Additional Information
Book Details
Abstract
Prepare for success on certification exams and in perioperative nursing! Alexander’s Care of the Patient in Surgery, 16th Edition is the definitive text for nurses and surgical technologists training for a career in the operating room. Illustrated, step-by-step instructions cover patient care in more than 400 surgical interventions, including positioning, instrumentation, and postoperative care. New to this edition is additional coverage of robotic surgery, along with review of evidence-based guidelines for practice. From well-known educator Jane C. Rothrock — and with every chapter authored by an expert nurse — Alexander’s gives you the tools you need to provide safe, high-quality care in the surgical setting.
- Over 400 general and specialty surgical interventions are covered, as well as many minimally invasive surgical procedures, whether performed in a hospital, outpatient clinic, or in a doctor's office.
- 900 full-color photos and illustrations show surgical anatomy, procedures, and methods.
- Comprehensive coverage includes basic perioperative nursing principles, such as patient and environmental safety, infection prevention and control, positioning, anesthesia and pain management, the unique needs of special populations such as pediatric and geriatric patients, and more.
- Comprehensive practice exams on the Evolve companion website include 300 exam-style questions with rationales.
- Perioperative nursing considerations include assessment, nursing diagnosis, outcome identification, planning, implementation, evaluation, discharge planning, and patient and family education.
- Sample plans of care include nursing diagnoses, outcomes, and interventions.
- Surgical Pharmacology tables summarize the drugs most commonly used for each surgical procedure, including generic and trade names, indications, and pharmacokinetics.
- Patient and Family Education boxes include specific guidelines for preprocedural and postprocedural care, side effects and complications, home care, discharge instructions, and psychosocial care.
- Patient Safety boxes highlight Joint Commission initiatives for patient and staff safety in the surgical setting.
- Best Practice and Research Highlight boxes apply the latest scientific research to patient care.
- Critical thinking questions at the end of each chapter let you assess your understanding of important material.
- NEW! Robotic-Assisted Surgery boxes highlight a rapidly expanding surgical modality.
- NEW! Enhanced Recovery After Surgery boxes promote review of protocols for early recovery for patients undergoing major surgery.
- NEW! Patient Engagement Exemplar boxes optimize surgical outcomes by addressing AORN guidelines on the issues of patient care and involvement of the patient’s family.
- NEW standards and AORN toolkits cover topics ranging from enhanced post-surgical recovery to prevention of pressure ulcers.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Brief contents | i | ||
| Alexander's Care of the Patient in Surgery | iii | ||
| Copyright Page | vi | ||
| Contributors | vii | ||
| Clinical Consultants | x | ||
| Reviewers | xi | ||
| About the Author | xiii | ||
| Preface | xiv | ||
| Table Of Contents | xvii | ||
| Unit I Foundations for Practice | 1 | ||
| 1 Concepts Basic to Perioperative Nursing | 1 | ||
| Overview of Perioperative Nursing Practice | 1 | ||
| Perioperative Patient Focused Model | 2 | ||
| Standards of Perioperative Nursing Practice | 2 | ||
| Perioperative Nursing Practice Standards | 2 | ||
| Nursing Process | 3 | ||
| Assessment | 3 | ||
| Nursing Diagnosis | 4 | ||
| Outcome Identification | 5 | ||
| Planning | 5 | ||
| Implementation | 6 | ||
| Delegation. | 7 | ||
| Documenting Interventions. | 8 | ||
| Syntegrity. | 8 | ||
| Evaluation | 8 | ||
| Institutional Standards of Care | 9 | ||
| Evidence-Based Practice | 9 | ||
| Performance Improvement | 9 | ||
| Perioperative Nursing Roles | 12 | ||
| Traditional Perioperative Roles | 12 | ||
| Registered Nurse First Assistant | 12 | ||
| Advanced Practice Registered Nurse | 12 | ||
| Emerging Roles | 13 | ||
| Key Points | 13 | ||
| Critical Thinking Question | 13 | ||
| References | 13 | ||
| 2 Patient Safety and Risk Management | 15 | ||
| Evolution of Perioperative Patient Safety | 15 | ||
| Safety as an Individual Responsibility | 15 | ||
| Concentrated Emphasis on Systems | 15 | ||
| Major Professional Association and Government Regulatory Safety Activities | 16 | ||
| The Joint Commission | 17 | ||
| Sentinel Events | 17 | ||
| National Patient Safety Goals | 17 | ||
| Universal Protocol | 18 | ||
| The Association of periOperative Registered Nurses | 18 | ||
| Federal Agencies | 18 | ||
| Centers for Medicare and Medicaid Services | 18 | ||
| Agency for Healthcare Research and Quality | 19 | ||
| Centers for Disease Control and Prevention | 19 | ||
| The World Health Organization | 19 | ||
| Other Patient Safety Groups/Coalitions/Companies | 21 | ||
| Nonprovider Members of the Perioperative Patient Safety Team | 21 | ||
| Perioperative Nursing Safety Issues | 21 | ||
| Communication and Teamwork | 21 | ||
| Clinical Documentation | 21 | ||
| Handoffs/Handovers | 22 | ||
| Wrong Site, Person, or Procedure Surgery | 23 | ||
| Retained Surgical Items | 25 | ||
| Prevention of Retained Surgical Items | 26 | ||
| Care and Handling of Specimens | 26 | ||
| Specimens for Frozen Section | 27 | ||
| Risks for Burns: Electrical Hazards | 28 | ||
| Fires and Explosions | 28 | ||
| Risk for Chemical Burns | 29 | ||
| Pressure Injuries | 29 | ||
| Medication Administration | 29 | ||
| Robotic-Assisted Surgery | 29 | ||
| Risk Management in the “Near” Future | 31 | ||
| Patient Rights | 31 | ||
| Freedom From Negligent Treatment | 31 | ||
| Privacy | 31 | ||
| Privacy and Social Media | 32 | ||
| Patient Autonomy | 32 | ||
| Informed Consent | 32 | ||
| Advance Directives and Do Not Resuscitate Orders | 33 | ||
| Veracity and Fidelity | 33 | ||
| Key Points | 34 | ||
| Critical Thinking Questions | 34 | ||
| References | 34 | ||
| 3 Workplace Issues and Staff Safety | 37 | ||
| Ergonomics | 38 | ||
| Safe Patient Handling and Movement | 38 | ||
| Seven Ergonomic Tools for Safe Patient Handling and Movement | 38 | ||
| National Institute for Occupational Safety and Health Lifting Equation | 40 | ||
| Slips, Trips, and Falls | 41 | ||
| Slips, Trips, and Falls: Causes and Prevention | 41 | ||
| Wet Floors | 41 | ||
| Uneven Floor Surfaces | 41 | ||
| Obstructed Pathways | 41 | ||
| Inadequate Lighting | 41 | ||
| Improper Footwear | 41 | ||
| Programmatic Slips, Trips, and Falls Prevention and Reduction | 42 | ||
| Sharps Safety and Bloodborne Pathogens | 42 | ||
| Scope and Significance of Problem | 42 | ||
| Personal Protective Equipment | 42 | ||
| Double-Gloving | 42 | ||
| Responding to Exposure | 43 | ||
| If You Sustain an Injury | 43 | ||
| Immediate Response | 43 | ||
| Follow-Up | 43 | ||
| Exposure Prevention Information Network and Stop Sticks Campaign | 43 | ||
| A Culture of Safety | 43 | ||
| Protecting Yourself | 43 | ||
| Waste Anesthetic Gases | 44 | ||
| Scope and Significance of Problem | 44 | ||
| Chemicals and Drugs | 45 | ||
| Standard Precautions | 46 | ||
| Cell Phone Hygiene | 46 | ||
| Immunizations and Infectious Disease Exposure | 47 | ||
| Radiation Safety | 48 | ||
| Latex Allergy | 48 | ||
| Fatigue and Burnout | 49 | ||
| Noise | 51 | ||
| Workplace Violence | 51 | ||
| Active Shooter | 52 | ||
| Key Points | 52 | ||
| Critical Thinking Question | 52 | ||
| References | 53 | ||
| 4 Infection Prevention and Control | 54 | ||
| Causes of Infection | 54 | ||
| Pathogenesis of Surgical Site Infection | 54 | ||
| Microorganisms That Cause Infection | 57 | ||
| Virulence Factors | 57 | ||
| Bloodborne Pathogens | 57 | ||
| Multidrug-Resistant Organisms | 59 | ||
| Perioperative Considerations | 59 | ||
| Antibiotic Stewardship | 60 | ||
| Multidrug-Resistant Mycobacterium Tuberculosis (MDR-TB). | 60 | ||
| Management of New and Emerging Microorganism of Perioperative Significance | 60 | ||
| Prions: Creutzfeldt-Jakob Disease. | 60 | ||
| Carbapenem-Resistant Enterobacteriaceae. | 61 | ||
| Mycobacterium chimaera. | 62 | ||
| Ebola. | 62 | ||
| Zika. | 62 | ||
| Preventing Infection | 62 | ||
| Asepsis | 62 | ||
| Universal, Standard, and Transmission-Based Precautions | 62 | ||
| Universal Precautions | 62 | ||
| Standard Precautions | 66 | ||
| Transmission-Based Precautions | 66 | ||
| Airborne Precautions. | 67 | ||
| Droplet Precautions. | 67 | ||
| Contact Precautions. | 67 | ||
| Infection Control and Bioterrorism | 67 | ||
| Engineering Practices to Prevent Infection | 67 | ||
| Environment of Care | 67 | ||
| Heating, Ventilation, Air Conditioning | 70 | ||
| Practices to Prevent Infection | 70 | ||
| Preparation of Items/Instruments for Sterilization and High-Level Disinfection | 70 | ||
| Cleaning. | 70 | ||
| Packaging and Sterilizer Loading. | 72 | ||
| The Spaulding Classification System. | 74 | ||
| Sterilization | 74 | ||
| Steam Sterilization. | 75 | ||
| Theory of Microbial Destruction. | 75 | ||
| Principles and Mechanisms. | 75 | ||
| Sterilizing. | 75 | ||
| Drying, Cooling, and Storing. | 75 | ||
| Quality Monitoring Practices. | 76 | ||
| Types of Steam Sterilizers. | 78 | ||
| Immediate-Use Steam Sterilization. | 79 | ||
| Chemical Sterilization. | 79 | ||
| Ethylene Oxide. | 79 | ||
| Low-Temperature Hydrogen Peroxide Gas Plasma Sterilization. | 81 | ||
| Hydrogen Peroxide Vapor. | 81 | ||
| Liquid Peracetic Acid Sterilant Systems. | 82 | ||
| Managing Loaned Instruments. | 82 | ||
| Disinfection | 82 | ||
| Types of Disinfectants. | 82 | ||
| High-Level Disinfectants Commonly Used for Instrument Processing | 83 | ||
| Glutaraldehyde Solutions. | 83 | ||
| Ortho-Phthalaldehyde. | 83 | ||
| Peracetic Acid Solutions. | 83 | ||
| Other Disinfectants | 83 | ||
| Alcohols. | 83 | ||
| Chlorine Compounds. | 83 | ||
| Hydrogen Peroxide. | 84 | ||
| Iodine and Iodophors. | 84 | ||
| Phenolics. | 84 | ||
| Quaternary Ammonium Compounds. | 84 | ||
| Pasteurization | 84 | ||
| Reprocessing/Reuse of Items Labeled for Single Use Only | 84 | ||
| Aseptic Practices to Prevent Infection | 84 | ||
| Surgical Aseptic Principles | 84 | ||
| Traffic Control | 86 | ||
| Surgical Attire | 88 | ||
| Surgical Hand Antisepsis | 89 | ||
| Surgical Hand Rubs | 91 | ||
| Surgical Hand Scrub | 91 | ||
| Scrub Procedure. | 91 | ||
| Drying the Scrubbed Area. | 92 | ||
| Gowning | 92 | ||
| Self-Gowning Procedure | 93 | ||
| Assisted-Gowning Procedure | 94 | ||
| Gloving | 95 | ||
| Latex Allergies and Sensitivities | 95 | ||
| Closed-Gloving Technique | 95 | ||
| Open-Gloving Technique | 96 | ||
| Assisted-Gloving Technique | 97 | ||
| Process When a Team Member’s Gown and/or Glove Becomes Contaminated | 97 | ||
| Removing Soiled Gown, Gloves, and Mask | 98 | ||
| Patient Skin Antisepsis | 98 | ||
| Creating the Sterile Field With Surgical Drapes | 100 | ||
| Reusable Drapes | 100 | ||
| Single-Use (Disposable) Drapes | 101 | ||
| Drape Configurations | 101 | ||
| Draping Procedure | 102 | ||
| Environmental Cleaning | 103 | ||
| Key Points | 104 | ||
| Critical Thinking Questions | 104 | ||
| References | 105 | ||
| 5 Anesthesia | 107 | ||
| Anesthesia Providers | 108 | ||
| Patient Safety | 108 | ||
| Environmental Noise | 108 | ||
| Awareness During Anesthesia | 108 | ||
| Preoperative Preparation | 109 | ||
| Patient Evaluation | 109 | ||
| Choice of Anesthesia | 110 | ||
| Premedication | 110 | ||
| Types of Anesthesia Care | 112 | ||
| General Anesthesia | 112 | ||
| Regional Anesthesia | 113 | ||
| Monitored Anesthesia Care | 113 | ||
| Moderate Sedation/Analgesia | 113 | ||
| Local Anesthesia | 113 | ||
| Perioperative Monitoring | 113 | ||
| Pulse Oximetry | 115 | ||
| Capnography | 116 | ||
| Anesthesia Machines and Anesthetic Gases | 116 | ||
| General Anesthesia | 118 | ||
| Mechanism of Action | 118 | ||
| Protein Receptor Theory | 118 | ||
| Endogenous Endorphins | 118 | ||
| Levels of General Anesthesia | 118 | ||
| Phases of General Anesthesia | 119 | ||
| Types of General Anesthesia | 122 | ||
| Muscle Relaxants | 122 | ||
| Typical Sequence of General Anesthesia | 124 | ||
| Regional Anesthesia | 129 | ||
| Spinal Anesthesia | 129 | ||
| Hypotension | 129 | ||
| Total Spinal Anesthesia | 129 | ||
| Positioning Problems | 129 | ||
| Postdural Puncture Headache | 129 | ||
| Epidural and Caudal Anesthesia | 130 | ||
| Inadvertent Dural Puncture | 130 | ||
| Subarachnoid Injection | 130 | ||
| Vascular Injection | 131 | ||
| Peripheral Nerve Blocks | 131 | ||
| Peripheral Nerve Anatomy and Physiology | 131 | ||
| Common Peripheral Nerve Blocks | 132 | ||
| Upper Extremity: The Brachial Plexus. | 132 | ||
| Lower Extremity. | 132 | ||
| Peripheral Nerve Block Equipment | 132 | ||
| Important Perioperative Nursing Considerations | 132 | ||
| Expected Side Effects and Special Care Concerns. | 132 | ||
| Preparation for Adverse Events. | 132 | ||
| Intravenous Regional Anesthesia | 132 | ||
| Monitored Anesthesia Care | 133 | ||
| Moderate Sedation/Analgesia | 133 | ||
| Local Anesthesia | 133 | ||
| Pain Management | 134 | ||
| Fluid Management | 135 | ||
| Blood Loss | 135 | ||
| Blood and Blood Products | 135 | ||
| Maintaining Fluid and Electrolyte Balance | 136 | ||
| Body Fluids | 136 | ||
| Electrolytes | 137 | ||
| Diffusion, Active Transport, and Osmosis | 137 | ||
| Preoperative Considerations | 137 | ||
| Deficient Fluid Volume | 137 | ||
| Sodium and Water Imbalances | 137 | ||
| Potassium Imbalances | 138 | ||
| Temperature Control | 138 | ||
| Malignant Hyperthermia | 138 | ||
| Perioperative Nursing Considerations | 139 | ||
| Key Points | 139 | ||
| Critical Thinking Questions | 139 | ||
| References | 140 | ||
| 6 Positioning the Patient for Surgery | 142 | ||
| Anatomic and Physiologic Considerations | 142 | ||
| Skin and Underlying Tissue | 142 | ||
| Pressure Injury | 143 | ||
| Risk Factors for Pressure Injury. | 144 | ||
| Extrinsic Factors. | 144 | ||
| Intrinsic Factors. | 144 | ||
| Musculoskeletal System | 149 | ||
| Nervous System | 149 | ||
| Peripheral Neuropathies | 150 | ||
| Upper Extremity Neuropathies. | 150 | ||
| Lower Extremity Neuropathies. | 153 | ||
| Vascular System | 155 | ||
| Respiratory System | 155 | ||
| Obesity | 156 | ||
| Eye Injuries and Perioperative Vision Loss | 156 | ||
| Perioperative Nursing Considerations | 157 | ||
| Assessment | 157 | ||
| Nursing Diagnosis | 158 | ||
| Outcome Identification | 158 | ||
| Planning | 158 | ||
| Implementation | 159 | ||
| Evaluation | 160 | ||
| Operating Room Beds and Accessories | 160 | ||
| Operating Room Beds | 160 | ||
| Mattress Materials and Their Pressure-Reducing Properties | 161 | ||
| Standard Foam Operating Room Mattress Pads | 162 | ||
| Bariatric Operating Room Bed Pads | 162 | ||
| Products | 163 | ||
| Positioning Accessories | 163 | ||
| Standard Surgical Positions | 163 | ||
| Supine | 163 | ||
| Trendelenburg | 165 | ||
| Reverse Trendelenburg | 166 | ||
| Fracture Bed Position | 166 | ||
| Lithotomy | 167 | ||
| Semi-Fowler | 169 | ||
| Fowler | 169 | ||
| Prone | 170 | ||
| Arm Support | 170 | ||
| Chest and Trunk Support | 170 | ||
| Head Support | 171 | ||
| Prone Jackknife | 172 | ||
| Prone Kneeling | 172 | ||
| Lateral | 173 | ||
| Lateral Chest | 173 | ||
| Lateral Kidney | 174 | ||
| Key Points | 174 | ||
| Critical Thinking Questions | 174 | ||
| References | 175 | ||
| 7 Sutures, Sharps, and Instruments | 176 | ||
| Suture Materials | 176 | ||
| Characteristics of Suture Material | 176 | ||
| Physical Characteristics | 176 | ||
| Handling Characteristics | 177 | ||
| Tissue-Reaction Characteristics | 177 | ||
| Types of Suture Material | 177 | ||
| Absorbable Sutures | 177 | ||
| Surgical Gut. | 177 | ||
| Synthetic Absorbable Sutures. | 177 | ||
| Nonabsorbable Sutures | 178 | ||
| Silk. | 178 | ||
| Nylon. | 178 | ||
| Polyester Fiber. | 178 | ||
| Polypropylene. | 179 | ||
| Polybutester. | 179 | ||
| Stainless Steel. | 179 | ||
| Suture Packaging and Storage | 179 | ||
| Types of Packaging | 179 | ||
| Color Codes | 179 | ||
| Trends in Suture Materials | 179 | ||
| Surgical Needles | 180 | ||
| Swage | 180 | ||
| Body | 180 | ||
| Point | 180 | ||
| Blunt Suture Needles | 181 | ||
| Suturing Technique and Wound Closure Materials | 181 | ||
| Suture Selection | 181 | ||
| Suturing Technique | 182 | ||
| General Considerations | 183 | ||
| Opening Primary Packets | 183 | ||
| Handling Suture Materials | 183 | ||
| Knot-Tying Techniques | 184 | ||
| Endoscopic/Robotic Suturing and Surgical Knot Tying | 184 | ||
| Skin Staples | 184 | ||
| Wound Closure Strips | 185 | ||
| Surgical Adhesives | 185 | ||
| Cyanoacrylates | 186 | ||
| Fibrin Tissue Adhesives | 186 | ||
| Hemostasis | 186 | ||
| Methods of Ligating Vessels | 186 | ||
| Ligating Clips | 186 | ||
| Instruments | 187 | ||
| Historical Perspective | 187 | ||
| Composition of Surgical Instruments | 187 | ||
| Instrument Categories | 187 | ||
| Cutting Instruments (Dissectors) | 187 | ||
| Clamps | 189 | ||
| Retractors | 190 | ||
| Accessory and Ancillary Instruments | 190 | ||
| Endoscopic Instrumentation | 192 | ||
| Robotic Instrumentation | 192 | ||
| Stapling Instruments | 193 | ||
| Selecting and Preparing Instruments for Patient Use | 194 | ||
| Basic Table Setups | 194 | ||
| Care and Handling of Instruments | 195 | ||
| Storing Instruments | 195 | ||
| Perioperative Nursing Considerations | 195 | ||
| Preventing Sharps Injuries During Surgery | 195 | ||
| Safety-Engineered Devices | 195 | ||
| Neutral Zone | 196 | ||
| No-Touch Technique | 196 | ||
| Work Practice Controls | 196 | ||
| Personal Protective Equipment | 196 | ||
| Preventing Retained Surgical Items | 196 | ||
| Reducing the Risk of Retained Surgical Items | 197 | ||
| Multidisciplinary Approach | 197 | ||
| Surgical Soft Goods | 199 | ||
| Sharps and Miscellaneous Items | 199 | ||
| Instruments | 199 | ||
| Device Fragments | 199 | ||
| Count Discrepancies | 199 | ||
| Key Points | 200 | ||
| Critical Thinking Question | 200 | ||
| References | 200 | ||
| 8 Surgical Modalities | 201 | ||
| Minimally Invasive Surgery Overview | 201 | ||
| Endoscopes | 201 | ||
| Light Sources and Fiberoptic Cables | 203 | ||
| Endoscopic Minimally Invasive Surgery Instrumentation | 204 | ||
| Trocar System | 204 | ||
| Dissecting Instruments | 206 | ||
| Clamping and Grasping Instruments | 207 | ||
| Suturing and Stapling Instruments | 207 | ||
| Loop Ligatures. | 208 | ||
| Extracorporeal Sutures. | 209 | ||
| Intracorporeal Sutures. | 210 | ||
| Retractors and Accessory Instruments | 210 | ||
| Care and Handling of Endoscopes and Instrumentation | 210 | ||
| Single-Use Versus Reusable Instrumentation | 211 | ||
| Reprocessing Single-Use Devices | 212 | ||
| Video Technology | 213 | ||
| Evolution of Video Technology | 213 | ||
| Visualization Systems | 214 | ||
| Camera, Cable, and Control Unit | 214 | ||
| Couplers (Adapters) | 215 | ||
| Video Monitor | 216 | ||
| Recording Systems | 216 | ||
| Storage Systems | 217 | ||
| Videoconferencing | 217 | ||
| Robotics | 217 | ||
| Practices and Potential Risks During Minimally Invasive Surgery | 220 | ||
| Insufflation | 220 | ||
| Anesthetic Considerations and Potential Complications During Minimally Invasive Surgery | 221 | ||
| Energies Used During Surgery | 222 | ||
| Electrosurgery | 222 | ||
| Physics of Electrosurgery | 222 | ||
| Electrosurgical Modes | 222 | ||
| Tissue Effects | 223 | ||
| Electrosurgical Units | 224 | ||
| Grounded Electrosurgical Units. | 224 | ||
| Isolated Electrosurgical Unit. | 224 | ||
| Dispersive Electrode Monitoring. | 224 | ||
| Tissue Response Monitoring. | 225 | ||
| Special Electrosurgery Considerations During Endoscopic Minimally Invasive Surgery | 226 | ||
| Direct Coupling. | 226 | ||
| Insulation Failure. | 226 | ||
| Capacitive Coupling. | 226 | ||
| Electrosurgery Safety | 227 | ||
| Argon-Enhanced Electrosurgery | 228 | ||
| Laser | 228 | ||
| Laser Biophysics | 228 | ||
| Principles of Light. | 228 | ||
| Characteristics of Laser Light. | 229 | ||
| Laser Power. | 229 | ||
| Tissue Interaction. | 229 | ||
| Laser Systems | 230 | ||
| Laser System Components. | 230 | ||
| Benefits of Laser Technology | 232 | ||
| Laser Safety | 233 | ||
| Eye Protection. | 233 | ||
| Controlled Access. | 235 | ||
| Fire Safety. | 235 | ||
| Endoscope Safety. | 236 | ||
| Smoke Evacuation. | 237 | ||
| Other Safety Measures. | 239 | ||
| Documentation. | 239 | ||
| Role of the Laser Team Member. | 239 | ||
| Ultrasonic Device Surgery | 240 | ||
| Neutral Plasma Coagulation | 240 | ||
| Microwave Ablation | 241 | ||
| Hydrodissection and Irrigation | 241 | ||
| Cryosurgery | 241 | ||
| Key Points | 242 | ||
| Critical Thinking Questions | 242 | ||
| References | 242 | ||
| 9 Wound Healing, Dressings, and Drains | 244 | ||
| Anatomy | 244 | ||
| Etiology of Wounds | 245 | ||
| Types of Wound Closure | 245 | ||
| Primary Intention | 245 | ||
| Second Intention (Granulation and Contraction) | 245 | ||
| Delayed Primary Closure or Third Intention | 245 | ||
| Phases of Wound Healing | 247 | ||
| Inflammatory Phase | 247 | ||
| Proliferative Phase | 247 | ||
| Remodeling Phase | 247 | ||
| Factors Affecting Wound Healing | 247 | ||
| Wound Classification | 250 | ||
| Clean Wounds (Class I) | 250 | ||
| Clean Contaminated Wounds (Class II) | 250 | ||
| Contaminated Wounds (Class III) | 250 | ||
| Dirty or Infected Wounds (Class IV) | 250 | ||
| Antimicrobial Prophylaxis | 250 | ||
| Nursing Diagnoses | 250 | ||
| Patient, Family, and Caregiver Education and Discharge Planning | 251 | ||
| Wound Management | 251 | ||
| Debridement | 251 | ||
| Hyperbaric Oxygenation | 253 | ||
| Negative-Pressure Wound Therapy | 253 | ||
| Hydrotherapy and Hydrosurgery | 253 | ||
| Skin Substitutes | 254 | ||
| Growth Factors | 254 | ||
| Wound Scaffolds | 255 | ||
| Dressings | 256 | ||
| Drains | 259 | ||
| Key Points | 259 | ||
| Critical Thinking Questions | 259 | ||
| References | 260 | ||
| 10 Postoperative Patient Care and Pain Management | 261 | ||
| Perianesthesia Considerations | 261 | ||
| Assessment | 261 | ||
| Admission to the Postanesthesia Care Unit | 261 | ||
| Initial Assessment | 261 | ||
| Nursing Diagnosis | 263 | ||
| Outcome Identification | 263 | ||
| Planning | 263 | ||
| Implementation | 263 | ||
| Evaluation | 265 | ||
| Perianesthesia Complications | 265 | ||
| Respiratory | 265 | ||
| Airway Obstruction | 265 | ||
| Laryngospasm | 265 | ||
| Bronchospasm | 266 | ||
| Obstructive Sleep Apnea | 266 | ||
| Cardiovascular | 266 | ||
| Hypotension | 267 | ||
| Hypovolemia | 267 | ||
| Hypertension | 267 | ||
| Dysrhythmias | 267 | ||
| Thermoregulation and Temperature Abnormalities | 267 | ||
| Hypothermia | 267 | ||
| Hyperthermia | 268 | ||
| Disturbances in Cognitive Function | 268 | ||
| Postoperative Nausea and Vomiting | 269 | ||
| Aspiration | 272 | ||
| Acute Pain | 272 | ||
| Discharge From the Postanesthesia Care Unit | 280 | ||
| Admission to the Ambulatory Surgery Phase II Unit | 280 | ||
| Fast-Tracking the Ambulatory Surgery Patient | 280 | ||
| Admission to the Surgical Unit | 280 | ||
| Postoperative Nursing Considerations | 280 | ||
| Assessment | 280 | ||
| Nursing Diagnosis | 280 | ||
| Outcome Identification | 282 | ||
| Planning | 282 | ||
| Implementation | 282 | ||
| Wound Healing | 282 | ||
| Adequate Respirations | 282 | ||
| Circulation | 282 | ||
| Urinary Function | 283 | ||
| Bowel Elimination | 283 | ||
| Early Ambulation | 284 | ||
| Evaluation | 284 | ||
| Patient, Family, and Caregiver Education and Discharge Planning | 284 | ||
| Key Points | 284 | ||
| Critical Thinking Questions | 285 | ||
| References | 285 | ||
| Unit II Surgical Interventions | 287 | ||
| 11 Gastrointestinal Surgery | 287 | ||
| Surgical Anatomy | 287 | ||
| Perioperative Nursing Considerations | 290 | ||
| Assessment | 290 | ||
| Nursing Diagnosis | 291 | ||
| Outcome Identification | 292 | ||
| Planning | 292 | ||
| Implementation | 295 | ||
| Evaluation | 298 | ||
| Patient, Family, and Caregiver Education and Discharge Planning | 298 | ||
| Surgical Interventions | 299 | ||
| Laparotomy | 299 | ||
| Open Abdominal Incisions | 299 | ||
| Procedural Considerations: Open Laparotomy | 300 | ||
| Vertical Incisions | 301 | ||
| Midline Incision | 301 | ||
| Paramedian Incision | 301 | ||
| Oblique Incisions | 302 | ||
| McBurney Incision | 302 | ||
| Subcostal Incision | 302 | ||
| Thoracoabdominal Incision | 303 | ||
| Transverse Incisions | 303 | ||
| Pfannenstiel Incision | 303 | ||
| Incision Complications | 304 | ||
| Dehiscence and Evisceration | 304 | ||
| Nerve Injury | 304 | ||
| Minimally Invasive Surgery: Laparoscopy | 304 | ||
| Procedural Considerations | 304 | ||
| Operative Procedure | 305 | ||
| Abdominal Access: Closed Technique | 305 | ||
| Abdominal Access: Cutdown or Hasson Technique | 305 | ||
| Abdominal Access: Direct Visual Entry | 306 | ||
| Single-Incision Laparoscopic Surgery | 307 | ||
| Unit III Special Considerations | 999 | ||
| 26 Pediatric Surgery | 999 | ||
| Pediatric Surgical Anatomy | 999 | ||
| Airway and Pulmonary Status | 999 | ||
| Cardiovascular Status | 999 | ||
| Temperature Regulation | 1000 | ||
| Metabolism | 1000 | ||
| Fluid Management | 1000 | ||
| Psychologic Development | 1000 | ||
| Perioperative Nursing Considerations | 1001 | ||
| Assessment | 1001 | ||
| Informed Consent | 1003 | ||
| Child Abuse and Neglect | 1003 | ||
| Nursing Diagnosis | 1004 | ||
| Outcome Identification | 1004 | ||
| Planning | 1004 | ||
| Implementation | 1005 | ||
| Instrumentation | 1007 | ||
| Sutures | 1007 | ||
| Anesthetic Considerations | 1007 | ||
| Pain Management | 1008 | ||
| Evaluation | 1009 | ||
| Patient, Family, and Caregiver Education and Discharge Planning | 1009 | ||
| Surgical Interventions | 1010 | ||
| Vascular Access | 1010 | ||
| Central Venous Catheter Placement | 1010 | ||
| Procedural Considerations | 1010 | ||
| Operative Procedure: External Jugular Vein Site | 1010 | ||
| Minimally Invasive Surgery | 1010 | ||
| Laparoscopic Pyloromyotomy for Pyloric Stenosis | 1011 | ||
| Procedural Considerations | 1011 | ||
| Operative Procedure | 1011 | ||
| Laparoscopic Fundoplication | 1011 | ||
| Procedural Considerations | 1012 | ||
| Operative Procedure | 1012 | ||
| Endoscopic Correction of Pectus Excavatum: Nuss Procedure | 1012 | ||
| Appendix A Laboratory Values | 1163 | ||
| Illustration Credits | 1168 | ||
| Chapter 1 | 1168 | ||
| Chapter 2 | 1168 | ||
| Chapter 3 | 1168 | ||
| Chapter 4 | 1168 | ||
| Chapter 5 | 1168 | ||
| Chapter 6 | 1168 | ||
| Chapter 7 | 1168 | ||
| Chapter 8 | 1168 | ||
| Chapter 9 | 1169 | ||
| Chapter 10 | 1169 | ||
| Chapter 11 | 1169 | ||
| Chapter 12 | 1169 | ||
| Chapter 13 | 1169 | ||
| Chapter 14 | 1169 | ||
| Chapter 15 | 1170 | ||
| Chapter 16 | 1170 | ||
| Chapter 17 | 1170 | ||
| Chapter 18 | 1170 | ||
| Chapter 19 | 1170 | ||
| Chapter 20 | 1171 | ||
| Chapter 21 | 1171 | ||
| Chapter 22 | 1171 | ||
| Chapter 23 | 1172 | ||
| Chapter 24 | 1172 | ||
| Chapter 25 | 1172 | ||
| Chapter 26 | 1172 | ||
| Chapter 27 | 1173 | ||
| Chapter 28 | 1173 | ||
| Chapter 29 | 1173 | ||
| Chapter 30 | 1173 | ||
| Index | 1174 | ||
| A | 1174 | ||
| B | 1178 | ||
| C | 1181 | ||
| D | 1185 | ||
| E | 1187 | ||
| F | 1190 | ||
| G | 1191 | ||
| H | 1194 | ||
| I | 1196 | ||
| J | 1199 | ||
| K | 1199 | ||
| L | 1200 | ||
| M | 1202 | ||
| N | 1204 | ||
| O | 1206 | ||
| P | 1208 | ||
| Q | 1213 | ||
| R | 1213 | ||
| S | 1215 | ||
| T | 1220 | ||
| U | 1223 | ||
| V | 1223 | ||
| W | 1225 | ||
| X | 1225 | ||
| Y | 1225 | ||
| Z | 1225 | ||
| Special Features | 1227 | ||
| Ambulatory Surgery Considerations | 1227 | ||
| Enhanced Recovery After Surgery | 1227 | ||
| Evidence for Practice | 1227 | ||
| Patient Engagement Exemplar | 1227 | ||
| Patient, Family, and Caregiver Education | 1228 | ||
| Patient Safety | 1228 | ||
| Research Highlight | 1228 | ||
| Robotic-Assisted Surgery | IBC1 | ||
| Surgical Pharmacology | IBC1 |