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A&S - Week 8
Urinary Tract Surgery & Reproductive Surgery
| Question | Answer |
|---|---|
| Define Cystotomy | A temporary incision into the bladder. |
| Why Might A Cystotomy Be Performed? | -To remove calculi (bladder stones) -To repair a bladder rupture -To remove a tumour of the bladder |
| What Are The General Steps To A Cystotomy Procedure? | -Patient is catheterised to remove urine -Ventral midline incision into abdomen -Bladder pulled out and abdomen packed to prevent urine contamination -Placing of stay sutures -Specific procedure carried out, lavage abdomen and closing |
| What Are The Pre-Operative Nursing Considerations For Cystotomy? | -Stabilisation of patient with IVFT, and poss antibiotics and ECG monitoring -Urinary catheterisation to take place -Ventral midline abdomen to be aseptically prepared |
| What Are The Intra-Operative Nursing Considerations For Cystotomy? | -Careful tissue handling if scrubbed in -Packing of abdomen to reduce contamination -Bladder flipped for ventral access (avoiding major blood vessels) |
| What Are The Post-Operative Nursing Considerations For Cystotomy? | -Monitor urine output (should be 1-2ml/kg/hr minimum) -Catheter care -Monitor for signs of uroabdomen -Pain scoring and analgesia -Urination needed before discharge - blood in urine (tinged) after surgery normal |
| What Are The Clinical Signs Of Uroabdomen? | -Abdominal pain -Hypothermia -Uraemia -Reduced urine output |
| What Are The Clinical Signs Of Urethral Obstruction? | -Dysuria (unproductive straining) -Haematuria -Lethargy -Abdominal discomfort |
| Why Is Urethral Obstruction More Common In Males? | The urethra has a smaller diameter. |
| Where In Male Cats/Dogs Is Urethral Obstruction Most Common? | Cats = Distal 3rd of urethra Dogs = Caudal to os penis or at level of ischial arch |
| What Is A Common Cause For Urethral Obstruction In Male Cats And How Is It Treated? | -Mucous plugs or urethral spasms -Catheterisation and flushing or perineal urethrostomy |
| Define Urethrostomy | Creating a permanent opening into the urethra. |
| What Are The General Steps To A Urethrostomy Procedure? | -Catheterisation to visualise urethra and remove urine -Purse string suture applied to anus to prevent contamination -Dissection of part of urethra that is the issue (usually distal third of penis) -Urethral mucosa is sutured to skin to form a stoma |
| What Are The Pre-Operative Nursing Considerations For Urethrostomy? | -Stabilisation of patient with IVFT, and poss antibiotics and ECG monitoring -Perineum to be aseptically prepared |
| What Are The Intra-Operative Nursing Considerations For Urethrostomy? | -Patient positioning in sternal recumbency, legs hanging off table with padding, pelvis elevated, tail secured dorsally -Urinary catheterisation -Purse string suture to anus -Monitoring of ventilation/oxygenation |
| What Are The Post-Operative Nursing Considerations For Urethrostomy? | -Monitor urination (may be bloody) -Catheter care if still in place -Application of barrier creams -Regular cleaning -Buster collar |
| What Other Procedures Are Available To Relieve Urethral Obstruction In Male Dogs Besides Urethrostomy? | Retrohydropropulsion = Used to flush uroliths back into the bladder Urethrotomy = Incision made over a urinary catheter in place within the urethra, pre scrotal, the urolith is removed and the wound is left to heal by second intention |
| What Is An Ectopic Ureter? | A congenital anomaly in which the ureter/s do not enter the bladder at the correct place resulting in incontinence and recurrent infections. |
| What Procedures Are Available to Correct Ectopic Ureters? | -Ureteral transplantation -Urethroscopic laser correction |
| What Are The Pre-Operative Nursing Considerations For Ectopic Ureter Correction? | -Urinary catheterisation to remove urine -Antibiosis -Abdomen aseptically prepared for ureteral transplantation -Caudal abdomen and perineum aseptically for urethroscopic correction (with purse string suture) |
| What Are The Intra-Operative Nursing Considerations For Ectopic Ureter Correction? | -Careful tissue handling if scrubbed in -Packing of abdomen to reduce contamination -Bladder flipped for ventral access (avoiding major blood vessels) |
| What Are The Post-Operative Nursing Considerations For Ectopic Ureter Correction? | -Monitor urine output (should be 1-2ml/kg/hr minimum) -Monitor for uroabdomen -Analgesia -Antibiosis |
| Define Nephrotomy | A temporary incision into the kidney. |
| Why Might A Nephrotomy Be Performed? | -To remove kidney calculi |
| What Are The General Steps To A Nephrotomy Procedure? | An incision is made into the renal pelvis (the funnel shaped expansion of the cranial end of the ureter) the calculi removed, the incision is then repaired. |
| Define Nephrectomy | Removal of the kidney. |
| Why Might A Nephrectomy Be Performed? | -Severe trauma -Neoplasia -Hydronephrosis -Severe pyelonephritis |
| What Are The General Steps To A Nephrectomy Procedure? | -Other kidney assessed prior to surgery to ensure functioning adequately to compensate -Midline laparotomy -Renal artery and vein are ligated close to the aorta and caudal vena cava, the ureter is ligated and transected adjacent to the bladder |
| What Are The Benefits To Neutering Female Patients? | -Prevents unwanted pregnancies -Prevents unwanted oestrus cycles -Reduces the risk of mammary tumours -Prevents the development of pyometra |
| When Is The Best Time To Neuter Female Patients? | -Often before the first season or midpoint between two seasons -Recommended before first season (6 months old) to get full benefits -Larger breeds often left until 12-18 months of age (to allow to have a cycle) -Pre-pubertal neutering in cats |
| Why Are Large Breed Dogs Often Left Till 12-18 Months Of Age For Neutering? | -Increased risk of orthopaedic and urinary issues if neutered too early |
| What Is An Ovariohysterectomy? | The removal of both the uterus and ovaries. |
| What Are The General Steps To An Ovariohysterectomy? | -The ovaries are located and ligatures tied around the arteries -The ovarian ligament is then cut -A ligature is placed around the uterine stump as close to the cervix as possible to ligate the uterine arteries The uterus is then removed |
| What Is An Ovariectomy? | Removal of the ovaries, uterus is left in-situ. |
| What Piece Of Surgical Equipment May Be Used To Help A Surgeon Locate The Ovaries? | Spay hook. |
| What Is Ovarian Remanent Syndrome? | When part of an ovary has been left in-situ, which may cause minor signs of heat. |
| What Are The Pre-Operative Nursing Considerations For Ovariohysterectomy/Ovariectomy? | -Taking an appropriate medical history to include the time of the last season, and whether their is a chance the animal could be pregnant -Patient preparation - ventral abdomen aseptically prepared in dogs, flank in cats |
| What Are The Intra-Operative Nursing Considerations For Ovariohysterectomy/Ovariectomy? | -Positioning - right lateral recumbency for cats, dorsal recumbency for dogs -Careful monitoring, especially during the breaking of the ovarian ligament – most painful part of procedure |
| What Are The Post-Operative Nursing Considerations For Ovariohysterectomy/Ovariectomy? | -Monitor for haemorrhage (pale mucous membranes, tachycardia, weaker pulse) |
| What Are The Benefits To Laparoscopic Spays (Keyhole Surgery)? | -Increased visualisation -Smaller incision -Less trauma and haemorrhage -Decreased post-op pain -Improved recovery |
| What Is The Two Port Laparoscopic Spay Technique? | -Ventral abdomen aseptically prepared -Placement of veress needle (inflation of abdomen) -Stab incision -Port 1 - laparoscope -Port 2 - forceps and ligature -Ovariectomy hook used to secure ovary -Ovary ligatured and cut, removed through port |
| What Is The Three Port Laparoscopic Spay Technique? | -Ventral abdomen aseptically prepared -Placement of veress needle (inflation of abdomen) -Stab incision -Port 1 - laparoscope -Port 2 - forceps -Port 3 - ligature -Ovary grasped, ligatured, and cut, removed through port |
| What Are The Pre-Operative Nursing Considerations For Laparoscopic Spay? | -Mid-xiphoid to the pubis, and lateral skin edges aseptically prepared -Equipment prep |
| What Are The Intra-Operative Nursing Considerations For Laparoscopic Spay? | -Positioning in dorsal recumbency – often rotated -Inflation of abdomen with carbon dioxide - monitor ventilation as may put pressure on diaphragm, also monitor for hypercapnia due to carbon dioxide being absorbed by the body and air-embolism |
| What Are The Post-Operative Nursing Considerations For Laparoscopic Spay? | -Monitor for haemorrhage (pale mucous membranes, tachycardia, weaker pulse) |
| What Is The Difference Between An Open And Closed Pyometra? | Open pyometra = Cervix open to allow pus to escape as discharge Closed pyometra = Cervix closed, pus and infection trapped within uterus |
| How Is A Pyometra Treated? | Patient stabilisation and ovariohysterectomy. |
| Define Orchidectomy | Removal of the testes. |
| Define Cryptorchid | Failure of one or both testicles to descend into the scrotum. |
| Define Monorchid | Animal with only one testicle in the scrotum. |
| What Is There An Increased Risk Of With Cryptorchid Animals? | Neoplasia. |
| How Are Male Cats Castrated? | -Via scrotal orchidectomy -Scrotal incision and testes are pulled out, ligature applied to vas deferens or vascular bundle tied in a knot, testes removed and vascular bundle released back into scrotum -Heals by secondary intention |
| What Are The Two Methods For Dog Castration? | -Prescrotal orchidectomy = Testes pushed forward into a single incision, ligatured and removed -Scrotal ablation = Scrotum removed as well as testes, usually performed when tumours are present |
| How Are Cryptorchid Testicles Removed? | Via exploratory laparotomy to find testicle/s in abdominal cavity. |
| What Are The Pre-Operative Nursing Considerations For Castration? | -Aseptic preparation of scrotal area |
| What Are The Intra-Operative Nursing Considerations For Castration? | -Careful monitoring especially when surgeon pulling on vas deferens - most painful part of procedure |
| What Are The Post-Operative Nursing Considerations For Castration? | -Monitor for haemorrhage (pale mucous membranes, tachycardia, weaker pulse) -Monitor for seroma formation |
| Why Might Caesarean Sections Be Performed? | -Primary or secondary uterine inertia -Foetal oversize -Foetal malpresentation -Obstruction of the birth canal -Elective reasons (breed dystocia etc) |
| What Are The General Considerations For Caesarean Sections? | -Quick as possible -Increased risk of hypoxia due to pressure in mothers abdomen, increased pressure on blood vessels -Delayed gastric emptying -Drugs that cross the blood brain barrier in the mother will cross the placental barrier -Opioid for premed |
| What Are The General Steps To A Caesarean Procedure? | -Midline incision or flank depending on surgeon preference -Surgeon will open amniotic sac, deliver foetuses, clamp umbilical cord -Foetus dropped into towel held by assistant to maintain asepsis -Assistant will stimulate breathing and tie off cord |
| What Are The Post-Operative Nursing Considerations For Caesarean Section (Mother)? | -Keep in sternal recumbency -Observe for vomiting -Introduce young as soon as possible – constant supervision -Monitor for post-op complications -Get mum and young home as soon as possible |
| What Are The Post-Operative Nursing Considerations For Caesarean Section (Neonates)? | -Absorbent bedding -Heat lamps, blankets etc -Place into clean, dry, warm towel -Clear fluids from nose and mouth -Stimulate breathing if necessary -Check for congenital defects -Get suckling as soon as possible |
| List Some Potential Complications To The Mother Following Caesarean Section? | -Haemorrhage -Hypovolaemia -Hypothermia -Peritonitis from exposure to uterine fluid -Wound infection or breakdown -Interference with the wound by the neonates sucking (dependant on incision site) -Problems with the dam accepting the litter |
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aimee_knows_nothing
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