Surgical Patient Care for Veterinary Technicians and Nurses E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 580

Veröffentlichungsjahr: 2023

Beschreibung

Surgical Patient Care for Veterinary Technicians and Nurses A step-by-step guide to caring for small animal surgical patients Surgical Patient Care for Veterinary Technicians and Nurses, Second Edition offers a complete, practical guide to nursing care for patients undergoing common and advanced surgeries in small animal practice. Written by veterinary technicians for veterinary technicians, the book is organized chronologically, beginning with the initial client contact and continuing through surgery to discharge and aftercare. The new edition significantly expands the surgical procedures chapter, adding new procedures, and incorporates updates to reflect new knowledge throughout. Topics cover all aspects of surgical patient care, including surgical assisting and patient comfort, for orthopedic, soft tissue, and emergency surgeries. A companion website offers video clips and review questions and answers, plus the figures from the book in PowerPoint. The Second Edition features: * Hundreds of clinical photographs to support the text, with more than 100 images new to this edition, including many new instrument photos * A logical chronological organization, from initial client communication through to discharge and aftercare instructions * Topics ranging from laboratory testing, patient preparation, and instrument care and maintenance to bandaging, client communication, rehabilitation, encompassing orthopedic, ophthalmic, soft tissue, and emergency surgeries * Expanded coverage of surgical procedures and wound management * A companion website with video clips, review questions and answers, and the figures from the book in PowerPoint Surgical Patient Care for Veterinary Technicians and Nurses is equally useful for veterinary technician and nursing students and for veterinary technicians and nurses in practice, providing practical advice in a well-illustrated format.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

Foreword to the First Edition

Preface

Acknowledgments

Author Biographies

List of Contributors

About the Companion Website

1 History and Physical Examination

History

Physical Exam

References

2 Preoperative Planning

Laboratory Tests

Other Diagnostic Tests

Imaging

Medications

References

3 Asepsis and Infection Control

Surgical Suite Preparation

Theater Design

Cleaning

Solutions to Use for Cleaning

Patient Preparation

Clipper Care

Patient Skin Preparation

Patient Prep Patterns

Patient Positioning

Patient Warming

Patient Sterile Prep

Personnel Preparation

Gowning

Instrumentation

Instrument Cleaning and Care

Pack Preparation

Pack Wrapping and Instrument Packaging

Sterilization

Monitoring the Sterilization Process

Shelf Life

Reference

Webliography

4 Intraoperative Surgical Assistant and Circulating Nurse

Patient Positioning

Sterile Patient Prep

Patient Draping

Other Responsibilities

Suture Materials and Suture Patterns

Suture Patterns

Cutting Suture

Staples

Circulating Nurse

References

Additional Resources

5 Surgical Procedures

Abdominal

Head and Neck

Minimally Invasive

Neurosurgery

Orthopedic

Hindlimb

Thoracic

Other Surgery

References

Additional Resources

Webliography

6 Wound Management

Types of Wounds

Phases of Wound Healing

General Wound Care

Burns

References

7 Postoperative Care

Anesthesia Recovery

Self‐Trauma

Housing

Urinary Bladder Care

Bandages

References

8 Aftercare and Home Care

Client Instructions

Physical Rehabilitation

Follow‐Up

References

Glossary

Index

End User License Agreement

List of Tables

Chapter 1

Table 1.1 Normal feline and canine TPR.

Table 1.2 Dosing and timeline of administration of sedative agents [4].

Chapter 2

Table 2.1 Complete blood count reference values.

Table 2.2 Serum chemistry reference values.

Table 2.3 Common blood collection tubes.

Table 2.4 United States Nuclear Regulatory Commission occupational dose lim...

Table 2.5 Sample radiograph technique chart.

Table 2.6 Non‐steroidal anti‐inflammatory drugs (NSAID) doses.

Table 2.7 Opioid drug doses.

Chapter 3

Table 3.1 Abdominal procedures’ clipping guidelines.

Table 3.2 Thoracic procedures’ clipping guidelines.

Table 3.3 Forelimb orthopedic procedures’ clipping guidelines.

Table 3.4 Hindlimb orthopedic procedures’ clipping guidelines.

Table 3.5 Neurologic procedures’ clipping guidelines.

Table 3.6 Ophthalmic procedures’ clipping guidelines.

Table 3.7 Facial/aural procedures’ clipping guidelines.

Table 3.8 Perineal procedures’ clipping guidelines.

Table 3.9 Sterilization guidelines.

Chapter 4

Table 4.1 Suture characteristics.

Table 4.2 Rules of aseptic technique.

Chapter 6

Table 6.1 Wound healing chronology.

Table 6.2 Centers for disease control criteria for defining a surgical site ...

Table 6.3 Wound cleaners.

Table 6.4 Topical treatments.

Table 6.5 Degree of classification of thermal burns.

Chapter 8

Table 8.1 Normal range of motion – flexion and extension.

List of Illustrations

Chapter 1

Figure 1.1 Lateral radiograph of a cat with cystic calculi.

Figure 1.2 Old charts: a mnemonic device to remember important aspects of a ...

Figure 1.3 (a) An obese pug (BCS 7) shown in lateral view, (b) an obese pug ...

Figure 1.4 (a) A thin pug (BCS 4) shown in lateral view, (b) a thin pug (BCS...

Figure 1.5 A physical exam on a comfortable floor mat provides patient and s...

Figure 1.6 The “sit test” often indicates a ruptured cranial cruciate ligame...

Figure 1.7 A Border Collie with carpal hyperextension.

Figure 1.8 Patients with biceps tendon conditions become more lame after per...

Figure 1.9 Labrador Retriever showing breakdown of surgical repair of lacera...

Figure 1.10 (a) Lateral radiograph of a normal left stifle, (b) lateral radi...

Figure 1.11 (a) Cranial radiograph of a right stifle showing Grade 4 medial ...

Figure 1.12 Patient with intervertebral disc disease demonstrating absent co...

Chapter 2

Figure 2.1 Left to Right: green (heparin), red (plain, no additive), and pur...

Figure 2.2 Blue (sodium citrate) blood collection tube.

Figure 2.3 “Puddle” of alcohol on a female dog prior to performing a cystoce...

Figure 2.4 Ultrasound‐guided cystocentesis.

Figure 2.5 Ultrasound image showing the urinary bladder (dark gray or hypoec...

Figure 2.6 Arthrocentesis of a stifle step 1: clipping the hair.

Figure 2.7 Arthrocentesis of a stifle step 2: prepping the skin.

Figure 2.8 Arthrocentesis of a stifle step 3: positioning the leg.

Figure 2.9 Arthrocentesis of a stifle step 4: inserting the needle two‐third...

Figure 2.10 Arthrocentesis of a stifle step 5: aspirating synovial fluid.

Figure 2.11 Arthrocentesis of a stifle step 6: applying pressure to the tap ...

Figure 2.12 Applying needle aspirate to a slide for cytology.

Figure 2.13 Idexx

™

digital cytology instrument.

Figure 2.14 Dosimeter for measuring radiation exposure.

Figure 2.15 Radiograph showing the lateral view of a severely comminuted dis...

Figure 2.16 Computerized Tomography (CT) 3‐D reconstruction of the same frac...

Figure 2.17 Shaving a patient for an abdominal ultrasound covers the distanc...

Figure 2.18 Performing an abdominal ultrasound with the patient in lateral r...

Figure 2.19 Sector ultrasound transducer.

Figure 2.20 Left kidney ultrasound image using a sector transducer.

Figure 2.21 Linear ultrasound transducer.

Figure 2.22 Left kidney (same as in Figure 2.20) ultrasound image using a li...

Figure 2.23 Contrast cystogram of patient hit by a car resulting in pelvic a...

Figure 2.24 University of Wisconsin (UW) – Veterinary School Pain Scale.

Figure 2.25 Pain pathway.

Figure 2.26 Simplified inflammatory cascade diagram.

Chapter 3

Figure 3.1 Bouffant hat.

Figure 3.2 Surgeon’s cap.

Figure 3.3 Surgical hood.

Figure 3.4 Surgical table with split top open for cleaning.

Figure 3.5 Disinfectants for cleaning the surgical suite.

Figure 3.6 Proper angle of clipper blade to skin.

Figure 3.7 Angle of clipper blade to achieve a straight clipped edge.

Figure 3.8 Infusing prepuce with dilute povidone‐iodine solution.

Figure 3.9 Gently massaging prepuce.

Figure 3.10 Releasing solution from prepuce.

Figure 3.11 Patient clip for lateral thoracotomy.

Figure 3.12 Orthopedic clip for stifle surgery.

Figure 3.13 Vacuuming with hand over end to control suction.

Figure 3.14 Scrub products available for patient prep.

Figure 3.15 Rinsing products available for patient prep.

Figure 3.16 Final solution products available for patient prep.

Figure 3.17 Abdominal prep.

Figure 3.18 Covering the distal end of the limb.

Figure 3.19 Applying a hanging stirrup.

Figure 3.20 Securing the stirrup with tape.

Figure 3.21 Orthopedic prep.

Figure 3.22 Purse string suture in anus – irritation from fecal matter.

Figure 3.23 Thoracic positioner for maintaining dorsal recumbency.

Figure 3.24 Leg tie with half hitch on limb.

Figure 3.25 Table bracket with figure 8 leg tie.

Figure 3.26 Table roller for securing leg tie.

Figure 3.27 Vacuum positioning device.

Figure 3.28 Control box for heated surgery table.

Figure 3.29 Supplemental heating devices.

Figure 3.30 Hot‐air warming system.

Figure 3.31 Alternative warming devices.

Figure 3.32 Sterile prep set with squeeze bottles of solutions.

Figure 3.33 Chloraprep™ final prep applicator.

Figure 3.34 Cleaning nails.

Figure 3.35 Scrubbing the nails.

Figure 3.36 Scrubbing fingers: start at the little finger and divide each fi...

Figure 3.37 Scrubbing the palmar surface.

Figure 3.38 Scrubbing the back of the hand.

Figure 3.39 Scrubbing the arm: divide the arm into four sides.

Figure 3.40 Both arms and hands scrubbed.

Figure 3.41 Rinsing first arm.

Figure 3.42 Rinsing second arm.

Figure 3.43 Letting arms drip at sink.

Figure 3.44 Picking up the towel by just one corner.

Figure 3.45 Drying the hand starting at the little finger and working throug...

Figure 3.46 Drying the arm by pushing the arm through the towel.

Figure 3.47 Place the dry hand on the underside of the towel. Drop the wet s...

Figure 3.48 Picking up the gown holding the arm sleeve seams, just down from...

Figure 3.49 Let the gown unfold.

Figure 3.50 Slide one arm into the sleeve.

Figure 3.51 Slide the other arm into the other sleeve, keeping both hands in...

Figure 3.52 Tying the waist of the gown.

Figure 3.53 The sterile person spins slowly to wrap the gown around them whi...

Figure 3.54 Glove wrapper edge folded under.

Figure 3.55 Right hand grabs the folded edge of the cuff.

Figure 3.56 Hold the glove vertically.

Figure 3.57 Flip the glove onto the hand, thumb to thumb, fingers pointing t...

Figure 3.58 Each hand grabs a folded edge of the cuff – through the gown sle...

Figure 3.59 Stretch the glove to insert the hand.

Figure 3.60 Pull the glove over the hand and completely cover the cuff of th...

Figure 3.61 Unroll the cuff of the glove.

Figure 3.62 Pull sleeve to get fingers into finger holes.

Figure 3.63 Glove wrapper edge folded under.

Figure 3.64 Right hand picks up the top fold of the cuff.

Figure 3.65 The left hand is cupped and slid into the glove.

Figure 3.66 The cuff is left folded.

Figure 3.67 The left hand is slid under the cuff of the right‐hand glove.

Figure 3.68 The right‐hand is cupped and slid into the glove.

Figure 3.69 The cuff is unrolled.

Figure 3.70 The right‐hand returns to the left glove and unrolls the cuff.

Figure 3.71 Presenting contaminated gloved hand for glove removal.

Figure 3.72 The circulating nurse grabs

only the glove

and pulls the glove o...

Figure 3.73 The open hand is left to re‐glove.

Figure 3.74 Stress mat in surgical suite.

Figure 3.75 Tungsten carbide insert (right) in a needleholder jaw.

Figure 3.76 Gold ring handles indicating tungsten carbide inserts.

Figure 3.77 Scissors: (a) Mayo dissecting, (b) Metzenbaum dissecting, and (c...

Figure 3.78 Operating scissors: (a) blunt/blunt, (b) sharp/blunt, and (c) sh...

Figure 3.79 Castroviejo corneoscleral scissors.

Figure 3.80 Ophthalmic scissors – Iris (a) and Stevens tenotomy (b).

Figure 3.81 Bandage scissors.

Figure 3.82 Suture removal scissors and staple remover.

Figure 3.83 Towel clamps: (a) Lorna Non‐Penetrating, (b) Backhaus Penetratin...

Figure 3.84 Scalpel handles (numbers 3 and 4); and Scalpel Blades (a–d) numb...

Figure 3.85 Hemostatic forceps: (a) Mosquito, (b) Kelly, (c) Crile, (d) Roch...

Figure 3.86 Hemostatic forcep tips: (a) Mosquito, (b) Crile, and (c) Kelly....

Figure 3.87 Thumb tissue forceps: (a) Debakey, (b) Russian, and (c) Rat Toot...

Figure 3.88 Adson tips: (a) brown, (b) 1 × 2, and (c) dressing.

Figure 3.89 Thumb tissue forceps (a) Russian, (b) Debakey, and (c) 1 × 2.

Figure 3.90 Needle holders: (a) Olsen‐Hegar and (b) Mayo‐Hegar (note gold ri...

Figure 3.91 Derf needle holder.

Figure 3.92 Mathieu needle holder.

Figure 3.93 Hand‐held retractors: (a) U.S. Army and (b) Senn double ended.

Figure 3.94 Senn double‐ended retractor ends: sharp and blunt.

Figure 3.95 (a) Needle rack, (b) snook spay hook, and (c) groove director.

Figure 3.96 Alligator forceps.

Figure 3.97 Allis tissue forceps.

Figure 3.98 Balfour retractor.

Figure 3.99 Finiochetto retractor.

Figure 3.100 45° Potts Smith scissors.

Figure 3.101 Right angle mixter forcep.

Figure 3.102 Debakey‐Satinsky clamp.

Figure 3.103 Gelpi self‐retaining retractor.

Figure 3.104 Weitlaner self‐retaining retractor.

Figure 3.105 Meyerding retractor.

Figure 3.106 Hohman retractor.

Figure 3.107 Single‐ and double‐action ronguers.

Figure 3.108 Freer periosteal elevator.

Figure 3.109 14 mm Round‐edge straight AO elevator.

Figure 3.110 Hibbs osteotome.

Figure 3.111 Sontec combo nylon mallet.

Figure 3.112 Kern bone clamp.

Figure 3.113 Verbrugge bone clamp.

Figure 3.114 Bone reduction clamp.

Figure 3.115 Stefan mini bone‐holding forceps.

Figure 3.116 Straight Stille‐Liston bone cutting forceps.

Figure 3.117 Jacob's chuck.

Figure 3.118 Securos Surgical

®

TPLO saw.

Figure 3.119 Arthrex

®

power system.

Figure 3.120 Intramedullary (IM) pin, K‐wire, orthopedic wire.

Figure 3.121 Wire twister.

Figure 3.122 Wire end cutter.

Figure 3.123 Wire side cutter.

Figure 3.124 Bolt cutter.

Figure 3.125 Examples of bone plates: 12‐hole reconstruction, 8‐hole DCP, an...

Figure 3.126 Locking plates.

Figure 3.127 TPLO plate – right or left standard, etc.

Figure 3.128 Bone screws: regular head – top, locking head – bottom.

Figure 3.129 Arthroscope, light cable, and camera.

Figure 3.130 Arthroscope assembled.

Figure 3.131 Arthroscopy tower.

Figure 3.132 Arthroscopy instruments: obturators – top, cannulas – middle, a...

Figure 3.133 Laparoscope.

Figure 3.134 Pnuematic drill for neurologic surgeries.

Figure 3.135 Hall drill burs.

Figure 3.136 Frasier laminectomy retractor.

Figure 3.137 Optivisor binocular magnifier.

Figure 3.138 Barraquer wire speculum.

Figure 3.139 Castroviejo eye speculum.

Figure 3.140 Lacrimal cannula.

Figure 3.141 Jaeger lid plate.

Figure 3.142 Stevens tenotomy scissors.

Figure 3.143 Iris scissors.

Figure 3.144 Iris 1 × 2 thumb tissue forceps.

Figure 3.145 Colibri 1× 2 thumb tissue forceps.

Figure 3.146 Castroviejo corneoscleral scissors.

Figure 3.147 Instrument cleaning product and lubricant.

Figure 3.148 Ultrasonic cleaning solution.

Figure 3.149 Ultrasonic cleaning unit overloaded.

Figure 3.150 Instrument lubricant.

Figure 3.151 Holders for instruments in packs.

Figure 3.152 Washing grid on gown.

Figure 3.153 Lay the gown out on the table with the outside of the gown faci...

Figure 3.154 Grasping the seamed edge of the gown closest to the folder, fol...

Figure 3.155 Pick up all layers of the neck with the left hand and all layer...

Figure 3.156 Picking up the edges closest to the folder, fold the gown in ha...

Figure 3.157 Place the left hand at the armhole of the sleeve, slide the rig...

Figure 3.158 Continue the accordion folding until all of the body of the gow...

Figure 3.159 Turn the gown over so the seams of the armholes are found diago...

Figure 3.160 Folding the hand towel starts with laying the towel out on the ...

Figure 3.161 Grasp the top raw edge and fold it down so the towel is folded ...

Figure 3.162 Pick up the towel on either short side to allow the bottom half...

Figure 3.163 Fold the towel in half horizontally. Grasp the top two layers o...

Figure 3.164 Pick up the towel so the bottom half folds underneath.

Figure 3.165 Peel packing options.

Figure 3.166 Protective end cap over sharp instrument; notice multiple seals...

Figure 3.167 Lay the wrapper out on the table in a diamond formation to wrap...

Figure 3.168 Grasp the point of the wrapper closest to the folder and fold i...

Figure 3.169 Grasp the point of the wrapper on either side and fold it over ...

Figure 3.170 Grasp the point of the wrapper on the opposite side. Fold the w...

Figure 3.171 Grasp the final point of the wrapper, fold in the extra materia...

Figure 3.172 Repeat the wrapping with a second wrapper. Label the pack with ...

Figure 3.173 Items in center of wrap for horizontal wrapping method.

Figure 3.174 Farthest long edge of wrapper is folded over items and then bac...

Figure 3.175 Closest long edge is folded over items and folded back on itsel...

Figure 3.176 Side edge is folded over items and folded back on itself for a ...

Figure 3.177 Opposite side edge is folded over and secured with tape.

Figure 3.178 Properly labeled drape pack.

Figure 3.179 Testing strips for chemical high‐level disinfectant.

Figure 3.180 High‐level disinfectant immersion tray.

Figure 3.181 Rinsing postimmersion.

Figure 3.182 One style of autoclave.

Figure 3.183 Properly loaded autoclave.

Figure 3.184 Ethylene oxide sterilizer.

Figure 3.185 Before and after sterilization indicators for steam sterilizati...

Figure 3.186 Before and after sterilization indicators for ethylene oxide st...

Figure 3.187 Unprocessed biological indicators.

Figure 3.188 Closed cabinet for storage of sterilized items.

Figure 3.189 Avoid crushing peel packs and risking contamination.

Chapter 4

Figure 4.1 Positioning the patient on the surgery table.

Figure 4.2 The instrument table over the chest of a patient having stifle su...

Figure 4.3 A surgery table with the split top in a “V.”

Figure 4.4 Leg with a half hitch.

Figure 4.5 Leg tie as a figure 8 on a surgery table bracket.

Figure 4.6 Leg tie through a roller‐style bracket on a surgery table.

Figure 4.7 Sterile prep set and solutions.

Figure 4.8 Sterile prep for orthopedic surgery.

Figure 4.9 Chloraprep application for final sterile prep.

Figure 4.10 Short‐side, open folds of ground drape towels.

Figure 4.11 Fingers in the appropriate folds of the towel.

Figure 4.12 Picking up the towel.

Figure 4.13 Opening the towel.

Figure 4.14 Lift each thumb and allow towel to open.

Figure 4.15 Rotate each hand so palms are facing the operator.

Figure 4.16 Pronate the hands so the fingers are protected by the towel.

Figure 4.17 Securing ground drapes for an orthopedic case.

Figure 4.18 Surgeon grabbing the foot with sterile Vetrap® while the circula...

Figure 4.19 Completed draping for an orthopedic case.

Figure 4.20 Iodine‐impregnated adhesive drape used in orthopedic surgery.

Figure 4.21 Proper method of passing a loaded scalpel blade and handle.

Figure 4.22 Proper method of passing a ring‐handled instrument.

Figure 4.23 Proper method of passing a thumb tissue forceps.

Figure 4.24 Fluid bowl too full.

Figure 4.25 Options for hemostasis: radiopaque gauze sponge, radiopaque lapa...

Figure 4.26 Electrosurgery unit.

Figure 4.27 Ground plate with gel.

Figure 4.28 Bipolar (top) and monopolar (bottom) handpieces.

Figure 4.29 Electrosurgery handpiece touching instrument to cauterize tissue...

Figure 4.30 Electrosurgery pencil and suction tubing set up on the sterile f...

Figure 4.31 Suction unit.

Figure 4.32 Poole suction tip.

Figure 4.33 Frazier suction tip.

Figure 4.34 Assistant providing retraction.

Figure 4.35 Holding the scalpel blade with the needle holder.

Figure 4.36 Begin placing the blade on the handle.

Figure 4.37 Fully seated blade.

Figure 4.38 Moistened lap pad protecting tissues from Balfour retractor.

Figure 4.39 Assistant stabilizing limb for placement of a TPLO plate.

Figure 4.40 Assistant removing pins.

Figure 4.41 Absorbable (bottom) vs. nonabsorbable.

Figure 4.42 Monofilament (top) vs. multifilament (braided).

Figure 4.43 Natural (top) vs. synthetic.

Figure 4.44 Simple continuous.

Figure 4.45 Assistant running suture for surgeon.

Figure 4.46 Ford interlocking.

Figure 4.47 Simple interrupted.

Figure 4.48 Horizontal mattress.

Figure 4.49 Cruciate.

Figure 4.50 Vertical mattress.

Figure 4.51 Scissor position for cutting internal sutures.

Figure 4.52 Suture strands crossed to indicate where to cut external sutures...

Figure 4.53 Proper approach for skin staple placement.

Figure 4.54 TA stapling device.

Figure 4.55 GIA stapling device.

Figure 4.56 Equipment needed for procedure on cart in room.

Figure 4.57 Electrosurgery ground plate on surgery table prior to the arriva...

Figure 4.58 Opening first flap of wrapped pack.

Figure 4.59 Opening second flap of wrapped pack.

Figure 4.60 Opening third flap of wrapped pack.

Figure 4.61 Opening final flap of wrapped pack.

Figure 4.62 Proper placement of hands on the glove wrapper to open the pack....

Figure 4.63 Opened glove wrapper in a horizontal fashion.

Figure 4.64 Turning wrists to flip the gloves onto the sterile field.

Figure 4.65 Circulating nurse offering sterile inner wrapped pack to surgeon...

Figure 4.66 Circulating nurse opening peel pack item for surgeon.

Figure 4.67 Sterile person taking item from opened peel pack.

Figure 4.68 Kick bucket positioned to catch runoff of fluid from a stifle su...

Chapter 5

Figure 5.1 Distended stomach with spotty necrosis.

Figure 5.2 Gastropexy.

Figure 5.3 Intestinal foreign body.

Figure 5.4 Plication of intestine from a linear foreign body.

Figure 5.5 Intestinal intussusception before reduction.

Figure 5.6 Intestinal intussusception after reduction – note compromised vas...

Figure 5.7 Assistant occluding intestine prior to resection.

Figure 5.8 Assistant occluding intestine for anastomosis.

Figure 5.9 Liver lobe mass.

Figure 5.10 Liver lobectomy with TA stapler.

Figure 5.11 Liver tumor.

Figure 5.12 Use of TA stapler to excise a liver tumor.

Figure 5.13 Ameroid constrictor placed on an extra‐hepatic portosystemic shu...

Figure 5.14 Gravid uterus exteriorized from abdomen.

Figure 5.15 Resuscitation of newborn.

Figure 5.16 Happy ending!

Figure 5.17 Draped area for canine castration.

Figure 5.18 Postoperative incisions from feline neuter.

Figure 5.19 Set up for laparoscopic OHE.

Figure 5.20 Ovariectomy via laparoscope.

Figure 5.21 Spleen being exteriorized.

Figure 5.22 Spleen following excision from abdominal cavity.

Figure 5.23 Urolith.

Figure 5.24 Urinary bladder isolated during cystotomy.

Figure 5.25 Bladder spoon with numerous urinary calculi.

Figure 5.26 Kidney prior to nephrectomy.

Figure 5.27 Postoperative perineal urethrostomy site.

Figure 5.28 External pinna – aural hematoma.

Figure 5.29 Total ear canal ablation – approach.

Figure 5.30 Total ear canal ablation – dissection.

Figure 5.31 Total ear canal ablation – closure.

Figure 5.32 Ventral bulla osteotomy positioning.

Figure 5.33 Ventral bulla osteotomy – intra‐operative.

Figure 5.34 Distichiasis in upper eyelid.

Figure 5.35 Ophthalmic cryogenic equipment.

Figure 5.36 Healed patient following bilateral enucleation.

Figure 5.37 Thyroidectomy dissection intra‐op.

Figure 5.38 Excision of thyroid.

Figure 5.39 Thyroidectomy positioning.

Figure 5.40 Pre‐operative view of an elongated soft palate in an English Bul...

Figure 5.41 Right‐angle clamp on transected palatal tissue.

Figure 5.42 Positioning for elongated soft palate reduction.

Figure 5.43 Stenotic nares – before correction.

Figure 5.44 Stenotic nares – after correction.

Figure 5.45 Triangulation of arthroscope, hand instrument, and outflow porta...

Figure 5.46 Arthroscopy tower with projector, shaver accessories, camera box...

Figure 5.47 Tower used for thoracoscopic and laparoscopic procedures.

Figure 5.48 Instruments used for thoracoscopic and laparoscopic procedures....

Figure 5.49 Thoracoscopy set up with scope, instruments, personnel.

Figure 5.50 Thoracoscopic image of lung tissue.

Figure 5.51 MRI performed on patient needing a hemi‐laminectomy.

Figure 5.52 Transverse fracture of femoral neck.

Figure 5.53 Mid‐shaft spiral fracture of humerus.

Figure 5.54 Comminuted non‐reducible radius/ulna fracture.

Figure 5.55 High‐velocity bullet, open comminuted non‐reducible fracture of ...

Figure 5.56 VD view of three‐dimensional CT fractured pelvis.

Figure 5.57 Post‐op radiograph of repaired fractured tibia using pin and wir...

Figure 5.58 Tibial fracture stabilized with locking plate and screws.

Figure 5.59 External fixator.

Figure 5.60 Autogenous bone graft packed around repaired fracture.

Figure 5.61 Allograft in place.

Figure 5.62 Plate benders used to manipulate bone plate to better conform to...

Figure 5.63 Pre‐op radiograph – OCD visible.

Figure 5.64 Arthrotomy to elevate proximal humeral OCD.

Figure 5.65 Radiograph of left‐fragmented coronoid process after removal....

Figure 5.66 Distal humeral osteochondritis dissecans (OCD) flap.

Figure 5.67 Arthroscopic view of distal humeral OCD flap.

Figure 5.68 Arthroscopic view following removal of OCD.

Figure 5.69 CT of united anconeal process (UAP).

Figure 5.70 UAP repair with screw fixation.

Figure 5.71 Valgus deformity of the distal portion of the radius.

Figure 5.72 Semantic scholar correction of biapical radial deformities. (a) ...

Figure 5.73 Pre‐op lateral radiograph of carpal joint needing carpal arthrod...

Figure 5.74 Post‐op lateral radiograph following carpal arthrodesis.

Figure 5.75 Dissection of claw and all surrounding tendons and ligaments....

Figure 5.76 Declaw bandage step 1: After declaw procedure, open a package of...

Figure 5.77 Declaw bandage step 2: Cut off middle finger of glove.

Figure 5.78 Declaw bandage step 3: Unfold two 3 × 3 gauze sponges, cover paw...

Figure 5.79 Declaw bandage step 4: Stretch glove finger over gauze to secure...

Figure 5.80 Declaw bandage step 5: Apply adhesive tape (1

″

) strip to e...

Figure 5.81 Declaw bandage step 6: Create “tab” on end of tape for ease remo...

Figure 5.82 CO

2

laser.

Figure 5.83 Pre‐op VD coxofemoral luxation.

Figure 5.84 Post‐op VD toggle placement.

Figure 5.85 Post‐op ventral–dorsal radiographic view of hips post‐femoral he...

Figure 5.86 CT of pelvis indicating gap in pubic symphysis.

Figure 5.87 Blade cauterizing of pubic symphysis for JPS.

Figure 5.88 Patient positioner for THA.

Figure 5.89 Total hip arthroplasty equipment.

Figure 5.90 Total hip arthroplasty implants.

Figure 5.91 Post‐op VD view of total hip arthroplasty (THA) implants.

Figure 5.92 Pre‐op VD radiograph of patient needing a triple pelvic osteotom...

Figure 5.93 Post‐op VD radiograph of patient having had a TPO performed.

Figure 5.94 Leader line knotted for extra‐capsular repair.

Figure 5.95 Locking axial drill guide with screw placement in TPLO plate.

Figure 5.96 Using saw for tibial plateau leveling osteotomy (TPLO). Note: As...

Figure 5.97 Tibial tuberosity advancement (TTA) cage, fork, and plate.

Figure 5.98 Post‐op radiograph of TTA surgery.

Figure 5.99 Cranial–caudal radiographic view of medial patellar luxation – p...

Figure 5.100 Repair of a lacerated calcaneal tendon using 0‐prolene and a Kr...

Figure 5.101 Pantarsal arthrodesis – lateral post‐op radiograph.

Figure 5.102 Pantarsal arthrodesis – CrCa post‐op radiograph.

Figure 5.103 Patent ductus arteriosus (PDA) before ligation.

Figure 5.104 Patent ductus arteriosus (PDA) after ligation.

Figure 5.105 Patent ductus arteriosus (PDA) hemorrhaging.

Figure 5.106 (Persistent right aortic arch (PRAA).

Figure 5.107 Occluded persistent right aortic arch (PRAA).

Figure 5.108 Finochietto retractor in chest.

Figure 5.109 Caudal lung lobe abscess.

Figure 5.110 Internal stapler in position for lung lobectomy.

Figure 5.111 Post‐lung lobectomy with internal stapler.

Figure 5.112 Orthopedic wire used to close the sternum.

Figure 5.113 Chest tube exiting thoracic cavity.

Figure 5.114 Tracheal collapse.

Figure 5.115 Tracheal rings.

Figure 5.116 Tracheal stent.

Figure 5.117 Anal sacculectomy.

Figure 5.118 Perineal/perianal patient positioning.

Figure 5.119 Perineal hernia.

Figure 5.120 Intra‐operative perineal hernia.

Figure 5.121 Mammary tumor removed.

Figure 5.122 Mastectomy closure site.

Chapter 6

Figure 6.1 Phase 1 of wound healing is characterized by purulent material ac...

Figure 6.2 Phase 1 of wound healing is characterized by

inflammation

within ...

Figure 6.3 Phase 2 of wound healing includes

proliferation

of tissue and gra...

Figure 6.4 Phase 2 of wound healing showing extensive granulation bed.

Figure 6.5 Phase 3 of wound healing is the

maturation

of the cells as collag...

Figure 6.6 Phase 3 of wound healing near a joint.

Figure 6.7 Irrigating a wound with saline removes debris, contaminants, and ...

Figure 6.8 Wet gauze applied to a wound is a traditional method of removing ...

Figure 6.9 Loose sutures are placed as step 2 of a‐tie‐over bandage.

Figure 6.10 The dry part of a wet–dry bandage (and step 3 of a tie‐over) abs...

Figure 6.11 A tie‐over bandage is secured in place with loose sutures acting...

Figure 6.12 A tie‐over bandage in place on an open wound over the hip. This ...

Figure 6.13 Sterilized Manuka honey provides antimicrobial treatment to a wo...

Figure 6.14 Oil‐emulsion gauze is easily made in a clinic following the reci...

Figure 6.15 Silver‐coated antimicrobial dressing applied to burn injuries....

Figure 6.16 Negative pressure wound therapy (NPWT) is applied to a non‐heali...

Figure 6.17 Vacuum‐assisted closure (VAC) units provide constant negative pr...

Figure 6.18 Cassette within the VAC system collects fluid removed via NPWT....

Figure 6.19 Burn diagram demonstrating the depth of injury in the three degr...

Figure 6.20 (a,b) Veterinary Burn Card (same size as a credit card) used to ...

Figure 6.21 Debridement of second‐ and third‐degree burns.

Figure 6.22 Insertion of silver‐coated dressing into a deep wound.

Figure 6.23 Application of NPWT to the burn wounds.

Figure 6.24 The burn patient is bandaged and attached to the VAC unit.

Chapter 7

Figure 7.1 Rigid Elizabethan Collars (E‐Collar) prevent self‐trauma.

Figure 7.2 Cage pads provide comfortable conditions for patients. They must ...

Figure 7.3 Perforated cage mats allow urine and other fluids to pass away fr...

Figure 7.4 Hammock beds allow fluids to pass away from the patient, are soft...

Figure 7.5 Boxes, crates, and litter pan covers provide a great secure “hidi...

Figure 7.6 Wolfhound is shown with a non‐healing granulating wound on the la...

Figure 7.7 The same patient as seen in Figure 7.6 with an orthotic device to...

Figure 7.8 A custom‐created orthotic with a hinge for treating a patient wit...

Figure 7.9 Anatomy of a bandage: (L – R) primary wound cover (oil‐emulsion g...

Figure 7.10 Tape stirrups applied to the medial and lateral side of the foot...

Figure 7.11 Primary wound cover examples: (L‐R) oil‐emulsion gauze in two si...

Figure 7.12 Begin by applying the padding layer of a soft‐padded bandage. Th...

Figure 7.13 The compressive layer is placed over the padding layer to apply ...

Figure 7.14 The protective layer of self‐adhering or adhesive‐backed bandagi...

Figure 7.15 (a) Bandage decoration is fun and entertaining for the client, a...

Figure 7.16 Newspaper splints for bilateral radius and ulna fracture provide...

Figure 7.17 Commercially available carpal support, for long‐term use, is com...

Figure 7.18 Begin a forelimb spica splint by wrapping counterclockwise or fr...

Figure 7.19 Spica splint: After reaching the most proximal aspect of the lim...

Figure 7.20 Spica splint: Bring the bandage material over the back and aroun...

Figure 7.21 Spica splint: Apply splint material to the lateral aspect of the...

Figure 7.22 Spica splint: Apply stretch gauze to maintain positioning of the...

Figure 7.23 Cutting a cast in half (bi‐valve) allows for wound care and easy...

Figure 7.24 The oscillating blade cast saw cuts a cast for removal or bi‐val...

Figure 7.25 Patients requiring a long‐term cast or splint benefit from fitti...

Figure 7.26 Patient seen in Figure 7.25 with the orthotic in place. Patient ...

Figure 7.27 Many types of materials are useful for protecting bandages from ...

Figure 7.28 Surgical instrument “sharps” covers are perfect for covering sha...

Figure 7.29 Covering the fixator bars with self‐adhesive bandaging tape keep...

Figure 7.30 Commercially available Ehmer slings maintain the proper position...

Figure 7.31 Velpeau sling Step 1: wrap stretch gauze several times around th...

Figure 7.32 Velpeau sling Step 2: While maintaining flexion of the carpus an...

Figure 7.33 Velpeau sling Step 3: Completed Velpeau sling on a Domestic Shor...

Figure 7.34 Commercially available Velpeau sling used for more long‐term use...

Chapter 8

Figure 8.1 Example of a medication chart to send home with clients to keep t...

Figure 8.2 Ziploc

®

bag used as a model to demonstrate to clients how a ...

Figure 8.3 Patients may go home with a stockinette bandage, like this Yorksh...

Figure 8.4 Canine body condition system scoring chart.

Figure 8.5 Feline body condition system scoring chart.

Figure 8.6 Slings and harnesses come in a wide variety of styles for multipl...

Figure 8.7 Slings provide support while allowing patients to bear some weigh...

Figure 8.8 Non‐ambulatory patient fitted for a full body harness.

Figure 8.9 The harness is used to lift non‐ambulatory patients and help them...

Figure 8.10 Patient receives strength and balance training while on a ball....

Figure 8.11 Passive range of motion: stifle flexion.

Figure 8.12 Passive range of motion: stifle extension.

Figure 8.13 An underwater treadmill provides active range of motion to all f...

Figure 8.14 Postoperative swelling of toes from bandage tightness. Following...

Figure 8.15 Observing the skin, every day, for redness, bruising, drainage, ...

Figure 8.16 Without protection, patients chew bandages and casts. A chewed c...

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

Foreword to the First Edition

Preface

Acknowledgments

Author Biographies

List of Contributors

About the Companion Website

Begin Reading

Glossary

Index

WILEY END USER LICENSE AGREEMENT

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Surgical Patient Care for Veterinary Technicians and Nurses

Second Edition

Edited By

Gerianne Holzman

University of Wisconsin,School of Veterinary Medicine Veterinary TechnicianEmeritaMadison, WI

Teri Raffel Kleist

Madison College Veterinary Technician Program (Retired)Madison, WI

Copyright © 2024 by John Wiley & Sons Inc. All rights reserved.Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.

Edition HistoryFirst Edition © 2015 by John Wiley & Sons, Inc.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.

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Library of Congress Cataloging‐in‐Publication DataNames: Holzman, Gerianne, editor. | Kleist, Teri Raffel, 1961– editor. | Holzman, Gerianne. Surgical patient care for veterinary technicians and nurses.Title: Surgical patient care for veterinary technicians and nurses / edited by Gerianne Holzman, Teri Raffel Kleist.Description: Second edition. | Hoboken New Jersey : Wiley‐Blackwell, [2024] | Includes index.Identifiers: LCCN 2023035265 (print) | LCCN 2023035266 (ebook) | ISBN 9781119760092 (paperback) | ISBN 9781119760306 (Adobe PDF) | ISBN 9781119760290 (epub)Subjects: MESH: Surgical Procedures, Operative–veterinary | Surgery, Veterinary–methods | Animal TechniciansClassification: LCC SF911 (print) | LCC SF911 (ebook) | NLM SF 911 | DDC 636.089/7–dc23/eng/20231004LC record available at https://lccn.loc.gov/2023035265LC ebook record available at https://lccn.loc.gov/2023035266

Cover Design: WileyCover Image: Courtesy of Teri Kleist; Gerianne Holzman

Foreword to the First Edition

It is a privilege to write the Foreword to Veterinary Surgical Patient Care by Gerianne Holzman and Teresa (Teri) Raffel. The objective of the authors was to create a comprehensive text targeted to the veterinary technician interested or involved with all aspects of veterinary surgical practice. This text follows a logical progression beginning with deciphering clinical information by history taking and physical examination; then onto preoperative planning, asepsis, infection control, a description of common surgical procedures, and a description of common surgical instruments; and finishing with postoperative patient care. The authors support each chapter with eloquent details and illustrations derived from their clinical experience, highlighting the crucial role played by the veterinary technician at each step. This text offers a unique perspective for veterinary technicians by two very capable veterinary technicians and educators.

The authors, Gerianne Holzman and Teresa Raffel, bring a wealth of clinical experience to this book. Both graduates of Madison Area Technical College, they quickly brought their combined talents to the academic environment of the newly created School of Veterinary Medicine in Madison, Wisconsin, in the mid‐1980s. When I was recruited at University of Wisconsin in 1984, I was a young and relatively naïve veterinary surgeon specializing in orthopedic surgery. Geri and Teri were instrumental in the refinement and development of my skills, both inside and outside of the operating room. Over the ensuing years, the authors have continued to educate and groom thousands of veterinary surgeons, veterinary students, and veterinary technicians. This book will stand as a legacy to their perseverance and endurance and will serve as a primer for all those interested in the practice of veterinary surgery.

Paul Manley, DVM, MSc, DACVS

Professor EmeritusSchool of Veterinary MedicineUniversity of Wisconsin, Madison

Preface

Welcome to the second edition of Surgical Patient Care for Veterinary Technicians and Nurses. The authors and editors updated and revised the book to address the needs of veterinary professionals in their daily patient care.

Veterinary technicians play an integral role in veterinary surgical patient care; however, this care begins before the patient enters the surgical suite and does not end when the patient goes home. A patient's history and physical exam impact preoperative care and surgical planning. While communicating with clients and performing physical exams, the veterinary technician aids in accumulating information to complete a patient's record.

Preoperative care of patients includes obtaining laboratory samples, radiographs, and medications. Additional needs vary to provide for the maximum physical and mental comfort of patients. Keeping patients calm and quiet during the entire perioperative period aids in healing and may lessen pain medication needs. A veterinary technician well versed in preoperative coordination contributes to the anesthetic and surgical plan.

Veterinary technicians not only prepare a patient for a surgical procedure by shaving hair and cleaning a surgical site; they employ their extensive knowledge of appropriate prepping techniques and materials for the specific situation. Technicians play an integral role in monitoring the surgical team and maintaining the surgical suite, instruments, and equipment in a sterile environment. Veterinary technicians assist in surgical procedures. Knowledge of a variety of common surgeries provides a capable assistant to the veterinary surgeon.

Veterinary technicians are essential in providing postoperative patient care while monitoring for pain control, surgical complications, and comfort. A well‐trained veterinary technician recognizes and tends to patients' needs. This may include immediate action and communication with a veterinarian. A veterinary technician experienced in bandage techniques and wound care frees up a veterinarian's time and provides more efficient patient care.

Communicating with clients after discharge is a great vehicle to increase client compliance, improve patient care, and promote a veterinary practice.

Gerianne and Teri

October 2023

Acknowledgments

Surgical Patient Care for Veterinary Technicians and Nurses came together to address the needs of veterinary professionals as they pursued their interests in veterinary surgery. We are proud to introduce the Second Edition of our book, written exclusively by veterinary technicians. This book has been a dream for both of us. While writing and editing both editions, we each experienced extreme personal challenges causing several delays in publication. However, the strong desire to provide a great resource for technicians, and a very understanding literary staff, helped us to persevere and finish the long journey to completion. Our combined experience, of over 80 years plus those of our co‐authors, shows in the personal knowledge conveyed in these pages. However, we could not have completed this book without the help of many individuals. We thank our co‐authors – Lana Bishop, Sandra Engelmeyer, JoAnne Mead, and Cassandra Simmons.

We particularly thank and recognize the following people for their inspiration, assistance, guidance, time, patience, and knowledge: Paul Manley, Susan Schaefer, Peter Muir, Jason Bleedorn, Robert Hardie, Dale Bjorling, Jonathan McAnulty, C.C. Sheldon, Krystal Telfer, the staff of Wiley‐Blackwell, and the many surgeons, residents, and technicians we have had the pleasure of working with through our careers. The thousands of veterinary medical and technician students, who taught us many lessons as we shared our knowledge with them, were instrumental in our growth as veterinary technicians. Finally, we thank our families for their support and encouragement: Rob Zimmerman, Sherry Freiberg, Penny Lamb, Bob J. Holzman, Tony Raffel, Patrick Raffel, Peter Raffel, Gerry Stoeberl, Carol Sliwka, and Peggy Marvin. We acknowledge those who inspired us and are no longer present to receive our thanks: Eb Rosin, Carole Vick, Ann and Bob F. Holzman, Tom Stoeberl, and Mary Ann and George Stoeberl.

We encourage all veterinary technicians and veterinary professionals to pursue their dreams, advance their careers, explore new challenges, but most of all, have fun while enjoying one of the best jobs in the world!

Gerianne and Teri

March 2023

Author Biographies

Gerianne Holzman, CVT, VTS (Dentistry) (Retired)After practicing for 40 years, Gerianne retired from veterinary practice in 2018. She began her career in a private small animal practice before entering the world of academia. Gerianne was one of the original veterinary technicians hired, in 1983, at the brand‐new University of Wisconsin School of Veterinary Medicine (UW‐SVM). She worked with all the surgical services performing preoperative and postoperative care. Her lifelong friendship with Teri began with their interactions while caring for surgical patients. This carried into professional organizations (including both serving as president of the Wisconsin Veterinary Technician Association), presentations, and their personal lives. Gerianne helped to create the UW Veterinary Care's dentistry service while becoming a charter member of the Academy of Veterinary Dental Technicians. She worked with and taught thousands of veterinary medical students and hundreds of surgery and dentistry residents. Over time, Gerianne's horizons expanded beyond the surgical ward and she originated the positions of feline renal transplant coordinator and orthopedic coordinator. While taking her away from her love of teaching, these positions provided her with more autonomy and client interaction. Over the years, peers and graduating veterinary medical students recognized her, many times, as an outstanding teacher. Gerianne retired from practice as a veterinary technician, emerita in 2015. She continued to work at the UW‐SVM as the first clinical studies coordinator before finally leaving veterinary medicine for good. Gerianne now fills her days volunteering, traveling, and spending time with her husband and pets.

Teri Raffel Kleist, CVT, VTS (Surgery)Having over 40 years of experience as a certified veterinary technician, Teri started her career in a mixed animal practice in Wisconsin after graduating from Madison Area Technical College's Veterinary Technician program. She then traveled to Purdue University where she began to discover her love of surgery while being employed as a surgical technician in the small animal surgery department. A new veterinary medical school opened in Wisconsin, and Teri applied for a position to bring her back to her home state. Teri and Gerianne's paths crossed when Teri traveled back to Wisconsin to join the original surgical staff at the University of Wisconsin. Teri obtained the position of a lead surgery tech serving both small animal and large animal patients. Teri enjoyed teaching hands‐on skills to fourth‐year veterinary students while instructing these future veterinarians on the need for great technical assistance. Teri eventually moved on to teaching these same skills to veterinary technician students in the veterinary technician program at Madison College. After 30 years at Madison College, Teri retired in 2021. She is a charter member of the Academy of Veterinary Surgery Technicians, earning her VTS in 2013, and remains busy with the credentialing exam that this organization offers. Teri has been involved with organized veterinary medicine on the local and national level for many years, holding many board positions for National Association of Veterinary Technicians (NAVTA), American Association of Veterinary State Boards (AAVSB), and Wisconsin Veterinary Technician Association (WVTA). Teri has contributed to multiple veterinary technician textbooks, in addition to co‐authoring the first edition of this book. She has published several articles in veterinary journals as well. In her retirement, she continues that involvement and is currently the Surgery Summit laboratory technician and the Veterinary Technician Seminar Chair on the Continuing Education committee for American College of Veterinary Surgeons (ACVS). In 2022 she went back to her early career roots and love of all things surgical and now works part‐time in a surgical referral practice in Madison, WI.

Lana Bishop, RVT, VTS (Surgery)Lana is a technician training coordinator at BluePearl Pet Hospital in Iowa. She graduated from Des Moines Area Community College in 2011 with an AAS degree in Veterinary Technology and became a registered veterinary technician (RVT) that same year after passing the national and state exams. After spending her first few years as an RVT in general practice, Lana decided to pursue her interest in surgery, and she started her career at Iowa Veterinary Referral Center (now BluePearl Pet Hospital) in 2014 as a technician in the surgical department. At BluePearl her interest grew into her passion as more opportunities became available to technicians. She continued to grow her knowledge through collaboration with veterinarians/technicians at the hospital, continuing education and independent study. She concentrated on learning advanced analgesia techniques, surgical techniques, and surgical instrument/suite management. In 2018, she became the surgery technician supervisor, leading a team of RVTs and assistants in the four‐surgeon department. Lana proudly earned her VTS as a member of the Academy of Veterinary Surgical Technicians (AVST) in 2019. In 2022 she became a technician training coordinator.

Sandra Engelmeyer, BS, CVT, RVT, VTS (Surgery)Sandra graduated from Iowa State University with a BS in Animal Science in 2009 and has been a licensed veterinary technician since 2010. She has been in specialty surgery since 2014 and has a VTS in Surgery. Sandra has spoken at conferences on surgical topics and serves on the executive board of the Academy of Veterinary Surgical Technicians (AVST). She works with Blue Pearl Veterinary Partners in Minnesota as a surgery technician.

JoAnne Mead, AAS, RVT, VTS (Surgery)JoAnne has worked at the North Carolina State University‐College of Veterinary Medicine for over 26 years. She started in the large animal hospital, anesthesia, small animal ICU, and research. She then discovered her true passion in the surgery department. JoAnne earned her VTS in Surgery from the Academy of Veterinary Surgical Technicians in 2017. She has been active in the academy, most recently as a member of the Exam committee. Her contribution to the second edition is her inaugural work in her writing career.

Cassandra Simmons, RVT, LAT, VTS (Surgery)Cassandra graduated from Purdue University's Veterinary Technology Program in 1990. The following year she started her surgical nursing career as an RVT in the Hillenbrand Biomedical Engineering Research Center at Purdue University. In 1991 she obtained her Laboratory Animal Technician (LAT) certification. From 2008 to 2011, she worked as a bio‐technician supervisor at ACELL, Inc., in Lafayette, IN. She then became an instructional surgical nurse in the Department of Small Animal Surgery at Purdue University's Veterinary Teaching Hospital. While in this position, Cassandra served as the veterinary technician student rotation supervisor for four years. She is currently the lecturer for the Purdue College of Veterinary Medicine Veterinary Technology Program Operating Room and Surgical Nursing Protocol course. She is the coordinating technician for the Junior DVM Surgery courses and Junior Surgery Facility Manager. Cassandra obtained her VTS in surgery, through the Academy of Veterinary Surgical Technicians, in 2017. She is also a member of the Indiana Veterinary Technology Association (IVTA) and NAVTA.

List of Contributors

Editor and Author

Gerianne Holzman, CVT, VTS (Dentistry) (Retired)University of WisconsinSchool of Veterinary MedicineMiddleton, WI, USA

Editor and Author

Teri Raffel Kleist, CVT, VTS (Surgery) (Retired)Madison CollegeMadison, WI, USA

Author

Lana Bishop, RVT, VTS (Surgery) Blue Pearl Pet HospitalDes Moines, IA, USA

Author

Sandra Engelmeyer, BS, CVT, RVT, VTS (Surgery)Blue Pearl Veterinary PartnersGolden Valley, MN, USA

Author

JoAnne Mead, AAS, RVT, VTS (Surgery)North Carolina State UniversityCollege of Veteirnary MedicineSurgery DepartmentRaleigh, NC, USA

Author

Cassandra Simmons, RVT, LAT, VTS (Surgery)College of Veterinary MedicinePurdue UniversityVeterinary Technology ProgramWest Lafayette, IN, USA

About the Companion Website

This book is accompanied by a companion website:

www.wiley.com/go/holzman/patient 

This website includes:

MCQs

Videos

1History and Physical Examination

Gerianne Holzman1 and Lana Bishop2

1 University of Wisconsin, School of Veterinary Medicine, Emerita, Madison, WI, USA

2 Blue Pearl Pet Hospital, Des Moines, IA, USA

The history and physical exam provide the basis for all patient care. Without this information, the veterinarian cannot formulate a correct diagnosis and treatment plan. Veterinary technicians provide an invaluable service in deciphering a client's perception of the problem while determining their true concerns. These may not be the same as the patient's actual medical condition. For example, a client brings a pet in for behavioral problems of urinating in the house. The client thinks the cat is “mad” because it is left alone for many hours. The client's concern is for the cat to stop urinating in the house. Questions are asked about litter pan behavior, urine color, and the cat's attitude. The patient shows pain on abdominal palpation and distended bladder. After consultation with the surgeon, it is decided to perform abdominal radiographs on this patient. Radiographs show the cat has cystic calculi (Figure 1.1). After discussing medical versus surgical options with the client, it is decided to surgically remove the bladder stones.

History

Surgical patients may present with many or no other medical conditions other than the original complaint. A careful medical history contributes to the patient's diagnosis, prognosis, and treatment plan. A complete history includes:

Vaccinations

Heartworm testing/preventative

Diet

Allergies

Current medication

Patient's lifestyle

Medical and surgical history

Client expectations

Figure 1.1 Lateral radiograph of a cat with cystic calculi.

Source: Courtesy of Amy Lang.

Vaccinations

Hospitalized patients may be exposed to many communicable diseases. Suggested canine vaccinations include distemper, adenovirus, parainfluenza, parvovirus, leptospirosis, rabies, and possibly Bordetella and influenza. Feline vaccinations include viral rhinotracheitis, calicivirus, rabies, and panleukopenia. Care is taken to protect unvaccinated emergency patients with minimal inter‐patient contact. Hospital policy and local regulations dictate vaccination requirements. In an emergency setting, the vaccination records may not be attainable at intake and treatment will still be initiated carefully.

Parasites

Every state reports cases of heartworm disease. Preventative treatment promotes patients' good health. Patients with active or prior heartworm disease pose an anesthetic risk. The client is quizzed to determine the status of heartworm testing and preventative. Flea infestation is avoided in the veterinary hospital with appropriate prevention, therefore determining a client's use of flea and tick preventative is imperative. Many intestinal parasites can also be prevented with these medications. Some intestinal parasites can be zoonotic such as giardia.

Diet

Diet affects all aspects of a patient's health. Knowledge of a patient's dietary habits aids treatment plans. For example, young puppies fed a high‐calcium diet can succumb to developmental orthopedic conditions. Obesity causes stress to most body systems including heart, lungs, and joints. Determining if a patient's feeding schedule is free choice or meal feeding aids in formulating weight management plans. Between‐meal snacks contribute to obesity. Maintaining a patient's current diet while hospitalized avoids gastrointestinal upset from food change. However, clients providing raw food diets might create an in‐hospital storage problem and hazard for hospital personnel. Patients undergoing oral or facial surgery may need a softened diet postoperatively. Crushing a normal diet of dry kibble and soaking for a short time in water maintains the animal's normal diet. There are also many non‐traditional diets such as grain free, raw, and home cooked. Nutritional balance may not be obtained with these diets and other health issues can arise from them. Dilated cardiomyopathy (DCM) can be the result of grain‐free diets according to the FDA and a study by the University of California, Davis [1].

Allergies

Food allergies are prevalent in the veterinary patient population. Determining a patient's food allergies avoids gastrointestinal problems while hospitalized. Unidentified medication allergies can cause very serious complications during hospitalization, surgery, and recovery. Obtaining information on past sedation and anesthetic episodes provides guidelines for future needs. Patients with a history of a poor response to anesthesia must be more closely monitored during any surgical procedure and recovery. Anesthetic complications include vomiting, diarrhea, cardiac arrhythmias, breathing difficulties, blood pressure changes, and slow recovery. Other previous or ongoing allergic reactions to medications or environmental conditions must also be noted.

Current Medication

A patient's current and prior medication and supplement history influences future treatment plans. For example, patients receiving anti‐inflammatory medications need a “wash‐out” period (three to seven days) prior to starting a different anti‐inflammatory drug to avoid gastrointestinal problems including stomach ulceration. Medications for many medical conditions influence the choice of perioperative drugs. Dietary supplements, such as glucosamine chondroitin, calcium, and vitamins, affect patients' health and food needs.

Patient's Lifestyle

Clients have different expectations for patients leading a sedentary life versus working or service animals. If a dog's main job is to sit on the couch most of the day, recovery from a ruptured cranial cruciate ligament and its attending arthritis is much different from a search and rescue animal. If a patient lives in a city‐dwelling apartment, it will have different experiences during recovery than a dog living in the country, with acres of freedom. If the patient is a working animal, an extensive rehabilitation regimen may be recommended to regain/maintain strength, flexibility, and endurance [2]. The same holds true for an indoor cat versus an outdoor cat. Will the client be able to medicate a mostly outdoor cat postoperatively? Do they have the ability to keep them inside for a short time?

Medical History

A complete medical history begins with confirming the signalment with the owner: age, breed, sex (intact or neutered), and presenting complaint. A preconceived diagnosis may affect physical exam findings; therefore, it is important to ask open‐ended questions. (For example, a patient presented with hip dysplasia may actually have a cranial cruciate rupture causing more lameness than poor