ANSWERS

1. Define a wound.
   An injury in which there is a forcible break in the continuity of the soft tissues.
2. List the 5 main categories of wound and briefly describe each.
   
   • Open wound - an injury causes a break in the skin or mucous membranes.
   • Closed wound - an injury does not cause a break in the body covering (these wounds are often internal).
   • Abrasion - a superficial wound whereby the injury does not penetrate the entire skin thickness.
   • Avulsed wound - an injury involving the tearing away of a flap of skin from the underlying tissues but that still remains attached at one point.
   • Contused wound - any wound in which bruising is present.
3. List the 4 types of open wound.
   
   • Incised.
   • Lacerated.
   • Puncture.
   • Abrasion.
4. Give 4 examples of possible causes of an incised wound.
   
   • Broken glass.
   • Barbed wire.
   • Cat claws.
   • Surgical incision by means of a scalpel blade.
5. Give 4 examples of possible causes of a puncture wound.
   
   • Thorns.
   • Teeth.
   • Airgun pellets.
   • Fish hooks.
6. What is the name of the condition that causes abrasions known as "hot spots", and commonly affects the Golden Retriever?
   Wet eczema.
7. What is another name for second intention healing?
   Granulation.
8. List 4 differences between first and second intention healing.
   
   • First intention healing is complete in 7-10 days, whilst second intention healing can take weeks or months.
   • No infection is present in wounds healing by first intention, but bacterial infection is often present in wounds healing by second intention.
   • There is minimal scarring following the repair of a wound by first intention healing, whilst scarring is usually extensive in granulating wounds.
   • The edges of the wound remain close together in wounds healing by first intention, whilst the wound edges are widely separated in granulating wounds.
9. List 4 factors that may contribute to a delay in wound healing.
   
   • Movement.
   • Impaired local circulation at the site of the wound.
   • Infection.
   • Interference of the wound by the patient.
10. List 8 methods in which patient mutilation of a wound may be prevented.
    
    • Application of a dressing.
    • Application of an Elizabethan collar.
    • Keeping the patient busy and distracted from the wound.
    • Ensuring adequate analgesia - a painful wound is more likely to be interfered with than a non-painful wound.
    • Dressing the feet to prevent scratching of the wound with sharp claws.
    • Keeping the patient isolated from other animals which may also try to lick the wound.
    • Using bitter spray to deter licking (this must not be sprayed directly onto a wound, but can be applied to socks placed over limb bandages to prevent removal of the dressing).
    • Using a dog boot (again these can be placed over a limb bandage to protect the dressing).
    • Sedation may be necessary in some cases if conventional deterrents prove ineffective.
11. List 6 important factors to be aware of when looking after a patient with a dressing.
    
    • Ensure that the dressing is not too tight.
    • Ensure that the dressing is kept clean.
    • Ensure that the dressing is kept dry.
    • Be vigilant for signs such as odour or discharge and promptly remove the dressing should any such signs occur.
    • Prevent patient interference.
    • Ensure that the dressing is changed in accordance with the veterinary surgeon's instructions.
    • Check for sores or redness at the edges of the dressing.
12. A greyhound is brought to the surgery having cut her stopper pad whilst exercising on the beach. The owner has applied a dressing which is already red with blood. List your actions.
    
    • In theory, prior to treating a case you should always take a full medical history. However, in practice if time is of the essence and a patient is unconscious or struggling to breathe then this should take priority. Therefore, the first step is to establish that the dog is conscious and able to breathe unaided, and control any excessive visible haemorrhage.
    • Step 2 is to take a full history (see Module 2) and ensure that the owner signs a consent form for treatment.
    • Introduce yourself to the patient and establish her trust by talking gently and approaching her in a quiet and calm manner. If the owner is squeamish, it is unwise for him/her to be present during the examination - enlist the assistance of a colleague to hold the dog or you may well end up dealing with 2 first aid cases and a fainting client!
    • Often, the third step is to treat shock. However, if shock is significant (eg. circulatory collapse), this would become a priority over history taking. Any animal suffering a large degree of blood loss is likely to be shocked, and fluid therapy should be initiated as soon as possible. A veterinary surgeon should be contacted if the condition of the animal is deemed to be serious.
    • If continued bleeding is apparent, then apply a new dressing over the old. If bleediing appears to have ceased or is minimal, remove the dressing applied by the owner, taking care not to disturb blood clots.
    • Control any severe haemorrhage.
    • Ensure that any foreign material is removed from the wound, including hair which should be clipped away.
    • Cleanse the wound with warm saline or dilute Povidone iodine solution (chlorhexidine should be avoided as it is associated with cell death in open wounds).
    • Dry the wound and dress.
    • Keep the animal warm and immobile until the veterinary surgeon arrives.
13. List the dressing materials that you would choose for the injury described in Q11 and state your reasons.
    
    • Wound dressing.
    • Padding layer (eg. Soffban) - conforming layer of absorbent material offering a soft layer of protection to the injured paw.
    • Secondary layer (eg. Knitfirm) - strong, conforming bandage ideal for holding the primary and padding layers in place.
    • Tertiary layer (eg. Coflex) - cohesive, conforming tape providing a neat, protective outer layer.
14. Describe what is meant by conforming and cohesive.
    
    • Conforming - this describes a flexible dressing that is easily moulded to the contours of the part of the animal's anatomy to be dressed.
    • Cohesive - this describes a dressing that sticks to itself but not to hair or skin (this means that it may be easily removed without hurting the animal).
15. List the 3 types of closed wound.
    
    • Contusion (bruise).
    • Haematoma (blood blister).
    • Damage to internal organs/structures.
16. List 4 signs that manifest following a contusion.
    
    • Skin discoloration.
    • Heat.
    • Swelling.
    • Pain.
17. How does the treatment of a recent contusion differ from that of one sustained some hours previous?
    A cold compress should be applied to a recent contusion in order to cause vasoconstriction in the damaged area, thus limiting the amount of blood lost and helping to prevent swelling of the tissues. A hot fomentation may be applied to a contusion that is several hours old and swollen, however the visual appearance of the contusion needs to be taken into consideration in deciding whether this should be done. In both cases, firm bandaging will benefit the patient by increasing back pressure, controlling haemorrhage, limiting swelling and thus reducing pain.
18. What is one of the most common sites for a haematoma?
    The pinnae of the ear.
19. How does the treatment of a bee sting differ to that of a wasp sting?
    Bees stings are acidic and thus may be treated with an alkaline solution such as bicarbonate. Wasp stings are alkaline and are neutralised with a mildly acidic solution such as lemon juice or vinegar. In all cases the sting should be removed if possible. The animal must be carefully observed if stung in the mouth since any subsequent swelling may compromise respiration. If the type of sting is unknown, the area should be bathed with saline.
20. Why do cat bite injuries commonly result in abscessation?
    Due to the bacteria present in cats' mouths (predominantly Pastuerella multocida).
21. Why is it important for a client to seek veterinary advice in the event of their pet suffering a cat bite abscess?
    Cat bite abscesses are painful. This pain can be alleviated by surgical drainage of the accumulation of pus. If left untreated, the abscess will eventually burst but it is likely that the area will turn necrotic and the possibility of septicaemia is a risk. In all abscess cases it is sensible to provide antibiotic cover.
22. Why can extensive burns cause dehydration?
    Appreciable volumes of body fluids evaporate from a large area of exposed flesh.
23. What is the difference between a burn and a scald?
    Burns are caused predominantly by dry heat (but also by excessive cold, corrosive chemicals, electricity or radiation) whilst scalds are caused by the effect of moist heat such as boiling water, steam, tar or oil.
24. State 2 possible causes of a burn resultant from excessive cold.
    
    • Frost bite.
    • Cryosurgery.
25. A client arrives at the surgery with a kitten that has fallen into a bath of very hot water. Describe your initial actions.
    
    • Establish that the airway is clear and that the kitten is able to breathe unaided.
    • Ask a colleague to take details from the owner since prompt action is essential.
    • Cool the kitten in a gentle stream of tepid water (freezing cold water is not suitable since it may worsen shock).
    • Provide warmth once the initial cooling process is complete (do not use direct heat, a warm ambient environment is best).
    • Ensure that the veterinary surgeon has been contacted in order to provide prompt analgesia.
    • Apply protective wound gel and dressings where possible; this may prove difficult if the entire kitten has been immersed but the more evaporation of moisture that you are able to prevent the better.
    • The kitten will require intensive care and must be monitored very closely; for this reason it is sensible to enlist the help of a colleague to set up the necessary equipment for fluid therapy.
26. Describe the follow-up actions that you would take in order to provide the very best nursing care for the kitten in Q25.
    
    • Ensure that the kennel is kept scrupulously clean to avoid contamination of the dressings/wounds.
    • Keep accurate hospital records and be extra vigilant for signs of shock, dehydration and pain.
    • Perform regular dressing changes under the direction of the veterinary surgeon (ensure that dressings are kept clean and dry and that the kitten is not interfering with them).
    • The fur will fall out if the hair follicles have been damaged, and this must gently be removed from the wounds.
    • Ensure that pain relief is administered in accordance with the veterinary surgeon's directions and at specified times.
    • Ensure that fluid therapy is administered in accordance with the veterinary surgeon's directions.
    • Use shredded paper in the litter tray rather than cat litter, since cat litter may stick to and contaminate any wounds that are not dressed.
    • Ensure that antibiotic therapy is administered in accordance with the veterinary surgeon's directions.
    • Ensure adequate nutrition is supplied.
    • Ensure adequate fluid is supplied, either orally or intravenously.
27. State why it is advisable for patients suffering from burns or scalds to be given antibiotic therapy.
    Burns and scalds are sterile since the initial heat destroys the bacteria on the skin. However, toxins are released when the damaged tissue begins to die and these may cause toxaemia or septicaemia when absorbed into the blood stream.
28. List 3 advantages of dressing wounds caused by burns or scalds.
    
    • Prevention of fluid loss from the exposed tissues.
    • Protection of the exposed tissues from further damage.
    • Prevention of patient interference and contamination from licking.
29. Give 2 reasons as to why dressings used to protect burns should be kept as light as possible.
    
    • Thick dressings prevent heat-loss from the inflamed, over-heated area (the cooler the area is kept, the less painful it will be for the animal).
    • Thick dressings absorb more fluid from the wound surface, and it is important that the exposed area be kept as moist as possible.
30. List the groups of drugs that may be used to treat patients with wounds in small animal practice and give an example of each.
    
    • Systemic antibacterial preparations - Enrofloxacin (Baytril).
    • Topical antibacterial preparations - Fucidin (Fuciderm).
    • Antiseptics - Povidone Iodine.
    • Non steroidal anti-inflammatories - Carprofen (Rimadyl).
    • Analgesics (to provide pain relief) - Buprenorphine (Vetergesic).
31. Give 3 instances when a local application of heat may be indicated.
    
    • Oedema.
    • Infected wounds.
    • Abscesses.
32. Give 4 instances when a local application of cold may be indicated.
    
    • Burns/scalds.
    • Haemorrhage.
    • Heat stroke.
    • Pain.