duration of 60 – 90 minutes or longer are linked to an increased risk of infection, due to factors such as hypothermia, hypotension and decreased tissue perfusion [ 52 ]. The TPLO surgery for this patient lasted 100 minutes, so the VS made the decision to dispense antibiotics for administration after surgery.
A Primapore dressing was applied over the surgical wound immediately after surgery, and a rigid Elizabethan collar was fitted on the patient once he was awake. Primapore is a perforated polyurethane membrane dressing that is used for wounds that require protection, most commonly incision sites and sutures. The dressing only provides a protective barrier to the area covered and does not provide an ideal wound-healing environment [ 53 ]. It should be noted that if a patient is licking or chewing a wound excessively then this could be a sign of pain, and a full pain score assessment should be carried out to determine whether the patient requires further analgesia. Unfortunately, most patients do not like wearing an Elizabethan collar; however, it is a necessary wound management technique, as any licking or chewing of the wound could lead to inflammation, infection or a breakdown of the surgical site [ 54 ]. The VN should select the correct size of Elizabethan collar so the patient cannot reach the surgical site but can continue normal activities such as eating and drinking.
It is important to ensure that the patient starts eating during the recovery period. A possible complication following surgery is postoperative ileus, which is a delay in the motility of the gastrointestinal system. This is caused by extensive periods of starvation and it can negatively affect the patient ' s nutritional status. Side effects of postoperative ileus include vomiting, abdominal tenderness and nausea, which can cause food aversions and lead to anorexia [ 55 ]. A system should be put in place to monitor the patient ' s daily intake. According to the protocol of the hospital in this case, each patient must have a feeding plan created on admission, in which its resting energy requirement( RER) is calculated using the equation: RER( in kcal) = 70 × bodyweight 0. 75( in kg). The RER is then used to calculate the total amount( in g) of food a patient is to receive each day. A feeding plan with a highly palatable, calorie-dense diet can help boost a patient ' s appetite [ 55 ].
Once the patient had fully recovered from the general anaesthetic, he was taken on walks to encourage toileting. The hospital protocol for toileting patients is to take them to a grassy area for 5 – 10 minutes, four times a day. During these walks the patient is encouraged to walk on all limbs, slowly, on non-slip floors. The patient is likely to use the affected limb because it will feel unsteady when limping and will naturally use the affected leg to provide balance. This is a form of physiotherapy known as active range of motion, whereby the patient performs an exercise that causes the joint to move in its natural motion [ 56 ].
Evaluation
VNs play a vital role in the treatment received by patients undergoing TPLO surgery, particularly in the monitoring of anaesthesia. However, nursing these patients can be challenging, so the VN should have good knowledge of the associated pathophysiology and pharmacokinetics.
On reviewing the treatment received by the patient in this case, the author believes the implementation of cryotherapy could have been beneficial. Cryotherapy is the use of cold temperatures to assist with pain management and inflammation. The cold temperatures cause vasoconstriction, which decreases blood flow to the tissue, reducing the oedema formed around the surgical site [ 57 ]. This treatment can reduce the doses of analgesic drugs required for pain management and the side effects they produce. Cryotherapy is an inexpensive treatment that can be provided during the patient ' s hospitalisation and their recovery at home.
Conclusions
It is important to have an understanding of basic anaesthetic monitoring in order to monitor a TPLO patient, as it can be challenging. A VN who feels comfortable and competent in monitoring patients under anaesthesia will be better able to advocate for a patient if they believe the patient requires further treatment, such as analgesia, during surgery.
EXCLUSIVE
DIGITAL CONTENT
AVAILABLE ONLY IN THE DIGITAL EDITION
Appendix 1 – AVA Anaesthetic Safety Checklist [ 13 ] [ view here ]
Appendix 2 – RCVS Surgical Safety Checklist [ 14 ] [ view here ]
Appendix 3 – Short form of the Glasgow Composite Pain Scale [ view here ]
56 Veterinary Nursing Journal