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X Clinical Veterinary Nursing Theory > GI Surgery > Flashcards

GI Surgery Flashcards

1
Q

what parts of the body are included in GI surgery?

A

anything from the oral cavity to the large intestine

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2
Q

what is a -otomy?

A

procedure for cutting open or dividing tissue during surgery, after which the tissue is repaired to allow it to heal normally

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3
Q

what is a gastrotomy?

A

temporary opening into the stomach

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4
Q

what is an -ostomy?

A

creation of an opening or stoma which communicates with the outside through the skin

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5
Q

what is used to keep an -ostomy open?

A

a device that is then removed to allow the skin to heal

permanent stoma are sutured to the skin and allowed to heal open

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6
Q

what is a gastrostomy?

A

opening in the stomach to allow feeding via a tube to bypass oesophagus

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7
Q

what is an -oscopy?

A

use of device or instrument to give visual access inside a cavity

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8
Q

what is endoscopy?

A

use of a camera to view the interior of an organ

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9
Q

what is an -ectomy?

A

surgical removal of all or part of a structure - the remaining part must be sutured back together

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10
Q

what is an anastomosis?

A

point of rejoining between two structures that have been surgically seperated

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11
Q

what is an enterectomy?

A

removal of a length of small intestine

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12
Q

what are the main roles of a VN in GI surgery?

A 
pre-operative care of the animal
surgical preparation of the animal
preparation of surgical equipment
assistance during surgery
anaesthetic management
post-op care of the animal
post-op advice to owners
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13
Q

what type of surgeries are most GI surgeries?

A

urgent or emergancy

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14
Q

what is the effect of many GI diseases on the whole patient?

A

vomiting, diarrhoea and anorexia often lead to fluid deficits and electrolyte disturbances

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15
Q

what must happen before a GI patient is anaesthetised?

A

any fluid or electrolyte deficits identified and stabilised (IVFT)

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16
Q

what may be needed to be placed in the GI patient to facilitate eating post op?

A

feeding tubes

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17
Q

what are the main areas of prep specific to GI patients?

A

pre-op starvation
enema
antibiotics
other

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18
Q

how long should animals ideally be starved before GI surgery?

A

ideally 12 hours but may not happen if an emergancy

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19
Q

is an enema usually required before GI surgery?

A

no - can make faecal material more liquid and so harder to deal with - check with surgeon

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20
Q

when may antibiotics be needed for GI surgery?

A

rarely used pre-op

can be used intra and post-op if contamination occurs during surgery

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21
Q

what other preparation may be needed in the surgical GI patient?

A

specific management of the condition e.g. stomach tube for GDV

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22
Q

how should the patient be surgically prepped for oral surgery?

A

flush mouth with saline to remove debris

prep any areas of skin (e.g. lip) that may be in surgical field as normal

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23
Q

what area should be clipped for a ventral midline laparotomy?

A

above xiphoid to below pubis and out to skin edges

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24
Q

how should a patient be surgically prepped for a ventral midline laparotomy?

A

clip and prep a large area to allow large incision and examination of entire abdominal contents

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25
Q

how should a patient be surgically prepped for anal/rectal surgery?

A

positioning can be specific - check with surgeon

anal ops may require packing and a purse string suture

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26
Q

how are most anal/rectal patients positioned for surgery?

A

in sternal with tail tied up

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27
Q

why is warmth a vital consideration for GI surgical patients?

A

often long ops with high heat loss due to exposed abdominal organs - plans should be made for heating at all times pre, intra and post op

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28
Q

why is a good ET tube seal even more essential in GI patients?

A

risk of regurgitation is higher in GI patients

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29
Q

how can patient positioning be used to prevent aspiration pneumonia?

A

patient angled 10 degrees downwards (head lower) to allow drainage and early identification

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30
Q

what instruments and equipment are needed for GI surgery?

A 
normal surgical kit 
laparotomy swabs
suction
histopathology pot (if biopsies)
specific instruments
at least two of everything (gloves, drapes, instruments, kits)
pre-warmed saline
stomach tube and bucket
endoscope (if required for procedure)
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31
Q

why are laparotomy swabs needed?

A

to pack off abdomen

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32
Q

how should laparotomy swabs be prepared?

A

pre-soaked in warm sterile saline

LOTS!

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33
Q

what specific instruments may be needed for GI surgery?

A

retractors e.g. balfour/ gelpis

atraumatic bowel clamps e.g. doyen may robson and mayo robson clamps

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34
Q

why are at least two of each item (kit, drapes, instruments, gloves etc) needed during GI surgery?

A

surgeon may need to switch contaminated kit during surgery

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35
Q

what is pre-warmed saline needed for during GI surgery?

A

abdominal lavage

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36
Q

what is the role of the scrubbed nurse during GI surgery?

A

surgical assistant (clamping bowel with fingers or atraumatic clamp)
keeping exposed GI contents moist with warm saline
keep contaminated instruments separated
control suction machine
have additional swabs and instruments to hand
take samples from surgeon

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37
Q

what type of suture material should be used for most of the GI tract?

A

synthetic monofilament, short duration absorbable

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38
Q

why should short duration absorbable suture be used for GI surgery?

A

most of the GI tract heals quickly (except oesophagus and LI) so shorter duration will reduce irritation

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39
Q

why should synthetic monofilament suture material be used for the viscera in GI surgery?

A

reduce tissue drag and don’t wick in infection like braided suture

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40
Q

what needle type is best for GI viscera?

A

round bodied rather than cutting as less traumatic

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41
Q

what are the common types of suture used for GI viscera?

A 
monocryl 
PDS (lasts longer so good for LI)
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42
Q

what suture material can be used for closure of muscle/linea alba, subcutaneous tissue and skin?

A

routine so normal preferred suture

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43
Q

when is GI surgery not considered to be a clean-contaminated procedure?

A

if tissue viability is in question
contamination has already occurred
there is gross contamination during surgery (e.g. spillage of GI contents)

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44
Q

what are the common antibiotics given intra and post-operatively if contamination occurs / surgeon deems it necessary?

A

amoxycillin + clavulanic acid (Augmentin)

metronidazole

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45
Q

what are the main types of oral surgery?

A

oral tumors
oronasal fistulae
cleft palate
foreign bodies and penetrating injuiries

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46
Q

in what animals are oral tumors most often seen?

A

usually older animals

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47
Q

what is the prognosis like for oral tumors?

A

may be poor, surgery could be extensive

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48
Q

what is oronasal fistulae seen secondary to?

A

trauma
dental extraction
tumors

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49
Q

what is the aim of surgical repair of oral nasal fistulae?

A

stop food material impacting in nasal cavity

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50
Q

what are the specific pre-op nursing considerations for oral surgery?

A

flush debris from mouth
consider how the patient will be monitored as head will be difficult to access
ask surgeon about specific positioning

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51
Q

what are the specific post-op nursing considerations for oral surgery?

A

ensure patient can eat and drink safely (food should be soft but formed and easy to swallow - too sloppy will affect sutures)
feeding tube may be required

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52
Q

what are the main reasons for oesophageal surgery?

A

oesophageal foreign bodies

oesophageal stricture

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53
Q

what can be caused by a full oesophageal obstruction?

A

dehydration and hypovolaemia which is an emergancy

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54
Q

how are oesophageal foreign bodies extracted?

A

via endoscope

pushed into stomach and removed surgically

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55
Q

what are the main risks associated with oesophageal foreign bodies?

A

tears / damage to oesophagus

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56
Q

what can cause oesophageal stricture?

A

secondary to FB
trauma
doxycycline
GA

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57
Q

how long can it take for oesophageal stricture to become apparent?

A

2-4 weeks

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58
Q

what is involved in the treatment of oesophageal stricture?

A

stretching with balloon endoscopically

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59
Q

what is the prognosis like for oesophageal stricture?

A

poor

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60
Q

what are the specific pre-op nursing considerations for oesophageal surgery?

A

treat dehydration and hypovolaemia as needed (IVFT)

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61
Q

what are the specific post-op nursing considerations for oesophageal surgery?

A

consider use of a gastrostomy tube if damaged oesophagus needs time to heal
liquidised diet may be needed

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62
Q

What are the main types of gastic surgery?

A 
Foreign body
Pyloric obstruction
Gastric neoplasia
GDV
Tube gastrostomy
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63
Q

What is the main sign of a gastric foreign body?

A

Persistant or intermittent vomiting

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64
Q

What methods may be used to remove a gastic foreign body?

A

Endoscopically

Midline laparotomy

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65
Q

What must be done after removing a gastirc foreign body?

A

Whole bowel must be checked

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66
Q

What is a pyloric obstruruction a type of?

A

Gastric outflow diseases

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67
Q

What causes pyloric obstruction?

A

Foreign body, thickening/neoplasia

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68
Q

How is pyloric obstruction treated surgically?

A

Widening or even removing pylorus

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69
Q

What causes GDV?

A

Accumulation of food and gas within the stomach which causes it to dilate and then rotate

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70
Q

What are the effects on the body of GDV?

A

Occulsion of oeophagus and venous drainage
Hypovoleamia
Toxic shock

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71
Q

How may GDV cause death?

A

Gastric wall necrosis due to reduced blood supply
Shock
Disseminated intravascular coagulation
Ventricular dysrhythmia

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72
Q

What is involved in emergancy treatment of GDV?

A

Treat shock
Decompress stomach (stomach tube)
Surgically derotate stomach
Gastropexy

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73
Q

What is a gastropexy?

A

Surgical fixation of the stomach in place

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74
Q

In what animals is GDV most common?

A

Deep chested

Middle to old age dogs

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75
Q

What happens during a tube gastrostomy?

A

Surgical of endoscopic placement of a tube for nutritional support or decompression of stomach

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76
Q

Where is a gastrostomy tube placed?

A

Anchored in the stomach and exits through body wall

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77
Q

what are the specific pre-op nursing considerations for gastric surgery?

A

treatment of dehydration/hypovolaemia as needed (IVFT)
prepare wide surgical site
monitor and prevent heat loss

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78
Q

what are the specific post-op nursing considerations for gastric surgery?

A

feed low fat / bland diet as appropriate, liquidised diet if pyloric obstruction
continue treatment for fluid and electrolyte losses
monitor for arrhythmias in GDV

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79
Q

what is the basic treatment plan for GDV?

A

treat shock with rapid admin of IVFT
IV antibiotics
decompression of stomach by passing stomach tube
right lateral radiograph to confirm volvulus
ECG to check for dysrhythmias
surgery to decompress and derotate stomach and assess gastric wall viability - gastropexy may be performed and spleen may need removal

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80
Q

what are the main reasons for small intestinal surgery?

A

intestinal biopsy
enterotomy (foreign body removal)
enterectomy
intussusception

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81
Q

when may an intestinal biopsy be performed?

A

in cases of persistent or recurrent vomiting or diarrhoea

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82
Q

what are the main types of foreign body found in the small intestine?

A

simple (mass like)

linear (string like)

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83
Q

what can linear small intestinal foreign bodies cause?

A

gut to concertina

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84
Q

when is a enterectomy performed?

A

where the gut is neoplastic or necrotic

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85
Q

what happens during an enterectomy?

A

section of SI is removed and the ends sutured together (anastomosis)

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86
Q

what is intussusception?

A

small intestine invaginates into itself

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87
Q

in what animals is intussusception seen?

A

young dogs after diarrhoea

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88
Q

what is done to correct intussusception?

A

invagination is reduced although blood supply has been compromised and so tissue may be necrotic and so need resecting

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89
Q

what are the specific pre-op and inter-op nursing considerations for small intestinal surgery?

A

treatment of dehydration / hypovolaemia as needed (IVFT)
keep intestinal contents moist whilst lifted out of the abdomen
prepare wide surgical site
keep an eye on heat loss
bowel clamps or scrubbed assistants fingers may be used to occlude gut while operated on

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90
Q

what are the specific post-op nursing considerations for small interstinal surgery?

A

ensure biopsy samples are labelled with site
encourage eating/drinking
bland low fat diet

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91
Q

why is large intestinal surgery higher risk than small?

A

increased bacterial load and slower healing time

92
Q

what are the 2 main reasons for large intestinal surgery?

A

intestinal biopsy

colectomy

93
Q

what happens during large intestinal biopsy?

A

partial thickness samples taken with endoscopy (rigid proctoscopy)
full thickness via laparotomy

94
Q

what must you be aware of during full thickness large intestine biopsies?

A

avoid contamination of abdomen with faecal matter

95
Q

what is a colectomy?

A

removal of the colon - high risk

96
Q

when may a colectomy be performed?

A

to treat chronic constipation in cats

97
Q

what are the specific pre-op and inter-op nursing considerations for large intestinal surgery?

A

avoid enemas - intestinal contents is more likely t spill

pre-op antibiotics may be indicated

98
Q

what are the specific post-op nursing considerations for large intestinal surgery?

A

make sure biopsy samples are labelled with site

post-op nutritional support to aid healing

99
Q

what are the main reasons for anal/rectal surgery?

A 
rectal polyps/tumors
rectal prolapse
imperforate anus
anal sac removal
anal furcunculosis
100
Q

what do rectal polyps/tumors cause?

A

straining (tenesmus), bleeding and discomfort

101
Q

how is rectal polyp/tumor surgery performed?

A

rectal pull out where the rectum is everted through the anus to allow removal of polyp
tumor would require larger excision

102
Q

what is rectal prolapse?

A

eversion of the wall of the rectum through the anus, often due to chronic straining (treat primary disease)

103
Q

what can be placed once rectal prolapse is replaced?

A

loose purse string suture around the anus

104
Q

what is imperforate anus?

A

congenital condition where anus doesn’t join with rectum - sometimes be corrected surgically

105
Q

why may anal sacs need removal?

A

chronic sacculitis / impaction / abscessation

106
Q

what dogs is anal furcunculosis seen in?

A

GSDs

107
Q

how is anal furcunculosis treated?

A

immunosuppressive drug therapy mostly - rarely surgery

108
Q

what are the specific pre-op and inter-op nursing considerations for anal/rectal surgery?

A

ask surgeon about preferred positioning
protect prolapse prior to surgery - moist lubricated and no self trauma (buster collar)
peri-anal surgery may need purse string suture

109
Q

what are the specific post-op nursing considerations for anal/rectal surgery?

A

post op nutritional support to aid healing

110
Q

what is the peritoneum?

A

lining of the abdominal cavity

111
Q

what is peritonitis?

A

life threatening infection of the the peritoneum

112
Q

what is peritonitis caused by?

A

if there is contamination or irritation of peritoneum leading to inflammatory response

113
Q

what does peritonitis lead to?

A

severe illness
sepsis
shock
CVS collapse

114
Q

what is the prognosis of peritonitis?

A

guarded

115
Q

what condition should you monitor for following GI surgery?

A

peritonitis - surgery is a possible cause

116
Q

what is a possible cause of peritonitis?

A

GI surgery

117
Q

what are the clinical signs of peritonitis?

A 
pyrexia
anorexia
depression
tachycardia
vomiting
ascites
abdominal pain
118
Q

what is involved in the treatment of peritonitis?

A

surgical exploration of abdomen to find source of contamination
lavage of abdomen

119
Q

how may infection during peritonitis be managed?

A

open peritoneal drainage

120
Q

what is open peritoneal drainage?

A

in peritonitis patients abdomen is not fully closed after lavage and is managed with sterile dressings

121
Q

what is involved in the nursing care of peritonitis patients?

A 
intensive - 
IVFT
close monitoring of blood albumin and electrolytes
hydration
bandage care
122
Q

is there a caecum in both cats and dogs?

A

yes

123
Q

what are the immediate post op signs / behaviours you expect in patients?

A

possible hypothermia and other electrolyte / physiological abnormalities
nutritional status affected
hydration status altered
clean, intact wound
analgesia appropriate but should be monitored
abnormal behaviour seen but will change

124
Q

what abnormalities may be seen in the post op patient?

A

hypothermia
hypovolaemia
hypotension

125
Q

how should hypothermia and other potential abnormalities be managed immediately post op?

A

close and regular monitoring of TPR and BP

appropriate warming

126
Q

what may be the effect on the animal post-op of their altered nutritional status?

A

hypoglycaemic

nauseus

127
Q

what post op feeding may be required in the GI patient?

A

early or delayed depending on feeding

128
Q

how should nutritional status and and effects be managed immediately post op?

A

nutrition plan in place
awareness of preferences and usual diet
monitor intake carefully
administration of anti-emetics, gastric protectants and motility agents as needed

129
Q

how should hydration status be managed immediately post op?

A

physical assessment of hydration status
monitor fluid intake carefully
fluid therapy plan in place (maybe IVFT)

130
Q

how should wounds be managed immediately post op?

A

ensure appropriately dressed and covered and dry
check frequently
ensure appropriate positioning of animal to minimise pressure on wound
prevent interference

131
Q

how should correct analgesia be managed immediately post op?

A

ensure planning and that appropriate is administered on time when pre-med analgesia wheres off

132
Q

what behaviour may be shown by an animal during recovery?

A

dysphoria

133
Q

how should abnormal behaviour / dysphoria be managed immediately post op?

A

ensure appropriate recovery environment that is quiet and safe if thrashing
use pain scoring
anticipate return to normal behaviour (chewing) by ensuring buster collar / vest in place when appropriate

134
Q

what are the immediate post-op complications seen in the recovery phase post-op?

A

physiological abnormalities (e.g. hypothermia) worsening
pain
haemorrhage
drug or anaesthetic reaction
vomiting / regurgitation (risk of aspiration)
trauma or increase in abdominal pressure causing acute wound breakdown

135
Q

what are he longer term post-op complications seen in hospital or at home?

A 
pain
haemorrhage
aspiration pneumonia
ileus
infection of wound or interference
issues with drains
136
Q

what are the major general complications seen post GI surgery?

A

dehiscence

peritonitis

137
Q

define dehiscence

A

disruption of wound edges (can refer to organ or tissue)

138
Q

when is dehiscence most commonly seen?

A

3-5 days post-op

139
Q

why is dehiscence seen most often at 3-5 days post op?

A

this is the end of the lag phase of healing

140
Q

where are the likely areas of dehiscence following GI surgery?

A

skin
abdominal wall
intestines

141
Q

when is skin / cutaneous dehiscence seen?

A

immediately post op if trauma occurs (self or accidental) or could be several weeks later

142
Q

what is the most likely time for skin / cutaneous dehiscence?

A

4-5 days post op

143
Q

what are the clinical signs of skin / cutaneous dehiscence?

A

serosanguinous or prurulent discharge from suture line
swelling and bruising
necrosis of edges

144
Q

what happens during abdominal wall dehiscence?

A

dehiscence of abdominal muscles underneath a wound creating a hernia
overlaying skin will remain intact (especially in chronic cases) but deeper layers will have separated

145
Q

when is abdominal wall dehiscence seen?

A

usually within first 7 days post op but can be weeks - years after surgery

146
Q

what are the signs of abdominal wall dehiscence?

A

wound oedema or inflammation
serosanguinous drainage from incision
painless swelling (main sign)

147
Q

when will intestinal dehiscence be seen?

A

following enteric or colonic surgery

148
Q

what does dehiscence after enteric sutures lead to?

A

septic peritonitis

149
Q

when does intestinal dehiscence occur?

A

2-5 days post op

150
Q

what are the clinical signs of intestinal dehiscence?

A

signs of peritonitis - depression, anorexia, vomiting, abdominal pain or acute collapse

151
Q

what are the main risk factors for dehiscence?

A

surgical technique (tension on wound or poor suture choice)
self trauma
underlying neoplasia of area making tissue non-viable
closure of non-viable skin
systemic factors (comorbidities)

152
Q

what systemic factors may be risk factors for dehiscence?

A 
endocrine disease
obesity
cat's viral status (FIV/FeLV)
hypoproteinaemia
hypovolaemia
153
Q

how can dehiscence be prevented?

A

bandaging to immobilise areas of excessive motion
buster collar to prevent self trauma
confine and reduce exercise for 2 weeks

154
Q

what is peritonitis?

A

inflammation of the peritoneum

155
Q

in what animals does primary peritonitis mostly occur?

A

in cats (e.g. FIP)

156
Q

what is secondary peritonitis the result of?

A

another pathology

157
Q

what are the 2 types of secondary peritonitis?

A

aseptic

septic

158
Q

what is aseptic peritonitis caused by?

A

mild reaction to surgery in the abdominal cavity

sterile object left in patient (gossypiboma)

159
Q

what is the most common type of peritonitis seen in small animals?

A

septic peritonitis

160
Q

is there bacterial infection in aseptic peritonitis?

A

no

161
Q

what causes septic peritonitis?

A 
result of dehiscence
ischemic necrosis
leakage during surgery
insufficient lavage
infection through technique
gossypiboma
162
Q

what can GI surgeries often lead to contamination of the abdomen?

A

often emergencies so pre-op prep of the patient is not ideal and there ay be faecal matter/fluid/food present in the intestines which leads to contamination the abdomen

163
Q

how does peritonitis present?

A

vague history of anorexia, vomiting or lethargy, pyrexia or acute collapse (due to whole body sepsis)
may adopt prayer position (due to abdominal discomfort)

164
Q

when is the most likely time for peritonitis to present?

A

3-5 days post op (close observation needed)

165
Q

what are the main GI tract complications associated with the oesophagus?

A

movement due to swallowing and breathing may interfere with healing
regurgitation
oesophagitis (ulceration)
strictures

166
Q

what are oesophageal strictures?

A

abnormal narrowing that occurs within a tubular lumen (e.g. oesophagus)

167
Q

when does oesophageal stricture often occur?

A

post surgery due to damage the mucosa which scars as it heals

168
Q

what are the common complications specific to the stomach seen after GI surgery?

A 
vomiting
anorexia (both post and pre op)
ulceration
gastric outlet obstruction
pancreatitis
169
Q

why is vomiting common following gastric surgery?

A

increased sensitivity

170
Q

what may cause gastric outlet obstruction?

A

strictures at the pylorus (anything that prevents gastric emptying)

171
Q

why does pancreatitis often occur following gastric surgery?

A

pancreas doesn’t respond well to being handled

172
Q

what surgery is commonly performed to remove gastric foreign bodies?

A

gastrotomy

173
Q

what surgery is required for patients with GDV?

A

gastropexy

174
Q

what complications are seen following GDV surgery that mean that ECG is needed?

A

arrhythmias due to re-perfusion of gastric tissues which may be filled with toxins once stomach is untwisted

175
Q

what complications are associated with the small intestine post op?

A 
excessive handling or rough technique leading to serosal and peritoneal adhesions
ileus
stenosis
intestinal strictures 
diarrhoea
anorexia due to nausea
176
Q

what is stenosis?

A

constriction of the lumen

177
Q

what are serosal or peritoneal adhesions?

A

formation of scar tissue between different tissues due to injury from surgery and following inflammation

178
Q

what are the common SI surgeries in first opinion practice?

A

enterotomy for FB

enterectomy following FB or intussusception

179
Q

what are the common complications with LI surgery?

A 
hemorrhage and faecal contamination during surgery (most common)
leakage
stenosis
stricture
incontinence (rare)
180
Q

what are the common complications of perineal, anal or rectal surgery?

A 
tenesmus
rectal prolapse
temporary or permanent incontinence
anal stricture
urethral obstruction
stenosis
181
Q

what are the common rectal surgeries?

A

anal sacculectomy

182
Q

what is an anal sacculectomy?

A

removal of one or both of the anal sacs

183
Q

why may a patient need an anal sacculectomy?

A

consistent anal gland impaction or infections

184
Q

what complications must owners be warned about before their dog under goes anal sacculectomy?

A

post-op complications that may be due to nerve damage or muscle resection

185
Q

what is developed in 20-32% of dogs in the 2 weeks following anal sacculectomy?

A

minor complications such as seroma (filling of surgical site)

186
Q

what is developed in 2% of dogs in the 2 weeks following anal sacculectomy?

A

permanent faecal incontinence or weak anal tone

187
Q

what must the patient be monitored for in the post op period following anal sacculectomy?

A

dehiscence as this can lead to septic peritonitis

188
Q

why are nursing care plans in the post op period so crucial?

A

many post op complications can be minimised by taking measures pre and peri operatively
consider plan when preparing equipment, and theatre (e.g warmed fluids)

189
Q

what must post op care plans be tailored to?

A

the patient - including surgery, pre-op status, temperament

190
Q

how much observation is required for the GI patient post-op?

A

3-5 days of careful monitoring

191
Q

where may post op GI monitoring take place?

A

hospital with TPR/bloods

at home following thorough owner discharge

192
Q

what are the key signs that must be monitored for in the GI post op patient?

A 
depression
pyrexia
abdominal tenderness
vomiting
anorexia
wound issues
193
Q

what are the aims of a GI post op care plan?

A 
restore hydration and maintain electrolyte balance
resume normal feeding and gut motility
manage GI effects (e.g. nausea)
manage pain
prevent infection
194
Q

how should hydration be managed in the post-op GI patient?

A

most patients need IVFT until are eating and drinking normally

195
Q

when is IVFT especially important in the post-op GI patient?

A

if biochemical or electrolyte abnormalities present or there are ongoing fluid losses

196
Q

what must be monitored in regards to hydration in the post-op GI patient?

A

signs of hydration (MM, skin tent)
overhydration (crackles on auscultation)
fluid input and output

197
Q

when are intestinal, rectal or anal patients encouraged to eat?

A

as soon as able after surgery to avoid ileus

198
Q

how should food and water be introduced to gastric and oesophageal patients?

A

water 2 hours post surgery

food attempted 12 hours later

199
Q

why does food need to be attempted later in oesophageal and gastric surgery patients?

A

due to vomiting risk

200
Q

what type of food should be fed to GI patients?

A

bland diet, high calorie

little and often

201
Q

what can encourage gut motility?

A

if patient is ambulatory

202
Q

what may the patient have placed if they are struggling to eat?

A

feeding tube - complications possible but wonderful for nutrition

203
Q

what animals are particularly reluctant to eat?

A

cats

204
Q

what is a common cause of anorexia in the post-op period?

A

nausea

205
Q

what are the signs of nausea?

A

salivation
repeated swallowing
lip-licking
turning away from food

206
Q

what is mariopitant used for (Cerinia, Prevomax)?

A

anti emetic

some abdominal pain relief

207
Q

what is metaclopromide used for (Vomend, Emiprid)?

A

anti-emetic and pro-kinetic

208
Q

what unlicensed drugs are often used to help with nausea?

A

ranitidine
sucralfate
omeprazole

209
Q

what is ranitidine used for?

A

H2 receptor blocker - prevents acid production

210
Q

what is Sucralfate?

A

cytoprotective agent

211
Q

what is omeprazole?

A

proton-pump inhibitor

212
Q

what other drugs may be useful to encourage eating?

A

prokinetic agents (metaclopromide) to manage ileus
probiotics or fibre products for diarrhoea (binding and increased gut flora)
appetite stimulants esp. in cats

213
Q

what is an example of an appetite stimulant?

A

mirtazapine

214
Q

are NSAIDs often used for post op GI pain?

A

not really - can cause GI ulceration and upset

case by case basis - once eating and drinking normally

215
Q

are opioids used to control post op pain in GI patients?

A

almost always used

216
Q

what is the issue for opioid use in GI patients?

A

may affect gut motility so will need to be weaned off and moved to alternative before going home

217
Q

what is the risk associated with codine for post op GI pain management?

A

can cause constipation

218
Q

what animals must not receive paracetamol?

A

cats

219
Q

what is the issue with tramadol?

A

may cause dysphoria in some animals

220
Q

what is the major issue with patients who are in pain?

A

won’t eat

221
Q

when are antibiotics most often given if needed in GI patients?

A

peri-operatively

222
Q

when must antibiotics for the GI patient be discontinued?

A

6-12 hours post op unless contaminated surgery or systemic illness

223
Q

what antibiotic is often used in GI patients?

A 
broad spectrum (anaerobes, gram +/-)
e.g. amoxy-clavulanic acid
224
Q

what is the key part of managing infection in the GI patient?

A

aseptic technique, preparation and management

225
Q

what are the 2 key areas that can reduce the risk of surgical complications?

A

surgical technique

post-op management

X Clinical Veterinary Nursing Theory (70 decks)

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