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Table of Contents


	List of Contributors	xiii
	Preface	xv
	Glossary	xvii
	Acknowledgements	xxv
SECTION I	THE BASIS OF SURGICAL CARE
1	Preoperative Assessment Melanie Oakley, Joanne Bratchell	3
	Introduction	3
	What is Preoperative Assessment?	3
	Aim of Preoperative Assessment	4
	Patient Information	8
	Documentation	10
	Conclusion	11
	Appendix	13
2	Perioperative Care Diane Gilmour	17
	Introduction	17
	Preoperative Care	18
	Care during Anaesthesia	19
	Intraoperative Care	21
	Immediate Postoperative Care	27
	Conclusion	32
3	Day Surgery Melanie Oakley	35
	Introduction	35
	Advantages of Day Surgery	36
	Disadvantages of Day Surgery	36
	Day Surgery Nursing	37
	Anaesthesia in Day Surgery	38
	Recovery in Day Surgery	39
	Discharge of the Patient from the Day Surgery Unit	41
	Conclusion	42
4	Perioperative Stress and Anxiety in the Surgical Patient Melanie Oakley, Rosie Pudner	45
	Introduction	45
	Anxiety in the Surgical Patient	46
	Methods of Relieving Anxiety in the Surgical Patient	47
	Conclusion	49
5	Wound Healing in the Surgical Patient Rosie Pudner	51
	Introduction	51
	The Structure and Function of the Skin	52
	Mechanisms of Wound Closure	54
	The Process of Wound Healing	54
	Factors Affecting the Healing Process	56
	Methods of Skin Closure	58
	Use of Wound Drains	62
	Principles of Care for a Patient with a Surgical Wound	65
	Discharge Advice	72
	Conclusion	73
6	Nutrition and the Surgical Patient Helen Ord, Melanie Baker	77
	Introduction	77
	Malnutrition	77
	Identifying Patients at Risk of Malnutrition	78
	The Nutritional Needs of the Surgical Patient	78
	Methods of Nutritional Support	81
	The Evidence for Nutritional Support in the Surgical Patient	85
	Monitoring Nutritional Support	86
	Ethics	86
	The Multidisciplinary Team	86
7	Altered Body Image and the Surgical Patient Ad�le Atkinson, Rosie Pudner	91
	Introduction	91
	What is Meant by Body Image?	91
	Perceptions of Altered Body Image	92
	Reactions to Altered Body Image	93
	Conclusion	100
8	Concepts of Pain and the Surgical Patient Sharon Kitcatt	103
	Introduction	103
	Classification of Pain	104
	General Principles in the Management of Acute Pain	104
	Methods of Administering Postoperative Analgesia	107
	Pharmacology in Acute Pain Management	114
	The Acute Pain Service Team	118
9	Discharge Planning Following Surgery Rosi Castle, Teresa Rooney-Kaymakci	123
	Introduction	123
	Defining and Describing Multidisciplinary Discharge Planning	124
	Discharge Planning within the Context of Past and Present Government Policy	125
	Patient Assessment	126
	The Provision of Services	128
	Evaluation of Discharge Planning	129
	Models of Discharge Planning	129
	Two Case Studies	129
	Conclusion	131
SECTION II	NURSING CARE FOR SPECIFIC SURGICAL PROCEDURES
10	Patients Requiring Neurosurgery Christine Eberhardie	137
	Introduction	137
	Overview of the Anatomy and Physiology of the Nervous System	137
	Specialist Investigations	139
	Neurosurgery	141
	Preoperative Assessment of the Patient Undergoing Cerebral Surgery	142
	Planning Care for the Neurosurgical Patient	148
	The Principles of Postoperative Care of a Patient Following a Craniotomy	158
	Conclusion	160
11	Patients Requiring Ophthalmic Surgery Biddy Knight, Sue Hart	163
	Introduction	163
	Structure of the Eye	163
	Assessment of the Eye	168
	Preoperative Assessment	170
	Pre- and Postoperative Care of Patients Undergoing Intraocular Surgery	170
	Pre- and Postoperative Care of Patients Undergoing Extraocular Surgery	188
	Discharge Planning	194
	Conclusion	195
12	Patients Requiring Surgery to the Ear, Nose and Throat Julie Wain	197
	Introduction	197
	The Ear	198
	The Nose	204
	The Throat	211
	Head and Neck	218
	Conclusion	226
13	Patients Requiring Thyroid Surgery Rosie Pudner	229
	Introduction	229
	Anatomy and Physiology	229
	Disorders of the Thyroid Gland	230
	Conservative Management of Hyperthyroidism	231
	Specific Investigations of a Patient with Thyroid Dysfunction	231
	Nursing Assessment of a Patient Requiring Thyroid Surgery	232
	Assessment of the Patient�s Voice and Trachea	232
	Specific Preoperative Preparation	232
	Surgical Interventions	233
	Specific Postoperative Nursing Care	234
	Potential Problems Following Thyroid Surgery	234
	Discharge Planning and Patient Education	238
	Conclusion	238
14	Care of the Patient Requiring Cardiac Interventions and Surgery Christine Spiers, Kevin Barrett	241
	Introduction	241
	Anatomy and Physiology of the Heart	241
	Basic Pathophysiology of the Heart	243
	Assessment and Investigations	244
	Therapeutic Catheterization	252
	Cardiac Treatments	256
	Open Cardiac Surgery	263
	Heart Transplantation	268
	Conclusion	271
15	Care of the Patient Requiring Thoracic Surgery Emma Gardner	275
	Introduction	275
	An Overview of the Respiratory System and the Mechanics of Breathing	276
	Respiratory Assessment	280
	Common Disorders Requiring Surgical Intervention	283
	Specific Investigations Required Prior to Surgery	286
	Preoperative Care	289
	Thoracic Surgical Procedures	290
	Postoperative Care	293
	Specific Health Education/Patient Teaching and Preparation for Discharge	297
	Conclusion	298
16	Patients Requiring Upper Gastrointestinal Surgery Melanie Seymour (With a Contribution by Nuala Davison)	301
	Introduction	301
	Overview of the Anatomy and Physiology of the Digestive System	302
	Investigations	302
	Upper Gastrointestinal Disorders	304
	Bariatric Surgery (Nuala Davison)	319
17	Patients Requiring Colorectal and Anal Surgery Fiona Hibberts	325
	Introduction	325
	Investigations	325
	Colorectal and Anal Disorders	327
	Enhanced Recovery Following Colorectal Surgery	345
18	Patients Requiring Surgery on the Renal and Urinary Tract Janice Minter	349
	Introduction	349
	Anatomy and Physiology of the Urinary Tract	349
	Renal and Urological Investigations	352
	Nursing Assessment of the Individual Requiring Surgery for a Urological Condition	357
	Surgical Interventions on the Kidney	358
	Surgical Management of Bladder Cancer	367
	Conclusion	372
19	Patients Requiring Surgery on the Male Reproductive System Aoife Donoghue	375
	Introduction	375
	Anatomy and Physiology of the Male Reproductive System	375
	Urological Investigations and Assessment	377
	Carcinoma of the Prostate Gland	377
	Surgery on the Prostate Gland	378
	Cancer of the Penis	385
	Penile Conditions and Surgery	385
	Scrotal Conditions and Surgery	388
	Nursing Care for Penile and Scrotal Surgery	390
	Surgery on the Male Urethra	392
	Conclusion	394
20	Patients Requiring Gynaecological Surgery Jacky Cotton	397
	Introduction	397
	Anatomy and Physiology of the Reproductive System	398
	Specific Investigations for Patients Requiring Gynaecological Surgery	399
	Assessment of Patient Requiring Gynaecological Surgery	404
	Minor Gynaecological Surgery	406
	Laparoscopic Surgery	408
	Nursing Care for Minor Gynaecological and Laparoscopic Surgery	409
	Myomectomy	415
	Hysterectomy	416
	Nursing Care for Major Gynaecological Surgery	418
	Endometrial Ablation	426
	Levonorgestrel Intrauterine System	428
	Vaginal Repair Surgery/Colporrhaphy	428
	Continence Surgery	429
	Nursing Care for Patients Requiring Vaginal Repair and Continence Surgery	430
	Laparoscopic Treatment of Ectopic Pregnancy	431
	Treatment for Gynaecological Cancers	433
	Conclusion	436
21	Patients Requiring Breast Surgery Lis Grimsey	441
	Introduction	441
	Anatomy and Physiology	441
	Assessment and Investigations	443
	Breast Surgery	445
	Breast Cancer	448
	Nursing Care of a Patient Undergoing Surgery for Breast Cancer	453
	Conclusion	459
22	Care of Patients Requiring Vascular Surgery Shelagh Murray Hall	463
	Introduction	463
	Physiology of Circulation	464
	Arterial Occlusive Disease	465
	The Patient with Chronic Ischaemia	468
	Nursing Assessment of Patients with Peripheral Vascular Disease	472
	Management of the Patient with Chronic Limb Ischaemia	474
	Acute Leg Ischaemia	483
	Management of the Patient Requiring Lower Limb Amputation	485
	Management of the Patient with an Abdominal Aortic Aneurysm	490
	Management of the Patient Requiring Carotid Endarterectomy	494
	Management of the Patient with Varicose Veins	496
23	Patients Requiring Orthopaedic Surgery Nicola L. Whiteing	503
	Introduction	503
	The Musculoskeletal System	504
	Common Orthopaedic Disorders	506
	Nursing Assessment of the Orthopaedic Patient	508
	Orthopaedic Investigations and Tests	509
	Lower Limb Orthopaedic Surgery	510
	Upper Limb Orthopaedic Surgery	522
	Orthopaedic Surgery of the Spine	525
	Fractures	526
	General Discharge Planning and Advice	530
	Conclusion	531
24	Patients Requiring Plastic Surgery Ad�le Atkinson, Mary Smith	535
	Introduction	535
	Types of Wound Closure	537
	Skin Grafts	537
	Flaps	542
	Use of Leeches in Reconstructive Surgery	551
	Use of Tissue Expanders in Reconstructive Surgery	552
	Discharge Planning	555
	Conclusion	555
	Index	559