Term
| What are the major principles of perioperative patient care? |
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Definition
-obtaining an appropriate history
-performing a physical exam
-patient stabilization
-evaluating diagnostics
-nutritional supprot
-pain management
-postop management |
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Term
| What are the major components of a hhistory? |
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Definition
-concurrent/historical medical problems
-vaccine, HW, wellness history
-meds administered
-drug allergies
-other pets/envrionment
-diet
-exercise
-previous surgeries |
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Term
| What are the important parts of a physical exam? |
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Definition
-Hands-off evaluation first: lameness, neuro deficits
-Systemic evaluation: orthopedic, neurologic, avoid painful areas until last
-hydration status
-mentation/attitude
-BCS
-evaluate all body systems |
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Term
| What are the 5 ASA Statses? |
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Definition
-I. healthy
-II. localized disease, mild systemic disease
-III. severe systemic disease
-IV. severe systemic disease that is life-threatening
-V. moribund patient, will not survive without surgery |
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Term
| What are the major concerns with prognosis and surgicalr isks? |
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Definition
-expected outcome: quality of life and definition of success
-financial burden vs what is best for the dog
-complications
-length of recovery |
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Term
| How can the definition of a successful surgery change? |
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Definition
-primary repair vs salvage technique to restore function
-disease free interval vs cure with neoplasia
-owner expectations |
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Term
| How do we decide which diagnostic tests to perform? |
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Definition
| -signalment, presenting complaint, underlying disease |
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Term
| What is the hardest thing to know? |
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Definition
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Term
| What is the second hardest thing to know? |
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Definition
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Term
| What do we assess to determine the necessity for fluid therapy? |
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Definition
-hydration, fluid losses
-acid/base status and electrolytes
-blood glucose |
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Term
| What is the importance of coloid oncotic pressure? What causes it to be low? |
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Definition
-important for healing and recovery
-low with: decreased alvumin, vasculitis |
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Term
| When do we give crystalloid fluid therapy? What is the maintenance dose in a dog and cat? |
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Definition
-shock, dehydration, ongoing losses
-Maintenance: dog = 60 ml/kg/day & cat = 45 ml/kg/day |
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Term
| When do we give colloid fluid therapy? |
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Definition
| -shock, rapid volume expansion, maintenance of intravascular volume |
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Term
| When do we give blood products? Examples? |
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Definition
-anticipated or current need, replace volume loss, maintain hemostasis, provdie oxygen carrying capacity
-ex: packed RBCs, fresh whole blood, fresh frozen plasna, cryoprecipitate |
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Term
| What are the 4 ways by which we supplement oxygen? How do they differ in "dose"? |
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Definition
-Face mask: 3-5 L/min
-Flow-by: 3-5 L/min
-Oxygen cage: <10 L/min at 40%
-Nasal cannula: 1-2 |
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Term
| Why is SpO2 important? What is the desired value? |
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Definition
-it is the hemoglobin saturation with O2 and relates to PaO2 = oxygenation efficiency of the lungs
-desired value of > 95% |
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Term
| What are some potential causes of decreased SpO2? |
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Definition
-intrinsic resp dz
-neuro dz, especially localized to C6-T2
-pain
-acid-base abnormalities: blood gas evaluation
-bandages are too tight |
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Term
| What is the major major major arrhythmia we see secondary to trauma? |
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Definition
| -ventricular arrhythmia (VPC's) |
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Term
| What are some examples trauma that arrhythmias are commonly secondary to? |
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Definition
-splenectomy
-hypoxemia
-primary cardiac pahtology
-GDV
-hypoperfusion |
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Term
| How do we treat arrhythmias?> |
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Definition
-adequate perfusion
-pain control
-anti-arrhythmics |
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Term
| What do we use to monitor indirect VP? Direct? |
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Definition
-Indirect = Doppler or Cardell
-Direct = invasive arterial catheter |
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Term
| What does monitoring central enous pressure monitor? |
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Definition
| -monitors the heart's ability to handle fluid therapy |
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Term
| HOw do we monitor central venous pressure?r |
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Definition
| -place a central venous catheter at the right atrium |
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Term
| What does it mean when I say "Tailor protocol for pain management to the specific patient"? |
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Definition
-not every patient receives an opioi or an NSAID
-not every patient reeives the same opioid or NSAID |
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Term
| What is the major benefit of multimodal therapy? |
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Definition
| -allows for standard dosages to be deceased |
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Term
| What are the benefits of pre-emptive analgesia? |
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Definition
-prevents wind-up
-better pain control
-aids in recovery and wound healing |
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Term
| What are the signs of pain in a dog? |
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Definition
-vocalization
-anorexia
-aggression
-withdrawn
-panting
-increased HR
-chewing/licking
-abnormal posture |
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Term
| What are the signs of pain in a cat? |
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Definition
-anorexia
-aggression
-withdrawn
-reluctance to groom
-attitude change
-salivation
-abnormal posture |
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Term
| What are the physical methods of nursing care that relate to pain management? |
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Definition
-keep them clean, warm, dry
-padded
-turned frequently
-avoid clipper burns
-monitor bandages
-bladder management |
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Term
| What are the physical methods of physical therapy that help in pain management? |
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Definition
-massage, range of motion, stacking
-cold then warm packs
-hydrotherapy
-ultrasound
-laser |
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Term
| What are the anti-inflammatory NSAIDs that we use in pain management? |
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Definition
| -prostaglandins and leukotrienes |
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Term
| What are the contrindications for use of NSAIDs? |
|
Definition
-shock
-pre-existing renal or GI dz
-prior corticosteroid administration
-non-animal NSAIDs
-pregnancy |
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Term
| What are the side effects of NSAIDs? |
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Definition
-GI
-liver
-renal
-hypotension
-bleeding |
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Term
| What type of opioid do we most commonly use in surgery? |
|
Definition
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Term
| Whata re the kinds of local/regional analgesia that we use? |
|
Definition
-Lidocaine
-Bupivacaine
-Epidural
-Regional
-Intracavitary
-Incisional
-Others: anti-epileptic (gabapentin), NMDA Rc antagonist (ketamine, methadone), anti viral (amantadine) |
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Term
| How long do we usually restrict food before surgery? For peds? Why? |
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Definition
-12 hours
-4-6 horus
-minimize regurgitation, vomiting, dec GI microbial flra |
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Term
| What are the major conerns with obesity for surgery? |
|
Definition
-inc anesthetic risk
-inc complication risk
-delays elective surgeries |
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Term
| What are the surgical impacts of poor nutrition? |
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Definition
-delayed healing
-anesthetic risk, altered drug metabolism
-dec immmunocompetence
-increased infection risk
-anemia
-hypoproteinemia |
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Term
| What is the general rule of thumb for surgical nutrition? |
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Definition
| -oral nutrition (feeding) is best |
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Term
| What can we use to supplement oral feeding? |
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Definition
-Glutamine: AA for GI health
-appetitie stimulants: mirtazapine, diazepam
-calorie rich diet |
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Term
| How do we change feeding protocol if the patient has been anorexic, cacetctic for a long period? |
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Definition
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Term
| In which instances may difficulty eating be an issue? |
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Definition
| -oral surgery, upper airway surgery, megaesophagus |
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Term
| What are secondary complications due to feeding? |
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Definition
| -re-feeding syndrome, vomiting |
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Term
| We monitor temperature until what point? |
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Definition
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Term
| What does te ability to recover from hypothermia depend on? |
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Definition
| -age, BCS, length of anesthesia, severity of disease process, environment, other factors |
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Term
| How do we manage hypothermia? |
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Definition
-warm blankets, water blanket, Hot Dog, Bair hugger
-Caution: electric blanket, rice socks, immobile patient, direct placement on skin |
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Term
| What do we monitor incisions for? |
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Definition
| -purulent material, hyperalgesia, redness, swelling, dehiscence, self mutilatoin, inflammaiton |
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Term
| How do we use cold packs and warm packs to manage incisions? |
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Definition
-cold packs for first 3 days after surgery to dec pain and inflammmation
-add warm packs after first 3 days if swelling is still present |
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Term
| What are our major CNS neuro concerns? |
|
Definition
-mentation
-puil size, symmetry, position, rxn to liht
-reflexes
-sensation: ear, nose
-inability to use/move limbs
-worsening of preoperative neuro status
-seizue potential: intrinsic disease or post-myelogram contrast admin |
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Term
| How do we handle a case where the patient cannot urinate on own due to neuro disease or epidural? |
|
Definition
-manual expression q6-8 hours
-urinary catheterization: temporary vs indwelling |
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Term
| What are the consequences of not being able to urinate? |
|
Definition
-detrusor muscle damage/stretch
-cystits
-urinary tract infection |
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Term
| Why would we consider urinary catheterization for critical patients or patients that cannot move? |
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Definition
-keeps patient clean from urine scald
-allows monitoring of urine production |
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