Perioperative Practice: Fundamentals of Homeostasis

304 Pages·2002·2.33 MB·English

by  John Clancy

Perioperative Practice
Fundamentals of Homeostasis
Written by experienced nurse lecturers and a theatre nurse, Perioperative Practice
highlights and explains the physiological processes which can be disrupted by any
major surgical procedure. Using the concept of homeostasis as a framework, the
authors look at issues common to all surgical procedures such as the influence of
anaesthesia on the nervous system or perioperative pain management. Individual
chapters cover:
■ the human body and principles of homeostasis
■ the surgical approach and endoscopic procedures
■ perioperative influences on body fluid homeostasis
■ perioperative influences on immunological homeostasis and wound healing
■ perioperative influences on cardiovascular homeostasis
■ perioperative influences on respiratory homeostasis
■ anaesthesia, stress and surgery
■ pain and pain relief in the perioperative patient.
Generously illustrated in colour and black and white, the text features reflective
learning activities and useful summaries of key points. Perioperative Practice can
be used as a supporting text by all nurses undertaking courses in theatre work or
related areas and provides an excellent resource for those already working in such
areas.
John Clancy is Team Leader of Applied Human Sciences, Nursing and Midwifery
Research Unit, University of East Anglia. Andrew McVicar is Reader and Prin-
cipal Lecturer, School of Health Care Practice, Anglia Polytechnic University.
Nicola Baird is a Specialist Practitioner in the In-Patient Theatres at the Norfolk
& Norwich University Hospital NHSTrust.

Perioperative Practice
Fundamentals of Homeostasis
John Clancy, Andrew J. McVicar and Nicola Baird
LONDON AND NEW YORK
First published 2002
by Routledge
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor and Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
© 2002 John Clancy, Andrew J. McVicar and Nicola Baird
All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Clancy, John.
Perioperative practice : fundamentals of homeostasis John Clancy, Andrew J. McVicar,
and Nicola Baird.
p. cm.
Includes bibliographical references and index.
1. Operating room nursing. 2. Surgical nursing. 3. Homeostasis. I. McVicar, Andrew J.
II. Baird, Nicola, 1962– III. Title.
RD32.3 .C56 2002
610.73’67—dc21
2001048953
ISBN 0-203-99428-0 Master e-book ISBN
ISBN 0-415-23310-0 (hbk)
ISBN 0-415-23311-9 (pbk)
Contents
List of figures ix
List of tables xiii
List of boxes xv
Foreword xix
About this book xxi
Acknowledgements xxiii
1 The human body and principles of homeostasis 1
Introduction 1
The basic needs of the human body and activities of daily living 11
Levels of organization 13
Homeostasis: the link with health and ill-health 15
Homeostasis and ill-health 22
Summary 26
Bibliography 26
Answers to multiple choice questions 27
2 The surgical approach and endoscopic procedures 28
Introduction 28
‘Open’ surgery: gaining access 28
Minimal access surgery: endoscopy 45
Summary 54
Bibliography 55
vi CONTENTS
3 Perioperative influences on body fluid homeostasis 57
Introduction 57
Body fluids and their distribution 59
Electrolyte composition of intracellular and extracellular fluids 65
Perioperative influences on water and electrolyte homeostasis 73
Infusates and the support of body fluid compartments 85
Summary 89
Bibliography 89
4 Perioperative influences on immunological homeostasis
and wound healing 91
Introduction: immunological homeostasis 91
The specific immune response 99
An overview of the homeostatic responses involved in wound healing 111
Details of the stages involved in wound healing 119
Summary 133
Bibliography 133
Answers to multiple choice questions 136
5 Perioperative influences on cardiovascular homeostasis 137
Introduction: relation of the cardiovascular system to cellular homeostasis 137
Overview of the anatomy and physiology of the cardiovascular system 137
Cardiac output, peripheral resistance and blood pressure 152
Shock: a failure to maintain cardiovascular homeostasis 163
Summary 174
Bibliography 175
Answers to multiple choice questions 176
6 Perioperative influences on respiratory homeostasis 177
Introduction 177
Principles of blood gas homeostasis 180
The respiratory system in the perioperative period 193
Ventilation therapy as a homeostatic mechanism 205
Summary 208
Bibliography 209
7 Anaesthesia, stress and surgery 212
Introduction 212
Surgical stress I: anxiety 218
Surgical stress II: general anaesthesia 219
Surgical stress III: responses to trauma 226
Summary 234
Bibliography 235
CONTENTS vii
8 Pain and pain relief in the perioperative patient 237
Introduction 237
Pain perception: an overview 238
Details of the neurophysiology associated with pain perception 240
The subjectivity of pain 248
Perioperative pain management 251
Pharmacological pain management 251
Non-pharmacological pain techniques 261
Summary 266
Bibliography 267
Answer to multiple choice question 269
Index 271

Figures
Figure 1.1 Common positioning of the patient for various surgical
procedures 4
Figure 1.2 Anatomical position 5
Figure 1.3 Planes through the body 6
Figure 1.4 Lateral and anterior views of the human body showing
major cavities 8
Figure 1.5 Anatomical sub-divisions of the abdomen and pelvic regions 9
Figure 1.6 The hierarchy of organizational levels of the human organism 12
Figure 1.7 Organ system’s involvement in regulation of intracellular
homeostasis 17
Figure 1.8 Principles of homeostatic control 20
Figure 1.9 Homeostasis 24–5
Figure 2.1 Structure of the skin 31–2
Figure 2.2 General anatomy of skeletal muscle 40
Figure 2.3 Sensory and motor neurons 43
Figure 2.4 Sites for inserting trocars for laparoscopic appendicetomy
surgery 52
Figure 3.1 Movement of water molecules by osmosis 58
Figure 3.2 Body fluid compartments and their volumes (adult) 59
Figure 3.3 Capillary exchange 61
Figure 3.4 Buffering 68
Figure 3.5 Roles of sodium and potassium ions in generating an action
potential in a nerve cell 70
Figure 3.6 Body fluid homeostasis 74
Figure 4.1 The immunogen is the bacterium which may have many
antigens attached to its cell membrane 95