Teryn Storti

Student number: 64643

Case Study Assignment ACM40412-CS-1: Foundation Skills

In this case study I will be discussing a routine spey.

The owner has called and asked to schedule an appointment to have her 11 month old female,
entire, canine, Dogue de Bordeaux speyed.
To schedule the appointment I first see when there are availabilities for surgery and discuss a
compatible date with the client. Only 2 or 3 routine surgeries may be booked per day depending on
approximated surgery time. Refer to SP-01. The appointment is then booked in an early morning
time for admission. This is so that the surgery vet on the day has time to admit, examine and sedate
the patient before surgery can begin. It also ensures Stella has plenty of time to recover from
anaesthetic before sending her home. The client is advised that the patient must be fasted for 12
hours prior to the admission time. The patient may have water up until the morning. This is to
ensure Stella does not asphyxiate on any regurgitated food or water whilst under anaesthetic.
The client is asked if Stella is on any medications or if she has any known health concerns. Also if
she is currently on heat. Stella has no known health concerns and is on no medications. She is not
on heat. I ask the client if she needs to be vaccinated or microchipped whilst in and am informed
that she is microchipped and up to date with her vaccinations. No additional procedures are
required. The client is given an estimate of surgery cost which includes a surcharge as she is a large
breed dog and has been on heat before.

On surgery day the surgery nurse is to admit routine surgery patients. In this particular case the
patient is an 11 month old Dogue de Bordeaux named Stella Males.
First off Stella is to be weighed on the way into the clinic. She weighs 35.5 kg.
In the admission appointment the surgery nurse will build a rapport with the client. This helps the
client feel at ease.
The client will be asked if the patient was fasted? If the patient is on any medications?
Does the client want pre- anaesthetic blood work run? The client should also be asked when the
patient was last in season. Pre-anaesthetic blood work can tell the vet if the patient has any
underlying issues with organ function. This may be congenital and gone undetected. These
questions let us understand how Stella is and how she will be affected by anaesthesia or surgery.
The client will be informed that Stella is to undergo a full anaesthetic and be speyed. They are to be
spoken to and given a consent form to sign that outlines the patient risks associated with anaesthetic
procedures. This form also states the client is responsible for any and all costs associated with
Stella's procedure. The client will be given an estimate of the procedure. The nurse then co signs the
form and dates it.
The client details are to be confirmed. This is very important so that we can contact the client if we
need to during the day.
Let the client know we will call them on their preferred number when Stella is out of surgery to
make a discharge time.
The patient is then taken out to the treatment area by slip lead and the vet does a clinical
examination as in SP-03. I help by restraining Stella whilst the Vet performs the examination. Stella
is then pre-medicated using a mix of Acepromazine and methadone. The ACP has a sedative effect
on the patient while the Methadone provides analgesia for when the patient is in procedure and
when she wakes up from the anaesthetic. Stella is then placed in a run, in a quiet place to let the
drugs take effect. A sedation sign and Stella'a consent form and a hospital chart with recorded drugs
and what time they have been administered will be placed on the front of her run door. It will be
labelled with her name, breed, weight, vet, nurse, and age. These forms and also Stella's anaesthetic
monitoring chart will be filed in clinic records under surgical consent forms when Stella leaves at
the end of her treatment.
Stella's full name, weight, age, vet and procedure and drug administration times and doses will be
written on the white board. This signals to all staff what patients and procedures are in for the day.
This ensures all patients can be accounted for and if they are sedated.

Preparing for surgery begins when the surgery nurse begins their shift. In this case myself.
Place shoe covers, a hat/ hair net on and gloves before setting up in theatre.
Theatre is to be damp wiped with antiseptic.
A large breed spey kit is to be set out on the instrument table along with sterile gloves/hat and a
scalpel blade. These are only to be opened when the vet is ready to commence surgery.
On the surgical table, a heat pad, cradle and fresh towel is to be set out. Layered in that order.
The bair hugger is to have the correct bag size attached and set to the side. A blanket is also set to
the side for over the bair hugger.
Oxygen bottles are turned on and the re-breathing circuit attached to the anaesthetic machine. A size
4 breathing bag is also attached.
The pulse oximeter, apalert, stethoscope, blood pressure machine, tattoo clamp and ink should also
be readied for use and set to the side.
In the treatment area set out tape, clippers, a catheter, alcohol swabs, sterile flush and the induction
agent. In this case Alfaxan. Stella is 35.5 Kgs so a mid range dose is usually drawn up for the vet.
Alfaxan for a dog is 0.1-0.2 mls per kgs. In this case 5.3 ml was drawn up. Set up an IV as per Sp-
05.
Draw up post surgery pain medication such as meloxicam ie Metacam and place on clip board with
patient anaesthetic chart. This can be administered after the patient wakes from anaesthesia. Our
clinic uses Metacam injectable. The dose rate for dogs is 0.4 mls per kgs. Stella's dose is 1.42 mls.

Once the patient is suitably sedated she can be led from her run to the treatment area. Stella is then
walked onto a scissor lift and elevated to the correct height for the vet to place catheter and induce
patient.
To place the catheter a nurse will correctly restrain the animal as in SP-02 for me to access the
cephalic vein in the dogs forelimb. The front of the patients leg will be clipped between the carpus
and elbow crease. The insertion site is to be scrubbed with a dilute chlorhex solution. For general
antiseptic dilute 20 ml of hexacon in 1 litre of clean water. Wipe with an alcohol swab. Stella is a
large breed dog and a 18g over the needle catheter was used.
The needle was positioned at 45 degrees to her skin over the vein with the bevel facing upward.
Slide the catheter off the stilette and place the end of the primed fluid line on to the catheter. Tape
the catheter in by placing a piece of tape sticky side down under the hub of the port and wrapping
around the limb going over the top of the port to secure. The patient is put on a rate of 177 mls per
hour of Hartmanns solution for the duration of the surgery. This is a surgical rate of 5 ml/kg/hr.

The patient is then induced by the surgical vet with the alfaxan and intubated with an endotrachael
tube suitable for Stellas size. In this case the vet used a size 10.5 ET tube. The tube was then cuffed
and Stella was put on a rate of 2% Isoflurane, 1 litre of oxygen to maintain the level of anaesthesia.
The pulse oximeter and apnoea alert is connected to patient to help monitor their vital signs.
Check the heart sounds and make sure the heart sounds similar to before. If distinctly different get
the vet to check.
An anaesthetic chart is used to help monitor Stellas anaesthesia. Write down when she was induced
and what Oxygen level, Isoflurane level, SP02, Heart rate, Mucous Membrane colour, Capillary
Refill Time, eye position, jaw tone and blood pressure are every 5 minutes. These signs may be
monitored by the help of monitoring equipment such as:
A blood pressure machine. This records Stella's blood pressure and heart rate.
A stethoscope. When monitoring a patient always have a stethoscope to check your patient's heart
rate and rhythm.
Pulse oximeter, This is clipped on Stella's tongue and reads her heartrate and SP02 levels.
Ap-alert reads how many breaths per minute Stella is taking.
Monitoring these signs ensures you keep your patient at a safe level of anaesthetic.

The surgical site is clipped of fur and skin brushed off. See SP-11
The nurse is to mix some chlorhex wash and warm water in a kidney dish and scrub with wash and
swabs all around the abdomen and surgical site. This helps clear the skin of debris and bacteria. For
general antiseptic dilute 20 ml of hexacon in 1 litre of clean water.
After the initial scrub to remove debris and most bacteria the patient is disconnected from the
treatment area anaesthetic machine and moved into the theatre along with her fluid bag. Using the
scissor trolley to minimise lifting of patient, 2 people are required to move Stella from the trolley to
the surgical table.
When she is moved she is reconnected to the anaesthetic and pulse oximeter, apalert and blood
pressure monitor.

Make sure she stays warm by placing the Bair hugger bag prepared earlier over her top half. Place
the blanket over the top leaving her midsection bare. Turn the Bair hugger on.
Put on a surgical scrub top, hair net and shoe covers upon entry of theatre. Put gloves on to scrub
the patient. Using our number 2 scrub ie For pre-operative skin, instrument and surface use, dilute
10 ml of hexacon in 15ml of clean water and make up to 100ml with industrial strength methylated
spirits. No specified contact time. Pour solution on clean gauze swabs for preparing site for surgery.
Using a swab for one stroke only start in the middle of the site and wipe away to the edge of the
site.
Do this as many times as needed to come away with a clean swab, in a 'clock' pattern. Never going
over the same area twice.
Adjust the surgical light over the surgical site so that the vet has good visibility when they are ready
to commence.

The vet will have surgically scrubbed their hands for 5 minutes and be ready for surgery.
Open the vets gloves in an aseptic manner. As discussed in SP-12.
Open the surgical kit in an aseptic manner.
Once the vet is ready open and drop the scalpel blade onto the open surgical kit making sure the vet
is aware of the sharp.
During surgery Stella's heart rate slows from 80 to 60 and her breathes per minute are slowing. Her
level of anaesthesia has deepened so I reduce the Iso to 1.8%.
Within 5 minutes her heart rate has returned to a rate of 80 and her breaths per minute are steady on
20 per minute. This level of anaesthesia is good for Stella.

The vet asks for some swaged on 2-0 suture material with a taper point needle, the suture is
absorbable and intradermal sutures are placed. The vet has chosen 2-0 sized suture as it is slightly
thicker and tougher than a suture they may have used in a cat spey.
I trim Stella's nails and tattoo her left ear with tattoo ink and a tattoo clamp for identifying she has
been desexed.

The vet has finished closing Stella's surgical wound and I turn off the gas. I disconnect Stella from
the anaesthetic machine and flush oxygen through the circuit by covering the end of the circuit and
pressing the oxygen flow button. Once the bag has filled I uncover the end and push the air out into
the scavenger unit so I do not inhale Isoflurane. I do this a couple of times until it is clean oxygen in
the circuit. Stella is reconnected to oxygen while she is still asleep.
After a few minutes Stella gets some blink reaction.The cuff on the ET tube is deflated and the
patient's wound gently cleaned. She is taken off IV fluids and off oxygen. With another nurses help
she is moved across to the scissor lift placed in lateral position with warm,soft bedding and wheeled
out into the kennel room for recovery. Stella is lowered down on the scissor lift and hot water
bottles placed around her, not touching her and blankets placed over her and bottles to keep her
warm and comfortable. I administer her meloxicam injection.
I put on a clean set of gloves and I do a post operative check on Stella to check her recovery.
MM: Pink
CRT: <2
Sp02: 99%
HR: 98
RR: 22
BP: systolic pressure:
Temp: 38.8

All of these values are within normal ranges.

Stella can swallow so I remove the tube immediately and position her laying back down in lateral
position.

Once Stella is awake she is offered some food. Initially she is offered 1.2 cans of A/D Hills science
diet. She readily eats this.
As Stella is 35.5 kgs she needs to consume 1093 mls of A/D in 24 hours to maintain her body
condition. In 3 to 6 meals to reduce gastrointestinal upset.
I have chosen to give stella A/D as she has undergone surgery and A/D's ingredients helps to
promote wound healing, decrease in inflammatory response and helps avoid post surgery
complications.
One can of A/D is 156gms this equates to 150 ml. Stella will need 7.2 cans of A/D over 24 hours.
However, she may not have large meals after surgery as this increases the chance of nausea and
vomiting. The remaining 6 cans may be spread out over the next 24 hours. An hour after she has
had initial feed she may again have a can of A/D.
This case study will focus on your discussion of the following areas: scheduling the appointment,
admitting the patient, preparing for surgery, preparing the patient, supportive care and nursing, post-
operative care, theatre cleaning and discharging the patient. Safe work practices (equipment,
machinery, animals, lifting and infectious agents) are to be described at each step

Part Three: Nutritional requirements carbohydrates,protein,fat,water,vitamins and minerals.

Discuss in detail the nutritional requirements for your patient if hospitalisation for 24 hours were to
be required.
This may be an actual or hypothetical discussion and must include:
1. What type of food would you select for your patient and why? Consider life stage and species.
You must refer to the six key nutrients and their relevance to your diet choice.
2. How much would you feed your patient and over how many feeds? Include calculations based on
the manufacturer’s recommendations. You do not need to discuss specific energy requirements.
3. How would you present the food to your patient? What food and water bowls would you select
and why? Where would you place the food?
4. What would be the water requirements for this patient? How would you present it?
5. What would be the expected feeding behaviour of your patient? Consider life stage and species.
What consideration would you give to the animal’s temperament when providing the food?
6. How would you record outcomes of feeding and report any abnormalities to your supervisor?
7. Were there any WHS considerations or PPE requirements specific to this patient?

Part Four: Theatre preparation

Discuss in detail all aspects of preparing the theatre or operating area for surgery in your
workplace, with reference to SP-07 Theatre Cleaning, SP-08 Theatre Preparation, SP-09 Setup of
Anaesthetic Equipment and SP-10 Surgical Personnel Preparation. Your discussion must include:

3. Preparation of surgical equipment including packs, drapes, and suture material. What
considerations were made for this patient?
4. Preparation of surgical personnel apparel. What was worn by the surgeon and surgical nurse and
why?
5. How were these tasks coordinated and what role did you play?

Part Five: Patient preparation Discuss in detail the preparation of the patient, excluding anaesthetic
requirements, prior to the surgical procedure, with reference to SP-11 Surgical Patient Preparation.
Your discussion must include:
1. Considerations prior to anaesthesia. Did the patient require cleaning or toileting?
2. Restraint for induction of anaesthesia. How was this performed and where? What was your role
for this patient?
3. Clipping of the patient. Describe the margins for clipping, using correct anatomical terminology,
for this surgical procedure.
4. Preparation of the surgical site. Did your technique vary from that described in SP-11? Justify
any adjustments made.
5. Patient transfer to theatre. How was this performed? What considerations were there for
anaesthetic tubing, fluid lines and maintenance of surgical site?
6. Patient positioning for the surgical procedure. What position was the patient placed in and how
were they restrained?
7. WHS considerations for self and others. Were there any considerations specific to this case? Part
Six: Theatre support Discuss in detail the support provided to the surgeon during the surgical
procedure, with reference to SP-12 Opening Sterile Packs and SP-13 Theatre Rules and Etiquette.
Your discussion must demonstrate an understanding of asepsis and focus on the coordination of
tasks between staff. What role did you play?

Part Seven: Post-operative nursing Discuss in detail the post-operative care provided for your
patient. Your discussion should include:
1. Immediate post-operative cleaning of the patient. How was this performed for your patient, what
solutions were used and why?
2. Patient transfer to recovery area. When and how did this occur? What considerations were made
for the endotracheal tube and when was it removed?
3. Observation of vital signs. What did you monitor for your patient, how often and why? What
were your findings for your patient? Were there any abnormalities and what was the significance of
your findings? Were any signs of pain observed and if so, how were these addressed?
4. Nursing care provided, including exercise, toileting, cleaning of cage and bedding, grooming and
psychological care. What was your role with this patient?

Part Eight: Theatre and equipment cleaning Discuss in detail the cleaning of the theatre and theatre
equipment after the surgical procedure and why these procedures were undertaken. Refer to SP-07
Theatre Cleaning, SP-14 Reprocessing Surgical Kits and SP-15 Reprocessing Surgical Linen. Your
discussion should include:
1. Theatre and surgical equipment cleaning and storage procedures postoperatively. Did the
procedures vary from those described in SP-07? Justify any adjustments.
2. Cleaning and sterilisation of the surgical instruments. Did your technique vary from that
described in SP-14? Justify any adjustments.
3. Cleaning, repacking and sterilisation of surgical linen. Did your technique vary from that
described in SP-15? Justify any adjustments.
4. How were these tasks coordinated? What role did you play?

Part Nine: Patient discharge Discuss in detail the process of discharging your patient following the
surgical procedure, with reference to SP-16 Patient Preparation for Discharge. Your discussion
should include:
1. Patient preparation for discharge. Did your procedures vary from that described in SP-16?
Discuss any specific examinations, procedures or cleaning required for your patient. How and when
was your patient returned to their owner?
2. Preparation of medications. If no medication was required, discuss how you would prepare a
Schedule 4 Prescription Only Medicine or Prescription Animal Remedy for your patient at
discharge, with reference to SP-04 Drug and Poison Scheduling.
Include: a. Name, active ingredient and action of medication b. Dosage in mg/kg and show
calculations for your patient c. Drug schedule and legal requirements for dispensing the medication
d. Labelling requirements and special instructions e. Who is responsible for dispensing the
medication and what was your role for your patient?
3. Billing procedures. Who was responsible for payment collection and when was this performed?
4. Home care advice. What advice was provided for this client? Consider recovery times, diet,
exercise, wound care, suture removal, medications and follow up appointments. Discuss this in your
own words.
5. How were these tasks coordinated? What role did you play?

Overall 1. Use clear, correct and concise English a. Spelling b. Grammar c. Correct use of
terminology
2. Describe safe work practices
3. Relevant supplementary information should be included a. Supplementary evidence examples
include admission forms, anaesthetic forms, discharge forms plus any other documentation related
to this case b. Client confidentiality is respected. Obscure (e.g. with black felt pen) or remove any
personal or financial details that identify the client
4. Appropriate presentation of documents a. Document file name includes your name, student
number and assignment code b. Document text includes your name, student number and title of
assignment c. Submitted in appropriate file format Assessment Criteria for Case Study Your written
case study will be assessed against the following criteria. Ensure that you have thoroughly
discussed all parts within your case study.
Part One:
Appointment scheduling
o Described patient effectively
o Detailed procedure to be performed
o Discussed appointment scheduling process:
o Client information collected
o Advice given to client
o Business factors that influence surgical scheduling times
o Recording of surgical appointment

Part Two: Admission process

o Discussed client greeting and confirmation of details
o Discussed questions asked in relation to the pet's condition and admission for surgery
o Discussed steps taken to admit patient
o Discussed associated documentation
o Discussed internal communication processes '
o Discussed performance of patient admission examination
o Discussed patient restraint and transfer within practice
o Discussed WHS considerations of self and others
o Provided a completed patient admission for
o Discussed patient nutritional requirements:
o Specific nutritional needs
o Feeding behaviour
o Food type, amount, frequency and presentation
o Water requirements and presentation
o WHS considerations o Recording and reporting of feeding outcomes

Part Four: Theatre preparation

o Discussed pre-operative theatre cleaning
o Discussed theatre set-up
o Discussed preparation of theatre equipment
o Anaesthetic equipment
o Monitoring equipment (manual and mechanical)
o Discussed preparation of surgical equipment (packs, drapes, suture material)
o Discussed preparation of surgical personnel apparel (gowns, gloves)
o Discussed task coordination

Part Five: Patient preparation

o Discussed specific patient considerations
o Discussed patient restraint for induction of anaesthesia
o Discussed clipping of surgical site with correct anatomical terminology
o Discussed preparation of surgical site
o Discussed patient transfer to theatre
o Discussed patient positioning in theatre
o Discussed WHS considerations of self and others

Part Six: Theatre support

o Discussed provision of support in theatre
o Discussed task coordination

Part Seven: Post-operative nursing

o Discussed cleaning of patient
o Discussed patient transfer to recovery area
o Discussed patient observations
o Discussed monitoring for pain
o Discussed specific nursing care provided

Part Eight: Theatre and equipment cleaning

o Discussed post-operative theatre cleaning
o Discussed cleaning and storage of anaesthetic, monitoring and theatre equipment
o Discussed cleaning and repacking of surgical instruments
o Discussed laundering and repacking of surgical linen
o Demonstrated knowledge of sterilisation procedures
o Discussed task coordination Part Nine: Patient discharge
o Discussed preparation of patient for discharge
o Discussed preparation of medications including legislative requirements
o Discussed billing procedures
o Discussed client home care advice provided
o Discussed task coordination

Overall
o Case fits specified Case study selection criteria
o Used clear, correct and concise English
o Spelling
o Grammar
o Correct use of terminology
o Safe work practices were described
o Relevant supplementary information included
o Provided supplementary evidence
o Respected client confidentiality
o Appropriate presentation of documents
o Document file name includes student name, student number and unit code
o Document text includes student name, student number and title of assignment
o Submitted in appropriate file format

Ref: Hills science diet key to nutrition.