38.3** - **39.2** degree c 4. Urine output = 1-2 ml/kg/hr or 24-48 ml/kg/day 5. Water intake = **40** - **60** ml/kg/day
171
What is the **Cats** normal: 1. HR 2. RR 3. Temp 4. Urine output p/day 5. Water intake p/day
Cats 1. HR = **100** - **200** bpm 2. RR = **20** - **30** rpm 3. Temp = **38.2** - **38.6** degrees c 4. Urine output = 1-2 ml/kg/hr or 24-48 mnl/kg/day 5. Water intake = 40 - 60 ml/kg/day
172
What is the **Rabbits** normal: 1. HR 2. RR 3. Temp 4. Urine output p/day 5. Water intake p/day
Rabbits 1. HR = **130** - **325** bpm 2. RR = **30** - **60** rpm 3. Temp = **38.5** - **40** degrees c 4. Urine output = **12** - **48** ml/kg/day (variable) 5. Water intake = **50** - **150** ml/kg/day (variable)
173
What is the normal USG for a **Dog**?
1.015 - 1.0**45** ## Footnote 30 difference!
174
What is the normal USG for a **Cat**?
1.020 - 1.060 ## Footnote 40 difference!
175
What is the normal **pulse oximetry** reading for a Cat + Dog?
95 - 100%
176
What is the normal PCV of a **Dog**?
37 - 55
177
What is the normal PCV of a **Cat**?
24 - 45
178
Identify the 6 functions of the Skin
1. **Protection** (Micorog, dehydration, UV light, mechanical damage) 2. **Sensation** (Pain, temp, tough, deep pressure starts) 3. **Mobility** (Smooth motion) 4. **Endocrine activity** (Vit D prod, Ca absorp, bone metabolism) 5. **Exocrine activity** (Release of water, urea, ammonia, sebum, sweat, pheromens, cytokines) 6. **Immunity** (Pathogens) 7. **Thermoregulation** (Conserving + releasing heat, maintain water + homeostatic balance)
179
State the 3 layers of the skin in order
1. Epidermis 2. Dermis 3. Hypodermis
180
List the 5 layers of the Epidermis
Stratum... 1. Corneum 2. Lucideum 3. Granulosum 4. **Spinosum** 5. **Basale**
181
Name the functions of these layeres of the skin: 1. Epidermis 2. Dermis 3. Hypodermis
1. **Epidermis**: * Outermost * **Waterproof** * 3 types of cells: Squamous, Basal + Melanocytes 2. **Dermis** * Middle layer * 2 layers: Papillary + Therectiular * Provides f**lexibility + strength** * Contains: **BVs, CT, Hair follicles, Lymph vessels, sweat glands** * **Held together by collagen** * Contains **pain + touch receptors** 3. **Hypodermis** * Deepest layer * **Protects body from injury** * Acts as **shock absorber** * Contains: Fat, CT + Collagen
182
Name the 5 types of **open** wounds
1. Incision 2. Abrasion 3. **Avulsion** 4. **Laceration** 5. Puncture
183
Name the 2 types of **closed** wounds
1. Contusion 2. Crushing injury
184
What's the characteristics of a **Incision** wound? + Give 1 example
1. Open 2. Created by **sharp tool** 3. **Minimal tissue trauma** 3. Scalpel blade
185
What's the characteristics of a **Abrasion** wound? + Give 1 example
1. Open 2. **Loss of Epidermis** 3. Loss of **portion of Dermis** 4. **Scuffed** skin
186
What's the characteristics of a **Avulsion** wound? + Give 1 example
1. Open 2. **Tearing of tissue away** from: * **Attachments** * **Underlying tissues** * Underlying **structures** 4. Dog bite
187
What's the characteristics of a **Laceration** wound? + Give 1 example
1. Open 2. **Irregular** 3. **Superficial damage** **underlying tissue** 4. **Barbed wire** injury
188
What's the characteristics of a **Puncture** wound? + Give 1 example
1. Open 2. **Penetrating** 3. Created by **sharp object** 4. Can **introduce contaminates deep into tissue** 5. Resulting in **high-risk infection** 6. Cat Bite
189
What's the characteristics of a **Contusion** wound? + Give 1 example
1. Closed 2. **Blunt-force trauma** 3. **Doesn't break skin** 4. Causes damage to skin + underlying tissue 5. **Bruise**
190
What's the characteristics of a **Crushing injury** wound? + Give 1 example
1. Closed 2. **Force applied to tissue** 3. For **long-period of time** 4. Fallen from height
191
What is the duration of Contamination?
* Time between: 1. **Infliction** + 1. **Treatment**
192
What is a **Class 1** contaminated wound?
1. **Clean** wound 2. **Minimal** contamination 3. **0 - 6 hr duration**
193
What is a **Class 2** contaminated wound?
1. **Significant** contamination or 1. **6 - 12 hr** duration
194
What is a **Class 3** contaminated wound?
1. **Gross** contamination or 1. **> 12hr** duration
195
What are the 4 classications given to **Surgical** wounds?
1. Clean 2. Clean-contaminated 3. Contaminated 4. Dirty
196
List the 4 stages of wound healing
1. Haemostasis 2. Inflammation 3. Repair 4. Maturation
197
How long does **Haemostasis** last for?
1. Occurs immediately 2. Lasts = varies
198
How long does **Inflammation** last for?
* Occurs within 6 hrs * Lasts = **3 - 6 days**
199
How long does **Repair or Proliferation** last for?
Occurs **3 - 7 days** post injury
200
How long does **Maturation or Remodelling** last for?
1. Occurs **5 - 7 days** post injury 2. Lasts = **Up to 2 years**
201
What intention is used for **Clean** wounds?
Primary
202
What intention is used for **Clean-Contaminated** wounds?
Delayed primary
203
What intention is used for **Contaminated or Dirty** wounds?
Secondary
204
What intention is used for **Wounds with Extensive contamination or Devitalisation** wounds?
Second Intention
205
How are **Clean** wounds, under **Primary** Intention be managed?
1. **Immediate closure** 2. No tension 3. Surgical **sutures**
206
How are **Clean-Contaminated** wounds, under **Delayed primary** Intention be managed?
1. **Lavage** 2. **Debridement** 3. Appropriate **dressing** 4. **Closure after 2 - 3 days**
207
How are **Contaminared** wounds, under **Secondary** Intention be managed?
1. Lavage 2. Debridement (Sedation) 3. **Closure after 5 - 7 days** to **allow granulation bed to form**. (ONLY IF **OPEN**)
208
How are **Extensively Contaminated or Devitalised** wounds, under **Second** Intention be managed?
1. **Unsuitable** for **sx closure** 2. **DO NOT consider over joint** (Blood flow restriction) 3. Open wound management 4. Lavage 5. Debridement 6. Appropriate dressing 7. **Allow to heal by self** 8. **Only dressings + bandages**
209
If trauma has caused a wound, why should you wait?
To allow the wound to **declare itself**
210
# 8 .. How do you prepare a wound for Debridement?
1. **Sterile** gloves + apron 2. Adequate analgesia + had time to take effect 3. **GA** (usually) 4. Keep **covered** w/**sterile, non-linting dressing** (Guaze swabs) prior to prep 5. **Swab** **around** **wound bed** for **culture** + **sensitivity** (Store in fridge) 6. Insert **Sterile water soluble Jelly** **into** wound (Soaks hair) 7. **Clip around** wound * Total injury **visible** * Clip **passed unviable tissue** * Provide **2cm margin** 8. Debridement
211
# 10 .. How do you perform a **Lavage** on an open wound?
1. Sterile gloves + apron 2. Use towel or liner to protect px from environment 3. Ensure patient **warm enough** 4. Lavage **solution** (Compatable w/tissues) **Isotonic Sterile saline** - **Hartmann**'s 5. **Dilute antiseptic scrub** (**DO NOT SCRUB as CYTOTOXIC**) for **contaminated** * **Chlorohexidine** = **0.05%** * Sterets Unisept sachets * **Povidone Iodine** **1%** (**NOT IN healing wounds**) 8. **20 ml syringe** 9. **19G needle** 10. Large vol = **minimum of 100ml/cm** 11. **Pressure** = **8 - 12 psi** 10. Prevent cross-contamination
212
# 3 ... Why are wounds Lavaged?
1. **Removes debris** 2. Reduces contamination 3. Significantly reduces infection risk
213
If a pressure **greater than 12 psi** is used to lavage a wound, what can this cause?
**Drives** pathogenic bacteria **into** wound + **cells**
214
If a pressure **lower than 8 psi** is used to lavage a wound, what can this cause?
Has minimal to no affect
215
Define Bioburden
**No. of micro-organisms** that the wound is **contaminated** with
216
Define Biofilm
1. Form of **multispecies bacterial communities** 2. **Organised** onto a **wound surface** 3. Forms **extracellular matrix** of: * **Polysaccharides** * **Proteins** * **Nucleic acids** 4. To provide **protection** + **ensure survival**
217
Name 3 forms of Debridement
1. **Autolytic** 2. **Mechanical** 3. Surgical
218
What does bioburden cause?
1. Prolonged inflammation 2. Healing delay
219
What does a **protein rich**, **devitalised** wound tissue do?
Perfect environment for **bacterial proliferation** > Infection
220
# 3 .. When a Bioburden + Biofilm is **removed**, alongside a moist wound-healing technique, what can this do?
1. **Optimise cell proliferation** 2. Mainitain comfort 3. **Avoid Eschar formation**
221
What is Active debridement?
Use of soft-purpose-made brush (Debrisoft)
222
What is Biological Debridement?
1. Use of **medical maggots + leeches** 1. M + L **grown in sterile environment** 1. Applied to wound bed 1. Maggots can be **applied w/pre-constructeed dressing** or individually created dressing, to keep maggots **secure** in wound bed ## Footnote Expensive..
223
# 6 .. Describe **Autolytic** Debridement
1. Use of **primary layer applications**: * **Alginates** * **Hydrocolloids** * **Hydrogels** * Manuca Honey * Sugar 7. **Most selective form** of debridement 8. **Spares healthy cells** 9. **Maintain intact matrix of molecules** 10. **While removing damaged** cells 11. With **Microscopic precision**
224
# 6 .. Describe **Mechanical** Debridement
1. **Physical removal** 2. Of tissue adheered to 3. To a **dried-on dressing** 4. Non-selective + **non-desirable form of debridement** 5. **Very painful** 6. Req **GA**/Analgesia
225
# 4 ... Describe **Surgical** Debridement
1. **Gold-standard** technique 2. Tissue removed by VS 3. According to: * **Colour** * **Texture** * **Vascular supply** * Temperature 8. **Selective form of debridement** on a **Macroscopic level**
226
Name 4 types of Closure techniques for wounds
1. Sutures 2. **Staples** 3. Surgical **Reconstruction** (Flaps + **Grafts**) 4. **Drains** (**Active** + **Passive**)
227
List 2 disadvantages of **Surgical Staples** for wound closure
1. Doesn't go very deep 2. Less reliable
228
Identify 1 **advantage** of **Surgical drains** for wound closure
Minimises fluid build-up/oedema
229
What is open wound management?
1. Covering wound with appropriate dressing + bandage 2. DOES NOT MEAN left open to environment
230
What are the aims of Open wound management?
1. **Work syngeristically with cells** 2. Provide **best environment** possible 3. **Support** healing process
231
What is it called when a wound closes by itself?
Second Intention
232
# 3 .. When is Second Intention appropriate for Open wounds?
1. Healing is **progressing well** 2. **Reconstructive sx is not required**: * To prevent contracture or scarring * Might inhibit mnobility * Cosmetically unacceptable 3. If **px tolerates banadging**
233
What does normal **Exudate** look like?
1. Clear 2. Pink-tinged
234
What does Infected **Exudate** look like?
1. Cloudy 2. Varied in colour * Yellow * Tan * Green * Reddish * Black * Milky * Thick * Viscous
235
What is Exudate? + What does it contain?
1. Exudate is: * Discharge from fluid * **Plasma leaking from capillaries** 3. Contains: * Nutrients * **Growth factors**
236
What is Exudates function for the body?
Provides a **moist environment** for **cell viability**
237
When should Exudate normally reduce?
1. Towards the **end of the Inflammatory phase** 2. As **granulation tissue + epitheliasation forms**
238
If Exudate is still present after the Inflammatory stage, what may this indicate?
1. **Increased bacterial burden** 2. Oedema 3. **Excess movement** 4. Patient interference
239
What is **Maceration**?
1. Wound with **excessive production of Exudate** 2. **Spilling onto adjacent healthy skin** 3. **Inc** susceptibility to **infection**
240
What is **Excortiation**?
1. Exudating wound 2. Had **contact with toxins from wound** 3. Causes **damage to top layers of skin**
241
What is Granulation?
1. **Tissue build up by fibroblasts** 2. **Secrete new extracellular matrix molecules** (Collagen, Elastin) + Endothelial cells 3. Which **help build new BVs**
242
# 3 .. What does healthy Granulation tissue look like?
1. **Bright red** 2. **Moist** 3. Slightly **un-even appearence** (Wound fluid levels depend on wound)
243
# 3 ... What is **Epithelialisation**?
1. **Process** of **Epithelial cells migrate onto** **Granulation** tissue 2. Which provides: * **Oxygen** * Moisture 5. **Surface req** for epithelial cells to: * Proliferate * **Cross wound** * **Create new Epidermis**
244
How long would **Wound Epithelialisation Process** take for a **1mm** wound?
10 days!
245
If it takes **10 days for a 1mm** wound to undergo **Epithelialisation**, how long would a **10cm** wound take?
Up to 500 days!
246
Out of these 3 options, chose when you should change the dressing
**Medium** Exudate! 1. Low = good ax of absorbancy left 2. Perfect time 3. Excess = Fully saturated, leads to Maceration of surrounding healthy tissue
247
# 4 .. What does Laser therapy do?
1. Enhance wound healing times 2. Reduce/prevent infection 3. Inc blood flow + oxygenation 4. Red inflammation + pain
248
Identify 7 types of advanced dressings
1. Hydrogels 2. Hydrocolloids 3. **Polyurethane foam** 4. **Polyhexamthylene biguanide (PHMB)** 5. Alginates 6. **Sodium chloride** 7. Super-absorbant
249
What is a **Hydrogel** dressing? + When is it appropriate to use?
1. They are: * **Fluid donators for dry wounds** * Donate + **trap water** * **Hydrate necrotic material** within wound * **Absorb exudate** 2. Used for: * Wounds at **risk of drying out** * **Necrotic** wounds * Wounds within **excess exudate**
250
What is a **Hydrocolloids** dressing? + When is it appropriate to use?
1. They are: * **Actively stimulate** wound healing * Encourage **debridement** * **Degrade on interaction with exudate** 2. Used for: * **Dry > semi-dry** wounds * **Req additional moisture** + natural debridement
251
What is a **Polyurethane foam** dressing? + When is it appropriate to use?
1. They are: * Foam * Highly **absorbant** * **Act by drawing excess exudate away from wound** * **Maintain some moisture + humidity** * **Keeps wound moist** * Now avaliable w/**antimicrobial properties** 2. Used for: * **Applied on top of other products** (**Hydrogels**, Honey)
252
What is a **Polyhexamthylene biguanide** (PHMB) dressing? + When is it appropriate to use?
1. They are: * Protozoan * **Antimicrobial agent** * Broad spectrum of activity * Against **bacteria** + **fungi** * **Breaks down bio-film** * The **PHMB attacks bacteria in wound exudate as it is absorbed** 2. Used for: * Staphylococci (Inc **MRSA**) * **Pseudomonas** * Proteus etc
253
What is a **Alginates** dressing? + When is it appropriate to use?
1. They are: * **Fine** * **Fiborous** * Absorb moisture * **Dereived from Kelp** * Wound **exudate interacts** w/Alginate to **release cations** that **actively stimulate** the wound 2. Used for: * ??
254
What is a **Sodium Chloride** dressing? + When is it appropriate to use?
1. They are: * New * **Guaze** * **Saturated w/20% Hypertonic saline solution** * Promotes biological cleaning * Promotes **autolytic debridement process** 1. Used for: * **Non-infected** * **Highly exudating** wounds
255
What is a **Super-absorbant** dressing? + When is it appropriate to use?
1. They are: * **Cope w/high vol** of exudate * **Incoperated Polyacrylate crystals** * Hi-tech silicone adhesives 2. Used for: * **Excessive exudate** * Difficult to manage
256
Name 2 types of Anti-microbial dressings + What they consist of? + When they are used?
1. **Manuka Honey** * Excellent anti-microbial effects * **Helps granulation bed form** * Must be **medical-grade** * **High-level filtering to remove debris** * Effective against: * Pseudomonas spp * **MRSA** * E-Coli 2. **Silver dressings** * Silver + salts have **antispetic + antibacterial** properties * **Silver - ionises to release active silver ions into wound** * **Req activation** prior to use * By **moistening w/water for 10 sec** * Effective against: * Pseudomonas spp * MRSA * E-Coli * **Common yeasts + fungi (Candida)**
257
What is VAC?
1. **Vaccum Assisted Closure** 2. Use of **negative pressure** 3. To **encourage epitheliaisation + contraction of wound** 4. Through vaccum pump 5. **Sealed within plastic dressing**
258
Name 5 wound complications
1. Devitalised tissue 2. Large vol exudating wounds 3. Infection 4. Oedema 5. Necrosis
259
List 5 signs of wound infection
1. Erythema 2. Pain 3. Oedema 4. Localised heat 5. Inflammation
260
Name 4 types of Suture material
1. Absorable 2. Non-absorable 3. Monofilament 4. Natural or Synthetic
261
Name 4 types of needle shapes
1. Round bodied 2. Straight 3. Half-curved 4. Curved
262
What are the 3 types of main suture patterns?
1. Apposing 2. Everting 3. Inverting
263
Identify 7 suture patterns
1. Simple interrupted 2. Horizontal mattress 3. Simple continous 4. Ford interlocking 5. Cruciate 6. Vertical mattress 7. Intradermal/Subcurticular
264
Name the 3 main components of Surgical knots
1. Loop 2. Knot 3. Ears
265
List 4 types of Surgical knot
1. Simple throw 2. Surgeon's knot 3. Square knot 4. Granny knot
266
Name 7 techniques to overcome skin tension
1. Px positioning 2. Undermining 3. Wound geometry 4. Suture patterns 5. Skin streching 6. Tissue expanders 7. Incisonal ''plasty'' techniques - V, Y, Z
267
Identify 3 tension relieving techniques
1. Subcuticular sutures 2. Walking sutures 3. Relaxing incisions (parrallel or multiple)
268
# Flaps.. Name 6 primary closures of large skin deficits
1. Single pedicle advancement flap 2. Bipedicle advancement flaps 3. Rotation flaps 4. Transposition flaps 5. Axillary + Inguinal flaps (Trunk, Ventral, Thorax, Abdomen) 6. Distant direct flaps (distal limbs)
269
What are 5 complications of skin flaps
1. Self-trauma 2. Seroma 3. Discharge 4. Dehiscence 5. Necrosis
270
When do you use a drain?
1. Repeated lavage of a space 2. Repeated aspiration of fluid from a space (drain dead space) 3. Prevention of seromas
271
What is the most common Passive drain?
Penrose
272
When are passive drains used?
1. Wounds w/**dead space** 2. Where **fluid accumilates** 3. **Cat bite abscesses**
273
How do passive drains work?
1. Gravity 2. Capillary action
274
When are passive drains contraindicated?
1. Latex allergies 2. **Thoracic** wounds 2. **Abdominal** wounds * As will **draw fluid into cavities** - causing Pneumothorax or **Peritonitis**
275
How are Passive drains removed?
1. Trim 1 end to level of skin 2. Pull 3. But if 1 end exiting - cut top off before to not bring the outside through internally - compromising sterility
276
What are Active drains?
1. Rigid tube 2. With a device that exerts constant gentle negative pressure
277
What is the most common Active drain?
Jackon-Pratt
278
How do Active drains work?
1. Active suction 2. Under negative pressure 3. Using bulb/chamber
279
When should Active drains be used?
1. **Body cavities** 2. **Large** dead spaces 3. Following surgery
280
What are the contraindications of Active drains?
1. None! 2. Generally wouldn't use if small ax of fluid is expected
281
How are Active drains removed?
1. **When fluid production decreases (2-5 days)** 2. Less than 2-4ml/kg/day 3. Large surgery decficits (Can be up to 3 weeks of fluid production)
282
What should you inspect of drains?
1. Kinks 2. Blockages 3. SSI at stoma site 4. Px interferance
283
What should you apply around passive drain stoma sites?
Barrier creams
284
How do you empty a closed drain?
1. PPE 2. Empty **Q 4-6 hrs** or when full 3. **BE AWARE - frequent emptying can inc chance for contamination + ascending infection**
285
True or False. All px's with open wounds should be barrier nursed
True!
286
What type of drain has a lesser risk of ascending infection?
Active drains
287
What are passive drains commonly made of?
Rubber or Latex
288
What is this?
Jackson Pratt, Active drain
289
How long may it take for Jackson Pratt drains to work well?
3 - 5 days
290
What ax of fluid indicates removal of a drain?
Fluid production **< 2ml/kg/24hrs**
291
What is the expected ax of fluid production from a drain?
**2 - 4ml/kg/24hrs**
292
When are Tracheostomy tubes used?
1. Complete **upper airway obstruction** 2. Req Airway **protection** 3. **Airway patency** 4. **Mechanical ventilation** 5. Unable to intubate (BOAS) 6. **Laryngeal paralysis**
293
What are the complications that can occur from Tracheotomy tubes?
1. Underlying disease 2. Tube dislodgement 3. Obstruction 4. Aspiration pneumonia 5. Infection 6. Tracheal necrosis 7. Tracheal stenosis 8. Pneumothorax 9. Pnuemomediastinum
294
How do you remove secretions from Tracheotomy tube?
1. Remove inner cannula Q 4-6 hrs minimum + disinfect 2. Replace w/sterile cannula 3. Single-lumen - entire tube needs replaced
295
When is a Chest drain required?
In-dwellng catheter into pleural space to drain air or fluid
296
If not trained when placing a chest drain, what can you cause?
Iatrogenic pneumothorax
297
What is a Central Line?
1. Long-stay catheters 2. Used for long-term hospitilization * Allow for: 1. Multiple blood draws 2. Large vol or rates of IVFT 3. High concentrations of medications at constant rate
298
When are Oesophagostomy tubes used?
1. Feeding longer than 7-10 days 2. Functioning, unobstructed oesophagus + GI tract * Disorders of: 1. Nasal passages 2. Jaw bones 3. Oral cavity
299
Which are **Insensible**/Inevitable losses? 1. Respiration 2. Urine 3. Faeces 4. Skin
1. Respiration + 4. Skin
300
Which are sensible losses? 1. Respiration 2. Urine 3. Faeces 4. Skin
2. Urine + 3. Faeces
301
What is the maintence fluid calculation?
M = 50ml x BW(kg)
302
What % of hydration causes: 1. Slight loss of skin elasiticity 2. Hair standing on end
1%
303
What % of hydration causes: 1. Dry mm 2. Slight dec skin elasitcity 3. Slight inc USG
5%
304
What % of hydration causes: 1. Marked loss of skin elasticity 2. Inc USG 3. Dec urine output 4. Sunken eyes 5. Tachycardia 6. Slightly prolonged CRT
7%
305
What % of hydration causes: 1. Skin tenting 2. Sunken eyes 3. 3rd eyelid protrusion/nictating membrane 4. Oliguria then anuria 5. Weak pulse 6. Prolonge CRT 7. Signs of shock 8. Lethargy
10%
306
What % of hydration causes: 1. Depression 2. Collapse 3. Shock 4. Moribund 5. Death
12 %
307
What is general normal pH of Dogs + Cats?
7.35 - 7.45
308
How can fluid therapy be admin?
1. Orally 2. IV 3. SC 4. IP 5. IO
309
What is a solute?
* Solid * Liquid * Gas * Dissolved to make solution
310
What is a solution?
A solute dissolved within a solvent
311
What is a Solvent?
Liquid protion of solution
312
What is an Isotonic solution?
1. Concentration 2. Equal to 3. Plasma
313
Name the 2 intracellular + 2 extracellular Electrolyte **Cations**
* Intracellular 1. Potassium 2. Magnesium * Extracellular 1. Sodium 2. Calcium
314
Name the 2 intracellular + 2 extracellular Electrolyte **Anions**
* Intracellular 1. Phosphate 2. Proteins * Extracellular 1. Chloride 2. Bicarbonate
315
What is the pH of blood dependent on?
Concentration of hydrogen ions (H+) dissolved within the blood
316
What is Hypovolaemia?
1. **Inc** concentration of **blood** 2. **Low plasma** volume
317
What is an Oedema?
1. Dec plasma proteins 2. Ineffective lymphatic drainage
318
What 3 organs maintain Fluid balance?
1. Brain 2. Adrenal glands 3. Kidneys
319
What is lost in V+, despite water?
Stomach acid
320
What is lost in D+, despite water?
Bicarbonate
321
What is the difference between dehydration + hypovolemia?
1. Dehydration = Lack of fluid in **interstitial** space 2. **Hypovolaemia** = Lack of fluid in **intravascular** space
322
What parameters are affected by **Hypovolemia**?
1. CRT 2. HR 3. Pulse quality 4. BP
323
What are 3 main methods of assessing hydration?
1. Clinical exam 2. Urine testing 3. Blood testing
324
Identify 5 lab tests used to assess **dehydration**
* All will rise: 1. PCV (1% loss = fluid loss of 10mg/kg) 2. Haemoglobin 3. Total Plasma Protein (TPP) 4. BUN + Creatinine 5. USG
325
What is the TP for a **Dog**?
54 - 71 g/dl
326
What is the TP for a **Cat**?
54 - 78 g/dl
327
Name the 4 primary acid-base distrubances
1. Metabolic Acidosis 2. Metabolic Alkalosis 3. Respiratory Acidosis 4. Respiratory Alkalosis
328
When may **Metabolic Acidosis** occur? + What are the signs?
1. Inc of acid in body 2. Due to abnormal metabolic function 3. Ingestion of acid substance 4. Dec in Bicarbonate 5. Compensatory dec in CO2 * Csigns: * V+ * D+ * RF * Shock
329
When may **Metabolic Alkalosis** occur? + What are the signs?
1. Excessive loss of Sodium or Potassium 2. Affects Kidney's ability to control acid-base balance 3. Inc is Bicarbonate 4. Compensatory inc CO2 * Csigns: 1. V+ stomach contents only 2. Over admin of Bicarbonate
330
When may **Respiratory Acidosis** occur? + What are the signs?
1. Resp system cannot excrete acid 2. Lungs don't expel Co2 3. Inc Co2 4. Compensatory inc Bicarbonate * Csigns: 1. Resp obstruction 2. Acute RF 3. Hypoventilation - for any reason 4. Anaesthetic problems
331
When may **Respiratory Alkalosis** occur? + What are the signs?
1. Excessive CO2 expelled from bloodstream 2. Hyperventilation 3. Dec Co2 4. Compensatory dec in Bicarbonate * Csigns: 1. Hyperventilation 2. Pain 3. Stress 4. Hyperthermia 5. Excessive IPPV
332
What must you considere prioir to admin of Fluid Therapy?
1. Type of dehydration 2. pH of body 3. Type req 4. Ax req
333
What is fluid vol req?
Maintenance vol + Deficit vol + Ongoing losses!
334
What is a **Crystalloid** fluid?
Solution containing water + electrolytes
335
What is a **Colloid** fluid?
Solution containing large molecules or plasma expanders
336
How often should you change catheters?
Q 48 - 72hrs
337
How often should you flush a catheter?
Q 6hrs
338
# 11 .. How should you monitor a px on IVFT?
1. Check Csigns of hydration 2. **Use calculated vol** 3. Monitor TPR + MM 4. **Record urine output + USG** 5. **Monitor PCV** 6. **Monitor ongoing losses** 7. **Central Venous Pressure** 8. Record all findings on fluid monitoring chart 9. Review fluid therapy reg 10. **Monitor signs of overperfusion** 11. **Weigh px daily**
339
Why is improtant to weight px's on IVFT?
Because if they are dehydrated, they'll weight less!
340
# IMPORTANT!! What is Central Venous Pressure?
1. Estimate of **BP in Right Atrium** 2. Reflects **ax of blood returning to heart** 3. **Reflects heart's ability to pump** blood into arterial system 4. Proportional to vol of blood in Anterior Vena Cava + Venous tone 5.** Dec w/hypovolaemia or vasodilatio**n 6. **Inc by IVFT** in critically ill px or **w/cardiac disease**
341
List 9 Csigns of overperfusion
1. **Soft, moist cough** 2. Pulmonary oedema 3. Dyspnoea 4. **Tachypnoea** 5. **Tachycardia** 6. **Lethargy** 7. **Runny nose** 8. Dec PCV 9. Inc urine output
342
What are the 5 aims of Rehabilitation?
1. Restore maximum: * Function * QOL * Independence * Following injury or illness 1. Limit pain 2. Return to normal functions (All activities) 3. Build muscle 4. Reduce recovery times
343
List 4 types of Rehabilitation
1. Physiotherapy 2. Acupuncture 3. Hydrotherapy 4. **Mctimoney**
344
What is **Acupuncture**? + When is it used?
1. Insertion of needles into specific points on body to produce a healing response 2. To: * Promote natural healing * Enhance blood circulation * Enhance oxygenation to BVs * Relax muscles * Relieve pain * Reduce swelling * Removal of waste products/toxins * Correcting energy imbalances within body * Stimulatese nervous system
345
What is **Hydroptherapy**? + When is it used?
1. Any healing or therapuetic water 2. Controlled exercise in water 3. Zero or low impact 4. Non-weight baring in controlled weight bearing exercise 5. Uses Buoyancy, Hydrostatic pressure, Cohsion + Turbulence 5. To: * Relieve pain * Reduce swelling + stiffness * Circulatory benefits * Improved cardiovascular fitness * Inc mental stimulation * Improved gait pattern * Muscle strength * Joint mobilisation
346
When is **Hydrotherapy** indicated? + Contraindicated?
1. Indicated * Pre + Post orthopaedic sx * Pre + Post spinal sx * Muscle atrophy * Obesity management * Orthopdic conditions/disease * Neurological conditios * Performance, working or show dog conditioning * Behavioural issues 1. Contraindicated * Cardiac dysfunction (overheat) * Respiratory dysfunction (hydrostatic pressure > inc effort) * Severe peripheral vascular disease (Damage BVs) * Infections (Spread) * Coagulopathies (Inc blood flow) * Unstable fractures (must be fully hx) * V+ * D+ * Precautionary conditions (Season, Epilepsy, Chemo, DM)
347
What is **Mctimoney**? + When is it used?
1. Physical manipulation using gentle hands to realign balance + muscoskeletal system * Precise + rapid adjustments of spine + pelvis by Chiropractor/VS referral 3. Used: * Post-Ortho sx * Injurd/accident * Working or competing dogs * Mobility issues (Conformation defects, Obese) * Lameness * Exercise intolerance * Uneven gait * Stiff + pain post-exercise * Changes in performance, behaviour + temperament * Uneven muscle development * Signs of discomfort when back touchde
348
What is **Physiotherapy**? + When is it used?
1. Combo of techniques to create a tailor made rehabilitative program for an individual * Thermotherapy * Massage * Therapuetic exercises * Laser therapy * Electrial stimulation * Therapuetic ultrasound * Extracorporeeal shockwave therapy (ESWT) 2. Used for: * Geratrics * Post-op recovery * Stable post-sx
349
When is **Physiotherapy** contraindicated?
1. Pyrexia (Inc blood flow = inc heat) 2. Infection (Spread) 3. Vascular compromise 4. Coagulopathy 5. New or Unstable fractures 6. Spinal instability
350
When do you use Thermotherapy? + When do you use Cyrotherapy?
1. Thermotherapy * Chronic pain * Relax tense muscles * Aches * Arthiritis 2. Cyrotherapy * Acute injury * After activity * Reduce swelling * Sprains * Bruises * Pain
351
Name the 4 types of massage techniques
1. Stroking (Long, slow gliding strokes) 2. Effleurage (Firm stroking movements towards lymph nodes) 3. Petrissage (Kneading, picking up, rolling + compressions) 4. Frictions (Deep transverse massage w/fingertips)
352
Give 1 indication of each of these Massage techniques: 1. Stroking 2. Effleurage 3. Petrissage 4. Frictions
1. Stroking (Long, slow gliding strokes) * Aids circulation * Inc lymph flow * Stimulates sensation 2. Effleurage (Firm stroking movements towards lymph nodes) * Inc lymph flow * Reduces oedema 3. Petrissage (Kneading, picking up, rolling + compressions) * Mobilises soft-tissue * Enhances deeper circulation * Aids toxin removal 4. Frictions (Deep transverse massage w/fingertips) * Breaks down adhesions * Improves fibre alignment
353
What is ROM or PROM?
Range Of Movement Or Passive Range Of Movement
354
Identify nursing care for suspect Spinal/Non-ambulatory px
1. Massage - Effleurage in UPWARDS DIRECTION 2. Standing 3. Toothbrush 4. ROM 5. Turning 6. Urinary catheter care +/- Manual bladder emptying 7. Grooming 8. Feeding 9. Wound interferance 10. Nursing Care Plan
355
What is Shock?
**Acute circulatory failure** resulting in **inadequate tissue prefusion** + **energy** production
356
What is Stage 1 shock?
* **Compensatory** shock * Attempt to reduce effects of shock 1. **Baroreceptors detect reduc cardiac output** 2. Stimulate **adrenaline** + noradrenaline 3. Causes **inc HR + contractility** 4. **Hypoxia** of tissues > **metabolic acidosis** 5. **Inc Ventilation** - to address acid-base balance 7. **Hypoperfusion of kidney **activates **RAA system** 8. Aldosterone a**cts on collecting ducts** to **retain Na + H20** 9. Causes **peripheral vasconstriction**
357
What is Stage 2 shock?
* **De**compensatory * No longer able to compensate * When shock is not treated 1. **Fluid** + **proteins** **leak** from **circulation > tissues** - due to peripheral **vasodilation** 3.** Inc blood viscosity** 4. **Acidosis** inc 5. **Gut becomes Ischaemic** 6. **Bac enter blood stream** 7. Inc stuporous of **comatose**
358
What is Stage 3 shock?
* **Irreversible** * Too much cell death - non-reversable 1. **Systemic Inflammatory Response Syndrome** (SIRS) * **Inflammatory injury to 1 organ systems** * Causes knock-on effect * Infectious or non-infectious cause 2. **Disseminated Intravascular Coagulation** (DIC) * **DEATH IS COMING** * **Activiation of haemostatic mechanisms** * Induces **prothrombotic state** * Leads > bleeding tendencies (can't clot) 3. **Multi-Organ Dysfunction** (MOD) * SIRS + Septic shock > MODs * Every organ + system is affected 4. Death ## Footnote 1. SIRS 2. DIC 3. MOD
359
List 3 stages of shock
1. Compensatory 2. Decompensatory 3. Irreversible
360
Name 4 types of shock
1. Hypovolaemic 2. **Septic/Distributive** 3. Cardiogenic 4. **Obstructive**
361
What happens in **Hypovolaemic** shock?
1. **Heart pumps well** 2. **But dec circulating vol** 3. Due to blood, fluid or plasma loss 4. Results in **Hypoperfusion**
362
What happens in **Septic/Distrubitive** shock?
1. Distrubitive due to hypotension 2. Heart pumps well 3. But peripheral vasodilation 4. Gram-ve bac infection 5. Endotoxins released from ruptured bac cells 6. Toxins > circulation inc capillary permeability - causing uneven fluid distrubution
363
What happens in **Cardiogenic** shock?
1. Reduc in cardiac efficacy 2. Heart loses ability to pump effectively 3. Leads to reduc in cardiac output 4. Results in congestion in Liver + Lungs 5. Causes oedema
364
What happens in **Obstructive** shock?
1. Obstruction of normal blood flow 2. Heart pumps well 3. Outflow obstructed 4. Causesed by pulmonary thromboembolism or pericardial effusion 5. Pericardial effusion - blood unable to fill ventricles > cardiac output is red 6. Removal of obs will resolve signs
365
What is the **Isotonic** fluid shock rate for a **Dog**?
90ml/kg
366
What is the **Isotonic** fluid shock rate for a **Cat**?
50ml/kg
367
What is the **Hypertonic** fluid shock rate for a **Dog**?
4 - 5 ml/kg
368
What is the **Hypertonic** fluid shock rate for a **Cat**?
2 - 4 ml/kg
369
What is the **Hydroxyetyl starches** fluid shock rate for a **Dog**?
* Up to 20ml/kg * Divide into 5ml/kg boluses + reassess
370
What is the **Hydroxyetyl starches** fluid shock rate for a **Cat**?
* Upe to 10 ml/kg * Divide into 2.5 - 3 ml/kg boluses + reassess
371
What is the **Crystalloid or Colloid** fluid shock rate for a **Dog**?
1. Crystalloid = 4 - 45 ml/kg 2. Colloid = 5 - 10ml/kg
372
What is the **Crystalloid or Colloid** fluid shock rate for a **Cat**?
1. Crystalloid = 25 - 27 ml/kg 2. Colloid = 1 - 5 ml/kg
373
How much blood can Cats + Dogs donate?
20% Max in Dogs = 18ml/kg Max in Cats = 11ml/kg
374
What is the formula for finding out correct total blood volume required for a transfusion?
Vol of donor blood req (ml) x BW(kg) x Desired change in PCV **ALL DIVIDED BY** PCV of transfused blood
375
Give calculation of how much blood volume to be transfused in mls to a px
k = Constant rate, 70 for dogs, 60 for cats k x BW(kg) x req PCV - Recipient PCV **Divided by** (only req PCV >>) PCV of red cell product
376
How many mls of PCV does it take to raise a PCV by 1%?
1 ml/kg of PCV OR 2ml/kg Whole blood
377
Collate a list of questions you would ask an **owner** on a care plan
1. What is Fluffy's **normal routine**? **When** does she normally **eat**, go to the **toilet** and **sleep**? 2. **How much**/what **type of exercise** does Fluffy get? What **type**, for **long** how? 3. What does Fluffy eat, how much, **how many meals**? Does she have any **treats**, if so, what are they? What **type of bowl** does she use? 4. How much does Fluffy **drink** + How is she given water? 5. What are her **normal activities behaviours**? Does Fluffy have any **stress triggers**? 6. Where does Fluffy **normally go** to the toilet? What are her normal **toileting behaviours**? **Type of area**? How **often** does she p**ass urine/stools**? 7. How do you normally **groom** Fluffy?
378
Collate a list of questions you would ask an **VS** on a care plan
1. Were there any **complications** during **surgery** or **GA**? 2. What is the **volume**, **strength**, **frequency** + **time** due for Fluffy's **medications**? 3. Is Fluffy **NPO** (nil per os) or **what**/**when** can she have **food**/**water**? 4. Is Fluffy on **strict cage** rest? If no cage rest - Can Fluffy be **allowed out** for **toileting**/**exercise**? 5. What are the **bladder considerations**? 6. Does Fluffy have a **buster collar** on? 7. Any **specific wound care** considerations? 8. What's the **plan**? 9. **How long might the ESF be inplace** for? 10. Is there any **specific monitoring information** required by the VS?
379
How would you provide **adequate nutrition** for a **Cardiac** patient?
1. Palatable diet 2. Maintain calorie intake 3. Provide high-quality BV protein 4. Restricted sodium diet 5. No high-salt treats
380
How would you provide **maintain hydration** for a **Cardiac** patient?
1. Ensure accurate fluid plan in place + followed 2. Check for overperefusion 3. Provide oral fluids
381
How would you ensure a **Cardiac** patient is able to **defecate normally**?
1. Maintain hydration 2. Low intensity exercise, if possible to stimulate persistaltic contractionss 3. Oral lubricants with food - if palatable
382
How would you ensure a **Cardiac** patient is able to **urinate normally**?
1. Allow frequent toilet trips - if able to mobilse 2. Indwelling catheter 3. Kennel liners
383
How would you provide **maintain oxygenation** for a **Cardiac** patient?
1. Provide 02; oxygen cage, flow-by + nasal cannula 2. Limited handling - reduce stress, care around neck + chest regions 3. Peripheral catheter inserted as precaustion if no fluids 4. Crash cart avaliable if required 5. Weight management
384
How would you provide **maintain body temperature** for a **Cardiac** patient?
1. Insultate to ensure peripheral circulation is maintained 2. Normal environmental temp/fan to ensure no overheating
385
How would you provide **maintain skin + coat conidtion** for a **Cardiac** patient?
1. Maintain skin integrity - skin care, bathing if soiled, keep skin dry 2. Assist with - grooming, eye + oral hygiene (Particulary if not drinking + panting)
386
How would you provide **mobilise adequately** for a **Cardiac** patient?
1. Cage rest - where appropriate 2. Low Intensity exercise - care with steps + inclines 3. Use harness, instead of collar 4. PROM exercises
387
How would you provide **maintain adequate sleep + rest** for a **Cardiac** patient?
1. Minimal procedures + handling 2. Group together observations, nursing interventions + medications 3. Periods with reduced lighting
388
How would you ensure a **Cardiac** patient is able to **Express normal behaviours**?
1. Stress-free handling - minimal contact, no scruffing, avoid neck area 2. Provide hide - care with monitoring 3. Reduce environmental noise - away from noisy patients, domestic noises, radio etc
389
# 15 .. What nursing interventions may you use for nursing **Neurological** patients?
1. **Supportive bedding** 2. Care handling 3. **No leads or collars** 4. **Sternal recumbency + Turn Q2 hrs** 5. **Coupage** 6. Nebulisation if required 7. **Supported walking or cage rest** 8. **Decubitus uclers - check + prevent** 9. Monitor urination + defecation 10. Manual expression or urinary catheterisation 11. **Assisted feeding - care to protect airways, tube feeding if required** 12. Ensure meet RER 13. **Pain management** 14. Skin care + grooming 15. **Maintain body temperature** (Q15 mins until within normal ranges)
390
What may a **Neurological** + Assessment + Plan involve?
1. Results from Neurological assessment 2. Urination + Defecation function assessment 3. Mobility 4. Independent feeding 5. Rehabilitation plan
391
When may this be used?
To perform a Neurological assessment
392
What nursing care is involved in the **Immediate** Post-op rehabilitation period for **Neurological** patients?
1. **Pain control** * Buprenorphine, Methadone etc * Pre + Post-op 2. **Massage** * **20 mins** * **2-3 x day** * Warms the muscles 3. **Cyrotherapy** * **10-15 mins** * **2-4 x day** * Reduce inflammation, pain, heat * **3 days** for **post-Orthopeadic**-surgery
393
What nursing care is involved in the **Early** Post-op rehabilitation period for **Neurological** patients?
1. **Massage** 2. **Passive ROM exercises** * **10-15 cycles** * **2-3 x day** 3. **Thermotherapy** * **10-20 mins** * **2-3 x day** * **Depends on weight** * 3-post surgery * Chronic conditions 4. **Alternative therapies** * Ultrasound * **TENS**
394
What nursing care is involved in the **Late** Post-op rehabilitation period for **Neurological** patients?
1. **Exercise** * Active * Active-**assisted** * Active-**resisted** 2. **Walkers/wheelchairs** 3. **Low-level light therapy**
395
What may a **Opthalmic** + Assessment + Plan involve?
1. Attempt to **evaluate level of sight** 2. **Ability to cope** w/u**nfamiliar environments** (will bring stress) 3. **Level** of **stress**
396
# 9 ... What possible Nursing Interventions would you use for **Opthalmic** patients?
1. **Use voice** to **make patient aware** of **approach** * Call name, make presence known 2. **Reassurance**, particulary **when moving/carrying out procedures** 3. **Reduces stress + excitement** * Quiet ward * **Reduced light** * Blanket over kennels * Pheremones 4. **Careful handling** * **Opthalmic pain is extreamly painful** 5. **Be aware of aggresive tendencies** 6. **Keep routine** for **feeding + bowls** * Ask O for **familiar** items + **scent** 7. **Prevent self-trauma** * E-collar * **Don't let them rub their eye**, **will if sutured**, may be in for 10+ days, as will req another op if so! 8.**Occular hygiene + lubrication** * Use **gentle, clean, cotton guaze** * Lubricating eye drops * **Remove secretions + blood etc** 9. **Accurate + Careful medication** 10. **Dim lights**
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Advanced EVPC Yr2 (28 decks)

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