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Surgical Nursing Review Surgical Procedures

Common Soft Tissue Surgeries Abdominal exploratoryAKA Celiotomy or laparotomy Indications diagnostics or curative Special instrumentsSoft tissue surgery pack, lap sponges, Balfour retractors Patient positioning- Dorsal recumbencyFour quadrant draping

Common Soft Tissue Surgeries Abdominal exploratory ClosureThree LayersLinea alba- Holding layer Subcutaneous layer- reduce dead space Skin Possible complications Sepsis/peritonitis Dehiscence EviscerationHemorrhage

Common Soft Tissue Surgeries Gastrotomy- Surgery involving stomachIndications Foreign body removalNeoplasiaDiagnosticsGastric perforations. Enterotomy- Small or large intestine Indications NeoplasiaBiopsies Foreign body removalLinear(plication) vs non-linear

Common Soft Tissue Surgeries Gastrotomy and Enterotomy Special instrumentation Soft tissue surgery pack(Doyen intestinal clamps)Balfour retractorsLaporatomy sponges Suction, lavage fluids Patient positioningDorsal recumbency with four quadrant draping Special considerationsMust change gloves and pack after closing stomach or intestine Closure Stomach closed in 2 layers, mucosa and submucosa, intestines simple interrupted layer and pressure checkAbdomen closed in three layers

Common Soft Tissue Surgeries Intestinal resection and anastomosis Excision/removal of a segment of bowel- re-establishment of the two remaining sections. Positioned in dorsal recumbency with four quadrant draping.Instruments- soft tissue surgery pack, lavage fluid, lap sponges. Gastric dilatation and volvulus Stretching of an organ beyond normal dimensions and rotation of organ- rotation on mesenteric axis. Position of stomach corrected and gastropexy is performed. Positioned in dorsal recumbency with four quadrant draping.Instruments- soft tissue surgery pack, lavage fluid, lap sponges.

Common Soft Tissue Surgeries Ovariohysterectomy(spay)Surgical removal of uterus and ovariesRecommended at 4 to 6 months, before first heat to reduce chances of mammary tumors Position: Dorsal recumbencyInstrument soft tissue pack with spay hookPatient Draping- 4 quadrant draping Post-op consideration- HemorrhageCesarean sectionDystocia not responding to medical management May be done with or spay Neonates must be rescucitated Pyometra Opened vs Closed(Cervix) Pus filled uterusSpay that is considered a surgical emergency Must provide antibiotic therapy in addition to pain meds and anesthesia

Common Soft Tissue Surgeries Orchiectomy(Castration)Canine- Prescrotal incision Feline- Scrotal incision Left to heal by second intention Opened vs closed- incise parietal vaginal tunic on opened but not on closed castrations Patient positioning- Dorsal recumbency Patient draping- Single fenestrated drape appropriate Cryptorchid- Inguinal vs. Abdominal Abdominal exploratory for abdominal

Common Soft Tissue Surgeries Cystotomy- Incision into urinary bladder IndicationsRemoval of cystic calculi (Struvite most common) Biopsy/diagnostics- Transitional cell carcinoma Patient positioning- Dorsal recumbency 4 quadrant draping.Special instruments- Soft tissue surgery pack, bladder spoon and urinary catheter.

Common Soft Tissue Surgeries Ear Procedures Instruments- Soft tissue surgery packPatient position- Lateral recumbency, affected ear upwardDraping- four quadrant drapingPostoperative considerations- Mutilation of surgical site, bandage ear, e-collar Aural Hematoma Formation of hematoma within auricular cartilage on concave surface of the earTreat underlying cause as well as Lateral ear resectionLateralization of the horizontal ear canalIndicated in animals with chronic otitis externa and calcified ear canals

Common Soft Tissue Surgeries Eye procedures Patient position- Sternal or lateral recumbancyDraping- specialized eye drape Instruments- Eye pack, including half curved tissue forceps, chalazion forceps, Jaeger lid plate, tenotomy scissors, needle holdersEntropion Inward rolling of eyelid Holtz-celsus procedure Protrusion of the gland of the third eyelid Cherry eyeTack down procedure, common for cherry eye to recur Eyelid mass removal Meibomian(sebacous) gland adenoma most common Enucleation Trauma, glaucoma, neoplasia Surgical removal of the globe

Surgical Procedure Orthopedics Fracture assessment Bone location- Which bone?Open or closed fracture- Open penetrated through the skin. Grade I to III Location of fracture on bone-Diaphysis, epiphysis, metaphysis. Type of fracture- Oblique, spiral, comminuted or transverse, Salter Harris Fracture.

Salter Harris Fractures

Salter Harris fracture types- growth plate fractures Type I runs through physis Type II Metaphysis and physis Type III fracture runs through physis and epiphysis Type IV metaphysis, physis and epiphysis Type V Crushing injury to physis- May not be detected on rads

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Surgical Procedure Orthopedics Internal vs. External fixationAntibiotic therapy is a MUSTVery painful- Adequate pain managementSplints/bandages- When needed Restricted activity for 6-8 weeks Follow up radiographs 4-6 weeksJuvenile animals must be monitored more closely

Surgical Procedure Orthopedics Internal fixation -Directly on or in bone Bone platesScrews Interlocking nailsIntramedullary pinsKirschner wireCerclage wire External fixation- Surgical or non surgical(Casts and splints) CastsRigid splintsSK fixation Kirschner-Ehmer fixation Ring fixation

External Fixation vs. Internal Fixation

Fracture repair of tibia and fibula 16

Surgical Procedure Orthopedics AmputationThoracic or pelvic limbsTrauma, neoplasia, irrepairable fractures, neuropathies Hip dysplasiaTriple pelvic osteotomy(Dogs under 10 months) Femoral head osteoctomy Total hip replacement Cranial Cruciate ligament ruptureExternal capsular repair Tibial plateau leveling osteotomy Tibial tuberosity advancement Medial patellar luxation Grade 1 to 4

Other Surgical Procedures Fine needle aspirateExfoliate cells to examine cells in mass Needle biopsy Larger needle is used to obtain small tissue sample Mass removal Incisional(remove part mass) vs. excisional(remove entire mass). Punch biopsies Punch biopsy used to obtain tissue sample, may incisional or excisional.

Minimally Invasive Surgeries Laporascopy- Performing abdominal procedure with laporascopic camera unit.Smaller incisions faster recoveryGastropexies, obtain biopsies, exploratory Fast patient 12 hours Express bladderDrape patient with four quadrant draping technique Position depends on procedure

Minimally Invasive Surgeries

Laparoscopy

Minimally Invasive Surgeries EndoscopyTechnique to examine internal organsHigh-yield, minimally invasive Obtain biopsies, remove foreign bodies Endoscopy is done under general anesthesiaGastrointestial- upper(Esophagus , stomach duodenum) or lower GI(colon) Rhinoscopy, tracheoscopyCystoscopy