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F o r m I n s t r u c t i o n s :
I m p o r t a n t : P l e a s e t y p e a l l a n s w e r s .
F i l l i n t h e p r o t o c o l i n f o r m a t i o n t a b l e
A n s w e r a l l o f t h e q u e s t i o n s .
A n [ x ] i s e q u i v a l e n t t o a y e s .
P r o t o c o l I n f o r m a t i o n P I N a m e : F O R M T E X T D a t e : F O R M T E X T P r o t o c o l T i t l e : F O R M T E X T T A M U K I A C U C O R S P # : F O R M T E X T
1 . P r e o p e r a t i v e C a r e . A n s w e r a - d f o r e a c h s u r g e r y o r p r o c e d u r e .
a . [ F O R M T E X T ] F o o d w i l l b e w i t h h e l d . S t a t e t h e l e n g t h o f t i m e : F O R M T E X T
b . [ F O R M T E X T ] W a t e r w i l l b e w i t h h e l d . S t a t e t h e l e n g t h o f t i m e : F O R M T E X T
c . [ F O R M T E X T ] P r o p h y l a c t i c a n t i b i o t i c s w i l l b e g i v e n . G i v e t h e n a m e , d o s e , r o u t e , a n d f r e q u e n c y o f a d m i n i s t r a t i o n : F O R M T E X T
d . [ F O R M T E X T ] A n a l g e s i c s w i l l b e g i v e n . G i v e t h e n a m e , d o s e , r o u t e , a n d f r e q u e n c y o f a d m i n i s t r a t i o n : F O R M T E X T
2 . A n e s t h e s i a
a . G i v e t h e n a m e , d o s e , r o u t e a n d f r e q u e n c y o f a d m i n i s t r a t i o n o f t h e a n e s t h e s i a t o b e u s e d . F O R M T E X T
b . [ F O R M T E X T ] M u s c l e r e l a x a n t s o r p a r a l y t i c d r u g s w i l l b e u s e d . I f c h e c k e d , a n s w e r t h e f o l l o w i n g ( i - i v ) :
i . G i v e t h e n a m e , d o s e , r o u t e , a n d f r e q u e n c y o f a d m i n i s t r a t i o n a n d a s c i e n t i f i c j u s t i f i c a t i o n f o r e a c h a g e n t . F O R M T E X T
i i . D e s c r i b e h o w p a i n a n d d i s t r e s s w i l l b e a s s e s s e d d u r i n g p a r a l y s i s . F O R M T E X T
i i i . G i v e t h e n a m e , d o s e , a n d r o u t e o f a n y a n e s t h e s i a o r a n a l g e s i a t o b e g i v e n d u r i n g p a r a l y s i s . F O R M T E X T
i v . I f a n a l g e s i c s a n d / o r a n e s t h e t i c s w i l l n o t b e u s e d d u r i n g p a r a l y s i s , p r o v i d e a s c i e n t i f i c j u s t i f i c a t i o n . F O R M T E X T
3 . A n i m a l , I n s t r u m e n t a n d S u r g e o n P r e p a r a t i o n . C o m p l e t e a l l o f t h e c h e c k l i s t s b e l o w .
A n i m a l P r e p a r a t i o n . P l e a s e c h e c k a l l t h a t a p p l y : F O R M T E X T C O M M E N T S \ * U p p e r \ * M E R G E F O R M A T O p e r a t i v e s i t e w i l l b e s h a v e d . F O R M T E X T C O M M E N T S \ * U p p e r \ * M E R G E F O R M A T F O R M T E X T C O M M E N T S \ * M E R G E F O R M A T O p e r a t i v e s i t e w i l l b e d i s i n f e c t e d w i t h b e t a d i n e o r c h l o r o h e x i d i n e a n d a l c o h o l . F O R M T E X T F O R M T E X T O p e r a t i v e s i t e w i l l b e d i s i n f e c t e d b y o t h e r m e t h o d . P l e a s e l i s t : F O R M T E X T F O R M T E X T O p e r a t i v e s i t e w i l l b e d r a p e d w i t h s t e r i l e m a t e r i a l . F O R M T E X T
I n s t r u m e n t P r e p a r a t i o n . P l e a s e c h e c k a l l t h a t a p p l y : F O R M T E X T I n s t r u m e n t s w i l l b e s t e r i l i z e d u s i n g a s t e a m a u t o c l a v e . F O R M T E X T F O R M T E X T I n s t r u m e n t s w i l l b e s t e r i l i z e d u s i n g e t h y l e n e o x i d e g a s . F O R M T E X T F O R M T E X T I n s t r u m e n t s w i l l b e s t e r i l i z e d u s i n g c h e m i c a l m e a n s . P l e a s e l i s t s o l u t i o n a n d c o n t a c t t i m e : F O R M T E X T F O R M T E X T I n s t r u m e n t s w i l l b e s t e r i l i z e d u s i n g a b e a d s t e r i l i z e r b e t w e e n a n i m a l s . F O R M T E X T
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l ap ^ ^ D^ F^ H^ \^ ^^ `^ j^ l^ n^ p^ r^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ 㫟|ua㟘 &j5" haf haf OJ QJ U\ hJ :\ &j haf haf OJ QJ U\ hJ 5:\ hJ 5\ hJ 5:OJ QJ \U+j haf haf OJ QJ U\mH nH u&j' haf haf OJ QJ U\ haf haf OJ QJ \ j haf haf OJ QJ U\ hJ \ hJ 6] ^ F^ n^ } k $$-D If M
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l af4p S u r g e o n w i l l w e a r s t e r i l e g l o v e s . F O R M T E X T F O R M T E X T S u r g e o n w i l l w e a r e x a m g l o v e s . F O R M T E X T F O R M T E X T S u r g e o n w i l l w e a r s t e r i l e g o w n . F O R M T E X T F O R M T E X T S u r g e o n w i l l w e a r s u r g i c a l m a s k . F O R M T E X T F O R M T E X T S u r g e o n w i l l w e a r h a i r b o n n e t . F O R M T E X T
4 . S u r g e r y / P r o c e d u r e
a . I n d i c a t e w h e r e t h e s u r g e r y , o r p r o c e d u r e w i l l t a k e p l a c e , ( i n c l u d i n g b u i l d i n g , f l o o r a n d r o o m n u m b e r ) . F O R M T E X T
b . G i v e a d e t a i l e d d e s c r i p t i o n o f t h e s u r g e r y / p r o c e d u r e a n d i n d i c a t e t h e n u m b e r o f t i m e s e a c h s u r g e r y / p r o c e d u r e w i l l b e p e r f o r m e d . F O R M T E X T
c . [ ] T h i s p r o c e d u r e i s a m a j o r s u r g e r y ( o n e t h a t p e n e t r a t e s a n d e x p o s e s a b o d y c a v i t y o r p r o d u c e s s u b s t a n t i a l i m p a i r m e n t o f p h y s i c a l o r p h y s i o l o g i c a l f u n c t i o n ) .
P r o v i d e s c i e n t i f i c j u s t i f i c a t i o n i f m o r e t h a n o n e m a j o r s u r g e r y i s p r o p o s e d . F O R M T E X T
d . G i v e a d e t a i l e d d e s c r i p t i o n o f t h e c r i t e r i a t h a t w i l l b e u s e d t o a s s e s s a d e q u a c y o f a n e s t h e s i a a n d a n i m a l i n t r a o p e r a t i v e w e l l - b e i n g . F O R M T E X T
5 . P o s t - s u r g i c a l / P o s t - p r o c e d u r a l c a r e . P r o c e d u r e s k n o w n t o c a u s e p a i n i n h u m a n s s h o u l d b e c o n s i d e r e d p a i n f u l t o a n i m a l s . I f a n i m a l s w i l l b e s u b j e c t t o p r o c e d u r e s t h a t h a v e p o t e n t i a l f o r p a i n , d e s c r i b e t h e p o s t o p e r a t i v e c a r e a n d a n a l g e s i c s .
a . I d e n t i f y t h e p e r s o n f r o m y o u r l a b w h o w i l l b e r e s p o n s i b l e f o r p o s t - p r o c e d u r a l c a r e a n d p a i n r e l i e f . F O R M T E X T
b . D e s c r i b e h o w p a i n a n d d i s t r e s s w i l l b e m o n i t o r e d a n d t h e c r i t e r i a t h a t w i l l b e u s e d t o i d e n t i f y p a i n a n d d i s t r e s s . F O R M T E X T
c . L i s t t h e m e t h o d s o f a n a l g e s i a t h a t w i l l b e u s e d t o p r e v e n t o r r e l i e v e p o s t - p r o c e d u r a l p a i n a n d d i s t r e s s .
i . G i v e t h e n a m e , d o s e , r o u t e , a n d f r e q u e n c y o f a d m i n i s t r a t i o n o f p a i n - r e l i e v i n g d r u g s . F O R M T E X T
i i . D e s c r i b e n o n p h a r m a c o l o g i c a l m e t h o d s s u c h a s c a g e p a d d i n g , b a n d a g i n g , a p p l i c a t i o n o f c o l d p a c k s , e t c . F O R M T E X T
d . D e s c r i b e p o s t - p r o c e d u r a l c a r e , w h i c h m a y i n c l u d e a d m i n i s t r a t i o n o f p a r e n t e r a l f l u i d s f o r m a i n t e n a n c e o f w a t e r a n d e l e c t r o l y t e b a l a n c e , m o n i t o r i n g f o r p o s t s u r g i c a l i n f e c t i o n s , m o n i t o r i n g o f t h e s u r g i c a l i n c i s i o n a n d r e m o v a l o f s u t u r e s o r w o u n d c l i p s . F O R M T E X T
e . D e s c r i b e t h e s t e p s y o u w i l l t a k e i f p a i n c a n n o t b e a d e q u a t e l y m a n a g e d . F O R M T E X T
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