1、Surgical nursing 外科护理学Instrument packs 595 器械包Postoperative care 597 术后护理Abdominal surgery 598 腹部外科Aural 603 耳部/听觉Integument 605 皮肤Ophthalmic 608 眼睛Orthopedic 611 矫形外科Reproductive tract surgery 614 生殖道外科Thoracic surgery 618 胸腔外科Urogenital tract surgery 620 泌尿道外科Many of the listed surgical procedures
2、 may not be performed in the average clinical setting. however ,at one point or another, technicians will be faced with having to explain a particular procedure to a client.许多列举的手术操作在普通的临床环境没有办法操作。然而，技术人员经常会面临要将特殊的操作解释给主人。These descriptions are not meant as directions on how to perform the procedure
3、 ,but rather a quick synopsis that will allow the technician to prepare for the procedure, manage patient care, and clearly explain the procedure and aftercare to a client whose pet may be undergoing these procedures. 这些描述不是作为如何进行手术操作的指导，而是一种能够让技术人员准备手术，进行患畜护理的概要和能够将患畜即将面临的操作和术后护理清晰的将给主人。With every
4、surgical procedure, pain management needs to be addressed and handled.Refer to chapter 8,Pain Management, for more information.对于每个手术操作，疼痛管理都是需要强调和给予的。可以参考第八章，疼痛管理获得更多的信息。Instrument packs 器械包These packs are examples of the instruments included in basic surgical packs.Each clinic will need to organiz
5、e packs that best fit their surgery type and surgeon.Each surgeon has preferences on individual types of instruments for different surgeries .Each pack may include gauze,laparotomy pads,towels ,saline bowl,needles,sutures,and scalpel blades ,or they may be prepared separately.以下的器械包是器械的例子，包括基本的外科包。每
6、个诊所要组织器械包使它更适合不同的外科手术类型和外科医生。每个外科医生对于不同的手术会选择个人喜好的器械。每个器械包应该包含纱布，毛巾，缝针，手术刀片，创巾等或者它们需要单独包装。Basic surgical packs 基本外科器械包Abdominal pack 腹部手术器械包Abdominal forceps 腹部镊子Abdominal retractors 腹壁牵开器Balfour retractorGeneral surgical pack 一般的外科包Groovrd directorHemostats 止血钳Needle holders 持针器Retractors 牵引器Scalpe
7、l handle 解剖刀柄Scissors 剪刀Spay hook 卵巢牵引钩Thumb forceps 按捏镊,组织镊Tissue forceps 组织镊Towel clamps 巾钳Laceration pack 伤口缝合器械包Hemostats 止血钳Needle holder 持针器Scalpel handle 解剖刀柄Scissors 剪刀Thumb forceps 按捏镊，组织镊Ophthalmic pack 眼科器械包Eyelid forceps 眼睑镊Eyelid retractor 开睑器,睑牵开器Hemostats 止血钳Lacrimal cannulas 泪管插管Need
8、le holders 持针器Scalpel handle 解剖刀柄Scissors 剪刀Thumb forceps 有齿镊Orthopedic pack 矫形外科器械包Bone drill 骨钻Bone chuck and key 骨卡盘和钥匙Bone-cutting forceps 骨剪Bone-holding forceps 持骨钳Bone rasps and files 骨锉和？Gigli handles and wireMallet 鼓槌Osteotome 骨凿,骨刀Rothopedic wirePeriosteal elevator 骨膜起子,骨膜分离器 ,骨膜剥离器Pin cutt
9、er 剪钉钳,钢丝钳,断针钳Retractors 牵引器Senn retractorVolkmann retractorRongeurs 修骨钳,咬骨钳Wire-cutting scissors 线剪Thoracic pack 胸部手术器械包General surgical pack instruments with long handles 常规外科器械包内的长柄器械Rib retractors 肋骨牵开器Wilson rib spreader Wilson 肋骨牵开器Bone-cutting forceps 骨剪Right-angle forceps 直角钳Vessel clamps 导管
10、夹,动脉止血钳Bulldog clamp 显微外科用的无损伤钳，动脉夹Specialized surgical packs 特殊的外科器械包Many instruments may be used only on occasion and should be set aside in separate packs.Instruments weaken with constant scrubbing and autoclaving and should therefore not be subjected to unnecessary sterilization.The instrument t
11、ype and number included in each of these packs will depend on surgeon preference.许多器械只是偶尔使用，应该单独打器械包。经常的刷洗和高压灭菌会使器械变钝，因此不应该进行不必要的灭菌。Biopsy/thephine pack 活组织检查包Curette pack 刮匙包Hemostat pack 止血钳包Implant set 植入物放置Periosteal elevator pack 骨膜起子,骨膜分离器,骨膜剥离器包Pin set Retractor pack 牵引器包Screw set suction tip
12、s and tubing pack 螺丝钉吸引头和？包Postoperative care 术后护理The success of each surgical procedure often lies in the patient care that follows the procedure.This often ends with the client to continue at home care.Clear and concise instructions are critical to enable this transition to occur successfully. Cli
13、ents should be strongly encouraged to phone for any questions or concerns arise. Follow-up phone calls 1-2days after a surgical procedure by the staff will also encourage client communication.每个外科手术操作的成功经常基于对患畜的术后护理。这些经常以主人将患畜接回家后继续护理而终止。清晰简要的说明是使这个过渡成功的关键。应该鼓励患畜主人在有任何疑问和担心打电话来咨询。应该鼓励医务人员外科手术后的 1-2
14、天给主人打电话进行交流。Skill box 12-1 /Standard postoperative care instructions技术表格 12-1/标准的术后护理说明Feed only half of the normal food and water the first evening after surgery 外科手术当天晚上只要喂平常食量和水量的一半Check incision daily for redness, swelling,discharge, or odor每日检查伤口是否发红、肿胀、渗液或者有异味Prevent licking,chewing,or rubbing
15、 at incision line or sutures制止动物舔舐、拒绝或者摩擦缝线Keep the animal and/or bandages dry and clean保持动物的包扎绷带干燥清洁Avoid bathing or swimming until suture removal or for 5-7days with sc Sutures在未拆线之前禁止洗澡和游泳？Phone the doctor if any of the following occur:Repeated vomitingExtreme listlessnessBleeding or dischargeLos
16、s of appetite for 24 hoursOpened incision lines如果遇到以下情况请致电医生：反复呕吐、非常没有精神、出血或者渗出、24 小时没有食欲、伤口开线Skill box 12-2 /preventing licking,chewing,or rubbing at incision site or sutures技术表格 12-2/制止动物舔舐、拒绝或者摩擦伤口或者缝线1 use an elizabethan collar(e-collar,neck brace,etc.)at all time1 要一直带着伊丽莎白圈2 apply abandage(e.g
17、. ,soft padded bandage,hobbles,or schroeder-thomas splint with sheet aluminum)2 应用绷带（软垫绷带？或者铝片 schroeder-thomas 夹板）3 Foul-tasting substance(e.g., bitter apple, atropine, tabasco, or thumb-sucking preparations)3 使用异味物质（药西瓜瓤、阿托品、辣椒粉、吮指癖制止剂）4 cover the area with a sock,baby t-shirt,or stockinette4 将术部用
18、短的幼儿 T 恤或者？覆盖5 body brace,side bar,or tail-tip protectorTable 12-1 abdominal surgeryprocedure Abdominal surgerydefinition See particular surgeryindications See particular surgeryinstruments Abdominal pack Electrocautery Gauze sponges/laparotomy pads General surgical pack Retractor pack Saline bowl S
19、aline,warmed Suction tips and tubing packpatient See particular surgerypreparationSurgical Th organ or area to be examined should be exteriorized and packed with saline moistened gauze spongestechnique All tissues must be kept consistently moist with warm saline Handling of the internal organs must
20、be done carefully to avoid further damage,but secure enough to not allow leakage of the bowel contents into the surgery site Provide clean,sterile drapes,towels,gloves,and instruments for abdominal closure Patient should be monitored for excessive blood loss,contamination of pertoneal cavity,and an
21、tendency to vomit with organ manipulationprocedural Abscess Dehiscence Gastric or intestinal perforation Hemorrhage(e.g. ,poor hemostasis and inadvertant injury to vascular organs) Ileus Intestinal stricture Pancreatitis Peritonitis/sepsis(e.g. ,contamination with gastrointestinal tract(GIT) content
22、 ) Pleural effusion Failure of intended surgery Adhesions between visceral surfacescomplicationspatient Hyperthaermia with prolonged procedures Abdominal pain Fecal incontinence Fever Tenesmus/constipation/dyschezia VomitingFolPatient care NPO for 12-24 hours Analgesia postoperatively Monitor abilit
23、y,frequency,and appearance of defecation Standard postoperative care Confine and restrict activity until suture/staple removal or as directed by DVMlo w- upClent education Recheck/suture removal in _ days Medication:_ Lab results in _ daysTable 12-1 腹部外科操作步骤 腹部外科定义 见详细外科说明适应症 见详细外科说明器械 腹部外科包 电烙器 纱布海
24、绵/剖腹术垫子 常用外科填塞物 牵引器包 Saline bowl 温生理盐水 吸引头和管包患畜 见详细外科说明准备外科技术 需要从腹部取出进行检查的器官或者区域需要用生理盐水润湿的纱布海绵包裹覆盖 需要使用温的生理盐水让所有的组织保持湿润 处理内脏的时候必须要仔细，避免对组织的进一步损伤，要尽量避免肠内容物漏入外科手术区域 为腹腔闭合提供干净无菌的布单、毛巾、手套和器械 需要监控患畜是否有过度失血，？腔污染和器官操作引增加的呕吐的可能性并发症 程序 脓肿 开裂 胃肠穿孔 出血（止血功能弱或者未注意损伤到了脉管器官） 肠梗阻 肠狭窄 胰腺炎 腹膜炎/败血症（胃肠道内容物污染） 胸膜积液 预期外科
25、手术失败 脏面粘连患畜 卵泡膜细胞增殖症使发情延长 腹部疼痛 大便失禁 发烧 里急后重/便秘/大便困难 呕吐患畜护理 禁食 12-24 小时 术后镇痛 监测排便能力、频率和表现 标准的术后护理 限制活动直到拆线或者由兽医进行指导后续 客户教育 在_天复查/拆线 药物治疗方案： _天获得实验室结果Table 12-2 abdominal surgery (continued)procedure Abdominal hernia Anal sacculectomy colotomydefinition Repair of a hole in the abdominal wall that is a
26、llowing an organ or part of an organ to protrude Removal of 1 or both anal sacs and associated anal sacduct Incision made into the colonindications Intestinal obstruction and/or strangulation damage Correction of long-term anal sac infection and neoplasia Full-thickness biopsy and foreign bodyPatien
27、t preparation Dorsal recumbency Prepare 3 on either side of the hernia Ventral recumbency with rear legs draped over end of table and tail secured cranially Prepare a 4 radius around anus Express anal sacs, evacuate as much of the feces from the colon as possible, and pack rectum with sponges Closed
28、；instill self-hardening gel orresin into sac(s) to be removed multiple enemas to risk of infection and to visibility Dorsal recumbency Prepare entire ventral abdomenSurgical technique An incision is made over the hernia and dissected down to the hernia orifice, Any adhesions are removed and the orga
29、ns and /or viscera are returned to the peritoneal cavity. The edges of hernial orifice are sharply freshened and sutured closed.Routine closure of the abdomen is performed Closed:the hardened sac is isolated, and an incision is made over the sac. The surrounding tissue is gently dissected away from
30、the sac,and the sac and duct are removed.The area is lavaged with warmed saline,and the remaining tissue is closed in a routine closure. Open:The anal sac orifice is visualized and a grooved director is placed into the sac orifice to the most ventral aspect.An incision is made along the grooved dire
31、ctor, and the entire sac and duct are dissected out. The area is lavaged with warmed saline,and the remaining tissue is closed A caudal midline abdominal incision is made. The affected area is exteriorized and packed with saline-moistened gauze sponges. Stay sutures are placed , and the colonic cont
32、ents are milked away from the intended incision site. An incision is made into the colon , and the foreign body is removed or biopsy speciments taken. The colotomy is closed , and the abdomen is flushed with warm saline. The colotomy is covered and tacked with a piece of omentum, and routine closure
33、 of the abdomen is performed .in a routin closurenotes Client education: chronic hernias may not require surgical intervention Instruments: closed: self- hardening gel or resin and administration equipmentOpen: grooved director Surgery:careful, atraumatic dissection with minimal muscle damage is ess
34、ential to preverve nerve and sphincter function Patient care:hot pack the surgical site immediately after surgery and antibiotics for 7-10 days postoperatively Client education:hot pack incision twice daily until suture removal Surgery:stay sutures may njot be necessary,especially if surgical assist
35、ant is present Patient care:antibiotics during surgery and postoperatively(only if contamination is suspected)Table 12-2 腹部外科（继续）程序步骤腹部疝气 Anal sacculectomy 肛门腺囊 结肠切开术定义 修复能够使部分器官或者整个器官突出腹壁的洞 Removal of 1 or both anal sacs and associated anal sacduct 移除一个或者双侧的肛门腺囊和？ 结肠切开适应症 肠梗阻或窒息,绞窄损伤 校正长期的肛门腺囊感染和瘤形
36、成 Full-thickness biopsy and foreign body 增厚部位的活组织采样和异物患 背侧斜卧 Ventral recumbency with rear legs draped 多次灌肠可以降低感染的风险并且增加可视度畜准备 Prepare 3 on either side of the hernia 准备双侧的疝气over end of table and tail secured cranially Prepare a 4 radius around anus Express anal sacs, evacuate as much of the feces fro
37、m the colon as possible, and pack rectum with sponges Closed；instill self-hardening gel orresin into sac(s) to be removed 背侧斜卧 准备整个腹部腹侧外科技术 从疝气表面切开至疝孔，除去粘连物并将器官或脏器还纳入腹膜腔。将疝孔边缘切割形成新鲜创，并由缝线闭合。常规闭合腹腔 封闭式：坚硬的囊相对独立，在囊上做切口。轻柔的分离囊、囊管和囊周围的组织。用温生理盐水冲洗周围区域，将剩余的组织常规闭合 开放式：肛周腺囊的口是可见的，将有槽探针从囊孔置于大部分腹侧位置。沿着有槽探针周围做
38、切口将整个囊和管切除。用温生理盐水冲洗附近区域，常规闭合剩余组织 后腹部中线切口。受影响的区域是从腹腔取出的脏器，需用生理盐水浸润的纱布海绵包裹，将伤口周围的缝处置好，将结肠内容物从预计的切口处挤走。将结肠切开，将异物取出或者进行活组织标本采样。将结肠封闭，用温生理盐水冲洗腹腔。用网膜将结肠覆盖，常规闭合腹腔。注意 客户教育：慢性疝气不需要外科手术的干预 器械闭合式：自我凝固的凝胶或者树脂及其投药的装置开放式：有槽的探针 外科：仔细的最小损伤肌肉进行切割以保护神经和括约肌的功能 患畜保护：术后对伤口进行热敷，并进行消毒 7-10 天 客户教育：热敷伤口两次知道拆线 外科手术：尤其是外科助手在的
39、情况下，stay sutures 是非必须的。 Patient care: antibiotics during surgery and postoperatively(only if contamination is suspected) 患畜护理：术中和术后需要抗生素治疗（只有如果怀疑污染的时候）Table 12-3 abdominal surgety (continued)procedure enterotomy Gastric-dilatation volvulus(GDV)see chapter 5, emergency careGastrotomydefinition Incisi
40、on made into the small intestines To reposition the stomach and the spleen in their correct location and restore their blood circulation Fix the stomach to the abdominal wall to prevent further torsion Incision made into the stomachIndications Examination for ulcers, strictures ,or neoplasia, full-t
41、hickness biopsy,and foreign body(FB) removal A stomach that dilates and twists around its central axis Full-thickness biopsy and foreign body (FB) removalPatient preparation Dorsal recumbency Prepare entire abdomen Orogastric decompression or needle trocarization Dorsal recumbency Prepare midsternum
42、 to 2-3 inches below the umbilicus Dorsal recumbency Prepare bottom third of the sternum to 2-3 inches below the umbilicusSurgical thchnique A midline abdominal incision is made. The affected area is exteriorized and packed with saline-moistened gauze sponges. Stay sutures are placed, and the bowed
43、contents are milked away from the intended incision site. An incision is made into the intestines,and the FB is removed or biopsy specimens taken. The intestines are examined for viability and recection, and A midline abdominal incision is made. Further orogastric decompression is performed if neces
44、sary via an orogastric tube or suction, The spleen is evaluated for rotation and necrosis. A splenectomy is performed if there is splenic necrosis. Gastroplexy is then performed on the right side of the dog by one of many methods, The abdomen is then closedn with routine closure. A cranial midline a
45、bdominal incision is made. The stomach is exteriorized and packed with saline moistened gauze sponges. Stay sutures are placed .The stomach is excised into and suctioned free of liquid contents. The FB is removed or biopsy specimens taken .The stomach is closed in a multi-layer fashion, lavaged with
46、 anastomosis is performed if necessary. The enterotomy is closed with a piece of omentum and tacked ,and routine closure of the abdomen is performed.warmed saline, and possibly covered with omentum. The abdomen is closed routinely.notes Surgery: stay sutures may not be necessary, especially if a sur
47、gical assistant is present Surgery:enterotomy incisions are usually made in tissue adjacent to the FB rather than directly over it for better incision healing Instruments:orogastric tube Patient care: monitor electrolytes , blood gases, hematocrit (Hct) , total protein (TP), urinary output , electro
48、cardiogram(ECG),and central venous pressure (CVP) as necessary, and keep NOP for 24-48 hours Client education:feed small meals 3-4 times daily ,and avoid exercise after each meal. NoneTable 12-4 abdominal surgery (continued)procedure Intestinal resection and anastomosis Hepatectomy, partialdefinitio
49、n removal of a diseased or nonviable section of the intestines and repair to the bowel with end-to-end bowel reattachment removal of 1 week Surgical: Flushing fluids should not contain sugars, because that provides nutrients for the pathogens ,and eliminating skin tension at suture line is imperative for healing Postoperatively: bandage and immobilize for
