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Copyright, iv
Reviewers, vii
Chapter 1. Preoperative Assessment and Care, 1
Presurgical Assessment, 1
Surgical Scheduling, 2
Timing of Surgery, 4
Patient Interview, 6
Patient History, 6
Review of Systems, 8
Physical Examination, 17
Determination of Physical Status, 18
Laboratory Testing, 19
Factors in Selecting the Type of Anesthesia, 20
Age of the Patient, 21
Physical Status of the Patient, 21
Type of Surgery to be Performed, 21
Preference of the Surgeon, 21
Inpatient versus Outpatient Status, 21
Skill and Requirements of the Anesthesia Provider, 22
Patient Preference and Needs, 22
Preoperative Teaching, 22
Legal Concerns, 22
Informed Consent, 23
High-Risk Patients and Informed Consent, 23
Advance Health-Care Directives, 24
Preoperative Medications, 24
Sending the Patient to the Operating Room, 28
Chapter 2. Perioperative Patient Teaching, 29
Preoperative Patient Teaching, 29
What To Teach: Process and Content, 30
Before Surgery, 30
During Surgery, 34
After Surgery, 35
How to Teach, 41
Teaching Strategies, 41
When to Teach, 43
Barriers to Teaching, 43
Chapter 3. Anesthesia, 45
General Anesthesia, 45
Inhalation Agents, 46
Intravenous Anesthetics, 47
Barbiturates, 47
Benzodiazepines, 49
Narcotics, 50
Muscle Relaxants, 52
Depolarizing Agents, 52
Nondepolarizing Agents, 53
Reversal Agents, 53
Regional Anesthetic Techniques, 55
Systemic Toxicity, 57
Cocaine, 58
Topical Use of Local Anesthetics, 59
Local Infiltration, 59
Peripheral Nerve Block, 60
IV Regional Block, 61
Epidural Anesthesia, 61
Side Effects of Epidural Anesthesia, 63
Complications of Epidural Anesthesia, 64
Spinal Anesthesia, 66
Complications of Spinal Anesthesia, 70
Caudal Anesthesia, 71
Regional Anesthesia in Children, 71
Chapter 4. Intraoperative Considerations, 73
Surgeon, 73
Registered Nurse First Assistant, 73
Anesthesia Provider, 74
Circulating Nurse, 74
Scrub Nurse, 74
Before the Procedure, 75
Surgical Scrub, 75
Sponge, Sharp, and Instrument Counts, 76
Surgical Time-out, 76
Positioning the Patient, 77
Skin Preparation and Surgical Draping, 81
During Surgery, 82
The Surgical Procedure, 83
Thoracic Surgical Patients, 84
Thoracic Surgical Procedures, 84
Cardiac Surgical Patients, 85
Cardiac Surgical Procedures, 85
Pediatric Cardiac Procedures, 86
Peripheral Vascular Patients, 87
Peripheral Vascular Surgical Procedures, 87
Neurosurgical Patients, 88
Neurosurgical Procedures, 88
Pediatric Neurosurgery, 90
Spinal Surgical Patients, 90
Spinal Surgical Procedures, 90
Orthopedic Surgical Patients, 91
Orthopedic Surgical Procedures, 91
Renal and Genitourinary Patients, 92
Genitourinary and Renal Surgical Procedures, 93
Pediatric Genitourinary and Renal Procedures, 95
Plastic and Reconstructive Surgical Patients, 95
Plastic and Reconstructive Surgical Procedures, 95
Pediatric Plastic Surgical Procedures, 96
Ophthalmic Surgical Patients, 97
Ophthalmic Surgical Procedures, 97
Pediatric Eye Surgical Procedures, 98
Ear, Nose, and Throat Surgical Patients, 98
Ear Surgery, 98
Pediatric Otologic Surgery, 99
Neck and Throat Surgery, 99
Gastrointestinal Surgical Patients, 100
Gastrointestinal Surgical Procedures, 100
Pediatric GI Procedures, 103
Gynecologic Surgical Patients, 103
Gynecologic Surgical Procedures, 104
After the Procedure, 105
Cleaning, Disinfection, and Sterilization of Equipment, 105
Chapter 5. Fluid, Electrolytes, and Acid-Base, 107
Anatomy of Body Fluids, 107
Fluid Regulation, 108
Plasma Proteins, 108
Objectives of Fluid Therapy, 109
Choice of Fluids, 109
Crystalloids, 109
Colloids, 111
Calculation of Fluid Rates, 112
Fluid Therapy in the Perioperative Period, 112
Evaluation of Volume Status, 113
Edema, 114
Electrolytes, 115
Sodium, 116
Potassium, 117
Chloride, 118
Calcium, 119
Magnesium, 120
Phosphate, 123
Bicarbonate, 124
Acid-Base Balance, 124
Acid-Base Alterations, 125
Regulation of Acid-Base Balance, 126
Chemical Buffer Systems, 126
Respiratory Control Mechanisms, 127
Renal Control Mechanisms, 128
Chapter 6. Post-anesthetic Assessment and Care, 129
Anesthesia Report, 131
Approaches to Assessment, 132
Major Body Systems Approach, 132
Head to Toe Approach, 134
PACU Scoring Systems, 134
PACU Care Plan, 135
Ineffective Breathing Pattern, 135
Alterations in Cardiac Output, 136
Alterations in Comfort, 137
Alterations in Thought Processes, 138
Ineffective Thermoregulation, 138
Setting Priorities, 139
Surgical-Specific Care, 139
Assessment of the Thoracic Surgical Patient, 140
Nursing Priorities for the Thoracic Surgical Patient, 144
Assessment of the Cardiac Surgical Patient, 145
Nursing Priorities for the Cardiac Surgical Patient, 146
Assessment of the Peripheral Vascular Surgical Patient, 149
Nursing Priorities for Peripheral Vascular Surgical Patients, 151
Assessment of the Neurosurgical Patient, 151
Nursing Priorities for Neurosurgical Patients, 155
Assessment of the Renal and Urologic Surgical Patient, 156
Nursing Priorities for Renal and Urologic Surgical Patients, 157
Assessment of the Orthopedic and Spinal Surgical Patient, 159
Nursing Priorities for Orthopedic and Spinal Surgery Patients, 160
Assessment of the Plastic and Reconstructive Surgical Patient, 162
Nursing Priorities for Plastic and Reconstructive Surgical Patients, 162
Assessment of the Ophthalmic Surgical Patient, 163
Nursing Priorities for Ophthalmic Surgical Patients, 163
Assessment of the Ear, Nose, and Throat Surgical Patient, 164
Nursing Priorities for the Ear, Nose, and Throat Surgical Patient, 164
Assessment of the Dental Surgical Patient, 167
Nursing Priorities for Dental Surgical Patients, 167
Assessment of the Gastrointestinal Surgical Patient, 167
Nursing Priorities for Gastrointestinal Surgical Patients, 167
Assessment of the Gynecologic Surgical Patient, 169
Nursing Priorities for Gynecologic Surgical Patients, 169
Chapter 7. Pain Management, 171
Types of Pain, 171
Effects of Untreated Pain, 172
Pain Assessment, 173
Subjective Assessment, 173
Objective Assessment, 173
Behavioral Indicators, 174
Physiologic Indicators, 174
Pain Assessment Tools, 174
Verbal Rating Scale, 175
Visual Analog Scale, 175
Descriptive Pain Intensity Scale, 176
Premature Infant Pain Profile, 176
CRIES Scale, 176
Neonatal Pain, Agitation, and Sedation Scale, 177
Riley Infant Pain Scale, 178
FLACC Postoperative Pain Tool, 178
Wong Baker FACES Pain Rating Scale, 178
Pain Assessment in Advanced Dementia Scale, 178
Pain Management, 185
Pharmacologic Interventions, 185
Local Anesthetics, 188
Postoperative Epidural Anesthesia, 188
Nonpharmacologic Interventions, 192
Evaluation of Pain Management, 192
Challenges in Pain Management, 193
Dosing Conversion Tables, 194
When Patients Are Not Opiate-naive, 194
Chapter 8. Wound Assessment and Care, 195
Classification of Surgeries by Degree of Contamination, 195
Clean Surgery, 196
Clean-Contaminated Surgery, 196
Contaminated Surgery, 196
Dirty Surgery, 197
Process of Wound Healing, 197
Classification of Wounds by Wound Healing, 199
Surgical Dressings, 199
Types of Surgical Dressings, 201
Wound Assessment, 201
Surgical Drains, 202
Types of Surgical Drains, 203
Nursing Management of Surgical Drains, 204
Wound Complications Delaying Healing, 206
Local Causes Delaying Wound Healing, 206
Systemic Causes Delaying Wound Healing, 206
Wound Dehiscence, 208
Other Surgical Drains and Tubes, 208
Urinary Catheter, 208
Nasogastric Tube, 209
Gastrostomy Tube, 209
Jejunostomy Tube, 210
Tracheostomy Tube, 210
Endotracheal Tube, 210
Chapter 9. Perioperative Complications, 213
Pulmonary Complications, 213
Obstruction, 213
Croup, 218
Hypoxemia, 218
Cardiovascular Complications, 226
Hypotension, 226
Hypertension, 228
Dysrhythmias, 231
Bleeding, 235
Chest Pain, 237
Complications of Awakening, 241
Emergence Delirium, 241
Delayed Awakening, 243
Complications of Thermoregulation, 244
Hypothermia, 244
Malignant Hyperthermia, 246
Complications of Positioning, 251
Nausea and Vomiting, 253
Chapter 10. Special Populations: The Elderly and Pediatric Patient, 257
The Elderly Patient, 257
Physiologic Changes Associated with Aging, 258
Cardiovascular Changes, 258
Respiratory Changes, 259
Central Nervous System Changes, 260
Gastrointestinal Changes, 260
Renal Changes, 261
Orthopedic Changes, 262
Endocrine Changes, 262
Metabolic Changes, 262
Changes in Body Composition, 263
Sensory Changes, 263
Pharmacokinetic and Pharmacodynamic Changes of Aging, 263
Vascular Volume, 265
Protein Binding, 265
Changes in Body Composition, 265
Renal and Hepatic Function, 265
Pathophysiologic Conditions in the Elderly, 266
Preoperative Assessment for the Elderly Patient, 267
Anesthetic Options for the Elderly Patient, 268
IV Sedation, 269
Ambulatory Surgery as an Anesthetic Option, 270
Most Common Surgical Procedures in Elderly Patients, 270
Postoperative Priorities for the Elderly Patient, 270
Ventilation, 271
Cardiovascular Stability, 271
Fluid Balance, 271
Activity Stir-Up Routine, 271
Comfort, 271
The Pediatric Patient, 271
Physiologic Differences Between Pediatric Patients and Adult Patients, 272
Cardiovascular System, 272
Respiratory System, 273
Nervous System, 274
Gastrointestinal System, 275
Genitourinary System, 275
Skeletal System, 276
Integumentary System, 276
Developmental Issues Related To Surgery and Hospitalization, 276
Preoperative Assessment for the Pediatric Patient, 278
Preoperative Medications for the Pediatric Patient, 279
Pharmacologic Differences in the Pediatric Patient, 280
Anesthetic Options for the Pediatric Patient, 280
General Anesthesia with Inhalation Agents, 281
General Anesthesia with Intravenous Agents, 281
Regional Anesthesia, 281
Postoperative Priorities for the Pediatric Patient, 281
Alterations in Ventilation, 282
Hypothermia, 283
Fluid Balance, 283
Emergence, 284
Comfort, 284
Chapter 11. Special Populations: The Pregnant, Diabetic, and Obese Surgical Patient, 285
The Pregnant Patient, 285
Physiologic Changes During Pregnancy, 285
Nonobstetric Surgery During Pregnancy, 289
Anesthetic Options for Nonobstetric Surgery During Pregnancy, 292
PACU Assessment of the Pregnant Patient Following Nonobstetric Surgery, 294
Obstetric Surgery during Pregnancy, 294
PACU Assessment Following Cesarean Section, 296
Termination of Pregnancy, 298
Pre-eclampsia–Eclampsia, 299
The Diabetic Patient, 301
Role of Insulin, 302
Medical Management of the Diabetic Patient, 302
Metabolic Response to Anesthesia and Surgery, 302
Perioperative Priorities for the Diabetic Patient, 303
Day of Surgery Management of the Type 1 Diabetic Patient, 304
Day of Surgery Management of the Type 2 Diabetic Patient, 305
Complications in the PACU for All Diabetic Patients, 306
The Obese Patient, 307
Risks of Obesity, 308
Causes of Obesity, 308
Perioperative Assessment, 308
Risk Management, 309
Chapter 12. Tools, 313
Anatomical Landmarks, 314
Anterior View with Landmarks, 314
Left Lateral View with Landmarks, 314
Structure of the Heart, 315
Abdominal Organs and Structures, 315
Internal Female Genitalia, 316
Internal Male Genitalia, 316
Cross-section of Musculoskeletal System, 317
Lobes of the Brain, 318
Origin of Cranial Nerves, 319
Body Mass Index, 327
Notes, 332
Illustration Credits, 333
References, 334
Index, 343

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