Term
Patient monitoring Evaluation of: |
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Definition
equipement in use, central nervous system, pulmonary function, cardiovascular function, body temperature, critically ill patients during general anesthesia when beginning new meds routine geriatric checkups |
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Term
Patient monitoring Equipment: functionality and precision |
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Definition
often forgotten! anesthetic equipement- check oxygen, anaesthetic machine and breathing circuit for leaks, ensure CO2 absorbent is adequate (not exhausted ie) regular calibration and cleaning |
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Term
Patient Monitoring Anesthetics |
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Definition
why? essential for patient safety, as drugs used will depress normal physiological function and responses during anesthesix, frequent checking of patient as well as machine and monitors in use help maintain patient safety! Frequent (at least every 5 mins!) Verify equipment readings by manual observation of vital signs Vital Signs: TPR, CRT (capillary refill time) Mucous membrane colour Also: BP, hearth rhythm, pulse quality, muscle tone, eye reflexes. " expect the unexpected" frequency of monitoring depends on case - risk level, ect every 5 mins in MINIMAL that is acceptable ensure adequate perfusion to avoid organ dysfunction "death is a late sign of poor perfusion" |
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Term
Patient Monitoring Anesthetics- 5 Hypos |
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Definition
Poor perfusion can lead to the 5 hypos Hypoxemia - low O2 levels Hypoventilation - not enough breath/air Hypotension - low PB Hypovolemia - low vol (circulating blood vol) Hypothermia- low temp |
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Term
Patient Monitoring Anesthetics - avoiding the 5 hypos |
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Definition
How to avoid the 5 hypos adequate monitoring of respiratory, cardiac function and body temp respond quickly to developing problems excellent record keeping: the anesthetic record |
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Term
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Definition
AHTs brain and eyes... stethoscope esophageal stethoscope ECG blood pressure monitoring: -direct: arterial catheterization/transducer -indirect: ultrasonic doppler and oscillometric methods |
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Term
Patient monitoring Respiratory |
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Definition
apnea monitors - do not work well respiratory monitors
blood gass analysers- tell the quantitative amt of each gas pulse oximetry-usually clip to tongue capnometry- measure amt of CO2 |
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Term
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Definition
eye position -pupil size, rolled up ect. eye reflexes (stregth) - blinking, how much, how fast? Species variability must be kept in mind muscle tension, general body reflexes |
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Term
Patient monitoring Other illnesses |
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Definition
anesthesia other illnesses: eg) BP and ECG in hypertentsivee, post HBC, heart failure cases epilepsy, toxin ingestion post GDV Sx Trauma |
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Term
Special Needs Nursing: Geriatrics Life stages, determing age, check ups |
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Definition
1) pediatric - bet. birth and 6 mo. 2) young adult - from 6mo to 2-5 yrs in dogs and to 4 yrs in cats 3) mature adult 2-5 yrs to 9-12 yrs for dogs; 4-12 years for cats 4) senior - above 9-12 for dogs; above 12 for cats (breed dependent) senior vs geriatric determining age: dog versus human years recommend checkups every 6 mos 1 yr for every 7? not quite true as either end of scale is inacurrate dif scales availabele to try and account for this 1st yr =about 13. senior yrs, considered approx 3-5 human years 6 month checkups analogy for clients |
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Term
Special Needs Nursing: Geriatrics Effects of aging |
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Definition
-degenerative changes, in metabolism, physical and mental -body wt increase; -decreased skin elasticity, dry skin, dull sparse hair coat, brittle nails, hyperkeratotic foot pads -digestion less efficient, more prone to constipation -decreased cardiac output-mitral valve insufficiency -COPD - chronic obstructive pulmonary ds, poor lung elasticity -decreasing kidney function (PU/PD; incontinence-poor control -degenerative join ds, possible muscle and bone atrophy -vision decrease possibl, hearing as well (can still smell) -memory? -behaviour changes-less adaptable? -periodontal ds -decreased ability to fight infection -testicular atrophy, or enlarged ovaries, mammary tumors more likely |
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Term
Special needs nursing: Geriatrics Common problems |
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Definition
obesity cancer dental ds quote Alzheimer-like changes in behaviour poor vision or hearing heart murmurs chronic bronchitis urinary or fecal incontinence hormonal deficiencies |
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Term
Special needs nursing: geriatrics Physical Exam |
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Definition
All body systems thorough, organ sizes, masses, assess gait, weight - record. Get full Hx, ask all the questions, record all answers blood and urine testing preventative medicine: owner education - councel the family on normal aging changes, early signs of metabolic problems, and appropriate nutrition senior blood panel- what are we looking for? make sure to make it seem very important for baseline data for clients importance of baseline data, and monitoring for changes from that Urinalysis - to rule out early kidney ds - proteinuria ect. |
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Term
Special needs nursing: geriatrics Palliative Care |
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Definition
-to maximize comfort, and enjoyment for both pet and family -prevent/relief pain -ensure free from hunger, and other physical discomforts -assist with bodily functions, if required (ensure no constipation, check anal glands etc) -minimize advers effects of condition: ex) NSAIDs, cartrophen, laxatives, fiber, B/D by hills, N/D (omega 3) -end of life decision making , the euthanasia visit, greif counselling The term senior is more client friendly then geriatric diminishing function of the immune system can predispose a geratric patient to bactieral and parasitic infections - note to watch for OLD AGE IS NOT A DS!!! |
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Term
Pedatrics Physical exam of the puppy or kitten |
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Definition
observe general condition, metation, posture, locomotion breathing pattern TPR, CRT, body wt Head and oral Cavity: -skull malformations, cleft palate, stenotic nares, "bite" Ears: -external canals, start to open 6-14days -completely open at 17days -can do full exam after 4 wks old Eyes: -eyelids open 5-14 days -menace reflex 3-4 wks -PLR's 5-14 days - but difficult to assess before 3 wks old Nose: -check for fluids and nostril patency Chest (thorax): - 0 to 4 wks - Heart Rate 220bpm, RR 15-35brpm -llisten at 5th -6th intercostal space left cardiac apex -left cardiac base - 3rd-4th intercostal space above costochrondral junction, -right cardiac apex 4th05th intercostal space opposite mitral valve area. Abdomen: -check for liver enlargement, spleen (cant usually feel), 2 kidneys -check stomach (variable sized fluid filled sac) and soft, slight fluid or gassy intestines - no pain, "slip" easily -bladder Umbilicus: -check for hernia (abdominal defect in abdominal wall), infection or inflammation -normally lose at 2-3 days or age Skin: -check for fleas, lice, cheyletiella (walking dandruff), ringworm (dermatophytes) -hydration Musculoskeletal: -bones, toes and pads, -number, shape, position, surrounding tissue -watch movement check joints for ROM(range of motion) and deformities -Check tail-deformities, movement Genitalia and anus: -check for presences of anus (rule our atresi ani), signs of diarrhea ect. -check appearance of genetalia Nervous system -sucking reflex present 0-3wk -anogential reflex 0-3-4wks |
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Term
Pediatrics Neonatal parapmeters for puppies, kittens and foals |
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Definition
temp pulse resp rate eyes open umbilical cord ear canals open hearing lose suckling reflex menace reflex appears weaning |
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Term
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Definition
-normal newbown suckling reflex 20mins after birth -stand w/in 1-2 hrs, nurse w/in 2-3hrs -first urine w/in 10hrs, meconium w/in 24hrs (enema) -should be alert, aware of surroundings -nursing 7X/hr bobbing head is normal (searching for udder) -newborns usually have loud murmur at left heart base - gone by 3 days of age (PDA) -Heart rate changes to normal |
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Term
Pediatrics immediate postpartum care (all species) |
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Definition
1) clear airway. remove fluid from nose and mouth 2) determine pulse and resp rate 3) confirm no hemorrhage at umbilicus 4)check mucous membranes and capilary refill time 5) help to dry neonate if needed 6) ensure colostrum ingested |
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Term
Pediatrics Newborn puppies and kittens needs: |
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Definition
-warmth, food, cleanliness, protection, assistance with elimination -thermal reg poor to absent 1st wk, assistance needed for 3 wks -warm dry box, bedding, warm-hot water bottle/lamp -nurse every 1-2 hrs first wk, mum licks genitalia to induce urination/defication -failure of any of these can result in illness -bacterial, viral, parasitic ds may be aquired in utero, at birth or due to environment/exposure -orphaned neonates more susceptible -many due to congenital anomalies, improper diet to mom, poor birth wt, trauma, autoimmune problems |
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Term
Pediatrics Managing the malnourished neonate |
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Definition
-hand feed if necessary: KMR, Mammilac ect. -if diarrhea, dilute formula one to one with LRS/dextrose or water or pedialyte, warm -if very weak or cool, may need "plain" electolytes first (warm) |
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Term
Pediatrics general signs of illness in the neonate |
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Definition
-crying, restlessness,weakness, diarrhea, failure to thrive, hypothermia, rest rate abnormal,hematuria, cyanosis -advanced-poor vascularization of extremities, eventual death (sometimes no clinical signs before death) |
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Term
Pediatrics management of he sick neonate |
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Definition
fluids, glucose supplimentation, warmth, often use antibiotics before cultures available Fluid- IV or IO, BES(balanced electrolyte solution), with 5% dextrose, and KCl (<2.5meq/L) monitor glucose: 80-200mg/dl ideal, use IV 5% dextrose as needed and give 1-2 ml 10% -20% dextrose sol per kilogram body wt. warming- with caution oat bags, circulating hot water pump/blanket, warm water bottle antibiotics? oxygen therapy, food as discussed closely monitor behaviour, cardiopulmonary status, wt, mm, hydration BAER - brainstem auditory evoked responese VER-visual evoked response ERG- electroretinogram useful in determining vision and hearing |
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Term
Pediatrics Drug use in neonates - potential difficulties |
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Definition
-poor distribution, poorly developed blood brain barrier, lower albumin level, absorption may be poor at gut level -dosages: often decrease 30-50% (from adult dose), possibly change frequency of drug given |
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Term
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Definition
-difficult foaling: the high risk mare -poor health, advanced age, poor perineal conformation, vaginal discharge, Hx of previous complications -always evaluate likelihood of high risk, so that proper fetal monitoring can occur! -premature foal: born before 320days -low birth wt, weak, delay and standing, prominent dome forehead, soft silky hair coat, flexor tendon lax,possible angular limb deformities Get Hx! Septicemia in the New born Foal: bacteria gain entry via the resp tract #1, the GI tract #2, urogenital #3 Careful exam: palpate, cleansing of umbilical cord area. monitor abdomen for distension - can be sign of bladder rupture or problem with urachus (hole in it?) (urachus remnants found in umbilical stump) -with intensive care, many high risk foal survive |
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Term
Urinary Catheterization -female dog Female Urethra |
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Definition
-shorter, wider, but harder to access for catheters -use of speculum - vaginal, rectal, nasal, otoscope (sterile) |
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Term
Urinary Catheterization -female dog |
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Definition
-sedation or even a general anesthetic may be required -positioning: dorsal or sternal recumbency; some may stand up for procedure Procedure: -assistant should restrain the dog and hold the tail out of the way -speculum should be introduced vertically up the vulvar lips, then turned to run horizontallys -on the floor of the vestibule are 2 small 'dents' - the one farthest is the urethral opening -visualization is difficult -wash with warm, dilute antiseptic and rinse with saline or plain water - instil approx. 1 cc or @% lidocaine to ventral vaginal floor -sterile flexible polypropylene lubricated catheter is used. -with sterile gloves, AHT places lubricated finger into vagina, slides it 3-5 cm along the ventral floor until external urethral orifice is found -gently introduce the catheter tip through the urethtral papilla. use finger to guide the catheter (blind technique) -avoid the clitoral fossa -alternatively, can use speculum to aid in visualization -gently advance the catheter into the bladder -soft Foley catheter (self retaining) can be used- inflate cuff with mew mls of water to keep it in the bladder -tape to tail, so she does not step on it and pull it out |
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Term
Urinary Catheterization -female cat |
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Definition
-female cat, very difficult to catheterize, so rarely done -asecptic preparation, then pull vulva caudally -sterile lubricated open-ended 3.5 Fr. tomcat catheter is gently inserted along the midline of the floor of the vagina, and into the urethra |
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Term
Wound Healing and Management |
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Definition
-wound: created when an insult disrupts the normal integrity of the tissue -this insult may be from trauma or surgical incision -it results in a complex of responses by the body |
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Term
Wound Healing and Management 4 phases of healing |
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Definition
1) Inflammatory 2) Debridement 3) Repair 4) Maturation note: thes can overlap - very complex |
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Term
Wound Healing and Management Phase 1- Inflammatory |
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Definition
-blood clot formation - starts as soon as injury occurs -platelets start reaction by releasing growth factors, these aid body in helping the healing process begin |
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Term
Wound Healing and Management Phase 2 - Debridement |
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Definition
-6 hrs post injury this begins -WBCs, especially neutrophils and monocytes appear in the wound -these help remove dead cells and foreign material from the wound -the debridement phase is also known as the lag phase, a time or poor wound strength -sutures can provide support at this time -scabs (dried blood clot) do not provide strength -scabs to provide protection and often prevent further hemorrhage |
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Term
Wound Healing and Management Phase 3 - Repair Phase |
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Definition
-begins 3-5days after injury, when fibroblasts first appear at the wound. -characterized by increased strength (dramatic) -granulation tissue - overactive in horses - lower leg injuries especially - fibroblasts are collagen producing cells (lead to scar tissue) |
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Term
Wound Healing and Management Phase 4 - Maturation |
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Definition
The final phase of wound healing -slow increase in wound strength -remodeling of collagen into fibrous (scar) tissue -can be several years before remodeling stops |
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Term
Wound Healing and Management Host Factors |
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Definition
-age, debilitation -poor nutrition -disease (liver or kidney ds) endocrine status, diabetes - poor healing |
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Term
Wound Healing and Management Wound Characteristics |
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Definition
-foreign material, dirt -contamination - bacterial, bacterial toxins -type of injury - surgery, trauma -timing - delay in Tx can lead to increased contamination |
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Term
Wound Healing and Management External Factors |
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Definition
-drugs can slow healing examples include cortisone, chemotherapy -radiation - adverse effects on healing tissue |
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Term
Wound Healing and Management Wound Care: immediate/first aid |
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Definition
-cover with clean bandage to decrease hemorrhage and prevent infection -water-soluble antibiotic ointment okay - avoid creams and powders -care for wounds once animal is stable: -KY jelly, clip hair away - clean up - standart procedure |
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Term
Wound Healing and Management Wound Lavage |
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Definition
-use warm, balanced electrolyte solution (crystalloid) -19guage needle, 35 ml syringe or 18guage needle and 60ml syringe - commonly used |
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Term
Wound Healing and Management Wound Debridement |
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Definition
-remove all contaminated and dead tissue from wound -remove all foreign material from wound -surgical - en bloc or layered; enzymatic -Sx excision of dead tissue ect... put good to good usually have to be layered or done in stages depends on injury - side note |
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Term
Wound Healing and Management Methods of wound care |
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Definition
1) Primary closure 2) Delayed primary closure 3) second-intension healing 4) third-intension healing |
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Term
Wound Healing and Management Decision Making: How to decide what closure to use? |
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Definition
factors include: time since injury, size of injury, how contaminated the wound is, level of tissue trauma, intial first aid method, circulation or blood supply to the wound, animal's health, tension on the wound - options may be limited by location |
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Term
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Definition
why? decision making: charateristics, choices steps in bandage placement Types - casts, splints, Robert Jones, abdominal, slings (Many!) Aftercare and home care -wound protection from trauma -wound protection from contamination -preventing drying out (desiccation) -preventing seromas and hematomas -immobilizing the wound, preventing cellular disruption -minimize postoperative edema -minimize exuberant granulation tissue (especially in horses) -absorb wound exudates, helps remove foreign material -promotes acid environment increasing available oxygen -how? prevents CO2 loss, absobs ammonia produced by bacteria. -increases the ability of hemoglobin to let go of oxygen -bandage can also keep wound warm - this speeds up healing - open wound DO NOT heal quickly |
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Term
Bandaging Three parts/layers |
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Definition
there are 3 parts or layers to most bandages: 1)Primary or contact layer - in contact with wound on skin 2)secondary or padded (conforming) layer - support 3)Tertiary or holding and protective layer - outer covering protects other layers and keeps things from moving aroundtoo much
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Term
Bandaging Primary layer types |
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Definition
1)adherent - rarely recommended now 2) non-adherent semi-occlusive eg) telfa pads -used in wounds with moderat to copious exudate and /or tissue debris. must change frequently every 24 -72 hrs 3)nonadherent occlusive - eg)Tegaderm, Bioclusive -for minimally exudative wounds, protection of new epithelial tissue |
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Term
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Definition
Padding - eg)cotton, cast padding - supports and pads wound, can absorb exudate,blood |
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Term
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Definition
-conformin Guaze ed) Kling -non-occlusive elastic adhesive tape ed) Elasticon -non-occlusive elastic bandage eg) Vetrap These act to hold primary and secondary bandages; is protective layer and lets moisture in and out (permeable) Note: occlusive bandaging is contraindicated - not a good idea to leave it on for longer the 30mins if used. |
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Term
Bandaging Placing a bandage |
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Definition
1) apply stirrups or anchoring tapes 2)apply primary layer 3)apply secondary layer or padded layer 4) apply tertiary layer or conforming layer ???
5) apply splint if needed 6) reflect and fasten tape stirups to gauze 7) apply tertiary or protective wrap or tape 8) ensure adequate home care instructions; check foot regularly if applicable |
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Term
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Definition
Aftercare or home care for bandage, splints, casts and slings -monitoring - frequency depends on case but at least every 24hrs for inpatients and every 7days for relatively stable other cases or more often -in young, rapidly growing animals, frequent changes and inspection are essential! -check for warmth, colour and swelling of toes -check for dampness or wetness -check for foul odors, chewed spots (often indicate areas of rubbing or abraision) -Restrict exercise! - especially in fracture repair -when outside protect from dirt and water (eg.dew) by use of occlusive dressing eg) plastic bag or used IV bag 15-30mins max only! |
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