T5: Getting the Patient Ready for Theatre Flashcards Preview

ASC183 Surgical Nursing > T5: Getting the Patient Ready for Theatre > Flashcards

Flashcards in T5: Getting the Patient Ready for Theatre Deck (31):
1

What are some procedures that may need to be performed to stabilise an animal?

  • Clearing the airway
  • Administration of oxygen via mask
  • Intubation -may require lignocaine gel or spray
  • Control of haemorrhage -apply direct pressure
  • IV fluids

2

What is the aim of pre-operative stabilisation?

to reduce the patient's anaesthetic risk so that their chances of surviving surgery are increased.

3

What is IPPV?

Intermittent Positive Pressure Ventilation

breaths performed manually by the nurse using the breathing bag or by a mechanical ventilator

4

Name some situations where the vet may require the veterinary nurse to assist with controlling the patient’s ventilation during anaesthesia

  • apnoea
  • hypoventilation
  • obesity
  • thoracotomy
  • muscle relaxant use
  • diaphragmatic hernia

5

What is hypoventilation?

  • abnormally low alveolar ventilation (i.e. the volume of gas delivered to the alveoli each minute is less than normal)
  • caused by a reduction in the tidal volume (size of breath) and/or a reduction in the respiratory rate.
  • Hypoventilation can lead to hypercapnia (an increase in expired carbon dioxide levels).

6

How may obesity cause breathing difficulties during anaesthesia?

  • Subcutaneous, intrathoracic and abdominal fat deposits may prevent adequate expansion of the chest and lungs

7

What type of ventilation is required during a thoracotomy?

  • PPV -ongoing ventilation, not intermitent
  • as the chest is opne, animal cannot breath for itself
  • mechanical ventilator often used

8

How may a diaphragmatic hernia interfere with a patients breathing during anaesthesia?

  • diaphragm contributes little to the expansion of the lungs and even very light anaesthesia may cause severe ventilatory depression
  •  

9

When using manual IPPV, what is the maximum breath size?

not greater than 20cm H2O

10

What is the normal ventilatory rate for:
Cats?
Dogs?

Adult horses?

Foals?

  • 15 breaths/min (cats)
  • 8 breaths/min (large dogs)
  • 4-6 breaths/min (adult horses)
  • 8-10 breaths/min (foals)

11

Describe how you would place an IV catheter

  • In either cephalic, jugular and  medial and lateral saphenous veins.
  • can be left for long periods of time (>72hrs) if properly maintained, and flushed w/ heparin saline every 4-6hrs.
  • Immobilsed and hold off vein
  • insert catheter w/ bevel up at 15degree angle
  • look for flash of blood, reduce angle of catheter to parallel w/ vein
  • advance, look for flash in chamber, advance fully
  • tape and plug

12

What is maintenance fluid rate?

2.5-3ml/kg/hr or 60ml/kg/day

13

For neonates or presence of massive tissue injury, fluids rates should be increased by a factor of...?

1.3

14

How quickly should a fluid deficit be replaced?

  • over 48 hours:

half in the first 6-8 hours

three quarters after 24 hours

and the remainder by 48 hours

15

Name the fluid used for routine fluid maintenance during surgery

Hartmann's

16

What characteristics should a canine blood donor have?

  • current vaccinations
  • tested negative for heartworm microfilaria
  • be receiving heartworm prophylaxis
  • not have received a blood transfusion
  • PCV greater than 35% immediately prior to blood collection

17

What characteristics should a feline blood donor have?

  • tested negative to feline leukaemia virus and feline immunodeficiency virus
  • be receiving heartworm prophylaxis.

18

The volume of blood collected from the donor on each occasion should be limited to:

  • 16ml/kg for greyhounds
  • 12ml/kg for other dog breeds
  • 10ml/kg for cats

19

Name the antcoagulant used in blood collection bags

Citrate Phosphate 2x Dextrose with Adenine (CP2D-A)

20

How may collected blood be stored?

  • be stored for four weeks at temperatures of 2-6°C.
  • Gentle agitation of the pack every day or so to mix the red cells, will optimise its condition.
  • Blood for patients with thrombocytopenia should be stored at about 20°C and administered within 6 hours
  • Refrigeration inactivates platelets.

21

Which canine blood type are universal blood recipients?

DEA 1.1

can receive a first transfusion of any type without developing a transfusion reaction

22

Clinical signs of a transfusion reaction include:

  • pyrexia
  • vomiting
  • salivation
  • trembling
  • elevated heart rate
  • urticaria (raised itchy areas of skin)
  • hypotension (leading to shock)

23

What does blood cross-matching involve?

  • separation and washing of red cells from the donor and recipient.

  • Donor cells are then mixed with the recipient’s plasma (“major cross-match”) and the recipient’s cells are mixed with the donor’s plasma (“minor cross match”).

  • Incompatibility is indicated by aggregation (clumping) of the red cells.

24

At what rate should you administer a blood transfusion?

  • initial rate of transfusion is slow (0.2 ml/kg/minute for 20 minutes) and the patient is observed for signs of a transfusion reaction.
  • A normovolaemic animal should not receive blood at a rate greater than 1.5 ml/kg/hour.

25

How may you transport a patient into the theatre?

  • manual carrying
  • trolley
  • stretcher
  • hydraulic winches
     

You may need to bring anaesthetic pump and fluids (clinic depending).

Be careful to:

  • not occlude breathing
  • not to contaminate surgical site
  • Keep animal warm

26

A patient should be positioned in surgery so that:

  • the surgeon has ample access to the surgical region
  • the patient is comfortable
  • swelling (oedema) of the feet does not occur because of constriction by ties
  • leg ties are not placed in front of a venipuncture - because of the danger of producing a haematoma.

27

What is dorsal recumbency?

animal placed on its back

28

What is ventral recumbency?

animal placed on its abdomen/thorax

29

What is lateral recumbency?

animal is placed on its side

30

Name some positioning equipement

  • sand bags
  • ties
  • v troughs

31

Explan the final clean of the surgical area before surgery

  • wash hands and gown/glove up
  • first solution applied is an alcohol-based antiseptic (strongly bactericidal) this is then removed with gauze swabs in an aseptic manner
  • final antiseptic to be applied is usually an iodophor or chlorhexidine solution (which is water based). These are not usually removed but left to dry on the skin