Alexander’s Care of the Patient in Surgery

Description

Alexander’s Care of the Patient in Surgery is the most dependable source for comprehensive perioperative information. Well-known author and educator, Jane C. Rothrock, continues to provide step-by-step instructions for over 400 surgical procedures, including many minimally invasive methods, all backed by the latest research. More than 1,000 full-color illustrations and photos depict current techniques, as well as surgical anatomy and instrumentation. This edition adds cutting-edge information to reflect new concepts for both invasive and non-invasive surgical procedures, whether the location is in a hospital, outpatient clinic, or doctor’s office. Over 400 specialty surgical interventions are included, as well as many minimally-invasive surgical procedures. A clear and consistent chapter format makes it easy to find information, including general discussions of surgical anatomy and perioperative nursing considerations, followed by more specific discussions of procedural considerations and operative procedure for each surgical intervention. Cutting-edge information keeps you up-to-date with the latest technological advances related to surgical procedures, both invasive and non-invasive, whether the location is in a hospital, outpatient clinic, or in a doctor's office. Updated coverage includes new surgical procedures and techniques, new care standards, and the importance of integrating evidence and research into patient care. 1,000 full-color illustrations and photos show surgical anatomy, procedures, and methods. Comprehensive discussions of perioperative nursing considerations cover assessment, nursing diagnosis, outcome identification, planning, implementation, evaluation, patient and family education, and discharge planning. Full-color design highlights special features and makes it easier to focus on essential concepts. Patient Safety boxes highlight Joint Commission initiatives and important safety topics. Evidence for Practice boxes apply scientific research to perioperative nursing. Research Highlight boxes provide the latest research and apply it to patient care. Patient and Family Education boxes include specific guidelines for preprocedural and postprocedural care, side effects and complications, home care, discharge/follow-up care, psychosocial care, and referrals. Surgical Pharmacology tables summarize and offer quick reference to the drugs most commonly used for specific surgical procedures, including generic and trade names, purpose/description, and pharmacokinetics. Ambulatory Surgery Consideration boxes highlight patient selection criteria, special anesthesia considerations, and patient assessment implications for outpatient surgical procedures. Sample plans of care include nursing diagnosis, outcome, and interventions, linking specific interventions to clearly identified outcomes. An emphasis on patient and workplace safety includes protocols from the major safety agencies and coalitions, perioperative nursing safety issues, patient rights, and safe patient handling and movement. Coverage of cross-specialty areas includes special considerations for pediatric, geriatric, and trauma surgeries, as well as interventional and image-guided procedures, and complementary and alternative therapy. NEW and UNIQUE! Patient-Centered Care boxes feature simplified conversations that you can have with patients to help them better understand their surgical procedure. NEW! A Critical Thinking Question at the end of every chapter tests your understanding of chapter content. NEW! Key Points at the end of every chapter help you retain important concepts from the text. NEW! Laboratory Values appendix contains all laboratory value information in one convenient location 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