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A&S - Week 7
Anaesthetic Monitoring & Perianal Surgery
| Question | Answer |
|---|---|
| What Are The Aims Of Anaesthetic Monitoring? | -Ensure adequate depth of anaesthesia -Whilst maintaining normal physiological function -Check parameters every 5 mins |
| What 4 Main Things Should Be Monitored While A Patient Is Under Anaesthetic? | -Anaesthetic depth -Circulation -Respiration -Temperature |
| What Reflexes Are Used To Monitor Anaesthetic Depth? | -Palpebral reflexes -Corneal reflexes -Pedal reflexes -Jaw tone (not considered actual reflex but used anyway) |
| How Can Eye Position Indicate Anaesthetic Depth? | -Eye ventromedial with some sclera visible = adequate anaesthetic depth -Eye central with pupil dilated = Too deep -This pattern is effected by ketamine |
| How Can Salivation Indicate Anaesthetic Depth? | -Excessive salivation can be an indicator of inadequate anaesthetic depth and pain -However some breeds naturally salivate more! |
| What Is A Normal Capillary Refill Time? | 2 seconds. |
| How Is Heart Rate And Pulse Rate Effected By Anaesthesia, And How Often Should It Be Checked? | -Rapid when too light -Slower with adequate anaesthetic depth -Slows further as gets too deep -Every 5 minutes |
| What Is A Normal Mucous Membrane Colour? | Salmon pink. |
| How Is Respiration Rate Effected By Anaesthesia, And How Often Should It Be Checked? | -Rapid and irregular if too light -Slower and regular with adequate anaesthetic depth -Shallower and slower as gets too deep -Every 5 minutes |
| How Often Should Temperature Be Checked While Monitoring Anaesthesia? | Every 5-30 minutes, depending on case. |
| What Are The Advantages Of Using Monitoring Aids? | -Allows a more precise picture of the patient’s health status -May detect early changes in patients’ health status allowing early intervention -Allow closer control over anaesthetised patients |
| What Are The Disadvantages Of Using Monitoring Aids? | -Must be monitored to ensure information provided is correct -Should never take the place of routine, basic monitoring procedures i.e., observations, listening and touching the patient |
| Define Systolic Blood Pressure | The peak pressure within the arteries that occurs towards the end of the cardiac cycle, when the ventricles are contracting, determined by a combination of peripheral vascular resistance, stoke volume and intravascular volume. |
| What Is The Normal Range For Systolic Blood Pressure In Cats And Dogs? | 90-120mmHg. |
| Define Diastolic Blood Pressure | The minimum pressure within the arteries that occurs towards the beginning of the cardiac cycle. This is when the ventricles are filled with blood and is predominately determined by the peripheral vascular resistance. |
| What Is The Normal Range For Diastolic Blood Pressure In Cats And Dogs? | 55-90mmHg. |
| Define Mean Blood Pressure | The average blood pressure during the cardiac cycle, provides information about tissue perfusion. |
| What Is The Normal Range For Mean Blood Pressure In Cats And Dogs? | 60-85mmHg. |
| What Are The Active And Passive Forms Of Temperature Support For Surgical Patients? | -Passive methods (preventative) = blankets, bubble wrap -Active methods (provide heat) = heat mats, bear huggers |
| What Are The Forms Of Cardiovascular Support For Surgical Patients? | -IVFT -Blood pressure monitoring -Chest auscultation |
| What Are The Forms Of Respiratory Support For Surgical Patients? | -IPPV (intermittent positive pressure ventilation) -Manual -Mechanical (ventilators) |
| What Factors Does The Speed Of Patient Recovery Depend On? | -Breed -Existing illness - renal, hepatic, respiratory, cardiac -Temperature -Duration and type of anaesthesia -Route of drug administration |
| What Should Be Monitored In A Patient Post-Operatively? | -Position -Pulse -Respiratory rate and pattern -MM colour and CRT -Temperature -Pain -Hydration -Wound management -Drug therapy -Nutrition |
| What Are The Risks To Extubating Surgical Patients Early? | -Risk of inhaling foreign bodies -Pollution of atmosphere -Multiple issues in brachycephalics |
| What Are The Benefits Of Extubating Surgical Patients Early? | -Prevents laryngeal spasm in cats |
| What Are The Risks To Extubating Surgical Patients Late? | -Prolonged carbon dioxide breathing -Laryngeal spasm in cats |
| What Are The Benefits To Extubating Surgical Patients Late? | -Airway protected until gag reflex returns -Protects airway from obstruction -Less pollution of atmosphere |
| What Is The Difference Between A Hernia And A Rupture? | -Hernia = occurs at a natural opening in the muscle wall, fat and intestines can move through -rupture = tear in the muscle wall, usually caused by trauma, structures can move through |
| What Is A Reducible Hernia? | Hernia that can be put back in with gentle pressure. |
| What Is An Irreducible Hernia? | Hernia that cannot move back into abdominal cavity with gentle pressure (usually because opening is to small or due to adhesion). |
| What Is A Strangulated Hernia? | Hernia in which blood supply becomes cut off to viscera that has moved through hernial opening (due to opening being too small). |
| What Are The Common Types Of Hernia? | -Umbilical hernia (congenital, often corrected during neutering) -Inguinal hernia (may involve intestines and bladder) -Perineal hernia (may involve colon, intestines and bladder) |
| What Are The Common Types Of Rupture? | -Diaphragmatic (seen in RTA cats) -Ventral rupture (also seen in RTA) |
| What Are The Pre-Operative Nursing Considerations For Hernias/Rupture? | -Often painful abdomen, care where handling -Monitoring for changes -Hernia area to be aseptically prepared |
| What Are The Intra-Operative Nursing Considerations For Hernias/Rupture? | -Positioning – dorsal recumbency -Careful tissue handling if scrub nurse -Further techniques may be required once tissues assessed |
| What Are The Post-Operative Nursing Considerations For Hernias/Rupture? | -Analgesia -Nutrition (faecal modifiers – to soften faeces) |
| What Are Perineal Hernias Most Common In? | Older male dogs. |
| How Are Perineal Hernias Corrected? | -Atrophied muscles can be apposed -Muscle flaps to support -Castration carried out if not done already – to prevent prostate enlargement and straining |
| What Are The Pre-Operative Nursing Considerations For Perineal Hernia Correction? | -Starved for 24 hours (to clear GI tract) -Area around perineum aseptically prepared (10-15cm cranial to tail, lateral to ischial tuberosity, caudal to include scrotum) -Manual evacuation (enema) -Empty bladder if necessary |
| What Are The Intra-Operative Nursing Considerations For Perineal Hernia Correction? | -Sternal recumbency, hindlimbs hanging off table (with padding), pelvis elevated, tail secured dorsally -Monitor ventilation -Purse string suture to prevent defecation (remove before patient wakes) |
| What Are The Post-Operative Nursing Considerations For Perineal Hernia Correction? | -High fibre diet to prevent straining (faecal softeners) -Hygiene -Analgesia -Antibiotics |
| What Are Clinical Signs Of Perianal Neoplasia And Polyps? | -Faecal tenesmus -Haematochezia (blood in faeces) -Dyschezia (straining to defecate) |
| What Is A Polyp? | Benign mass with stalk like attachment. |
| How Are Perianal Neoplasias And Polyps Diagnosed? | Colonoscopy, barium enema. |
| How Are Perianal Neoplasias/Polyps | -Simple excision -Pull out technique, rectum pulled out to sutures, allis tissue forceps to access polyp/growth -Endoscopic removal possible -If malignant will need wider excision |
| What Are The Pre-Operative Nursing Considerations For Perianal Neoplasias/Polyps? | -Starved for 24 hours (to clear GI tract) |
| What Are The Intra-Operative Nursing Considerations For Perianal Neoplasias/Polyps? | -Sternal recumbency -Tail secured dorsally |
| What Are The Post-Operative Nursing Considerations For Perianal Neoplasias/Polyps? | -Nutrition, faecal softeners -Monitor defecation (defecate before discharged) -Analgesia |
| What Causes Anal Gland Disease? | -Impaction of anal glands = causes irritation -Anal glands may need to be expressed regularly -Can be caused by breeding, prolonged diarrhoea, obesity, or neoplasia |
| What Are The Clinical Signs Of Anal Gland Disease? | -Bottom rubbing -Licking anal area -Perianal erythema -Jumping and spinning |
| What Are The Pre-Operative Nursing Considerations For Anal Gland Removal/Flush? | -Wide area around perineum aseptically prepared |
| What Are The Intra-Operative Nursing Considerations For Anal Gland Removal/Flush? | -Sternal recumbency, hindlimbs hanging off table (with padding), with tail positioning dorsally -Caudal body elevated -Care with ventilation |
| What Are The Post-Operative Nursing Considerations For Anal Gland Removal/Flush? | -Food introduced 8-12 hours later with faecal softeners -Temporary faecal incontinence possible -Monitor defecation -Analgesia |
| What Can Cause Rectal Prolapse? | -May be secondary to chronic straining or rectal tumour |
| What Are The Pre-Operative Nursing Considerations For Rectal Prolapse Correction? | -Prevent patient from self-mutilating (soft bedding, buster collar) -Keep prolapse moist to prevent drying out -Unlikely to be starved -Area to be aseptically prepared -Lavage tissue if necessary |
| What Are The Intra-Operative Nursing Considerations For Rectal Prolapse Correction? | -Sternal recumbency, hindlimbs hanging over table (with padding), pelvis elevated, and tail secured dorsally -Monitoring ventilation |
| What Are The Post-Operative Nursing Considerations For Rectal Prolapse Correction? | -Purse string suture initially -Low fibre diet initially to prevent defecation, then faecal softeners -Monitor for defecation before discharge -Analgesia |
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aimee_knows_nothing
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