Essentials Of Perioperative Nursing

by Spry, Cynthia

• ISBN13: 9780763748357
• ISBN10: 0763748358
• Additional ISBN(s): 9780763758813
• Edition: 3rd
• Format: Hardcover
• Copyright: 2005-03-01
• Publisher: Jones & Bartlett
• More Book Details
• Purchase Benefits

Summary

Essentials of Perioperative Nursinggives any new perioperative nurse a head start on achieving perioperative competency, as well as serving as an excellent refresher for the experienced nurse to test his or her knowledge of fundamental OR practice. Unique for its self-learning format, this text includes objectives, course outlines, testing tools, competency check-off lists. The tests at the end of each chapter identify additional learning needs.Essentials of Perioperative Nursingis user-friendly and allows the reader to progress at their own pace in order to function safely and appropriately during any procedure!Includes a free CD-ROM with over 125 test questions! A great evaluation tool for a variety of subjects!

Author Biography

Cynthia Spry, RN, MA, MSN, CNOR: International Clinical Consultant, Advanced Sterilization Products, Johnson and Johnson

Table of Contents

Introduction	iii
Introduction to Perioperative Nursing	1	(10)
Phases of the Surgical Experience	2	(1)
Preoperative	2	(1)
Intraoperative	2	(1)
Postoperative	2	(1)
Nursing Process throughout the Perioperative Period	2	(2)
Assessment	3	(1)
Nursing Diagnoses	3	(1)
Planning	3	(1)
Intervention	3	(1)
Evaluation	3	(1)
Patient Outcomes: Standards of Perioperative Care	4	(1)
Roles of the Perioperative Nurse	4	(1)
Expanded and Advanced Practice Roles	5	(1)
Practice Settings	5	(1)
Members and Responsibilities of the Surgical Team	5	(6)
Preparing the Patient for Surgery	11	(16)
Nursing Diagnoses	12	(1)
Desired Patient Outcomes	12	(1)
Preoperative Preparation	12	(2)
Preoperative Assessment and Interventions	14	(3)
Overview	14	(1)
Sources of Patient Information	14	(1)
Assessment Parameters	14	(1)
Physiologic	14	(1)
Psychosocial	14	(3)
Nursing Diagnoses and Interventions	17	(1)
Preoperative Period	17	(1)
Intraoperative Period	18	(1)
Prevention of Wrong Site Surgery	18	(1)
Patient-Family Teaching	19	(1)
Communication of Relevant Patient Data	20	(7)
Prevention of Infection---Preparation of Instruments and Items Used in Surgery: Sterilization and Disinfection	27	(36)
Definitions	29	(1)
Desired Patient Outcomes	29	(2)
Sterilization and Disinfection	31	(1)
Critical, Semicritical, and Noncritical Items	31	(1)
Critical Items---Examples	31	(1)
Semicritical Items---Examples	31	(1)
Noncritical Items---Examples	31	(1)
Sterility Assurance Level (SAL)	31	(1)
Disinfection	31	(1)
Methods of Sterilization	32	(6)
Overview	32	(1)
Thermal Sterilization---Steam under Pressure: Moist Heat	33	(1)
Advantages	33	(1)
Disadvantages	33	(1)
Steam Sterilizers---Autoclaves	34	(1)
Overview	34	(1)
Gravity Displacement	35	(2)
Prevacuum Sterilizer (Dynamic Air Removal)	37	(1)
Bowie-Dick Test	38	(1)
Steam-Flush-Pressure-Pulse Sterilizer	38	(1)
Flash Sterilization	38	(2)
Overview	38	(2)
Chemical Sterilization---Ethylene Oxide Gas (EO)	40	(1)
Description	40	(1)
Advantages	41	(1)
Disadvantages	41	(1)
Low-Temperature Hydrogen Peroxide Gas Plasma Sterilization	41	(1)
Description	41	(1)
Advantages	42	(1)
Disadvantages	42	(1)
Chemical Sterilization---Liquid Peracetic Acid	42	(1)
Description	42	(1)
Advantages	43	(1)
Disadvantages	43	(1)
Other Emerging Sterilization Technologies	43	(2)
Sterilization---Quality Control	45	(4)
Overview	45	(1)
Mechanical Process Indicators	45	(2)
Chemical Indicators	47	(1)
Biological Monitors	48	(1)
Rapid Readout Biological Monitors	48	(1)
Record Keeping	49	(1)
Disinfection	50	(2)
Overview	50	(1)
Levels of Disinfectants---Application	50	(1)
Glutaraldehyde	51	(1)
Ortho-phthalaldehyde	51	(1)
Disinfection---Quality Control	52	(1)
Documentation	52	(11)
Prevention of Infection---Preparation of Instruments and Items Used in Surgery: Cleaning, Packaging, and Storage	63	(20)
Definitions	64	(1)
Nursing Diagnosis---Desired Patient Outcomes	65	(1)
Nursing Responsibilities	65	(1)
Preparation of Items and Instruments for Sterilization	65	(4)
Cleaning	65	(1)
Intraoperative Cleaning	65	(1)
Postoperative Cleaning	66	(1)
Manual Cleaning	66	(1)
Mechanical Cleaning	66	(1)
Special Protocols for Instruments Exposed to Prions	66	(1)
Ultrasonic Cleaning	67	(1)
Lubrication	67	(1)
Inspection	68	(1)
Packaging Materials---Barriers	69	(3)
Selection Criteria	69	(1)
Types of Packaging	70	(1)
Overview	70	(1)
Woven Fabric	70	(1)
Nonwoven Materials	70	(1)
Plastic/Paper, Plastic/Tyvek®---Pouches	71	(1)
Rigid Containers	71	(1)
Principles of Packaging---Steam	72	(1)
Instruments	72	(1)
Other Items	73	(1)
Basins, Bowls, Cups	73	(1)
Rubber Goods, Tubing, Items with a Lumen, Wood Items	73	(1)
Reusable Textiles---Linen Packs	73	(1)
Packaging for Alternate Methods of Sterilization	73	(1)
Package Information and Identification	74	(1)
Chemical Indicators	74	(1)
Sealing	74	(1)
Labels	74	(1)
Shelf Life	74	(1)
Storage Considerations	74	(1)
Determining Factors	75	(1)
Reuse of Single-Use Devices	75	(8)
Prevention of Infection---Aseptic Practices: Attire, Scrubbing, Gowning, Gloving, Draping, Prepping, Creating and Maintaining a Sterile Field, and Sanitation	83	(48)
Nursing Diagnosis---Desired Patient Outcomes	85	(1)
Overview	85	(1)
Nursing Responsibilities	85	(1)
Pathogenic Microorganisms	86	(1)
Sources of Infection (Endogenous)	86	(1)
Patients	86	(1)
Sources of Infection (Exogenous)	87	(1)
Personnel	87	(1)
Environment	87	(1)
Equipment	87	(1)
Standard and Transmission-Based Precautions	87	(3)
Control of Sources of Infection	90	(41)
Control of Patient Sources of Infection---Skin Prep	90	(6)
Control of Personnel Sources of Infection	96	(1)
Attire	96	(1)
Scrubbing, Gowning, and Gloving	97	(1)
Definitions	97	(2)
Traditional Surgical Hand Antisepsis (Traditional Scrub Procedure)	99	(1)
Use of Alcohol-Based Hand Rubs	99	(1)
Gowning and Gloving Procedure	100	(3)
Assisting Others to Gown and Glove	103	(3)
Creating a Sterile Field	106	(1)
Draping	106	(1)
Draping Guidelines	107	(1)
Standard Drapes	108	(1)
Maintaining a Sterile Field	108	(6)
Control of Environmental Sources of Infection	114	(1)
Traffic Patterns	114	(1)
Operating Room Environment	115	(1)
Operating Room Sanitation	115	(2)
Additional Considerations---Cleaning and Scheduling	117	(14)
Prevention of Injury---Positioning the Patient for Surgery	131	(36)
Overview	132	(1)
Desired Patient Outcomes	132	(1)
Impact of Surgical Positioning	133	(6)
Overview of Injuries	133	(1)
Respiratory and Circulatory System Compromise	133	(1)
Neuromuscular---Injury	133	(1)
Facial Nerves	134	(1)
Brachial Plexus	134	(1)
Lower Extremity Nerves	134	(1)
Integumentary System Injury	135	(4)
Responsibilities of the Perioperative Nurse	139	(1)
Patient Advocate	139	(1)
Nursing Considerations	139	(1)
Patient Assessment	139	(1)
Planning Care	139	(1)
Additional Considerations for Positioning	140	(1)
Surgical Procedure	140	(1)
Anesthesia	140	(1)
Patient Dignity	141	(1)
Positioning Devices	141	(1)
Implementation of Patient Care	142	(2)
Transportation and Transfer	142	(1)
Initial Position Techniques	143	(1)
Basic Surgical Positions	144	(10)
Supine (Dorsal Recumbent)	144	(1)
Trendelenburg	145	(1)
Reverse Trendelenburg	146	(1)
Lithotomy	146	(1)
Sitting (Semi-sitting; Semi-Fowler's; Lawnchair)	147	(1)
Prone	148	(1)
Jackknife (Kraske's)	149	(1)
Lateral	150	(4)
Evaluating Implementation of Positioning	154	(1)
Postoperative Transfer	154	(1)
Documentation of Nursing Actions	154	(13)
Prevention of Injury---Counts in Surgery	167	(16)
Description	168	(1)
Nursing Diagnosis---Desired Patient Outcome	168	(1)
Overview	168	(1)
Nursing Responsibilities	168	(2)
Count Procedures	170	(3)
Sponge Counts	170	(2)
Sharps Counts	172	(1)
Instrument Counts	172	(1)
Documentation	173	(10)
Prevention of Injury---Hemostasis, Tourniquet, and Electrosurgical Equipment	183	(30)
Hemostasis	184	(14)
Natural Methods of Hemostasis	185	(1)
Artificial Methods of Hemostasis	185	(1)
Chemical Hemostasis	185	(1)
Thrombin	185	(1)
Absorbable Gelatin	185	(1)
Oxidized Cellulose	185	(1)
Microfibrillar Collagen	185	(1)
Styptic	186	(1)
Mechanical Hemostasis	186	(1)
Instruments, Ties, Suture Ligatures, Ligating Clips	186	(1)
Bonewax	186	(1)
Pressure	186	(1)
Tourniquet	187	(1)
Overview	187	(1)
Nursing Diagnosis---Desired Patient Outcome	187	(1)
Nursing Interventions	187	(3)
Electrical Hemostasis---Electrosurgery	190	(1)
Overview	190	(1)
Electrosurgical Components	190	(1)
The Generator	190	(1)
The Active Electrode	191	(1)
The Dispersive Electrode	192	(1)
Application	193	(1)
Nursing Diagnosis---Desired Patient Outcomes	194	(2)
Desired Patient Outcome/Criteria	196	(1)
Nursing Interventions---Patient and Staff Safety	196	(1)
Electrosurgical Use During Endoscopic Surgery---Special Precautions	197	(1)
Ultrasonic Energy Devices	198	(1)
Overview	198	(1)
System Components	198	(1)
Tissue Effects	198	(1)
Technology Characteristics	199	(1)
Applications	199	(1)
Argon Beam--Enhanced Electrosurgery	199	(14)
Overview	199	(1)
System Components	199	(1)
Application/Characteristics	199	(14)
Prevention of Injury---Use and Care of Basic Surgical Instrumentation	213	(22)
Nursing Diagnosis---Desired Patient Outcome	214	(1)
Overview	214	(2)
Evolution of Surgical Instruments	214	(1)
Proper Care and Handling---Departmental Impact	215	(1)
Manufacture of Surgical Instruments	215	(1)
Nursing Responsibilities Related to Surgical Instrumentation	216	(1)
Categories of Instruments	216	(9)
Cutting and Dissecting Instruments	216	(2)
Clamps	218	(1)
Hemostatic Clamps	218	(1)
Noncrushing Vascular Clamps	218	(1)
Occluding Clamps	218	(1)
Grasping/Holding Clamps	218	(1)
Grasping Forceps	219	(1)
Retractors	219	(2)
Suction	221	(1)
Other	222	(3)
Care and Handling	225	(10)
Cleaning	225	(1)
General Guidelines for Care and Cleaning	225	(1)
Inspection	226	(9)
Prevention of Injury---Wound Management	235	(24)
Nursing Diagnoses---Desired Patient Outcomes	236	(1)
Potential Injury	236	(1)
Desired Patient Outcomes/Criteria	236	(1)
Surgical Wounds	236	(2)
Surgical Wound Classification	236	(1)
Wound Healing	237	(1)
Primary, Secondary, and Tertiary Intention or Delayed Primary Closure	237	(1)
Process of Wound Healing	237	(1)
Suture Material	238	(7)
Classification of Suture Material	240	(1)
Monofilament and Multifilament	240	(1)
Absorbable Suture	240	(1)
Nonabsorbable Suture	241	(1)
Suture Diameter	242	(1)
Suture Selection---Considerations	242	(2)
Suture Package Information	244	(1)
Surgical Needles	245	(3)
Needle Characteristics	245	(1)
Needle Attachment	245	(3)
Other Wound Closure Devices	248	(1)
Stapling Devices	248	(1)
Skin Tapes, Skin Adhesives	248	(1)
Drains	249	(1)
Dressings	249	(1)
Nursing Responsibilities Related to Wound Management	250	(9)
Prevention of Injury---Anesthesia	259	(48)
Potential Injury---Desired Patient Outcomes	260	(5)
Nursing Diagnoses	261	(1)
Desired Patient Outcomes	261	(1)
Outcome Criteria	261	(1)
Overview of Nursing Responsibilities	261	(4)
Preanesthesia	265	(2)
Assessment Data	265	(1)
American Society of Anesthesiologists Classification	265	(1)
Patient Teaching	266	(1)
Patient Instructions	266	(1)
Selection of Anesthetic Agents and Technique	266	(1)
Anesthesia Techniques---Overview	267	(1)
Premedication	267	(1)
Goals	267	(1)
Medications/Protocols	267	(1)
Monitoring	268	(5)
Practice Recommendations and Standards	269	(1)
Monitoring Devices	269	(1)
Precordial or Esophageal Stethoscope	269	(1)
Electrocardiogram (ECG)	270	(1)
Pulse Oximetry	270	(1)
Blood Pressure	270	(1)
Temperature	270	(1)
Capnography	271	(2)
General Anesthesia	273	(11)
Inhalation Agents	273	(2)
Anesthesia Machine	275	(1)
Intravenous Agents	276	(1)
Barbiturate Induction Agents	276	(1)
Nonbarbiturate Induction Agents	276	(1)
Dissociative Induction Agent	276	(1)
Narcotics	276	(1)
Tranquilizers---Benzodiazepines	276	(1)
Neuromuscular Blockers (Muscle Relaxants)	276	(4)
Stages of Anesthesia	280	(1)
Preparation for Anesthesia---Nursing Responsibilities	281	(1)
Sequence for General Anesthesia---Nursing Responsibilities	281	(3)
Malignant Hyperthermia	284	(3)
Overview	284	(1)
Treatment	285	(1)
Nursing Responsibilities	286	(1)
Moderate Sedation/Analgesia	287	(2)
Overview	287	(1)
Nursing Responsibilities	288	(1)
Regional Anesthesia	289	(18)
Overview	289	(1)
Spinal	289	(1)
Epidural and Caudal	290	(1)
Intravenous Block (Bier Block)	290	(1)
Nerve Block	291	(1)
Local Infiltration	291	(1)
Topical	291	(1)
Regional Anesthesia---Nursing Responsibilities	292	(15)
Workplace Safety	307	(22)
Regulations	308	(1)
Standards and Recommendations	308	(1)
Job Safety Analysis	309	(1)
Physical Hazards	310	(10)
Fire	310	(5)
Electricity	315	(1)
Radiation	315	(2)
Lifting and Moving	317	(2)
Slips, Trips, and Falls	319	(1)
Chemical Hazards	320	(9)
Formaldehyde	320	(1)
Methyl Methacrylate	320	(1)
Waste Anesthetic Gases	321	(1)
Latex Considerations	321	(8)
Glossary	329	(8)
Index	337