Chapter 2: Preoperative Patient Consideration

Describe hair removal protocols for a variety of soft tissue, orthopedic, neurologic, and miscellaneous surgical cases.

- 40 clipper blade - use "pencil grip" when using clippers - 2 blade width rule - trim against hair growth - remove hair with vacuum - joint above and below (for orthopedics)

List antiseptic products available for use to prepare patients for surgery.

- Povidone- Iodine scrub and solution - Chlorhexidine scrub and solution - alcohol or saline (used as rinse)

Explain the steps to perform a sterile preparation of the surgical site.

- clip hair - vacuum hair off - scrub with iodine or chlorhexidine scrub followed by rinse with saline or alcohol. repeat this a min of 3 times - make sure to use one of the sterile techniques (ex target aka bull's-eye)

Discuss potential patient reactions from clipper or chemical irritation.

- clipper burn - can inhibit wound healing if irritation is over the proposed incision site -irritation can promote bacteria growth leading to infection - cause patient to lick excessively - chemical reactions manifests as plaques or wheals from prepping products

Discuss different patterns used in applying materials for the surgical preparation.

- target aka "bull's-eye" - orthopedic pattern - perineal pattern

List the supplies required for IV catheter placement.

1. catheter 2.injection caps, t-ports and fluids 3. extension sets 4. tape 5. clippers 6. cotton balls with chlorhexidine scrub 7. cotton balls with alcohol or saline 8. Hep flush 9. Bandage material (vet wrap)

Discuss the 5 indications for placement of an intravenous (IV) catheter

1. site of placement 2. length of time the catheter will be needed 3. reason for the placement 4. diameter of vessel 5. length of vessel

why does an orthopedic "clip and prep" of an extremity need to include a circumferential clip around the entire limb? a. if the incision goes all the way through the limb and out the other side the other side will already be prepared for the scenario b. if the surgeon mistakenly incises the wrong side of the limb with the first incision, and if the leg is clipped the mistake is easily corrected c. for patient comfort d. all of the above. e. none of the above

E

true or false: for orthopedic surgeries of the extremity, only the side of the limb to be incised needs to be clipped and prepped

False

how can the patient's correct identity be verified?

ID band, cage card, medical record + dr

what is the primary purpose of the anesthesia form?

The anesthesia form "tells the story" of the anesthesia event from beginning to end. It is an important piece of the patient's medical record and can serve as a legal document. It can help guide the choice of anesthetic protocols and follow in the future

true or false: Central venous pressure measurements require that a central line be placed

True

true or false: Peripheral catheters generally suffice for short-term use (1-3 days) and central lines are more appropriate for long-term vascular access (>3days)

True

what information is included the patient's signalment? a. age, gender, breed b. "proceed with caution" signals c. previous surgical history d. all of the above

a. age gender, breed

the basic principles of pain management involve which of the following? a. preemptive analgesia, multimodal analgesia and appropriate follow-up analgesia b. the use of NSAIDs c. the use of opioid as a premedication d. none of the above

a. preemptive analgesia, multimodal analgesia and appropriate follow-up analgesia

what position is the patient placed in for the abdominal exploratory surgery? a. Sternal recumbency b. Dorsal recumbency c. right of left lateral recumbency, depending on which side of the abdomen needs to be accessed

b. Dorsal recumbency

why should taking the patient's temp be saved for the end of the PE? a. It is the least important part of the PE b. most patients dislike having their temp taken rectally and it is easier to preform a PE on a cooperative patient c. by the end of the exam of the PE, the examiner should have already ascertained whether the patient is febrile and only then does the temp need to be taken d all of the above e. none of the above

b. most patients dislike having their temp taken rectally and it is easier to preform a PE on a cooperative patient

which tactic(s) may stop a cat from purring during thoracic auscultation? a. gently squeezing the thorax with one hand while the other hand holds the stethoscope on the chest wall. b. massaging under the cat's chin c. holding the cat near a sink or faucet, with or without water running. d. all of the above e. none of the above

c. holding the cat near a sink or faucet, with or without water running.

a surgical consent form includes all of the following? a. all of the patient's prior surgeries, medical history and current medications b. an estimate for the surgical procedures to be performed c. identification of the patient, the specific procedures to be performed along with the potential risks to the patient, and the physician who will be performing the surgeries and the signature of the owner consenting to the procedures d. patient's diet e none of the above

c. identification of the patient, the specific procedures to be performed along with the potential risks to the patient, and the physician who will be performing the surgeries and the signature of the owner consenting to the procedures

all of the following are goals of balanced anesthesia except a. maximize the positive effects of certain drugs b. minimize the side effects of certain drugs c. maximize the likelihood of allergic reactions d. minimize cardiac depression

c. maximize the likelihood of allergic reactions

what position is the patient placed in on the surgery table for thoracic surgery? a. Dorsal recumbency b. Right lateral recumbency c. left lateral recumbency d any of the above may be appropriate e. none of the above

d any of the above may be appropriate

which of the following provide multimodal anesthesia? a. gas anesthetic, morphine, butorphanol and fentanyl b. NSAIDs such as Carprophen and meloxicam c. Xylazine and medetomidine d opioids, NSAIDs, local anesthetic gents, and A2 adrenergic agonists e. none of the above

d opioids, NSAIDs, local anesthetic gents, and A2 adrenergic agonists

the minimum database (MDB) for a young healthy feline patient having elective surgery would most likely include which of the following diagnostic tests? a. CBC, parvovirus test, electrolytes and blood typing b. CBC, blood serum chemistry panel, FeLV/FIV test, Fecal test and UA c. FEL/FIV, abdominal xrays, and ECG d. PCV/TS, estimate of BUN, BG and ALT e. PCV/TS, T4 and FEL/FIV test

d. PCV/TS, estimate of BUN, BG and ALT

what can be done to prevent a deep-chested dog from tilting to the side while in dorsal recumbency? a. using a V-trough b. bracing the chest with sandbags c. tying the forelegs crossed over the chest d. all of the above e. both a and c

d. all of the above

what is the purpose of premeditating a patient before inducing anesthesia for surgery? a. to provide a smooth transition to anesthesia b. to provide preemptive analgesia c. to facilitate a smooth recovery from anesthesia d. all of the above e. none of the above

d. all of the above

what needs to be done to the patient after the hair clip and before the patient is moved into the surgery suite? a. vacuum the clipped hair and clipped area of the skin b. check to see whether the bladder needs expressing c. perform initial skin scrub d. all of the above e. none of the above

d. all of the above

which of the following should be performed on the day of the surgery? a. thorough physical exam b. review of the patient's medical history with the owner c. verbal review of the consent form and obtain the owner's signed consent for anesthesia and surgery d. all of the above e. none of the above

d. all of the above

why is it important to review all medications and supplements that a patient is taking before beginning the surgery? a. to avoid possible drug interactions b. to know whether other diagnostic tests are indicated. c. to make any necessary adjustments to the anesthetic protocol d. all of the above

d. all of the above

why are leading questions inappropriate to ask during the history taking? a. they make the owner feel compelled to answer a certain way b. they may encourage the owner to answer inaccurately c. they are appropriate and should be asked d. both a and b e. none of the above

d. both a and b

why should the patient's identity be verified before the animal is anesthetized for surgery? a. to avoid anesthetizing the wrong patient b. to avoid performing surgery on the wrong patient. c. it is not nesscessary to cross-check the patient's identity because any good tech should be able to distinguish all black cars in the hospital d. both a and b

d. both a and b

which of the following is the next step after the patient has been induced with anesthesia and the intended surgical site has been clipped and had initial pre preformed?

d. the patient is moved to the surgery room and is positioned on and secured to the surgery table, and the final prep is performed

Identify appropriate sites for placement of IV catheters.

dog: cephalic and lateral saphenous veins cats: cephalic, medial saphenous and femoral veins

which of the following contributes to hypothermia in the anesthetized patient? a. anesthetic-induced muscle relaxation b. the surgical prep using water and alcohol c. administering room temp IV fluids d. breathing cold gases from compressed cylinders e. all of the above

e. all of the above

which of the following should be assessed during the history taking? a. patient's attitude and mental status b. patients previous medical problems and treatments c. patient's ability to see and hear d. patient's gait and body condition e. all of the above

e. all of the above

what are some safe techniques for preventing hypothermia in small animal surgical patients? a. circulating warm-water pads b. electric heating pads c. snuggleSafe discs d all of the above e. both a and c

e. both a and c

which is true regarding positioning patients on the surgery table? a. the particular position of the limb is insignificant. b. Bony prominences should be cushioned to protect against excessive compression c. the patient's legs should not be forced into unnatural anatomical alignment d. all of the above e. both b and c

e. both b and c

True or false: when scrubbing the skin on the intended surgical site, sufficient friction should be generated to cause hyperemia

false

true or false: It is appropriate to premeditate a patient with a preexisting cardiovascular disease with Xylazine.

false

true or false: Chlorhexidine scrub or solution can be used as he final, serial surgical paint

false - you cannot use any type of "scrub" for the final paint because they contain detergents and solutions do not

true or false: Anesthesia (as provided by gas anesthetic) provides multimodal analgesia

false??? gas anesthesia doesn't have an analgesia component

True or false: Anticholinergics such as glycopyrrolates and atropine, increase the heart rate and provide purely beneficial effects for the patient

false???? they increase the heart rate but thats not always a good thing

true or false: it is accepted practice to scrub a patient initially with a povidone-iodine product.

true

truer false: the first spray of the final prep should be directly over he incision site

true