BOOK
Perioperative Nursing - EBook-epub
Lois Hamlin | Menna Davies | Marilyn Richardson-Tench | Sally Sutherland-Fraser
(2016)
Additional Information
Book Details
Abstract
Perioperative Nursing 2e has been written by local leaders in perioperative nursing and continues to deliver a contemporary, practical text for Australian and New Zealand perioperative nurses.
Appropriate for nursing students and graduates entering the perioperative environment, Perioperative Nursing, 2e offers a sound foundational knowledge base to underpin a perioperative nursing career. This unique text will also be of value to those undertaking postgraduate perioperative studies, as well as to more experienced perioperative nurses seeking to refresh their knowledge or expand their nursing practice. This essential title examines the roles and responsibilities of nurses working within a perioperative environment, providing an overview of key concepts in perioperative care. The scope of this book addresses anaesthetic, intraoperative and postanaesthetic recovery care, as well as day surgery and evolving perioperative practices and environments.
- Research boxes where appropriate
- Feature boxes on special populations, such as paediatric, geriatric and bariatric patients
- Emphasis is placed on the concept of the patient journey, working within interprofessional teams, communication, teamwork, patient and staff safety, risk management strategies and medico-legal considerations.
- Now endorsed by ACORN
- Aligns with the 2016 ACORN and PNC NZNO Standards
- Reflects the latest national and international standards, including the NSQHS Standards, the new NMBA Standards for Practice for Registered and Enrolled Nurses and the WHO Surgical Safety Checklist
- Includes two new chapters: The perioperative team and interdisciplinary collaboration and Perioperative patient safety
- Supporting online resources are available on evolve.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Perioperative Nursing | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Foreword | ix | ||
| Preface | x | ||
| Editors | xi | ||
| Contributors | xiii | ||
| Reviewers | xv | ||
| Acknowledgements | xv | ||
| 1 Perioperative nursing | 1 | ||
| Learning Outcomes | 1 | ||
| Key Terms | 1 | ||
| Introduction | 2 | ||
| The History and Philosophy of Perioperative Nursing | 2 | ||
| The Patient Journey | 2 | ||
| Cultural Safety | 3 | ||
| Patient Advocate | 3 | ||
| Perioperative Nursing Roles | 4 | ||
| Preadmission nurse | 5 | ||
| Anaesthetic nurse | 5 | ||
| Circulating nurse | 5 | ||
| Instrument nurse | 6 | ||
| Surgical assistant nursing roles | 6 | ||
| PACU nurse | 7 | ||
| Perioperative NP | 8 | ||
| The Regulatory Environment | 8 | ||
| Competency | 10 | ||
| Accountability | 10 | ||
| Relationship between accountability, delegation and supervision | 10 | ||
| Scope of nursing practice | 11 | ||
| Influences for Change in Nursing Practice | 12 | ||
| Informal and Continuing Professional Development | 12 | ||
| Formal Development | 13 | ||
| The Role of Professional Associations | 15 | ||
| Professional nursing associations | 15 | ||
| Perioperative nursing associations | 16 | ||
| Australian College of Operating Room Nurses (ACORN) | 16 | ||
| Perioperative Nurses College of the New Zealand Nurses Organisation (PNC NZNO) | 16 | ||
| International perioperative associations | 16 | ||
| Professional practice standards | 17 | ||
| Research and Evidence-Based Practice | 17 | ||
| An evidence-based approach to practice | 17 | ||
| The Future of Perioperative Nursing Practice | 19 | ||
| Creating opportunities for nursing specialisation | 19 | ||
| Changing ancillary and unregulated worker roles | 20 | ||
| Changing, evolving and advanced roles for perioperative registered nurses | 21 | ||
| Nurse endoscopist | 22 | ||
| Nurse sedationist | 23 | ||
| Conclusion | 23 | ||
| Resources | 24 | ||
| References | 25 | ||
| Further Reading | 29 | ||
| 2 The perioperative team and interdisciplinary collaboration | 30 | ||
| Learning Outcomes | 30 | ||
| Key Terms | 30 | ||
| Introduction | 30 | ||
| The Interdisciplinary Team | 30 | ||
| The Perioperative Team and Professional Hierarchy | 31 | ||
| The Culture and Context of the Perioperative Environment | 32 | ||
| Human Factors | 32 | ||
| Non-technical skills | 33 | ||
| Lessons learnt from aviation | 33 | ||
| Teamwork | 35 | ||
| Communication | 35 | ||
| Shared mental models | 37 | ||
| Situation awareness | 37 | ||
| Leadership and a multigenerational workforce | 38 | ||
| Environmental factors | 39 | ||
| Task management | 39 | ||
| Ergonomics | 40 | ||
| Noise and distraction | 40 | ||
| The ‘sterile cockpit’ | 41 | ||
| Graded assertiveness | 41 | ||
| Conclusion | 43 | ||
| Resources | 44 | ||
| References | 44 | ||
| Further Reading | 46 | ||
| 3 Perioperative patient safety | 47 | ||
| Learning Outcomes | 47 | ||
| Key Terms | 47 | ||
| Introduction | 48 | ||
| Clinical Governance | 48 | ||
| Patient Safety and Risk Management in the Perioperative Environment | 49 | ||
| Adverse events and sentinel events | 49 | ||
| Reporting on adverse events in Australasia | 50 | ||
| Reporting on sentinel events in Australasia | 50 | ||
| Safety and Quality | 52 | ||
| National Safety and Quality in Healthcare Standards | 53 | ||
| Standard 1: Governance for safety and quality in health service organisations | 55 | ||
| Standard 2: Partnering with consumers | 55 | ||
| Standard 3: Preventing and controlling healthcare-association infections | 55 | ||
| Standard 4: Medication safety | 56 | ||
| Standard 5: Patient identification and procedure matching | 56 | ||
| Standard 6: Clinical handover | 57 | ||
| Standard 7: Blood and blood products | 57 | ||
| Standard 8: Preventing and managing pressure injuries | 58 | ||
| Standard 9: Recognising and responding to clinical deterioration in acute healthcare | 58 | ||
| Standard 10: Preventing falls and harm from falls | 58 | ||
| National Standards: Version 2 | 59 | ||
| Australian Council on Healthcare Standards | 60 | ||
| Professional practice standards and patient safety | 61 | ||
| Use of Checklists | 62 | ||
| WHO Surgical Safety Checklist | 62 | ||
| Management of accountable items | 62 | ||
| Medication Management | 63 | ||
| Labelling of injectable medicines, fluids and lines | 64 | ||
| Clinical Audit | 65 | ||
| Conclusion | 68 | ||
| Resources | 69 | ||
| References | 70 | ||
| Further Reading | 73 | ||
| 4 Medico-legal aspects of perioperative nursing practice | 74 | ||
| Learning Outcomes | 74 | ||
| Key Terms | 74 | ||
| Introduction | 75 | ||
| Accountability and Advocacy | 75 | ||
| Statutes and Common Law | 76 | ||
| Common law | 76 | ||
| Health policies and professional practice standards | 76 | ||
| Negligence | 77 | ||
| Vicarious liability | 77 | ||
| Open disclosure | 77 | ||
| Pursuing cases of negligence in civil courts | 78 | ||
| Consent to treatment | 79 | ||
| Patients unable to give consent | 79 | ||
| Consent and minors | 81 | ||
| Consent and mental illness | 81 | ||
| Consent and blood transfusions | 82 | ||
| Culture, religion and surgery | 82 | ||
| Coroners’ courts | 83 | ||
| Documentation | 84 | ||
| Electronic health record | 85 | ||
| Regulatory Action and Disciplinary Hearings | 85 | ||
| Notifications and complaints | 85 | ||
| Mandatory notifications | 85 | ||
| Assessment of complaints and notifications | 86 | ||
| Performance | 86 | ||
| Conduct | 86 | ||
| Health matters | 87 | ||
| Immediate action | 87 | ||
| Investigation | 87 | ||
| Panel and committee hearings | 89 | ||
| Tribunal hearings | 89 | ||
| Appeals | 89 | ||
| Monitoring and compliance | 89 | ||
| Confidentiality and Privacy | 89 | ||
| Breaches of confidence and privacy | 90 | ||
| Social Media | 91 | ||
| Misuse of social media | 91 | ||
| Use of cameras within hospitals | 92 | ||
| Patient care and social media | 92 | ||
| Conclusion | 93 | ||
| Resources | 94 | ||
| References | 94 | ||
| Further Reading | 95 | ||
| 5 The perioperative environment | 97 | ||
| Learning Outcomes | 97 | ||
| Key Terms | 97 | ||
| Introduction | 97 | ||
| Operating Suite Design | 98 | ||
| Traffic Patterns | 101 | ||
| Operating Suite Zones | 101 | ||
| Unrestricted | 101 | ||
| Semi-restricted | 102 | ||
| Restricted | 102 | ||
| Operating Suite Layout | 102 | ||
| Changing rooms | 102 | ||
| Reception | 102 | ||
| Preoperative holding bay | 102 | ||
| Anaesthetic rooms | 102 | ||
| Storage areas | 102 | ||
| Sterile stock room | 102 | ||
| Staff rooms | 102 | ||
| The PACU | 102 | ||
| Sterilising department | 103 | ||
| Scrub bays | 104 | ||
| Standard operating rooms | 104 | ||
| Dedicated operating rooms | 104 | ||
| Hybrid operating rooms | 104 | ||
| Technological Advances in the Operating Suite | 105 | ||
| Operating Suite Environmental Controls | 105 | ||
| Windows | 105 | ||
| Ceilings, doors, floors and walls | 106 | ||
| Temperature | 106 | ||
| Humidity | 106 | ||
| Ventilation | 106 | ||
| Lighting | 107 | ||
| Electrical Safety | 108 | ||
| Electrosurgical equipment | 109 | ||
| The electrosurgical unit | 109 | ||
| Monopolar diathermy | 109 | ||
| Bipolar diathermy | 109 | ||
| Hazards of electrosurgery | 110 | ||
| Related equipment | 111 | ||
| Laser | 112 | ||
| Laser safety | 113 | ||
| Workplace Health and Safety | 113 | ||
| Manual handling | 114 | ||
| Surgical plume | 114 | ||
| Prevention of fire or explosions | 115 | ||
| Sensitivities and allergies | 117 | ||
| Types of allergic reactions to Latex | 117 | ||
| Prevention of latex allergy | 117 | ||
| Occupational exposure | 117 | ||
| Radiation safety | 117 | ||
| Chemical safety | 119 | ||
| Noise | 120 | ||
| Preparation of the Operating Room | 120 | ||
| Room cleaning | 120 | ||
| Terminal cleaning | 120 | ||
| Waste Management | 121 | ||
| Conclusion | 122 | ||
| Resources | 123 | ||
| References | 123 | ||
| Further Reading | 126 | ||
| 6 Infection prevention and control | 128 | ||
| Learning Outcomes | 128 | ||
| Key Terms | 128 | ||
| Introduction | 129 | ||
| Classification and Types of Microorganisms | 129 | ||
| Bacteria | 129 | ||
| Gram-positive cocci | 129 | ||
| Staphylococci | 129 | ||
| Streptococci | 129 | ||
| Enterococci | 129 | ||
| Gram-positive rods | 130 | ||
| Fungi | 130 | ||
| Viruses | 130 | ||
| Prions | 131 | ||
| Development of resistance to antimicrobial drugs | 132 | ||
| Risk Management of Microorganisms | 132 | ||
| Infectious agent | 132 | ||
| Reservoir | 132 | ||
| Portal of exit | 132 | ||
| Transmission | 132 | ||
| Portal of entry | 132 | ||
| Susceptible host | 133 | ||
| Normal Body Defences | 133 | ||
| External barriers | 133 | ||
| Inflammatory response | 134 | ||
| Immune response | 134 | ||
| Infection as an Adverse Event | 134 | ||
| Infection Prevention and Control Practices | 134 | ||
| Environmental controls | 135 | ||
| Healthcare personnel attire | 135 | ||
| Standard precautions | 137 | ||
| Hand hygiene | 137 | ||
| Personal protective equipment | 138 | ||
| Non-sterile gloves | 138 | ||
| Face masks | 138 | ||
| Eye protection | 139 | ||
| Sharps safety | 139 | ||
| Respiratory hygiene and cough etiquette | 139 | ||
| Food and drink in clinical areas | 139 | ||
| Environmental cleaning | 140 | ||
| Transmission-based precautions | 140 | ||
| Airborne precautions | 140 | ||
| Droplet precautions | 140 | ||
| Contact precautions | 140 | ||
| Environmental cleaning following use of contact precautions | 140 | ||
| Patient considerations in infection prevention | 140 | ||
| Asepsis and Aseptic Technique | 141 | ||
| Opening sterile supplies | 142 | ||
| Putting principles into practice | 142 | ||
| Pouring liquids onto an aseptic field | 143 | ||
| Moving around the operating room | 145 | ||
| Surgical conscience | 145 | ||
| Aseptic non-touch technique | 145 | ||
| The surgical scrub | 146 | ||
| Gowning | 147 | ||
| Gloving | 147 | ||
| Skin preparation of the patient | 149 | ||
| Safe use of alcohol-based skin preparation solutions | 149 | ||
| Prepping procedure | 149 | ||
| Draping the patient | 150 | ||
| Strikethrough | 150 | ||
| Instrument Cleaning, Decontamination and Sterilisation | 150 | ||
| Decontamination and cleaning | 151 | ||
| Inspection, assembly and packaging | 152 | ||
| Inspection | 152 | ||
| Assembly | 152 | ||
| Packaging | 152 | ||
| Sterilisation | 153 | ||
| Methods of sterilisation | 153 | ||
| Steam | 153 | ||
| Dry heat | 154 | ||
| Ethylene oxide gas | 154 | ||
| Gas plasma | 155 | ||
| Peracetic acid | 155 | ||
| Gamma radiation | 155 | ||
| Creutzfeldt-Jakob disease | 155 | ||
| Monitoring sterilisation processes | 156 | ||
| Physical | 156 | ||
| Chemical | 156 | ||
| Biological | 156 | ||
| Tracking and traceability | 156 | ||
| Disinfection | 156 | ||
| Storage of sterile equipment | 157 | ||
| Conclusion | 157 | ||
| Resources | 157 | ||
| Video Resources | 158 | ||
| References | 158 | ||
| Further Reading | 159 | ||
| 7 Assessment and preparation for surgery | 160 | ||
| Learning Outcomes | 160 | ||
| Key Terms | 160 | ||
| Introduction | 160 | ||
| Pre-Admission | 161 | ||
| Patient selection and assessment for surgery | 161 | ||
| Patient selection | 161 | ||
| Preoperative assessment | 161 | ||
| Nurse-led clinics | 163 | ||
| Patient Education and Information | 163 | ||
| Paediatric patients | 171 | ||
| Factors Affecting Selection for Surgery | 171 | ||
| Preoperative investigations | 172 | ||
| Chest X-rays | 172 | ||
| Electrocardiography | 172 | ||
| Blood investigations | 173 | ||
| Other perioperative considerations | 173 | ||
| Preoperative visiting | 174 | ||
| Cultural Sensitivity | 174 | ||
| Special Population Considerations | 174 | ||
| Smoking | 174 | ||
| Obesity | 176 | ||
| Diabetes | 176 | ||
| Preparation in the Immediate Preoperative Period | 177 | ||
| Preoperative bathing | 177 | ||
| Preoperative hair removal | 177 | ||
| Surgical site marking | 177 | ||
| Prevention of deep vein thrombosis | 179 | ||
| Preoperative Care in the Operating Suite | 179 | ||
| Admission to the preoperative holding area | 179 | ||
| Patient identification | 184 | ||
| Consent | 184 | ||
| Allergies and sensitivities | 184 | ||
| Preoperative fasting | 184 | ||
| Premedication and medications | 184 | ||
| Implants | 185 | ||
| Return of body parts or hair | 185 | ||
| Jewellery and piercings | 185 | ||
| Preoperative patient warming | 185 | ||
| Conclusion | 187 | ||
| Resources | 188 | ||
| References | 188 | ||
| Further Reading | 191 | ||
| 8 Patient care during anaesthesia | 193 | ||
| Learning Outcomes | 193 | ||
| Key Terms | 193 | ||
| Introduction | 194 | ||
| Medical Pre-Anaesthetic Assessment of the Patient | 194 | ||
| Assessment of the airway | 194 | ||
| Mallampati assessment | 195 | ||
| Nursing assessment and preparation of the patient | 195 | ||
| Types of Anaesthetics | 196 | ||
| General anaesthesia | 196 | ||
| Pharmacological agents used in general anaesthesia | 197 | ||
| IV induction agents | 197 | ||
| Inhalational agents | 197 | ||
| Adjuncts to general anaesthesia | 198 | ||
| Analgesics | 198 | ||
| Muscle relaxants | 198 | ||
| Depolarising neuromuscular blockers | 198 | ||
| Non-depolarising neuromuscular blockers | 201 | ||
| Antiemetics | 201 | ||
| Procedure for General Anaesthesia | 201 | ||
| Preparation and equipment | 201 | ||
| Airway management equipment and techniques | 202 | ||
| Artificial airways | 202 | ||
| Face masks | 203 | ||
| Laryngeal mask airway | 203 | ||
| Endotracheal tubes | 204 | ||
| Intubation equipment | 206 | ||
| Complications of intubation | 207 | ||
| Rapid sequence induction | 207 | ||
| Sequence of general anaesthesia | 208 | ||
| Nursing considerations during general anaesthesia | 208 | ||
| Induction of anaesthesia | 208 | ||
| Establishment of the airway | 208 | ||
| Direct laryngoscopy and intubation | 208 | ||
| Maintenance of anaesthesia | 208 | ||
| Emergence from general anaesthesia | 210 | ||
| Clinical handover | 211 | ||
| Airway Emergencies and Management | 211 | ||
| Airway complications | 211 | ||
| Laryngospasm | 212 | ||
| Management | 212 | ||
| Bronchospasm | 213 | ||
| Management | 213 | ||
| Aspiration | 213 | ||
| Other Types of Anaesthesia | 214 | ||
| Sedation/analgesia | 214 | ||
| Local anaesthetic techniques | 214 | ||
| Central neural blockade | 214 | ||
| Management of the patient undergoing spinal or epidural anaesthesia | 216 | ||
| Local infiltration | 218 | ||
| Regional anaesthesia | 218 | ||
| Local anaesthetic toxicity | 218 | ||
| Haemodynamic Monitoring during Anaesthesia | 218 | ||
| Circulation | 219 | ||
| Electrocardiograph | 219 | ||
| Blood pressure | 219 | ||
| Central venous pressure | 220 | ||
| Respiration | 220 | ||
| Pulse oximetry | 220 | ||
| Capnography | 221 | ||
| Temperature | 221 | ||
| Fluid and Electrolyte Balance | 221 | ||
| Electrolyte balance | 222 | ||
| Fluid and blood loss | 222 | ||
| Blood transfusions | 223 | ||
| Anaesthetic Emergencies | 223 | ||
| Anaphylaxis | 223 | ||
| Malignant hyperthermia | 223 | ||
| Treatment | 224 | ||
| Paediatric Considerations in Anaesthesia | 224 | ||
| Preoperative assessment and preparation | 224 | ||
| Equipment | 224 | ||
| Anaesthetic induction | 225 | ||
| Temperature | 225 | ||
| Drugs and IV fluids | 225 | ||
| Anaesthetic Considerations for the Elderly Patient | 226 | ||
| Anaesthetic Considerations for the Bariatric Patient | 226 | ||
| Preoperative assessment | 226 | ||
| Airway and ventilation | 227 | ||
| Intraoperative care | 228 | ||
| Conclusion | 229 | ||
| Resources | 229 | ||
| References | 229 | ||
| Further Reading | 231 | ||
| 9 Intraoperative patient care | 232 | ||
| Learning Outcomes | 232 | ||
| Key Terms | 232 | ||
| Introduction | 233 | ||
| Patient Positioning | 233 | ||
| Patient transfer | 233 | ||
| Transfer methods and rationales | 235 | ||
| Complications | 235 | ||
| Patient positioning | 236 | ||
| Anatomical and physiological considerations for patient positioning | 236 | ||
| Integumentary system | 236 | ||
| Pressure | 236 | ||
| Shear | 237 | ||
| Friction | 237 | ||
| Moisture | 237 | ||
| Pressure injury prevention | 237 | ||
| Musculoskeletal system | 238 | ||
| Nervous system | 238 | ||
| Cardiovascular system | 238 | ||
| Respiratory system | 242 | ||
| Surgical positions | 242 | ||
| Supine position | 244 | ||
| Trendelenburg and reverse Trendelenburg positions | 244 | ||
| Prone position | 245 | ||
| Lateral position | 245 | ||
| Lithotomy position | 247 | ||
| Sitting positions: Fowler’s/ semi-Fowler’s position | 247 | ||
| Fracture table position | 251 | ||
| Prevention and Management of Venous Thromboembolism | 251 | ||
| Signs and symptoms of VTE | 252 | ||
| Prevention | 252 | ||
| Anticoagulant prophylaxis | 254 | ||
| Mechanical prophylaxis | 254 | ||
| Prevention and Management of Inadvertent periOperative Hypothermia | 255 | ||
| Adverse effects of IPH | 255 | ||
| Patients at risk of developing IPH | 255 | ||
| Management strategies | 255 | ||
| Surgical Complications and the Elderly | 256 | ||
| Ensuring Correct Patient/Site of Surgery | 256 | ||
| Tourniquets | 259 | ||
| Tourniquet use | 259 | ||
| The Management of Accountable Items Used during Surgery | 260 | ||
| The count | 261 | ||
| Incorrect count | 262 | ||
| Emergency situations | 263 | ||
| Collection of Specimens | 263 | ||
| Conclusion | 265 | ||
| Resources | 265 | ||
| Video Resources | 266 | ||
| References | 266 | ||
| Further Reading | 268 | ||
| 10 Surgical intervention | 269 | ||
| Learning Outcomes | 269 | ||
| Key Terms | 269 | ||
| Introduction | 270 | ||
| Historical Surgical Perspective | 270 | ||
| Sequence of Surgery | 271 | ||
| Stages of the surgical procedure | 271 | ||
| Instruments | 272 | ||
| Instrument categories | 272 | ||
| Anatomy of a ring-handled instrument | 272 | ||
| Cutting and dissecting instruments | 273 | ||
| Sharp dissection | 273 | ||
| Scalpels | 273 | ||
| Scissors | 273 | ||
| Blunt dissection | 273 | ||
| Grasping and holding instruments | 273 | ||
| Dissecting/tissue forceps | 274 | ||
| Towel clips | 275 | ||
| Needle holders | 275 | ||
| Sponge-holding forceps | 276 | ||
| Clamps | 276 | ||
| Artery clamps/forceps | 277 | ||
| Crushing clamps | 277 | ||
| Non-crushing clamps | 277 | ||
| Retractors | 277 | ||
| Miscellaneous/ancillary/accessory | 278 | ||
| Instrument handling and passing | 278 | ||
| Care of instrumentation | 281 | ||
| Sutures and Needles | 281 | ||
| Properties of suture materials | 281 | ||
| Absorbable/non-absorbable materials | 281 | ||
| Natural/synthetic materials | 285 | ||
| Diameter or size of suture material | 285 | ||
| Monofilament/multifilament | 285 | ||
| Ties | 285 | ||
| Handling characteristics | 285 | ||
| Pliability and coefficient friction | 286 | ||
| Elasticity or memory | 286 | ||
| Capillarity | 286 | ||
| Tensile strength and knot strength | 286 | ||
| Tissue reaction characteristics | 287 | ||
| Skin adhesives | 287 | ||
| Barbed sutures | 287 | ||
| Needles | 288 | ||
| Anatomy of a needle | 288 | ||
| Types of needle points | 289 | ||
| Cutting edge | 289 | ||
| Taper point | 289 | ||
| Body of the needle | 290 | ||
| Swaged needles | 290 | ||
| Ordinary needles | 290 | ||
| Loading needles | 291 | ||
| Sharps Safety | 291 | ||
| Minimally Invasive Surgery | 291 | ||
| Sequence of surgery for abdominal MIS | 292 | ||
| Exposure | 292 | ||
| Visualisation | 294 | ||
| Performing the procedure | 295 | ||
| Equipment | 295 | ||
| Paediatric considerations | 297 | ||
| Operating room set-up for minimally invasive surgery | 297 | ||
| Advances in minimally invasive surgery | 297 | ||
| Conclusion | 300 | ||
| Resources | 301 | ||
| Video Resources | 301 | ||
| References | 301 | ||
| Further Reading | 302 | ||
| 11 Wound healing | 304 | ||
| Learning Outcomes | 304 | ||
| Key Terms | 304 | ||
| Introduction | 304 | ||
| Skin Anatomy | 305 | ||
| Wounds | 305 | ||
| Surgical wounds | 305 | ||
| Traumatic wounds | 305 | ||
| Chronic wounds | 305 | ||
| Surgical Incisions | 306 | ||
| Langer’s lines | 306 | ||
| Abdominal incisions | 306 | ||
| Wound Classification | 309 | ||
| The Phases of Wound Healing | 309 | ||
| The inflammatory phase | 311 | ||
| Haemostasis | 311 | ||
| Biochemical mediator release | 311 | ||
| Vasodilation | 312 | ||
| Increased capillary permeability | 312 | ||
| Phagocytosis | 312 | ||
| Plasma protein systems | 312 | ||
| The reconstructive phase | 312 | ||
| Fibroblasts | 312 | ||
| Granulation | 313 | ||
| Epithelialisation | 313 | ||
| Wound contraction | 313 | ||
| The maturation phase | 313 | ||
| Types of Wound Healing | 313 | ||
| Primary intention | 313 | ||
| Secondary intention | 314 | ||
| Tertiary intention | 314 | ||
| Factors Affecting Wound Healing | 314 | ||
| Debridement | 315 | ||
| Surgical Haemostasis | 315 | ||
| Methods of surgical haemostasis | 315 | ||
| Mechanical haemostasis | 315 | ||
| Instruments | 316 | ||
| Ligature/ties | 316 | ||
| Ligating clips | 316 | ||
| Bone wax | 317 | ||
| Packing | 317 | ||
| Pledgets | 317 | ||
| Patties | 317 | ||
| Tourniquets | 317 | ||
| Adjuncts to mechanical haemostasis | 317 | ||
| Absorbable gelatin | 317 | ||
| Absorbable collagen sponge | 318 | ||
| Oxidised cellulose | 318 | ||
| Pharmacological and chemical haemostasis | 318 | ||
| Thrombin | 318 | ||
| Oxytocin | 318 | ||
| Adrenaline | 318 | ||
| Fibrin glue | 318 | ||
| Energy-based methods of securing haemostasis | 318 | ||
| Electrosurgery | 318 | ||
| Laser | 319 | ||
| Ultrasonic scalpel | 319 | ||
| Haemostatic scalpel | 319 | ||
| Additional methods of haemostasis | 319 | ||
| Embolisation | 319 | ||
| Sclerotherapy | 319 | ||
| Wound Closure | 319 | ||
| Wound closure methods | 319 | ||
| Single-layer closure | 320 | ||
| Multiple-layer closure | 320 | ||
| Simple continuous sutures | 320 | ||
| Simple interrupted sutures | 320 | ||
| Knot placement | 320 | ||
| Continuous running/locking (blanket stitch) | 320 | ||
| Subcutaneous sutures | 320 | ||
| Retention sutures | 320 | ||
| Drain sutures | 321 | ||
| Other methods of wound closure | 321 | ||
| Staples | 321 | ||
| Tapes | 321 | ||
| Tissue adhesives | 321 | ||
| Wound Care | 321 | ||
| Dressings | 321 | ||
| Types of dressings | 323 | ||
| One-layer dressings | 323 | ||
| Skin closure dressings (island dressings) | 323 | ||
| Dry sterile dressings | 323 | ||
| Three-layer dressings | 323 | ||
| Pressure dressings | 323 | ||
| Stent dressings | 323 | ||
| Bolster/tie-over dressings | 323 | ||
| Wet-to-dry dressings | 323 | ||
| Hydrocolloid dressings | 323 | ||
| Silver dressings | 324 | ||
| Vacuum-assisted dressings | 324 | ||
| Application of dressings | 324 | ||
| Drains | 324 | ||
| Drain types | 325 | ||
| Passive drains | 325 | ||
| Active drains | 325 | ||
| Closed wound drainage systems | 325 | ||
| Chest drains | 325 | ||
| Specialised drains | 325 | ||
| Urinary drainage | 325 | ||
| Gastric decompression | 325 | ||
| Technological Advances in Wound Management | 325 | ||
| Implantable tissue repair and replacement material | 326 | ||
| Skin substitutes | 327 | ||
| Growth factors and biological wound products | 328 | ||
| Scaffolds | 328 | ||
| Hyperbaric oxygen therapy | 328 | ||
| Conclusion | 328 | ||
| Resources | 329 | ||
| Video Resources | 329 | ||
| References | 329 | ||
| Further Reading | 330 | ||
| 12 Postanaesthesia nursing care | 331 | ||
| Learning Outcomes | 331 | ||
| Key Terms | 331 | ||
| Introduction | 332 | ||
| The Role of the Nurse and Function of the PACU | 332 | ||
| PACU Design Features | 332 | ||
| Equipment requirements | 333 | ||
| Clinical Handover from Anaesthetist to Nurse | 334 | ||
| Patient Management in the PACU | 335 | ||
| Initial patient management | 335 | ||
| Assessment of airway and breathing | 336 | ||
| Respirations | 336 | ||
| Patient observations and monitoring | 337 | ||
| Cardiovascular assessment | 339 | ||
| ECG | 339 | ||
| Heart rate | 339 | ||
| Blood pressure | 339 | ||
| Level of consciousness | 339 | ||
| Central neural blockade | 339 | ||
| Temperature control | 340 | ||
| General comfort measures | 340 | ||
| Postanaesthesia and Postsurgical Complications | 341 | ||
| The deteriorating patient | 341 | ||
| Airway and breathing complications | 341 | ||
| Hypoxaemia | 341 | ||
| Obstruction by the tongue | 341 | ||
| Obstruction by secretions/blood | 341 | ||
| Laryngospasm | 343 | ||
| Post-intubation croup/subglottal oedema | 343 | ||
| Bronchospasm | 344 | ||
| Inadequate reversal of muscle relaxants | 344 | ||
| Hypoventilation | 344 | ||
| General complications | 344 | ||
| PO nausea and vomiting | 344 | ||
| Aspiration pneumonitis | 345 | ||
| Inadvertent perioperative hypothermia | 345 | ||
| Hyperthermia | 345 | ||
| High spinal/epidural block | 345 | ||
| Urinary retention | 346 | ||
| Hypotension | 346 | ||
| Shock | 346 | ||
| Hypertension | 346 | ||
| Emergence delirium | 346 | ||
| Management of Pain in the PACU | 347 | ||
| Pain assessment and management | 347 | ||
| Pharmacological interventions | 348 | ||
| Opioid analgesics | 348 | ||
| Morphine | 348 | ||
| Fentanyl | 349 | ||
| Pethidine | 349 | ||
| Targin® | 349 | ||
| Tramadol | 349 | ||
| Non-steroidal anti-inflammatory drugs | 349 | ||
| Diclofenac | 350 | ||
| Ibuprofen | 350 | ||
| Ketamine | 350 | ||
| Paracetamol | 350 | ||
| Serotonin syndrome | 350 | ||
| Codeine in children | 350 | ||
| Patient-controlled analgesia | 350 | ||
| Local anaesthetic | 350 | ||
| Non-pharmacological pain management | 350 | ||
| Acute pain service | 351 | ||
| Special Populations | 351 | ||
| Management of patients with diabetes mellitus | 351 | ||
| Management of the paediatric patient | 351 | ||
| Care of the older patient | 351 | ||
| Care of the obese patient | 352 | ||
| Discharge Criteria | 352 | ||
| Patient Handover from PACU Nurse to Ward Nurse | 352 | ||
| Conclusion | 354 | ||
| Resources | 355 | ||
| References | 355 | ||
| Further Reading | 357 | ||
| 13 Evolving models of care in perioperative environments | 358 | ||
| Learning Outcomes | 358 | ||
| Key Terms | 358 | ||
| Introduction | 358 | ||
| Growth of Day Surgery, Endoscopy and Interventional Radiography | 359 | ||
| Advantages of day surgery | 361 | ||
| The Patient Journey in Ambulatory Care Settings | 363 | ||
| Patient acceptance | 363 | ||
| Patient selection | 363 | ||
| Special Populations and Ambulatory Settings | 363 | ||
| Paediatric patients | 363 | ||
| Bariatric patients | 364 | ||
| Elderly patients | 365 | ||
| Patients with dementia | 365 | ||
| Advances in Procedures Performed in Ambulatory Care Settings | 365 | ||
| Advances in flexible endoscopy | 365 | ||
| Diagnostic procedures | 366 | ||
| Therapeutic interventions | 368 | ||
| Diagnostic and interventional endovascular procedures | 369 | ||
| Transoesophageal echocardiogram | 370 | ||
| Radiofrequency ablation to treat atrial fibrillation | 370 | ||
| Stents (angioplasty) | 372 | ||
| Preoperative Patient Preparation | 372 | ||
| Preparation for flexible endoscopic procedures | 373 | ||
| Preparation for Endovascular Procedures | 373 | ||
| Postoperative Nursing Care Following Endoscopic and Endovascular Procedures | 374 | ||
| Post-Discharge | 375 | ||
| Patient Safety and Risk Management | 375 | ||
| Care of endoscopy equipment | 376 | ||
| Conclusion | 378 | ||
| Resources | 379 | ||
| Video Resources | 379 | ||
| References | 379 | ||
| Further Reading | 382 | ||
| Glossary | 383 | ||
| Index | 390 | ||
| A | 390 | ||
| B | 391 | ||
| C | 391 | ||
| D | 392 | ||
| E | 392 | ||
| F | 393 | ||
| G | 393 | ||
| H | 394 | ||
| I | 394 | ||
| J | 395 | ||
| K | 395 | ||
| L | 395 | ||
| M | 395 | ||
| N | 396 | ||
| O | 396 | ||
| P | 397 | ||
| Q | 399 | ||
| R | 399 | ||
| S | 399 | ||
| T | 401 | ||
| U | 401 | ||
| V | 402 | ||
| W | 402 | ||
| X | 402 |