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Chapter 1 AN ADMINISTRATOR LOOKS AT INTENSIVE THERAPYMANUEL JSEGALL,MAX SSADOVE,MD,AND JAMES HCROSS,MD 1

Advantages of an Intensive Therapy Unit 1

Aims and Objectives 2

Planning the Intensive Therapy Unit 4

Formulation of Policies and Practices 6

Arrangement of Physical Facilities 7

Size of the Intensive Therapy Unit 9

Equipment and Supplies 12

Temperature and Lighting 25

Financing the Intensive Therapy Unit 26

Administration of the Unit 27

Admission,Transfer and Discharge of Patients 27

Personnel 29

Training 30

Need for Refresher In-Service-Type Training Programs 30

Public Relations 31

Intensive Therapy Area—An Adjunct to Preventive Medicine 32

Importance of the Intensive Therapy Unit to Short-Stay Patients 33

Relationships with Other Hospital Departments 33

Chapter 2 PRINCIPLES OF RECOVERY ROOM MANAGEMENTMAX SSADOVE,MD,AND JAMES HCROSS,MD 35

General Care 35

Control of Pain 41

Classification of Pain 42

Drug Therapy for Relief of Pain 43

General Principles of Pain Relief 52

Other Therapy for Control of Pain 53

Summary 54

Sedation 54

Antibiotic and Chemotherapeutic Agents 58

Penicillin 59

Streptomycin 59

Chloramphenicol 63

Tetracyclines 63

Sulfa Drugs 63

Acute Gastric Dilatation and Abdominal Distention 64

Nausea and Vomiting 65

Hiccough 67

Wound Dehiscence 68

Chapter 3 MANAGEMENT OF CIRCULATION,SHOCK,RESPIRATION AND NUTRITIONMAX SSADOVE,MD,AND JAMES HCROSS,MD 70

Circulation 70

Factors Altering Circulation During Surgery 71

Factors Altering Circulation Immediately Following Surgery 78

Shock 80

Principles of Technique of Intravenous Therapy 111

Administration of Blood 118

Respiration 122

Normal Respiration 122

Alterations of Respiration Due to Surgery 123

General Management 125

Atelectasis and Postoperative Pneumonia 129

Hypoxia 131

Carbon Dioxide Excess 135

Oxygen Inhalation Therapy 136

Respiratory Assistors and Respirators 144

Aerosol Therapy 147

Nutrition 153

Water and Electrolytes 154

Proteins,Carbohydrates and Fats 160

Vitamins 162

Tube Feedings 163

Chapter 4 NEUROSURGERYOSCAR SUGAR,MD 165

Vital Signs 166

Fever 167

Respiration 168

Position 168

Bowel and Bladder Care 169

Sedation 169

Dehydration 170

Spinal and Ventricular Puncture 171

Drainage 171

Vasodilator Therapy 172

X-ray Examination 173

Postoperative Orders 173

Chapter 5 SURGERY OF THE EYEMAURICE DPEARLMAN,MD 178

Instruments,Dressings and Medication 178

Special Aspects of Eye Anesthesia 181

Prevention and Recognition of Ocular Complications 183

Specific Problems and Routines in Eye Care 184

A Brief Glossary of Ophthalmological Surgical Terms 187

Chapter 6 SURGERY OF THE EAR,NOSE AND THROATFRANCIS LLEDERER,MD,AND EMANUEL MSKOLNIK,MD 189

The Ear 189

Radical Mastoidectomy 189

Fenestration 191

Otoplasty 193

The Throat 193

Tonsillectomy 193

Incision of Peritonsillar Abscess 195

Hemiglossectomy 195

The Nose and Accessory Sinuses 196

Submucous Resection of Nasal Septum 196

Nasoantral Window 197

Caldwell-Luc Operation 197

Radical Frontal Sinus Operation 198

Maxillary Resection 199

Nasal Fracture 200

Rhinoplasty 200

Chapter 7 SURGERY OF THE CHESTHIRAM TLANGSTON,MD 202

General Considerations Common to All Thoracic Surgical Procedures 202

Special Consideration in Specific Types of Thoracic Surgical Procedures 226

Minor Surgical Procedures During the Postoperative Period 234

Chapter 8 LARYNGOLOGY AND BRONCHOESOPHAGOLOGYPAUL HHOLINGER,MD,AND KENNETH CJOHNSTON,MD 243

Postoperative Respiratory Obstruction Emergencies 243

Postoperative Laryngeal Complications 249

Postoperative Pulmonary Complications 250

Care Following Laryngoscopy,Bronchoscopy and Esophagoscopy 253

Post-Laryngectomy Care 256

Chapter 9 SURGERY OF THE ABDOMENWILLIAM JGROVE,MD 259

Preoperative Care 259

General Routine Postoperative Care 260

Gastrointestinal Intubation 264

General Postoperative Complications 270

Care Following Specific Surgical Procedures 275

Esophageal Surgery 275

Gastric Surgery 277

Duodenal Surgery 282

Small Bowel Surgery 283

Appendectomy 283

Ileostomy 285

Colon Surgery 286

Gallbladder Surgery 290

Surgery of the Liver 292

Surgery of the Pancreas 293

Surgery of the Spleen 293

Chapter 10 SURGERY FOR ANORECTAL DISEASECAESAR PORTES,MD 295

Control of Constipation 295

Control of Diarrhea 296

Control of Infection 297

Postoperative Hemorrhage 298

Postoperative Urinary Difficulties 298

Postoperative Pain 299

General Care 300

Care of Patients Having Operations for Pilonidal Disease 301

Care of Patients Having Operations for Rectal Polyps 301

Chapter 11 SURGERY OF THE SOFT TISSUESMELVIN GIBBEL,MD 303

Thyroidectomy 303

Routine Postoperative Care 304

Complications 304

Herniorrhaphy 312

Soft Tissue Injuries 315

Hand Injuries 318

Tetanus 319

Gas Gangrene 322

Chapter 12 ORTHOPEDIC SURGERYTHEODORE AFox,MD 326

Special Factors in the General Postoperative Care of the Orthopedic Patient 326

Care of the Severely Injured Patient 329

Care of the Postoperative Patient 331

Special Equipment Needed for Care of Orthopedic Patients 338

Sample Orders 338

Chapter 13 UROLOGICAL SURGERYROLAND RCROSS,JR,MD 339

Special Problems 339

Renal Surgery 354

Ureteral Surgery 356

Bladder Surgery 358

Prostatic Surgery 360

Surgery of the External Gentialia 365

Postoperative Orders 366

Nephrectomy 366

Pyeloplasty of the Kidney 366

Ligation of a Blood Vessel at Ureteropelvic Junction 367

Nephrolithotomy 367

Pyelolithotomy 368

Ureterolithotomy 368

Ureterosigmoid Implant 368

Transurethral Resection of Bladder Tumor 369

Suprapubic Prostatectomy 370

Transurethral Resection of Prostate 370

Retropubic Prostatectomy 371

Radical Lymph Node Dissection and Orchiectomy 371

Chapter 14 PLASTIC SURGERYROBERT FSTOKES,MD 373

General Problems 373

Specific Problems 377

Chapter 15 THE TREATMENT OF BURNSROBERT FSTOKES,MD 393

General Supportive Therapy 393

Surface Treatment of Burns 400

Chapter 16 ONCOLOGICAL SURGERYHARRY WSOUTHWICK,MD,AND DANELY PSLAUGHTER,MD 404

Preoperative State of the Patient 404

General Considerations in Postoperative Therapy 406

Summary of General Measures 408

Specific Considerations in Postoperative Therapy 408

General Postoperative Axioms 412

Chapter 17 OBSTETRICS AND GYNECOLOGYJOHN WPAYNE,MD,AND JOHN WOLFF,MD 413

Normal Obstetrical Delivery 415

Operative Obstetrical Delivery 416

Medical Complications During and Preceding Obstetrical Delivery 419

Immediate Postpartum Period 421

Complications 423

Specific Obstetrical Problems 429

The Newborn 444

Preoperative Gynecological Management 447

Special Preoperative Gynecological Procedures 449

Immediate Postoperative Gynecological Care 450

Postoperative Gynecological Complications 455

Special Gynecological Problems Needing Intensive Therapy 459

The Acute Abdomen in Relation to Obstetrics and Gynecology 461

Chapter 18 VASCULAR SURGERYWILLIAM SDYE,JR,MD,AND ORMAND CJULIAN,MD 463

Intrathoracic Surgery 463

Preoperative Orders(Mitral Commissurotomy) 468

Immediate Postoperative Orders(Mitral Commissurotomy) 469

Postoperative Care When Hypothermia Has Been Employed 470

Vascular Abdominal Surgery 470

Preoperative Orders(Resection of Bifurcation of Aorta with Replacement) 471

Postoperative Orders(Resection of Bifurcation of Aorta with Replacement) 472

Peripheral Vascular Surgery 473

Anticoagulant Therapy 476

Chapter 19 PEDIATRIC SURGERYJOHN LKEELEY,MD 477

Preoperative Care 478

Anesthesia 479

Nutrition 480

Postoperative Care 481

Chapter 20 MANAGEMENT OF MEDICAL PROBLEMSEDWARD JWISS,MD 493

Cardiac Emergencies 493

Cerebrovascular Accidents 508

Massive Gastrointestinal Hemorrhage 511

Intoxications 513

Metabolic-Endocrine Emergencies 516

Acute Renal Insufficiency 528

Chapter 21 NURSING CARE IN THE RECOVERY ROOMROSE MILONE,RN,MAX SSADOVE,MD,AND JAMES HCROSS,MD 531

Recovery Room and the Nurse 531

General Care of Patient in Recovery Room 532

Recovery Room Charting 535

Medicine Card 539

Evening and Morning Care 540

Equipment in Recovery Room 540

Equipment in Cabinets 541

Visiting in Recovery Room 544

Postoperative Nursing Care of Cardiac Patients 545

Postoperative Nursing Care of Patients Having Radical Neck Dissections 547

Care of Tracheotomy Patient 548

Chest Drainage(Water Seal or Closed Drainage) 551

Postoperative Recovery Bed 553

Positions Used in Treatment of Patient 554

Oxygen Inhalation Therapy 556

Nasal Catheter for Oxygen Administration 556

Carbon Dioxide Therapy 557

Extubation of Airways and Endotracheal Tubes 558

Use of Aspirator(Wall-Type,Built-In) 559

Transporting the Patient from the Recovery Room 560

General Information 561

Reminders to Personnel 562

Duties for Nurses Aides on All Shifts 563

Nurses Aides Assignments 564

Critically Ill Patients 565

INDEX 567