Nursing Flashcards
(256 cards)
1
Q
Dehydration
A
Fluid lost slowly from extravascular compartment. Patient unable to keep up with ‘ins’ and ‘outs’.
Water loss equal from all compartments.
2
Q
Intravascular volume assessment
A
Heart rate Pulse quality CRT and mucous membranes colour Blood pressure Mentation Temp
3
Q
Extravascular volume assessment
A
Moistness of MM Skin turgor Weight Globe position Urine output
4
Q
What clinicopathological features will be affected by patients hydration status
A
PCV / Total solids
Urea and creatinine
Urine specific gravity
5
Q
Hypovolaemia fluid administration
A
Rapid fluid resuscitation
6
Q
Dehydration fluid recovery
A
Correct slowly
7
Q
What are fluids trying to achieve
A
Change in volume status
Change in content
Change in distribution
8
Q
Crystalloids
A
Solutions containing solutes
Solutes and water move freely between membranes
Distributed through all body compartments by 1hour
Cheap
Isotonic / Hypertonic / Hypotonic
9
Q
Isotonic crystalloids
A
Mostly used
Same tonicity as plasma
Treatment of hypovolaemia and dehydration
Replacement fluids
Mimic intravascular electrolyte conc (high sodium and low potassium)
0.9% NaCl and Hartmanns
10
Q
Hypertonic crystalloids
A
More common in large animals
Tonicity larger than plasma
Prolongs intravascular volume expansion
11
Q
Hypotonic crystalloids
A
Very rarely used Tonicity lower than plasma 0.18% saline and 4% glucose Glucose metabolised Monitor fir electrolyte disturbances
12
Q
What co morbidities need to be considered when prescribing fluid therapy
A
Cardiac disease and heart failure Renal disease Respiratory disease Those that can balance ins and outs as suffer from volume overload Be more cautious
13
Q
Signs of volume overload
A
Pulmonary Odense
Venous engorgment
Peripheral Odema formation
Cagily effusions
14
Q
Per os
A
Fluid by mouth
Absorption in intestinal tract, relatively slow and body can be selective
15
Q
Subcut fluids
A
Injected under skin
Slowly absorbed into regional capillaries and distributed equally beteeen fluid compartments
16
Q
IV fluids
A
Into intravascular compartment
17
Q
Central venous access fluids
A
Common in large animals
Catheters directly into larger vessels usually jugular vein
18
Q
Intra Osseus fluids
A
Into medullary cavity of long bone. This is highly vascularised so rapidly absorbed.
19
Q
Pain
A
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
How patient interprets nociception
20
Q
Nociception
A
The neural process of encoding noxious stimuli
21
Q
Nociceptive pain
A
Pain that arises from actual or threatened damage to non neural tissue and is due to the activation of nociceptors.
22
Q
Neuropathic pain
A
Pain caused by a lesion or disease of the somatosensory nervous system
Harder to treat
23
Q
Hyperalgesia
A
Increased pain from a stimulus that normally provokes pain
Reduced pain threshold
24
Q
Allodynia
A
Pain due to stimulus that doesn’t normally provoke pain
25
Acute pain
Short period of time
Miniutes / hours / weeks
Can be protective at first
Can be one chronic if not treated
26
Chronic pain
Pain that lasts longer than a few weeks
27
Physiological signs associated with pain
Increased heart rate blood pressure abs temp
Altered resp
Stress hormones
28
NRS
VAS
SDS
CSOM
Numerical rating scale
Visual analogue scale
Simple descriptive Scale
Client specific outcome measures
29
Pharmacokinetics
What the body does to the drug
30
Pharmacodynamics
What the drug does to the body
31
What are the targets for drug action
Receptors
Enzymes
Transporters
Ion channels
32
Full agonist
Able to generate a maximal response after binding to receptor
High affinity and high intrinsic activity
33
Affinity
How well drug binds ti receptor
34
Intrinsic activity / efficacy
Magnitude of effect once bound
35
Partial agonist
Drug that has an intrinsic activity of less than 1
| Receptor occupancy produces submaximal effect
36
Inverse agonist
Drug binds and has opposite effec to agonist
37
Antagonist
Exhibits affinity but no intrinsic activity
38
Therapeutic index
Maximum non toxic dose / minimum effective dose
39
ADME
Absorption
Distribution
Metabolism
Excretion
40
Bioavailability
The fraction of a dose reaching the systemic circulation after administration compared to the dose administer iv
41
Factors determining drug distribution
```
Protien binding
Tissue binding
Organ blood flow
Membrane permeability
Brig solubility
```
42
Preventive analgesia
Administration of analgesia before during and after procedure to prevent in regulation of the nervous system. Should reduce intensity and duration of acute pain and reduce chronic pain.
43
Multi modal analgesia
Uses different classes of analgesic agents to overcome pain. More effective abs often can use lower doses.
Lower doses = less side effects.
44
Types of analgesic agents
Opioids
NSAIDs
LA
45
NSAID
Non steroidal anti inflammatory drug
46
Opioids
Controlled drug.
Act at the endogenous opioid receptors primarily in brain and spinal cord.
Usually administered IV ( not pethidine)
Some administered buccally.
Side effects - resp depression sedation bradycardia nausea decrease in GI motility
47
NSAIDs
Prostaglandins are an inflammatory mediator.
Metabolised in liver.
Can’t use two of these at once.
Side effects - GI ulceration renal ischhemia
48
Local anaesthetics
Enter nerve fibres abs block the voltage operated Na+ channel. This blocks nerve conduction.
Metabolism depends on if it’s an ester or amide.
49
Epidural
Anaesthetic injected into epidural space via catheter
50
Spinal anaesthesia
Aesthetic is injected directly into cerebrospinal fluid with small needle.
51
Baricity
Is the weight of one substance compared with the weight of an equal volume of another substance.
Glucose can be added to make solutions heavier.
52
Addition of vasconstructors
Reduces speed of systemic absorption abs therefore prolong duration of action.
53
General anaesthesia
State of unconsciousness produced by anaesthetic agents. No pain across body.
54
Regional anaesthetic
Insensibility caused by interruption of sensory in region
55
Local anaesthetic
Lack of sensation in localised part if body.
56
Sedation
Allaying if irritability or excitement
57
Anxidysis
Reduces anxiety
58
Analgesia
Reduced sensibility to pain
59
Narcosis
Sleep like state
60
Hypnosis
Artificially induced state of passivity
61
What is premedication
A drug combination given prior to induction of GA.
Calms patient and aids restraint.
Provides preemptive analgesia.
Allows reduction of induction drugs and maintenance drugs. MAC sparing.
Helps smooth induction and recovery.
62
Preoperative phase
```
Owner conversation and informed consent.
Full history.
ASA classification.
Getting ready.
Set up machine / equipment.
Prep drugs / IV catheter.
Premed.
```
63
Induction phase
```
Takes patient from conscious to anaesthetised.
IV catheter.
Pre oxygenation.
Premed IM.
Admin of induction agent.
Securing of airway.
```
64
Order of admission phases
Preoperative
Induction
Maintenance
Recovery
65
Maintenance phase
Maintain anaesthesia.
Placement of local or regional blocks.
Surgery / diagnostic procedure.
66
Recovery phase
Cessation of gas.
Remove airway device.
Recovery area.
67
Anaesthetic triad
Analgesia
| Narcosis. Muscle relaxation
68
Reasons for anaesthesia
Facilitate surgery etc
Prevention of pain
Research
Immobility
69
The CEPSAF inquiry
Overal risk of an animal not waking from sedation
70
Brachycephalic problems
Airways GOR ocular skin skeletal
71
What drug can boxers not have
ACP - Acepromazine
72
MDR1
Collies sheepdog shepherd.
| Can’t remove drugs and toxins from brain when this gene is present
73
Greyhounds problem
Lack of body fat = slow recovery and keep warm.
P4SO clearance mechanism.
74
Doberman problems
Dialysed cardiomyopathy can be asymptomatic
| Von willerbrand factor - BMBT , blood clotting issues
75
The female dog of what breed is effected with sick sinus syndrome
Mini Schnauzer
76
Preventative analgesia
Prevent unregulation of nervous system in the face of noxious stimuli.
Should reduce intensity and duration of acute pain and reduce chronic pain.
77
Muti modal analgesia
Use several agents abs techniques to be effective.
| This means lower dose which is less side effects.
78
Analgesic agents in practice
```
Opioids
Non steroidal anti inflammatory drugs
Local anaesthetics
Alpha-2 agonists
Ketamine
```
79
NSAIDs
Non steroidal anti inflammatory drugs
80
Alpha -2 agonists
Sedatives that are analgesic
81
Ketamine
Anaesthetic that is analgesic
82
Opioids factoids
```
Controlled drugs in UK
Schedule 2
Act at the endogenous opioid receptors
Can be IV
Well absorbed orally subcut im
Can cause resp depression sedation bradycardia nausea
```
83
NSAIDs
Prostaglandins are inflammatory mediators.
Metabolised in liver. Effective for acute abs chronic pain.
Can’t use two non steroidal as a multi modal anaesthetic regimen.
Can cause GI ulceration renal ischaemia.
GI side effects very common - vomiting diarrhoea.
84
Local anaesthetics
Enter nerve fibre and block voltage operated Na+ channel which blocks nerve conduction.
Membrane stabilising effect.
Can be esters or amides.
85
What analgesic is toxic to cats
Paracetamol
86
Tramadol
Centrally acting analgesic
| More evidence in dogs than cats
87
Metabolism of esters
Metabolised in plasma
| Hydrolysis if ester link
88
Metabolism if amides
Broken down in liver
89
Baricity
Weight of one substance compared to the weight of equal volume of another substance.
Glucose can be added to make solution heavier
90
Why would adrenaline be added to a solution
Added as a vasoconstrictor to local anaesthetics to reduce speed of systemic absorption and therefore prolong duration of action
91
Balanced anaesthesia
Premed
Induction
Maintenance
Recovery
92
Sedation factoids
Dose dependant up to plateau dose.
Improved by combination with opioid.
Improved when animal left in quiet environment.
93
Petechia
Blood clots in mouth or stomach
94
ASA classification
```
I normal healthy animal
II mild systemic disease
III systemic disease we’ll controlled by treatment
IV severe systemic disease
V unlikely to survive 24 hours
E emergency
```
95
Pre op fasting
Reduce volume of stomach contents
Prevent GOR regurgitation aspiration
Feeding a small canned food 3 hours pre op reduced incidence of GOR.
Prolonged starvation may actually caused an increased of GOR.
96
What is shock
An imbalance between oxygen delivery to the tissues and oxygen consumption by the tissues.
Cells respire anaerobicly = less oxygen = less energy = more lactate = acidic environment
97
Types of circulatory shock
Hypovolaemic
Cardiogenic
Obstructive
Distributive
98
Hypovolaemic shock
Resulting in decreased blood volume.
Result of fluid losses or decreased intake.
Usually due to haemorrhage
99
Cardiogenic shock
Reduced cardiac output.
| Heart failing as pump.
100
Obstructive shock
Due to physical obstructions in blood flow to or from the heart through the great vessels.
101
Distributive shock
Due to maldistribution of blood flow.
| Usually due to inappropriate or widespread vasodilation.
102
The minimum database
```
PCV
TS
Urea
Glucose
Lactate
Blood smear examination
```
103
Main electrolytes we check
Potassium
Sodium
Chloride
104
Potassium disturbance
Most common
Needs to be maintained in narrow range
Hyper or hypo kalaemia
105
Hyperkalaemia
Life threatening effects upon myocardial conduction.
| Managed with fluids and monitoring
106
Hypokalaemia
Less life threatening
| Managed with potassium supplementing
107
Sodium disturbance
Use fluids to correct both 24-48 hours
108
Chloride disturbance
Should be 1:1 ratio with sodium
109
Anion gap
Imbalance between anions and cations.
| Helps to narrow down list of differentials that may explain patient state
110
Acidaemia
Blood pH < 7.35
111
Alkalaemia
Blood pH > 7.45
112
Main types of acid / base disturbance
Metabolic acidosis
Metabolic alkalosis
Resp acidosis
Resp alkalosis
113
Metabolic acidosis
Loss of base from body / failure to excrete acid / accumulation of acid.
The body will try to increase pH back to normal. Does this by ‘blowing off’ Co2 - hyperventilating.
Patients will have low pH and PCO2
114
Metabolic alkalosis
Relative increase in hydrogen / loss of acid in body.
Body will attempt to lower pH. Does this not increasing Co2 hypoventulating.
Patient will have high pH and PCO2
115
Resp acidosis
Rise in blood Co2
To compensate the kidneys will retain more bicarbonate and excrete more hydrogen ions.
Patient will have low pH and high PCO2
116
Resp alkalosis
Fall in blood Co2. Caused by any disease / condition that results in hyperventilating.
Body attempts to lower pH. Kidneys increase bicarbonate elimination.
Patient has high pH and low PCO2
117
Sedation vs Premedication
Sedation - patient is sedated but not under GA (still conscious)
Premed - administered prior to GA
118
Problem with sedation for minor things
No control over airway
| No option of deepening sedation of it’s not working
119
When to use injectable anaesthetic agents
Induction of anaesthesia before administration of an inhalant agent.
Adjunct to inhalational anaesthesia.
Short term anaesthesia.
TIVA
120
Injectable anaesthetic agents
Propofol ( dogs abs cats)
Alfaxalone ( dogs cats pet rabbits)
Ketamine ( horses dogs cats)
Tiletamine / zolazepam ( dogs and cats)
121
Drugs for euthanasia
Pentobarbital - large number of species
122
Anaesthetic agents exert their effects on the brain so …
… they have to cross from thr systemic circulation through the blood brain barrier to the brain
123
Factors effecting the effects of drugs
```
Blood flow to brain
Amount of non ionised drug
Lipid solubility
Molecular size
Concentration gradient
Protien binding
Distribution
Metabolism
Excretion
```
124
Propofol
Highly plasma protien bound and lipid soluble
Post induction apnoea common
Hypotension myocardial depression and peripheral vasodilation
Pain on injection
Can be stored for 28 days after opening and can repierve the lid.
125
Anflaxalone
```
Steroid anaesthetic
Clear solution
High therapeutic index
20% plasma protien bound
Some resp depression
Preserved baroreceptor tone
```
126
Ketamine
Reflexes maintained
Sympathetic stimulation
Maintains CV and resp function
50% plasma protien bound
127
Tiletamine / Zolazepam
Repeated doseing = poor recovery
IM or IV
Recent MA in uk dogs cats but not rabbits
128
Thiopental
```
Powder mace up to 2.5/5%
Alkaline
Peru vascular tissue necrosis - make sure to secure IV access
Rapid onset
Highly plasma protien bound - 80%
Predictable
```
129
IV injectable anaesthetic
Propofol
| Alfaxalone
130
IM injectable anaesthetic
Sedation
| GA comb
131
Inhalant anaesthesia induction
Face mask
| Gas chamber
132
Injectables main points
IV - quickest 2-10 min, reliable, expected efficacy, less stres for animal, relies on catheter placement.
IM - fairly quick 10-20 min, reliable but can be painful and slower.
SC - easy to administer, less painful than IM but can cause pain, 30-40 min, lower efficacy.
133
Airway management
Mask
Laryngeal mask
Supraglottic device V gel
Endotracheal tube ETT
134
Low volume / high pressure
| High volume / low pressure
Circle vs rectangle cuffs put different pressure on airway
135
What is the Murphy eye
Safety feature of ET tubes incsse if blockages
136
Placing a tube
```
Visualise
Positioning
Secure tube
Inflate cuff
Confirmation of correct placement
```
137
Providing oxygen when under GA
Cylinder
| Pipeline
138
What oxygen cylinders should be stored vertically
FGJ
139
What oxygen cylinders should be stored horizontally
CDE
140
What is the cylinder yolk
Supports cylinder and provides gas tight seal.
| Prevents wrong attachments.
141
What is the pin index
Yoke on the machine had 2 protruding parts which are aligned with the 2 holes in corresponding gas cylinder
142
Piped gas is supplied from a main source and feeds into colour coded pipes which are corresponded to schrader sockets. What are the colours?
Oxygen white
Nitrous blue
Medical air black with white collar
143
What does the pressure regulator on the anaesthetic machine do
Regulates gas from cylinder to anaesthetic machine because pressure needs to be reduced to prevent damage. Also smooths any fluctuations of gas.
144
Safety features of anaesthetic machine
O2 failure alarm - sound or light. Should cut out delivery of nitrous oxide.
Nitrous oxide cut off- it’s dependent on oxygen pressure as can’t be administered alive. Prevents hypoxic mixture being delivered.
Hypoxic guard - not in all machines, makes sure oxygen is sufficient before releasing nitrous.
Flow meter - gas specific, flow control valve , tapered transparent tube , bobbin or ball to read.
Vaporisers - contains volatile liquid anaesthif agent.
Scavenging - removal of environmental contaminants.
Oxygen exposure - takes in air and purifies it
145
Active vs passive scavenging
Active - waste gases and anaesthetic agents are drawn outside the building by a fan and vent system. Requires an air break.
Passive scavenging - not suitable for nitrous oxide. Gas is pushed by patients resp efforts.
146
Dead space
Volume of gas that does not eliminate carbon dioxide
147
Tidal volume
Volume of gas entering the king with each inspiration
148
Minute volume
Volume of gas entering the lungs in each minute
149
Metabolic oxygen requirements
Amount of oxygen required each minute for metabolic processes
150
Rebreathing
Occurs when the inspired gases reaching alveoli contain more carbon dioxide than can be accounted for by more reinhalation from the patients dead soacs
151
Rebreathing vs non rebreathing system
Rebreathing - soda lime removes carbon Dioxide
Non rebreathing - t piece Bain and lack fresh gas flow removed expired co2
152
Fluid requirements
Extravascular deficit + maintenance + ongoing losses
153
SSI
Surgical site infection
154
Sterilisation
Heat - auto clave and dry heat
Cold - ethylene oxide, commercial solution and gamma radiation
155
Vacuums assisted autoclave
```
Steam penetration
Dries the load
Fully automatic
Packaging
Maintenance
```
156
Isofluarane used with
Cats and dogs primarily
157
Sevoflurane used primarily with
Dogs abs cats
158
MAC
Minimum alveolar concentration
159
What does MAC do
Conc required to prevent purposeful movement in response to a supramaximal noxious stimulus
160
Partial pressure
Pressure that gas exerts in a mixture of gases
161
Partition coefficient
Ratio of the concentration of a compound in two solvents at equilibrium
162
Balanced anaesthesia technique
```
Inhalant anaesthetics
Balanced anaesthesia
Anaesthetic triad
Monitoring
Supportive therapy
```
163
Stage 1
Time of induction ti unconsciousness. Pulse abs resp often elevated. Breath holding can occur.
164
Stage 2
From unconsciousness to rhythmic breathing. All crainial nerve reflexes present. Eye will soon rotate yo vebtromedial position
165
Stage 3 plane 1
Resp regular abs deep. Spontaneous limb movement is absent. Pinch reflex response. Nystagmus if present will slow abs disappear. Ventromedial eye.
Suitable for minor procedures.
166
Stage 3 plane 2
Eyelids partially separated. Palprebral reflex is sluggish or gone. Corneal reflex still. Muscles relaxed.
Adequate for most procedures
167
Stage 3 plane 3
Eyeball is central and eyelids begin to open. Pulpillary diameter increases. Abdominal muscles relax.
Good for all procedures
168
Stage 4
Overdose.
Characterised by progressive heart failure.
Pulse rapid or very slow. No oalprebral reflex.
169
Monitoring anaesthesia without equipment
```
Pulse palpitations.
Resp rate.
Eye position.
Temperature.
Mm and crt
Oesophageal stethoscope
```
170
What can hypothermia result in
CNS depression
Hypotension
Bradycardia
Decreased urine output
171
Reducing risk of hypothermia
```
Keep anaesthetic minimal
Minimise wetting fur
Maintain high ambient temp
Heat and moisture exchanges
Use correct breathing system
Warm fluids
Keep patient warm
```
172
Capnograph results
Carbon dioxide abs how it moves in the resp system
Ins and exp co2 abd resp rate show as numbers
Capnogrwoh shows as wave form
173
Side stream capnography
Endotracheal tube and connector. Breathing system. Adapter abs sample line.
Patient has fresh gas going into the lungs, this takes sample for machine tk analyse.
Cheap. Harder to break. Easy to replace.
Almost real tome. Sample line easily damaged. Must be changed regularly.
174
Mainstream capnography
No sample line. One fret connector. Light source and connector - where analysis happens.
Real time results. No need for sample line.
Expensive. Damaged easily. Adds drag to system.
175
Oxyhaemoglobin dissociation curve
Sigmoid curve shows relationship between arterial partial pressure of oxygen PaCo2 and the % of haemoglobin saturation (SPo2)
176
Difference between oxyhaemoglobin and de oxyhaemoglobin
Saturated with oxygen vs not carrying oxygen.
177
Where to place pulse ox probe
Tongue interdigital ear preoucd etc
178
Blood pressure
Indirect indicator of blood flow
| Measurement of pressure on walls of blood vessels by blood
179
Direct / indirect blood pressure
Non invasive = Doppler / oscillometric
| Invasive = placement of arterial line
180
What should the cuff width be
40% of limb circumference
181
Stages of removing tube
```
Loosen / untie
Depends on situation (species)
Deflate cuff a minute before extubation
- dogs and rabbits remove when signs of laryngeal reflex
- cats extubate when ear or eye reflex
- brachy can leave
Remove tube smoothly
Late extubstion depending on situation
```
182
Hypothermic
```
Bradycardia
Cardiac arrhythmia
Impaired coagulation and sound healing
Decreased oxygen delivery to tissues
Shivering increases oxygen requirements
```
183
Hyperthermia
Decreased heat loss
Excessive external heat
Increase metabolic production of heat.
Increased oxygen requirement
184
ECG
Not diagnostic
| Looking for normal / reporting abnormal
185
When would you investigate SpO2
When at 95%. Ideally should be higher. Worry at 90%
186
Volatile anaesthetic
A liquid that at room temperature changes fo a vapour that’s can be inhaled for GA
187
Isoflurane
```
MAC 1.4-1.6
Irritant to mucous membranes
Causes peripheral vasodilation
No analgesia
Dogs abs cats
```
188
Sevoflurane
```
Dogs and cats
MAC 2 .1-2.6
Low blood solubility
Non irritant to mm
Poor analgesic
```
189
Nitrous
```
Administered as gas
MAC >100%
Supplement to analgesia
Rapid uptake and elimination
Insoluble
```
190
Azotemia
Elevation of urea +/- creatinine in blood stream
191
Uraemia
Clinical signs associated with azotemia
192
Pre renal, renal or post renal azotemia
Pre renal - inadequate renal perfusion
Renal azotemia - reduced functional mass of the kidneys due to underlying kidney disease
Post renal - kidneys are functional but waste products are not excreted.
193
Acute vs chronic kidney injury
AKI - acute nephron damage / dysfunction. Affects worse as very abrupt over hours / days
CKD - chronic nephron loss. Gradual process.
194
Clinical findings of AKD
```
Lethargic
Depressed
Inappetant
Nauseas
Cardiac arrhythmias
```
195
CKD - functional vs structural
Functional - lab measurable
Structural - visually seen on scan
Management aimed at protecting remaining nephrons and managing clinical consequences
196
Historical and clinical findings of CKD
```
Subtle non specific
Pupd
Weight loss
Lethargy weakness
Inappetance
```
Typically dehydrated
Kidneys small and itrehular
Rubber Jaw
Reduced muscle condition
197
Incontinance
Congenital or aquired
| Most common in females due to anatomy but less so in cats
198
Urethral sphincter mechanism incontinence
USMI
Most managed with oestrogen
Can be treated surgically
Common after spaying
199
feline lower urinary tract disease
FLUTD
Secondary to some kind of bladder disease
Leads to urethral obstruction in some male cats.
If males suffer repeatedly it becomes surgical disease
200
Urethrotomy
Incision into urethra
| Last resort for stones that cannot be flushed back into bladder
201
Urethrostomy
Creation of new opening
Used as last resort for recurrent obstruction
Must be made upstream from diseased urethra
202
Prostatic disease
```
Prostate surrounds urethra of the male
Rare in cats
Dogs
- benign hyperplasia
- prostatis
- abscessstion
- cysts
- neoplasia
```
203
Benign prostatic hyperplasia
```
BPH
Caused dischezia/ dysuria
Seen in older entire males
Managed medically with anti androgens
Often castration is preferred as definitive treatment
```
204
Prostatitis
Bacterial infection often with BPH
Disease in entire males
Dysuria, pyrexia,
Antibiotics
205
Prostatic abscess
Usually with prostatitis in entire males
| Variable systemic signs
206
Prostatic cyst
Entire males
| Often associated with BPH
207
Prostatic neoplasia
Disease in elderly dogs
Usually very painful
More common in castrsted
208
CPCR
Cardiopulmonary cerebral resuscitation
209
Horses at lowest risk going under anaesthesia
Ages 2-7
210
Are surgical diseases more common in the upper or lower urinary tract
Lower
211
White blood cells =
Inflammation / infection
212
Renal neoplasia
Carcinomas are most common in dogs
Vague clinical signs, palpable abdominal mass, haematuria
Pulmonary metastasis is present in half of dogs and bilateral neoplasia is common. Surgery not indicated.
Lymphoma is most common renal tumour in cats. Chemotherapy.
213
Renal trauma
May follow RTA or bite injury.
| Uncontrolled haemorrhage may require nephrecotomy.
214
Renal stones
```
Renoliths
Aetiology similar to other uroliths
Often seen in animals with chronic kidney failure.
Surgery not recommended
Diet and antibiotic therapy.
```
215
Nephrotomy
Surgical incision into kidney
216
Nephrectomy
Surgical removal of kidney
217
Bladder stones
Struvite and urate uroliths can be medically dissolved. All others or those causing obstruction can be removed by cystomy.
Haematuria.
Frequency / urgency to urinate.
218
Bladder neoplasia
```
Not uncommon in elderly.
Haematuria
Frequency / urgency urinate
Malignant
Partial cystomy
```
219
Bladder trauma
Blunt abdominal trauma can cause rupture.
| Uroabdomen and post renal failure.
220
Why provide fluid therapy
Maintain hydration or perfusion
221
Lower urinary tract disease
LUTD
| Diseases of the bladder and urethra
222
Urolith
Urinary stone
| Macroscopic
223
Crystal
Microscopic mineral precipitate
| Can make up stone
224
Crystalluria
Crystals in urine
225
Whst type of urine is at less risk of Crystal and stone formation
Dilute
226
Nephroliths
Upper urinary
Kidney stones
Abdominal pain = anorexia inappetance lethargy haematuria
227
Urethroliths
Lower urinary
Urethral stones
Obstruction
Cystoliths signs
228
Can crystals predict stones present
No
229
Feline idiopathic cystitis
```
Young to middle aged
Overweight, inactive
Indoor litter tray users
Multi animal household
Nervous disposition
Dry diet
Stressors
Autumn winter
```
Manage with opioids, NSAIDs
230
Urethral sphincter mechanism incompetence
USMI
Larger breed spay bitches
Leak during recumbency
231
When and why do we castrate horses
```
Behaviour modification
Control breeding
Can turn out with mares
Medical reasons
6months - 2 tests when both tested are descended
```
232
What to check before horse castration
```
Age
Tetanus status
Weather it’s been used for breeding
Facilities at yard
Both testicles
```
233
Post op monitoring of open castration
Bleeding- drips okay for first 12 hours. Can’t count call asap. Pulsing / arterial requires immediate attention.
Sedation / analgesia.
Swelling expected but excessive contact.
Monitor
234
ACP clinical effects
Sedation and anxiolytic
| Not analgesic so combine with opioids
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Clinical effects of alpha 2 agonists
Sedation analgesia and muscle relaxation
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Clinical effects benzodiazepines
Minor tranquilisers, muscle relaxation, anticonvulsant
237
What electrolytes do we typically check
Potassium
Sodium
Chloride
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Sodium and clinical signs
It is the rate that the abnormalities develop opposed to the absolute value which determines the severity of the clinical signs.
239
How to prevent hypoxia
Give 5-10 mints of pure oxygen to counteract nitrous
240
What does Doppler measure
Systolic bp only
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What does oscillometric measure
Systolic diastolic abs mean
242
Systolic
Measure if force the heart exerts on the walls of arteries
243
Diastolic
Pressure in the arteries when the heart is between contractions
244
Acoustic impedance
Density of tissue X speed of sound in tissue
245
Speculate reflection
Beam hits large smooth surface
246
Non speculative reflection
Beam hits small structures
| ‘Texture’ to organs
247
Brightness of sound waves
Depends on amplitude of signal
248
Transducers
Electronic
| Either phased or linear arrays
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Difference between phased array and linear array
Phased - beam is stewed electronically
Linear - multiple elements, triggered in groups
Micro convex / convex - elements arranged in curve
250
Phased array / micro convex
Easy to manipulate
Small contact area
Wide field at depth
251
Linear
Large contact area
| Large view near skin - good for superficial structures
252
High frequency
Superficial structures in large animals
All structures in small animals
Good resolution
Can’t image deeper structures
253
Low frequency
Deeper structures
Larger animals
Poorer resolution
Can image deeper structures
254
Patent prep for untraslund
Starve overnight
Empty stomach preferable
Improves ability to examine organs
Cab safety sedate / GA if needed
255
Tissue appearance ultrasound
Fluid = anechoic / black
Fat = echogenic /white
Soft tissues = variable
256
What will Doppler ultrasound show
Direction of blood flow
Velocity of blood flow
Weather flow is laminar or turbulent
