Alexanders Care Of The Patient In Surgery – Jane C Rothrock

Skin closure is accomplished with skin staples, and dressings are applied. Adrenalectomy Adrenalectomy is partial or total excision of one or both adrenal glands. It may be performed as a treatment for hypersecretion of adrenal hormones, neoplasms of the adrenal gland, or secondary treatment of neoplasms that depend on adrenal hormonal secretions, such as pheochromocytoma or carcinoma of the prostate or breast.

Caring for a patient with pheochromocytoma raises particular concerns for the perioperative nurse. These patients are subject to extreme elevations in blood pressure, often accompanied by tachy- cardia, and hypovolemic states that can induce vascular collapse. If an adrenal tumor is being excised, early ligation of the adrenal vein is crucial for avoiding a sudden elevation of the patient’s blood pressure caused by manipulation of the gland. After tumor removal, there will be a rapid drop in the patient’s blood pressure that can be minimized by maintaining blood volume and administering norepinephrine.

Procedural Considerations Adrenalectomy may be performed as a laparoscopic or an open procedure. The laparoscopic approach is generally associated with less morbidity and shorter hospital stays. For unilateral adrenalectomy, the patient may be placed in a lateral or supine position, depending on the intended approach. If both glands are to be removed, a supine or prone position is used. Using a prone position is helpful for patients with a known disorder (e.g., aldosteronism), localized benign lesions and solitary ade- nomas of Cushing syndrome, and for debilitated patients with an advanced neoplasm.

The setup for a lateral approach is as described for nephrectomy, including rib resection instruments, vascular instruments, and vessel clips and appliers. The setup for an abdominal approach is as described for laparotomy, including vascular instruments, extra- long scissors, tissue forceps, Rochester-Péan forceps, Mixter forceps, and needle holders. Penrose tubing may be used for retraction.

Vessel clips and appliers also may be needed, as well as various sizes of nonabsorbable braided sutures. The setup for a posterior approach is as described for the lat- eral approach. The patient is positioned in a 35-degree jackknife (Kraske) position with the kidney rest under the inferior margin of the anterior rib cage.

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If you rented or purchased a used book and the scratch-off code at right has already been revealed, the code may have been used and cannot be re-used for registration. To purchase a new code to access these valuable study resources, simply follow the link above. Contents UNIT I Foundations for Practice 1 Concepts Basic to Perioperative Nursing, 1 2 Patient Safety and Risk Management, 16 3 Workplace Issues and Staff Safety, 39 4 Infection Prevention and Control, 53 5 Anesthesia, 103 6 Positioning the Patient for Surgery, 139 7 Sutures, Sharps, and Instruments, 174 8 Surgical Modalities, 199 9 Wound Healing, Dressings, and Drains, 241 10 Postoperative Patient Care and Pain Management, 256 UNIT II Surgical Interventions 11 Gastrointestinal Surgery, 285 12 Surgery of the Biliary Tract, Pancreas, Liver, and Spleen, 341 13 Hernia Repair, 374 14 Gynecologic and Obstetric Surgery, 398 15 Genitourinary Surgery, 454 16 Thyroid and Parathyroid Surgery, 527 17 Breast Surgery, 547 18 Ophthalmic Surgery, 568 19 Otorhinolaryngologic Surgery, 614 20 Orthopedic Surgery, 664 21 Neurosurgery, 753 22 Reconstructive and Aesthetic Plastic Surgery, 808 23 Thoracic Surgery, 852 24 Vascular Surgery, 878 25 Cardiac Surgery, 911 UNIT III Special Considerations 26 Pediatric Surgery, 995 27 Geriatric Surgery, 1066 28 Trauma Surgery, 1089 29 Integrative Health Practices, 1116 APPENDIX A Laboratory Values, 1132 Illustration Credits, 1137 Index, 1144 Special Features, 1191 CARE PATIENT of the in A L E X A N D E R ’ S 17th Edition SURGERY 17th Edition CARE of the in Jane C.

Rothrock, PhD, RN, CNOR, FAAN Adjunct Professor, Perioperative Programs Delaware County Community College Media, Pennsylvania Associate Editors Donna McEwen, RN, BSN, CNOR(E) (Deceased) Instructional Designer Consultant Optum Operations Training Optum/UnitedHealthcare San Antonio, Texas Sharon Ann Van Wicklin, PhD, RN, CNOR, CRNFA(E,) CPSN-R, PLNC, FAAN, ISPAN-F Perioperative and Legal Nurse Consultant Self-employed Aurora, Colorado; Editor-in-Chief Plastic and Aesthetic Nursing International Society of Plastic and Aesthetic Nurses Beverly, Massachusetts A L E X A N D E R ’ S PATIENT SURGERY ELSEVIER 3251 Riverport Lane St. Louis, Missouri 63043 ALEXANDER’S CARE OF THE PATIENT IN SURGERY, SEVENTEENTH EDITION Copyright © 2023 by Elsevier Inc.

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