Part One：Fundamentals of Surgical Nursing 1
UNIT ONE BASIC PRINCIPLES OF SURGICAL NURSING AND SURGICAL ASEPSIS 2
1．THE SURGICAL NURSE AND HER PATIENT 3
Surgery in the Past 3
Surgery at Present 4
The Nurse and Her Patient Before Surgery 7
The Nurse and Her Patient After Surgery 9
Meeting the Needs of the Surgical Nurse 9
Bibliography and Suggested Reading 13
2．INFLAMMATION AND INFECTION 15
Bacteria 15
Body Defense Mechanisms 16
Inflammation 19
Surgical Infections 31
Bibliography and Suggested Reading 34
3．ANTISEPSIS AND ASEPSIS 36
Development of Antisepsis 36
Development of Asepsis 36
Principles of Sterilization 38
Physical Methods of Sterilization 51
Chemical Methods of Disinfection 52
Chemotherapy 56
Antibiotics 56
Bibliography and Suggested Reading 60
UNIT TWO MEETING THE OVER-ALL NEEDS OF THE SURGICAL PATIENT 61
4．PHYSIOLOGIC NEEDS：FLUID BALANCE，NUTRITIONAL NEEDS AND SPECIAL OXYGEN REQUIREMENTS 62
The Nurse and Fluid Therapy 62
Physiology 62
Specific Needs of the Surgical Patient 63
Methods of Administration 67
Inhalation Therapy 75
Bibliography and Suggested Reading 82
5．PREOPERATIVE NURSING CARE 83
Admission of the Surgical Patient 83
Psychological Preparation 84
Early Physical Preparation 87
Immediate Preoperative Preparation 91
Bibliography and Suggested Reading 95
UNIT THREE MEETING THE NEEDS OF THE PATIENT IN THE OPERATING ROOM 96
6．THE PATIENT IN THE OPERATING ROOM：ANESTHESIA 97
Reception and Greeting of the Patient 97
The Anesthetist and the Patient 98
Types of Anesthesia 99
Position on Operating Table 112
Bibliography and Suggested Reading 116
7．OPERATING ROOM NURSING A．THE NURSE IN THE OPERATING ROOM 117
Operating Room Nursing 117
Teamwork in the Operating Room 118
Maintenance of Surgical Asepsis 119
Technic of Scrubbing，Putting on Gown and Gloves 123
Surgical Draping 127
Handling of Sterile Equipment by the Circulating Nurse 128
Preparation of Tables for the Operation 134
Immediately Before the Operation 141
During the Operation 142
Between Operations 149
At the End of the Operative Schedule 150
Instrument Setups 153
Safety Practices in the Operating Room 153
7．OPERATING ROOM NURSING B．THE OPERATING ROOM AND ITS EQUIPMENT 156
Operating Suite 156
Sterilization and Care of Various Articles 161
Bibliography and Suggested Reading 177
UNIT FOUR MEETING THE NEEDS OF THE PATIENT RECOVERING FROM SURGERY 179
8．POSTOPERATIVE NURSING CARE 180
Recovery Room 180
Removing Patient from Operating Table 181
Immediate Postoperative Nursing Care 184
Return to Complete Consciousness 188
Body Alignment and Good Body Mechanics 190
Early Postoperative Ambulation and Postoperative Diet 193
Care of the Wound 194
Charts and Nurses＇Records 205
Bibliography and Suggested Reading 208
9．POSTOPERATIVE DISCOMFORTS AND COMPLAINTS 209
Pain 209
Vomiting 210
Restlessness 211
Sleeplessness 212
Thirst 212
Abdominal Distention 213
Constipation and Diarrhea 213
Bibliography and Suggested Reading 215
10．POSTOPERATIVE COMPLICATIONS 216
Shock 216
Hemorrhage and Pulmonary Complications 219
Femoral Phlebitis or Thrombosis 223
Hiccough(Singultus) 224
Intestinal Obstruction 225
Urinary Retention 226
Urinary Incontinence 227
Delirium 228
Wound Complications 231
Bibliography and Suggested Reading 233
UNIT FIVE MEETING THE NEEDS OF THE CONVALESCING SURGICAL PATIENT 234
11．REHABILITATION OF THE SURGICAL PATIENT 235
The Meaning of Rehabilitation 235
The Surgical Nurse as a Member of the Rehabilitation Team 235
Basic Assumptions and Aims of the Surgical Nurse 236
Normal Range of Motion 239
Activities of Daily Living 242
Conditions Which Affect Progress in Rehabilitation 242
Appliances and Devices 244
Referral and Follow-up of Surgical Patients 248
Bibliography and Suggested Reading 249
UNIT SIX MODIFICATIONS IN CARE TO MEET THE PARTICULAR NEEDS OF THE SURGICAL PATIENTS 251
12．NURSING CARE OF THE GERIATRIC SURGICAL PATIENT 252
The Nurse and the Elderly Surgical Patient 252
Significant Characteristics of the Older Patient 253
Preoperative Care 256
Postoperative Care 257
Convalescence 258
Bibliography and Suggested Reading 260
13．TUMORS AND CANCER NURSING 261
Classification of Tumors 261
Incidence of Malignancy 264
The Nurse and the Cancer Patient 265
Treatment of Neoplasms 266
Psychological Aspects of Nursing the Cancer Patient 272
Terminal Nursing Care 273
Cysts 275
The Follow-Through 275
Bibliography and Suggested Reading 276
Part Two：Nursing Care of Patients with Specific Surgical Problems 278
UNIT SEVEN NURSING IN CONDITIONS OF THE RESPIRATORY TRACT 279
14．SURGERY OF THE NOSE AND THE THROAT 280
Surgical Conditions of Nose and Sinuses 280
Surgery of Tonsils and Pharynx 284
Surgery of the Larynx 287
Tracheotomy 289
Clinical Situation：Tracheotomy 294
Bibliography and Suggested Reading 294
Patient Teaching Aids and Information 295
15．SURGERY OF THE CHEST 296
The Nurse and the Chest Surgical Patient 296
Anatomy and Physiology 296
Diagnostic Studies 297
Collections of Air and Fluid in the Pleural Cavity 300
Chest Wounds 301
Respiratory Infections 303
Empyema Thoracis(Pyothorax) 303
Lung Abscess 304
Bronchiectasis 305
Cancer of the Lung 306
Surgery of the Mediastinum 315
Surgery in Pulmonary Tuberculosis 315
Decortication of the Lung 321
Clinical Situation：Pulmonary Resection 321
Bibliography and Suggested Reading 322
Patient Teaching Aids and Information 323
UNIT EIGHT NURSING IN CONDITIONS OF THE CIRCULATORY SYSTEM，THE BLOOD AND THE BLOOD-FORMING ORGANS 324
16．SURGERY OF THE HEART AND THE BLOOD VESSELS 325
History of Cardiovascular Surgery 325
Cardiovascular Surgical Nursing 326
Diagnostic Aids and Aids to Modern Open Heart Surgery 328
Intracardiac Surgery 331
Cardiovascular Surgical Nursing 339
Thrombosis and Embolism 346
Peripheral Arterial Disease 347
Methods of Improving Circulation 350
Arterial Hypertension and Aneurysm 352
Varicose Veins 353
Varicose Ulcers 354
Phlebitis 355
Clinical Situations：Coarctation of Aorta and Saphenous Ligation 357
Bibliography and Suggested Reading 358
Patient Teaching Aids and Information 359
17．SURGICAL CONDITIONS OF THE BLOOD，THE LYMPHATIC SYSTEM AND THE SPLEEN 360
The Blood 360
The Lymphatic System 361
The Spleen 364
Clinical Situation：Splenectomy 365
Bibliography and Suggested Reading 365
Patient Teaching Aids and Information 365
UNIT NINE NURSING IN CONDITIONS OF THE ALIMENTARY SYSTEM 366
18．SURGERY OF LIPS，MOUTH，TONGUE AND ESOPHAGUS 367
Surgery of the Lips 367
Surgery of the Mouth and Tongue 369
Diseases of the Esophagus 372
Bibliography and Suggested Reading 383
Patient Teaching Aids and Information 383
19．SURGERY OF THE ABDOMEN 384
Basic Considerations in Abdominal Surgery 384
Peritonitis 387
Surgery of the Stomach and the Duodenum 390
Regional Enteritis 408
Appendicitis 409
Surgery of Colon，Rectum and Anus 412
Pilonidal Cyst 425
Surgery of Liver and Biliary Passages 426
Surgery of the Pancreas 431
Abdominal Hernia 434
Clinical Situations：Abdominoperineal Resection and Cholecystectomy 436
Bibliography and Suggested Reading 437
Patient Teaching Aids and Information 438
UNIT TEN NURSING IN CONDITIONS OF THE URINARY TRACT AND THE REPRODUCTIVE SYSTEM 441
20．SURGERY OF THE URINARY TRACT AND THE MALE REPRODUCTIVE SYSTEM 441
The Nurse and the Urologic Patient 441
Anatomy and Physiology of the Urinary System 441
Methods of Study of the Urinary Tract 443
Maintaining Adequate Drainage 444
Surgery of the Kidney 448
Surgery of the Bladder 455
Male Genito-urology 460
Clinical Situations：Nephrectomy and Suprapubic Prostatectomy 469
Bibliography and Suggested Reading 470
Patient Teaching Aids and Information 471
21．DISEASES OF THE FEMALE REPRODUCTIVE ORGANS 472
The Nurse，the Woman，and the Patient with a Gynecologic Problem 472
Anatomy and Physiology 473
Disturbances of Menstruation 477
Diagnostic Tests 480
Preparation of Patient for Gynecologic Operations 483
Conditions of External Genitalia and Vagina 484
Conditions of Uterus 488
Conditions of Ovaries and Broad Ligaments 492
Conditions of Fallopian Tubes 493
Infertility 494
Clinical Situation：Radium Implantation 495
Bibliography and Suggested Reading 495
Patient Teaching Aids and Information 496
UNIT ELEVEN NURSING IN CONDITIONS OF THE INTEGUMENTARY SYSTEM(INCLUDING THE SUBCUTANEOUS AND THE AREOLAR TISSUE AND THE BREASTS) 497
22．SURGERY OF THE SKIN 498
General Considerations 498
Staphylococcic Infections 498
Infections of Hand and Fingers 500
Burns 503
Ulcerations 507
Cysts and Tumors 507
Plastic or Reconstructive Surgery 509
Dermal Abrasion 516
Clinical Situation：Third-Degree Burn 517
Bibliography and Suggested Reading 518
Patient Teaching Aids and Information 518
23．SURGERY OF THE BREAST 519
Introduction 519
Fissure of Nipple 519
Inflammations 519
Tumors of the Breast 521
The Male Breast 523
Plastic Surgery of the Breast 523
Nursing Care of Patients Having Breast Operations 523
Clinical Situation：Radical Mastectomy 527
Bibliography and Suggested Reading 528
Patient Teaching Aids and Information 528
UNIT TWELVE NURSING IN CONDITIONS OF THE EYE AND THE EAR 530
24．SURGERY OF THE EYE 531
Anatomy and Physiology 532
Examinations and Diagnostic Procedures 534
Drugs Used Frequently in Eye Disease 535
Trauma to the Eye 543
Diseases of the Eye 545
The Nurse and the Newly Blind 553
Clinical Situation：Surgery for Glaucoma 553
Bibliography and Suggested Reading 554
Patient Teaching Aids and Information 555
25．SURGERY OF THE EAR AND THE MASTOID 556
Anatomy and Physiology 556
The External Ear 558
The Middle Ear 559
Operations for Otosclerosis 564
Communicating with a Person Who Has a Hearing Impairment 566
Clinical Situation：Fenestration Operation 566
Bibliography and Suggested Reading 567
Patient Teaching Aids and Information 567
UNIT THIRTEEN NURSING IN CONDITIONS OF THE ENDOCRINE GLANDS 568
26．SURGERY OF THE THYROID AND OTHER ENDOCRINE GLANDS 569
The Thyroid Gland 569
The Parathyroid Glands 574
The Adrenal Glands 575
Surgery in Diabetes 576
Clinical Situation：Thyroidectomy 578
Bibliography and Suggested Reading 580
Patient Teaching Aids and Information 580
UNIT FOURTEEN NURSING IN CONDITIONS OF THE NERVOUS SYSTEM 581
27．SURGERY OF BRAIN AND SPINAL CORD 582
History 582
Anatomy of Brain and Spinal Cord 584
Examinations and Diagnostic Procedures 588
Special Examinations 589
Special Neurosurgical Problems 595
Scalp，Skull and Cranial Injuries 600
Brain Injury 601
Surgery of the Spinal Cord 613
Congenital Disorders 624
Clinical Situation：Craniotomy 625
Bibliography and Suggested Reading 626
Patient Teaching Aids and Information 627
UNIT FIFTEEN NURSING IN CONDITIONS OF THE MUSCULOSKELETAL SYSTEM 628
28．INJURIES OF THE MUSCULOSKELETAL SYSTEM 629
General Considerations，Anatomy and Physiology 629
Contusions and Sprains 630
Dislocations and Fractures 631
Fracture Reduction 636
Amputation 663
Clinical Situation：Fracture of the Femur 668
Bibliography and Suggested Reading 669
Patient Teaching Aids and Information 669
29．DISEASES OF BONES，JOINTS AND BURSAE 671
Deformities 671
Infantile Paralysis 679
Osteomyelitis 679
Tuberculosis 682
Osteitis Fibrosa Cystica 685
Bone Tumors 686
Diseases of Joints and Bursae 687
Clinical Situation：Congenital Dislocation of the Hip 688
Bibliography and Suggested Reading 689
Patient Teaching Aids and Information 689
Part Three：Nursing in an Emergency or Disaster 691
UNIT SIXTEEN NURSING IN AN EMERGENCY OR DISASTER 692
30．NURSING IN AN EMERGENCY OR DISASTER 692
＂Being Prepared＂ 692
The Meaning of Disaster 693
Accidents 693
Nuclear Warfare 696
Philosophy and Principles of Medical and Nursing Care 697
Mobilization of Medical and Nursing Services 698
Surgical Problems 700
Artificial Respiration 705
Psychological First Aid 707
Improvisation and Resourcefulness 709
An Emergency Creed 710
Bibliography and Suggested Reading 711
Appendix 711
INDEX 715