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Immediate post-operative care (Nursing post-caesarian (Making sure the…
Immediate post-operative care
Anaesthetic recovery
One of the most dangerous phases of anaesthesia, should be constantly monitored until the ET tube is removed
The ET tube is removed:
In the dog, after the gag-reflex has returned
In the cat, often preferred to removed before there is a gag reflex present. If the ET tube is left in for a prolonged period, this can lead to laryngeal spasm. The tube can be removed when there is a strong palpebral reflex or the ears are twitching
In some patients it may be preferable to leave the ET tube in for a longer period, e.g. brachycephalic breeds, a dog that has regurgitated under anaesthesia
Monitoring
Possible complications that can occur in the post-operative patient are:
Vomiting
Hypothermia
Haemorrhage
Postural complications
Respiratory arrest
Cardio pulmonary arrest
Shock
Infection
Wound breakdown
Animals should recover from anaesthesia in an environment where there is constant or regular nursing attendance so that any problems can be recognised and rectified quickly
Close supervision of a patient should be paid until:
Its rectal temperature is greater than 37 degrees
Its trachea is extubated
It can lift its head up without assistance
Post operative checks include:
Heart rate
Pulse rate
Blood pressure
O2 saturation of haemoglobin
Post-operative haemorrhage
Can be minor, oozing from the wound requiring the application or changing of a dressing
Can be serious/life threatening, particularly if there is a large volume of blood lost internally as might occur if a ligature slipped from around an artery e.g. after a bitch spay
Surgical sites should be monitored for signs of bleeding. Pale MM, a swollen abdomen, rapid heart rate or collapse might indicate internal haemorrhage
If internal haemorrhage is suspected, the patient should be placed on IVFT, blood transfusion or repeated surgery to identify the source of bleeding
Respiratory/cardiac arrest
60% of small animal perioperative fatalities occur in the recover phase, it is therefore possible that patients may suffer a cardiac or respiratory arrest during recovery
Emergency steps must be taken
Cardiac arrest
Ensure there is a patent airway
Begin cardiac massage: this is best performed with the animal in right lateral recumbency with a sandbag wedged under the chest. - Using the palm of your hand, apply pressure across the costochondral junctions which overlay the heart.
Use a rate of 60-120 compressions per minute
Tilt the patients head down to improve venous return
Rapid IVFT
Drug therapy
Respiratory arrest
Establish a patent airway (ET tube)
Ventilate the lungs using an anaesthetic circuit or ambu bag
Administer 4-6 breaths rapidly and then ventilate at 8-16 breaths per minute
Make sure there is good chest movement
Monitor pulse (cardiac arrest may occur) and watch for spontaneous respiration
Dopram can be used in newborn puppies and kittens to stimulate breathing
Analgesia
Signs of pain include:
Vocalisation
Hiding away/sitting in an 'awkward' position
Reluctance to use the affected area e.g. lameness
Reluctance to eat in patients that have had oral surgery
Maintaining body temperature and preventing hypothermia
Patients temperature should be checked every 15-30 minutes once until it reaches 37 degrees. Provide post-operatively a warm kennel, free from draught, with soft bedding and an incontinence pad
Nursing post-caesarian
Making sure the bitch is fully recovered from the anaesthetic before putting neonates with her, incase of accidental suffocation if sedated
Keep neonates warm in an incubator
Encourage neonates to suckle as soon as possible
Monitor the introduction of the neonates to the mother carefully. Animals may reject their young after caesarian and can also harm or cannibalise her babies
General care and advice for the owner includes to monitor the incision site carefully due to it possibly becoming traumatised during nursing, during lactation feed the animal a high protein diet such as premium puppy/kitten food, puppies/kittens should be weighed regularly to ensure all are suckling properly
Nursing the spinal patient after surgery
Refers to nursing patients with some degree of paralysis or paresis
Often require intensive nursing as they are unable to move themselves so care must be taken to attend to their bodily functions, prevent pressure sores and hypostatic pneumonia which can result from laying in one position for too long, provide physiotherapy and mental stimulation
Monitor for signs of pain and ensure analgesia is adequate
If the patient has had a
myelogram
the head should be elevated slightly on a foam pillow to prevent the contrast medium from running into the brain as this will cause eye damage and seizures.
Long-term postoperative care
Walk-in kennels are the most satisfactory design for the spinal recovery patient. The kennel should be small enough to restrict patient activity and large enough to allow nursing access
Foam mattresses are very suitable as they provide padding to prevent decubital ulcers and are easy to clean. Selecting a mattress that covers the entire floor of the kennel is recommended to stop the patient from falling off the edge.
Specific considerations with spinal cases
Food and water must be offered on a regular basis. Initially patients will need hand feeding and watering
A suitable ambient temperature
Monitor TPR 2x daily
Patients with neck braces may require feeding from a height to avoid the neck bending
Feeding: calorific requirement may be increased post operatively
Monitor weight daily
Monitor general neurological signs
Monitor urination - bladder may need expressing manually or catheterising
Assess reflexes/ bladder control/ pain perception
Moving the animal may require 2-3 nurses. Slings and towels can be useful recovery aids as they encourage the animal to start to test their body load
Recumbent patients need turning every 2-4 hours to prevent hypostatic pneumonia
Coupage - firm patting of the chest wall to aid elimination by coughing
Provide mental stimulation: TLC, radio, owner visits
Use physiotherapy to keep the joints moving
Where possible ensure same staff members remain with nursing care so progress is assessed consistently and a bond develops between the patient and nurse