Contents UNIT I: FOUNDATIONS FOR PRACTICE, 1 Chapter 1 Concepts Basic to Perioperative Nursing, 1 Chapter 2 Patient Safety and Risk Management, 16 Chapter 3 Workplace Issues and Staff Safety, 47 Chapter 4 Infection Prevention and Control, 69 Chapter 5 Anesthesia, 124 Chapter 6 Positioning the Patient for Surgery, 155 Chapter 7 Sutures, Needles, and Instruments, 186 Chapter 8 Surgical Modalities, 211 Chapter 9 Wound Healing, Dressings, and Drains, 253 Chapter 10 Postoperative Patient Care and Pain Management, 270 UNIT II: SURGICAL INTERVENTIONS, 295 Chapter 11 Gastrointestinal Surgery, 295 Chapter 12 Surgery of the Liver, Biliary Tract, Pancreas, and Spleen, 350 Chapter 13 Hernia Repair, 383 Chapter 14 Gynecologic and Obstetric Surgery, 405 Chapter 15 Genitourinary Surgery, 461 Chapter 16 Thyroid and Parathyroid Surgery, 538 Chapter 17 Breast Surgery, 558 Chapter 18 Ophthalmic Surgery, 580 Chapter 19 Otorhinolaryngologic Surgery, 626 Chapter 20 Orthopedic Surgery, 679 Chapter 21 Neurosurgery, 768 Chapter 22 Reconstructive and Aesthetic Plastic Surgery, 823 Chapter 23 Thoracic Surgery, 869 Chapter 24 Vascular Surgery, 899 Chapter 25 Cardiac Surgery, 931 UNIT III: SPECIAL CONSIDERATIONS, 1008 Chapter 26 Pediatric Surgery, 1008 Chapter 27 Geriatric Surgery, 1081 Chapter 28 Trauma Surgery, 1104 Chapter 29 Interventional and Image-Guided Procedures, 1132 Chapter 30 Integrative Health Practices: Complementary and Alternative Therapies, 1161 APPENDIX A Laboratory Values, 1175 Illustration Credits, 1180 Index, 1186 This page intentionally left blank Alexander’s CARE 15th Edition PATIENT OF THE SURGERY IN Jane Rothrock, PhD, RN, CNOR, FAAN Adjunct Professor, Perioperative Programs Delaware County Community College Media, Pennsylvania Associate Editor Donna McEwen, RN, BSN, CNOR(E) Clinical Training Instructional Designer Optum—Shared Services San Antonio, Texas 3251 Riverport Lane St. Louis, Missouri 63043 ALEXANDER’S CARE OF THE PATIENT IN SURGERY, 15th EDITION ISBN: 978-0-323-08942-5 Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Copyright 2011, 2007, 2003, 1999, 1995, 1991, 1987, 1983, 1978, 1972 by Mosby, Inc., an affiliate of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Alexander’s care of the patient in surgery.—15th edition / [edited by] Jane Rothrock ; associate editor, Donna McEwen. p. ; cm. Care of the patient in surgery Includes index. ISBN 978-0-323-08942-5 (pbk. : alk. paper) I. Rothrock, Jane C., 1948- editor of compilation. II. McEwen, Donna R., editor of compilation. III. Title: Care of the patient in surgery. [DNLM: 1. Perioperative Nursing. 2. Nursing Care. 3. Operating Room Nursing. 4. Surgical Procedures, Operative—nursing. WY 161] RD99.24 617′.0231—dc23 2014000316 Acquisitions Editor: Terry Hines Burnham Developmental Editor: Laura Selkirk Publishing Services Manager: Jeff Patterson Project Manager: Jeanne Genz Design Direction: Jessica Williams Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors Jacqueline R. Bak, RN, MSN, CNOR, RNFA, CST Troy J. DeRose, RN, MSN, CRNP, ANCC-C, Director of Perioperative Programs RNFA, CORLN Delaware County Community College Certified Registered Nurse Practitioner Media, Pennsylvania Department of Otolaryngology—Head and Chapter 9: Wound Healing, Dressings, and Drains Neck Surgery Thomas Jefferson University Hospital Kay A. Ball, RN, PhD, CNOR, FAAN Philadelphia, Pennsylvania Associate Professor, Nursing Department Chapter 19: Otorhinolaryngologic Surgery Otterbein University Westerville, Ohio; Leigh Ann DiFusco, RN, MSN, CNOR, PCNS-BC Consultant Clinical Nurse Specialist, Cardiac Care Unit K & D Medical Inc. The Children’s Hospital of Philadelphia Lewis Center, Ohio Philadelphia, Pennsylvania Chapter 8: Surgical Modalities Chapter 26: Pediatric Surgery Robert M. Blumm, BS, MS, PA-C, DFAAPA Terri Fink, RN, BSN, CNOR Senior Surgical PA, Department of Plastic Surgery Registered Nurse First Assistant St. Joseph Hospital University Medical Center at Princeton Bethpage, New York; Plainsboro, New Jersey Chairman, PA Advisory Board Chapter 22: Reconstructive and Aesthetic Plastic Surgery New York City, New York Chapter 22: Reconstructive and Aesthetic Plastic Surgery Allison Lindsey Flanagan, RN, MSN, CNOR Staff Nurse, Operating Room Barbara A. Bowen, RN, MSN, CRNP, CRNFA Paoli Hospital President Paoli, Pennsylvania; Perioperative Consulting & Surgical Services, LLC Adjunct Faculty, Perioperative Nursing Program Collegeville, Pennsylvania; Delaware County Community College Consultant Media, Pennsylvania Stryker Performance Solutions Chapter 27: Geriatric Surgery Chicago, Illinois Chapter 20: Orthopedic Surgery Maria Arlene Gapac LeMin, RN, BSN, CNOR, RNFA Clinical Coordinator, Cardiac Surgery Brian D. Campbell, BS, BSN, CRNA, COL (USAR Ret.) Penn Presbyterian Medical Center Staff Anesthetist Philadelphia, Pennsylvania Winchester Anesthesia Associates Chapter 23: Thoracic Surgery Winchester, Massachusetts Chapter 5: Anesthesia David P. Gawronski, RN, MSN, CNOR Perioperative Educator/Manager Susan A. Carzo, RN, BSN, CNOR Mercy Hospital of Buffalo RNFA/Staff Nurse, Operating Room Buffalo, New York Winchester Hospital Chapter 28: Trauma Surgery Winchester, Massachusetts Chapter 14: Gynecologic and Obstetric Surgery Sarah Krizman Germanovich, BSN, MSN, CNOR Staff Nurse, Operating Room Maya Nicole Clark-Cutaia, RN, BSN, MSN, PhD, ACNP-BC Thomas Jefferson University Hospital; Ruth L. Kirschstein T32 Postdoctoral Fellow Adjunct Faculty, Nursing Center for Global Women’s Health and Center for Health Equity Thomas Jefferson University Hospital School Research of Nursing University of Pennsylvania, School of Nursing Philadelphia, Pennsylvania Philadelphia, Pennsylvania Chapter 21: Neurosurgery Chapter 13: Hernia Repair v vi Contributors Pauline A. Heizenroth, RN, MSN, CNOR Janice A. Neil, RN, PhD, CNE Perioperative Nurse/Clinical Nurse Educator Associate Professor and Chair Bryn Mawr Hospital Surgicenter Undergraduate Nursing Science Junior Division Bryn Mawr, Pennsylvania; East Carolina University Perioperative Nurse Greenville, North Carolina Paoli Surgery Center Chapter 12: Surgery of the Liver, Biliary Tract, Pancreas, Paoli, Pennsylvania and Spleen Chapter 6: Positioning the Patient for Surgery Jan Odom-Forren, RN, PhD, CPAN, FAAN Denise Jackson, BSN, MSN Assistant Professor, College of Nursing Clinical Nurse Specialist, Certified RN First Assistant University of Kentucky Shannon Health System and The Better Weigh Center; Lexington, Kentucky Clinical Supervisor, APRN, RNFA Program Chapter 10: Postoperative Patient Care and Pain Management Angelo State University San Angelo, Texas Rebecca M. Patton, RN, MSN, CNOR, FAAN Chapter 11: Gastrointestinal Surgery Atkinson Scholar in Perioperative Nursing Case Western Reserve University Helene P. Korey Marley, RN, BSN, CNOR, CRNFA Cleveland, Ohio; Clinical Service Coordinator, Operating Room Immediate Past President Pennsylvania Hospital American Nurses Association Philadelphia, Pennsylvania Washington, DC Chapter 15: Genitourinary Surgery Chapter 3: Workplace Issues and Staff Safety Rachael Larner, RN, BSN, MSN Elizabeth Pearsall, RN, BSN, CNOR Senior Professional Nurse, Post Anesthesia Staff Nurse, Perioperative Services Care Unit Taylor Hospital UPMC Hamot Ridley Park, Pennsylvania; Erie, Pennsylvania Adjunct Faculty, Nursing and Allied Health Chapter 30: Integrative Health Practices: Complementary and Delaware County Community College Alternative Therapies Media, Pennsylvania Chapter 17: Breast Surgery Maria C. Marinelli, BSN, MSN, RNFA, CNOR BSN Nursing Faculty Jennifer Schaadt, MS, MBA Thomas Jefferson University School of Nursing Principal Consultant Philadelphia, Pennsylvania Integrated Services Management Chapter 16: Thyroid and Parathyroid Surgery Siemens Medical Cary, North Carolina James R. McCarthy, RN, AS Chapter 29: Interventional and Image-Guided Procedures Certified Registered Nurse, First Assistant Perioperative Nursing Services Patricia C. Seifert, RN, MSN, CNOR, CRNFA, FAAN, RNFA Temple University Hospital Cardiovascular Operating Room Philadelphia, Pennsylvania Inova Heart and Vascular Institute Chapter 7: Sutures, Needles, and Instruments Falls Church, Virginia; Former Editor-in-Chief, AORN Journal Eileen Mielcarek, BSN, RNFA, COE Denver, Colorado Practice Administrator Chapter 25: Cardiac Surgery Mielcarek Eye Lifetime Vision Center RNFA, Perioperative, Operating Room Cynthia Spry, RN, MA, MS, CNOR, CBSPDT Main Line Health Care (MLHC) Riddle Hospital Independent Consultant Media, Pennsylvania New York City, New York Chapter 18: Ophthalmic Surgery Chapter 4: Infection Prevention and Control Ellen Murphy, RN, MS, JD, FAAN Victoria Steelman, RN, PhD, CNOR, FAAN Professor Emerita, College of Nursing Assistant Professor, College of Nursing University of Wisconsin-Milwaukee The University of Iowa Milwaukee, Wisconsin Iowa City, Iowa Chapter 2: Patient Safety and Risk Management Chapter 1: Concepts Basic to Perioperative Nursing Contributors vii Joseph H. Viveiros, RN, CNOR Patricia Wieczorek, RN, MSN, CNOR RNFA/Staff Nurse Nurse Manager, Perioperative Services Winchester Hospital The Johns Hopkins Hospital Winchester, Massachusetts Baltimore, Maryland Chapter 14: Gynecologic and Obstetric Surgery Chapter 24: Vascular Surgery Maryann Papanier Wells, RN, PhD, FAAN Nurse Manager, Perioperative Nursing Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Chapter 27: Geriatric Surgery Clinical Consultants Gerald A. Acker, MD Allen S. Gabroy, MD, FACS Director of Cosmetic Surgery Chief of Surgery Catholic Health Services of Long Island Taylor Hospital Roslyn, New York Ridley Park, Pennsylvania Gregory Artz, MD Maureen W. Hemingway, RN Assistant Professor, Co-Director for Jefferson Center for Balance Clinical Nurse Specialist and Hearing Massachusetts General Hospital Department of Otolaryngology, Head and Neck Surgery Boston, Massachusetts Thomas Jefferson University Hospital Philadelphia, Pennsylvania Lori J. Howell, MS, RN Executive Director, Center for Fetal Diagnosis and Treatment James Black, MD The Children’s Hospital of Philadelphia Associate Professor Vascular Surgery Philadelphia, Pennsylvania The Johns Hopkins Hospital Baltimore, Maryland David Kaczorowski, MD Attending Cardiac Surgeon David Cognetti, MD York Hospital Assistant Professor, Co-Director for Jefferson Center for Head York, Pennsylvania and Neck Surgery Department of Otolaryngology, Head and Neck Surgery Sean P. Larner, DO Thomas Jefferson University Hospital ENT Resident Philadelphia, Pennsylvania Department of Otolaryngology and Facial Plastic Surgery Millcreek Community Hospital Alan S. Crandall, MD Erie, Pennsylvania Professor of Ophthalmology Senior Vice Chair and Director of Glaucoma and Maureen Lewis, BSN, CNOR, CRNFA Cataracts RN First Assistant Co-Director of Moran International Division Riddle Hospital, Main Line Health Moran Eye Center, University of Utah System Salt Lake City, Utah Media, Pennsylvania Glen A. Dixon, Jr., MD Frederic Ramsey, MD Obstetrics and Gynecology Staff Anesthesiologist Winchester Hospital Winchester Anesthesia Associates Winchester, Massachusetts Winchester, Massachusetts Marc A. Drimmer, MD Angela N. Reeves, BS, RT(R) Princeton Plastic Surgery Associates; Product Manager, Interventional Radiology Chief of the Department of Plastic Surgery Siemens Healthcare University Medical Center at Princeton Malvern, Pennsylvania Princeton, New Jersey Marc Rosen, MD Ginger D. Elmore, RN, BSN, ASLCN Certified Vice Chairman for Clinical Affairs Registered Nurse Clinician III Jefferson Medical College; James Madison University and Legal Nurse Consulting Associate Professor, Department of Otolaryngology, Head and Center Neck Surgery Charlotte, North Carolina Thomas Jefferson University Hospital Philadelphia, Pennsylvania Arlan F. Fuller, Jr., MD Clinical Vice President for Oncology Services Winchester Hospital Winchester, Massachusetts viii Clinical Consultants ix Heather Rozencwaig, RN, MSN, CRNP Brittany Shumway, PA-C Inpatient Care Coordinator Inpatient Care Coordinator Department of Otolaryngology, Head and Department of Otolaryngology, Head and Neck Surgery Neck Surgery Thomas Jefferson University Hospital Thomas Jefferson University Hospital Philadelphia, Pennsylvania Philadelphia, Pennsylvania Ariana L. Smith, MD Eric Sarin, MD Assistant Professor of Surgery/Urology Cardiac Surgeon Pelvic Medicine and Reconstructive Surgery Inova Fairfax Hospital; Hospital of the University of Pennsylvania, Division of Urology Inova Heart and Vascular Institute Philadelphia, Pennsylvania Falls Church, Virginia Kevin Smith, BS, RN, MHA Katie Schrack, MD Staff Nurse Ophthalmologist Temple University and St. Joseph’s University Mielcarek Eye Lifetime Vision Center Philadelphia, Pennsylvania Media, Pennsylvania Dorothy M. Urschel, MS, ACNP-BC, FNP-BC, CCRN, MBA, Peter F. Sharkey, MS, MD NEA-BC Professor of Orthopedic Surgery Director of Cardiovascular Surgery and Critical Care Services Thomas Jefferson University Hospital, Rothman Daemen College Institute Amherst, New York Philadelphia, Pennsylvania