Index

Page numbers followed by ‘f’ denotes figures, ‘t’ denotes tables and ‘b’ denotes boxes.

A

accredited postgraduate programs, 5, 7, 8, 291
acrylic nails, 101, 107
active immunity, 104
active warming devices, 85, 132, 138, 145, 154, 216, 221
acupuncture therapy, 232, 233
adjunct drugs, 135, 146, 227
adrenaline, 173
administering, 148, 156, 157
advanced practice, 301–303
certificate for, 304
adverse events in hospital study, 276
airborne-transmitted diseases, 110
air-conditioning systems, 54
airway assessment, 130–131, 138, 218–220
airway, breathing and colour (ABC), 218, 219, 220
Mallampati assessment with pharyngeal classification, 131f, 143
airway obstruction, 222t
airways
anatomy of upper airway, 140f
artificial, 138
dealing with difficult, 146
intubation, 141–146
laryngeal mask airway (LMA), 140–141
paediatric-sized equipment, 235
Aldrete scoring system, 235, 237t
allergic contact dermatitis, 62
allergies and sensitivities, 36, 132, 250
allergy bands, 253
ambulatory surgery, 237, 243, 245
American Society of Anesthesiologists (ASA), 24–25
physical status classification system, 25t, 131, 248
anaesthesia
adverse reactions, 156–158
awareness under, 146
differences between subarachnoid and epidural, 149t
emergence, 146–147
local, 147–149
complications, 148
local infiltration, 150, 229, 247
maintaining, 146
other types of, 147
paediatric, 159
patient evaluations, 250
regional blocks, 150–151
regional blocks, continuous, 230
technological advancements, 247
total intravenous anaesthesia (TIVA), 158, 247
anaesthesia planes, 133t
anaesthetic agents, 137, 146, 157, 244, 247
effects on cardiovascular system, 75–76
effects on nervous system, 75, 84
side-effects of, 130, 157, 220, 221, 225
anaesthetic assistants, 145
anaesthetic drugs, 147–148, 233
anaesthetic face masks, 138, 140
anaesthetic machine, 139f, 149
preoperative ANZCA guidelines, 137–138
anaesthetic nurses, 60, 131
acute malignant hyperthermia management, 158
advanced practice, 302
anaphylaxis resuscitation, 156
direct laryngoscopy techniques, 144
ECG equipment, 152
intubation equipment checks, 143–144
local anaesthesia, 149
patient monitoring, 150
role overlaps, 6–7
role responsibilities, 5b, 72
anaesthetic overdose, 133t
anaesthetic rooms, 50
anaesthetics, types of, 132–137
anaesthetist
patient handover, 218
role responsibilities, 72, 217, 250
analgesia, 132, 147, 218, 226, 228–229
side-effects of, 227
stages of, 133t
analgesic drugs, 136, 227, 229, 232
anaphylaxis, 156
ancillary workers, 300–301
antianginal medications, 37
antiarrhythmic medications, 37
anticoagulant medications, 37
anticonvulsant medications, 37
anti-embolism stockings, 40
antiemetic drugs, 136t, 146, 247
use in postoperative period, 137
antihypertensive medications, 37
antimicrobial agents, 101, 103, 109, 114, 116, 117
antimuscarinic drugs, 137
anxiety-reduction interventions, 132
aqueous scrub solutions, 114
argon-enhanced electrosurgery, 57
arrhythmias, 151, 158
artery clamps, 195–196
asepsis practices, 111–112, 120
techniques, 104, 120, 149
aspiration, 145, 157, 222t, 233
assisted gloving, 116
atelectasis, 157, 222t
atraumatic instruments, 194, 196, 199, 200
atraumatic needles, 197, 199, 200, 206
double armed, 200
single armed, 200
Australian and New Zealand College of Anaesthetists (ANZCA), 5, 22, 36, 250
Australian and New Zealand Standards, 253, 256
Australian College of Operating Room Nurses (ACORN), 266, 290, 301
perioperative environment classifications, 49–53
standards of practice, 297–299
workplace bullying and harassment, 13
Australian Commission for Safety and Quality in Health Care (ACSQHC), 275–276, 278
Australian Day Surgery Council (ADSC), 243, 245, 257
Australian Nursing and Midwifery Council (ANMC), 263, 289, 304
competency standards, 297
Continuing Competence Framework, 292
defining accountability, 264b
scope of practice framework, 265–266
Australian preoperative checklist, 34f
axillary thermometers, 220

B

bacteria, 100–101, 103
enterococci, 101
Gram-positive cocci, 100
Gram-positive rods, 101
benzodiazepines, 135t
short-acting, 147, 150, 224, 253
bereavement counselling, 273
bioburden, 119, 123
biochemical mediator release, 165–166
biocides, 256
bioterrorism, 100, 105
bipolar diathermy, 38, 56f
bipolar diathermy haemostasis, 173f
bispectral index (BIS), 146
blood patch, 148
blood testing, 27
blood transfusions, 155–156
acute transfusion reactions, 156
body piercings, 38
bolus doses, 228, 229, 230
bone wax, 171
bone-cutting instruments, 194
bovine spongiform encephalopathy (BSE), 102 See also mad cow disease
bradycardia, 137
bronchodilators, 156
bronchospasm, 157, 222t, 224
burns patients, 54
inadvertent hypothermia, 84, 153

C

Candida albicans, 101
cannulas, 71, 133, 155, 208, 209–210
capnography, 153
caring roles, 3–4
dialectic between caring and technical roles, 4b
catheters
epidural catheters, 231
pulmonary artery, 153
urinary, 182
cavitation process, 119
Centers for Disease Control and Prevention (CDC), 31, 32, 105
classification of surgical wounds, 169b
central nerve blocks, 147–149
spinal curvature for insertion, 150f
central venous pressure (CVP) catheter, 152–153
complications, 153
chemical safety, 66
chemotherapy patients, 104
tension sutures, 191
chest X-ray examinations, 26, 152
chickenpox, 110
chlorhexidine solution, 32, 109, 114, 117
circulating nurses, 5, 60, 155
documentation keeping, 273
negligence cases, 270
role overlaps, 6
role responsibilities, 6b, 57
specimen handling, 275
specimen verification, 190
sterile items, handling guidelines, 112f
supporting surgical teams, 189
surgical count, 89
tourniquets usage, 87
wound dressings, 181
clamps, 171, 191, 192
artery, 195–196
bowel, 196
crushing, 196
non-crushing, 196
ring-handled, 192f
cleaning metal instruments, 119
cleaning reusable instruments standards, 118–119
cleaning specialised instruments, 119
closed cart system, 49, 51
closed gloving, 115–116
closed-drainage systems, 182
clostridia, 101
cochlear implants, 38
Cochrane Collaboration, 299
code of ethics, 294
College of Nursing, 287, 291
advanced practice certificate courses, 304
colonoscopy, 147, 246, 247, 249, 250
bowel preparation assessment, 253
communication skills, 3
dynamics in surgery, 14b
failures in, 15b
team, 14–15
comorbidities management, 21–22, 147, 152, 214, 235
compartment syndrome, 77
Consent/Agreement to Treatment forms, 10, 27, 33, 37, 249
continuing education providers, 287
continuous opioid infusions, 229
coroners courts, 271–272
‘correct patient, correct site, correct procedure’ protocol, 278–279
count sheets, 89–90, 270, 273, 274
conventional air system, 54
Creutzfeldt-Jakob disease (CJD), 102
sterilising instruments contaminated by, 124
cultural competence, 9 See also cultural safety
cultural safety, 8–11
tenets of safety model, 11b
curare, 137
curettes, 194
cytotoxic agents, 66

D

day surgeries
accreditation process, 257, 258
Australia’s first purpose-built, 244
booklet for general information, 251b
caregiver information, 253b
common procedures in, 246
defining, 243
discharge checklist, 254t
follow-up telephone calls, 255
historical development of, 243–244
inpatient referrals, 248
instructions and procedures information, 251–252b
intraoperative care guidelines, 253–255
lack of governmental support, 244–245
legislative policies, 258
national activity rates 2005–6, 245t
operation activity rates, 244–245
patient assessment and selection, 248
patient education, 250–251
patients’ expectations of, 247–248
patients’ suitability for anaesthesia, 250
percentage completed cases by country, 246t
postoperative patient care guidelines, 254–255
procedure-specific information, 252b
risk management, 255–257
role in future, 258
systematic reviews, 245b
debridement, 167, 168, 178, 180
sharp, 170
decontaminating reusable instruments standards, 118–119
decontamination process, 119
dedicated operating rooms, 51–52
‘dedicated stream’ rotation models, 288, 289
deep vein thrombosis, 38–39, 93
dermatomes, 194
diabetic patients, 37–38, 234, 249
diagnosis-and-treatment models, 15
diathermy machines, 56–57
fire hazards, 62
direct laryngoscopy, 144–146
backwards, upwards rightwards pressure (BURP), 145–146
rapid sequence induction, 144–145
disinfection processes, 125
documentation errors, 90, 273–274
errors in counting, 274b
double gloving, 110, 115, 300
drains, 87, 181–183
abdominal drains study, 181b
active, 182
haemovac, 182
passive, 182
prophylactic, 181–182
types of tubes, 183f
drapes, 117–118
contain and confine approach, 118
reusable linen, 117
synthetic single-use linen, 117
dressings, 178–181
bolster/tie-over, 180
closed-system, 181
dry sterile, 179
one layer, 178
pressure, 180
skin closure (island), 179
stent, 180
three layer, 180
vacuum-assisted, 181
wet-to-dry, 180
wet-to-wet, 180

E

elderly patients, 71, 93
colonoscopy considerations, 250
inadvertent hypothermia, 84
opioids pain relief, 228
tension sutures, 191
electrical safety procedures, 55–56
electrocardiography (ECG), 55, 220
analysis, 151–152
five-lead, 152
preoperative, 26–27
three-lead, 152
electrocution from equipment, 55–56
electrolytes, 154–155
extracellular, 154
imbalance, 151, 253
intracellular, 154
normal values, 154t
serum electrolytes imbalance, 154
electronic health records (EHR), 274
electronic intraoperative care plans, 274
electrosurgery, hazards, 57–58
electrosurgical unit (ESU), 38, 56–57, 173–174 See also diathermy machines
safety procedures, 57
embolisation, 174
endoclips, 208
endogenous infections, 103
endoloops, 208–209
endoscopes, 210–211
cold light See fibreoptic light
double-balloon, 246
fibreoptic light, 209
fibrescope, 243
flexible, 210, 246, 255, 256
ingestible capsules, 246
rigid, 210
sterilisation techniques, 119, 123
types of, 210t
endoscopic instruments, 208–209, 253
documentation of sterilisation, 256
specialised care of, 255–256
endoscopic minimally invasive surgery, 206–211
endoscopic specimen bag, 211
endoscopic stapling devices, 209
endoscopic surgery
camera set-up for, 210f
patient education, 247–248, 249
public hospitals, 253
endoscopist nurses, 257, 258
endoscopy
emerging nursing roles within, 257–258
flexible, 243
technology, 59–60, 246
endotracheal tubes (ETT), 140
correct position, 145f, 157
Murphy eye, 143
Ring-Adair-Elwyn (RAE) tubes, 143
endovascular operating rooms, 52 See also interventional operating rooms
enrolled nurse (EN), 287
advanced practice, 303–304
competency standards, 297–299
educational pathway, 267b, 289
medication administration, 303, 304
Perioperative Education Program for ENs (PEPEN), 304
role responsibilities, 33
scope of practice, 5, 6, 8, 289
environmentally controlled units, 46–48, 66
enzymatic cleaners, 66, 119, 123, 256
epidural anaesthesia, 108, 147, 148, 230–231
advantages of, 231
ineligible patients, 148–149
location of needle points, 148f
epithelialisation, 167, 168
Esmarch’s rubber bandage, 86
evidence-based practice, 299–300
exogenous infections, 103

F

face-to-face interviews, 248, 249
fasting, 30, 249, 253
unknown times, 143, 145
fibrin glue, 173, 177, 178b
fibroblasts, 166
fire and explosion in operating rooms, 61–62
New Zealand case, 62b
first surgical assistants, 6
fluid balance, 154–155
complications from imbalance, 155
overload symptoms, 155
fluid-resistant face masks, 107–108
forceps, 56, 144, 194f
artery, 89, 171, 189, 192
bone-holding, 194
dissecting/tissue forceps, 194–195
non-toothed, 194
ring-handled, 195
toothed, 194
types of, 194f
haemostat, 171, 192
non-toothed, 189
sponge-holding, 194, 195
toothed, 189
Fowler’s/semi-Fowler’s positions, 83–84
fracture table position, 83
illustration, 84f
friction injuries, 74
fungi, 101, 103

G

gamma radiation, 122
gangrene, 101
gaseous inhalational agents, 133–134t, 135
paediatric patients, 133
general anaesthesia, 130, 132–133, 135
adjuncts to, 135–136t
intravenous induction agents, 132
preoxygenation, 138
procedures for preparation, 137–138
stages of, 133t
Geobacillus stearothermopholis, 125
Glasgow Coma Scale, 234
gowns, 114–116
disposable, 115
manufacturing standards for disposable and resposable, 114f
reusable, 116
reusable gowning techniques, 115f
graduate certificate courses, 291
granulation tissues, 166–167, 168
group teaching, 29
Guedel airways, 138
guided imagery and music therapy pain management, 233b

H

haemodynamic monitoring, 150, 151–156
direct blood monitoring, 152
equipment, 151
indicators for invasive blood monitoring, 152b
indirect blood monitoring, 152
invasive blood monitoring, 152–153
minimum requirements, 151b
non-invasive blood monitoring, 153
respiratory function monitoring, 153
temperature monitoring, 153–154
haemorrhage, 225–226
haemostasis
additional methods, 174
chemical methods, 172–173
electrosurgical methods, 173–174
ligating a bleeding vessel, 171f
mechanical methods, 170–172
mechanisms of, 165f
surgical, 170–174
hair clipping from surgical site, 117, 252
hair removal from surgical site, 30, 32, 117
hand hygiene, 100, 104, 105, 109, 300
illustration, 114f
handover of care, 217–218, 238
health workforce reviews, 300
healthcare-associated infections, 101
HEPA filtered air, 54
hepatitis B immunoglobulin injections, 104
hepatitis viruses, 102, 256
herbal dietary supplements, 130
hierarchical models, 12–13
histamine, 165
hormone replacement medications, 93
hospital-acquired infections (HAI), 103, 104 See also nosocomial infections
hover mats, 61, 71, 72
Hudson masks, 150, 217, 219
human immunodeficiency virus (HIV ), 102, 256
hydrocortisone, 156
hypertension, 157
hypotension, 148, 155, 225
hypothermia See inadvertent hypothermia
hypoventilation, 223t
hypovolaemia, 155, 165
shock management, 225
hypoxaemia, 38, 157, 222t

I

immediate hypersensitivity to latex, 63
implants, care with, 38
inadvertent hypothermia, 40, 84–85, 153–154
patients at risk, 84
Indigenous populations, 8
infection
body’s defences against, 104–105
immune responses, 104
process of infection, 103–104
rate of morbidities, 104
infection control, 100, 256
additional precautions, 110–111
airborne precautions, 110
blood-borne diseases, 109–110
contact precautions, 110
correct perioperative attire, 106–107
droplet precautions, 110–111
environmentally controlled units, 106
history of, 109b
isolating patients, 110, 216
legislative policies, 268
prevention strategies, 104f
quality and risk management policies, 106
standard precautions, 108–110
two-tiered approach, 108
influenza, 110
informed consent, 27, 33, 270
instrument nurses, 5, 6–7, 60
advanced practice, 302
applying dressings, 192
educational pathway, 267b
negligence cases, 270
professional socialisation, 11
role responsibilities, 7b, 57, 72
scalpel handling, 193
specimen handling, 275
specimen verification, 190
sterile items, handling guidelines, 112f
surgical count, 89, 171
surgical sequence knowledge, 189
transient role overlaps, 6
wound dressings, 181
insulin medications, 37
integrated operating rooms, 52
interpreter services, 33
interventional operating rooms, 52
intraoperative repositioning, 71–72
intraoperative X-ray machine, 52f
intravenous induction agents, 132, 145
intravenous solutions, 155
intubation process, 141–146
adult and paediatric equipment, 142f
complications, 143
endotracheal tubes (ETT), 141, 143
equipment requirements, 143–144
extubation, 146–147
techniques, 144–146
invasive haemodynamic monitoring devices, 135
ionising radiation, 65
irritant dermatitis, 62

J

jewellery, 38, 107, 113–114

K

keyhole surgery, 59, 206
knot replacements, 175–176

L

laminar airflow, 54
laparoscopic surgery, 206
laparotomy surgical procedure, 189–192, 209
laryngeal mask airway (LMA), 140–141
laryngeal oedema, 222t
laryngospasm, 157, 222t, 223–224
laser technology, 58–59, 173–174
hazards, 58
lateral position, 79–80, 217
nursing interventions and rationales, 80t
latex allergies, 36
occupational health and safety case, 64b
signs of developing, 63b
types of reactions, 62–63
latex-sensitive patients, 63
legislations, 258, 263, 268, 271, 272
ligatures, 171
limb occlusion pressure (LOP), 86, 87
line isolation monitoring (LIM), 55
linear staples, 189
lithotomy position, 77, 209
boot-type stirrups, 81f
four basic positions, 81f
nursing interventions and rationales, 82t
ligating clips, 171
lobby groups, 294
local anaesthetics, 147, 150, 151, 227, 229, 230, 232
complications from, 230–231

M

macroshock, 55
mad cow disease, 102
malignant hyperthermia, 157–158, 221
treatment, 158
malignant hyperthermia patients, 130
alternative anaesthesia, 158
Mallampati assessment, 143
pharyngeal classification, 131f
manual handling techniques, 61
manual handling training, 73
Māori culture, 38, 275
respect for traditional values and beliefs, 9b
Material Safety Data Sheets (MSDS), 125
medical/health questionnaires, 23, 248
Mendelson’s syndrome, 145
meningococcal infections, 110
methicillin-resistant staphylococcal infections (MRSA), 101, 103
microorganisms, 100–103
acellular, 101–102
cellular, 100–101
common microorganisms in perioperative environments, 102t
entry and exit portals, 103–104
transient, 103
transmission of, 104, 108
microshock, 55–56
minimal access surgery, 206–207
minimally invasive insertion techniques, 209–211
closed (blind) technique, 209
open technique, 209
minimally invasive surgery, 59, 206–211
history of, 207b
risks within, 208
monopolar diathermy, 38, 56f
monopolar diathermy haemostasis, 173f
Montgomery straps, 180f
morphine, 227, 230
mouth care, 221
multidisciplinary approaches, 14, 15
multi-drug resistant tuberculosis, 103
multimodal analgesics, 232
multiresistant organisms (MROs), 110
specific policies, 104–105
muscle relaxants See also neuromuscular blocking agents
inadequate reversal, 225
non-depolarising, 137
short-acting depolarising, 145, 224
side-effects of, 157, 221, 223
musculoskeletal system injuries, 74–75
myocardial ischaemia, 151, 152

N

nasogastric tubes, 182
nasopharyngeal airways, 138
needles, 200–206
body types, 205–206
curved, 200, 204
cutting point, 204
conventional, 204
reverse, 204
holders, 195
insufflation, 209
loading, 206
point types, 204f
swaged, 206
taper point, 204–205
blunt, 204
taper cut, 205
types and their uses, 205t
Veress, 209
negligence cases, 269–271
neonates, 153
inadvertent hypothermia, 84
normothermia, 154, 159
neostigmine, side-effects of, 137
neuromuscular blocking agents, 136t, 137, 144, 145, 157
New Zealand, 8
accreditation process, 296
adverse events results, 276
body parts or tissue release form, 39f
code of conduct, 264t
Code of Rights, 265, 268, 270
District Health Boards nursing funding, 287, 291
fire and explosion in operating rooms, 62b
nursing registration legislations, 263
Perioperative Nurses College (PNC), 296
postgraduate program providers, 291
preoperative checklist, 35f
return of body parts and tissue, 9b, 38, 275
New Zealand Health Strategy, 21
New Zealand Nurses Organisation (NZNO), 294, 296
non-allergenic tapes, 180
non-invasive haemodynamic monitoring devices, 135
non-ionising radiation, 65
non-steroidal anti-inflammatory drugs (NSAIDS), 226, 232
normothermia, 40, 153–154
maintaining, 220–221
neonates, 154, 159
paediatric patients, 159
nosocomial infections, 101, 103, 255
Nurse Practitioners
advanced practice, 301–302
development of new perioperative roles, 7, 303
legislative framework, 257, 265
paediatric orthopaedic, 303
perioperative environment, 266b, 300
prescribing and referral responsibilities, 303
role responsibilities, 23
standards of practice, 297–299
transitional perioperative, 303
nurse regulatory authorities (NRA), 263
nurse-led clinics, 21, 22
referrals, 23–25
nurse-led discharges, 238
Nursing Council of New Zealand (NCNZ), 8, 263
advanced nursing roles, 265
cultural safety, 9–10
nursing graduates, 288–291
developing skills on rotation, 288–289
nursing unions, 294
nursing workforce, ageing, 2

O

obese patients, 37, 93, 249
patient positioning, 30, 73, 77–78
safe patient transfer, 71
supine hypotensive syndrome, 75
tension sutures, 177, 191
obtaining consent, 10, 23–24, 132, 268
occupational health and safety, 55–56, 58
chemical safety, 66
correct method of passing scalpel, 64f
ethylene oxide (ETO) sterilisation, 123
hepatitis B immunoglobulin injections, 104
latex allergies, 62–64
radiation safety, 65–66
sharps injuries, 64–65, 104
online nursing educational courses, 290, 291
open gloving, 116
operating list, 15–16
operating room culture, 12–13
operating room preparation, 60
operating suite designs, 46–54, 215
design features, 53–54
operating room specifications, 51
PARU unit considerations, 51
temperature and humidity control, 54
traffic patterns considerations, 48–49
typical operating room, 52f
ventilation systems, 54
opioids, 135t, 136, 147, 226, 230, 247, 253
continuous infusion, 229
intravenous, 227–228
postoperative management, 227–228, 230
side-effects of, 231
oral analgesics, 232
oral thermometers, 220
organ and tissue donation legislations, 272–273
organ donation after brain death, 272–273
organ donation after cardiac death, 273
orientation and clinical programs, 289–291
oropharyngeal airways, 138
oxygen therapy, 219
oxytocin, 172–173

P

P2 masks, 110
pacemaker dysfunction, 151
packaging sterilised items, 120
paediatric patients
anaesthesia methods, 133
anaesthetic alternatives, 147
discharge criteria, 235
family-centred care approach, 235
malignant hyperthermia treatment, 158
normothermia, 159
pain assessment tools, 226–227
pain management, complementary therapies, 232–233
pain management education information, 250–251
passive immunity, 104
patient advocacy, 6, 264–265, 271
patient discharge criteria, 235–238
patient empowerment, 28–30
patient identification process, 33, 131–132
patient medical history, 26
patient notes as evidence in court, 273
patient positioning, 71–74, 75, 147, 149, 209, 217
patient safety, maintaining, 14–15, 71, 235, 267
patient satisfaction surveys, 251
patient social history, 26, 250
patient transfer safety, 71–73, 79, 217
injuries, 72–75
patient-controlled analgesia (PCA), 228–229
patient-nurse relationship, 4, 9
patients’ correct site of surgery, 87–88
patients’ drug history, 130
patients’ family history, 130
patient-specific issues, 71
patties, 171
pelvic pooling, 84
peracetic acid, 66
perioperative nurse surgeon’s assistant (PNSA), 5, 7, 295, 302
advanced practice, 302–303
role responsibilities, 7b, 303
Perioperative Nurses College of the New Zealand Nurses Organisation (PNCNZNO), 266, 290, 296
Perioperative Nurses College (PNC), 88, 253–255, 268, 294, 296
perioperative nursing, 303
accountability, 264
cleaning protocols, 60
code of conduct, 263–264
competency standards, 267–268, 295
cross-professional boundaries, 300–301
defining, 2–4
delegating work to other health workers, 266
development of new perioperative roles, 303
documentation keeping, 273
electronic intraoperative care plans, 274
holistic approach, 3
identifying cultures in, 11
intraoperative roles, 5
multidisciplinary approach, 3, 301
philosophy, 3
professional standards, 266–267
role confusions, 4
roles of, 3
safety and risk management, 275–279
systems approach, 278–279
scope of practice, 5, 265–266
specialty knowledge, 11–12
specialty language, 12b
surgical count standards guide, 88
transferability of skills, 293
wound management, 182, 183
perioperative patient warming, 154
perioperative speciality, history of, 2
peripheral nerves injuries, 75t
personal protective equipment (PPE), 109
phagocytosis, 166
physical status classification system, 25t, 131, 248
physiotherapy, 232
planned hypothermia, 153
plasma cholinesterase, 137
plasma protein systems
clotting system, 166
complement system, 166
kinin system, 166
pledgets, 171
pneumoperitoneum, 209
pneumothorax, 152, 153, 230
positional aids, 80, 83
Post Anaesthetic Discharge Scoring System (PADSS), 237t
Postanaesthesia Discharge Scoring System (PADS) modified, 254
postanaesthetic recovery unit (PARU) facilities
access into, 216
allocated patient bays, 216
day surgeries, 214
design features, 214–216
equipment requirements for, 216–217
equipment requirements for patient bays, 216
first Australian facility, 215b
isolation bays for patients, 216
paediatric patients, 221
patient transfer, 217
postanaesthesia care chart, 236f
recovery unit, 51
stage 1 areas, 214
stage 2 areas, 214, 238
tertiary hospitals, 214–216
typical set-up, 215f
postanaesthetic recovery unit (PARU) nurses, 5, 7–8
adult discharge criteria, 235–238
advanced practice, 302
airway assessment and management, 218–220
bronchospasm management, 224
complementary therapies pain management, 232–233
continuous opioid infusions administration, 229
continuous peripheral (regional) nerve block management, 230
epidural analgesia management, 230–231
haemodynamic monitoring, 219
haemorrhage management, 225–226
handover of care procedures, 217–218, 238
hypotension management, 225
intravenous opioid administration, 227–228
laryngospasm management, 223–224
paediatric discharge criteria, 235
paediatric patient care, 234–235
pain assessments, 218–219, 226–228
patient-controlled analgesia (PCA) education, 228
post local anaesthesia infiltration management, 229
post regional anaesthesia management, 229–230
postoperative handover, 217–218
postoperative nausea and vomiting management, 233–234, 247
postoperative patient care management, 218–221
reducing patient anxieties, 221
role responsibilities, 8b
secretions obstruction management, 223
specialty surgery patient care, 234
spinal anaesthesia management, 231–232
temperature monitoring, 220–221
tongue obstruction management, 221, 223
postanaesthetic respiratory complications, 221–225
postoperative blood pressure readings, 220
postoperative cardiovascular complications, 225–226
postoperative circulation assessment, 220
postoperative complications, 148
postoperative handover of care, 217–218
postoperative nausea and vomiting, 233–234, 247, 254
postoperative pain management, 226–233
drug interventions, 226–232
non-drug interventions, 232–233
postoperative patient care, 254–255
postoperative respiratory complications, 222–223t
povidone-iodine solutions, 114, 117
preadmission care, 26b
preadmission clinics, 21, 23
preadmission interviews, 22–23
preadmission nurses, 5
role responsibilities, 23
preadmission stage, 21
preanaesthetic assessments, 130–131
pregnant patients, 75
patient positioning, 77–78
premedication and medication assessments, 37–38
preoperative admission
checking patient in operating suite, 33f
requirements for, 32b
preoperative assessments, 21–23
day surgeries, 248
face-to-face interviews, 248, 249
factors affecting, 249–251
models available for, 248–249
non-physician practitioner role, 22
objectives, 22b
patient questions, 24–25t
patients’ medical history, 249–250
routine screening tests, 249
telephone assessments, 23, 248, 249
preoperative bathing, 30, 31–32
preoperative care, 21
preoperative checklists, 34–36, 131–132
preoperative education, 28–30
follow-up, 30
preoperative fasting, 36–37
preoperative holding bays, 50
preoperative investigations, 26–28
preoperative patient warming, 40, 85
preoperative preparation, 21
preoperative preparation education guide, 31t
preoperative preparation patient education guide, 31t
preoperative screening, 23
preoperative skin preparation, 116–117
preoperative visiting, 30
pressure injuries, 73–74
prions, 102
professional associations, 293–297
ACORN state/territory branches, 295
governance standards, 294
international member organisations, 296–297
perioperative associations, 294–296
professional nursing development, 291–293
hospital-based certificates, 291
professional portfolios, 292
professional socialisation, 10–11, 12
professional status recognition, 292–293
prone position, 78–79
nursing interventions and rationales, 79t
prophylactic antibiotic therapy, 250
prophylactic antiemetic medications, 233–234
provision-of-care models, 15
psychological interventions, 232
pulmonary embolus (PE), 93, 94
pulse oximetry, 153, 220
punches, 194

R

racetrack style operating suite, 46
model, 47f
radiation safety, 65–66
recovery position, 147
regional anaesthesia, 229–230
complications, 230
registered nurse (RN), 5, 287, 290
administering sedatives, 253
advanced practice, 301–303
competency standards, 297–299
role responsibilities, 33, 72
scope of practice, 6
surgical count, 88, 89
venepuncture accreditation, 23
restricted areas, 51, 106
retained surgical instruments
case study, 279b
contributing factors, 278t
retractors
hand-held, 196, 197
manual, 196f
self-retaining, 196
self-retracting abdominal, 189
reversal drugs, 137, 146
reverse Trendelenburg position, 75, 81, 209
nursing interventions and rationales, 83t
robotics surgery, 59–60

S

scalpels, 174, 193, 208
cartilage, 193
correct method of passing scalpel, 64f
haemostatic, 174, 189
harmonic, 208
tonsil, 193
ultrasonic, 174
scar tissue, 38
scissors, 193–194
cavitation process, 119
dissecting, 193
dressing, 193
range of typical surgical, 193f
suture, 193
wire cutters, 193
sclerotherapy, 174
scrub areas, 53
secretions obstruction, 222t, 223
sedation, 147
sedationist nurses, 257, 258
Sellick’s manoeuvre, 145
semi-restricted areas, 50, 106, 116, 216
sentinel events, 276–279
common, 276
contributing factors, 277t
contributing factors for retained surgical instruments, 278t
retained surgical instrument after surgery case study, 279b
system factors, 277–278
wrong patient or body part case study, 277b
septicaemia, 101
serotonin, 165, 166
sharps injuries, 64–65, 104
shear injuries, 74, 81
short-acting intravenous induction agents, 132
silent myocardial infarction, 27
single corridor operating suite, 46
model, 47f
skills shortage, 2
skin anatomy, 163
diagram, 164f
skin hooks, 197
skin staples, 191–192
skin wounds, closing, 191–192
small clusters operating suite, 46
model, 48f
smoke plume hazards, 57, 59
smoking
complications from, 27–28
interventions for preoperation, 28b
preoperative educative material, 29b
snares, 194
Spaulding’s classification of infectious risks, 118t
specialised indicator tape, 120
specialty-specific journals, 299
specialty knowledge, 11–12
specialty language, 12b
specimen handling procedures, 275
spinal anaesthesia, 108, 147, 231–232
ineligible patients, 148–149
location of needles, 148f
side effects of, 231–232
staff rooms, 51
staphylococci, 100–101
sterile fields, 111, 113
handling and pouring procedures, 112–113
strikethrough, 118
surgical scrub, 113–114
sterile items, handling guidelines, 112–114
flipping procedures, 113f
pouring solution into sterile galipot, 113f
presenting items in operation, 112f
unwrapping items, 112f
sterile stock rooms, 50
sterilisation, 120–125
19th century, 197
biological indicators, 125
dry heat sterilisation, 122
endoscopic instruments, 255–256
ethylene oxide (ETO) sterilisation, 123
external indicators, 124
flash sterilisation, 122
gamma radiation, 122, 124
gas plasma sterilisation, 123
instruments contaminated by CJD prions, 124
integrator, 124
internal chemical strips See integrator
methods of, 121t
peracetic acid sterilisation, 123
reusable instruments standards, 118–119
steam sterilisation, 122, 125
tracking and traceability systems, 125, 256
validation processes, 124
sterilising departments, 51
steroids, 157
storage areas, 50
streptococci, 100–101
supine hypotensive syndrome, 75
supine position, 148, 209, 217, 221
nursing interventions and rationales, 78t
surgeons, role responsibilities, 89
surgical conscience, 111
surgical count, 88–91, 190, 191
completed count sheet, 90
counting procedures, 89–90
electronic tagging, 88
emergency situations, 90–91
incorrect count, 90
limitations, 90
public hospitals, 268
radiofrequency identification chips, 88
standards guide, 88
surgical instruments, 192–197
blunt dissection, 194
caring for, 197
clamps, 195–196
cutting and dissecting, 193–194
grasping and holding, 194–196
retractors, 196–197
sterilisation checks, 192
sutures and needles, 197–206
surgical positions, standard, 78–84
surgical priorities, determining, 15–16
surgical procedures
archaeological evidence, 187
closing procedure, 190
collection and verification of specimen procedure, 190
common indications for, 187t
dissection and exposure procedure, 189
exploration and isolation procedure, 189
five stages of, 189t
haemostasis and irrigation stage, 189
invasive, 188
minimally invasive, 59, 206–211
non-invasive, 188
open procedure, 189
operative technique, 188
repair procedure, 189
sequence, 188–192
technological advancements, 2, 188
surgical scrub techniques, 113–114
surgical sequence, 188–192
surgical site infection (SSI), 30–32, 100, 101
sutures, 197–200
absorbable, 200
absorbable monofilament, 191
braided, 203t
braided monofilament, 201t
coefficient friction, 199
continuous running/locking, 176
controlled-release, 206
diameter, 198
drain, 176
elasticity, 199
handling characteristics, 198–199
history of, 197
laparoscopic, 208
material gauge, 199f
monofilament, 198, 201t, 202t, 203t
multifilament, 198, 199, 202t, 203t
multifilament braided, 201t, 202t
natural, 198
non-absorbable, 200
pliability, 199
properties, 198
retention, 176
silk, 176, 199–200
simple continuous, 175
simple interrupted, 175–176
subcuticular technique, 191
synthetic, 198, 199
tensile strength, 199
tension, 191
tissue reactions, 199–200
sympathomimetic agents, direct-acting, 156
systematic reviews, 30, 31, 32, 37b, 245b, 299–300

T

tachycardia, 155, 157
tachypnoea, 157
TAFE provision of enrolled nursing courses, 287, 289
teamwork, 13–15
multidisciplinary approach, 14, 15
technical roles, 3–4, 11–12
dialectic between caring and technical roles, 4b
telephone assessments, 23, 248, 249
telescopic surgery, 206
temperature monitoring, 220–221
tenaculums, 195
terminal cleaning, 60
tetanus, 101
therapeutic touch, 132
thrombin, 172
ties, 171, 200 See also ligatures
‘time out’ procedure, 87–88
tissue implants and wound replacement materials, 179t
tissue specimens
care and handling, 91
correct handling and transportation guidelines, 91–92t
division of, 190t
tongue obstruction, 221, 222t, 223
jaw thrust manoeuvre and chin lift illustration, 223f
total intravenous anaesthesia (TIVA), 158, 247
tourniquets, 73, 85–87, 172
adult inflation pressures, 86t
automated, 87
injuries from, 86, 93
non-automated, 87
pneumatic, 86, 87, 172
towel clips, 194, 195
toxic shock syndrome, 101
transcutaneous electrical nerve stimulation, 233
transient hypoxaemia, 138
transition areas, 49–50
tray lists, 120
Trendelenburg position, 77–78, 81, 82f
nursing interventions and rationales, 83t
trocars, 207, 209
tuberculosis, 110
tympanic thermometers, 220

U

ultra clean air system, 54
ultrasonic cleaning, 119
ultrasonic technology, 58
undergraduate curriculum, 287–288
impact of clinical placements, 288
inadequate perioperative electives, 287
undergraduate nursing opportunities, 288–289
university nursing degrees
extended programs providers, 290–291
perioperative specialties, 288, 290
postgraduate program providers, 291
unrestricted areas, 50, 116

V

vancomycin-resistant enterococci (VCE), 103
vascular disease patients, 86
vasodilation, 148, 155, 166
venous stasis, 84 See also pelvic pooling
venous thromboembolism (VTE), 92–94
intraoperative risks, 93
patients at risk, 93
prevention management, 94t
signs and symptoms, 93t
viruses, 101–102, 103
volatile inhalational agents, 132, 133–134, 134t, 247

W

warm packs, 171, 218, 221
waste management, 61
waterless alcohol-based hand rubs, 109
workplace cultures, 10–11, 293
bullying and harassment, 13
wound care, 178–183
drains, 181–183
dressings, 178–181
wound classification, 168–170
CDC classification of surgical wounds, 169b
wound closures, 167–168
biological materials, 177
continuous running/locking sutures, 176
delayed primary closure, 168
drain sutures, 176
fibrin glue, 173, 177
fibrin glue compound and supplies, 178b
illustration, 175f
laparotomy surgical procedure, 190–192
methods of, 174–178
multiple layer closure, 175
primary intention closure, 167–168
retention sutures, 176
secondary intention closure, 168
simple continuous sutures, 175
simple interrupted sutures, 175–176
single layer closure, 175
skin clip application, 177f
skin tapes, 177f
stapling, 176–177
subcutaneous incision greater than 3 cm deep, 168b
subcutaneous sutures, 176
suturing techniques samples, 175f
synthetic mesh materials, 177
tissue adhesives, 177
tissue implants and replacement materials, 179t
wound healing, 164–167
contraction, 167
haemostasis mechanism, 165f
inflammatory phase, 164, 165–166
mechanisms of, 167f
proliferative (reconstructive) phase, 164, 166–167
remodelling phase, 164, 167
wounds, 163–164
chronic, 164
intentional, 163
unintentional, 163–164

X

X-ray protective attire, 65–66