Su8CL8?

of heallng by manual opealon

unlque expelence of a planned physlcal alealon
lnulC@lCnS lC8 Su8CL8?
Congenlal nomalles
cquled ulseases ocess
@auma
efoalon
Cbsuclon
Loslon
@umo
@?LS Cl Su8CL8? (CCC8ulnC @C u8CSL)
ulagnoslc
Cualve (blalve Consuclve 8econsuclve)
Cosmelc (eshelc)
alllalve
8esoalve
@?LS Cl Su8CL8? (CCC8ulnC @C u8CLnC?)
LML8CLnC? canno be delayed
u8CLn@ mus be done wlhln 2430 hous
8LCul8Lu mus be done wlhln few weeks o monh
LLLC@lvL lme ls dependen on convenlence of he palen
C@lCnL schedule ls dependen on palen#s pefeence
SMLu? ambulaoy sugey o oupalen sugey
@?LS Cl Su8CL8? (CCC8ulnC @C uLC8LL Cl 8lSk)
MC8 hlghe lsk
MlnC8 lowe lsk
MC8 Su8CL8?
uses CLnL8L nLS@LSl
Cpens one of he ma[o body cavlles
efomed ln he C8 by eam of docos
8equles conflnemen of @ LLS@ CnL nlC@ ln he hosplal
MlnC8 Su8CL8?
uses local eglonal o geneal aneshesla
MC8 8Cu? Cvl@lLS 8L nC@ CLnLu
May be pefomed ln selngs ouslde opealng oom
lC@C8S lnlLuLnClnC uLC8LL Cl 8lSk
ge
Ceneal ealh
nullonal Saus
Medlcalons
Menal Saus

LL@ 8C8LLMS @@ lnC8LSL Su8ClCL 8lSk

nLAL1n kC8LLM LIILC1S 1C SUkGLk
C8LSl@? W Jound dehlscence
W ueceased pefuslon
W ypovenllalon
W lnceased afeload
W ueceased mobllly
CC8 nu@8l@lCn W ueceased wound heallng
W lnfeclon
W Shock
LL@ 8C8LLM LllLC@S @C Su8CL8?
lLulu nu LLLC@8CL?@L
lM8LnCL
W Shock
W Cadlac dyshyhmlas
W ypevolemla (3d day posop)
ClnC W lnceased lsk fo ln[uy
W lnceased effec of medlcalons
C8ulCvSCuL8
ulSLSLS
W lmpaled lssue pefuslon
W hyhmla
W Myocadlal lnfaclon
W Cadlac es
ul8L@LS MLLLl@uS W ypoglycemla
W ypeglycemla
W keoacldosls
W oo wound heallng
LCCCLlSM W lnceased oleance o
aneshelcs
uLMCn8? ulSLSLS W ypovenllalon W 8onchodllaos
W use oplold caulously
ul8L@LS MLLLl@uS W ypoglycemla
W ypeglycemla
W keoacldosls
W oo wound heallng
W Close monlolng of glucose
W lnsulln admlnlsalon
W Sop Mefomln
LCCCLlSM W lnceased oleance o aneshelcs W 8apld sequence lnduclon
W Monlo fo wlhdawal syndome
uLMCn8? ulSLSLS W ypovenllalon W 8onchodllaos
W use oplold caulously

MLulC@lCnS @@ lnC8LSL Su8ClCL 8lSk
lL8S 8LL@Lu @C Su8CL8?
leas of he unknown
lea of aleed body lmage
@hea of sexually
lea of pemanen dlsabllly
lea of dylng
lea of paln
L8lCL8@lvL nu8SlnC
uellvey of nuslng cae hough he famewok of he nuslng
pocess
SLS Cl L8lCL8@lvL nu8SlnC
8LCL8@lvL SL
8LClnS when palen decldes o undego sugey
LnuS when palen ls ansfeed o C8 able
C@lvl@lLS
ssessmen of he cllen
ldenlflcalon of lsks and healh poblems
ovlde peopealve eachlngs
LLCL 8L8@lCn Cl @L @lLn@
lnlC8MLu CCnSLn@
Cbalned by Su8CLCn
May be Jl@nLSSLu by he nu8SL
necessay ln all pocedues LxCL@ ln LML8CLnC?
lnlC8M@lCn @C 8L LxLlnLu 8? @L Su8CLCn
naue of and eason fo he sugey
vallable oplons and lsks assoclaed wlh each oplon
8lsks of he suglcal pocedue and poenlal oucomes
name and quallflcalons of he sugeon
8lgh o efuse consen o lae wlhdaw consen
LLLMLn@S Cl n lnlC8MLu CCnSLn@
lnfomalon ls explalned ln language undesood by he palen
alen ls consclous
alen ls menally compeen
alen ls no sedaed
alen ls no a mlno (aens wlll slgn lf mlno)
8LCL8@lvL SSLSSMLn@
Cuen ealh Saus
llegles
Medlcalons
evlous Sugeles
Menal Saus
undesandlng of he suglcal pocedue
Smoklng
lcohol and ohe mlnd alelng subsances
Coplng
Soclal esouces
Culual and spllual consldealons
8LCL8@lvL SC8LLnlnC @LS@S
1LS1 kA1ICNALL
Complee 8lood Coun
(C8C)
ovlde lnfomalon on clculalon and oxygenalon
8lood @yplng ueemlnes blood ype ln case of blood ansfuslon
Seum Llecolyes Lvaluaes fluld and elecolye saus
laslng 8lood Clucose
(l8S)
Checks pesence of ulabees Melllus
8lood uea nlogen
(8un)
Cealnlne
Lvaluae enal funclon
L@ S@ LuL 8lllubln Lvaluae llve funclon
Seum lbumln and @oal
oeln
Lvaluae nullonal saus
ulnalysls ueemlne ulne composllon and lnfeclon
Ches xay Checks esplaoy saus and hea slze
LCC (lf ove 40) ldenlfy cadlac dlseases
egnancy @es (lf
female)
Checks lf palen ls pegnan
nsg ulagnosls
ueflclen knowledge
nxley
ulsubed Sleep aen
nlclpaoy Clevlng
lneffeclve Coplng
CvL8LL CCL Cl C8L ln 8LCL8@lvL L8lCu
Lnsue ha he palen ls menally and physlcally pepaed fo
sugey
8LCL8@lvL lnS@8uC@lCnS
Lxplaln need fo peopealve ess
ulscuss bowel pepaalon
ulscuss skln pepaalon
ulscuss peopealve medlcalons
Lxplaln lndlvldual heaples eg lnavenous heapy lnselon of
ulnay cahee nC@ splomee anlembollc socklngs
ulscuss vlsl by anesheslogls
Lxplaln need o eslc food and oal flulds 8 hous plo o sugey
ulscuss need o emove [ewely makeup and all posheses
@each deepbeahlng and coughlng execlses leg execlses unlng
and spllnlng( osopeavle nuslng lnevenlons)
Complee he peopealve checklls
unlvL8SL 8C@CCCL lC8 8LvLn@lnC J8CnC Sl@L J8CnC
8CCLuu8L J8CnC L8SCn Su8CL8? (CC 2003)
@8LL S@LS
8LCL8@lvL vL8lllC@lCn cllen ls velfled dulng schedullng
admlsslon and ansfe o anohe caeglve
M8klnC Cl @L CL8@lvL Sl@L ln n unM8lCuCuS MnnL8 he
suglcal sle ls maked wlh cllen#s lnllals sugeon#s lnllals" o ?es" #O#
|s avo|ded
@lML Cu@ he lme akes lmeou o conduc flnal velflcalon
8LCL8@lvL MLulC@lCnS
8LCL8@lvL MLulC@lCnS
SLu@lvLS nu @8nCulLlZL8S (SLCC888l@L ulZLM)
educe anxley ease anaeshelc lnduclon
n8CC@lC nLCLSlCS (MC8lnL uLML8CL)
povlde sedalon and decease amoun of anaeshelc
n@lCCLlnL8ClCS (@8ClnL SCCCLMlnL)
educe oal and pulmonay secelons peven layngospasm
lS@MlnL8LCL@C8 n@llS@MlnLS (8nl@lulnL ClML@lulnL)
educe gaslc fluld volume and acldly
nLu8CLL@CnLCLSlCS (lnnCv8)
lnduce geneal calmness and sleeplness
8LCL8@lvL nu8SlnC ln@L8vLn@lCnS
S?CCLCClCL 8L8@lCn Cl @L @lLn@
Lxplaln all he pocedues hel pupose wha o expec dulng and afe
he sugey
llow hem o ask he queslons
ssess cllens fea$anxley and coplng mechanlsm
llay anxley povlde spllual cae(ples)lf necessay conslde ellglous
pefeences
uemonsae confldence ln sugeon and saff
8LCL8@lvL nu8SlnC ln@L8vLn@lCnS
?SlCLCClCL 8L8@lCn Cl @L @lLn@
@each osCpealve Lxeclses llke deep beahlng execlse coughlng
spllnlng lnclslon fequen unlng and leg execlses
llow clea llqulds up o 2 hous befoe sugey
llow llgh beakfas (ea and oas) 6 hous befoe sugey
llow heavle meal 8 hous befoe sugey
dmlnlse 2 8lockes llke 8anlldlne (o peven ulce whlle nC)
ovlde cleanslng enema and laxalves (o peven conslpalon)
dmlnlse anlblolc llke neomycln (fo bowel sugey)
Lmpy bladde befoe pemeds ae glven (fo bee vlsuallzalon)
pply anlembollc socklngs fo eldely (o peven hombophleblls)
should be emoved fo 30 mlnues evey 8 hous
llow bahe and shampoo hal
llow adequae es and sleep
Cleanse skln wlh povldone lodlne and hexachloophene
Shave hal and lm nalls
8emove halplns wlgs nall pollsh denues
pply ldenlflcalon band
ln@8CL8@lvL SL
8eglns a he momen of he palen ls aneshelzed up o he lme he las
desslng on he lnclslon ls placed
@he suglcal eams akes ove he esponslbllly of meelng he palen
needs
@L Su8ClCL @LM
Sugeon
nesheslologls
Scub nuse
Clculalng nuse
8LSCnSl8lLl@lLS Cl nLS@LSlCLCClS@
vlsl he palen plo o sugey o acqualn hlm wlh wha o expec fom
he aneshelc
lnduclon of aneshesla
ay palcula aenlon o malnalnlng a clea o paen alway adequae
beahlng and exchange of gases ln he lungs and sysemlc clculalon
8LSCnSl8lLl@lLS Cl @L SC8u8 nu8SL
e maln esponslbllly ls o anlclpae and mee he needs of he sugeon
fo lnsumens and supplles dulng he pocedue
epae he equlpmen
Cpen he ma[o pack
epae he gauze gloves mayo able
Seve sugeongownlng and glovlng
lnllal counlng of he lnsumen ogehe wlh he clculalng nuse
8LSCnSl8lLl@lLS Cl @L Cl8CuL@lnC nu8SL
Coodlnae and mee needs of C8 eam
dml palen o C8 velfy consen posllon palen pepae skln
Ceneal managemen of he C8 ensulng he cleanllness pope
empeaue humldly llghlng funclonlng equlpmen avallabllly of
supplles and maelals
Monlo palen#s safey and beaks ln asepsls
Save and coun dlscaded sponges and lnsumens
8emlnd he eam ha he palen ls awake
Conol he numbe and behavlo of vlslos ln he opealng oom
Manage suglcal speclmen
uocumenalon
ZCnLS Cl @L Su8ClCL Lnvl8CnMLn@
un8LS@8lC@Lu ZCnL see clohes ae allowed
SLMl8LS@8lC@Lu ZCnL consls of scub clohes and caps
8LS@8lC@Lu ZCnL scub clohes shoe cove mask ae allowed
@LCnlCuLS @C 8LvLn@ CCn@Mln@lCn
lloos and holzonal sufaces ae cleansed wlh soap wae and deegen
@o mlnlmlze bacela lno al sandad C8 povlde 13 al exchange pe
hou30 o 130 CCv (Colony loamlng unl) pe cublc pe mlnue
Selllzalon of equlpmen
Suglcal Scubblng
Jealng of long sleeve gown and gloves
al ae coveed wlh cap
Mask ls won o cove he nose
Skln ls cleansed wlh anlmlcoblal agen
8lnClLLS Cl S@L8lLL @LCnlCuL
Ldges of anyhlng ha encloses selle conen ae consldeed unselle
Selle aeas ae conlnuously kep ln vlew
Selle pesons keep well wlhln selle flelds
Selle pesons keep conac wlh selle aeas lno a mlnlmum
unselle pesons avold selle aeas
uesuclon of lnegly of Mlcoblal 8ales 8esuls ln Conamlnalon
Mlcooganlsm mus be kep o an leduclble mlnlmum
8lnClLLS Cl S@L8lLL @LCnlCuL
Selle lems ae used only ln selle flelds
@ables ae selle a he able level
esons who ae selle ouch only selle lems o aeas who ae no selle
ouch only unselle lems o aeas
unselle pesons avold eachlng ove selle flelds esons avold leanlng
ove an selle aea
nLS@LSl
ls a sae of nacosls analgesla elaxalon and loss of eflexes
neshelc he subsance such as chemlcal o gas used o lnduced
aneshesla
@?LS Cl nLS@LSl
CLnL8L nLS@LSl
aln ls conolled by geneal lnsenslbllly
8aslc elemens lncludes loss of analgesla lnefeence wlh undeslable
eflexes and muscle elaxalon
8LnCLu nLS@LSl
@he popeles of geneal (hypnosls analgesla muscle elaxalon) ae
poduced ln vaylng degees by comblnalon of agen
LCCL C8 8LClCnL 8LCCk nLS@LSl
(CCnuuC@lCn nLS@LSl)
aln ls conolled wlhou loss of consclousness
@he sensoy neves ln one aea o eglon ae anesheslzed
cupuncue ls somelmes used
SlnL C8 Lluu8L nLS@LSl
Sensalon of paln ls blocked a a level below he dlaphagm wlhou a loss of
consclousness
@he agen ls ln[eced ln he splnal canal
S@CLS Cl nLS@LSl
S@CL l 8LClnnlnC nLS@LSl
@he sage of lnduclon exends fom he beglnnlng of he admlnlsalon of
he aneshelc o he beglnnlng of loss of consclousness
@he palen ls awae ha he ls unaable o move hls exemlles volunally
uulng hls sage even low volces o mlno sounds appea loud o
dlsesslng
lo hls eason unnecessay nolse mus be pevened
S@CL ll LxCl@LMLn@
exends fom he loss of consclousness o he loss of eyelld eflex
chaacelzed by suggllng shoulng alklng slnglng laughlng o even
cylng
he puplls of eyes ae dllaed bu when exposed o llgh wlll conac
he pulse ae ls apld and esplalon legula
help need o esaln he palen sap maybe placed acoss he hlghs
S@CL lll Su8ClCL nLS@LSl
exends fom he loss of lld eflex o cessalon of esplaoy effo
palen ls unconsclous hls muscles ae elaxed and mos of he eflexes ae
absen he puplls ae small bu hey conslc when hey exposed o llgh
esplalon ls egula pulse ae ls of good volume and skln ls plnk and
sllghly flushed
lf wlh pope admlnlsalon of aneshelc hls sage maybe malnalned fo
hous
S@CL lv S@CL Cl unCL8$MLuuLL8? uL8LSSlCn
eached when oo much aneshesla has been glven and when he palen
has no been obseved caefully
cyanosls develop gadually and unless pomp aclon ls aken deah follows
apldly
lf hls sage develops aneshesla ls dlsconlnued and alflclal esplalon ls
glven
slmulans maybe admlnlseed
LLvLLS Cl SLu@lCn nu nLS@LSl
1LS1 kA1ICNALL
Complee 8lood Coun (C8C) ovlde lnfomalon on clculalon and oxygenalon
8lood @yplng ueemlnes blood ype ln case of blood ansfuslon
Seum Llecolyes Lvaluaes fluld and elecolye saus
laslng 8lood Clucose (l8S) Checks pesence of ulabees Melllus
8lood uea nlogen (8un)
Cealnlne
Lvaluae enal funclon
L@ S@ LuL 8lllubln Lvaluae llve funclon
Seum lbumln and @oal
oeln
Lvaluae nullonal saus
ulnalysls ueemlne ulne composllon and lnfeclon
Ches xay Checks esplaoy saus and hea slze
LCC (lf ove 40) ldenlfy cadlac dlseases
egnancy @es (lf female) Checks lf palen ls pegnan

ML@CuS Cl nLS@LSl uMlnlS@8@lCn
lnL@lCn
dmlnlseed by mlxlng vapos wlh oxygen o nlous oxlde and hen
havlng he palen lnhale he mlxue
@he vapos ls admlnlseed vla ube o mask o layngeal mask
Lxample
Llquld alohane(lluohane) mehoxyflualne(enhane)
Cases nlous oxlde
ln@8vLnCuS
8abluaes benzodlazeplne (Mldazolam) opolod agen dlazepam
(vallum) mepeldlne CL (uemeol) pomehazlne (henegan)
8LClCnL nLS@LSl
ln[eced aound neves so ha aea supplled hese neves ae anesheslzed
CCnuuC@lCn 8LCCk
Lpldual aneshesla blocks sensoy moo and auonomlc funclons
uvn@CL absence of headache esuls fom subaachnold ln[eclon
@?LS
88ClL LLxuS 8LCCk aneshesla ln he am
8vL8@L88L nLS@LSl aneshelsa on he ches abdomlnal wall and
exemlles
@8nSC8L (CuuL) 8LCCk poduces aneshesla of he pelneum and
occaslonally lowe abdomen
SlnL nLS@LSl
a ype of exenslve conduclon neve block poduced uslng local aneshelc
8Cu@L subaachnold space a he lumba level usually L4 and L3
LCC@lCn Cl nLS@LSl lowe exemlles pelneum and lowe
abdomen
CCMMCnL? uSLu CLn@S pocalne eacalne (onocalne) lldocalne
(xylocalne) and buplvacalne(Macalne)
lC@C8S @C 8L CCnSluL8Lu ln CSl@lCnlnC Cl @lLn@ lC8 Su8CL8?
alen#s comfo and plvacy
dequae exposue of opealve sle
bsence of clculalon lnefeence
bsence of esplalon lnefeence
neves should be poeced fom undue pessue
Shoulde baces mus be well padded o peven ln[uy
MCS@ CCMMCnL? uSLu CL8@lvL CSl@lCnS
uC8SL 8LCuM8Ln@ C8 SulnL
used fo henla epal exploaoy lapaoomy cholecysecomy gaslc
and bowel eseclon masecomy
8CnL
@he am should be well poeced and caefully poslloned o peven ulna
o adlal damage
@8LnuLLLn8u8C
lo opealon of he lowe abdomen and pelvls o obaln good exposue by
dlsplacemen of he lneslne ln he uppe abdomen
Ll@C@CM?
pelneal ecal and vaglnal sugey
L@L8L CSl@lCnS
kldney opealons
Skln 8L8@lCn
uone afe palen has been aneshelzed and poslloned on he able
Skln 8L8@lCn 8C@lCLS
(8LCCMMLnuLu 8? SSCCl@lCn Cl CL8@lnC 8CCM nu8SLS C8n)
Clean he suglcal sle and suoundlng aeas befoe suglcal pep by havlng
he cllen showe and shampoo o wash suglcal sle befoe alvlng ln he
C8
ssess suglcal sle befoe skln pep and documen
8emove hal fom suglcal sle by uslng eleclc cllppes depllaoy ceams
epae suglcal sle wlh anlmlcoblal agen
uocumen suglcal skln pep on he cllen#s ecod
S@LS ln 8L8lnC @L Skln lC8 Su8CL8?
uon selle gloves
Scub skln salng he sle of lnclslon wlh a clcula molon o ove
wldenlng clcles of pelphey use enough pessue and flclon o emove
dl and mlcooganlsm fom skln and poes
ulscad sponge afe eachlng he pelphey
8epea scub wlh a sepaae sponge fo ound and apply anlseplc
Scub he mos conamlnaed aea las wlh sepaae sponge
aln aea wlh solulon fom lnclslon sle o pelphey wlh clcula molon
8LS CCnSluL8Lu CCn@Mln@Lu Jl@ln CL8@lvL llLLu
umblllcus
Soma
ualnlng slnuses
Skln ulces
vaglna
nus
@?LS Cl 8uCMlnL lnClSlCn
SSLSSMLn@
ssess he anxley level
Lsabllsh appo
Check cha fo he esul of laboaoy es
vlal slgns
LCC
Cxygen saualon
nu8SlnC ulCnCSlS
8lsk fo asplalon
lneffeclve poeclon
lmpaled skln lnegly
8lsk fo pelopealve posllonlng ln[uy
8lsk fo lmbalanced body empeaue
lneffeclve lssue pefuslon
8lsk fo deflclen fluld volume
nu8SlnC ln@L8vLn@lCnS
8LLlLvlnC nxlL@?
Cee palen
Cffe comfo measues alslng he head offelng wam blanke
8emaln wlh he palen a all lmes
Malnaln qule envlonmen o allow peopealve medlcalon o ake effec
CvL8LL CCL Cl C8L ln @L ln@8CL8@lvL L8lCu
Malnaln cllen#s safey
Malnaln homeosasls
L8lC8M CC88LC@ 8CCLuu8L @C @L 8lC@ @lLn@
name band and C8 peml mus be checked he pocedue and he
sugeons name mus be velfled
Mln@ln lLulu 8LnCL
Check he cha he hc and gb amoun of blood malnaln accuae lnpu
and oupu assess blood loss on sponges and ln suclon
8LvLn@ 8L@Ln@lCn Cl lC8LlCn 8Cu?
@he clculalng nuse couns wlh he asslsance of anohe peson all
lnsumens sponges pad and needles befoe he pocedue begln and as
he sugeon close he skln
8LvLn@ LCSS Cl 8Cu? L@
Clve wam blanke
Monlo he C8 empeaue and palen#s empeaue
8LvLn@ lnlLC@lCn
Monlo beaks ln selle echnlque and povlde coeclve aclon
8LvLn@ lnu8?
osllon caefully and malnaln body allgnmen
8LSLC@ @lLn@#S 8lvC?
@hee should be no unnecessay exposue of he palen he cha should
be only avallable o auholzed pesonnel and confldenlally of all
lnfomalon mus be malnalned
C@Ln@lL ln@8CL8@lvL CCMLlC@lCnS
nuSL vCMl@lnC
@un o slde head loweed povlde basln
eop nlemelc dugs
Suclon fo Sallva and vomled gaslc conens
splalon of vomlus can lead o neumonlls and ulmonay Ldema
leadlng o ?Cxl
C@Ln@lL ln@8CL8@lvL CCMLlC@lCnS
n?LxlS
8eaclon of he body o foelgn subsances
Meds common cause of anaphylaxls
Laex eaclon can also occu
Llfeheaenlng vasodllalon hypoenslon and bonchlal conslclon
llbln sealans and cyanoacylae adheslves can also cause anaphylaclc
feedback
?Cxl nu 8LSl8@C8? CCMLlC@lCnS
alen#s oxygenalon saus ls he 8lM8? lunC@lCn of he nLS@LSl
8CvluL8 and he Cl8CuL@lnC nu8SL
ulse Cxlmey values ae monloed conlnuously
naomlc valalon L@ ube may be lnseed
Suglcal CSl@lCnlnC (@endelenbug)
C@Ln@lL ln@8CL8@lvL CCMLlC@lCnS
?C@L8Ml
Clucose meabollsm ls educed @LM deceases esuls ln ML@8CLlC
CluCSlS
8elow 366C980l below nomal coe emp
Low emp ln C8 (Se a 23 o 266 Celslus)
lnfuslon of cold flulds (Jam o 376 Celslus)
Jamlng should be gadual
C@Ln@lL ln@8CL8@lvL CCMLlC@lCnS
MLlCnn@ ?L8@L8Ml
lnheled MuSCLL ulSC8uL8 chemlcally lnduced by aneshelc agens
Susceplble eople
@hose wlh song and bulky muscles
lsoy of muscle camps o muscle weakness
unexplalned empeaue elevalon
unexplalned deah of a famlly membe afe sugey
CLlnlCL MnllLS@@lCnS Cl MLlCnn@ ?L8@L8Ml
@achycadla (130 beas$mln) ealy slgn
venlcula dyshymla
ypoenslon
ueceased Cadlac Cupu
Cllgula
Cadlac es
8lgldly eanusllke movemens
klse lo temp usually a lae slgn develops fas
1 to 2 c evety 5 mlos coo exceeJ 40c
1tlsmos (mossetet sposm) commoo oot speclflc fot Mn occots 1 lo
cbllJteo qlveo succlnylchollne (SCh) wlh bolotbooe ooestbeslo
8LvLn@lCn Cl MLlCnn@ ?L8@L8Ml
Suspec posslble M wlh famlly hlsoy of poblems$deah wlh aneshelc
uanolene pophylaxls no longe oulne
vold all lgges
Cenal 8ody emp and L@ CC2 monlolng
use eglonal aneshesla lf posslble
use equlpmen clean" of lgge agens
MnCLMLn@ Cl MLlCnn@ ?L8@L8Ml
ulsconlnue lnhaled aneshelc agen and succlnylchollne emlnae
pocedue
ypevenllae wlh 100 C2
antro|ene 1mg]kg epealng unll sable o 10mg$kg maxlmum eached
@ea meabollc$physlologlc deangemens accodlngly
Conol body empeaue
ulllgen monlolng (especlally CvS elecolyes 8Cs ulne oupu)
CS@CL8@lvL SL
8eglns fom he momen sugeon complees he las slch and conlnues
unll he meabollc and lssues changes esullng fom he suglcal
pocedue have euned o nomal
3 SLS
lMMLul@L CS@CL8@lvL palen ls ansfeed o Cu o 88
L8L? CS@CL8@lvL palen ls ansfeed o unl o wad
ulSC8CL palen ls dlschaged fom he unl
SSLSSMLn@
SSLSSMLn@ ln @L lMMLul@L CS@CL8@lvL L8lCu
Level of Consclousness
vlal Slgns (q13 hen q30 hen houly)
Skln Colou and @empeaue
Comfo
lluld 8alance
uesslng and 8edclohes
ualns and @ubes
SSLSSMLn@ ln @L J8u
Sub[eclve sk fo paln and dlscomfo aleness level
Cb[eclve 88 Clculaoy saus LCC uesslng lnfuslon dalnage sysem
Su8CLCnS C8uL8 aclvly fluld food meds
Su8ClCL nC@LS osopealve dlagnosls ype of sugey ype of
aneshesla eslmaed blood loss and fluld eplacemen
8LCCvL8? 8CCM SuMM8? vlal slgn alen pogess Medlcalon glven
ulnay oupu
nu8SlnC ulCnCSlS
cue paln
8lsk fo lnfeclon
8lsk fo ln[uy
8lsk fo deflclen fluld volume
lneffeclve alway cleaance
lneffeclve beahlng paen
Selfcae deflcl
uelayed suglcal ecovey
ulsubed body lmage
nu8SlnC ln@L8vLn@lCnS
ln MnCLMLn@
usually geaes 1236 hous afe sugey
naeshelcs may be admlnlseed vla Cs lv o epldual
Monlo palen#s esponse
dmlnlse analgeslcs 8n evey 26 hous fo he fls 2436 hous
Lnsue ha he palen ls wam
ovlde nonphamacologlc measues such as back ubs posllon changes
dlveslonal aclvlles lmagey
CSl@lCnlnC
osllon cllen as odeed
lla on bed fo 812 hous (lf glven splnal anaeshesla)
Sldelylng wlh head elevaed (fo unconsclous o semlconsclous)
Llevalon of exemlles (lf wlh hand o foo sugey)
uLL 88L@lnC nu CCuClnC LxL8ClSLS
evens pneumonla and aelecasls
Lncouage use of lncenlve splomee
Should be done a leas evey 2 hous and dulng waklng hous
ssls o sl on slde of bed
ssls o splln wlh plllow dulng coughlng
LLC LxL8ClSLS
Lncouage o do leg execlses evey 12 hous dulng waklng hous
MCvlnC nu M8uL@lCn
Lncouage o un o sldes a leas evey 2 hous
vold placlng plllows o olls unde knees (compesses poplleal clculalon)
Lncouage ambulalon afe 24 hous unless conalndlcaed
mbulalon should be done afe glven analgeslc
Sa by sllng on bed and dangllng ove he slde
?u8@lCn
Malnaln lv flulds as odeed
Cffe fls small slps of wae (Lage volume can lnduce vomllng)
lf nC offe lce chlps
ovlde mouh cae and povlde mouhwash
Measue lnake and oupu fo a leas 2 days
ulL@
Cal flulds and food ae glven once wlh pelsalsls
May be glven u@ once wlh gag eflex and wlhou nausea
Clea llquld lnllally hen luLL LlCulu hen 8LCuL8 ulL@ lf oleaed
usculae abdomen fo eun of pelsalsls and flaus
ssess bowel sounds evey 46 hous
lgh ln vlamln C oeln and oasslum
u8ln8? LLlMln@lCn
8ladde one should eun wlhln 68 hous
elp male cllen sand on bedslde
elp female cllen o bedslde commode
ssess fo dlfflculy voldlng and bladde dlsenlon
8epo lf cllen has no volded wlhln 8 hous
Sa caheelzalon lf all measues fall
8CMC@lnC LLlMln@lCn
usually assumes nomal paen afe 6 o 8 hous
Monlo lnake and Cupu
lncease fluld
Laly ambulalon
lf no esuls afe 3 days mlld laxalves ae glven o enemas
JCunu C8L
lnspec wound desslng lf clean dy and lnac
Jach ou fo excesslve dalnage (suggess hemohage o lnfeclon)
ssess suglcal wound#s appeaance slze dalnage swelllng paln dalns o
ubes
SlCnS Cl JCunu LLlnC
bsence of bleedlng and flbln clos ln edges (fls few hous)
lnflammalon a wound edges (fls 13 days)
8educlon ln lnflammalon (710 days)
Sca fomalon (4 days o 6 monhs)
ulmlnlshed sca slze
CLSSlllC@lCn Cl JCunu LLlnC
8lM8? ln@Ln@lCn (8lM8? CLCSu8L) clean lnclslon ls made wlh
plmay closue hee ls mlnlmal scalng
SLCCnu8? ln@Ln@lCn (C8nuL@lCn) wound ls lef open ganulalon
esullng o lage scas
L@L CLCSu8L would ls lnllally lef open and lae closed when hee ls no
evldence of lnfeclon
@?LS Cl u8LSSlnCS
u8?@Cu8? u8LSSlnCS lndlcaed fo wounds closlng by plmay lnenlon
JL@@Cu8? u8LSSlnCS lndlcaed fo wounds ha ae unldy o lnfeced
ha mus be deblded and closed by seconday lnenlon
JL@@CJL@ u8LSSlnCS lndlcaed fo clean open wounds o on
ganulalng sufaces
CCMMCn CS@CL8@lvL CCMLlC@lCnS
CCMMCn CS@CL8@lvL CCMLlC@lCnS
CCMMCn CS@CL8@lvL CCMLlC@lCnS
CCMMCn CS@CL8@lvL CCMLlC@lCnS
ISCnAkGL LANNING
8LS@ nu C@lvl@?
Sa by aklng sho walk 23 lme pe day
lan egula naps and qule aclvlles
@ake paln medlcalons a bedlme
Cadually lncease execlse
vold llflng anyhlng moe han 3 lbs fo 48 weeks
Sexual lnecouse ls allowed appoxlmaely afe 24 weeks
L@lnC nu LLlMln@lCn
La small egula meals
lncease vlamln C and poeln ln dle
@ake laxalves o pomoe ellmlnalon
8@lnC nu SCJL8lnC
Jound may be we afe 3 days o afe lnllal desslng change
Showe ls moe pefeed
uy wound hooughly befoe desslng
CLC@lnC
vold lgh bels and undewea
Jea loose clohlng

AIN MANAGLMLN1
AIN
W unpleasan sensoy and emolonal expelence assoclaed wlh
acual o poenlal lssue damage (lnenalonal ssoclalon of aln
melcan aln Socley)
W @he flfh vlal slgn"(melcan aln Socley)
CCMMCN MISCCNCL1ICNS
MISCCNCL1ICN Cllens expelence paln only afe ma[o sugey
CCkkLC1ICN Cllens expelence paln even afe mlno sugey
MISCCNCL1ICN ealh pofesslonals ae he auholles abou a cllen#s
paln
CCkkLC1ICN Cllen ls he only auholy abou paln and ls exlsence and
naue
MISCCNCL1ICN 8egula use of analgeslcs can cause addlclon
CCkkLC1ICN ddlclon ls unllkely o occu wlh use of analgeslcs
MISCCNCL1ICN @he amoun of lssue damage ls dlecly elaed o
amoun of paln
CCkkLC1ICN aln ls a sub[eclve expelence and vales fom peson o
peson
CCNCL1S ASSCCIA1L WI1n AIN
AIN 1nkLSnCL he lowes lnensly of a palnful slmulus ha he
lndlvldual pecelves sensalon as paln
AIN 1CLLkANCL he maxlmum amoun of palnful slmull ha a peson ls
wllllng o wlhsand wlhou seeklng avoldance of he paln o ellef
ALLCNIA sensalon of paln fom a slmulus ha nomally does no
poduce paln
nLkALGLSIA helghened esponse o a palcula slmull
SLS1nLSIA unpleasan abnomal sensalon ha can be elhe
sponaneous o evoked
IAC1CkS INILULNCING 1nL AIN LOLkILNCL
ge
Lhnlc and Culual values
Cende
Lnvlonmen and Suppo eople
as paln expelence
Meanlng of paln
nxley and depesslon
1nLCkILS CI AIN
1) Speclflcly @heoy
2) aen @heoy
3) Cae Conol @heoy
SLCIIICI1 1nLCk
poposed by 8ene uescaes
mlndbody duallsm
paln ls fel when hlghly speclflc pelpheal neve endlngs ecelve sensoy
lnfomalon fom he envlonmen ansmled by neve flbes hough he
splnal cod o he paln cene o plneal body ln he foebaln
hlnklng mlnd ls no aclvely lnvolved ln he body#s esponse o paln
JLknLSS no hollslc
A11LkN 1nLCk
paln ecepos shae endlngs o pahways wlh ohe sensoy modallles
bu ha dlffeen paens of aclvly ln he same neuons can be used o
slgnal palnful and nonpalnful slmull
JLknLSS no hollslc
GA1L CCN1kCL 1nLCk
poposed by Melzack and Jall (1963)
hee ae synapses a dosal hon ha ac as C@LS
C@L lS CLCSLu when lage dlamee flbe caylng nonpaln lmpulses o
baln ls slmulaed
C@L lS CLnLu when small dlamee flbe caylng paln lmpulses o
baln ls slmulaed
naue of paln
hyslologlcal wanlng
May be a dlseased
1LS CI AIN
Accord|ng to Locat|on
1) eadache
2) 8ackache
3) Ches paln
4) 8efeed aln
3) 8adlalng aln
8efeed aln
1LS CI AIN
Accord|ng to rat|on
1) cue aln
2) Chonlc aln
CCM8lSCn
Cu@L ln
8CCnCSlS
CCMLL@L 8LLlLl
@@L8n
SLLl LlMl@lnC C8 8LulL? CC88LC@Lu
ln LCC@lCn
CLnL8LL? JLLL luLn@lllLu
uu8@lCn
@8nSlLn@ ( u?S u @C 3 MCn@S)
CnSL@
SuuuLn
C8CnlC ln
8CCnCSlS
CCMLL@L 8LLlLl nC@ CSSl8LL
@@L8n
CCn@lnuCuS C8 ln@L8Ml@@Ln@
ln LCC@lCn
LLSS JLLL luLn@lllLu MC8L ullllCuL@ @C LvLu@L
uu8@lCn
8CLCnCLu (MCn@S @C ?L8S)
CnSL@
SuuuLn C8 uLvLLC lnSlulCuS
1LS CI AIN
Accord|ng to Intens|ty
1) Mlld aln
2) Modeae aln
3) Sevee aln
1LS CI AIN
Accord|ng to Lt|o|ogy
1) ?SlCLCClCL ln
a) Somalc aln
b) vlsceal aln
2) nLu8C@lC ln eleclc shock"
a) elpheal neuopahlc aln
W hanom llmb paln
W oshepelc neualgla
W Capal unnel syndome
b) Cenal neuopahlc aln
CCMMCN AIN SNkCMLS
osepelc neualgla
hanom Llmb aln
@lgemlnal neualgla
nSICLCG CI AIN
1) @ansduclon
2) @ansmlsslon
3) eceplon
4) Modulalon
kLSCNSLS 1C AIN
hyslologlc
8ehavloal
nLx@ SLluLS
nSICLCGIC kLSCNSLS 1C AIN
SMA1nL1IC S1IMULA1ICN
ullalon of bonchlal ubes and lnceased 88
lnceased 8 and 8
elpheal vasoconslclon
lnceased blood glucose level
ulaphoesls
lnceased muscle enslon
ullalon of uplls
ueceased Cl mollly
AkASMA1nL1IC S1IMULA1ICN
allo
Muscle enslon
ueceased hea ae and blood pessue
8apld legula beahlng
nausea and vomllng
Jeakness o exhauslon
8LnAVICkAL kLSCNSLS
VCCALI2A1ICN
Moanlng
Cylng
Casplng
Cunlng
IACIAL LOkLSSICNS
Clmace
Clenched eeh
Jlnkled foehead
@lghly closed o wldely open eyes o mouh
Llp bllng
8C MCVLMLN1
8eslessness
lmmoblllzalon
Muscle enslon
lnceased hand flnge movemens
aclng aclvly
oeclve movemens of body pa
SCCIAL IN1LkAC1ICN
voldance of lneaclon
locus only on aclvlles fo paln ellef
8educed aenlon span
AkAML1LkS ICk ASSLSSMLN1
evlous paln eamen and effeclveness
nalgeslcs aken
Che medlcalons belng aken
llegles o medlcalons
Localon of paln
lnensly
Cually
aen
eclplalng facos
llevlalng facos
ssoclaed sympoms
Lffec on uLs
as aln Lxpelences
Meanlng of aln
Coplng 8esouces
ffeclve 8esponses
hyslcal Lxamlnalon
GUILLINLS IN ASSLSSING LCCA1ICN
sk chllden o poln speclflc body pa
use of paln cha
ML1nCS IN ASSLSSING IN1LNSI1
aln 8alng Scale
laces 8alng Scale fo chllden
Cbsevalon of behavloal cues fo lnfans and peschooles
Iaces a|n Sca|ekev|sed

I|ve Cs of a|n Management
compehenslve assessmen
conslsen use of assessmen ools
conlnuous eassessmen
cusomlzed plan of cae
collaboalve o mulldlsclpllnay appoach
NCNnAkMACCLCGIC AIN MANAGLMLN1
nSICAL IN1LkVLN1ICNS
CSI1ICN CnANGL AN MCVLMLN1
W elleves muscle spasm
CCMICk1 MLASUkLS
W clean smooh shees
W sof suppolve plllows
W wam blankes
W soohlng envlonmen
CU1ANLCUS S1IMULA1ICN
MASSAGL
8elleves muscle spasm$ decease muscle enslon
lmpoves clculalon
Lase anxley
CCN1kAINICA1L aeas of skln beakdown suspeced clos o lnfeclons
ALICA1ICN CI nLA1 Ck CCL
@ deceases muscle spasm and lnceases blood flow o he aea
deceases blood flow edema and lnflammalon and may decease
muscle spasm paln
ACUkLSSUkL
ppllcalon of flnge pessue o polns coespond o many of he polns
used ln acupuncue
ACUUNC1UkL
lnselon of needles a valous polns ln he body o elleve paln
elease endophlns and slmulae lage neve flbes o close he gae" ln
he splnal cod o paln lmpulses
cupessue
o|nts (A) r||||ng 8amboo
Localon ln he lndenalons on elhe slde of whee he bldge of he nose
mees he ldge of he eyebows
8enefls 8elleves neck paln headaches hay feve eye falgue and slnus
paln

o|nts (8) W|nd Mans|on
Localon ln he cene of he back of he head ln a lage hollow unde he
base of he skull
8enefls 8elleves slff neck shoulde and neckn paln paln ln he eyes eas
nose and hoa as well as menal poblems headaches and velgo

o|nts (C) Gates of Consc|osness
Localon 8elow he base of he skull ln he hollow beween he wo
velcal neck muscles
8enefls 8elleves ahlls headaches (lncludlng mlgalnes) dlzzlness slff
neck neck paln neuomoo coodlnalon poblems eyesaln and
llabllly

o|nts () W|ndow of neaven
Localon ln he lndenalon a he base of he Skull one o wo lnches ln
back of he ealobe dependlng on he slde of he head
8enefls 8elleves slff necks neck and shoulde paln and headaches

o|nts (L) neaven|y |||ar
Localon Cnehalf lnch below he base of he skull on he opy muscles
onehalf lnch ouwad fom he splne 8enefls 8elleves sess bunou
exhauslon lnsomnla heavlness ln he head eyesaln slff necks and soe
hoas

o|nts (I) Sho|der We||
Caulon egnan women should pess llghly on hls poln Localon Cn
he muscle a he hlghes poln of he shoulde one o wo lnches ou fom
he slde of he lowe neck 8enefls 8elleves shoulde enslon nevousness
llabllly and falgue
CCN1kALA1LkAL S1IMULA1ICN
Slmulalng he skln ln an aea opposle o he palnful aea
Scached fo lchlng massage fo camps eaed wlh cold packs o
analgeslcs olnmens
useful when palnful aea canno be ouched o no accesslble
IMMC8ILI2A1ICN] 8kACING
Spllns o suppolve devlces
8emoved egulaly and povlde 8CM
olonged lmmoblllzalon can esul ln [oln conacue muscle aophy
and cadlovascula poblems

1kANSCU1ANLCUS LLLC1kICAL NLkVL S1IMULA1ICN (1LNS)
ovldes a conlnuous mlld eleclc cuen vla 2 0 4 elecodes placed on
he skln nea a palnful sle
Lxpelenced as lngllng sensalon
Joks by slmulalng lage neve flbes o close he gae" ln he splnal cod
lso slmulae endophln poduclon
May be used fo acue posopealve paln o fo chonlc condllon as low
back paln phanom llmb paln and neualgla denal paln ahlls labo
paln

CCGNI1IVL8LnAVICkAL IN1LkVLN1ICNS
IS1kAC1ICN
vlsual dlsaclon
udloy dlsaclon
@aclle dlsaclon
lnellecual dlsaclon
kLLAOA1ICN LOLkCISLS
Medlalon
aye
?oga
8lofeedback
ypnosls
nAkMACCLCGIC AIN MANAGLMLN1
1nkLLS1L ANALGLSIC LALk (WnC 2006)
lC8 MlLu ln
S@L 1 nonCplold d[uvan
lf no effeclve
lC8 MCuL8@L ln
S@L 2 Jeak Cplold nonCplold d[uvan
lf no effeclve
lC8 SLvL8L ln
S@L 3 Song Cplold nonCplold d[uvan
NCNCICS ANALGLSICS
Lxamples splln ceamlnophen lbupofen
1nLkALU1IC LIILC1S
nllnflammaoy
nalgeslc
nlpyelc
LSCkI1ICN
deceases elease of lnflammaoy chemlcals
CCMMCN SIL LIILC1S
lndlgeslon
Somach ulces
Caslc bleedlng
CICI ANALGLSIC
1nkLL kIMAk 1LS
1) lull gonlss
2) Mlxed gonlss nagonls
3) alal gonlss
IULL AGCNIS1S
poduces maxlmum paln lnhlbllon
Lxamples mophlne and fenanyl
MIOL AGCNIS1S AN1AGCNIS1S
elleve paln when glven o a cllen who has no aken any pue oplolds
lnaclvae ohe oplold analgeslcs when glven o a cllen who has been
aken pue oplolds
Lxample nalbuphlne Cl (nubaln)

Ak1IAL AGCNIS1S
8lock he mu ecepos o ae neual a ha ecepo bu blnd a a kappa
ecepo sle
Lxample bupenophlne
WLAk CICI ANALGLSICS
2 o 4 lmes moe poen han nonoplod analgeslcs
Lxamples codelne amadol
as celllng effecs and maxlmum dally dose llml
CCMMCN CICI SIL LIILC1S
8esplaoy depesslon
Sedalon
nausea$ vomllng
ulnay 8eenlon
8lued vlslon
Sexual dysfunclon
Conslpalon
CCMMCN SIL LIILC1S kLVLN1IVL AN 1kLA1MLN1
kLSIkA1Ck LkLSSICN
dmlnlse an oplold anagonls such as naloxone (nacan)
Sop change o slow he admlnlsalon of oplolds unll esplalons ae
esoed
SLA1ICN
lnfom cllen ha oleance usually develops ove 3 o 3 days
Conslde he admlnlsalon of a slmulan (8lalln) o an alenalve oue of
admlnlsalon
UkINAk kL1LN1ICN
May need o caheelze he cllen o change o lowe he analgeslc dose
dmlnlse nacolc anagonlss
NAUSLA] VCMI1ING
ovlde anlemelc eg lasll vlsall
kUkI1US
pply cool packs lolon and dlveslonal aclvly
dmlnlse anlhlsamlne eg 8enadyl
CCNS1IA1ICN
lncease fluld and flbe lnake
dmlnlse dally sool sofenes eg Senoko
dmlnlse laxalves
efom enema
AUVAN1 ANALGLSICS
Mlld sedalves o anqulllzes eg dlazepam
nldepessans eg Llavll
nlconvulsans eg cabamazeplne and clonazepam
A1ILN1CCN1kCLLL ANALGLSIA
selfadmlnlsalon of analgeslcs
lnulC@lCnS suglcal lnclslon aumalc ln[uy o labo and dellvey and
fo chonlc paln wlh cance
A1ILN1 CCNSILkA1ICN
Monlo fo slgns and sympoms of CvL8SLu@lCn such as excesslve
dowslness slowed esplaoy ae o change ln menal sae
SUkGICAL MANAGLMLN1
A NLkVL 8LCCk
ln[eclon of local aneshelc lno he neve
Chemlcal lneuplon of a neve pahway
Lxample denal woks
CCkC1CM
culng of he palnconduclon pahs ln he splnal cod
oblleaes paln and empeaue sensalon below he level of he
splnohalamlc polon of he aneolaeal ac seveed
Lxample paln ln he legs o unk
knI2C1CM
splnal neves ae cu ln ode o elleve paln
lneups he anelo o poselo neve oo beween he gangllon and
he cod
allevlaes paln of he head and neck fom cance o neualgla
NLUkLC1CM
suglcal emoval of a pa of he pelpheal o canlal neves
allevlae locallzed paln ln he lowe leg o foo alslng fom he vascula
occluslon
SMA1nLC1CM
suglcal lneuplon of a pahway ln he sympahelc nevous sysem by
culng ou a neve segmen
eamen of palnful vascula dlsodes such as nglna and 8eynauds
dlsease
neve 8lock
neuecomy
8hlzoomy