Surgical Nursing of Exotics Flashcards
(156 cards)
1
Q
why is the pre-op assessment of small mammals so important?
A
as they hide signs of illness well and so an exam will highlight any potential complications
2
Q
what is involved in small mammals pre-op check?
A
check respiratory system and CVS
record accurate weight
pre-anaesthetic bloods
3
Q
why are pre-anaesthetic bloods not always performed in exotic species?
A
anaesthesia may be required to take the samples which defeats the object
4
Q
how can you prepare for small animal surgery?
A
pre-empt any problems
clipping of surgical site
5
Q
what problems must you pre-empt before anaesthetising your exotic patient?
A
blood loss - place catheter, prepare fluids
heat loss - hot hands and heat pads
apnoea - pre-oxygentaion
6
Q
what method can be used to give fluids pre-operatively in exotics?
A
SC bolus
7
Q
what area should be clipped for exotic surgery?
A
smallest area possible to reduce heat loss - damp down edges of fur around site
8
Q
what must be avoided when prepping the patients skin?
A
alcohol as it will cool the patients body
9
Q
how can heat loss be prevented under GA?
A
bubble wrap bear hugger silver foil heat mat take care not to overheat (heat stroke is a risk)
10
Q
what exotic small mammals are often intubated?
A
rabbits and ferrets
11
Q
how can rabbits and ferrets be intubated?
A
visualise larynx using otoscope or use urinary catheter
12
Q
how can you monitor small mammals under GA?
A
direct monitoring of heart and respiration
pulse ox
capnography
rectal thermometer
13
Q
how can HR be monitored?
A
clip patch over heart and use doppler
14
Q
in what animals is capnography especially useful?
A
tubed rabbits
15
Q
how should small mammals be positioned for surgery?
A
raise chest to reduce the pressure of abdominal contents on lungs
16
Q
what may be used to support small mammal ventilation?
A
mechanical ventilator
17
Q
what are the main potential post-op complications for exotic small mammals?
A
haemorrhage hypothermia pain hypoglycaemia gut stasis
18
Q
how can post-op haemorrhage in exotic small mammals be monitored for and prevented?
A
monitor HR, MM and pulse quality for signs of shock
maintain IV access in case it is needed
monitor wounds for haemorrhage
try to ensure minimal haemorrhage during surgery
19
Q
how can hypothermia be prevented post op in exotic patients?
A
maintain temperature in an incubator or on a heat pad as animal recovers
monitor rectal temperature
20
Q
how can hyperthermia of exotic patients be prevented in the post op period?
A
transfur to cooler environment once temperature of the patient is normal to prevent over heating
21
Q
how can pain be prevented post op in exotic patients?
A
give adequate pain relief and place local blocks during srugery
22
Q
what drugs may be given for post-op pain relief in exotic small mammals?
A
opioids
NSAIDs
23
Q
how can hypoglycaemia be prevented post op in exotic patients?
A
encourage to eat, if not responding check blood glucose
24
Q
how can gut stasis be prevented post op in exotic small mammal patients?
A
encourage to eat as soon as possible syringe feed if not tempted by high value foods offered prokinetics analgesia monitor for droppings
25
how long following surgery may it take for small exotic mammals to pass droppings?
up to 24hrs
26
what are the key things to remember during the post-op recovery period for exotic small mammals?
keep warm on recovery
move to a cooler environment once recovered to prevent heat stroke
analgesia at appropriate doses is very important (higher than dogs and cats)
27
how does surgery on exotics differ from that done on cats and dogs?
most can be extrapolated from cats and dogs
fine instruments may be used to make surgery easier
magnification can be used
good haemostasis is even more crucial
28
what magnification equipment may be used in exotic surgery?
loops
| operating microscope
29
what equipment can be used to ensure good haemostasis in exotic surgery?
electro-cautery
| radiosurgery
30
what are the best suture materials for exotics?
synthetic monofilament absorbable materials
31
give 2 examples of suture that is commonly used for exotics
Monocryl
| Caprosyn
32
what suture material should be avoided in exotics?
catgut
33
why should catgut suture be avoided in exotics?
generates a pyo-hgranulomatous reaction as is dissolves which increases adhesions
34
what technique of skin sutures should be used for exotics?
buried - prevents chewing out
35
what may be used to secure skin wounds alongside sutures in exotics?
tissue glue
36
what makes wound dressing difficult in small exotic mammals?
difficulty keeping dressings in place and thin nature of skin in small mammals
37
what are the main aspects of wound care in small exotic mammals?
surgical closure with buried sutures and tissue glue is preferable
buster collars are useful if tolerated
clean dry bedding (e.g. incosheet or vet bed) is best and avoid hay or straw initially
38
in what species is radiography useful?
rabbits and ferrets
39
what may make interpretation of some radiographs in some small mammal species difficult?
small size
40
what types of radiographs are best for small mammals?
digital
41
why are digital radiographs best for small mammals?
they may be enlarged and manipulated to highlight changes
42
how many imaging views are needed when imaging small exotic mammals?
at least 2
43
what may affect radiographic contrast in the abdomen of some mammals?
presence of large amounts of fat
44
what makes ultrasound difficult in some rodents?
small size
45
what can ultrasound be used for in exotic small mammals?
imaging the bladder or looking at a mass
46
what is the issue with ultrasound in rabbits and guinea pigs?
gas within the bowel may limit the views available
47
what can be assessed by ultrasound in rabbits and guinea pigs?
GI motility
presence of free fluid
masses
48
what is CT used for in exotic small mammals?
teeth and jaws especially
49
how must small exotic mammals be restrained for CT?
GA or sedation
50
what are the common surgical procedures seen in exotic small animals?
```
neutering (spay, castration or vasectomy in ferrets)
lump / abscess removal
dentistry
GI obstruction
enucleation
liver lobe torsion
```
51
what is key about castration in guinea pigs and rats?
vaginal tunic must be closed to prevent a hernia
52
during a ferret vasectomy how is the ductus defrens prevented from regrowing?
a section is removed rather than just cutting it and leaving it
53
what can make spaying more difficult in small exotic mammals?
broad ligament is fatty and so removal is difficult
rabbits have friable tissue that is easily torn
ferrets have corkscrew shaped uteruses and these can be hard to remove
54
what surgical procedure is common in rabbits?
lump / abscess removal
55
how is abscess removal performed in rabbits?
if in the jaw - cut around, leave and open crater. Anaerobic bacteria are unable to survive
anywhere else - complete removal
56
how may GI obstructions be surgically removed in small exotic mammals?
milk through to LI and allow to pass naturally if moveable
| eneterotomy/ectomy if tissue is damaged or object will not pass through
57
what condition can make spaying of exotic mammals more easy?
pyometra as uterus is enlarged and so easier to visulaise
58
from what aspect should cystotomy be performed?
least vascular aspect
59
why must care be taken if performing enucleation in rabbits?
blood sinus located behind eye
60
what can occur as a result of liver lobe torsion?
necrosis
61
in what small exotic animals are dental problems common?
hystricomorph rodents (e.g. guinea pigs, chinchillas and degus) and rabbits
62
what teeth problems may other (non-hystricomorph) rodents get?
incisors
63
what is the key factor which contributes to molar and incisor and malocclusion?
diet
64
how can diet cause molar and incisor malocclusion?
inadequate grass / hay means that teeth wear differently and overgrow with sharp edges formed
not enough fibre can lead to differnet chewing action
calcium in the diet may also affect bone quality and teeth formation
65
what can have and effect on teeth due to overcrowding?
breeding leading to smaller heads
66
what are the signs of dental issues found on clinical exam?
weight loss
ptyalism
swellings on ventral boarder of mandible
67
what is ptyalism?
dribbling of saliva
68
what equipment can be used to examine small mammals teeth?
otoscope
69
what is used to assess rodents teeth and roots?
good radiogrpahs
70
can malocclusion be cured?
no - can be managed with correction of diet to help
71
what is needed to access the molar teeth of rodents?
appropriate dental gag
72
how can spurs and tooth overgrowth be treated in small mammals?
spurs removed and crown height reduced
73
what equipment is used to remove tooth spurs and reduce crown height?
molar burr with guard
74
what can be used to reshape incisors?
dental burr or cutting disc
75
what should not be used to cut incisors?
nail clippers
76
can incisors be removed?
yes but is complex
77
what dietary corrections may aid dental issues?
increased fibre
| reduced carbohydrates
78
what should be performed on exotics before anaesthesia?
thorough clinical exam and faecal and blood screens
79
why is a through clinical exam of reptiles necessary before anaesthesia?
they effectively hide any signs of illness
80
what is required to maintain a reptiles body temperature before and after the procedure?
facilities such as a vivarium which will maintain the correct POTZ
81
is fasting needed before a reptiles operation?
no but maybe avoid feeding animals on the day of the procedure (reptiles only usually fed weekly or less)
82
why do reptiles require respiratory support under GA?
they breathe via skeletal muscle movement as they have no diaphragm
83
how may a reptiles respiration be supported under GA?
IPPV
| ventilator (e.g. vetronics)
84
how many breaths per minute do most reptiles need?
~4
85
why is monitoring of reptiles under anaesthetic difficult?
at surgical depths few, if any reflexes are able to be monitored and respiration is usually controlled externally
86
how can heart rates be monitored in reptiles under GA?
doppler probe can be used
87
how fast are reptiles HR?
slow
88
when are capnographs useful in monitoring reptiles under anaesthesia?
particularly useful on recovery as animal will not breathe if over oxygenated
89
how are wound sites prepared for surgery in reptiles?
as for any surgery
90
what solution is used to prep the skin of reptiles before surgery?
chlorhexadine or iodine
91
why is alcohol not recommended to scrub reptiles skin before surgery?
it will lead to cooling and increase hypothermia risk
92
what can be used to allow visualisation of a reptile while still ensuring sterility?
clear plastic drapes which adhere to the scales up to the incision site
93
how should reptilian scales be prepped for surgery?
scrub solution allowed to soak into scales
| brush may be used to ensure scrubbed area is clean
94
what makes the positioning of reptiles for surgery so difficult?
varying shape of reptiles
95
what has had to happen to surgical techniques in some species of reptile?
altered due to the reptiles shape e.g. coelotomy performed in lateral on chameleons and iguanas ventrally
96
what can be used to position reptiles for surgery?
foam wedges and sand bags
97
what must be done to minimise pressure on the lungs of reptiles during surgery?
elevate chest and use assisted ventilation
98
what is breathing in reptiles stimulated by?
low O2 not high CO2 - unlike mammals
99
what is involved in post-op recovery of reptiles?
gradually reduce RR on ventilator to stimulate spontaneous breathing
use capnography
keep animal at POTZ to speed up recovery
100
what are the main areas of post-op care in reptiles?
wound management
| analgesia
101
what dressings can be used for wound management in reptiles?
opsite and primapore
| something absorbent
102
how should wounds be managed post op in reptiles?
clean wound regularly
| ensure enclosure is clean as ventral abdomen is often in contact with floor/bedding and faecal material
103
what analgesia is used for reptiles post op?
NSAIDs - meloxicam (metacam)
| opioids - butorphanol
104
where are surgical incisions made on reptiles?
between the scales to improve healing
105
where are incisions often made in snakes skin during surgery?
between 1st and 2nd row of small scales
106
what suture material are wounds closed with in reptiles?
monofilament
107
what suture pattern is used to close reptiles skin?
everting pattern such as horizontal mattress sutures
108
why are everting sutures needed to close reptiles skin?
prevents the natural inversion of skin below scales
109
when are sutures removed from reptiles?
after 4-6 weeks as healing is slower
110
why are removable sutures needed in reptiles?
absorbable material will eventually absorb but takes a very long time so skin sutures still need to be removed
111
what sutures are avoided in reptiles?
catgut and polyfilament sutures
112
why are polyfilament and catgut sutures to be avoided in reptiles?
create a lot of tissue reaction
113
what can be used alongside sutures to aid wound opposition in reptiles?
tissue glue
114
what is a coeliotomy?
entry into coelomic cavity
115
how is a coeliotomy performed in lizards?
ventral midline approach
116
what must be avoided when performing coeliotomy on lizards?
midline ventral abdominal vein
117
how can the midline ventral abdominal vein be avoided in lizards when performing coeliotomy surgery?
entering the abdomen caudal to the xiphoid and cranial to the umbilicus or cranial to the pubis and less than a fourth of the distance to the umbilicus
118
what happens if the midline ventral abdominal vein is damaged in lizards?
can be tied off without affecting the lizard
119
how should the coelomic cavity be closed in lizards?
close coelomic membranes if possible and then the skin
120
how can coeliotomy be performed in laterally compressed lizards?
right or left lateral approach just behind last rib extended along the curve of teh rib
121
how is the coelom entered in snakes?
between the ribs and the ventral musculature
122
how can the coelom of snakes be closed following surgery?
2 layer of muscle and skin
123
what must be assessed about the incision site before operating on snakes?
exactly where the incision needs to be made as it is not possible to access all snakes organs through one incision
124
how can the coelom be accessed in chelonia?
trapdoor in the plastron cut using an oscillating or circular saw
125
how are the wounds in the chelonia's plastron cut to ensure the shell can be replaced after surgery and not fall inwards?
with a 45 degree bevel
126
how is the plastron separated from underlying muscle attachments in chelonia?
scalpel handle or periosteal elevator
127
what must you be careful of when opening the plastron of chelonia?
not to damage the paired abdominal veins that run in the coelomic membrane
128
how is the trapdoor in the plastron replaced after surgery?
glued back in place
129
what is used to clean wounds in reptiles?
dilute iodine followed by wound fully rinsed
130
what dressings can be used on chelonia?
adhesive dressings such as primapore or opsite
131
what can be used to aid reptilian wound healing?
water based gels or hoeny
132
why is diagnostic imaging particularly useful in reptiles?
often difficult to palpate abdominal structures (especially tortoises)
133
do most exotic species require sedation for imaging?
no -their sedate nature makes imaging easier
134
what views are often used in reptile imaging?
dorso-ventral
horizontal beam lateral
horizontal beam cranio-caudal
135
why are vertical beam lateral images difficult in reptiles?
there is no diaphragm so little seperation between lungs and coelom
136
why does ultrasonography work well in reptiles?
absence of fur means good contact
137
what can improve ultrasound images in reptiles?
allowing gel to soak between the scales
138
how may amphibious species be scanned with ultrasound?
immerse probe and the animal in water
139
what is ultrasound good for imaging in reptiles?
heart
reproductive tract
GI
masses
140
what species of reptiles are best for CT?
chelonia
141
how long does CT imaging take?
15 seconds
142
what tissue is CT good for imaging?
soft tissue
143
what can be produced from CT images?
3D images
144
how should animals be restrained for CT/imaging?
within a box to keep safe and reduce movement
145
what are the most common surgical procedures in reptiles?
mass/abscess removal
ovariosalpingectomy
GI obstruction
hemipenile amputation
146
what is the issue with mass removal in reptiles?
skin cannot be closed so the wound remains open
147
why do abscesses have to be removed in reptiles?
they are solid so lancing and draining is not possible
148
what is removed during an ovariosalpingectomy?
ovary and shell gland
149
what is performed in lizards to remove reproductive organs?
ovarectomy
150
what incision is needed to perform ovariosalpingectomy / ovarectomy?
midline incision
151
what must you ensure has been removed when spaying reptiles?
all ovarian tissue to prevent regrowth
152
when does GI obstruction often occur in reptiles?
lizards eating bedding or stones
153
what surgery may be needed to correct GI obstruction?
enterotomy
| coliotomy
154
when does hemipenile amputation need to be performed?
if there is persistent prolapse
155
how is hemipenile amputation performed?
clamp and ligation
156
should wounds to scutes be closed with glue?
no - if unclean the wound will lead to abscess. Should be closed with tape
