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Chapter 1AN ADMINISTRATOR LOOKS AT INTENSIVE THERAPYMANUEL JSEGALL,MAX SSADOVE,MD,AND JAMES HCROSS,MD1

Advantages of an Intensive Therapy Unit1

Aims and Objectives2

Planning the Intensive Therapy Unit4

Formulation of Policies and Practices6

Arrangement of Physical Facilities7

Size of the Intensive Therapy Unit9

Equipment and Supplies12

Temperature and Lighting25

Financing the Intensive Therapy Unit26

Administration of the Unit27

Admission,Transfer and Discharge of Patients27

Personnel29

Training30

Need for Refresher In-Service-Type Training Programs30

Public Relations31

Intensive Therapy Area—An Adjunct to Preventive Medicine32

Importance of the Intensive Therapy Unit to Short-Stay Patients33

Relationships with Other Hospital Departments33

Chapter 2PRINCIPLES OF RECOVERY ROOM MANAGEMENTMAX SSADOVE,MD,AND JAMES HCROSS,MD35

General Care35

Control of Pain41

Classification of Pain42

Drug Therapy for Relief of Pain43

General Principles of Pain Relief52

Other Therapy for Control of Pain53

Summary54

Sedation54

Antibiotic and Chemotherapeutic Agents58

Penicillin59

Streptomycin59

Chloramphenicol63

Tetracyclines63

Sulfa Drugs63

Acute Gastric Dilatation and Abdominal Distention64

Nausea and Vomiting65

Hiccough67

Wound Dehiscence68

Chapter 3MANAGEMENT OF CIRCULATION,SHOCK,RESPIRATION AND NUTRITIONMAX SSADOVE,MD,AND JAMES HCROSS,MD70

Circulation70

Factors Altering Circulation During Surgery71

Factors Altering Circulation Immediately Following Surgery78

Shock80

Principles of Technique of Intravenous Therapy111

Administration of Blood118

Respiration122

Normal Respiration122

Alterations of Respiration Due to Surgery123

General Management125

Atelectasis and Postoperative Pneumonia129

Hypoxia131

Carbon Dioxide Excess135

Oxygen Inhalation Therapy136

Respiratory Assistors and Respirators144

Aerosol Therapy147

Nutrition153

Water and Electrolytes154

Proteins,Carbohydrates and Fats160

Vitamins162

Tube Feedings163

Chapter 4NEUROSURGERYOSCAR SUGAR,MD165

Vital Signs166

Fever167

Respiration168

Position168

Bowel and Bladder Care169

Sedation169

Dehydration170

Spinal and Ventricular Puncture171

Drainage171

Vasodilator Therapy172

X-ray Examination173

Postoperative Orders173

Chapter 5SURGERY OF THE EYEMAURICE DPEARLMAN,MD178

Instruments,Dressings and Medication178

Special Aspects of Eye Anesthesia181

Prevention and Recognition of Ocular Complications183

Specific Problems and Routines in Eye Care184

A Brief Glossary of Ophthalmological Surgical Terms187

Chapter 6SURGERY OF THE EAR,NOSE AND THROATFRANCIS LLEDERER,MD,AND EMANUEL MSKOLNIK,MD189

The Ear189

Radical Mastoidectomy189

Fenestration191

Otoplasty193

The Throat193

Tonsillectomy193

Incision of Peritonsillar Abscess195

Hemiglossectomy195

The Nose and Accessory Sinuses196

Submucous Resection of Nasal Septum196

Nasoantral Window197

Caldwell-Luc Operation197

Radical Frontal Sinus Operation198

Maxillary Resection199

Nasal Fracture200

Rhinoplasty200

Chapter 7SURGERY OF THE CHESTHIRAM TLANGSTON,MD202

General Considerations Common to All Thoracic Surgical Procedures202

Special Consideration in Specific Types of Thoracic Surgical Procedures226

Minor Surgical Procedures During the Postoperative Period234

Chapter 8LARYNGOLOGY AND BRONCHOESOPHAGOLOGYPAUL HHOLINGER,MD,AND KENNETH CJOHNSTON,MD243

Postoperative Respiratory Obstruction Emergencies243

Postoperative Laryngeal Complications249

Postoperative Pulmonary Complications250

Care Following Laryngoscopy,Bronchoscopy and Esophagoscopy253

Post-Laryngectomy Care256

Chapter 9SURGERY OF THE ABDOMENWILLIAM JGROVE,MD259

Preoperative Care259

General Routine Postoperative Care260

Gastrointestinal Intubation264

General Postoperative Complications270

Care Following Specific Surgical Procedures275

Esophageal Surgery275

Gastric Surgery277

Duodenal Surgery282

Small Bowel Surgery283

Appendectomy283

Ileostomy285

Colon Surgery286

Gallbladder Surgery290

Surgery of the Liver292

Surgery of the Pancreas293

Surgery of the Spleen293

Chapter 10SURGERY FOR ANORECTAL DISEASECAESAR PORTES,MD295

Control of Constipation295

Control of Diarrhea296

Control of Infection297

Postoperative Hemorrhage298

Postoperative Urinary Difficulties298

Postoperative Pain299

General Care300

Care of Patients Having Operations for Pilonidal Disease301

Care of Patients Having Operations for Rectal Polyps301

Chapter 11SURGERY OF THE SOFT TISSUESMELVIN GIBBEL,MD303

Thyroidectomy303

Routine Postoperative Care304

Complications304

Herniorrhaphy312

Soft Tissue Injuries315

Hand Injuries318

Tetanus319

Gas Gangrene322

Chapter 12ORTHOPEDIC SURGERYTHEODORE AFox,MD326

Special Factors in the General Postoperative Care of the Orthopedic Patient326

Care of the Severely Injured Patient329

Care of the Postoperative Patient331

Special Equipment Needed for Care of Orthopedic Patients338

Sample Orders338

Chapter 13UROLOGICAL SURGERYROLAND RCROSS,JR,MD339

Special Problems339

Renal Surgery354

Ureteral Surgery356

Bladder Surgery358

Prostatic Surgery360

Surgery of the External Gentialia365

Postoperative Orders366

Nephrectomy366

Pyeloplasty of the Kidney366

Ligation of a Blood Vessel at Ureteropelvic Junction367

Nephrolithotomy367

Pyelolithotomy368

Ureterolithotomy368

Ureterosigmoid Implant368

Transurethral Resection of Bladder Tumor369

Suprapubic Prostatectomy370

Transurethral Resection of Prostate370

Retropubic Prostatectomy371

Radical Lymph Node Dissection and Orchiectomy371

Chapter 14PLASTIC SURGERYROBERT FSTOKES,MD373

General Problems373

Specific Problems377

Chapter 15THE TREATMENT OF BURNSROBERT FSTOKES,MD393

General Supportive Therapy393

Surface Treatment of Burns400

Chapter 16ONCOLOGICAL SURGERYHARRY WSOUTHWICK,MD,AND DANELY PSLAUGHTER,MD404

Preoperative State of the Patient404

General Considerations in Postoperative Therapy406

Summary of General Measures408

Specific Considerations in Postoperative Therapy408

General Postoperative Axioms412

Chapter 17OBSTETRICS AND GYNECOLOGYJOHN WPAYNE,MD,AND JOHN WOLFF,MD413

Normal Obstetrical Delivery415

Operative Obstetrical Delivery416

Medical Complications During and Preceding Obstetrical Delivery419

Immediate Postpartum Period421

Complications423

Specific Obstetrical Problems429

The Newborn444

Preoperative Gynecological Management447

Special Preoperative Gynecological Procedures449

Immediate Postoperative Gynecological Care450

Postoperative Gynecological Complications455

Special Gynecological Problems Needing Intensive Therapy459

The Acute Abdomen in Relation to Obstetrics and Gynecology461

Chapter 18VASCULAR SURGERYWILLIAM SDYE,JR,MD,AND ORMAND CJULIAN,MD463

Intrathoracic Surgery463

Preoperative Orders(Mitral Commissurotomy)468

Immediate Postoperative Orders(Mitral Commissurotomy)469

Postoperative Care When Hypothermia Has Been Employed470

Vascular Abdominal Surgery470

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

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

Peripheral Vascular Surgery473

Anticoagulant Therapy476

Chapter 19PEDIATRIC SURGERYJOHN LKEELEY,MD477

Preoperative Care478

Anesthesia479

Nutrition480

Postoperative Care481

Chapter 20MANAGEMENT OF MEDICAL PROBLEMSEDWARD JWISS,MD493

Cardiac Emergencies493

Cerebrovascular Accidents508

Massive Gastrointestinal Hemorrhage511

Intoxications513

Metabolic-Endocrine Emergencies516

Acute Renal Insufficiency528

Chapter 21NURSING CARE IN THE RECOVERY ROOMROSE MILONE,RN,MAX SSADOVE,MD,AND JAMES HCROSS,MD531

Recovery Room and the Nurse531

General Care of Patient in Recovery Room532

Recovery Room Charting535

Medicine Card539

Evening and Morning Care540

Equipment in Recovery Room540

Equipment in Cabinets541

Visiting in Recovery Room544

Postoperative Nursing Care of Cardiac Patients545

Postoperative Nursing Care of Patients Having Radical Neck Dissections547

Care of Tracheotomy Patient548

Chest Drainage(Water Seal or Closed Drainage)551

Postoperative Recovery Bed553

Positions Used in Treatment of Patient554

Oxygen Inhalation Therapy556

Nasal Catheter for Oxygen Administration556

Carbon Dioxide Therapy557

Extubation of Airways and Endotracheal Tubes558

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

Transporting the Patient from the Recovery Room560

General Information561

Reminders to Personnel562

Duties for Nurses Aides on All Shifts563

Nurses Aides Assignments564

Critically Ill Patients565

INDEX567

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