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