Rapid Perioperative Care is an essential text for students and practitioners requiring up-to-date fundamental information on the perioperative environment. Covering a wide range of subjects related to perioperative practice and care, each chapter is concise and focused to guide the reader to find information quickly and effectively. This book uses a structured approach to perioperative care, starting with an introduction to the perioperative environment, anaesthetics, surgery and recovery, followed by postoperative problems and finally the roles of the Surgical Care Practitioner (SCP).
Covering all the key topics in the perioperative environment, this concise and easy-to-read title is the perfect quick-reference book for students and theatre practitioners to support them in their work in clinical practice, and enable them to deliver the best possible care.
Paul Wicker is Visiting Professor at the First Hospital of Nanjing, China and Fellow of the Higher Education Academy, UK.
Sara Dalby is Surgical Care Practitioner at Aintree University Hospital Trust, and Associate Lecturer at Edge Hill University, UK.
Rapid Perioperative Care is an essential text for students and practitioners requiring up-to-date fundamental information on the perioperative environment. Covering a wide range of subjects related to perioperative practice and care, each chapter is concise and focused to guide the reader to find information quickly and effectively. This book uses a structured approach to perioperative care, starting with an introduction to the perioperative environment, anaesthetics, surgery and recovery, followed by postoperative problems and finally the roles of the Surgical Care Practitioner (SCP). Covering all the key topics in the perioperative environment, this concise and easy-to-read title is the perfect quick-reference book for students and theatre practitioners to support them in their work in clinical practice, and enable them to deliver the best possible care.
Paul Wicker is Visiting Professor at the First Hospital of Nanjing, China and Fellow of the Higher Education Academy, UK. Sara Dalby is Surgical Care Practitioner at Aintree University Hospital Trust, and Associate Lecturer at Edge Hill University, UK.
Cover???????????????????????? 1
Title Page?????????????????????????????????? 5
Copyright???????????????????????????????? 6
Contents?????????????????????????????? 7
Preface???????????????????????????? 11
Acknowledgements?????????????????????????????????????????????? 13
Abbreviations???????????????????????????????????????? 15
Section 1 Preoperative Preparation 19
Chapter 1 The Role of the Anaesthetic Practitioner?????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 21
Preanaesthetic phase?????????????????????????????????????????????????????? 21
Anaesthesia???????????????????????????????????? 22
Checking the anaesthetic machine?????????????????????????????????????????????????????????????????????????????? 22
Monitoring responsibilities???????????????????????????????????????????????????????????????????? 23
Conclusion?????????????????????????????????? 24
Chapter 2 The Role of the Surgical Practitioner???????????????????????????????????????????????????????????????????????????????????????????????????????????? 25
Scrub practitioners???????????????????????????????????????????????????? 25
Circulating practitioners???????????????????????????????????????????????????????????????? 26
Chapter 3 The Role of the Recovery Practitioner???????????????????????????????????????????????????????????????????????????????????????????????????????????? 29
The role of practitioners in recovery???????????????????????????????????????????????????????????????????????????????????????? 29
Admission to recovery???????????????????????????????????????????????????????? 30
Initial assessment of a patient???????????????????????????????????????????????????????????????????????????? 30
Discharge of patient?????????????????????????????????????????????????????? 31
Chapter 4 Preoperative Assessment of Perioperative Patients???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 32
Introduction?????????????????????????????????????? 32
Preoperative preparation?????????????????????????????????????????????????????????????? 32
Reducing postoperative complications?????????????????????????????????????????????????????????????????????????????????????? 35
Chapter 5 Perioperative Patient Care?????????????????????????????????????????????????????????????????????????????????????? 39
Preoperative visiting???????????????????????????????????????????????????????? 39
Patient preparation???????????????????????????????????????????????????? 39
Care during anaesthesia???????????????????????????????????????????????????????????? 40
Intraoperative care???????????????????????????????????????????????????? 41
Transferring the patient to recovery?????????????????????????????????????????????????????????????????????????????????????? 42
Postoperative care?????????????????????????????????????????????????? 42
Discharge of the patient back to the ward???????????????????????????????????????????????????????????????????????????????????????????????? 44
Chapter 6 Operating Theatre Attire and Personal Protective Equipment?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 45
Chapter 7 Surgical Safety Checklist???????????????????????????????????????????????????????????????????????????????????? 47
Team brief?????????????????????????????????? 47
Pre-anaesthetic SIGN IN???????????????????????????????????????????????????????????? 47
TIME OUT?????????????????????????????? 48
SIGN OUT?????????????????????????????? 48
Conclusion?????????????????????????????????? 48
Chapter 8 Teaching Students How to Use Operating Theatre Equipment?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 50
Anaesthetic equipment???????????????????????????????????????????????????????? 50
Surgical equipment?????????????????????????????????????????????????? 51
Principles of the swab and instrument count (SIC)???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 51
Basic surgical instruments?????????????????????????????????????????????????????????????????? 52
Chapter 9 Perioperative Equipment???????????????????????????????????????????????????????????????????????????????? 55
Initial equipment checks?????????????????????????????????????????????????????????????? 55
Operating room equipment?????????????????????????????????????????????????????????????? 55
Anaesthetic equipment???????????????????????????????????????????????????????? 55
Equipment for resuscitation???????????????????????????????????????????????????????????????????? 56
Patient-monitoring equipment?????????????????????????????????????????????????????????????????????? 56
Surgical equipment?????????????????????????????????????????????????? 57
Other operating room equipment?????????????????????????????????????????????????????????????????????????? 57
Conclusion?????????????????????????????????? 58
Chapter 10 Managing Perioperative Medication?????????????????????????????????????????????????????????????????????????????????????????????????????? 59
Introduction?????????????????????????????????????? 59
Principles of managing medication???????????????????????????????????????????????????????????????????????????????? 59
Perioperative medications???????????????????????????????????????????????????????????????? 59
Conclusion?????????????????????????????????? 63
Chapter 11 Interprofessional Learning and Collaboration???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 64
Providing interprofessional learning?????????????????????????????????????????????????????????????????????????????????????? 64
IPL for students?????????????????????????????????????????????? 65
Conclusion?????????????????????????????????? 66
Chapter 12 Preventing Surgical Site Infection???????????????????????????????????????????????????????????????????????????????????????????????????????? 67
Surgical site infections?????????????????????????????????????????????????????????????? 67
Risks associated with SSIs?????????????????????????????????????????????????????????????????? 67
Causes of SSIs?????????????????????????????????????????? 68
Perioperative care?????????????????????????????????????????????????? 68
Conclusion?????????????????????????????????? 69
Chapter 13 Skin Preparation for Surgery???????????????????????????????????????????????????????????????????????????????????????????? 70
Surgical skin preparation???????????????????????????????????????????????????????????????? 70
Skin prep solutions???????????????????????????????????????????????????? 71
Summary???????????????????????????? 71
References and Further Reading 72
Section 2 Anaesthesia 83
Chapter 14 Preoperative Evaluation of the Anaesthetic Patient???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 85
Identification of high-risk patients?????????????????????????????????????????????????????????????????????????????????????? 85
Preoperative visits???????????????????????????????????????????????????? 86
Previous problems???????????????????????????????????????????????? 86
Smoking???????????????????????????? 86
Alcohol and medications???????????????????????????????????????????????????????????? 86
Obesity???????????????????????????? 87
Bleeding problems???????????????????????????????????????????????? 87
Conclusion?????????????????????????????????? 87
Chapter 15 Preparing Anaesthetic Equipment?????????????????????????????????????????????????????????????????????????????????????????????????? 88
Anaesthetic machine???????????????????????????????????????????????????? 88
Anaesthetic equipment???????????????????????????????????????????????????????? 89
Chapter 16 Checking the Anaesthetic Machine???????????????????????????????????????????????????????????????????????????????????????????????????? 92
Checking the anaesthetic machine?????????????????????????????????????????????????????????????????????????????? 92
Checking the anaesthetic machine?????????????????????????????????????????????????????????????????????????????? 93
Manual Ventilation?????????????????????????????????????????????????? 94
Conclusion?????????????????????????????????? 95
Chapter 17 Anatomy and Physiology: The Cardiovascular System?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 96
The heart???????????????????????????????? 96
Blood vessels???????????????????????????????????????? 96
Arteries and arterioles???????????????????????????????????????????????????????????? 97
Blood???????????????????????? 98
Cardiovascular system physiology?????????????????????????????????????????????????????????????????????????????? 98
Chapter 18 Anatomy and Physiology: The Lungs?????????????????????????????????????????????????????????????????????????????????????????????????????? 100
Oxygen exchange???????????????????????????????????????????? 101
Lung problems???????????????????????????????????????? 101
Conclusion?????????????????????????????????? 102
Chapter 19 General Anaesthesia?????????????????????????????????????????????????????????????????????????? 103
Premedication???????????????????????????????????????? 104
Anaesthetic induction???????????????????????????????????????????????????????? 104
Airway management???????????????????????????????????????????????? 105
Maintenance of anaesthetic?????????????????????????????????????????????????????????????????? 105
Monitoring?????????????????????????????????? 105
Complications???????????????????????????????????????? 105
Chapter 20 Local Anaesthesia?????????????????????????????????????????????????????????????????????? 107
Pathophysiology???????????????????????????????????????????? 107
Action of local anaesthetics?????????????????????????????????????????????????????????????????????? 107
Local anaesthetics?????????????????????????????????????????????????? 108
Administration of LAs???????????????????????????????????????????????????????? 109
Allergic reaction to LAs?????????????????????????????????????????????????????????????? 110
Chapter 21 Regional Anaesthesia???????????????????????????????????????????????????????????????????????????? 111
Examples of surgical procedures???????????????????????????????????????????????????????????????????????????? 111
Regional blocks???????????????????????????????????????????? 112
Chapter 22 Rapid Sequence Induction???????????????????????????????????????????????????????????????????????????????????? 114
Introduction?????????????????????????????????????? 114
Airway protection???????????????????????????????????????????????? 114
Steps taken for rapid sequence induction?????????????????????????????????????????????????????????????????????????????????????????????? 115
Preparing for RSI???????????????????????????????????????????????? 115
Drugs used for RSI?????????????????????????????????????????????????? 116
Undertaking RSI in different settings???????????????????????????????????????????????????????????????????????????????????????? 116
Chapter 23 Total Intravenous Anaesthesia (TIVA)???????????????????????????????????????????????????????????????????????????????????????????????????????????? 119
TIVA actions?????????????????????????????????????? 119
Main aims of TIVA???????????????????????????????????????????????? 120
Conclusion?????????????????????????????????? 121
Chapter 24 Airway Management?????????????????????????????????????????????????????????????????????? 122
Assessing the airway?????????????????????????????????????????????????????? 122
Airway management techniques?????????????????????????????????????????????????????????????????????? 123
Preparation for intubation?????????????????????????????????????????????????????????????????? 124
Airway emergencies?????????????????????????????????????????????????? 125
Conclusion?????????????????????????????????? 126
Chapter 25 General Anaesthetic Pharmacology???????????????????????????????????????????????????????????????????????????????????????????????????? 127
Premedication???????????????????????????????????????? 127
Anaesthetic induction???????????????????????????????????????????????????????? 128
Neuromuscular blocking agents???????????????????????????????????????????????????????????????????????? 128
Maintenance of anaesthesia?????????????????????????????????????????????????????????????????? 128
Emergence from anaesthesia?????????????????????????????????????????????????????????????????? 129
Postoperative care?????????????????????????????????????????????????? 129
Chapter 26 Intraoperative Fluid Management?????????????????????????????????????????????????????????????????????????????????????????????????? 130
Body water distribution???????????????????????????????????????????????????????????? 130
Capillary fluid shifts?????????????????????????????????????????????????????????? 130
Distribution of crystalloid fluids?????????????????????????????????????????????????????????????????????????????????? 131
Distribution of colloid fluids?????????????????????????????????????????????????????????????????????????? 131
Administration of intraoperative fluids???????????????????????????????????????????????????????????????????????????????????????????? 132
Oesophageal doppler monitoring?????????????????????????????????????????????????????????????????????????? 132
Conclusion?????????????????????????????????? 132
Chapter 27 Monitoring Perioperative Patients?????????????????????????????????????????????????????????????????????????????????????????????????????? 133
Setting up monitors before anaesthesia?????????????????????????????????????????????????????????????????????????????????????????? 133
Monitors during and after anaesthesia???????????????????????????????????????????????????????????????????????????????????????? 134
Chapter References and Further Reading?????????????????????????????????????????????????????????????????????????????????????????? 136
Section 3 Surgical Specialities 147
Chapter 28 Laparoscopic Surgery???????????????????????????????????????????????????????????????????????????? 149
Basic principles of laparoscopic surgery?????????????????????????????????????????????????????????????????????????????????????????????? 149
Equipment???????????????????????????????? 149
Difficulties for surgeons???????????????????????????????????????????????????????????????? 150
Conversion to open?????????????????????????????????????????????????? 150
Further developments and innovations?????????????????????????????????????????????????????????????????????????????????????? 150
Chapter 29 Vascular Surgery???????????????????????????????????????????????????????????????????? 152
Vascular risk factors???????????????????????????????????????????????????????? 152
Aneurysms???????????????????????????????? 152
Lower limb ischaemia?????????????????????????????????????????????????????? 153
Amputations???????????????????????????????????? 154
Arterial disease of the upper limb?????????????????????????????????????????????????????????????????????????????????? 154
Carotid embolisation?????????????????????????????????????????????????????? 154
Venous disease?????????????????????????????????????????? 155
Chapter 30 Cardiothoracic Surgery???????????????????????????????????????????????????????????????????????????????? 156
Cardiac surgery???????????????????????????????????????????? 156
Acquired heart disease?????????????????????????????????????????????????????????? 156
Congenital cardiac disease?????????????????????????????????????????????????????????????????? 157
Valvular heart disease?????????????????????????????????????????????????????????? 158
Thoracic surgery?????????????????????????????????????????????? 158
Presenting symptoms???????????????????????????????????????????????????? 159
Diagnostic investigations for lung tumours?????????????????????????????????????????????????????????????????????????????????????????????????? 159
Chapter 31 Orthopaedics and Trauma?????????????????????????????????????????????????????????????????????????????????? 161
Investigations?????????????????????????????????????????? 161
Orthopaedic specialities?????????????????????????????????????????????????????????????? 161
Conservative management???????????????????????????????????????????????????????????? 163
Operative management?????????????????????????????????????????????????????? 163
Fractures???????????????????????????????? 164
Joint replacements?????????????????????????????????????????????????? 165
Specialist equipment?????????????????????????????????????????????????????? 165
Chapter 32 Gynaecology Surgery?????????????????????????????????????????????????????????????????????????? 166
Gynaecology presenting symptoms???????????????????????????????????????????????????????????????????????????? 166
Examination and diagnostic tests?????????????????????????????????????????????????????????????????????????????? 166
Gynaecological infections???????????????????????????????????????????????????????????????? 166
Pelvic floor dysfunction?????????????????????????????????????????????????????????????? 167
Pelvic neoplasms?????????????????????????????????????????????? 168
Chapter 33 Plastic Surgery?????????????????????????????????????????????????????????????????? 171
Scope of plastic surgery?????????????????????????????????????????????????????????????? 171
Wounds?????????????????????????? 171
Grafts?????????????????????????? 172
Other grafts?????????????????????????????????????? 172
Flaps???????????????????????? 172
Tissue expansion?????????????????????????????????????????????? 172
Burns???????????????????????? 173
Reconstructive surgery?????????????????????????????????????????????????????????? 173
Congenital abnormalities?????????????????????????????????????????????????????????????? 174
Chapter 34 Urology?????????????????????????????????????????????????? 175
Common urological symptoms?????????????????????????????????????????????????????????????????? 175
Investigations?????????????????????????????????????????? 175
Common diagnoses?????????????????????????????????????????????? 176
Urological surgery?????????????????????????????????????????????????? 177
Chapter 35 Breast Surgery???????????????????????????????????????????????????????????????? 179
Breast clinic???????????????????????????????????????? 179
Specific evaluation of breast patients?????????????????????????????????????????????????????????????????????????????????????????? 179
Factors which increase the risk of breast cancer?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 180
Management of high-risk patients?????????????????????????????????????????????????????????????????????????????? 180
Breast disease?????????????????????????????????????????? 180
Surgical procedures???????????????????????????????????????????????????? 181
Imaging???????????????????????????? 182
Tissue diagnosis?????????????????????????????????????????????? 182
Complications of mastectomy???????????????????????????????????????????????????????????????????? 182
Risk factors for tumour recurrence?????????????????????????????????????????????????????????????????????????????????? 182
Chapter 36 Endocrine Surgery?????????????????????????????????????????????????????????????????????? 183
Thyroid???????????????????????????? 183
Parathyroid???????????????????????????????????? 185
Adrenal disorders???????????????????????????????????????????????? 185
Gastrointestinal endocrine tumours?????????????????????????????????????????????????????????????????????????????????? 185
Chapter 37 Colorectal Surgery???????????????????????????????????????????????????????????????????????? 186
Investigations?????????????????????????????????????????? 186
Colorectal disorders?????????????????????????????????????????????????????? 186
Colorectal cancer???????????????????????????????????????????????? 188
Anal, perianal and rectal disorders???????????????????????????????????????????????????????????????????????????????????? 189
Procedures?????????????????????????????????? 189
Colon tests and investigations?????????????????????????????????????????????????????????????????????????? 190
Indications for resections?????????????????????????????????????????????????????????????????? 190
Factors to consider with anastamosis?????????????????????????????????????????????????????????????????????????????????????? 190
Complications of colonic resection?????????????????????????????????????????????????????????????????????????????????? 190
Chapter 38 Upper Gastrointestinal Surgery???????????????????????????????????????????????????????????????????????????????????????????????? 192
Oesophagus?????????????????????????????????? 192
Investigations for oesophageal clinical symptoms?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 192
Peptic ulceration???????????????????????????????????????????????? 194
Gastric neoplasia???????????????????????????????????????????????? 194
Miscellaneous disorders of the stomach?????????????????????????????????????????????????????????????????????????????????????????? 194
Miscellaneous disorders of the duodenum???????????????????????????????????????????????????????????????????????????????????????????? 195
Acute upper GI bleeding???????????????????????????????????????????????????????????? 195
Chapter 39 Hepato-Pancreato-Biliary Surgery???????????????????????????????????????????????????????????????????????????????????????????????????? 196
Liver disease???????????????????????????????????????? 196
Liver tumours???????????????????????????????????????? 196
Liver cysts???????????????????????????????????? 197
Liver infections?????????????????????????????????????????????? 197
Liver trauma?????????????????????????????????????? 197
Biliary tract???????????????????????????????????????? 197
Biliary strictures?????????????????????????????????????????????????? 198
Gallbladder tumours???????????????????????????????????????????????????? 198
Biliary tract cancers???????????????????????????????????????????????????????? 198
Pancreatic disease?????????????????????????????????????????????????? 199
Pancreatic carcinoma?????????????????????????????????????????????????????? 199
Chapter References and Further Reading?????????????????????????????????????????????????????????????????????????????????????????? 201
Section 4 Surgical Scrub Skills 209
Chapter 40 Basic Surgical Instrumentation???????????????????????????????????????????????????????????????????????????????????????????????? 211
Introduction?????????????????????????????????????? 211
Sharps/cutting instruments?????????????????????????????????????????????????????????????????? 211
Clamps?????????????????????????? 211
Haemostatic forceps (Artery forceps)?????????????????????????????????????????????????????????????????????????????????????? 212
Grasping/holding instruments?????????????????????????????????????????????????????????????????????? 212
Retraction?????????????????????????????????? 213
Accessory instruments???????????????????????????????????????????????????????? 213
Chapter 41 Surgical Positioning???????????????????????????????????????????????????????????????????????????? 214
Supine?????????????????????????? 214
Trendelenburg???????????????????????????????????????? 215
Reverse trendelenburg???????????????????????????????????????????????????????? 215
Lithotomy???????????????????????????????? 215
Prone???????????????????????? 216
Jack-knife?????????????????????????????????? 216
Lateral???????????????????????????? 217
Lateral chest???????????????????????????????????????? 217
Lateral kidney?????????????????????????????????????????? 217
Fowler?????????????????????????? 217
Semi-fowler???????????????????????????????????? 218
Knee-chest?????????????????????????????????? 218
Documentation???????????????????????????????????????? 218
Postoperative assessment?????????????????????????????????????????????????????????????? 218
Chapter 42 Thermoregulation???????????????????????????????????????????????????????????????????? 219
Ways the body loses heat?????????????????????????????????????????????????????????????? 219
Assessment of patient's temperature???????????????????????????????????????????????????????????????????????????????????? 219
Inadvertent hypothermia???????????????????????????????????????????????????????????? 220
Patients at increased risk of inadvertent hypothermia???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 220
Complications of inadvertent hypothermia?????????????????????????????????????????????????????????????????????????????????????????????? 220
Preoperative management???????????????????????????????????????????????????????????? 221
Anaesthetic care?????????????????????????????????????????????? 221
Intraoperative management strategies?????????????????????????????????????????????????????????????????????????????????????? 221
Postoperative management?????????????????????????????????????????????????????????????? 222
Chapter 43 Skin Preparation???????????????????????????????????????????????????????????????????? 223
Rationale for skin preparation?????????????????????????????????????????????????????????????????????????? 223
General considerations?????????????????????????????????????????????????????????? 223
Antiseptic choices?????????????????????????????????????????????????? 223
Optimum method of skin preparation?????????????????????????????????????????????????????????????????????????????????? 224
Chapter 44 Surgical Draping???????????????????????????????????????????????????????????????????? 226
Basic principles of draping???????????????????????????????????????????????????????????????????? 226
Considerations when selecting drapes?????????????????????????????????????????????????????????????????????????????????????? 227
Reusable versus disposable drapes???????????????????????????????????????????????????????????????????????????????? 227
Chapter 45 Surgical Site Marking?????????????????????????????????????????????????????????????????????????????? 228
Wrong site surgery?????????????????????????????????????????????????? 228
Steps to surgical site marking?????????????????????????????????????????????????????????????????????????? 228
Factors which increase wrong site surgery???????????????????????????????????????????????????????????????????????????????????????????????? 229
Theatre staff responsibility?????????????????????????????????????????????????????????????????????? 229
Chapter 46 Swab Counts, Sharps and Instrument Checks?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 231
What should be checked????????????????????????????????????????????????????????????? 231
When they should be checked???????????????????????????????????????????????????????????????????? 231
Count board???????????????????????????????????? 232
Taking additional items???????????????????????????????????????????????????????????? 232
Swabs???????????????????????? 232
Sharps and miscellaneous items?????????????????????????????????????????????????????????????????????????? 233
Instruments???????????????????????????????????? 233
Who should carry out the checks??????????????????????????????????????????????????????????????????????????????? 233
What happens if the count is wrong????????????????????????????????????????????????????????????????????????????????????? 233
Documentation???????????????????????????????????????? 234
Chapter 47 Measures to Prevent Wound Infection?????????????????????????????????????????????????????????????????????????????????????????????????????????? 235
Patient factors???????????????????????????????????????????? 235
Preoperative practices to reduce surgical site infection?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 236
Perioperative practices to reduce surgical site infection???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 237
Chapter 48 Electrosurgery???????????????????????????????????????????????????????????????? 239
Monopolar diathermy???????????????????????????????????????????????????? 239
Monopolar settings?????????????????????????????????????????????????? 239
Bipolar diathermy???????????????????????????????????????????????? 240
Hazards of diathermy?????????????????????????????????????????????????????? 240
Laparoscopic diathermy hazards?????????????????????????????????????????????????????????????????????????? 241
Chapter 49 Wound Healing and Dressings?????????????????????????????????????????????????????????????????????????????????????????? 243
Introduction?????????????????????????????????????? 243
Physiology of wound healing???????????????????????????????????????????????????????????????????? 243
Patient factors which inhibit wound healing???????????????????????????????????????????????????????????????????????????????????????????????????? 243
Environmental factors which inhibit healing???????????????????????????????????????????????????????????????????????????????????????????????????? 244
Types of wound healing?????????????????????????????????????????????????????????? 244
Wound classifications???????????????????????????????????????????????????????? 244
Things to consider when selecting dressings???????????????????????????????????????????????????????????????????????????????????????????????????? 244
Types of dressings?????????????????????????????????????????????????? 245
Wound dressing contraindications?????????????????????????????????????????????????????????????????????????????? 246
Chapter 50 Bladder Catheterisation?????????????????????????????????????????????????????????????????????????????????? 247
Steps of bladder catheterisation?????????????????????????????????????????????????????????????????????????????? 247
Complications of bladder catheterisation?????????????????????????????????????????????????????????????????????????????????????????????? 248
Documentation after bladder catheterisation???????????????????????????????????????????????????????????????????????????????????????????????????? 248
Indications for bladder catheterisation???????????????????????????????????????????????????????????????????????????????????????????? 248
Contraindications for bladder catheterisation???????????????????????????????????????????????????????????????????????????????????????????????????????? 249
Chapter 51 Tourniquet Management?????????????????????????????????????????????????????????????????????????????? 250
Types of tourniquet???????????????????????????????????????????????????? 250
Digit tourniquets???????????????????????????????????????????????? 250
Steps to tourniquet application for limb surgery?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 250
Caution when exsanguinating a limb?????????????????????????????????????????????????????????????????????????????????? 251
Caution and contraindications when using tourniquet???????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 251
Key points to remember when using a tourniquet on a limb?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 252
Complications of tourniquet use???????????????????????????????????????????????????????????????????????????? 252
Aftercare of limb following tourniquet use?????????????????????????????????????????????????????????????????????????????????????????????????? 252
Chapter 52 Haemostatic Techniques???????????????????????????????????????????????????????????????????????????????? 254
Introduction?????????????????????????????????????? 254
Contributing factors to surgical bleeding???????????????????????????????????????????????????????????????????????????????????????????????? 254
Adverse effects of surgical bleeding?????????????????????????????????????????????????????????????????????????????????????? 254
Methods of haemostasis?????????????????????????????????????????????????????????? 255
Pharmacological agents?????????????????????????????????????????????????????????? 256
Topical haemostatic agents?????????????????????????????????????????????????????????????????? 256
Chapter 53 Surgical Drains?????????????????????????????????????????????????????????????????? 259
Rationale for wound drains?????????????????????????????????????????????????????????????????? 259
Drain uses?????????????????????????????????? 259
Disadvantages to surgical drains?????????????????????????????????????????????????????????????????????????????? 260
Closed drainage systems???????????????????????????????????????????????????????????? 260
Securing of wound drains?????????????????????????????????????????????????????????????? 261
Other considerations?????????????????????????????????????????????????????? 262
Drain removal???????????????????????????????????????? 262
Documentation???????????????????????????????????????? 262
Chapter 54 Handling of Specimens?????????????????????????????????????????????????????????????????????????????? 263
Principles of specimens???????????????????????????????????????????????????????????? 263
Laparoscopic specimen removal???????????????????????????????????????????????????????????????????????? 264
Documentation???????????????????????????????????????? 264
Safety issues???????????????????????????????????????? 265
Chapter References and Further Reading?????????????????????????????????????????????????????????????????????????????????????????? 266
Section 5 Surgical Assisting 275
Chapter 55 Legal, Professional and Ethical Issues???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 277
Accountability and responsibility for practitioners in advanced roles???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 277
Delegating responsibility???????????????????????????????????????????????????????????????? 277
Record keeping?????????????????????????????????????????? 277
Informed consent?????????????????????????????????????????????? 278
Risk assessment???????????????????????????????????????????? 279
Guidelines, policies and protocols?????????????????????????????????????????????????????????????????????????????????? 280
Chapter 56 Surgical First Assistant???????????????????????????????????????????????????????????????????????????????????? 281
Background to role?????????????????????????????????????????????????? 281
Role definition???????????????????????????????????????????? 281
Scope of practice???????????????????????????????????????????????? 282
Experiences of the role???????????????????????????????????????????????????????????? 282
Professional and legal considerations???????????????????????????????????????????????????????????????????????????????????????? 282
Chapter 57 Surgical Care Practitioner???????????????????????????????????????????????????????????????????????????????????????? 283
Background to role?????????????????????????????????????????????????? 283
Benefits and challenges of the surgical care practitioner role?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 283
Definition of role?????????????????????????????????????????????????? 284
Practitioner background???????????????????????????????????????????????????????????? 284
Scope of practice???????????????????????????????????????????????? 284
Educational requirements?????????????????????????????????????????????????????????????? 285
Surgical speciality pathways?????????????????????????????????????????????????????????????????????? 285
Professional and legal considerations???????????????????????????????????????????????????????????????????????????????????????? 286
Chapter 58 Pre and Postoperative Visiting???????????????????????????????????????????????????????????????????????????????????????????????? 287
Introduction?????????????????????????????????????? 287
Preoperative visits???????????????????????????????????????????????????? 287
Postoperative visits?????????????????????????????????????????????????????? 288
Patient-centred communication???????????????????????????????????????????????????????????????????????? 288
Things to consider?????????????????????????????????????????????????? 288
Barriers to pre and postoperative visits?????????????????????????????????????????????????????????????????????????????????????????????? 289
Chapter 59 Retraction???????????????????????????????????????????????????????? 291
Handling of tissues???????????????????????????????????????????????????? 291
Considerations when retracting?????????????????????????????????????????????????????????????????????????? 291
Choice of retractor???????????????????????????????????????????????????? 292
Alternative methods of retraction???????????????????????????????????????????????????????????????????????????????? 292
Placement of the retractor?????????????????????????????????????????????????????????????????? 293
Chapter 60 Cutting of Sutures???????????????????????????????????????????????????????????????????????? 294
Communication with the surgeon?????????????????????????????????????????????????????????????????????????? 294
Importance of having the right tools?????????????????????????????????????????????????????????????????????????????????????? 294
Handling the scissors???????????????????????????????????????????????????????? 294
Knowledge needed?????????????????????????????????????????????? 295
Potential risks???????????????????????????????????????????? 295
Chapter 61 Suture Materials???????????????????????????????????????????????????????????????????? 296
Selecting suture materials?????????????????????????????????????????????????????????????????? 296
Patient factors???????????????????????????????????????????? 296
Wound support???????????????????????????????????????? 296
The 'perfect' suture?????????????????????????????????????????????????????? 297
Disadvantages of suturing???????????????????????????????????????????????????????????????? 297
Absorbable and non-absorbable???????????????????????????????????????????????????????????????????????? 297
Natural versus synthetic?????????????????????????????????????????????????????????????? 298
Monofilament versus multifilament???????????????????????????????????????????????????????????????????????????????? 298
Chapter 62 Surgical Needles???????????????????????????????????????????????????????????????????? 300
Needle selection?????????????????????????????????????????????? 300
Needle classification???????????????????????????????????????????????????????? 300
Handheld needles?????????????????????????????????????????????? 300
The main aspects of a surgical needle???????????????????????????????????????????????????????????????????????????????????????? 301
Different types of needles?????????????????????????????????????????????????????????????????? 301
Chapter 63 Wound Closure?????????????????????????????????????????????????????????????? 303
Rationale for wound closure???????????????????????????????????????????????????????????????????? 303
Patient factors for consideration???????????????????????????????????????????????????????????????????????????????? 303
Selection of wound closure materials?????????????????????????????????????????????????????????????????????????????????????? 304
Consideration of different wound closure methods?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 304
Chapter 64 Suturing Methods???????????????????????????????????????????????????????????????????? 305
Simple interrupted?????????????????????????????????????????????????? 305
Horizontal mattress???????????????????????????????????????????????????? 306
Subcuticular?????????????????????????????????????? 306
Continuous?????????????????????????????????? 307
Chapter 65 Alternative Methods of Wound Closure???????????????????????????????????????????????????????????????????????????????????????????????????????????? 308
Skin clips?????????????????????????????????? 308
Surgical glue???????????????????????????????????????? 309
Chapter 66 Injection of Local Anaesthetic for Wound Infiltration?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 311
Ideal local anaesthetic???????????????????????????????????????????????????????????? 311
Delivery of local anaesthetic???????????????????????????????????????????????????????????????????????? 311
Types of local anaesthetic?????????????????????????????????????????????????????????????????? 311
Local anaesthetic additives???????????????????????????????????????????????????????????????????? 313
Communicating with the patient?????????????????????????????????????????????????????????????????????????? 313
Guidelines and documentation?????????????????????????????????????????????????????????????????????? 314
Chapter 67 Injection of Local Anaesthetic for Wound Infiltration-Caution and Complications?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 315
Toxicity?????????????????????????????? 315
Allergies to local anaesthetics???????????????????????????????????????????????????????????????????????????? 315
Signs and symptoms of toxicity and allergic reactions of local anaesthetic?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 315
Patient factors to consider???????????????????????????????????????????????????????????????????? 316
Local factors to take into account with toxicity?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 317
Caution when using local anaesthesia?????????????????????????????????????????????????????????????????????????????????????? 317
Contraindications of local anaesthesia?????????????????????????????????????????????????????????????????????????????????????????? 317
Chapter 68 Camera Holding???????????????????????????????????????????????????????????????? 319
Introduction?????????????????????????????????????? 319
Laparoscopic surgery?????????????????????????????????????????????????????? 319
Laparoscopic equipment?????????????????????????????????????????????????????????? 319
Telescopes?????????????????????????????????? 320
Camera set-up???????????????????????????????????????? 320
Light intensity???????????????????????????????????????????? 320
Skills necessary for camera holding???????????????????????????????????????????????????????????????????????????????????? 320
Poor camera holding???????????????????????????????????????????????????? 320
Challenges for the camera holder?????????????????????????????????????????????????????????????????????????????? 321
Training and learning curve of camera holding???????????????????????????????????????????????????????????????????????????????????????????????????????? 321
Chapter References and Further Reading?????????????????????????????????????????????????????????????????????????????????????????? 322
Section 6 Recovery 329
Chapter 69 Recovery Room Design???????????????????????????????????????????????????????????????????????????? 331
Recovery bays???????????????????????????????????????? 331
Recovery room facilities?????????????????????????????????????????????????????????????? 332
Recovery room equipment???????????????????????????????????????????????????????????? 333
Conclusion?????????????????????????????????? 333
Chapter 70 Patient Handover???????????????????????????????????????????????????????????????????? 335
The patient's handover?????????????????????????????????????????????????????????? 335
Effective handovers???????????????????????????????????????????????????? 335
Effective handover process?????????????????????????????????????????????????????????????????? 336
Conclusion?????????????????????????????????? 337
Chapter 71 Postoperative Patient Care???????????????????????????????????????????????????????????????????????????????????????? 338
Airway care???????????????????????????????????? 338
Pain relief???????????????????????????????????? 339
Mental health???????????????????????????????????????? 339
Wound care?????????????????????????????????? 339
Deep venous thrombosis?????????????????????????????????????????????????????????? 340
Fever???????????????????????? 340
Other problems?????????????????????????????????????????? 340
Conclusion?????????????????????????????????? 341
Chapter 72 Postoperative Patient Monitoring and Equipment???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 342
Monitoring equipment?????????????????????????????????????????????????????? 342
Respiratory monitoring?????????????????????????????????????????????????????????? 342
Cardiovascular monitoring???????????????????????????????????????????????????????????????? 344
Neuromuscular monitoring?????????????????????????????????????????????????????????????? 344
Psychological monitoring?????????????????????????????????????????????????????????????? 345
Temperature monitoring?????????????????????????????????????????????????????????? 345
Pain monitoring???????????????????????????????????????????? 345
Nausea and vomiting???????????????????????????????????????????????????? 345
Fluid monitoring?????????????????????????????????????????????? 346
Urine output?????????????????????????????????????? 346
Drainage and bleeding???????????????????????????????????????????????????????? 346
Discharge???????????????????????????????? 346
Chapter 73 Maintaining the Airway???????????????????????????????????????????????????????????????????????????????? 348
Patient assessment?????????????????????????????????????????????????? 348
Basic airway management???????????????????????????????????????????????????????????? 349
Conclusion?????????????????????????????????? 351
Chapter 74 Diagnosis and Management of Postoperative Infection?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 352
Preoperative infection prevention???????????????????????????????????????????????????????????????????????????????? 352
Intraoperative infection prevention???????????????????????????????????????????????????????????????????????????????????? 352
Management of postoperative infection???????????????????????????????????????????????????????????????????????????????????????? 353
Postoperative care?????????????????????????????????????????????????? 353
Conclusion?????????????????????????????????? 354
Chapter 75 Postoperative Pain Management?????????????????????????????????????????????????????????????????????????????????????????????? 355
Pain assessment???????????????????????????????????????????? 355
Side effects of pain?????????????????????????????????????????????????????? 355
Systemic opioids?????????????????????????????????????????????? 356
Nonsteroidal Anti-inflammatory Drugs (NSAIDS)???????????????????????????????????????????????????????????????????????????????????????????????????????? 356
Regional techniques???????????????????????????????????????????????????? 357
Two effective drugs???????????????????????????????????????????????????? 357
Conclusion?????????????????????????????????? 357
Chapter 76 Fluid Balance in Postoperative Patients?????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 358
Maintenance fluids?????????????????????????????????????????????????? 359
Fluid balance chart???????????????????????????????????????????????????? 360
Care of the infusion site???????????????????????????????????????????????????????????????? 360
Conclusion?????????????????????????????????? 360
Chapter 77 Postoperative Medications?????????????????????????????????????????????????????????????????????????????????????? 361
Antibiotics???????????????????????????????????? 361
Antifungals???????????????????????????????????? 361
Analgesics?????????????????????????????????? 362
IV Fluids and electrolytes?????????????????????????????????????????????????????????????????? 362
Anticoagulants?????????????????????????????????????????? 363
Diuretics???????????????????????????????? 363
Antacids?????????????????????????????? 363
Mouth care?????????????????????????????????? 364
Conclusion?????????????????????????????????? 364
Chapter 78 Managing Bleeding Problems???????????????????????????????????????????????????????????????????????????????????????? 365
Postoperative haemorrhage???????????????????????????????????????????????????????????????? 365
Actions to prevent haemorrhage?????????????????????????????????????????????????????????????????????????? 366
Conclusion?????????????????????????????????? 367
Chapter 79 Managing Postoperative Nausea and Vomiting???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 368
The physiology of PONV?????????????????????????????????????????????????????????? 368
The management of PONV?????????????????????????????????????????????????????????? 368
Risk factors associated with PONV???????????????????????????????????????????????????????????????????????????????? 369
Anti-emetics?????????????????????????????????????? 369
Rescue treatment for PONV???????????????????????????????????????????????????????????????? 370
Conclusion?????????????????????????????????? 371
Chapter 80 Critical Issues in Postoperative Care?????????????????????????????????????????????????????????????????????????????????????????????????????????????? 372
Managing sepsis???????????????????????????????????????????? 372
Immediate postoperative care?????????????????????????????????????????????????????????????????????? 373
Postoperative care?????????????????????????????????????????????????? 373
Conclusion?????????????????????????????????? 374
Chapter 81 Enhanced Recovery?????????????????????????????????????????????????????????????????????? 375
Introduction?????????????????????????????????????? 375
Communication???????????????????????????????????????? 375
Enhanced recovery???????????????????????????????????????????????? 376
Summary???????????????????????????? 379
Chapter References and Further Reading?????????????????????????????????????????????????????????????????????????????????????????? 380
Section 7 Perioperative Critical Care 393
Chapter 82 Critical Care Nurses and Practitioners Roles???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 395
The roles of critical care nurses???????????????????????????????????????????????????????????????????????????????? 395
The role of critical care practitioners (commonly used in the icu)?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 396
Conclusion?????????????????????????????????? 397
Chapter 83 Management of the Critically Ill Surgical Patient?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 398
Introduction to critical illness?????????????????????????????????????????????????????????????????????????????? 398
Infection???????????????????????????????? 398
Fluid balance???????????????????????????????????????? 399
Organ dysfunction and failure???????????????????????????????????????????????????????????????????????? 399
Actions for the critically ill?????????????????????????????????????????????????????????????????????????? 399
Conclusion?????????????????????????????????? 400
Chapter 84 Malignant Hyperthermia???????????????????????????????????????????????????????????????????????????????? 401
Introduction?????????????????????????????????????? 401
Causes of malignant hyperthermia?????????????????????????????????????????????????????????????????????????????? 401
Symptoms of MH?????????????????????????????????????????? 402
Diagnosis???????????????????????????????? 402
Prevention of MH?????????????????????????????????????????????? 402
Treatment???????????????????????????????? 403
Conclusion?????????????????????????????????? 403
Chapter 85 Inadvertent Hypothermia?????????????????????????????????????????????????????????????????????????????????? 404
Physiology of thermoregulation?????????????????????????????????????????????????????????????????????????? 404
Managing temperature during anaesthesia???????????????????????????????????????????????????????????????????????????????????????????? 405
Complications associated with inadvertent hypothermia???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 405
Temperature measurements?????????????????????????????????????????????????????????????? 406
Postoperative care?????????????????????????????????????????????????? 407
Conclusion?????????????????????????????????? 408
Chapter 86 Congestive Heart Failure???????????????????????????????????????????????????????????????????????????????????? 409
Introduction?????????????????????????????????????? 409
Congestive cardiac failure?????????????????????????????????????????????????????????????????? 410
Congestive heart symptoms and signs???????????????????????????????????????????????????????????????????????????????????? 411
Diagnosis of congestive heart failure???????????????????????????????????????????????????????????????????????????????????????? 412
Congestive heart failure treatment?????????????????????????????????????????????????????????????????????????????????? 412
Conclusion?????????????????????????????????? 414
Chapter 87 Venous Thromboembolism???????????????????????????????????????????????????????????????????????????????? 415
Introduction?????????????????????????????????????? 415
Deep venous thrombosis (DVT)?????????????????????????????????????????????????????????????????????? 415
Pulmonary embolism?????????????????????????????????????????????????? 415
Signs and symptoms of DVT and PE?????????????????????????????????????????????????????????????????????????????? 416
Risk factors for DVT?????????????????????????????????????????????????????? 416
Diagnostic tests for DVTs???????????????????????????????????????????????????????????????? 416
Risk factors for PE???????????????????????????????????????????????????? 417
Diagnostic tests for PE???????????????????????????????????????????????????????????? 417
Treatment???????????????????????????????? 418
Surgical interventions?????????????????????????????????????????????????????????? 419
Conclusion?????????????????????????????????? 419
Chapter 88 Latex Allergy?????????????????????????????????????????????????????????????? 420
Introduction?????????????????????????????????????? 420
Definition of latex allergies???????????????????????????????????????????????????????????????????????? 420
Assessment of latex allergy???????????????????????????????????????????????????????????????????? 420
Management of latex allergy patients?????????????????????????????????????????????????????????????????????????????????????? 421
Preventing contact with latex???????????????????????????????????????????????????????????????????????? 421
Minimising contact with latex???????????????????????????????????????????????????????????????????????? 421
Conclusion?????????????????????????????????? 423
Chapter 89 Pressure Ulcers?????????????????????????????????????????????????????????????????? 424
Intraoperative pressure ulcers?????????????????????????????????????????????????????????????????????????? 424
Risk factors for the development of pressure ulcers???????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 425
Formation of pressure ulcers?????????????????????????????????????????????????????????????????????? 425
Preventing pressure ulcers?????????????????????????????????????????????????????????????????? 426
Conclusion?????????????????????????????????? 429
Chapter 90 Managing Diabetes in Perioperative Patients?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? 430
Introduction?????????????????????????????????????? 430
Preoperative assessment???????????????????????????????????????????????????????????? 430
Intraoperative care???????????????????????????????????????????????????? 431
Postoperative care?????????????????????????????????????????????????? 432
Conclusion?????????????????????????????????? 433
Chapter 91 Smoking, Alcohol and Drug Abuse?????????????????????????????????????????????????????????????????????????????????????????????????? 434
People drinking alcohol???????????????????????????????????????????????????????????? 434
People smoking?????????????????????????????????????????? 435
People taking drugs???????????????????????????????????????????????????? 435
Conclusion?????????????????????????????????? 436
Chapter 92 Perioperative Care of Elderly Patients???????????????????????????????????????????????????????????????????????????????????????????????????????????????? 437
Elective surgery?????????????????????????????????????????????? 437
Emergency surgery???????????????????????????????????????????????? 438
Care pathways for elderly patients?????????????????????????????????????????????????????????????????????????????????? 438
Postoperative delirium?????????????????????????????????????????????????????????? 438
Postoperative pain?????????????????????????????????????????????????? 439
Discharge of elderly patients???????????????????????????????????????????????????????????????????????? 439
Conclusions???????????????????????????????????? 439
Chapter 93 Anaemia, Coagulopathy and Bleeding???????????????????????????????????????????????????????????????????????????????????????????????????????? 441
Nutritional deficiency anaemia?????????????????????????????????????????????????????????????????????????? 441
Phlebotomy?????????????????????????????????? 441
Drug reactions?????????????????????????????????????????? 442
Bleeding complications?????????????????????????????????????????????????????????? 442
Coagulation abnormalities???????????????????????????????????????????????????????????????? 442
Blood transfusion???????????????????????????????????????????????? 443
Conclusion?????????????????????????????????? 443
Chapter 94 Care of Morbidly Obese Patients?????????????????????????????????????????????????????????????????????????????????????????????????? 444
Caring for obese patients???????????????????????????????????????????????????????????????? 444
Staff training?????????????????????????????????????????? 444
Risk reduction?????????????????????????????????????????? 445
Specialised equipment???????????????????????????????????????????????????????? 445
Preoperative assessment???????????????????????????????????????????????????????????? 445
Respiratory system?????????????????????????????????????????????????? 446
Cardiac disease???????????????????????????????????????????? 446
Metabolic disease???????????????????????????????????????????????? 446
Thromboprophylaxis?????????????????????????????????????????????????? 446
Intraoperative care???????????????????????????????????????????????????? 447
Conclusion?????????????????????????????????? 447
Index???????????????????????? 461
EULA 481
"...this book would be a recommended read for all perioperative practitioners, including students, nurses, ODPs and junior doctors. It covers a wide range of subjects within perioperative care in an easy to follow, step by step guide. Each chapter is short, yet concise, making it straightforward to read. The section regarding the critical care side of perioperative practice is particularly useful and therefore opens this book out to a wider readership." - Journal of Perioperative Practice
| Erscheint lt. Verlag | 20.9.2016 |
|---|---|
| Reihe/Serie | Rapid | Rapid |
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie |
| Pflege ► Fachpflege ► Anästhesie / Intensivmedizin | |
| Schlagworte | Acute, Critical & Emergency Care • Anaesthesia • Anaesthetics • Care • Chirurgie • Chirurgie u. chirurgische Spezialgebiete • Gesundheits- u. Sozialwesen • Health & Social Care • Intensiv- u. Notfallpflege • Krankenpflege • Medical Science • Medizin • nursing • perioperative • Perioperative Pflege • postoperative • Practice • Recovery • SCP • Surgery • Surgery & Surgical Specialities • Surgical Care Practitioner |
| ISBN-13 | 9781119121244 / 9781119121244 |
| Informationen gemäß Produktsicherheitsverordnung (GPSR) | |
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PDF (Adobe DRM)Kopierschutz: Adobe-DRM
Adobe-DRM ist ein Kopierschutz, der das eBook vor Mißbrauch schützen soll. Dabei wird das eBook bereits beim Download auf Ihre persönliche Adobe-ID autorisiert. Lesen können Sie das eBook dann nur auf den Geräten, welche ebenfalls auf Ihre Adobe-ID registriert sind.
Details zum Adobe-DRM
Dateiformat: PDF (Portable Document Format)
Mit einem festen Seitenlayout eignet sich die PDF besonders für Fachbücher mit Spalten, Tabellen und Abbildungen. Eine PDF kann auf fast allen Geräten angezeigt werden, ist aber für kleine Displays (Smartphone, eReader) nur eingeschränkt geeignet.
Systemvoraussetzungen:
PC/Mac: Mit einem PC oder Mac können Sie dieses eBook lesen. Sie benötigen eine
eReader: Dieses eBook kann mit (fast) allen eBook-Readern gelesen werden. Mit dem amazon-Kindle ist es aber nicht kompatibel.
Smartphone/Tablet: Egal ob Apple oder Android, dieses eBook können Sie lesen. Sie benötigen eine
Geräteliste und zusätzliche Hinweise
Buying eBooks from abroad
For tax law reasons we can sell eBooks just within Germany and Switzerland. Regrettably we cannot fulfill eBook-orders from other countries.
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