Alexander’s Care of the Patient in Surgery

Front cover......Page 1
Brief Contents......Page 2
Alexander's Care of the Patient in Surgery......Page 4
Copyright page......Page 5
Contributors......Page 6
Clinical Consultants......Page 9
Reviewers......Page 11
About the Author......Page 14
Preface......Page 15
Table of Contents......Page 18
Overview of Perioperative Nursing Practice......Page 23
Online_Part I_text......Page 22
Perioperative Nursing Practice Standards......Page 24
Assessment.......Page 25
Outcome Identification.......Page 27
Delegation.......Page 28
Evaluation.......Page 30
Evidence-Based Practice......Page 31
Performance Improvement......Page 32
Traditional Perioperative Roles......Page 34
Emerging Roles......Page 35
References......Page 36
Concentrated Emphasis on Systems......Page 39
Centers for Medicare & Medicaid Services.......Page 41
The World Health Organization......Page 44
Clinical Documentation......Page 45
Wrong Site, Person, or Procedure Surgery......Page 47
Retained Surgical Items......Page 52
Prevention of RSIs.......Page 53
Specimens for Frozen Section.......Page 55
Risk for Chemical Burns......Page 56
Medication Administration......Page 57
Blood and Blood Products.......Page 58
Body Fluids.......Page 61
Deficient Fluid Volume.......Page 62
Privacy......Page 64
Informed Consent......Page 65
Key Points......Page 67
References......Page 68
Safe Patient Handling and Movement......Page 72
NIOSH Lifting Equation......Page 74
Obstructed Pathways.......Page 75
Scope and Significance of Problem......Page 76
The Neutral Zone.......Page 77
Double-Gloving......Page 78
Responding to Exposure......Page 79
Protecting Yourself......Page 80
Chemicals......Page 86
Immunizations and Infectious Disease Exposure......Page 87
Radiation Safety......Page 88
Latex Allergy......Page 89
Workplace Violence......Page 90
Key Points......Page 91
References......Page 92
Staphylococci.......Page 95
Enterococci.......Page 96
Streptococci.......Page 97
Viruses.......Page 98
Human Immunodeficiency Virus.......Page 99
Mechanisms of Resistance.......Page 100
Methicillin-Resistant Staphylococcus aureus (MRSA).......Page 102
Vancomycin-Resistant Enterococci.......Page 103
Asepsis......Page 104
Universal Precautions.......Page 106
Standard Precautions.......Page 109
Infection Control and Bioterrorism.......Page 110
Environment of Care.......Page 112
Cleaning.......Page 113
Packaging and Sterilizer Loading.......Page 115
Principles and Mechanisms.......Page 117
Drying, Cooling, and Storing.......Page 118
Quality Monitoring Practices.......Page 119
Immediate Use Steam Sterilization.......Page 121
Ethylene Oxide.......Page 122
Hydrogen Peroxide Vapor.......Page 124
Glutaraldehyde Solutions.......Page 125
Hydrogen Peroxide.......Page 126
Cleaning and Processing Endoscopes and Accessories.......Page 127
Reprocessing/Reuse of Items Labeled for Single Use Only.......Page 128
Surgical Aseptic Principles......Page 129
Surgical Attire......Page 131
Surgical Hand Scrub.......Page 134
Drying the Scrubbed Area.......Page 135
Gowning......Page 136
Self-Gowning Procedure.......Page 137
Gloving......Page 138
Assisted-Gloving Technique.......Page 139
Removing Soiled Gown, Gloves, and Mask......Page 140
Patient Skin Antisepsis......Page 141
Drape Configurations.......Page 144
Draping Procedure.......Page 145
Environmental Cleaning......Page 146
Key Points......Page 147
References......Page 148
Patient Safety......Page 151
Awareness During Anesthesia......Page 152
Patient Evaluation......Page 153
Premedication......Page 154
General Anesthesia......Page 156
Perioperative Monitoring......Page 157
Pulse Oximetry......Page 159
Anesthesia Machines and Anesthetic Gases......Page 160
Levels of General Anesthesia......Page 162
Muscle Relaxants......Page 163
Typical Sequence of General Anesthesia......Page 167
Postdural Puncture Headache.......Page 172
Inadvertent Dural Puncture.......Page 173
Peripheral Nerve Anatomy and Physiology.......Page 174
Monitored Anesthesia Care......Page 175
Local Anesthesia......Page 176
Pain Management......Page 177
Malignant Hyperthermia......Page 178
Perioperative Nursing Considerations......Page 179
References......Page 180
Skin and Underlying Tissue......Page 184
Extrinsic Factors.......Page 185
Intrinsic Factors.......Page 186
Musculoskeletal System......Page 188
Upper Extremity Neuropathies.......Page 189
Lower Extremity Neuropathies.......Page 192
Respiratory System......Page 194
Obesity......Page 195
Assessment......Page 196
Planning......Page 197
Implementation......Page 198
Evaluation......Page 199
OR Beds......Page 200
Standard Foam OR Mattress Pads.......Page 201
Supine......Page 202
Trendelenburg......Page 204
Lithotomy......Page 205
Semi-Fowler......Page 207
Fowler......Page 208
Chest and Trunk Support.......Page 209
Prone Jackknife.......Page 210
Lateral......Page 211
Lateral Kidney.......Page 212
References......Page 213
Handling Characteristics.......Page 216
Absorbable Sutures.......Page 217
Synthetic Absorbable Sutures.......Page 218
Polyester Fiber.......Page 219
Barbed Suture.......Page 220
Point......Page 221
Suture Selection......Page 222
Suturing Techniques/Wound Closures......Page 223
Handling Suture Materials......Page 224
Skin Staples.......Page 225
Wound Closure Strips.......Page 227
Historical Perspective......Page 228
Composition of Surgical Instruments......Page 229
Cutting Instruments (Dissectors).......Page 230
Clamps.......Page 231
Retractors.......Page 232
Accessory and Ancillary Instruments.......Page 233
Stapling Instruments......Page 234
Care and Handling of Instruments.......Page 235
Storing Instruments.......Page 236
Surgical Counts......Page 237
References......Page 239
Endoscopes......Page 242
Light Sources and Fiberoptic Cables......Page 244
Trocar System.......Page 245
Clamping and Grasping Instruments.......Page 247
Suturing and Stapling Instruments.......Page 248
Care and Handling of Endoscopes and Instrumentation.......Page 249
Reprocessing Single-Use Devices (SUDs).......Page 253
Evolution of Video Technology......Page 254
Visualization Systems......Page 255
Couplers (Adapters).......Page 256
Recording Systems.......Page 258
Robotics......Page 259
Insufflation......Page 260
Anesthetic Considerations and Potential Complications During Minimally Invasive Surgery......Page 262
Electrosurgical Modes.......Page 263
Grounded ESU.......Page 264
Dispersive Electrode Monitoring.......Page 265
Insulation Failure.......Page 266
Capacitive Coupling.......Page 267
Principles of Light.......Page 268
Tissue Interaction.......Page 269
Laser System Components.......Page 270
Eye Protection.......Page 273
Fire Safety.......Page 275
Smoke Evacuation.......Page 277
Documentation.......Page 278
Role of the Laser Team Member.......Page 279
Ultrasonic Device Surgery......Page 280
Hydrodissection and Irrigation......Page 281
Cryosurgery......Page 282
References......Page 283
Primary Intention......Page 285
Second Intention (Granulation and Contraction)......Page 286
Factors Affecting Wound Healing......Page 288
Wound Classification......Page 290
Antimicrobial Prophylaxis......Page 291
Debridement......Page 292
Hyperbaric Oxygenation (HBO)......Page 293
Negative-Pressure Wound Therapy......Page 294
Dressings......Page 295
Drains......Page 300
References......Page 301
Initial Assessment.......Page 303
Implementation......Page 305
Laryngospasm.......Page 307
Dysrhythmias.......Page 308
Hypothermia.......Page 309
Nausea and Vomiting......Page 310
Aspiration......Page 312
Acute Pain......Page 313
Discharge from the PACU......Page 319
Admission to the Surgical Unit......Page 322
Circulation.......Page 323
Evaluation......Page 325
References......Page 326
Surgical Anatomy......Page 330
Online_Part II_text......Page 329
Assessment......Page 333
Implementation......Page 335
Patient and Family Education and Discharge Planning......Page 340
Open Abdominal Incisions......Page 341
Midline Incision.......Page 342
McBurney Incision.......Page 343
Thoracoabdominal Incision.......Page 344
Dehiscence and Evisceration.......Page 345
Abdominal Access: Closed Technique......Page 346
Abdominal Access: Direct Visual Entry......Page 347
Procedural Considerations......Page 348
Procedural Considerations......Page 349
Procedural Considerations.......Page 350
Endoscopic Ultrasound......Page 351
Endoscopic Mucosal Resection.......Page 352
Esophagectomy......Page 353
Operative Procedure......Page 354
Operative Procedure—Laparoscopic Technique......Page 355
Operative Procedure—Laparoscopic Approach......Page 356
Operative Procedure......Page 357
Repair of Perforated Peptic Ulcer......Page 358
Operative Procedure—Billroth I......Page 359
Operative Procedure......Page 361
Adjustable Gastric Band......Page 364
Operative Procedure......Page 365
Operative Procedure......Page 366
Operative Procedure......Page 367
Operative Procedure......Page 368
Operative Procedure......Page 369
Operative Procedure......Page 370
Operative Procedure......Page 372
Laparoscopic Colon Resection......Page 373
Operative Procedure (Laparoscopic Right Hemicolectomy)......Page 374
Procedural Considerations.......Page 375
Ileoanal Endorectal Pull-Through (Ileal  Pouch–Anal Anastomosis)......Page 376
Operative Procedure......Page 378
Key Points......Page 381
References......Page 382
Surgical Anatomy......Page 388
Assessment......Page 390
Outcome Identification......Page 392
Planning......Page 393
Positioning the Patient.......Page 394
Drainage Materials.......Page 395
Aseptic Considerations.......Page 396
Patient and Family Education and Discharge Planning......Page 397
Laparoscopic Cholecystectomy......Page 398
Procedural Considerations.......Page 399
Operative Procedure......Page 400
Laparoscopic Transcystic Duct Exploration  of the Common Bile Duct......Page 401
Operative Procedure......Page 402
Procedural Considerations.......Page 403
Procedural Considerations.......Page 405
Drainage or Excision of Pancreatic Cysts (Open Method)......Page 407
Operative Procedure......Page 408
Operative Procedure......Page 409
Procedural Considerations.......Page 410
Drainage of Abscess......Page 411
Operative Procedure......Page 412
Procedural Considerations.......Page 413
Preparing the OR for the Recipient.......Page 414
Operative Procedure......Page 415
Operative Procedure......Page 416
Operative Procedure......Page 417
Procedural Considerations.......Page 418
Critical Thinking Question......Page 419
References......Page 420
Inguinal Hernias......Page 423
Femoral Hernias......Page 424
Assessment......Page 425
Implementation......Page 427
Patient and Family Education and Discharge Planning......Page 429
Procedural Considerations.......Page 432
McVay, or Cooper, Ligament Repair.......Page 433
Bassini Repair.......Page 434
Mesh-Plug Repair.......Page 435
Surgical Technique Using the PerFix Plug......Page 436
Operative Procedure—Totally Extraperitoneal Patch Approach (Figure 13-11)......Page 437
Repair of Femoral Hernias.......Page 438
Operative Procedure......Page 439
Ventral or Incisional Hernias......Page 440
Key Points......Page 442
References......Page 443
Uterus......Page 447
Ovaries......Page 449
Assessment......Page 450
Gynecologic Carcinoma.......Page 453
Nursing Diagnosis......Page 456
Prepping.......Page 457
Lasers in Gynecologic Surgery......Page 459
Excision of Condylomata Acuminata......Page 460
Procedural Considerations.......Page 461
Procedural Considerations.......Page 462
Plastic Reconstructive Repair of the Vagina (Anterior and Posterior Repair; Colporrhaphy)......Page 463
Rectocele Repair......Page 464
Operative Procedure......Page 465
Rectovaginal Fistula Repair (Vaginal Approach).......Page 468
Operative Procedure......Page 469
Operative Procedure......Page 470
Operative Procedure......Page 471
Operative Procedure......Page 472
Internal Radiation Therapy (Brachytherapy) for Cervical and Endometrial Malignancy......Page 473
Operative Procedure......Page 474
Endometrial Ablation......Page 476
Operative Procedure......Page 477
Operative Procedure......Page 478
Operative Procedure......Page 479
Operative Procedure.......Page 480
Operative Procedure......Page 481
Procedural Considerations.......Page 482
Operative Procedure......Page 483
Procedural Considerations.......Page 485
Procedural Considerations.......Page 486
Operative Procedure......Page 487
Operative Procedure......Page 488
Oophorectomy and Oophorocystectomy......Page 490
Operative Procedure.......Page 491
Operative Procedure.......Page 492
Mini-Laparotomy Approach......Page 493
Obstetric Surgery......Page 494
Procedural Considerations—Abdominal Approach.......Page 497
Cesarean Birth......Page 498
Operative Procedure......Page 499
References......Page 501
Ureters......Page 505
Urethra......Page 506
Prostate Gland......Page 507
Male Reproductive Organs......Page 509
Implementation......Page 510
Aseptic Techniques and Safety Measures.......Page 512
Ureteral and Urethral Catheters.......Page 513
Patient and Family Education and Discharge Planning......Page 516
Procedural Considerations.......Page 518
Periurethral-Transurethral Injection of Bulking Agents......Page 519
Procedural Considerations.......Page 520
Procedural Considerations.......Page 521
Internal Urethrotomy......Page 522
Horton-Devine Urethroplasty (Urethral Patch Graft).......Page 523
Penile Implant......Page 524
Procedural Considerations.......Page 525
Implantation of Inflatable Prosthesis......Page 526
Operative Procedure......Page 527
Vasovasostomy......Page 529
Procedural Considerations.......Page 530
Scrotal Approach......Page 531
Surgery of the Prostate Gland......Page 532
Procedural Considerations.......Page 533
Transrectal, Ultrasonically Guided Biopsy.......Page 534
Transurethral Resection of the Prostate Gland......Page 535
Procedural Considerations.......Page 536
Transurethral Incision of the Ejaculatory Ducts......Page 537
Operative Procedure......Page 538
Operative Procedure......Page 539
Operative Procedure......Page 540
Operative Procedure......Page 541
Operative Procedure.......Page 543
Transrectal Cryosurgical Ablation of the Prostate Gland......Page 544
Operative Procedure......Page 545
Radical Perineal Prostatectomy.......Page 548
Operative Procedure......Page 551
Operative Procedure......Page 552
Operative Procedure......Page 553
Trocar Cystostomy......Page 554
Procedural Considerations.......Page 555
Vesicovaginal Fistula Repair—Transperitoneal (Transvesical) Approach......Page 556
Tension-Free Vaginal Tape Sling......Page 557
Operative Procedure......Page 558
Procedural Considerations.......Page 559
Bladder Augmentation......Page 560
Implantation of Prosthetic Urethral Sphincter......Page 561
Bulbous Urethral Cuff......Page 562
Operative Procedure.......Page 563
Bladder Substitution (Substitution Cystoplasty)......Page 564
Operative Procedure......Page 565
Procedural Considerations.......Page 566
Surgery of the Ureters and Kidneys......Page 567
Ureteral Surgery......Page 568
Pyelotomy and Pyelostomy......Page 569
Extracorporeal Shock-Wave Lithotripsy (ESWL).......Page 570
Laparoscopic Approach.......Page 571
Procedural Considerations.......Page 572
Operative Procedure......Page 573
Operative Procedure......Page 574
Procedural Considerations.......Page 575
Operative Procedure......Page 576
Transplant Recipient.......Page 577
Operative Procedure......Page 578
Lateral Approach—Open......Page 579
References......Page 580
Thyroid Gland......Page 585
Assessment......Page 586
Thyroid Assessment.......Page 589
Parathyroid Assessment.......Page 590
Nursing Diagnosis......Page 591
Skin Preparation.......Page 592
Patient and Family Education and Discharge Planning......Page 594
Unilateral Thyroid Lobectomy, Subtotal Lobectomy, Bilateral Subtotal Lobectomy, Near-Total Thyroidectomy, and Total Thyroidectomy......Page 595
Operative Procedure—Open Thyroidectomy......Page 597
Intraoperative Procedure......Page 599
Thyroglossal Duct Cystectomy......Page 600
Neck Dissection......Page 601
Operative Procedure—Open Approach......Page 602
Critical Thinking Question......Page 603
References......Page 604
Benign Lesions of the Breast......Page 607
Breast Cancer in Men......Page 608
Breast Cancer in Women......Page 609
Screening Technologies......Page 611
Diagnostic Techniques......Page 612
Surgical Treatment Options......Page 613
Assessment......Page 615
Implementation......Page 617
Procedural Considerations......Page 620
Operative Procedure......Page 622
Operative Procedure......Page 623
Procedural Considerations......Page 624
Operative Procedure......Page 625
Key Points......Page 626
References......Page 628
Cornea......Page 631
Conjunctiva......Page 632
Eyelid......Page 633
Assessment......Page 634
Nursing Diagnosis......Page 635
Preventing Infection.......Page 636
Safety Measures in Administering Medications.......Page 637
Instillation of Eyedrops.......Page 638
Local Anesthesia.......Page 640
Topical Anesthesia.......Page 645
Instrumentation.......Page 646
Range of Equipment Used.......Page 647
Evaluation......Page 648
Patient and Family Education and Discharge Planning......Page 649
Cataract Extraction......Page 650
Intraocular Lens.......Page 651
Procedural Considerations.......Page 653
Operative Procedure......Page 654
Vitreoretinal Surgery......Page 655
Procedural Considerations.......Page 657
Operative Procedure (Figure 18-22)......Page 659
Retinopexy......Page 661
Operative Procedure......Page 662
Procedural Considerations.......Page 664
Operative Procedure......Page 665
Refractive Corneal Procedures......Page 666
Procurement of Corneas.......Page 667
Lamellar Keratoplasty......Page 668
Procedural Considerations.......Page 669
Operative Procedure (Transconjunctival Approach)......Page 670
Procedural Considerations.......Page 671
Procedural Considerations.......Page 672
Enucleation......Page 673
Operative Procedure......Page 675
References......Page 676
External, Middle, and Inner Ear......Page 679
Oral Cavity......Page 681
Hypopharynx.......Page 682
Trachea.......Page 684
Assessment......Page 685
Implementation......Page 689
Otologic Surgical Positioning.......Page 691
Anesthesia.......Page 692
Facial Nerve Monitoring.......Page 696
Surgical Microscope.......Page 697
Evaluation......Page 698
Patient and Family Education and Discharge Planning......Page 699
Endaural Approach......Page 700
Procedural Considerations.......Page 701
Operative Procedure......Page 702
Mastoidectomy......Page 703
Procedural Considerations.......Page 704
Labyrinthectomy......Page 705
Procedural Considerations.......Page 706
Osseointegrated Bone-Anchored Hearing Implants......Page 707
Treatment of Epistaxis......Page 708
Procedural Considerations.......Page 709
Sinus Surgery......Page 710
Procedural Considerations.......Page 711
Operative Procedure......Page 712
Endoscopic Transnasal Repair of Cerebrospinal Fluid Leak.......Page 713
Surgery of the Oral Cavity and Pharynx......Page 714
Parotidectomy.......Page 716
Uvulopalatopharyngoplasty.......Page 717
Tonsillectomy.......Page 718
Procedural Considerations.......Page 719
Laryngoscopy.......Page 720
Bronchoscopy.......Page 721
Transoral Robotic Surgery (TORS).......Page 722
Operative Procedure......Page 723
Total Laryngectomy.......Page 724
Operative Procedure......Page 725
Operative Procedure......Page 727
Reconstructive Procedures.......Page 729
Critical Thinking Question......Page 730
References......Page 731
Anatomic Structures......Page 734
Shoulder and Upper Extremity......Page 735
Pelvis, Hip, and Femur......Page 737
Knee, Tibia, and Fibula......Page 738
Assessment......Page 742
Planning......Page 743
Implementation......Page 744
Positioning and Positioning Aids.......Page 745
Pneumatic Tourniquets.......Page 747
Traction.......Page 748
Postoperative Immobilization.......Page 749
Implant Inventories.......Page 750
Polymethylmethacrylate.......Page 751
Evaluation......Page 752
Procedural Considerations......Page 753
Operative Procedure......Page 754
Closed Reduction.......Page 755
External Fixation.......Page 756
Internal Fixation.......Page 757
Correction of Acromioclavicular Joint Separation......Page 758
Clavicular Fracture......Page 759
Procedural Considerations.......Page 760
Correction of Recurrent Anterior Dislocation  of the Shoulder......Page 761
Fractures of the Humeral Shaft......Page 762
Medullary Fixation: Antegrade Technique......Page 763
ORIF Comminuted Distal Humeral Fracture (Figure 20-40)......Page 765
Procedural Considerations.......Page 766
Operative Procedure......Page 767
Operative Procedure......Page 768
Operative Procedure (Figure 20-45)......Page 769
Procedural Considerations.......Page 770
Procedural Considerations.......Page 771
Free-Lock Compression Plate and Lag Screw (Figure 20-48)......Page 772
Femoral Head Prosthetic Replacement: Unipolar  and Bipolar Implants......Page 773
Femoral Shaft Fractures: Internal Fixation......Page 775
Russell-Taylor Rod With or Without Locking Screws......Page 776
Procedural Considerations.......Page 777
Intercondylar Fracture of the Femur, T Type (AIM Supracondylar Intramedullary Nail).......Page 779
Medial and Lateral Y-Type Tibial Plateau Fractures......Page 780
Repair of Collateral or Cruciate Ligament Tears......Page 781
Popliteal (Baker) Cyst Excision......Page 782
Closed or Open Tibial Intramedullary Nailing (Figure 20-58)......Page 783
ORIF Trimalleolar Fracture......Page 785
Bunionectomy......Page 786
Procedural Considerations.......Page 787
Total Joint Arthroplasty......Page 788
Total Hip Arthroplasty......Page 789
Cemented Modular Hip System, Posterior Approach......Page 790
Procedural Considerations.......Page 791
Operative Procedure (VerSys Hip System)......Page 794
Operative Procedure......Page 795
Total Knee Arthroplasty......Page 796
NexGen Total Knee Arthroplasty (Figure 20-65)......Page 797
Operative Procedure......Page 800
Operative Procedure.......Page 801
Neer Total Shoulder Arthroplasty (Figure 20-68)......Page 802
Procedural Considerations.......Page 805
Procedural Considerations.......Page 806
Arthroscopy......Page 807
Procedural Considerations.......Page 808
Diagnostic Arthroscopy......Page 809
Arthroscopic Resection and Repair of Meniscal Tear.......Page 810
Operative Procedure: Reconstruction of the ACL with Patellar Tendon Graft......Page 811
Arthroscopic Posterior Cruciate Ligament Repair.......Page 812
Operative Procedure (Figure 20-85)......Page 813
Operative Procedure......Page 814
Procedural Considerations.......Page 815
Operative Procedure......Page 816
Procedural Considerations.......Page 817
Operative Procedure......Page 818
Procedural Considerations.......Page 819
Operative Procedure.......Page 820
Key Points......Page 821
References......Page 822
Scalp......Page 826
Skull......Page 827
Meninges......Page 828
Brain......Page 829
Cerebrum.......Page 830
Pathologic Lesions of the Brain.......Page 832
Ventricular System and Cerebrospinal Fluid......Page 834
Pathologic Conditions Related to CSF.......Page 835
Cerebral Blood Supply......Page 836
Hematomas.......Page 837
Second Cranial Nerve.......Page 838
Ninth Cranial Nerve.......Page 840
Vertebral Column......Page 841
Spinal Nerves......Page 842
Meningocele.......Page 843
Spinal Epidural Abscess.......Page 845
Intervertebral Disk Disease.......Page 846
Peripheral Nerves.......Page 847
Preparation for Surgery.......Page 849
Diagnostic Procedures.......Page 850
Planning......Page 851
Equipment.......Page 852
Operating Microscope.......Page 853
Stereotactic and Image-Guided Equipment.......Page 854
Instrumentation, Implants, and Supplies.......Page 855
Positioning.......Page 856
Draping.......Page 858
Hemostasis and Visualization.......Page 859
Evaluation......Page 861
Neuroendoscopy......Page 862
Endovascular Procedures......Page 863
Stereotactic Radiosurgery......Page 864
Burr Holes......Page 865
Procedural Considerations.......Page 866
Evacuation of Epidural or Subdural Hematoma......Page 867
Operative Procedure—Pterional Craniotomy......Page 868
Procedural Considerations.......Page 870
Procedural Considerations.......Page 871
Operative Procedure......Page 872
Operative Procedure......Page 873
Procedural Considerations.......Page 874
Operative Procedure......Page 875
Procedural Considerations.......Page 876
Operative Procedure—Laminectomy for Intradural Spinal  Cord Tumor......Page 877
Spinal Cord Stimulators......Page 878
Key Points......Page 879
References......Page 880
Perioperative Nursing Considerations......Page 884
Assessment......Page 885
Implementation......Page 886
Equipment and Special Mechanical Devices.......Page 888
Lasers.......Page 889
Anesthesia.......Page 890
Preoperative Skin Preparation.......Page 891
Evaluation......Page 892
Burn Surgery......Page 893
Operative Procedure......Page 897
Treatment of Pressure Ulcers......Page 898
Skin and Tissue Grafting......Page 899
Operative Procedure......Page 900
Flaps.......Page 901
Breast Reconstruction Using Tissue Expanders and Permanent Implants.......Page 902
Breast Reconstruction Using Myocutaneous Flaps.......Page 903
Procedural Considerations.......Page 904
Microsurgery......Page 905
Replantation of Amputated Body Part.......Page 906
Procedural Considerations.......Page 907
Procedural Considerations for Maxillofacial Surgery.......Page 908
Operative Procedure......Page 909
Procedural Considerations.......Page 910
Procedural Considerations—Open Reduction.......Page 911
Procedural Considerations.......Page 912
Procedural Considerations.......Page 913
Operative Procedure......Page 914
Operative Procedure—Upper Lids......Page 915
Liposuction......Page 916
Operative Procedure......Page 920
Procedural Considerations.......Page 921
Operative Procedure—Unfilled Saline Implants......Page 923
Operative Procedure.......Page 924
Operative Procedure......Page 927
References......Page 928
Surgical Anatomy......Page 932
Assessment......Page 934
Nursing Diagnosis......Page 935
Positioning.......Page 936
Chest Drainage Systems.......Page 938
Transfer Report.......Page 939
Evaluation......Page 940
Endoscopy (Diagnostic or Therapeutic)......Page 941
Procedural Considerations.......Page 943
Operative Procedure......Page 944
Operative Procedure......Page 945
Operative Procedure......Page 946
Operative Procedure......Page 947
Procedural Considerations.......Page 948
Thoracotomy......Page 949
Operative Procedure......Page 951
Operative Procedure......Page 952
Operative Procedure......Page 953
Procedural Considerations.......Page 954
Decortication......Page 956
Procedural Considerations.......Page 957
Procedural Considerations.......Page 958
Lung Transplantation......Page 959
Key Points......Page 960
References......Page 961
Surgical Anatomy......Page 964
Aneurysmal Disease......Page 967
Arterial Insufficiency: Cerebrovascular Disease  and Stroke......Page 968
Chronic Venous Insufficiency......Page 969
Nursing Responsibilities.......Page 971
Doppler Scanning.......Page 972
Planning......Page 973
Site Verification: Time-Out.......Page 974
Skin Preparation and Draping.......Page 975
Medications and Solutions.......Page 976
Vascular Prostheses.......Page 977
Instrumentation.......Page 978
Patient and Family Education and Discharge Planning......Page 979
Abdominal Aortic Aneurysm Resection......Page 981
Procedural Considerations.......Page 982
Exploration of Common Femoral Artery......Page 984
Operative Procedure......Page 985
Procedural Considerations.......Page 986
Carotid Endarterectomy......Page 988
Operative Procedure.......Page 989
Arteriovenous Fistula......Page 990
Procedural Considerations.......Page 992
Procedural Considerations.......Page 993
Key Points......Page 994
References......Page 995
Surgical Anatomy......Page 998
Perioperative Nursing Considerations......Page 1001
History.......Page 1003
Physical Examination.......Page 1005
Diagnostic Studies.......Page 1006
Laboratory Tests.......Page 1009
Nursing Diagnosis......Page 1010
Special Facilities.......Page 1013
Instrumentation and Equipment.......Page 1014
Suture Materials.......Page 1015
Prosthetic Material.......Page 1016
Valve Prostheses.......Page 1017
Preinduction Care.......Page 1022
Monitoring.......Page 1024
Positioning.......Page 1027
Median Sternotomy.......Page 1028
Cardiopulmonary Bypass.......Page 1029
Circulatory Arrest.......Page 1033
Closing.......Page 1034
Evaluation......Page 1035
Patient and Family Education and Discharge Planning......Page 1038
Minimally Invasive Cannulation.......Page 1040
Minimally Invasive Endovascular Antegrade-Retrograde Cardioplegia.......Page 1041
Closure of Femoral Incisions......Page 1042
Surgery for Coronary Artery Disease......Page 1043
Operative Procedure.......Page 1045
Laser Transmyocardial Revascularization......Page 1048
Surgery for the Mitral Valve......Page 1049
Operative Procedure......Page 1051
Procedural Considerations.......Page 1053
Surgery for the Pulmonary Valve......Page 1054
Surgery for the Aortic Valve......Page 1055
Operative Procedure......Page 1056
Procedural Considerations—Transcatheter Aortic Valve Replacement.......Page 1058
Combined Surgery......Page 1059
Procedural Considerations.......Page 1060
Operative Procedure......Page 1061
Operative Procedure......Page 1062
Assisted Mechanical Circulation......Page 1063
Ventricular Assist Device......Page 1064
Heart Transplantation (Figure 25-77)......Page 1065
Operative Procedure.......Page 1068
Operative Procedure—Mini-Thoracotomy (Figure 25-80)......Page 1069
Insertion of Myocardial (Epicardial) Pacing Electrodes......Page 1070
Critical Thinking Question......Page 1071
References......Page 1072
Cardiovascular Status......Page 1079
Online_Part III_text......Page 1078
Assessment......Page 1080
Informed Consent.......Page 1082
Nursing Diagnosis......Page 1083
Implementation......Page 1084
Anesthetic Considerations.......Page 1087
Evaluation......Page 1088
Vascular Access......Page 1089
Procedural Considerations.......Page 1090
Procedural Considerations.......Page 1091
Operative Procedure......Page 1092
Procedural Considerations.......Page 1093
Procedural Considerations.......Page 1094
Open Fetal Surgery......Page 1096
Operative Procedure......Page 1098
Procedural Considerations.......Page 1100
Reduction of Intussusception......Page 1101
Resection and Pull-Through for Hirschsprung Disease (Reconstruction)......Page 1102
Operative Procedure......Page 1103
Operative Procedure......Page 1104
Inguinal Hernia Repair with Laparoscopic Exploration of Contralateral Side......Page 1105
Operative Procedure......Page 1106
Procedural Considerations.......Page 1107
Procedural Considerations.......Page 1108
Operative Procedure......Page 1109
Resection of Wilms Tumor......Page 1110
Pediatric Cystoscopy......Page 1111
Operative Procedure......Page 1112
Adjacent Skin Flap.......Page 1114
Mobilized Vascularized Flaps.......Page 1115
Epispadias Repair......Page 1116
Operative Procedure......Page 1117
Operative Procedure......Page 1118
Repair of Vesicoureteral Reflux......Page 1120
Foreign-Body Removal......Page 1121
Operative Procedure......Page 1122
Procedural Considerations.......Page 1123
Orthopedic Procedures......Page 1124
Derotational Osteotomy for Developmental Dysplasia of the Hip.......Page 1125
Operative Procedure......Page 1126
Procedural Considerations.......Page 1127
Total Ear Reconstruction......Page 1128
Operative Procedure......Page 1129
Orbital-Craniofacial Surgery......Page 1130
Pediatric Ophthalmic Surgery......Page 1131
Operative Procedure—Lateral Rectus Recession......Page 1132
Operative Procedure......Page 1133
Trabeculotomy for Glaucoma......Page 1134
Trauma......Page 1136
Surgery for Congenital Heart Disease......Page 1140
Procedural Considerations.......Page 1141
Repair of Ventricular Septal Defect......Page 1142
Operative Procedure.......Page 1143
Closure of Patent Ductus Arteriosus......Page 1144
Operative Procedure......Page 1145
Repair of Hypoplastic Heart Syndromes......Page 1146
Stage I (Norwood Procedure) (Figure 26-69)......Page 1147
For Neck Cannulation.......Page 1148
For Median Sternotomy Cannulation.......Page 1149
Key Points......Page 1150
References......Page 1151
27 Geriatric Surgery......Page 1154
Preliminary Evaluation......Page 1155
Assessment......Page 1158
Normal Age-Related Changes.......Page 1159
Integumentary System.......Page 1160
Musculoskeletal System.......Page 1162
Psychologic Changes.......Page 1163
Routine Laboratory and Diagnostic Tests.......Page 1164
Nursing Diagnosis......Page 1165
Preoperative Evaluation Guidelines......Page 1166
Preoperative Preparation.......Page 1168
Aseptic Techniques and Safety Measures.......Page 1169
Evaluation......Page 1170
Patient and Family Education and Discharge Planning......Page 1171
Common Surgical Procedures in Geriatric Patients......Page 1172
Abdominal Surgery......Page 1173
Orthopedic Surgery......Page 1174
Key Points......Page 1175
References......Page 1176
28 Trauma Surgery......Page 1179
Preliminary Evaluation: Mechanism of Injury......Page 1180
Assessment......Page 1182
Routine Laboratory Tests.......Page 1184
Other Diagnostic Tests.......Page 1185
Increased Risk for Infection.......Page 1187
Procedure Preparation.......Page 1189
Evidence Preservation.......Page 1190
Anesthesia Implications.......Page 1191
Pregnancy.......Page 1192
Invasive Emergency Department Interventions.......Page 1193
Evaluation......Page 1194
End-of-Life Care......Page 1195
Injuries of the Head and Spinal Column......Page 1196
Injuries of the Chest and Heart......Page 1199
Injuries of the Abdomen......Page 1200
Injuries of the Genitourinary System......Page 1202
Skeletal Injuries......Page 1203
Organ and Tissue Procurement......Page 1204
References......Page 1205
Hybrid OR......Page 1209
Personnel and Staffing Requirements for a Hybrid OR.......Page 1211
MRI.......Page 1212
Fluoroscopic Dose Measurement.......Page 1213
CT Dose Measurement.......Page 1214
Radiation Dose Factors.......Page 1216
Pregnancy and Radiation.......Page 1217
Diabetes.......Page 1218
Planning......Page 1219
Angiography Equipment Configuration.......Page 1220
Imaging Monitors.......Page 1221
Supplies and Instrumentation.......Page 1222
Medications and Contrast Agents.......Page 1223
Iodinated Contrast.......Page 1225
Iodine-Based Contrast Reactions.......Page 1226
Contrast Media Extravasation of Iodinated Contrast.......Page 1227
Evaluation......Page 1228
Patient and Family Education and Discharge Planning......Page 1229
Angiography.......Page 1230
Dialysis and Fistula Graft Repair.......Page 1231
Uterine Fibroid Embolization (UFE).......Page 1232
Balloon-Occluded Retrograde Transvenous Obliteration (BRTO).......Page 1233
Intraoperative MRI.......Page 1234
Key Points......Page 1235
References......Page 1236
Alternative Medical Systems......Page 1240
Manipulative and Body-Based Methods......Page 1242
Therapeutic Touch.......Page 1243
Perioperative Medical Hypnotherapy......Page 1244
Music and Surgery......Page 1245
Psychoneuroimmunology......Page 1247
Coagulation Interactions.......Page 1248
Cardiovascular Interactions.......Page 1249
Integrative Health Practices and Perioperative  Patient Care......Page 1252
References......Page 1253
Appendix A Laboratory Values......Page 1255
Chapter 9......Page 1260
Chapter 15......Page 1261
Chapter 20......Page 1262
Chapter 23......Page 1263
Chapter 26......Page 1264
Chapter 30......Page 1265
A......Page 1266
B......Page 1269
C......Page 1271
D......Page 1274
E......Page 1276
F......Page 1278
G......Page 1279
H......Page 1281
I......Page 1283
L......Page 1285
M......Page 1287
N......Page 1289
O......Page 1290
P......Page 1292
R......Page 1296
S......Page 1297
T......Page 1301
V......Page 1304
W......Page 1305
Z......Page 1306
Special Features......Page 1308