Surgical and Medical Procedures for Nurses and Paramedical Staff

Surgical and Medical Procedures for Nurses and Paramedical Staff

Prakash Nathan MS

Ex-Airforce OT. Tech/Optometrist

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi

Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: 3272143, 3272703, 3282021, 3245672, 3245683 Fax: 011-3276490 e-mail: [email protected] Visit our web site: http://www.jpbros.20m.com Branches • 202 Batavia Chambers, 8 Kumara Kruppa Road Kumara Park East, Bangalore 560 001, Phones: 2285971, 2382956 Tele Fax : 2281761 e-mail: [email protected] • 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza Pantheon Road, Chennai 600 008, Phone: 8262665 Fax: 8262331 e-mail: [email protected] • 4-2-1067/1-3, Ist Floor, Balaji Building, Street No.6, Ramkote Cross Road, Hyderabad 500 095, Phone: 6590020, 4758498 Fax: 4758499 e-mail: [email protected] • 1A Indian Mirror Street, Wellington Square, Kolkata 700 013, Phone: 2451926 Fax: 2456075 e-mail: [email protected] • 106 Amit Industrial Estate, 61 Dr SS Rao Road Near MGM Hospital, Parel, Mumbai 400 012 Phones: 4124863, 4104532 Fax: 4160828 e-mail: [email protected] Surgical and Medical Procedures for Nurses and Paramedical Staff © 2003, Prakash Nathan All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only. First Edition : 2003 Publishing Director: RK Yadav ISBN 81-8061-031-4 Typeset at JPBMP typesetting unit

Printed at Repro India Limited

Foreword I have great pleasure in writing a Foreword for Sri Prakash Nathan’s manual. I have known Sri Prakash Nathan when he was an ORA (Operation Room Assistant) in Indian Air Force, from 1981-1996. He had specialized later in Optometry during 1988-1989. He is an intelligent person and always showed his keenness to learn. It was during his career in Air Force as an ORA, that he found the difficulty in finding the details of various procedures used in day-to-day practice of nursing and allied professions, compiled in one place. This shortcoming prompted him to give an account of all routine procedures, which he experienced during his work in hospitals, in the form of a manual. Many of the procedures are simple and well illustrated; many are important and life saving. I appreciate his endeavour and I hope, this will be useful to all, who in their professional capacity are called upon to perform or actively assist in various procedures in hospital or elsewhere.

DP Sarker Air Marshal (Retd) Formerly Director General Hospital Services (Armed Forces)

Preface In today’s world families put health at the top of their concern and they are also aware that freedom from disease hails through healthy life style, but are uncertain about what is really important and what is not. In my career during my fruitful service I always dared to write down any simple procedure what I had seen or assisted. There was no hard and fast books which guided the paramedics specially OT Nurses and of course today patients are not ready to be merely passive recipients of medical case. They want to be involved with their doctors in decision that affect their health. In addition they like to know not only what is wrong with them but also the choices of treatment with the possible risks involved in it. My ambition was always to help students of all paramedical courses to know the information and advances made in medicine and surgery. I have put all my efforts and dedication to the paramedics who serve the sick as an invisible almighty. We do not see divinity. Let us see the divine light in serving the sick. Some of the common ailments come across by paramedics are also included to the benefit of the students. Dedicating this book to all the paramedics and Nurses globally. Prakash Nathan

A ABORTION In medical terminology abortion means medically induced termination of pregnancy. Abortion can either be spontaneous or induced. Legally it can be performed upto the 28th weeks of pregnancy but in practice an upper limit of 24 weeks is preferred. Abortion may be performed if continuance of pregnancy involves: a. Risk to the woman’s life b. Risk to the mental or physical health of women c. To her existing children d. If there is a risk of serious handicap to the baby. Reasons Induced abortion may be either therapeutic or elective. An abortion may be recommended if conditions affecting either the woman or the fetus. In the women situation of condition that may worsen during pregnancy possible become life threatening include severe heart disease. Chronic kidney disease and cancer (breast or cervix). Fetal condition revealed by ultrasound scanning, aminocentesis or chorionic villus sampling include severe developmental defects incompatible with normal life. — Anencephaly (absence of brain and cranial vault at birth) — Chromosomal abnormalities (Down’s syndrome). Termination may also be recommended if rubella is been contracted during pregnancy which will damage the baby’s eyes, ears and heart. If the mother has been infected with AIDS virus, termination is recommended as the virus can be transmitted to the baby. Procedure Induction 9th week of pregnancy termination may be induced with a combination of mifepristone and a prostaglandin.

2

Surgical and Medical Procedures

Within 48 hours the uterus contract and expels the embryo and the placenta. Vacuum Suction If drug treatment fails surgical termination will be done with in a week or so later. Upto 12th week the pregnancy may be terminated by the surgical technique of vacuum suction curettage either under a general anaesthesia or local anaesthetic. Dilutation and Curettage (D&C) is performed. The tissue may be analysed to confirm the pregnancy existed and that the tissue is complete to rule out ectopic pregnancy (development of embryo outside the uterus). However, the surgeon knows there has been a pregnancy and the same is terminated by his experience. Complications Perforation of the uterus, septic abortion, severe bleeding, repeated abortion may cause infertility. ABSCESS A collection of pus formed as a result of infection by microorganism usually bacteria. The pus forms from destroyed tissue cells. Leucocytes (WBC) on the site fighting the infection and from the dead and live microorganism. Types Abscess may develop in any organ and in the soft tissues beneath the skin in any area. Common site include: • Breast— breast abscess • Gums— dental abscess • Rare site include: liver — liver abscess and brain — brain abscess. A collar stud abscess is one in which a small abscess cavity under the skin connects via a sinus (channel) to a much larger in deeper tissues. Causes • Staphylococci • Tubercle baccilli — tuberculosis abscess • Amoeba — liver abscess amoebiasis. Symptoms and Signs • Discomfort and pain on the site of abscess

Surgical and Medical Procedures • • • • • •

3

Fever with or without chills Sweating Malaise Redness, increased skin temperature Tenderness Tuberculous abscess are totally exception. Hence known as cold abscess.

Diagnosis Signs and symptoms, confirmation by imaging techniques such as CT scanning MRI. Treatment Antibiotics, antifungal antiamoebic deep abscess with lining of abscess cavity needs surgical drainage with drainage. See Drain Surgical. ACUPUNCTURE A branch of Chinese medicine in which needles are inserted into patients skin as therapy for various disorders or to induce anaesthesia. According to the chief tradition the chi (life force) flows through the body along meridians (channels). Any blockage in any one or more of this meridians is believed to cause it health. Identifying the affected meridian accupuncturist restore the health by inserting needles on the points/site known as acupuncture. Acupuncture has been successfully used as an anaesthetic for dental procedures and surgical operation and quite exclusively. During labour and delivery including caesarean section postoperative pain and chronic pain such as arthritis which sometimes does not respond to standard treatment have responded well to acupunture. Acupuncture is said to be particularly effective for condition that affect muscles, bones, joints, eyes, heart and the digestive respiratory and nervous system, also claimed to help in the treatment of addiction, depression and anxiety. ADENOIDECTOMY Surgical removal of adenoids. Adenoids are in the midline swelling at the back of nose and above the tonsils made up of lymph nodes. These nodes form part of the body’s

4

Surgical and Medical Procedures

defences against upper respiratory tract infection which tends to enlarge during early childhood, a time when URTI are common. In most children adenoids shrink after the age of about 5 years disappearing altogether by puberty. Adenoidectomy is usually done on a child with abnormally large adenoid that are causing repeated infection of the middle ear or air sinuses. The operation is often performed together with tonsillectomy. Removal of adenoid is generally an operation with minimal after effects. The child can begin to eat normally the next day itself. ALVEOLOPLASTY It is dental surgery to remove the protuberances and to smoothen out uneven area from tooth bearing bone in the jaw. The procedure is usually performed before the denture is fitted to patients whose alveolar ridge would not otherwise be even enough for denture to be fitted or worn comfortably. Most of alveoloplasty requires general anaesthesia, however, minor ones can be done under local itself. PROCEDURE An incision is made in the gum which is then peeled back to expose the uneven bone, the bone is either reshaped with large bone forceps or filled down to the required shape. Finally the gum is drawn back over the bone and stitched together. With little swelling of the mouth the gum heals within two weeks. AMINOCENTESIS A diagnostic procedure in which a small amount of amniotic fluid is withdrawn from the amniotic sac. Indication The amniotic fluid contains cells and chemicals from the fetus that can be analysed to detect fetal abnormalities such as Down’s syndrome, chromosomal abnormalities, genetic disorders such as haemophilia, cystic ribosis, TaySach’s disease or developmental disorders (spinabifida), rhesus incompatibility and to check the maturity of fetal lungs.

Surgical and Medical Procedures

5

Procedure It is usually performed between 16 to 18 weeks of gestation. Ultrasound scanning is done to find the age and position of the fetus, the placenta site and the amount of amniotic fluid present in the sac. A needle is then inserted through the abdomen and uterine wall into the amniotic sac avoiding the fetu and the placenta, about 20 to 30 ml of fluid is with drawn for analysis. Usually the procedure does not need for anaesthesia, although a local may be used. In most of the cases the woman need not be hospitalised after the procedure but is been advised to rest for 24 hours. Result The fluid is analysed for biochemically and the fetal cells are cultured for chromosomal analysis. Complications Miscarriage and early rupture of membrane, hence aminocentesis is advised as a last resort when other diagnostic such as α feto protein have revealed fetal abnormality or some compelling medical reasons such as family history of chromosomal abnormality (Fig. 1).

Fig 1: Procedure for amniocentesis: A needle is introduced through the abdomen and uterine wall into the amniotic sac; a sample of amniotic fluid is then withdrawn.

6

Surgical and Medical Procedures

AMNIOTOMY Artificial rupture of the amniotic sac (membrane) performed for induction of labour. AMPUTATION Surgical removal of part of all of a limb. Amputation was formerly a common operation during war time, but is now rarely performed except in the treatment of severe arterial disease and cancer. Indication Today most amputation are performed on patients with peripheral vascular disease in which a combination of artherosclerosis and thrombosis which may completely block the blood supply to a limb causing gangrene. It is also performed to prevent the spread of bone cancer or malignant melanoma (a type of skin cancer). Procedure Before the operation the surgeon decides where on the limb to operate, the tissue at the site of amputation must be healthy if the wound is to heal satisfactorily. During the operation the skin and muscle are cut below the level at which the bone is to be severed part. Blood vessels are tied off or cauterised, bone is sawn through, the area is washed with saline. The nerves are well-severed well above the stump to reduce pressure pain. The flaps of the muscle and skin are stitched over the sawn end of the bone to form a smooth and rounded edge stump. To avoid becoming unaccumstomed to walking after the amputation a temporary prosthesis may be fitted. ANAESTHESIA Anaesthesia means absence of all sensation. It can be induced to abolish pain during surgical procedure and sometimes during childbirth. Types a. Local b. General c. Spinal.

Surgical and Medical Procedures

7

Local Anaesthesia A patient given LA remains conscious and sensation is achieved in only part of the body. Local anaesthetics can be in the form of eyedrops, sprays, skin creams and suppositaries. Acupuncture also reliefs local pain. General Anaesthesia It is a loss of sensation and consciousness, induced to prevent pain and discomfort to patient and relaxation to the surgeon to operate on with ease. The state of anaesthesia is produced and maintained by anaesthetist who gives combination of drugs by injection, inhalation or both. He is also responsible for the PA (pre-anaesthetic) assessment and medication of patients, their safety during surgery and their recovery during post anaesthetic period. The main phases in the administration are of: a. Induction (bringing on unconsciousness) b. Maintainence c. Emergence (returning to consciousness). If a surgical manipulation is been necessary, muscle relaxant must be given in addition to anaesthetic gases and injection to paralyse the breathing and over here the patients lungs must be ventilated artificially. Different types of drugs used in GA and their actions: Premedication drugs relaxes patients, abolishes pain and apprehension, reduce saliva and mucous formation, e.g. morphine, diazepam and atrophine. Induction agents induces unconsciousness, e.g. sodium thipentone. Anaesthetic gases and volatine agents induce and maintain unconsciousness, e.g. nitrousoxide, halothane, isoflurane, enflurane. Analgesics abolishes pain, e.g. morphine, fentanyl. Muscle relaxants relaxes muscles, e.g. pancuronium, vecuronium. Reversal agents reverses muscle relaxants, e.g. neostigimine. Complications Depending on the preoperative condition of the patient, the anaesthetic technique used, the nature of operation performed and the duration of the surgery the complication depends on it such as nausea, vomitting, hypotension, (low BP) physical injury such as chipped teeth, lip injury, muscle strains, allergic reactions cardiac arrythmia (irregular heartbeat) respiratory depression, hypoxia, aspiration and airway obstruction.

*

*

Procedures are simple and well illustrated; many are important and life saving. It is a boon to paramedics and nurses.

ISBN 81-8061-031-4

788180 610318