Additional Information
Book Details
Abstract
Trusted for 30 years, Drain’s PeriAnesthesia Nursing, A Critical Care Approach, 7th Edition is the only book on the market that provides comprehensive clinical content tailored specifically for perianesthesia nurses. An easy-to-use format with five distinct sections — covering the PACU, anatomy and physiology, pharmacology, nursing care, and special considerations — means you get five books in one. Nursing and pharmacologic interventions are integrated with in-depth coverage of pathophysiology, and updated content includes the latest standards and current issues affecting perianesthesia nursing practice. Focusing on research, documentation, and psychosocial considerations, this is the one book that can take you all the way from being a novice nurse in the PACU to preparing for your CPAN® or CAPA® certification!
- Updated Evidence-based Research boxes in sections IV and V provide the latest standards of care.
- Five separate sections provide comprehensive coverage, including: the PACU, anatomy and physiology, pharmacology, nursing care, and special considerations.
- Addresses current policies and issues affecting perianesthesia nursing practice such as patient safety, infection control, managed care implications, pain management, and bioterrorism.
- Special Considerations section details the care of patients with conditions such as malignant hyperthermia, substance abuse, sickle cell anemia, and cardiac arrest.
- Comprehensively covers the various types of anesthetic agents to be anticipated in the PACU.
- In-depth coverage of pathophysiology for all body systems integrated with nursing and pharmacologic interventions.
- Streamlined format includes an overview, definitions, summary, and references for each chapter.
- NEW and EXPANDED! Updated content covers the latest evidence and standards, including new sedation and pain guidelines, new information on older patients, implications of new surgical techniques, and more bariatric implications.
- NEW and UPDATED! New illustrations and thoroughly updated references throughout.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover\r | Cover | ||
| Contents | ES1 | ||
| Drain’s PERIANESTHESIA NURSINGA: Critical Care Approach | i | ||
| Contributors | v | ||
| Reviewers | ix | ||
| Preface | xi | ||
| Contents | xiii | ||
| I - THE POSTANESTHESIA CARE UNIT | 1 | ||
| 1 - Space Planning and Basic Equipment Systems | 1 | ||
| SPACE | 1 | ||
| Purpose of the Space | 1 | ||
| Determine the Location | 2 | ||
| Components of the Space | 2 | ||
| Standard Equipment | 6 | ||
| 2 - Perianesthesia Nursing as a Specialty | 9 | ||
| Roles of Perianesthesia Nurses Through the Continuum of Care | 11 | ||
| Role of the Perianesthesia Nurse in the Preoperative Evaluation, Preadmission Testing, and Preanesthesia Evaluation Setting | 11 | ||
| Role of the Perianesthesia Nurse in Ambulatory Surgery and Preoperative Holding | 12 | ||
| Role of the Perianesthesia Nurse in the Postanesthesia Care Unit Phase I | 13 | ||
| Role of the Perianesthesia Nurse in the Postanesthesia Phase II | 14 | ||
| Role of the Perianesthesia Nurse in the Fast-Tracking of Patients to Phase II | 15 | ||
| Role of the Perianesthesia Nurse in Extended Care | 15 | ||
| Nontraditional Perianesthesia Settings | 15 | ||
| Areas for Growth Within Perianesthesia Nursing | 16 | ||
| SUMMARY | 16 | ||
| REFERENCES | 16 | ||
| 3 - Management and Policies | 18 | ||
| PURP\rOSE OF THE PACU | 18 | ||
| Organizational Structure | 18 | ||
| Patient Classification | 18 | ||
| Visitors | 20 | ||
| Patient Records | 21 | ||
| Discharge of the Patient From the PACU | 21 | ||
| Standards of Care | 22 | ||
| Quality Assessment and Performance Improvement | 23 | ||
| Collaborative Management | 23 | ||
| Role Delineation | 24 | ||
| Nurse Manager | 24 | ||
| Clinical Nurse Specialist | 24 | ||
| Staff Nurses | 25 | ||
| Ancillary Personnel | 26 | ||
| Talent Recruitment, Retention, and Review Considerations | 26 | ||
| Retaining Nursing Staff in the PACU | 26 | ||
| Shared Governance | 28 | ||
| Self-Scheduling | 28 | ||
| Basic Staff Orientation Program | 28 | ||
| Content of the Orientation Program | 29 | ||
| Development of Expertise | 31 | ||
| Competency Assessment | 31 | ||
| Staffing | 32 | ||
| REFERENCES\r | 32 | ||
| 4 - Crisis Resource Management in the PACU | 34 | ||
| DEFINITIONS | 34 | ||
| The Nature of Human Error | 35 | ||
| A Systems Approach to Understanding Error | 36 | ||
| Crisis Management Principles | 37 | ||
| Environment | 37 | ||
| Resources | 38 | ||
| Reevaluation | 38 | ||
| Workload | 38 | ||
| Attention Allocation | 39 | ||
| Teamwork | 39 | ||
| Communication | 39 | ||
| Call for Help | 40 | ||
| Simulation and CRM Training | 40 | ||
| SUMMARY | 42 | ||
| REFERENCES | 43 | ||
| 5 - Infection Prevention and Control in the PACU | 44 | ||
| DEFINITIONS | 44 | ||
| Managing the Environment and Equipment | 46 | ||
| Environment | 46 | ||
| Laundry | 46 | ||
| Furnishings and Equipment | 47 | ||
| Sinks | 47 | ||
| Bays and Isolation Rooms | 47 | ||
| Traffic Flow | 47 | ||
| General Infection Control Practices | 47 | ||
| Handwashing | 47 | ||
| Personal Protective Equipment | 48 | ||
| Standard Precautions | 49 | ||
| MANAGEMENT OF THE INFECTEDOR CONTAGIOUS PATIENT | 49 | ||
| Communicable Diseases of Concern | 49 | ||
| Antibiotic-Resistant Organisms | 50 | ||
| Isolation and Precautions | 51 | ||
| Standard Precautions | 51 | ||
| Transmission-Based Precautions | 51 | ||
| Prevention of Health Care–Associated Infections | 52 | ||
| Occupational Health | 54 | ||
| Safe Injection Practices | 56 | ||
| SUMMARY | 56 | ||
| REFERENCES | 56 | ||
| 6 - The Changing Health Care System and Its Implications for the PACU | 59 | ||
| DEFINITIONS | 59 | ||
| Health Care Financing | 59 | ||
| Private Business | 59 | ||
| Households | 60 | ||
| Governments | 60 | ||
| The Uninsured Population | 62 | ||
| Health Care Workforce | 63 | ||
| Major Medical Services | 65 | ||
| Governments’ Role in Health Care | 67 | ||
| Role of the Federal Government | 67 | ||
| Role of State and Local Governments | 67 | ||
| 2010 Health Care Reform | 67 | ||
| Coverage Expansion | 67 | ||
| Health Insurance Market Reforms | 68 | ||
| Delivery System Reorganization | 68 | ||
| Challenges to the PPACA | 68 | ||
| Implications for the Pacu | 68 | ||
| Working Within a Changing Health Care System | 68 | ||
| Financial Management in the PACU | 69 | ||
| Fixed Costs | 69 | ||
| Variable Costs | 69 | ||
| Nursing Quality Improvement in the PACU | 69 | ||
| Cultural Competency in the PACU | 70 | ||
| SUMMARY | 70 | ||
| REFERENCES | 70 | ||
| 7 - Patient Safety and Legal Issues in the PACU | 73 | ||
| DEFINITIONS | 73 | ||
| Ethical Values | 75 | ||
| Conscientious Objection | 76 | ||
| Current Approaches to Patient Safety | 76 | ||
| Anatomy of A Malpractice Claim | 77 | ||
| Sources for Identification of Malpractice in the PACU | 80 | ||
| Individual Liability and the Standard of Care | 81 | ||
| Suggestions to Decrease Legal Liability and improve Patient Safety | 82 | ||
| SUMMARY | 84 | ||
| REFERENCES | 84 | ||
| 8 - \rEthics in Perianesthesia Nursing | 86 | ||
| DEFINITIONS | 86 | ||
| UNDERSTANDING ETHICS | 86 | ||
| The Emergence of Bioethics | 87 | ||
| Paradigmatic Cases | 87 | ||
| Research With Human Subjects | 87 | ||
| End-of-life Cases | 89 | ||
| Guiding Principles | 91 | ||
| Perianesthesia Ethics | 92 | ||
| Informed Consent | 92 | ||
| Resuscitation in the Perioperative Context | 93 | ||
| Privacy and Confidentiality | 94 | ||
| Patient Safety | 95 | ||
| Resources for Resolving Ethical Dilemmas | 96 | ||
| Ethics Committees and Consultation Services | 96 | ||
| Ethics Case Review Methodology | 97 | ||
| SUMMARY | 97 | ||
| REFERENCES | 98 | ||
| 9 - Evidence-Based Practice and Research | 101 | ||
| DEFINITIONS | 101 | ||
| Research, EBP, Quality, AND IMPROVEMENT | 101 | ||
| Overview of EBP | 102 | ||
| The Process of EBP | 102 | ||
| Identify the Problem/Need for Change | 103 | ||
| Refine the Question | 103 | ||
| Locate the Evidence | 104 | ||
| Critically Appraise and Synthesize the Evidence | 105 | ||
| Design and Implement the Practice Change | 105 | ||
| Evaluate the Outcomes of the Change | 108 | ||
| Adjust, Integrate, and Sustain Change | 108 | ||
| Disseminate Outcomes | 108 | ||
| Relationship of EBP to Bedside Practice | 108 | ||
| SUMMARY | 109 | ||
| REFERENCES | 109 | ||
| II - PHYSIOLOGIC CONSIDERATIONS IN THE PACU110 | 110 | ||
| 10 - The Nervous System | 110 | ||
| DEFINITIONS | 110 | ||
| The Nervous System | 111 | ||
| Central Nervous System | 111 | ||
| The Brain | 111 | ||
| Forebrain | 111 | ||
| Cerebral Cortex | 111 | ||
| Functional Aspects of the Cerebrum | 111 | ||
| Motor Areas\r | 112 | ||
| Primary Motor Area\r | 112 | ||
| Premotor Area\r | 112 | ||
| Motor Speech Area\r | 113 | ||
| Prefrontal Area\r | 113 | ||
| Sensory Areas\r | 113 | ||
| Association Areas\r | 114 | ||
| Limbic System\x0B | 114 | ||
| Basal Ganglia\r | 114 | ||
| Diencephalon | 115 | ||
| Midbrain | 116 | ||
| Hindbrain | 116 | ||
| Pons | 116 | ||
| Medulla Oblongata | 116 | ||
| Cerebellum | 116 | ||
| Fourth Ventricle | 117 | ||
| Brainstem | 117 | ||
| Reticular Formation | 117 | ||
| Protection of the Brain | 118 | ||
| Cranial Bones | 118 | ||
| Meninges | 119 | ||
| Dura Mater\r | 119 | ||
| Arachnoid Mater\r | 120 | ||
| Pia Mater\r | 120 | ||
| Cerebrospinal Fluid System | 121 | ||
| Blood-Brain Barriers of the Central Nervous System | 121 | ||
| Arterial Blood Supply to the Brain | 122 | ||
| Regulation of Cerebral Blood Flow | 124 | ||
| Intracranial Pressure Dynamics | 124 | ||
| Cerebral Perfusion Pressure | 124 | ||
| Spinal Cord | 125 | ||
| Protection of the Spinal Cord | 125 | ||
| Bones of the Spine | 125 | ||
| Spinal Meninges | 126 | ||
| Lumbar Puncture | 127 | ||
| Structure and Function of the Spinal Cord and the Spinal Nerve Roots | 127 | ||
| Vascular Network of the Spinal Cord | 131 | ||
| Autonomic Nervous System | 131 | ||
| Sympathetic Nervous System | 131 | ||
| Parasympathetic Nervous System | 131 | ||
| SUMMARY | 132 | ||
| REFERENCES | 132 | ||
| 11 - The Cardiovascular System | 133 | ||
| DEFINITIONS | 133 | ||
| The Heart | 134 | ||
| The Cardiac Cycle | 134 | ||
| Cardiac Output | 135 | ||
| Arterial Blood Pressure | 136 | ||
| Valves of the Heart | 136 | ||
| Heart Muscle | 136 | ||
| Conduction of Impulses | 137 | ||
| Coronary Circulation | 138 | ||
| Effect of Anesthesia on the Heart | 139 | ||
| Myocardial Infarction | 139 | ||
| Serum Markers of Infarction | 140 | ||
| Perianesthesia Nursing Care | 140 | ||
| Central Venous Pressure Monitor | 140 | ||
| Pulmonary Artery Catheter | 140 | ||
| Circulatory System | 141 | ||
| Red Blood Cells | 141 | ||
| White Blood Cells | 141 | ||
| Blood Platelets | 141 | ||
| Blood Vessels | 142 | ||
| Microcirculation | 142 | ||
| Adrenergic and Cholinergic Receptors | 142 | ||
| Functional Anatomy: The Mediators | 143 | ||
| Cholinergic Neurotransmitter: Biochemistry | 143 | ||
| Adrenergic Neurotransmitter: Biochemistry | 143 | ||
| Cholinergic Receptors | 144 | ||
| Adrenergic Receptors | 145 | ||
| Site of Action of Autonomic Drugs | 147 | ||
| Hypotension Therapy | 148 | ||
| Hypertension Therapy | 149 | ||
| Dexmedetomidine | 151 | ||
| Diazoxide | 151 | ||
| Clonidine | 151 | ||
| Sodium Nitroprusside | 151 | ||
| Phentolamine | 152 | ||
| Hydralazine | 152 | ||
| Trimethaphan Camsylate | 152 | ||
| Nitroglycerin | 153 | ||
| Propranolol | 153 | ||
| Esmolol | 153 | ||
| Labetalol | 153 | ||
| Metoprolol | 153 | ||
| SUMMARY | 153 | ||
| REFERENCES | 153 | ||
| 12 - The Respiratory System | 155 | ||
| DEFINITIONS | 155 | ||
| Respiratory System Anatomy | 156 | ||
| The Nose | 156 | ||
| The Pharynx | 156 | ||
| The Larynx | 156 | ||
| The Trachea | 159 | ||
| Bronchi and Lungs | 160 | ||
| Respiratory System Physiology | 161 | ||
| Lung Volumes and Capacities | 161 | ||
| Lung Volumes | 162 | ||
| Lung Capacities | 162 | ||
| Lung Mechanics | 163 | ||
| Mechanical Features of the Lungs | 163 | ||
| Pulmonary Hysteresis | 163 | ||
| Elastic Properties of the Lung | 163 | ||
| Recruitment of Lung Units | 164 | ||
| Surface Tension Phenomenon | 164 | ||
| Lung Compliance | 164 | ||
| Equal Pressure Point | 165 | ||
| Pulmonary Time Constant | 166 | ||
| Mechanical Features of the Chest Wall | 166 | ||
| Combined Mechanical Properties of the Lungs and Chest Wall | 167 | ||
| Alterations in the Balance of Pulmonary Forces in the Perianesthesia Patient | 167 | ||
| Pulmonary Circulation | 169 | ||
| Gas Exchange | 169 | ||
| Reservoir for the Left Ventricle | 169 | ||
| Nutrition | 170 | ||
| Protection | 170 | ||
| Water Balance in the Lung | 170 | ||
| Blood Gas Transport | 171 | ||
| Oxygen Transport | 172 | ||
| Factors Affecting Oxygen Transport | 173 | ||
| Pulse Oximetry and the Oxygen Dissociation Curve | 173 | ||
| Carbon Dioxide Transport | 173 | ||
| Carbon Dioxide in Simple Solution | 174 | ||
| Carbaminohemoglobin | 174 | ||
| Bicarbonate | 174 | ||
| Acid-Base Relationships | 175 | ||
| Respiratory Acid-Base Imbalances | 175 | ||
| Metabolic Acid-Base Imbalances | 176 | ||
| Matching of Ventilation to Perfusion | 176 | ||
| Distribution of Ventilation | 176 | ||
| Distribution of Perfusion | 177 | ||
| Matching | 177 | ||
| Causes of Hypoxemia | 177 | ||
| Hypoventilation | 177 | ||
| Ventilation or Perfusion Mismatching | 177 | ||
| Decreased Ventilation to Perfusion | 177 | ||
| Increased Ventilation to Perfusion | 178 | ||
| Implications for Perianesthesia Care | 179 | ||
| Regulation of Breathing | 179 | ||
| The Sensors | 179 | ||
| Peripheral Chemoreceptors | 179 | ||
| Central Chemoreceptors | 180 | ||
| Response to Carbon Dioxide | 181 | ||
| Upper Airway Receptors | 181 | ||
| Lung Receptors | 181 | ||
| The Controllers | 182 | ||
| The Brainstem | 182 | ||
| Sleep Apnea | 183 | ||
| Postoperative Lung Volumes | 183 | ||
| Patients with Abnormal Pulmonary Function | 183 | ||
| Preexisting Pulmonary Disease | 183 | ||
| Cigarette Smoking | 185 | ||
| Obesity | 185 | ||
| Advanced Age | 185 | ||
| Physiology of Perianesthesia Pulmonary Nursing Care | 185 | ||
| OXYGEN ADMINISTRATION INTHE POSTANESTHESIACARE UNIT | 186 | ||
| Perianesthesia Nursing Care | 186 | ||
| Oxygen Toxicity | 187 | ||
| Eyes | 187 | ||
| Lungs | 188 | ||
| Central Nervous System | 188 | ||
| SUMMARY | 188 | ||
| REFERENCES | 188 | ||
| 13 - The Renal System | 189 | ||
| DEFINITIONS | 189 | ||
| Anatomy of the Kidneys | 189 | ||
| Kidney Physiology | 191 | ||
| Regulation of Kidney Function | 191 | ||
| Countercurrent Mechanism | 191 | ||
| Autoregulation | 191 | ||
| Hormonal Control | 192 | ||
| Regulation of Body Homeostasis | 192 | ||
| Components of Urine | 192 | ||
| Acid-Base Balance | 193 | ||
| Diuretic Therapy | 194 | ||
| Osmotic Diuretics | 194 | ||
| Thiazide Diuretics | 194 | ||
| Potassium-Sparing Diuretics | 194 | ||
| Loop Diuretics | 194 | ||
| Carbonic Anhydrase Inhibitors | 195 | ||
| Effects of Anesthesia | 195 | ||
| Effects of Drugs in Patients with Compromised Kidney Function | 195 | ||
| Acute Kidney Injury | 196 | ||
| Assessment of Kidney Function | 196 | ||
| Preexisting Kidney Disease | 197 | ||
| Perianesthesia Nursing Care | 197 | ||
| SUMMARY | 197 | ||
| REFERENCES | 198 | ||
| 14 - Fluid and Electrolytes | 199 | ||
| DEFINITIONS | 199 | ||
| Body Fluid Balance | 199 | ||
| Surgical Patient Considerations | 200 | ||
| Lungs | 200 | ||
| Gastrointestinal Tract | 201 | ||
| Skin | 201 | ||
| Kidneys | 201 | ||
| Surgical Fluid Loss | 201 | ||
| Distribution of Body Fluids | 201 | ||
| Edema | 202 | ||
| Electrolytes | 203 | ||
| Sodium | 203 | ||
| Potassium | 204 | ||
| Calcium | 204 | ||
| Phosphorus | 205 | ||
| Magnesium | 205 | ||
| Perioperative Blood and Fluid Replacement | 206 | ||
| Assessment of Coagulation | 206 | ||
| Crystalloid and Colloid Administration | 207 | ||
| Perioperative Replacement for Crystalloid and Colloid Administration | 208 | ||
| Blood Component Therapy | 208 | ||
| Perioperative Fluid Therapy | 210 | ||
| Types of Blood Component Therapies | 210 | ||
| Red Blood Cells | 210 | ||
| Fresh Frozen Plasma | 210 | ||
| Platelets | 210 | ||
| Cryoprecipitate | 211 | ||
| Albumin | 211 | ||
| Transfusion Reactions | 211 | ||
| VOLUME STATUS ASSESSMENT OF THE PATIENT IN THE POSTANESTHESIACARE UNIT | 211 | ||
| SUMMARY | 211 | ||
| REFERENCES | 212 | ||
| 15 - The Endocrine System | 213 | ||
| DEFINITIONS | 213 | ||
| The Endocrine System: Structure and Function | 213 | ||
| Mediators of the Endocrine System: the Hormones | 213 | ||
| Physiology of the Endocrine Glands | 214 | ||
| Pituitary Gland | 214 | ||
| Hormones of the Adenohypophysis | 214 | ||
| Growth Hormone or Somatotropin | 214 | ||
| Thyroid-Stimulating Hormone or Thyrotropin | 215 | ||
| Adrenocorticotropin | 215 | ||
| Gonadotropic Hormones | 215 | ||
| Lactogenic Hormone or Prolactin | 215 | ||
| Melanocyte-Stimulating Hormone | 215 | ||
| Hormones of the Neurohypophysis | 215 | ||
| Antidiuretic Hormone or Vasopressin | 215 | ||
| Oxytocin | 215 | ||
| Pituitary Dysfunction | 216 | ||
| Pineal Gland | 216 | ||
| Thyroid Gland | 216 | ||
| Parathyroid Glands | 216 | ||
| Adrenal Glands | 217 | ||
| Pancreas | 217 | ||
| Gonads | 218 | ||
| Selected Syndromes and Diseases Associated with the Endocrine System | 218 | ||
| Hypoadrenocorticism | 218 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Hypersecretion | 219 | ||
| SUMMARY | 220 | ||
| REFERENCES | 220 | ||
| 16 - The Hepatobiliary and Gastrointestinal System | 221 | ||
| DEFINITIONS | 221 | ||
| The Esophagus | 221 | ||
| Disorders of the Esophagus | 221 | ||
| The Stomach | 222 | ||
| Effect of Pregnancy on Gastric Motility and Secretions | 222 | ||
| Postoperative Nausea and Vomiting | 223 | ||
| The Intestine | 223 | ||
| The Colon and Rectum | 224 | ||
| The Anus | 224 | ||
| The Liver | 224 | ||
| Protein Synthesis | 224 | ||
| Drug Biotransformation | 225 | ||
| The Gallbladder | 225 | ||
| The Pancreas | 225 | ||
| Pancreatitis | 225 | ||
| The Spleen | 226 | ||
| SUMMARY | 226 | ||
| REFERENCES | 226 | ||
| 17 - \rThe Integumentary System | 228 | ||
| DEFINITIONS | 228 | ||
| INTEGUMENTARY SYSTEM ANATOMY | 228 | ||
| Epidermis | 228 | ||
| Dermis | 229 | ||
| Hypodermis | 229 | ||
| Integumentary Functions | 229 | ||
| Thermoregulation | 229 | ||
| Protection | 230 | ||
| Importance of Aseptic Technique | 230 | ||
| Standard Precautions in the Preoperative and Postanesthesia Care Units | 230 | ||
| Preoperative Assessment | 231 | ||
| Postoperative Assessment | 231 | ||
| Sterile Technique for Intravenous Therapy | 231 | ||
| Burn Injuries | 231 | ||
| SUMMARY | 233 | ||
| REFERENCES | 233 | ||
| 18 - The Immune System | 234 | ||
| DEFINITIONS | 234 | ||
| PHYSICAL AND CHEMICAL BARRIERS\r | 234 | ||
| Innate Immunity | 235 | ||
| Acquired Immunity | 235 | ||
| Humoral Immunity | 235 | ||
| Cellular Immunity | 237 | ||
| Hypersensitivity Reactions | 238 | ||
| Type I Hypersensitivity Reaction (Anaphylactic, Immediate) | 238 | ||
| Type II Hypersensitivity Reaction (Cytotoxic) | 238 | ||
| Type III Hypersensitivity Reaction (Arthus) | 238 | ||
| Type IV Hypersensitivity Reaction (Delayed or Cell-Mediated) | 239 | ||
| Latex Allergy | 239 | ||
| Immunosuppression | 240 | ||
| Forms of Immunosuppression | 240 | ||
| Perianesthesia Care of the Patient With Immunosuppression | 241 | ||
| Anesthetics and Immune Function | 241 | ||
| Inflammatory Response and Surgery | 241 | ||
| SUMMARY | 241 | ||
| REFERENCES | 242 | ||
| III - CONCEPTS IN ANESTHETIC AGENTS | 243 | ||
| 19 - Basic Principles of Pharmacology | 243 | ||
| DEFINITIONS | 243 | ||
| Drug Responses | 244 | ||
| Pharmacokinetic Actions | 244 | ||
| Systemic Absorption by Various Routes of Administration | 244 | ||
| Sublingual Route of Administration | 244 | ||
| Subcutaneous and Intramuscular Routes of Administration | 244 | ||
| Intravenous Route of Administration | 245 | ||
| Aerosolized Medications to the Respiratory Tract | 245 | ||
| Drug Distribution | 245 | ||
| Metabolism and Elimination | 245 | ||
| Removal of Drugs from the Systemic Circulation | 245 | ||
| Effects of Physiologic Dysfunction on Pharmacokinetic Action | 246 | ||
| Renal Disease | 246 | ||
| Hepatic Disease | 246 | ||
| Cardiovascular Disease | 246 | ||
| Obesity | 246 | ||
| Drug-Drug Interactions | 246 | ||
| Pharmacokinetic Interactions | 246 | ||
| Absorption | 246 | ||
| Distribution | 253 | ||
| Biotransformation | 255 | ||
| Excretion | 255 | ||
| Pharmacodynamic Interactions | 255 | ||
| Drug-Drug Interactions and the Perianesthesia Care Unit | 255 | ||
| Antibiotics | 255 | ||
| Opioids | 255 | ||
| Steroids | 256 | ||
| Special Considerations in Pharmacology Associated with Perianesthesia Care | 256 | ||
| Sedative Drugs for PACU Patients | 256 | ||
| Antiemetics | 256 | ||
| Anticoagulants | 256 | ||
| Herbal Medicines | 256 | ||
| Drugs Used in the Postanesthesia Care Unit | 257 | ||
| SUMMARY | 257 | ||
| REFERENCES | 259 | ||
| 20 - Inhalation Anesthesia | 260 | ||
| DEFINITIONS | 260 | ||
| Basic Concepts | 261 | ||
| Evolution of the Signs and Stages of Anesthesia | 261 | ||
| Pharmacokinetics of Inhalation Anesthetics | 263 | ||
| Movement of Inhalation Anesthetic From Anesthesia Machine to Alveoli | 263 | ||
| Movement of Inhalation Anesthetic From Alveoli to Arterial Blood | 263 | ||
| Movement of Inhalation Anesthetic From Arterial Blood to the Brain | 264 | ||
| Emergence of Inhalation Anesthesia | 265 | ||
| Potency of Inhalation Anesthetic Agents | 265 | ||
| Techniques of Administration | 266 | ||
| Circle Systems | 266 | ||
| Inhalation Agents | 266 | ||
| Modern Inhalation Anesthetics | 267 | ||
| Isoflurane (Forane) | 267 | ||
| Sevoflurane (Ultane) | 268 | ||
| Desflurane (Suprane) | 268 | ||
| Nitrous Oxide | 268 | ||
| ASSESSMENT OF THE EFFECTS OF INHALATION AGENTS IN THE PERIANESTHESIA CARE UNIT | 269 | ||
| SUMMARY | 270 | ||
| REFERENCES | 271 | ||
| 21 - Nonopioid Intravenous Anesthetics | 272 | ||
| DEFINITIONS | 272 | ||
| Barbiturates | 273 | ||
| Thiopental | 273 | ||
| Perianesthesia Care | 273 | ||
| Methohexital | 273 | ||
| Nonbarbiturates | 274 | ||
| Propofol | 274 | ||
| Perianesthesia Care | 275 | ||
| Etomidate | 275 | ||
| Sedatives | 275 | ||
| Benzodiazepines | 275 | ||
| Midazolam | 275 | ||
| Diazepam | 276 | ||
| Lorazepam | 277 | ||
| Benzodiazepine Antagonists | 277 | ||
| Flumazenil | 277 | ||
| Physostigmine | 278 | ||
| Butyrophenones | 278 | ||
| Haloperidol | 278 | ||
| Droperidol | 279 | ||
| Perianesthesia Care | 279 | ||
| Nonsteroidal AntiinflamMatory Drugs | 280 | ||
| Ketorolac | 280 | ||
| Indomethacin | 280 | ||
| Nonopioid Medications | 280 | ||
| Other Sedative Medications | 281 | ||
| Dexmedetomidine | 281 | ||
| Dissociative Anesthetics | 281 | ||
| Ketamine | 281 | ||
| Perianesthesia Care | 282 | ||
| SUMMARY | 283 | ||
| REFERENCES | 283 | ||
| 22 - Opioid Intravenous Anesthetics | 284 | ||
| DEFINITIONS | 284 | ||
| CONCEPT OF OPIOIDS AND\rOPIOID RECEPTORS\r | 284 | ||
| Opioids | 285 | ||
| Meperidine Hydrochloride | 286 | ||
| Morphine | 286 | ||
| Methadone | 287 | ||
| Hydromorphone | 287 | ||
| Fentanyl | 288 | ||
| Sufentanil | 288 | ||
| Alfentanil | 289 | ||
| Remifentanil | 289 | ||
| Partial Agonist-Antagonist Drugs | 290 | ||
| Pentazocine | 290 | ||
| Butorphanol | 290 | ||
| Nalbuphine | 290 | ||
| Opioid Antagonists | 291 | ||
| Naloxone | 291 | ||
| Nalmefene | 292 | ||
| Naltrexone | 292 | ||
| Selected Methods of Opioid Administration | 292 | ||
| Intrathecal and Epidural Routes of Administration | 292 | ||
| Patient-Controlled Analgesia | 293 | ||
| Patient-Controlled Epidural Analgesia | 293 | ||
| Monitoring the Patient Receiving Opioids in the PACU | 294 | ||
| Opiate Detoxification in the PACU | 295 | ||
| SUMMARY | 295 | ||
| REFERENCES | 295 | ||
| 23 - Neuromuscular Blocking Agents | 297 | ||
| DEFINITIONS | 297 | ||
| Physiology of Neuromus-cular Transmission | 298 | ||
| Nondepolarizing Neuromuscular Blocking Agents | 301 | ||
| rLong-Acting Nondepolarizing Skeletal Muscle Relaxants | 301 | ||
| rPancuronium Bromide | 301 | ||
| Intermediate-Acting Nondepolarizing Skeletal Muscle Relaxants | 301 | ||
| Vecuronium Bromide | 301 | ||
| Atracurium Besylate | 302 | ||
| Cisatracurium Besylate | 302 | ||
| Short-Acting Nondepolarizing Skeletal Muscle Relaxants | 302 | ||
| Rocuronium Bromide | 302 | ||
| Reversal of Nondepolarizing Neuromuscular Blocking Agents | 303 | ||
| Depolarizing Neuromuscular Blocking Agents | 304 | ||
| Succinylcholine | 304 | ||
| Advantages and Uses | 304 | ||
| Untoward Reactions | 305 | ||
| Disadvantages and Side Effects | 305 | ||
| Factors That Influence the Effects of the Neuromuscular Blocking Agents | 306 | ||
| Fluid Balance | 306 | ||
| Sodium | 306 | ||
| Potassium | 306 | ||
| Magnesium | 307 | ||
| Calcium | 307 | ||
| pH and Carbon Dioxide | 307 | ||
| Catecholamines | 307 | ||
| Mycins | 307 | ||
| Cardiac Antidysrhythmic Drugs | 307 | ||
| Temperature | 308 | ||
| Inhalation Anesthetics | 308 | ||
| Assessment of Neuromuscular Blockade | 308 | ||
| Special Problems in the Postanesthesia Care Unit | 311 | ||
| Dual or Phase II Block | 311 | ||
| Residual Paralysis | 314 | ||
| Bradycardia | 314 | ||
| SUMMARY | 314 | ||
| REFERENCES | 315 | ||
| 24 - Local Anesthetics | 316 | ||
| DEFINITIONS | 316 | ||
| NERVE PHYSIOLOGYAND CONDUCTION | 316 | ||
| Nerve Fiber Type and Local Anesthetic Effects | 316 | ||
| Local Anesthetics | 318 | ||
| Local Anesthetic Pharmacology | 318 | ||
| Chemistry and Stereoisomerism | 318 | ||
| Pharmacokinetics | 318 | ||
| Maximum Doses | 320 | ||
| Individual Local Anesthetics | 320 | ||
| Topical Anesthetics | 320 | ||
| Sustained-Release Local Anesthetics: Bupivacaine Liposomes | 322 | ||
| Complications | 323 | ||
| Allergic Reactions | 323 | ||
| Methemoglobinemia | 324 | ||
| Local Tissue Toxicity | 325 | ||
| Local Anesthetic Systemic Toxicity | 325 | ||
| Incidence and Clinical Presentation | 325 | ||
| Central Nervous System and Cardiovascular Signs of Toxicity | 326 | ||
| Diagnosis and Treatment of Local Anesthetic Systemic Toxicity | 326 | ||
| SUMMARY | 327 | ||
| REFERENCES | 328 | ||
| 25 - Regional Anesthesia | 329 | ||
| DEFINITIONS | 329 | ||
| Neuraxial Anesthesia and Analgesia | 330 | ||
| Anatomy of the Spine | 330 | ||
| Spinal Versus Epidural Blocks | 331 | ||
| Contraindications | 332 | ||
| Spinal Anesthesia | 332 | ||
| Epidural Anesthesia | 333 | ||
| Neuraxial Complications | 334 | ||
| High Spinal Block | 334 | ||
| Local Anesthetic Systemic Toxicity | 334 | ||
| Hypotension | 334 | ||
| Nausea and Vomiting | 334 | ||
| Urinary Retention | 334 | ||
| Hypothermia | 334 | ||
| Postdural Puncture Headache | 334 | ||
| Neurologic Complications | 335 | ||
| Transient Neurologic Symptoms | 335 | ||
| Cauda Equina Syndrome | 335 | ||
| Spinal or Epidural Hematoma | 335 | ||
| Care of Patients After Neuraxial Blockade | 335 | ||
| Peripheral Nerve Blocks | 336 | ||
| Paravertebral Block | 336 | ||
| Transversus Abdominus Plane Block | 336 | ||
| Ultrasound | 336 | ||
| Basic Ultrasound Anatomy and Characteristics | 336 | ||
| Transducer Orientation | 337 | ||
| Assisting With Ultrasound-Guided Peripheral Nerve Blocks | 337 | ||
| Peripheral Nerve Stimulators | 338 | ||
| Peripheral Nerve Block Catheters | 339 | ||
| Nursing Considerations for Peripheral Nerve Blocks | 339 | ||
| Upper Extremity Peripheral Nerve Blocks | 339 | ||
| Brachial Plexus | 339 | ||
| Interscalene | 339 | ||
| Supraclavicular | 341 | ||
| Infraclavicular | 341 | ||
| Axillary | 342 | ||
| Bier Block | 342 | ||
| Lower Extremity Peripheral Nerve Blocks | 342 | ||
| Femoral | 342 | ||
| Sciatic | 343 | ||
| Popliteal | 344 | ||
| Ankle | 344 | ||
| SUMMARY | 344 | ||
| REFERENCES | 344 | ||
| IV - NURSING CARE IN THE PACU | 347 | ||
| 26 - Transition From the Operating Room to the PACU | 347 | ||
| DEFINITIONS | 347 | ||
| PERIOPERATIVE NURSING | 347 | ||
| Perianesthesia Nursing | 348 | ||
| COMMUNICATION BETWEENPERIOPERATIVE AND PERIANESTHESIANURSES | 348 | ||
| AORN Recommended Practices for Transfer of Patient Care Information | 349 | ||
| Handoff Communication | 350 | ||
| Written (Including Electronic) and Verbal Communication | 351 | ||
| Documentation and Reporting of Patient Positioning | 354 | ||
| Cardiovascular | 354 | ||
| Skin | 354 | ||
| Pressure | 354 | ||
| Shearing | 355 | ||
| Friction | 355 | ||
| Maceration | 355 | ||
| Musculoskeletal System | 355 | ||
| Nervous System | 355 | ||
| Respiratory System | 355 | ||
| SUMMARY | 355 | ||
| REFERENCES | 356 | ||
| 27 - Assessment and Monitoring of the Perianesthesia Patient | 357 | ||
| DEFINITIONS | 357 | ||
| Preoperative Assessments | 358 | ||
| Admission Observations | 358 | ||
| Respiratory Function | 359 | ||
| Clinical Assessment | 359 | ||
| Inspection | 359 | ||
| Listening and Auscultation | 360 | ||
| Palpation | 360 | ||
| Percussion | 360 | ||
| Monitoring of Oxygenation With Pulse Oximetry | 360 | ||
| Technology Overview | 361 | ||
| Applications | 361 | ||
| Interpretation of Pulse Oximetry Measurements | 361 | ||
| Clinical Issues | 361 | ||
| Monitoring of Ventilation With Capnography | 363 | ||
| Technology Overview | 363 | ||
| The Normal Capnogram | 364 | ||
| End-Tidal Versus Arterial Carbon Dioxide | 364 | ||
| Interpretation of Changes in the Capnogram | 364 | ||
| Clinical Issues | 365 | ||
| Cardiovascular Function and Perfusion | 366 | ||
| Clinical Assessment | 366 | ||
| Blood Pressure Monitoring | 366 | ||
| Noninvasive Measurement | 366 | ||
| Automatic Method | 367 | ||
| Invasive Measurement | 368 | ||
| Clinical Issues | 368 | ||
| Pulse Pressure Monitoring | 369 | ||
| Pulses | 370 | ||
| Electrocardiographic Monitoring | 370 | ||
| Lead Placement | 370 | ||
| Sinus Dysrhythmias | 371 | ||
| Sinus Bradycardia | 371 | ||
| Sinus Tachycardia | 371 | ||
| Sinus Arrest (Atrial Standstill) | 372 | ||
| Supraventricular Dysrhythmias | 372 | ||
| Premature Atrial Contraction | 372 | ||
| Atrial Tachycardia | 372 | ||
| Atrial Flutter | 372 | ||
| Atrial Fibrillation | 372 | ||
| Ventricular Dysrhythmias | 373 | ||
| Premature Ventricular Contraction | 373 | ||
| Ventricular Tachycardia | 373 | ||
| Ventricular Fibrillation | 374 | ||
| Hemodynamic Monitoring | 374 | ||
| Right-Atrial Pressure | 374 | ||
| Pulmonary Artery Pressure | 374 | ||
| Pulmonary Capillary Wedge Pressure | 375 | ||
| Left-Atrial Pressure | 375 | ||
| Mean Arterial Pressure | 378 | ||
| Cardiac Output and Cardiac Index | 378 | ||
| Systemic Vascular Resistance | 378 | ||
| Pulmonary Vascular Resistance | 378 | ||
| Central Nervous System Function | 378 | ||
| Emergence From Anesthesia | 378 | ||
| Thermal Balance | 379 | ||
| Fluid and Electrolyte Balance | 379 | ||
| Fluid Intake | 380 | ||
| Intravenous Fluids | 380 | ||
| Oral Fluids | 380 | ||
| Fluid Output | 380 | ||
| Musculoskeletal Assessment | 381 | ||
| Integumentary System | 382 | ||
| Psychosocial Assessment | 382 | ||
| Discharge/Transfer of Care | 384 | ||
| SUMMARY | 384 | ||
| REFERENCES | 384 | ||
| 28 - Patient Education and Care of the Perianesthesia Patient | 385 | ||
| DEFINITIONS | 385 | ||
| Patient Education Concepts and Perianesthesia Care | 385 | ||
| Learning Environment and Learning Needs | 386 | ||
| Learner Characteristics | 386 | ||
| Types of Learners | 386 | ||
| Influences on Learning | 386 | ||
| Teaching Characteristics and Planning | 386 | ||
| Content of Teaching Plan | 387 | ||
| Teaching Strategies | 387 | ||
| Patient Education on the Day of Surgery | 388 | ||
| Discharge Instructions | 388 | ||
| Documentation | 388 | ||
| Care of the Perianesthesia Patient | 389 | ||
| Stir-Up Regimen | 389 | ||
| Deep-Breathing Exercises | 389 | ||
| Coughing | 389 | ||
| Positioning | 390 | ||
| Mobilization | 390 | ||
| Pain Management | 390 | ||
| Modifications of the Stir-Up Regimen | 390 | ||
| Intravenous Therapy | 390 | ||
| Maintenance of Respiratory Function | 390 | ||
| Oxygen Therapy | 390 | ||
| Methods of Administration | 391 | ||
| Humidity | 391 | ||
| Capnography | 391 | ||
| Mechanical Ventilation | 392 | ||
| Positive End-Expiratory Pressure | 392 | ||
| Continuous Positive Airway Pressure | 392 | ||
| Bilevel Positive Airway Pressure | 393 | ||
| Synchronized Intermittent Mandatory Ventilation | 393 | ||
| Nursing Responsibilities | 393 | ||
| Suctioning | 394 | ||
| Oral and Nasal Suctioning | 394 | ||
| Tracheal Suctioning | 394 | ||
| General Comfort and Safety Measures | 395 | ||
| Transfer of the Patient From the Postanesthesia Care Unit | 396 | ||
| SUMMARY | 397 | ||
| REFERENCES | 397 | ||
| 29 - Postanesthesia Care Complications | 398 | ||
| DEFINITIONS | 398 | ||
| Respiratory Complications | 399 | ||
| Airway Obstruction | 399 | ||
| Laryngospasm | 400 | ||
| Subglottic Edema | 401 | ||
| Bronchospasm | 401 | ||
| Aspiration | 401 | ||
| Hypoventilation | 402 | ||
| Hypoxemia | 402 | ||
| Pneumothorax | 402 | ||
| Pulmonary Edema | 402 | ||
| Noncardiogenic Pulmonary Edema | 402 | ||
| Pulmonary Embolism | 403 | ||
| Cardiovascular Complications | 403 | ||
| Dysrhythmias | 403 | ||
| Bradycardia | 403 | ||
| Tachycardia | 403 | ||
| Hypotension | 403 | ||
| Hypertension | 404 | ||
| Acute Myocardial Infarction | 404 | ||
| Thermoregulation | 405 | ||
| Hypothermia | 405 | ||
| Hyperthermia | 405 | ||
| Malignant Hyperthermia | 406 | ||
| Anesthesia-Related Complications | 406 | ||
| Awareness Under Anesthesia | 406 | ||
| Emergence Excitement/Delirium | 407 | ||
| Delayed Emergence (Awakening) | 408 | ||
| Plasma Cholinesterase Deficiency | 409 | ||
| Nausea and Vomiting | 409 | ||
| Mechanism of Action | 409 | ||
| Incidence of Postoperative Nausea and Vomiting | 409 | ||
| Care of the Patient with Nausea and Vomiting | 410 | ||
| Pharmacologic Interventions | 410 | ||
| Nonpharmacologic Interventions | 410 | ||
| Airway Management | 412 | ||
| Postdischarge Nausea and Vomiting | 412 | ||
| Neurologic Complications | 412 | ||
| Spinal Epidural Hematoma | 412 | ||
| Postdural Puncture Headache | 412 | ||
| Postoperative Visual Loss | 412 | ||
| Procedure-Related Complications | 413 | ||
| Perforated Viscus | 413 | ||
| Hemorrhage | 413 | ||
| Dilutional Hyponatremia | 413 | ||
| Reactions: Allergic and Transfusion Related | 413 | ||
| Allergic Reactions or Anaphylaxis | 413 | ||
| Transfusion Reactions | 414 | ||
| Other Transfusion-Related Issues | 415 | ||
| Hemolytic Reactions | 414 | ||
| Nonhemolytic Febrile Reactions | 414 | ||
| Anaphylactic Reactions | 414 | ||
| Transfusion-Related Acute Lung Injury | 414 | ||
| Treatment of Immediate Reactions | 415 | ||
| Delayed Reactions | 415 | ||
| SUMMARY | 416 | ||
| REFERENCES | 416 | ||
| 30 - Assessment and Management of the Airway | 417 | ||
| DEFINITIONS | 417 | ||
| Airway Management | 417 | ||
| Airway Anatomy | 417 | ||
| Airway Assessment | 417 | ||
| Potential Airway Issues | 419 | ||
| Airway Obstruction | 419 | ||
| Hypoventilation and Apnea | 419 | ||
| Loss of Airway Reflexes | 420 | ||
| Laryngospasm | 420 | ||
| Mask Ventilation | 420 | ||
| Intubation of the Trachea | 422 | ||
| Equipment for Endotracheal Intubation | 422 | ||
| Laryngoscope | 422 | ||
| Endotracheal Tube | 423 | ||
| Positioning the Patient | 424 | ||
| Insertion of the Laryngoscope Blade | 424 | ||
| Raising the Epiglottis and Visualizing the Vocal Cords | 425 | ||
| Orotracheal Intubation | 425 | ||
| Assessing the Patient for Proper Endotracheal Tube Placement | 425 | ||
| Ventilating the Lungs | 426 | ||
| Nasotracheal Intubation | 426 | ||
| Emergency Airway Management | 426 | ||
| Perianesthesia Care of the Intubated Patient | 427 | ||
| Extubation of the Trachea | 427 | ||
| Laryngeal Mask Airway | 428 | ||
| Caring for Patients With an LMA | 429 | ||
| SUMMARY | 430 | ||
| REFERENCES | 430 | ||
| 31 - Pain Management | 431 | ||
| DEFINITIONS | 431 | ||
| Definition of Pain | 431 | ||
| Types and Categories of Pain | 431 | ||
| Nociception and Analgesic Action Sites | 433 | ||
| Transduction | 433 | ||
| Transmission | 434 | ||
| Perception | 434 | ||
| Modulation | 435 | ||
| Pathophysiology of Neuropathic Pain | 435 | ||
| Peripheral Mechanisms | 435 | ||
| Central Mechanisms | 435 | ||
| Harmful Effects of Unrelieved Pain | 436 | ||
| Pain Assessment: the Foundation | 436 | ||
| Challenges in Assessment | 438 | ||
| Reassessment of Pain | 439 | ||
| Pain Control on a Continuum | 439 | ||
| Routes of Administration | 440 | ||
| Nonopioid Analgesics | 440 | ||
| Adverse Effects of Nonopioids | 441 | ||
| Opioid Analgesics | 442 | ||
| Safe Opioid Titration | 443 | ||
| Selected Opioid Therapies | 443 | ||
| Transition to Oral Analgesics | 444 | ||
| Adverse Effects of Opioid Analgesics | 445 | ||
| Sedation and Respiratory Depression | 446 | ||
| Addiction, Physical Dependence, and Tolerance | 448 | ||
| Opioid Administration to Patients With Addictive Disease | 448 | ||
| Management of the Opioid-Dependent Surgical Patient With Chronic Pain | 449 | ||
| Local Anesthetics | 449 | ||
| Anticonvulsants | 450 | ||
| Nonpharmacologic Methods | 450 | ||
| SUMMARY | 450 | ||
| REFERENCES | 451 | ||
| 32 - Care of the Ear, Nose, Throat, Neck, and Maxillofacial Surgical Patient | 456 | ||
| DEFINITIONS | 456 | ||
| Surgery on the Ear | 457 | ||
| Special Considerations | 458 | ||
| Myringotomy | 458 | ||
| Mastoidectomy | 458 | ||
| Tympanoplasty | 459 | ||
| Stapedectomy | 459 | ||
| Cochlear Implant | 459 | ||
| Surgery on the Nose and Sinuses | 459 | ||
| Nasal Surgery | 459 | ||
| Sinus Surgery | 460 | ||
| Surgery on the Tongue | 460 | ||
| Throat Surgery | 461 | ||
| Tonsillectomy and Adenoidectomy | 461 | ||
| Laryngoscopy | 463 | ||
| Tracheostomy | 464 | ||
| Suctioning and Tracheostomy Care | 464 | ||
| Complications | 466 | ||
| Laryngectomy | 467 | ||
| Radical Neck Surgery | 468 | ||
| Complications | 469 | ||
| Reconstruction Surgery in Head and Neck Cancer | 470 | ||
| Maxillofacial Surgery | 471 | ||
| SUMMARY | 472 | ||
| REFERENCES | 472 | ||
| 33 - Care of the Ophthalmic Surgical Patient | 473 | ||
| DEFINITIONS | 473 | ||
| Preoperative Evaluation | 474 | ||
| Ophthalmic Medications | 474 | ||
| Preoperative Phase | 476 | ||
| Anesthetic Options | 476 | ||
| Perioperative Phase | 477 | ||
| Postoperative Phase | 478 | ||
| SUMMARY | 480 | ||
| REFERENCES | 481 | ||
| 34 - Care of the Thoracic Surgical Patient | 482 | ||
| DEFINITIONS | 482 | ||
| Anesthesia | 483 | ||
| Surgical Procedures | 485 | ||
| Positioning | 486 | ||
| Respiratory Assessment and Care | 486 | ||
| Respiratory Management | 487 | ||
| Pain Management | 487 | ||
| Fluid Management | 488 | ||
| Chest Tube Management | 490 | ||
| Complications | 492 | ||
| Risks of General Anesthesia | 492 | ||
| Wound Infection | 492 | ||
| Bleeding | 492 | ||
| Pneumonia | 492 | ||
| Worsening of Existing Heart Problems | 493 | ||
| SUMMARY | 493 | ||
| REFERENCES | 493 | ||
| 35 - Care of the Cardiac Surgical Patient | 494 | ||
| DEFINITIONS | 494 | ||
| Preoperative Considerations | 497 | ||
| Anesthesia | 498 | ||
| Procedures | 498 | ||
| Monitoring | 498 | ||
| Incisions | 498 | ||
| Cardiopulmonary Bypass | 501 | ||
| Myocardial Protection | 503 | ||
| Surgery for Coronary Artery Disease | 505 | ||
| Left Ventricular Aneurysm Repair | 509 | ||
| Valvular Heart Surgery | 509 | ||
| Aortic Valve Surgery | 510 | ||
| Aortic Insufficiency | 510 | ||
| Aortic Stenosis | 510 | ||
| Procedure | 512 | ||
| Mitral Valve Surgery | 513 | ||
| Mitral Regurgitation | 514 | ||
| Mitral Stenosis | 515 | ||
| Procedure | 515 | ||
| Tricuspid Valve Repair | 516 | ||
| Surgery for Thoracic Aortic Aneurysms and Dissections | 518 | ||
| Ventricular Assistance | 518 | ||
| Transplantation | 519 | ||
| Surgery for Adult Congenital Heart Disease | 520 | ||
| Atrial Septal Defect | 520 | ||
| Coarctation of the Aorta | 520 | ||
| Patent Ductus Arteriosus | 520 | ||
| Pulmonary Stenosis | 521 | ||
| Ventricular Septal Defects | 521 | ||
| Dysrhythmia Surgery | 521 | ||
| Completion of Surgery | 521 | ||
| Postanesthesia Care | 521 | ||
| Complications | 524 | ||
| Cardiovascular System | 524 | ||
| Cardiac Complications of Coronary Artery Bypass Grafting and Valvular Surgery | 525 | ||
| Myocardial Infarction | 525 | ||
| Heart Failure (Alterations in Myocardial Contractility) | 525 | ||
| Cardiac Tamponade | 525 | ||
| Dysrhythmias | 526 | ||
| Peripheral Vasoconstriction (Postoperative Hypertension) | 526 | ||
| Noncardiac Complications of Coronary Artery Bypass Grafting and Valvular Surgery | 526 | ||
| Hemorrhage | 526 | ||
| Sternal Wound Dehiscence and Infection | 527 | ||
| Inadequate Volume Status | 527 | ||
| Respiratory System | 527 | ||
| Nervous System | 528 | ||
| Renal System | 528 | ||
| Gastrointestinal System | 528 | ||
| Peripheral Vascular System | 528 | ||
| SUMMARY | 528 | ||
| REFERENCES | 529 | ||
| 36 - Care of the Vascular Surgical Patient | 531 | ||
| DEFINITIONS | 531 | ||
| General Considerations | 531 | ||
| Diagnostic Procedures | 532 | ||
| Interventional Procedures | 532 | ||
| Medications Used in Vascular Surgery | 533 | ||
| Preprocedural Assessment | 536 | ||
| Arterial Surgical Procedures | 538 | ||
| Extremity Vessels and Extraanatomic Procedures | 538 | ||
| Positioning | 539 | ||
| Cardiopulmonary Status | 539 | ||
| Neurovascular Status | 540 | ||
| Dressings | 540 | ||
| Pain Relief | 540 | ||
| Intake and Output | 540 | ||
| Carotid Vessels | 541 | ||
| Positioning | 541 | ||
| Cardiopulmonary Status | 541 | ||
| Neurologic Status | 541 | ||
| Dressings | 542 | ||
| Pain Relief | 542 | ||
| Large Vessels | 542 | ||
| Positioning | 544 | ||
| Cardiopulmonary Status | 544 | ||
| Neurovascular Status | 544 | ||
| Dressings | 544 | ||
| Pain Relief | 544 | ||
| Intake and Output | 544 | ||
| Temperature | 544 | ||
| Sympathectomy | 544 | ||
| Amputation | 545 | ||
| Postoperative Care | 545 | ||
| Venous Surgical Procedures | 545 | ||
| Postoperative Care | 546 | ||
| Vena Caval Filters | 546 | ||
| SUMMARY | 547 | ||
| REFERENCES | 547 | ||
| 37 - Care of the Orthopedic Surgical Patient | 549 | ||
| DEFINITIONS | 549 | ||
| General Perianesthesia Care | 550 | ||
| Positioning | 550 | ||
| Neurovascular Assessment | 552 | ||
| Care of Immobilization Devices (Cast Care) | 552 | ||
| Wound and Drain Care | 553 | ||
| Range-of-Motion Exercises | 553 | ||
| Observation for Complications | 553 | ||
| Deep Vein Thrombosis | 553 | ||
| Pulmonary Embolism | 554 | ||
| Fat Embolism Syndrome | 554 | ||
| Compartment Syndrome | 554 | ||
| Shock | 555 | ||
| Urinary Retention | 555 | ||
| Infection | 555 | ||
| Perianesthesia Care After Hand Surgery | 555 | ||
| Perianesthesia Care After Arm and Forearm Surgery | 556 | ||
| Perianesthesia Care After Shoulder Surgery | 556 | ||
| Perianesthesia Care After Hip or Femoral Surgery | 557 | ||
| Perianesthesia Care After Knee Surgery | 558 | ||
| Perianesthesia Care After Foot and Ankle Surgery | 560 | ||
| Perianesthesia Care After Spinal Surgery | 560 | ||
| Perianesthesia Care After Limb Amputation | 561 | ||
| SUMMARY | 563 | ||
| REFERENCES | 563 | ||
| 38 - Care of the Neurosurgical Patient | 565 | ||
| DEFINITIONS | 565 | ||
| Cranial Surgery | 566 | ||
| Diagnostic Tools | 566 | ||
| Conventional Radiography | 566 | ||
| Computed Tomography | 566 | ||
| Magnetic Resonance Imaging | 566 | ||
| Positron Emission Tomography | 567 | ||
| Cerebral Angiography | 567 | ||
| Injuries and Pathologic Conditions of the Brain | 567 | ||
| Types of Injuries | 567 | ||
| Consequences of Injury | 568 | ||
| Types of Pathologic Conditions | 569 | ||
| Consequences of Pathologic Conditions | 570 | ||
| Intracranial Pressure Dynamics | 571 | ||
| Neurosurgical Procedures | 572 | ||
| Minimally Invasive Surgical Procedures | 572 | ||
| Open Surgical Procedures | 573 | ||
| Anesthetic Agents and Intracranial Pressure | 573 | ||
| Inhalation Anesthetics | 573 | ||
| Intravenous Anesthetics | 574 | ||
| Adjunctive Drugs and Interventions Used to Reduce Intracranial Pressure | 575 | ||
| Diuretics | 575 | ||
| Corticosteroids | 575 | ||
| Barbiturate Therapy | 575 | ||
| Temperature Management | 575 | ||
| Positioning | 575 | ||
| Intracranial Pressure Monitoring | 575 | ||
| Pressure Waves in Increased Intracranial Pressure | 577 | ||
| Intracranial Pressure Assessment | 578 | ||
| Perianesthesia Nursing Management | 578 | ||
| Vital Signs | 579 | ||
| Level of Consciousness | 579 | ||
| Motor and Sensory Functioning | 580 | ||
| Pupillary Activity | 580 | ||
| Pain and Nausea | 580 | ||
| Nursing Care in the Postanesthesia Care Unit | 581 | ||
| Spinal Surgery | 581 | ||
| Diagnostic Tools | 581 | ||
| Injuries of the Spine | 582 | ||
| Complete Spinal Cord Lesion | 582 | ||
| Incomplete Spinal Cord Lesion | 583 | ||
| Surgical Intervention for Spinal Cord Injuries | 584 | ||
| Perianesthesia Nursing Care for the Patient With Spinal Cord Injury | 584 | ||
| Complications Associated With Spinal Cord Injury | 584 | ||
| Hypotension | 584 | ||
| Bradycardia | 584 | ||
| Thrombosis | 585 | ||
| Autonomic Dysreflexia | 585 | ||
| Pain Management | 585 | ||
| Concomitant Head Injury | 585 | ||
| Respiratory Complications | 585 | ||
| Skin Breakdown | 585 | ||
| Gastrointestinal Complications | 586 | ||
| Urologic Complications | 586 | ||
| Anesthetic Considerations | 586 | ||
| Herniated Intervertebral Disk | 586 | ||
| Intraspinal Neoplasms | 587 | ||
| Postoperative Care for Spinal Cord Injury and Other Spinal Surgical Interventions | 587 | ||
| SUMMARY | 588 | ||
| REFERENCES | 588 | ||
| 39 - Care of the Thyroid and Parathyroid Surgical Patient | 589 | ||
| DEFINITIONS | 589 | ||
| Anesthesia | 589 | ||
| Perianesthesia Nursing Care | 589 | ||
| Surgical Indications | 589 | ||
| Preoperative Considerations | 589 | ||
| Positioning | 589 | ||
| Cardiopulmonary Assessment and Care | 590 | ||
| Pain Management | 590 | ||
| Dressings and Drains | 590 | ||
| Intake and Output | 591 | ||
| Complications | 591 | ||
| Bleeding and Airway (Respiratory) Compromise | 591 | ||
| Recurrent Laryngeal Nerve Injury | 591 | ||
| Hypoparathyroidism and Hypocalcemia | 591 | ||
| Thyroid Storm | 592 | ||
| Infection | 592 | ||
| SUMMARY | 592 | ||
| REFERENCES | 593 | ||
| 40 - Care of the Gastrointestinal, Abdominal, and Anorectal Surgical Patient | 594 | ||
| DEFINITIONS | 594 | ||
| General Care after Abdominal Surgery | 596 | ||
| Perianesthesia Care | 596 | ||
| Positioning | 596 | ||
| Dressings and Drains | 596 | ||
| Respiratory Function | 597 | ||
| Fluid and Electrolyte Balance | 597 | ||
| Care of the Patient With Nasogastric or Intestinal Tubes | 597 | ||
| Tube Patency | 598 | ||
| Irrigation | 598 | ||
| Patient Comfort | 598 | ||
| Diagnostic Studies | 599 | ||
| Care After Surgery on the Gastrointestinal Tract | 599 | ||
| Esophagus | 599 | ||
| Stomach | 599 | ||
| Perforated Ulcer | 600 | ||
| Pyloric Stenosis | 600 | ||
| Bariatric Gastric Surgery | 600 | ||
| Small Bowel | 601 | ||
| Large Bowel | 601 | ||
| Abdominoperineal Resection | 602 | ||
| Appendectomy and Herniorrhaphy | 602 | ||
| Lower Rectum and Anus | 603 | ||
| Surgery on Related Organs within the Abdominal Cavity | 603 | ||
| Liver | 603 | ||
| Spleen | 603 | ||
| Pancreas | 604 | ||
| Biliary Tract | 604 | ||
| SUMMARY | 605 | ||
| REFERENCES | 605 | ||
| 41 - Care of the Genitourinary Surgical Patient | 606 | ||
| DEFINITIONS | 606 | ||
| Nursing Care After Diagnostic Procedures | 607 | ||
| Renal Angiography | 607 | ||
| Renal Biopsy | 608 | ||
| Cystoscopy | 608 | ||
| General Postoperative Care | 608 | ||
| Suprapubic Catheters | 610 | ||
| Ureteral Catheters and Stents | 610 | ||
| Intake | 610 | ||
| Dressings | 610 | ||
| Abdominal Distention | 611 | ||
| Management of Discomfort and Pain | 611 | ||
| Nursing Care After Specific Procedures | 612 | ||
| Renal and Ureteral Surgery | 612 | ||
| Extracorporeal Shock Wave Lithotripsy | 612 | ||
| Ureteroscopy | 613 | ||
| Percutaneous Nephrolithotomy | 613 | ||
| Kidney Transplantation | 614 | ||
| Bladder Surgery | 616 | ||
| Cystectomy | 616 | ||
| Bladder Neck Suspensions | 616 | ||
| Artificial Urinary Sphincter | 617 | ||
| Prostatic Surgery | 617 | ||
| Scrotal Surgery | 620 | ||
| Penile and Urethral Surgery | 621 | ||
| Adrenalectomy | 621 | ||
| SUMMARY | 622 | ||
| REFERENCES | 622 | ||
| 42 - Care of the Obstetric and Gynecologic Surgical Patient | 624 | ||
| DEFINITIONS | 624 | ||
| Obstetric Surgery | 626 | ||
| Care After Specific Procedures | 626 | ||
| Cesarean Delivery | 626 | ||
| Ectopic Pregnancy | 627 | ||
| Cervical Cerclage | 627 | ||
| Dilation and Curettage | 628 | ||
| Gynecologic Surgery | 628 | ||
| Laparoscopy | 628 | ||
| Lower Genital and Vaginal Surgery | 631 | ||
| Other Vaginal Surgeries | 632 | ||
| General Perianesthesia Care | 633 | ||
| Abdominal Gynecologic Surgery | 633 | ||
| SUMMARY | 634 | ||
| REFERENCES | 635 | ||
| 43 - Care of the Breast Surgical Patient | 637 | ||
| DEFINITIONS | 637 | ||
| Surgical Interventions and Perianesthesia Nursing Care | 639 | ||
| Breast Biopsy | 639 | ||
| Surgical Choices for the Treatment of Cancer | 640 | ||
| Lumpectomy | 641 | ||
| Sentinel Lymph Node Biopsy | 641 | ||
| Mastectomy | 642 | ||
| Simple Mastectomy | 642 | ||
| Modified Radical Mastectomy | 642 | ||
| Radical Mastectomy | 642 | ||
| Breast Reconstruction | 643 | ||
| Mastopexy (Breast Lift) | 644 | ||
| Augmentation Mammoplasty | 645 | ||
| Reduction Mammoplasty | 645 | ||
| Surgery in Gynecomastia | 646 | ||
| SUMMARY | 646 | ||
| REFERENCES | 647 | ||
| 44 - Care of the Plastic and Reconstructive Surgical Patient | 648 | ||
| DEFINITIONS | 648 | ||
| Perianesthesia Nursing Care | 649 | ||
| Skin Grafts | 649 | ||
| Flaps | 650 | ||
| Microvascular Tissue Transfer and Free Flaps | 650 | ||
| Breast Reconstruction Flap Techniques | 651 | ||
| Bone Grafts | 652 | ||
| Surgical Repair of Facial Bone Injuries | 652 | ||
| Surgical Repair of Cleft Lip and Palate | 652 | ||
| Cleft Palate | 653 | ||
| Cosmetic Surgery | 653 | ||
| Blepharoplasty | 653 | ||
| Dermabrasion | 654 | ||
| Liposuction | 654 | ||
| Otoplasty | 654 | ||
| Rhinoplasty | 654 | ||
| Rhytidectomy | 654 | ||
| SUMMARY | 654 | ||
| REFERENCES | 655 | ||
| 45 - Care of the Patient Undergoing Bariatric Surgery | 656 | ||
| DEFINITIONS | 656 | ||
| Physiologic Considerations in Obesity | 657 | ||
| Pulmonary | 657 | ||
| Cardiovascular | 657 | ||
| Psychological | 658 | ||
| Integumentary | 658 | ||
| Endocrine | 658 | ||
| Other Disorders | 658 | ||
| Bariatric Procedures | 658 | ||
| Perianesthesia Care of the Obese Patient | 659 | ||
| Equipment | 659 | ||
| Respiratory | 661 | ||
| Cardiovascular | 662 | ||
| Pain and Comfort Management | 662 | ||
| Glucose Management | 663 | ||
| Fluid Dynamics | 663 | ||
| Psychological Aspects | 663 | ||
| SUMMARY | 663 | ||
| REFERENCES | 663 | ||
| 46 - Care of the Ambulatory Surgical Patient | 664 | ||
| DEFINITIONS | 664 | ||
| Assessment and Preparation of the Patient | 666 | ||
| Admission of the Patient | 670 | ||
| Fasting Before Surgery | 670 | ||
| Diagnostic Testing | 670 | ||
| Preoperative Medications | 671 | ||
| Emotional Support | 671 | ||
| Preoperative Goals | 671 | ||
| Intraoperative Period | 672 | ||
| Anesthesia Considerations | 672 | ||
| Postanesthesia Period | 672 | ||
| Postanesthesia Care Unit (PACU) | 673 | ||
| Progressive or Phase II Care | 673 | ||
| Postdischarge Follow-Up | 675 | ||
| SUMMARY | 675 | ||
| REFERENCES | 676 | ||
| 47 - Care of the Laser/Laparoscopic Surgical Patient | 677 | ||
| DEFINITIONS | 677 | ||
| Laser Surgery | 677 | ||
| Laser Light | 677 | ||
| Tissue Interaction | 678 | ||
| Types of Lasers | 679 | ||
| Preoperative Care | 679 | ||
| Intraoperative Issues | 681 | ||
| Postoperative Care | 683 | ||
| Laparoscopic Surgery | 683 | ||
| Preoperative Issues | 684 | ||
| Intraoperative Issues | 684 | ||
| Pneumoperitoneum | 684 | ||
| Cardiovascular Changes | 685 | ||
| Respiratory Changes | 685 | ||
| Other System Effects | 685 | ||
| Gasless Laparoscopy | 686 | ||
| Patient Positioning | 686 | ||
| Postoperative Issues | 686 | ||
| Pneumoperitoneum Complications | 687 | ||
| Laparoscopy Complications | 687 | ||
| Bowel Injuries | 687 | ||
| Vascular Injuries | 687 | ||
| Bladder Injuries | 688 | ||
| Other Complications | 688 | ||
| SUMMARY | 688 | ||
| REFERENCES | 689 | ||
| V - SPECIAL CONSIDERATIONS | 690 | ||
| 48 - Care of the Patient With Chronic Disorders | 690 | ||
| DEFINITIONS | 690 | ||
| CHRONIC OBSTRUCTIVEPULMONARYDISEASE | 690 | ||
| Description of COPD | 691 | ||
| Surgical Considerations | 691 | ||
| Care of the COPD Patient | 692 | ||
| Diabetes Mellitus | 693 | ||
| Preoperative Considerations | 694 | ||
| Hyperglycemia Versus Hypoglycemia | 695 | ||
| Intraoperative Guidelines | 696 | ||
| Postoperative Guidelines | 696 | ||
| Research Needs | 697 | ||
| Sickle Cell Disease | 697 | ||
| Surgical Considerations | 698 | ||
| Care of the Patient With Sickle Cell Disease | 698 | ||
| Rheumatoid Arthritis | 699 | ||
| Surgical Considerations | 700 | ||
| Care of the Patient With Rheumatoid Arthritis | 700 | ||
| Myasthenia Gravis | 701 | ||
| Care of the Patient With Myasthenia Gravis | 702 | ||
| Multiple Sclerosis | 702 | ||
| Surgical Considerations | 703 | ||
| Care of the Patient With MS | 704 | ||
| SUMMARY | 705 | ||
| REFERENCES | 705 | ||
| 49 - Care of the Pediatric Patient | 707 | ||
| DEFINITIONS | 707 | ||
| Growth and Development: PsychoSocial Review | 708 | ||
| Neonate: Birth to 1 Month | 708 | ||
| Infant: 1 to 12 Months | 709 | ||
| Toddler: 1 to 3 Years | 709 | ||
| Preschool: 3 to 5 Years | 709 | ||
| School Age: 5 to 13 Years | 710 | ||
| Adolescent: 13 to 18 Years (Some Define Until Age 21 Years) | 710 | ||
| Anatomic and Physiologic Considerations | 710 | ||
| Respiratory System | 710 | ||
| Cardiovascular System | 712 | ||
| Composition and Regulation of Body Fluids | 713 | ||
| Thermal Regulation | 714 | ||
| Prematurity | 715 | ||
| Pediatric Perianesthesia Considerations and Techniques | 715 | ||
| Preoperative Period | 715 | ||
| Postoperative Care of the Pediatric Patient | 717 | ||
| Equipment | 718 | ||
| Admission and Hand-Off | 718 | ||
| Initial Assessment | 718 | ||
| Respiratory | 719 | ||
| Airway Obstruction | 719 | ||
| Laryngospasm | 719 | ||
| Cardiovascular | 722 | ||
| Pain | 723 | ||
| Emergence Delirium | 726 | ||
| Fluid Management | 727 | ||
| Thermal Regulation in the Postanesthesia Care Unit | 728 | ||
| Selected Postoperative Concerns in Pediatrics | 728 | ||
| Postoperative Nausea and Vomiting | 729 | ||
| Malignant Hyperthermia | 729 | ||
| Discharge from the Postanesthesia Care Unit | 730 | ||
| SUMMARY | 731 | ||
| REFERENCES | 731 | ||
| 50 - Care of the Older Patient | 733 | ||
| DEFINITIONS | 733 | ||
| The Aging Body: An Overview | 734 | ||
| Cardiovascular System | 734 | ||
| Functional Capacity | 734 | ||
| Structural Changes | 735 | ||
| Cardiovascular Risk Assessment | 736 | ||
| Heart | 737 | ||
| Respiratory System | 737 | ||
| Renal System | 737 | ||
| Hepatic Function | 738 | ||
| Thermoregulation | 738 | ||
| Sensory System | 738 | ||
| The Aging Mind: An Overview | 739 | ||
| Memory and Cognition | 739 | ||
| Dementia and Delirium | 739 | ||
| Working with the Aging Population: Essential Concepts | 740 | ||
| Geropharmacology | 740 | ||
| Person-Centered Care and Cultural Competence | 741 | ||
| SUMMARY | 742 | ||
| REFERENCES | 742 | ||
| 51 - Care of the Pregnant Patient | 744 | ||
| DEFINITIONS | 744 | ||
| Hematologic Alterations | 747 | ||
| Respiratory Changes | 747 | ||
| Upper Airway Anatomy | 747 | ||
| Lung Mechanics and Ventilation | 747 | ||
| Gastrointestinal Changes | 747 | ||
| Motility and Secretions | 747 | ||
| Hepatic System | 748 | ||
| Renal Changes | 748 | ||
| Care of the Obstetric Patient | 748 | ||
| Positioning | 748 | ||
| Gastrointestinal Considerations | 748 | ||
| General Anesthesia | 748 | ||
| Induction | 748 | ||
| Maintenance | 748 | ||
| Emergence | 749 | ||
| Regional Anesthesia | 749 | ||
| Perianesthesia Care of the Mother and the Fetus | 750 | ||
| Positioning | 750 | ||
| Psychological and Emotional Support | 750 | ||
| Fetal Monitoring | 750 | ||
| Pain Management | 751 | ||
| The Patient After Cesarean Section | 751 | ||
| The Pregnant Patient | 751 | ||
| SUMMARY | 752 | ||
| REFERENCES | 752 | ||
| 52 - Care of the Patient With Substance Use Disorder | 753 | ||
| DEFINITIONS | 753 | ||
| Opioid Analgesics | 755 |