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A&S - Week 3
Analgesia & Cutaneous Surgery
| Question | Answer |
|---|---|
| What Are The Four Main Categories Of Analgesic Drug? | -Nitrous oxide -NSAIDS -Opioids -Local anaesthetics |
| What Are The Considerations For Using Nitrous Oxide As An Analgesic Drug? | -Environmental -Second gas effect -Gas filled spaces -Diffusion hypoxia |
| What Are The Properties Of NSAIDS? | -Inhibits COX1 and COX2 (mediators) -Anti-inflammatory and analgesic (mild to moderate) -Potential for acute renal failure/gastric irritation |
| What Are The Properties Of Opioids? | -Act on opioid receptors -Full agonist = full response at receptor – higher analgesia -Partial agonist = partial response - lower analgesia -Antagonists (reversals) available -Controlled drug status -Respiratory depression/constipation side effect |
| Give Some Examples Of Opioid Full Agonists? | -Fentanyl -Methadone -Morphine -Pethidine |
| Give Some Examples Of Opioid Partial Agonists? | -Buprenorphine -Butorphanol |
| What Are The Benefits Of Using Local Anaesthesia? | -Potential to be safer -Reduces dose of other anaesthetic drugs when used in combination -Used as multimodal analgesia, pre-emptive analgesia -Blocks pain receptors completely, depression of CNS -Used to treat arrhythmias (but can cause in overdose) |
| What Are Some Examples Of Local Anaesthetic Drugs? | -Lidocaine -Procaine -Bupivacaine -Mepivacaine -Proxymetacaine -Amethocaine |
| How Does Local Anaesthesia Work? | -Prevents transmission of nerve impulse (by blocking sodium channels) -Sensory nerves affected at lower dose than motor nerves -Eventually absorbed into circulation - some faster than others |
| Why Might Adrenaline Be Added To Local Anaesthetics? | To cause local vasoconstriction and slow absorption – prolongs local anaesthetic action |
| What Are Some Issues With Local Anaesthetics? | -Overdose can cause toxicity -Able to cross blood-brain barrier -At high levels can cause seizures (due to inhibitory neurone blocking) -Can cause slow myocardial conduction, peripheral vasodilation Bradycardia, hypotension, possible arrest |
| How May Local Anaesthesia Be Administered? | -Topical -Infiltration -Regional (nerve supply to a specific area) |
| What Are Some Regional Areas In Which Local Anaesthesia Can Be Administered To Block? | -Brachial plexus -Intercostal -Maxillary/mandibular -Intrasynovial -Intravenous (cattle) -Intrapleural -Epidural -Para-vertebral (cattle) |
| What Should You Never Do When Administering Local Anaesthetic To A Regional Area? | Directly inject nerve = damage. |
| What Are The Different Forms Of Pain Score? | -Subjective scales -Objective measures -Multiparameter scores (colorado and glasgow) -Validated scores |
| What Are Some Nursing Considerations For Painful Patients? | -Positioning -Bedding -Noise and light -Handling -Urination/defaecation -Feeding support |
| What Is An Abscess? | A localised collection of pus, usually due to bacterial infection. |
| What Are The Causes Of An Abscess? | -Bites -Foreign bodies -Penetrating wounds -Dental disease -Impaction of secretions |
| How Do Rabbit Abscesses Differ From Dog/Cat Abscesses? | -Difficult to remove -Pus is thicker -Recurrence is common |
| What Are The Clinical Signs Of Abscesses? | -Local swelling -Local pain -Warmth -Erythema of the overlying skin -Discharge -Systemic signs (pyrexia, depression, anorexia, tachycardia |
| What Are The Treatment Options For Abscesses? | -Release the encapsulated pus -Address underlying cause -Treat infection -Lance and flush or surgical resection |
| What Are The Main Steps Of An Abscess Lance And Flush? | -Ideally performed when abscess begins to point, warm compress can encourage -Sedation or GA -Lance with scalpel, stab incision -Express, drain and flush with sterile fluids -Encourage to remain open (via cleaning or a drain) |
| What Are The Main Steps Of An Abscess Surgical Resection? | -Technique for deep or rabbit abscess -Dissect fibrous capsule -Hydrogels or debriding solutions into dead space |
| What Are The Surgical Considerations For Abscess Patients? | -Wide clip margins -Imaging to confirm? -Systemic illness? -Position on surgical list -Post op: flushing or drain care required |
| Define Tumour | Abnormal and uncontrolled growth of cells (neoplasia). |
| What Systemic Issues Can Tumours Cause? | -Pressure on surrounding tissues -Increased energy requirements -Paraneoplastic syndromes (conditions due to tumour growth) -Metastasis |
| What Are Benign Tumours And Give Some Examples? | -Tumours which tend to grow slowly and do not metastasise -Lipoma, histiocytoma, adenoma, papilloma |
| What Are Malignant Tumours And Give Some Examples? | -Tumours that spread locally and aggressively metastasise -Carcinoma, sarcoma, melanoma |
| What Are The Main Steps Of Tumour Removal? | -Diagnosis via biopsy (FNA, punch, needle core, incisional) -Tumour free margins -Shelling out vs elliptical incision |
| What Are The Surgical Considerations For Tumour Patients? | -Which mass is to be removed? -Clip margins -Pre-op tumour staging -Underlying systemic disease -Pre-op meds -Closure, need for drains or reconstruction -Histopathology (pots needed?) -Change of equipment for closure -Post op care |
| What Is Primary, Delayed Primary, And Secondary Closure Of Wounds? | Primary closure = wound closed straight away Delayed primary closure = wound closed 1-3 days later Secondary closure = wound closed several days later |
| What Are Some Surgical Tension Relieving Techniques? | -Undermining (separation of skin from muscle layer) -Walking sutures (undermining + suture to hold skin in new place) -Suture patterns -Relaxing incisions (use of many minor skin incisions to increase skin elasticity to bring wound edges together) |
| What Are The Surgical Considerations For Traumatic Wounds? | -Clipping (sterile lubricant in the wound) -Treat systemic illness? -Careful handling -Flushing (with sterile solution) -Use of a drain? -Tension relieving techniques -Post op: wound dressing, analgesia, monitor for exudate, drain care |
| What Is A Single Advancement Pedicle Flap? | -Partially detached segment of skin and subcutaneous tissue brought to cover wound -The base or pedicle of the flap maintains circulation |
| What Is A Bipedicle Advancement Flap? | -Two surgical flaps either side of wound |
| What Is A Rotational Pedicle Flap? | -Triangular wounds -Surgical flap rotated towards wound |
| What Is A Transposition Pedicle Flap? | -Surgical flap rotated 90 degrees |
| What Are Free Skin Grafts? | -Skin completely detached -Nutrition in first 48hrs is via absorbing tissue fluid -Blood vessels grow into the graft -Sheet vs pinch/punch/strip -Sheet skin graft = graft came from elsewhere |
| What Techniques Are Used To Allow Exudate To Leave Skin Graft Wounds? | Drain placement or pie crusting/meshing method. |
| What Are The Surgical Considerations For Skin Graft/Flap Patients? | -Pre op: patient stability, position on surgical list, wide clip, management of initial wound -Intra op: careful tissue handling, monitoring -Post op: analgesia, RJ bandaging, non-adherent dressing, cage rest 5 days, exercise restriction 10-14 days |
| What Is The Difference Between Eyed And Swaged-On Surgical Needles? | -Eyed = surgeon threads the needle through the eye, increased drag, cheap, needle can become blunt with use -Swaged-on = suture bonded to needle, less drag, expensive |
| What Shapes Of Surgical Needle Are There? | -1/2 curved needle -1/2 circle needle -Straight needle -Round bodied needle -Cutting needle |
| What Are Functions/Roles Of Round Bodied Needles? | -Separates tissue fibres rather than cutting them -Used in soft tissue or in tissues where fibres can be separated easily -Tissue closes forming a leak proof suture line |
| What Are Functions/Roles Of Cutting Needles? | -Used in fibrous or dense tissue |
| Define Suture Capillarity | Extent to which tissue fluids are attracted along a length of suture material. |
| Define Suture Chatter | The lack of smoothness as a throw of knot is tightened down. |
| Define Suture Tissue Drag | The frictional force as the material is pulled through the tissue. |
| Define Suture Knot Security | The surface frictional characteristics of the material. |
| Define Suture Tensile Strength | Breaking strength per unit area of tissue. |
| Define Suture Memory | Tendency of the material to return to its original shape. |
| What Are The Properties Of Absorbable Sutures? | -Degrade within animal tissue and lose tensile strength after 60 days -Natural fibres are removed by phagocytosis -Synthetic materials are hydrolysed -Used internally where long term support is not required |
| What Are Some Examples Of Absorbable Sutures? | -Catgut -Polyglactin 910 (vicryl) -Polyglycolic acid PGA (Dexon) -Polydioxanone (PDS) -Polyglyconate (Maxon) -Poligecaprone 25 (Monocryl) |
| What Are The Properties Of Non-Absorbable Sutures? | -Maintain tensile strength for greater than 60 days -Become encapsulated within fibrous tissue |
| What Are Some Examples Of Non-Absorbable Sutures? | -Polypropylene (prolene) -Silk -Linen -Polyamide |
| What Two Systems Are Used In Suture Sizing? | Metric and imperial system. |
| What Are Some Alternatives To Using Sutures? | -Glue -Staples -Surgical guns -Adhesive tapes |
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aimee_knows_nothing
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