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Surgical Nursing
Vet Tech Small Animal Surgical Nursing
| Question/Term | Answer/Definition |
|---|---|
| What is the intended use for Operating Scissors? | To cut inanimate objects (sutures, sponges, etc.) |
| What is the intended use for Mayo Scissors? | Used when cutting large muscle masses, cartilage or other non-delicate tissue |
| What is the intended use for Metzenbaum Scissors? | Delicate surgical dissection |
| What is the difference between the Crile and Kelly hemostatic forceps? | The horizontal serrations only extend half the length of the jaw on Kelly forceps vs. the entire length seen in Crile. |
| Describe Rochester-Pean Forceps: | Usually 8in length, horizontal serrations on entire length of rounded jaw, used to clamp large muscle/tissue masses or vessels. |
| How does the Olsen-Hegar differ from other needle holders? | It has scissors built into the jaw allowing for suture cutting without needing another instrument. |
| Which scalpel blades fit a No. 3 scalpel handle? | Blades numbered 10-15 |
| Which scalpel blades fit a No. 4 scalpel handle? | Blades numbered 20-23 (usually large animal surgery) |
| What is the intended use for DeBakey thumb tissue forceps? | Thoracic, vascular or neurologic procedures. Delicate tissue. |
| When is it most appropriate to use a Gelpi retractor? | Orthopedic or neurologic surgery. It is too traumatic for soft-tissue. |
| What is the Finochietto retractor used for? | Retraction of the thoracic wall. |
| What are Rongeurs used for? | Breaking up bits and pieces of bone for grafting purposes. |
| What is the intended use for a Balfour retractor? | Self-retaining retraction tool for abdominal procedures. |
| Which suction tip is best used for removal of large volumes of fluid? | Poole |
| An increased PCV may indicate: | Dehydration |
| What is the normal PCV in a canine? | 37 - 54% |
| What is the normal PCV in a feline? | 27 - 48% |
| A blood glucose reading of less than ____mg/dl indicates hypoglycemia in both dogs and cats. | 40mg/dl |
| A normal blood glucose range for Canines is between: ___ & ___mg/dl | 80 - 130mg/dl |
| A normal blood glucose range for Felines is between: | 70 - 180mg/dl |
| BUN levels are used to evaluate: | The kidney's ability to remove nitrogenous waste (urea) from the blood. |
| Define Prophylaxis: | The measures taken in the prevention of disease (antibiotic admin, sterile & aseptic technique, etc.) |
| What are the 5 determining factors for selecting a catheter? | Location, length of time needed, reason, diameter of vessel, length of vessel. |
| What does CVP monitoring assess? | How well blood pumps to and from the heart. |
| What 5 methods can help determine proper ET tube placement? | Coughing, fogging in tube, blowing of gauze or hair at end of tube, air movement, palpation |
| What is a Pulse Deficit? | When the heart beats but doesn't generate enough push to produce a palpable peripheral pulse. |
| Define Pulse Strength: | The ease or difficulty of palpating blood flow through the artery. |
| The normal ETCO2 levels for canines & felines is between: ____ & ___ mm Hg | 35 - 45mm Hg |
| Which drug class causes muscle rigidity? | Dissociative anesthetics |
| A blood pressure cuff should be what % of the width of the limb? | 30-50% |
| What does the term: "Surgical Conscience" mean? | Commitment of surgical personnel to strictly adhere to aseptic technique to prevent infection and thus harm to the patient. |
| What is "Strike-Through?" | When liquids soak through a drape from a sterile area to an unsterile area. |
| What is microbial shedding? | Occurs when microorganisms are released from the body of surgery personnel into the environment. (Sweat, hair follicles) |
| What are 5 desirable characteristics of a surgical scrub? | 1) FDA compliant, 2) Broad activity spectrum, 3) fast & effective, 4) non-irritating, 5) persistent effects & cumulative activity. |
| What does "Supination" mean? | Indicates the palm of the hand is facing upward or outward. |
| What does "Pronation" mean? | The rotation of the hand and forearm so the palm faces backward or downward. |
| What solutions are used to keep exposed tissues moist? | LRS or 0.9% Normal Saline |
| Approx. how many mls of Blood does a 3x3 and 4x4 sponge hold? | 6ml and 10ml respectively |
| Generally speaking, where should the edge of a surgical drape be placed on the patient? | 1/2 to 3/4 inch from the incision line |
| Where and why are Subcuticular suture patterns placed? | Just under the skin to eliminate need for skin sutures. |
| Where and why are Subcutaneous suture patterns placed? | In the subcutaneous layer to decrease dead space in a wound, but skin sutures will still be required. |
| Where and why are Lembert suture patterns placed? | Usually on a hollow organ (stomach, bladder, intestine) to create a fluid tight & relatively air-tight apposition. |
| What are the disadvantages of placing a simple interrupted suture pattern? | Time consuming and results in more foreign materials in the wound (sutures). |
| If pulled too tightly, which suture pattern can result in an everting pattern? | Horizontal mattress |
| If pulled too tightly, which suture pattern can result in an inverting pattern? | simple interrupted pattern |
| When are sutures generally removed? | 10-14 days postoperatively |
| What tools are used to remove sutures? | Suture removal scissors, thumb tissue forceps. |
| Explain the process to remove a skin suture that was done in a simple continuous pattern: | Using thumb tissue forceps, grab the free end of the suture and using the hook blade of suture removal scissors, cut the suture next to the knot. Cut every 3rd or 4th stitch and pull each out with the forceps. |
| How should the patient be positioned for an abdominal procedure? | Dorsal recumbency for a ventral mid-line approach. |
| How should skin be closed after a procedure? | With a simple interrupted or continuous suture pattern or with staples. |
| What does "Dehiscence" mean? | Separation of all layers of an incision or wound resulting from suture breakage, knot slippage/untying or by the animal chewing/scratching the site. |
| What does "Plication" mean? | Pleating or folding of the intestines sometimes caused by linear foreign bodies (ex: ingested string). |
| What is the primary reason to perform a Gastrotomy? | To remove a foreign body from the stomach. |
| What is a trichobezoar? | Hair ball |
| Why are Stay Sutures applied during a gastrotomy procedure? | To allow for manipulation of the stomach and prevent leakage of gastric fluid into the abdomen. |
| What is the primary reason to perform a Enterotomy? | To remove a foreign body from the intestines. |
| What are Doyen Clamps used for? | Clamping of the intestine on either side of the incision site to prevent contents from leaking into the abdomen during an enterotomy procedure. |
| What suture type is appropriate for closure of an intestinal incision? | Monofilament, taper-point suture in a simple, interrupted suture pattern. |
| What is ischemia? | An inadequate blood supply to an organ or area of the body. |
| Why is it necessary to wrap an anastomosis site with omentum? | It reduces the risk of leakage after end-to-end anastomoses. By adhering to the surgical site, omentum rapidly seals the incision, fills dead space, and provides an environment conducive to healing. |
| What does "Volvulus" refer to? | The rotation of an organ |
| What does GDV stand for? | Gastric Dilation and Volvulus |
| What are clinical signs of GDV? | Severe abdominal distention past the rib cage, restlessness, hypersalivation, abdominal pain, retching/dry-heaving, signs of shock. |
| What are the steps to correct GDV? | 1) Stabilization/reversal of shock 2) decompression of stomach gas 3) Surgery to re-position organs or permanently affix the stomach (gastropexy) |
| What does a Gastropexy accomplish? | Permanent affixation of the stomach to the body wall to prevent future occurrences of GDV. |
| What is a common complication in dogs post-GDV surgery? | Cardiac arrhythmias lasting 2-3 days post-op. |
| What is a bladder spoon used for? | To aid in retrieval of cystic calculi, especially if in neck of the bladder |
| What are Tenotomy scissors used for? | Dividing and dissecting the muscles and tendons of the eye. |
| What is Entropion? | The rolling inward of the eyelid(s). |
| What is the Holtz-Celsus Procedure? | Involves excision of a crescent-shaped section of skin and muscle from the affected portion of the eyelid showing entropion. |
| What does "coaptation" mean? | The application of an external cast or splint to immobilize a fracture. |
| The Ehmer sling is used for: | Pre and Post op support of a hip luxation |
| A Spica Splint is used for: | Pre and Post op support of humeral or femoral fractures |
| The Velpeau sling is used for: | Pre and Post op support of scapular fractures |
| How often should an orthopedic bandage be checked and what should you be checking for? | 3-4 times a day. Check for swelling, slippage, moisture or soiling |
| List some of the factors that can affect orthopedic healing time: | Age of the patient, whether active growth plates are present, proper confinement and restriction of activity, size and weight, too much force or pressure on repaired limb, owner compliance. |
| Describe Grade 1 of an Open Fracture: | Grade 1 = small puncture hole in skin. Bone broke through but no longer visible. Soft tissue damage minimal |
| Describe Grade 2 of an Open Fracture: | Grade 2 = large puncture or tear. Soft tissue damage associated with external trauma evident |
| Describe Grade 3 of an Open Fracture: | Grade 3 = large tears, loss of skin. Soft tissue damage extensive - usually from severe bone fragmentation or force of external impact. Shearing injuries also fall into this category. |
| What is a Physeal Fracture? | Fractures involving the growth plate cartilage. a.k.a Salter-Harris fractures. |
| Describe the meniscus and its function in the body: | The meniscus is a fibrocartilaginous structure between the femur and tibia that acts as a cushion and helps center the joint. |
| What does 'Laser' stand for? | Light Amplification by Stimulated Emission of Radiation |
| What is the CO2 laser predominantly used for? | To create surgical incisions, excise after incision or for ablation of tissue. |
| Which surgical prep should be used when lasers are involved for surgery? | Chlorhexidine or povidone-iodine. NEVER alcohol. |
| An Endoscope should ideally have the following features: | 4-way distal tip deflection w/180 degree of upward deflection, Water flushing, air insufflation, suctioning, locking controls, accessory channel, forward viewing optics. |
| Describe the steps to check and prepare an endoscope for a procedure: | Check light source is working, confirm adequate amount of distilled water is available for flushing. Submerge distal end to check the air/water valve for insufflation. Lastly, submerge distal end to test for suctioning. |
| Which conditions can be definitively diagnosed via Gastroscopy? | Chronic inflammation, superficial erosions, foreign bodies, motility disorders, ulcerations and neoplasia. |
| Which conditions can be definitively diagnosed via Duodenoscopy? | intestinal parasites, inflammation, lymphangiectasia, ulcerations, neoplasia. |
| True or False: the bladder of a traumatic injury patient should be expressed prior to entering the surgery room? | False. |
| The stomach of a dog with GDV generally rotates in which direction? | Clockwise. |
| Why should animals be spayed before their first ovarian cycle? | To decrease the incidence of mammary tumors |
| What is the most common complication that occurs after OHE? | Hemmorhage |
| What are some advantages of laser surgery vs traditional? | More rapid healing time of tissue, less risk of post-op infection, reduced post-op pain & swelling, decreased surgery time. |
| Why should narcotics be avoided when performing gastroduodenoscopies? | They may cause spasms making it more difficult to enter the duodenum. |
| What are the major diagnostic tests for CCL injury? | Palpation, tibial compression test, cranial drawer test |
| How far into the needle's curve should the needle holder be placed? | About 2/3rds into the needle's curve |
| Where are absorbable sutures generally cut? | Approx. 1/8 to 1/4 inch beyond the knot |
| Where are non-absorbable sutures generally cut? | Approx. 1/2 inch beyond the knot to help with their removal |
| When should a fenestration drape be cut? | Prior to placing on patient. Once it touches the patient, the underside is considered non-sterile and shouldn't be manipulated. |
| What are the 4 ways heat is lost in a patient? | Conduction (skin touching a cold surface), Convection (tail wag), Radiation and evaporation of moisture from the skin (panting, wet fur drying). |
| For every 1 degree (celsius) of heat loss, there is also a ____% decrease in MAC requirements | 5% decrease |
| Hypothermia occurs when: | Heat loss exceeds heat production |
| How much time prior to anesthesia should neonates be fasted? | Not at all, or for only 1-2 hours prior to avoid hypoglycemia |
| What is the preferred therapeutic correction for hypoglycemia? | 50% Dextrose with sterile water or 0.9% saline in a 1:1 ratio |
| What is a Seroma? | Collection of tissue fluid in a pocket under the skin formed in areas of excessive movement. |
| When does wound healing begin? | Directly after the injury occurs |
| What are the four classes of wounds and their characteristics? | Clean = Surgical | Clean-Contaminated = Surgical contaminated with GI, Resp, or Urinary contents | Contaminated = Heavy contamination w/grass, asphalt, comprimised tissue | Infected = inflamed, purulent, necrotic tissue |
| What is the goal of lavaging a wound? | To reduce the number of microorganisms in the wound to a level the immune system can handle. |
| Leaving a wound open for approx. 5-7 days before suturing it closed is known as: | Secondary Closure |
| A wound that is left open for a few days, protected with dressings and sutured closed later is known as: | Delayed Primary Closure |
| Wounds left to heal without suturing is known as | Second-Intention healing |
| Name the basic layers of a bandage: | Primary (contact) | Secondary (padded) | Tertiary (outer) |
| How often does a peripheral catheter require replacement? | Every 72 hrs and in a different vein. |
| How often does a central catheter require replacement? | 5-7 days providing there is no indication of phlebitis and the line is patent. |
| What does swelling proximal to a catheter indicate? | That the catheter is perivascular (not in the vein) |
| An animal must be able to consume at least ___% of its resting energy requirements to be able to feed orally. | 85% - otherwise assisted feeding is necessary |
| What are Passive ROM Exercises? | Exercises that support a joint while moving it to the extent of its limitations. |
| What does the term: "Terminal Cleaning" mean? | The cleaning of all equipment in the surgery and prep areas after completion of the daily surgery schedule. |
| What is the main limitation of gas plasma sterilization? | It cannot penetrate the walls of instruments with a lumen and thus the area within can't be sterilized. |
| What is the difference between antiseptics and disinfectants? | Antiseptics are intended for use on living tissues; disinfectants on inanimate objects. |
| For a patient that underwent anesthesia, what should be included in the client instructions once the patient is discharged? | Care for the next 24 hrs addressing: confinement, feeding, meds, adverse reaction signs, emergency contact for hospital |
| What does "running a suture" mean? | The process of keeping the suture out of the incision and out of the way of the surgeon so they can place a continuous pattern. |
| How many layers are closed during an abdominal procedure? | 3 - Linea Alba (strength), Subcutaneous (reduce dead space), Skin |
| What type of incision is indicated for a Laparotomy? | Flank incision |
| Why are stay sutures placed during gastrotomy procedures? | To allow for manipulation of the stomach while preventing leakage of gastric fluid into the abdomen. |
| Which tool is used to grasp foreign bodies from the stomach during a gastrotomy? | Allis tissue forceps |
| How many layers are involved when closing an incision into the stomach? | 2 layers. 1st = simple continuous, 2nd = continuous inverting both using absorbable monofilament sutures |
| Where is the incision made during an enterotomy to remove a foreign object? | Just distal to the foreign object on the antimesenteric border of the intestine. |
| What type of draping is used for an aural hematoma? | Single fenestrated drape. |
| What is the purpose of a Jaeger Lid plate? | To provide a firm surface under the eyelid when making an incision |
| How should a ring-handled instrument be handled? | The thumb and ring finger should be placed in the rings. The thumb shouldn’t go beyond the first knuckle on the ring and the ring finger should be no further than the second knuckle |
| What are the positioning and clipping guidelines for an ovariohysterectomy | Dorsal recumbency, hair removed within two clipper blade widths in every direction from the incision site, which will likely be mid-sternum to pubis and laterally to the edge of the ribs |
| Describe the target pattern scrub technique: | Start at proposed surgical site using a sterile scrub sponge w/scrub solution that is a soap or detergent base. Move sponge outward in a circle to the hairline w/o going back to incision site. Repeat w/alcohol sponge. Repeat 3 times or until clean. |
| How is the patient positioned for surgery of the right femur? | left lateral recumbency. The right paw should be wrapped in gauze, tape, or stockinet and suspended from an IV pole with the use of a stirrup |
| What are the four classes of drugs that can be effectively used to deliver preemptive analgesia? | Opioids, nonsteroidal anti-inflammatories, local anesthetic agents, and α2-adrenergic agonists |
| Describe an iodophor antimicrobial scrub solution and indicate some of its properties. | Consists of iodine & a carrier w/fungal, viral, & bacterial activity. Neutralized quickly by organic matter. Immediate antimicrobial effect persistent for 4–6 hours. Odorous, staining, & causes tissue irritation. |
| What’s the difference between closed gloving and open gloving? | Closed gloving= no bare skin is exposed b/c the gloves are grasped through the folded cuff of the sleeve or another glove. Open gloving used when only the hands need to be sterile/no gown needed. |
| Explain the purpose of cerclage wires: | They are used to hold bone fragments in alignment. They are a form of internal fixation. |
| What are the phases of wound healing? | Inflammation, debridement, repair (fibroblastic), maturation |
| If using an ultrasonic cleaner, what type of solution should be used and why? | Enzymatic solution containing a surfactant. The enzymes break down the debris on the instruments; the surfactant reduces the surface tension so that the solution can penetrate into the dried debris. |
| Frazier/Adson, Poole and Yankauer are all examples of: | Different types of Suction tips |
| What are Halstead Mosquito Hemostatic Forceps used for? | clamping small vessels |
| What are Kelly Hemostatic Forceps used for? | clamping medium-sized vessels or small tissue masses |
| What are Ferguson Angiotribe Forceps used for? | clamping any vessel of any size and any tissue that will not need to be viable in the body (uterine stump). |
| Describe Rochester-Carmalt Hemostatic Forceps: | "checkerboard" pattern with both horizontal and vertical serrations at the tip of the jaw. Usually 8in long used for clamping large vessels or tissue masses. |
| Describe a No. 12 scalpel blade: | Hook shaped often used for declawing |
| Describe the difference between a backhaus and Roeder towel clamp: | Backhaus are the most common and have penetrating tips. Roeder have balls on the tips preventing the clamp from going to deeply into tissue. |
| What is the intended use for Lorna (Edna) towel clamps? | Non-penetrating and used to secure second-later drapes to ground drapes. |
| What are bone curettes for? | Harvesting bone graft material or shaping and scraping bony surfaces. |
| Taper-point needles are best used for: | When a sealed suture line is needed (intestine, hollow organ). It has a sharp point that pierces/penetrates without leaving small cuts behind b/c the cross section is rounded. |
| What does the term: "Capillarity" mean with regards to sutures? | The ability of the suture to allow wicking of microbes to the interior of the suture strand. More common with un-coated, multi-filament than monofilament. |
| Give an example of a chlorine-based disinfectant and some of its properties: | Bleach. Used for both cleaning and disinfecting. Corrodes metals, deteriorates fabrics. Irritating, deactivated by fecal matter. |
| Give an example of a Phenol-based disinfectant and some of its properties: | Lysol/Pine-sol. Works in presence of organic material, some skin irritation. Can cause toxicity in cats, not commonly used in veterinary setting. |
| Give an example of a quarternary amine-based disinfectant and some of its properties: | Roccal-D plus. Broad-spectrum activity: germicidal, viricidal, fungicidal. Inactivated by organic material. Hard water may deactivate it. |
| For castration in a male canine, where should the hair clipping be done? | From the tip of the prepuce to just above the scrotum and then extending laterally in each direction. |
| What is the difference between an open and closed castration? | Closed = tunics are not incised and the entire spermatic cord encased in its parietal vaginal tunic is ligated and transected. Open = tunics are incised and contents of the cord are ligated and transected separately. |
| What is the standard post-op care for internal fixation of a fracture? | Strict confinement for 6-8 weeks. |
| During a declaw procedure, why shouldn't you place a tourniquet proximal to the elbow? | It may lead to radial nerve damage. |
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