ADVANDCED PRACTICE NURSING EMPHASIZING COMMON RULES

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Advanced Practice Nursing:
Emphasizing Common Roles
Edition 2
Joan M. Stanley, PhD, RN, CRNP
Director of Education Policy
American Association of Colleges of Nursing
Washington, DC
F.A. Davis Company • Philadelphia


F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2005 by F. A. Davis Company
Copyright © 2005 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No
part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Joanne Patzek DaCunha, RN, MSN
Developmental Editor: Kristin L. Kern
Design Manager: Joan Wendt
As new scientific information becomes available through basic and clinical research, recommended treatments
and drug therapies undergo changes. The author(s) and publisher have done everything possible
to
make this book accurate, up to date, and in accord with accepted standards at the time of publication.
The
author(s), editors, and publisher are not responsible for errors or omissions or for consequences
from
application of the book, and make no warranty, expressed or implied, in regard to the contents of
the
book. Any practice described in this book should be applied by the reader in accordance with professional
standards of care used in regard to the unique circumstances that may apply in each situation. The
reader
is advised always to check product information (package inserts) for changes and new information
regarding dose and contraindications before administering any drug. Caution is especially urged
when
using new or infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
Advanced practice nursing : emphasizing common roles / [edited by] Joan M. Stanley.—2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-8036-1229-X (hardcover : alk. paper)
1. Nurse practitioners. 2. Midwives. 3. Nurse anesthetists.
[DNLM: 1. Nurse Clinicians. 2. Nurse Practitioners. 3. Nurse Midwives. WY 128 A2445 2005] I.
Stanley, Joan M.
RT82.8.A37 2005
610.73′06′92—dc22
2004001938
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific
clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center
(CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC,
222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy
license by CCC, a separate system of payment has been arranged. The fee code for users of the
Transactional Reporting Service is: 8036-1229/05 0 $.10.

Contents
Foreward  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XIX
CHAPTER 1
The Evolution of Advanced Practice in Nursing  . . . . . . . . . . . . . . . . . . . . . . . .1
Pauline Komnenich, PhD, RN
Certified Nurse Midwives, 4
Nurse Anesthetists, 14
Clinical Nurse Specialists, 22
Nurse Practitioners, 27
Joining Forces: Role Parameters and Concerns, 33
CHAPTER 2
Advanced Practice Nursing in the Current Sociopolitical Environment  . . . . .46
Lucille A. Joel, EdD, RN, FAAN
The American People and Their Health, 48
The Health Care Delivery System: Origins of Change, 54
Dominant Trends in American Health Care, 55
The Advanced Practice Nurse and the Emergent Delivery System, 56
Barriers to Advanced Nursing Practice, 57
Summary, 66
CHAPTER 3
The American Health Care System: Implications for Advanced
Practice Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Mary Knudtson, MSN, NP
The American Health Care System, 72
Financing Health Care, 74
The Evolution of Managed Care, 88
Implications for Advanced Practice Nursing, 90

CHAPTER 4
Selected Theories and Models for Advanced Practice Nursing  . . . . . . . . . . . .93
Michelle Walsh, PhD, RN, CPNP, Linda A. Bernhard, PhD, RN
Theories of Leadership, 96
Theories of Change, 102
Models of Health Promotion, 107
Models of Advanced Practice Nursing, 113
Summary, 119
CHAPTER 5
Primary Care and Advanced Practice Nursing: Past, Present,
and Future  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Catherine L. Gilliss, DNSc, RN, FAAN, Linda Lindsey Davis, PhD, RN
Health Care in the Twentieth Century, 124
Health Care in the Twenty-First Century, 124
The Nature of Primary Care, 125
Primary Care Providers in the Twenty-First Century, 131
Policy Issues Influencing Advanced Practice in Emerging Primary
Care Systems, 137
Summary, 142
CHAPTER 6
Advanced Practice Nurses in Non-Primary Care Roles: The Evolution
of Specialty and Acute Care Practices  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
Dennis J. Cheek, PhD, RN, FAHA, Karol S. Harshaw-Ellis, MSN, RN, A/GNP, ACNP-CS
Advanced Practice Nursing Roots in Acute Care, 148
Evolution of NPs in Neonatal and Acute Care, 149
Hospitalist/Acute Care Nurse Practitioner Model, 152
Non-Primary Care Roles: Growing Specialties, 154
Summary, 155
CHAPTER 7
Formulation and Approval of Credentialing and Clinical Privileges  . . . . . . .158
Geraldine “Polly” Bednash, PhD, RN, FAAN, Judy Honig, EdD, CPNP, Linda Gibbs, BSN, RN, MBA
Regulation: Professional and Public, 160
Professional Certification for APNs, 169
Clinical Practice and Institutional Privileges, 174
Summary, 183
CHAPTER 8
Reimbursement for Expanded Professional Nursing Practice Services  . . . . .187
Michael J. Kremer, DNSc, CRNA, FAAN, Margaret Faut-Callahan, DNSc, CRNA, FAAN
The Economic System, 191
Criteria for an Economic System in Relation to Health Care, 191
Types of Economic Systems, 192
Market Competition, 194
Disequilibrium, 196
Supplier-Induced Demand, 197
The Effects of Changes in Price, Supply, and Demand for Health Care, 199
Cost Considerations in Provision of Care and Reimbursement for Physicians and APNs, 201
Key Terms in Finance and Reimbursement, 210
Reimbursement for Specific APN Groups, 214
Summary, 223
CHAPTER 9
Marketing the Role: Formulating, Articulating, and Negotiating
Advanced Practice Nursing Positions  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Christine E. Burke, PhD, CNM
The Traditional Marketing Approach: The 4 Ps, 228
Knowledge of Personal Values, Professional Skills, and Practical Necessities, 230
Knowledge of Practice Regulations, 232
Knowledge of Existing Services, 232
Knowledge of Clients’ Health Care Needs and Desires, 233
Knowledge of the Target Population’s Understanding of the Role and Scope
of Practice of the APN, 234
Knowledge of the Utilization and Cost-Effectiveness of and Satisfaction with
APN Services, 234
Knowledge of Specific Marketing Elements, 235
Communication Skills, 237
Evaluation of Job Opportunities, 246
Close of the Deal, 248
Mentors and Career Advancement, 250
Summary, 252
CHAPTER 10
Caring for a Diverse Population: Ensuring Cultural Competency
in Advanced Practice Nursing  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
Pier Angeli Broadnax, PhD, RN
Diversity, 258
Commonly Used Culture-Related Terms, 259
Principles of Cultural Competency, 260
Cultural Assessment Models, 261
Healthy People 2010, 264
Culturally Sensitive Life Events, 264
Summary, 273
CHAPTER 11
Clinical Research in the Advanced Practice Role . . . . . . . . . . . . . . . . . . . . . .277
Julie Reed Erickson, PhD, RN, FAAN, Christine Sheehy, PhD, RN
APNs as Consumers of Research, 282
APNs as Researchers, 293
Summary, 297
CHAPTER 12
Publishing Scholarly Works  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
Suzanne Hall Johnson, MN, RN,C, CNS
Avoiding the “School Paper” Style Rejection, 307
Adapting the Thesis Style for Publication, 313
Summary, 320
CHAPTER 13
Legal and Ethical Aspects of Advanced Practice Nursing  . . . . . . . . . . . . . . .322
Linda Callahan, PhD, CRNA, Mary Jeannette Mannino, JD, CRNA
Nurse Practice Acts, 324
Professional Negligence (Malpractice), 327
Malpractice Insurance, 331
The Patient and the APN, 332
Professional Ethics, 332
CHAPTER 14
Advanced Practice Nursing and Global Health . . . . . . . . . . . . . . . . . . . . . . . .351
Katherine Crabtree, DNSc, FAAN, APRN, BC, Anita Hunter, PhD, RN, CNS, CPNP
Global Health Challenges, 354
Globalization of Advanced Practice Nursing, 355
Education Competencies for NP Practice in the U.S. and Abroad, 357
Advanced Practice Nursing in Other Developed Nations, 361
Advanced Practice in Developing Nations, 364
Ethics and Spiritual and Cultural Competence in a Global Environment, 367
Opportunities for Advanced Practice Outside the United States, 367
Preparing APNs with a Global Perspective, 369
Summary, 371
CHAPTER 15
Advanced Practice Nursing and Health Policy  . . . . . . . . . . . . . . . . . . . . . . . .374
Eileen T. O’Grady, PhD, RN, NP
Tensions Among Health Care Costs, Quality, and Access, 376
The American Health Policy Process, 379
The APN Health Policy Agenda, 384
APN Political Competence, 388
Important Health Policy Websites, 392
CHAPTER 16
Creating Excellence in Practice  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .395
Marla J. Weston, MS, RN, Vicki L. Buchda, MS, RN, Debra Bergstrom, MS, RN, FNP
Attributes of Excellence, 398
Summary, 409
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .413

ANXIETY MANAGEMENT IN ADULT DAY SURGERY A NURSING PERSPECTIVE

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Anxiety Management in
Adult Day Surgery
A Nursing Perspective
Mark Mitchell BA, MSc, PhD, RGN, NDNCert, RCNT, RNT
University of Salford, Greater Manchester, UK

© 2005 Whurr Publishers Ltd
First published 2005
by Whurr Publishers Ltd
19b Compton Terrace
London N1 2UN England and
325 Chestnut Street, Philadelphia PA 19106 USA
All rights reserved. No part of this publication may 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 permission of Whurr Publishers Limited.
This publication is sold subject to the conditions that it shall not, by
way of trade or otherwise, be lent, resold, hired out, or otherwise
circulated without the publisher’s prior consent in any form of
binding or cover other than that in which it is published and
without a similar condition including this condition being imposed
upon any subsequent purchaser.
British Library Cataloguing in Publication Data
A catalogue record for this book
is available from the British Library.
ISBN 1 86156 463 5

Contents
Preface vii
Chapter 1 Twenty-first century: a time for change 1
Growth of day surgery 1
Psychoeducational management 5
Summary 10
Chapter 2 Day surgery: patients’ perceptions 12
Advancements in surgical practice 12
Preassessment and patient teaching 13
Information provision 15
Patient experiences on the day of surgery 23
Patient recovery 28
Conclusion 46
Summary 48
Chapter 3 Patient anxiety and elective surgery 50
Patient anxiety 50
Conclusion 73
Summary 73
Chapter 4 Psychological approaches to coping 75
Broad psychological approaches 75
Specific psychological approaches 80
Conclusion 95
Summary 96
Chapter 5 Information selection 98
Information categories 98
Conclusion 115
Summary 115
Chapter 6 Information Delivery 117
Information provision and elective surgery 117
Conclusion 141
Summary 142
Chapter 7 Anxiety management in day surgery 144
Preoperative psychoeducational care 144
Implementation 156
Conclusion 169
Summary 171
Chapter 8 Twenty-first century elective surgical nursing 173
Day-surgery innovation 173
Conclusion 191
Summary 192
Glossary 194
References 205
Index 235


Preface
This book is centrally concerned with the formal management of preoperative
anxiety.
The vast majority of patients experience varying degrees
of
anxiety when entering hospital for surgery and yet little formal intervention
is commonly provided. This is the first book of its kind to be
written
for nurses exclusively concerning the complete formal pre- and
postoperative
management of anxiety in relation to modern, elective,
adult
day surgery.
During the early 1970s
classic nursing studies suggested
information provision to be crucial for effective inpatient preoperative
anxiety
management. However,
following such early recommendations
no
other formal aspects of psychoeducational care have impacted on
mainstream
surgical nursing intervention. Physical aspects of care have
dominated
proceedings for the last three decades or more, whereas psychoeducational
aspects have largely remained informal, marginal issues.
Both
surgery and anaesthesia have changed dramatically during this period
and nursing intervention must now do likewise.
The domination of physical nursing intervention is, however, slowly
changing as the continuous global rise in elective ambulatory surgery has
highlighted the need for more structured psychoeducational approaches
to patient care. The psychological theories to aid preoperative anxiety
management have been available for many years. However, they have not
succeeded in making an impact within the clinical surgical setting,
because they have not previously been constructed into a coherent, clinically
realistic plan of care. The purpose of this book is therefore (1)
to
consider
the relevant psychological concepts that can inform and guide
modern
surgical nursing practices, (2)
to provide a comprehensive map of
the
wider evidence available and (3)
to introduce clinically realistic nursing
interventions necessary for the complete psychoeducational
management of adult patients undergoing elective, ambulatory surgery.
On a philosophical level, I hope to communicate with a wide audience
of nurses working in the field of adult ambulatory surgery or studying
modern surgical nursing practices. We need to re-evaluate nursing
knowledge for this new surgical era so that compelling nursing evidence
can help to guide practice and not remain in the shadows of medical
advances. This book is intended to provoke debate within the profession,
present the case for change and, above all, demonstrate the ability of
nursing knowledge to make a significant contribution to the care required
by patients experiencing modern ambulatory surgery. Much evidence,
within the nursing domain, is widely available to help guide important
global nursing issues in ambulatory surgery.
The political reforms currently running through the National Health
Service in the UK have resulted in nursing knowledge largely becoming
marginalized. The utilization of nurses and their skills features widely in
these reforms, but not the utilization of nursing skills based on nursing
knowledge. Surgical self-preparation and self-recovery are now implicit
aspects of the modern surgical patients’ experience. Patients and their relatives
did not request this new,
essential role although most now welcome
the
social convenience and swift treatment that day surgery affords. Such
advances
have, however,
guaranteed that many of yesterday’s
professional
nursing interventions have become today’s
layperson interventions.
Much
physical surgical nursing is increasingly becoming obsolete because
it
can now be undertaken by laypeople. I am hopeful that this book will
add
to the debate about the future of modern surgical nursing intervention,
because the trend of surrendering much pre- and postoperative care
to
relatives and replacing it with interventions that once were the domain
of
junior doctors must not remain unchallenged. ‘New’ nursing knowledge
has much to offer the ambulatory surgery patient and we must
robustly
demonstrate how our professional knowledge can make this contribution.
Professional knowledge and its application are powerful,
liberating
and motivating forces. I hope that this book empowers, liberates
and motivates all who read it and that you find it as stimulating to
read
as I have found it to write.
Mark Mitchell

ATLAS OF HUMAN ANATOMY THIEME 2000

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Pocket Atlas of
Human Anatomy
Based on the International Nomenclature
Heinz Feneis
Professor
Formerly Institute of Anatomy
University of Tübingen
Tübingen, Germany
Fourth edition, fully revised
800 illustrations by Gerhard Spitzer
Thieme
Stuttgart · New York 2000
Wolfgang Dauber
Professor
Institute of Anatomy
University of Tübingen
Tübingen, Germany
Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme


Contents
Bones ...................................... 2
Sutures, joints and ligaments ................ 54
Muscles .................................... 74
Muscles, synovial bursae and sheaths ........ 100
Digestive system ............................ 108
Digestive and respiratory system ............ 134
Urogenital system ........................... 154
Peritoneum ................................. 176
Endocrine glands ............................ 182
Heart ....................................... 184
Arteries .................................... 190
Veins ....................................... 230
Lymphatic system ........................... 254
Spleen, meninges ........................... 268
Meninges ................................... 268
Spinal cord ................................. 272
Brain ....................................... 278
Cranial nerves .............................. 320
Spinal nerves ............................... 334
Autonomic nervous system .................. 348
Sense organs ................................ 354
Skin and its appendages ..................... 390
General terms .............................. 396
References .................................. 409
Index ....................................... 412
Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme

ATLAS OF MEDICAL HELMINTOLOGY AND PROTOZOOLOGY

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ATLAS OF NEURO ANATOMY AND NEURO PHYSIOLOGY FRANK H NETTER

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Atlas of
Neuroanatomy and
Neurophysiology
Selections from the Netter Collection of Medical Illustrations
Illustrations by
Frank H. Netter, MD
John A. Craig, MD
James Perkins, MS, MFA
Text by
John T. Hansen, PhD
Bruce M. Koeppen, MD, PhD

Atlas of Neuroanatomy and Neurophysiology
Selections from the Netter Collection of Medical Illustrations
Copyright ©2002 Icon Custom Communications. All rights reserved.
The contents of this book may not be reproduced in any form without written
authorization from Icon Custom Communications. Requests for permission
should be addressed to Permissions Department, Icon Custom Communications,
295 North St., Teterboro NJ 07608, or can be made at www. Netterart.com.
NOTICE
Every effort has been taken to confirm the accuracy of the information presented.
Neither the publisher nor the authors can be held responsible for errors or for any
consequences arising from the use of the information contained herein, and make
no warranty, expressed or implied, with respect to the contents of the publication.
Printed in U.S.A.

Foreword
Frank Netter: The Physician, The Artist, The Art
This selection of the art of Dr. Frank H. Netter on neuroanatomy and neurophysiology is drawn
from the Atlas of Human Anatomy and Netter’s Atlas of Human Physiology. Viewing these pictures
again prompts reflection on Dr. Netter’s work and his roles as physician and artist.
Frank H. Netter was born in 1906 in New York City. He pursued his artistic muse at the Sorbonne,
the Art Student’s League, and the National Academy of Design before entering medical school at
New York University, where he received his M.D. degree in 1931. During his student years, Dr.
Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allowing
him
to
augment
his
income
by
illustrating
articles
and
textbooks.
He
continued
illustrating
as
a
sideline
after
establishing
a
surgical
practice
in
1933,
but
ultimately
opted
to
give
up
his
practice
in
favor
of

a full-time commitment to art. After service in the United States Army during the Second
World War, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (now
Novartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraordinary
collection of medical art so familiar to physicians and other medical professionals worldwide.
When Dr. Netter’s work is discussed, attention is focused primarily on Netter the artist and only
secondarily on Netter the physician. As a student of Dr. Netter’s work for more than forty years, I can
say that the true strength of a Netter illustration was always established well before brush was laid to
paper. In that respect each plate is more of an intellectual than an artistic or aesthetic exercise. It is
easy to appreciate the aesthetic qualities of Dr. Netter’s work, but to overlook its intellectual qualities
is
to
miss
the
real
strength
and
intent
of
the
art.
This
intellectual
process
requires
thorough
understanding
of
the
topic,
as
Dr.
Netter
wrote:
“Strange
as
it
may
seem,
the
hardest
part
of
making
a
medical
picture
is
not
the
drawing
at
all.
It
is
the
planning,
the
conception,
the
determination
of
point
of
view
and
the
approach
which
will
best
clarify
the
subject
which
takes
the
most
effort.”

Years before the inception of “the integrated curriculum,” Netter the physician realized that a
good medical illustration can include clinical information and physiologic functions as well as anatomy.

In pursuit of this principle Dr. Netter often integrates pertinent basic and clinical science elements

in his anatomic interpretations. Although he was chided for this heresy by a prominent
European anatomy professor, many generations of students training to be physicians rather than
anatomists have appreciated Dr. Netter’s concept.
The integration of physiology and clinical medicine with anatomy has led Dr. Netter to another,
more subtle, choice in his art. Many texts and atlases published during the period of Dr. Netter’s
career depict anatomy clearly based on cadaver specimens with renderings of shrunken and shriveled
tissues
and
organs.
Netter
the
physician
chose
to
render
“live”
versions
of
these
structures—not
shriveled,
colorless,
formaldehyde-soaked
tissues,
but
plump,
robust
organs,
glowing
with
color!

The value of Dr. Netter’s approach is clearly demonstrated by the plates in this selection.
John A. Craig, MD
Austin, Texas


Part 1 Neuroanatomy
Cerebrum—Medial Views. . . . . . . . . . . . . . . . . 2
Cerebrum—Inferior View. . . . . . . . . . . . . . . . . . 3
Basal Nuclei (Ganglia). . . . . . . . . . . . . . . . . . . . 4
Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Fourth Ventricle and Cerebellum . . . . . . . . . . . 8
Accessory Nerve (XI) . . . . . . . . . . . . . . . . . . . . 9
Arteries to Brain and Meninges . . . . . . . . . . . 10
Arteries to Brain: Schema . . . . . . . . . . . . . . . . 11
Arteries of Brain: Inferior Views . . . . . . . . . . . 12
Cerebral Arterial Circle (Willis) . . . . . . . . . . . 13
Arteries of Brain: Frontal View and Section . . 14
Arteries of Brain:
Lateral and Medial Views. . . . . . . . . . . . . . . 15
Arteries of Posterior Cranial Fossa . . . . . . . . . 16
Veins of Posterior Cranial Fossa . . . . . . . . . . . 17
Deep Veins of Brain. . . . . . . . . . . . . . . . . . . . . 18
Subependymal Veins of Brain . . . . . . . . . . . . . 19
Hypothalamus and Hypophysis . . . . . . . . . . . 20
Arteries and Veins
of Hypothalamus and Hypophysis . . . . . . . . 21
Relation of Spinal Nerve Roots to Vertebrae . . . 22
Autonomic Nervous System:
General Topography. . . . . . . . . . . . . . . . . . . 23
Spinal Nerve Origin: Cross Sections. . . . . . . . 24
Olfactory Nerve (I): Schema . . . . . . . . . . . . . . 25
Optic Nerve (II)
(Visual Pathway): Schema . . . . . . . . . . . . . . 26
Oculomotor (III), Trochlear (IV)
and Abducent (VI) Nerves: Schema. . . . . . . 27
Trigeminal Nerve (V): Schema . . . . . . . . . . . . 28
Facial Nerve (VII): Schema . . . . . . . . . . . . . . . 29
Vestibulocochlear Nerve (VIII): Schema. . . . . 30
Glossopharyngeal Nerve (IX): Schema . . . . . . 31
Vagus Nerve (X): Schema . . . . . . . . . . . . . . . . 32
Accessory Nerve (XI): Schema . . . . . . . . . . . . 33
Hypoglossal Nerve (XII): Schema . . . . . . . . . . 34
Nerves of Heart . . . . . . . . . . . . . . . . . . . . . . . . 35
Autonomic Nerves
and Ganglia of Abdomen. . . . . . . . . . . . . . . 36
Nerves of Stomach and Duodenum . . . . . . . . 37
Nerves of Stomach
and Duodenum (continued) . . . . . . . . . . . . 38
Nerves of Small Intestine . . . . . . . . . . . . . . . . 39
Nerves of Large Intestine . . . . . . . . . . . . . . . . 40
Nerves of Kidneys,
Ureters and Urinary Bladder . . . . . . . . . . . . 41
Nerves of Pelvic Viscera: Male . . . . . . . . . . . . 42
Nerves of Pelvic Viscera: Female . . . . . . . . . . 43
Median Nerve . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ulnar Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Radial Nerve in Arm
and Nerves of Posterior Shoulder . . . . . . . . 46
Radial Nerve in Forearm . . . . . . . . . . . . . . . . . 47
Sciatic Nerve and Posterior
Cutaneous Nerve of Thigh . . . . . . . . . . . . . . 48
Tibial Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Common Fibular (Peroneal) Nerve. . . . . . . . . 50

BASIC OF BLOOD

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Basics of Blood
Management
Petra Seeber
MD
Department of Anesthesiology
Critical Care Medicine
Pain Management, Emergency Medicine
HELIOS Klinik Blankenhain
Wirthstr. 5
99444 Blankenhain
Germany
Aryeh Shander
MD, FCCM, FCCP, Chief
Department of Anesthesiology, Critical Care Medicine
Pain Management and Hyperbaric Medicine
Englewood Hospital and Medical Center
350 Engle Street
Englewood, NJ 07631
and
Clinical Professor of Anesthesiology, Medicine and Surgery
Mount Sinai School of Medicine, Mount Sinai Hospital,
New York
first edition

C

2007 Petra Seeber and Aryeh Shander
Published by Blackwell Publishing
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053,
Australia
The right of the Author to be identified as the Author of this Work has been asserted in
accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, except as permitted by the UK Copyright,
Designs and Patents Act 1988, without the prior permission of the publisher.
First published 2007
1 2007
Library of Congress Cataloging-in-Publication Data
Seeber, Petra.
Basics of blood management / Petra Seeber, Aryeh Shander. – 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN: 978-1-4051-5131-3
1. Transfusion-free surgery. 2. Blood–Transfusion. 3. Bland banks.
I. Shander, Aryeh. II. Title.
[DNLM: 1. Blood Substitutes–therapeutic use. 2. Blood Banks–organization &
administration. 3. Blood Loss, Surgical–prevention & control.
4. Blood Transfusion. WH 450 S451b 2008]
RD33.35.S44 2008
617–dc22
2007005030
ISBN: 978-1-4051-5131-3
A catalogue record for this title is available from the British Library
Set in 9.25/11.5 Minion by Aptara Inc., New Delhi, India
Printed and bound in Singapore by Fabulous Printers Pte Ltd
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misapplication of material in this book.

Contents
Preface to the first edition, vii
Acknowledgments, viii
Introduction, ix
1 History and organization of blood management, 1
2 Physiology of anemia and oxygen transport, 9
3 Anemia therapy I: erythropoiesis stimulating proteins, 21
4 Anemia therapy II (hematinics), 35
5 Growth factors, 50
6 Fluid therapy, 65
7 The chemistry of hemostasis, 77
8 Recombinant blood products, 96
9 Artificial blood components, 110
10 Oxygen therapy, 125
11 Preparation of the patient for surgery, 139
12 Iatrogenic blood loss, 160
13 The physics of hemostasis, 172
14 Anesthesia—more than sleeping, 191
15 The use of autologous blood, 200
16 Cell salvage, 211
17 Blood banking, 227
18 Transfusions. Part I: cellular components and plasma, 243
19 Transfusions. Part II: plasma fractions, 265
20 Law, ethics, religion, and blood management, 287
21 Step by step to an organized blood management program, 299
Appendix A: Detailed information, 322
Appendix B: Sources of information for blood management, 329
Appendix C: Program tools and forms, 334
Appendix D: Teaching aids: research and projects, 346
Appendix E: Address book, 350
Index, 376


Preface to first edition
The benefit-to-risk ratio of blood products needs constant
evaluation. Blood products, as therapeutic agents,
have had the test of time but lack the evidence we expect
from other medicinals. Blood, an organ, is used as
a pharmaceutical agent by the medical profession, due to
the achievements in collection, processing, banking, and
distribution. The fact that the most common risk of blood
transfusion is blood delivery error supports the notion that
blood is handled as a pharmaceutical agent. Over the last
few decades, the risk of blood transfusion and associated
complications has raised concerns about safety of blood
by both the public and health-care providers. At the same
time, experience with patients refusing blood and data on
blood conservation brought to light the real possibility of
other modalities to treat perisurgical anemia and to avoid
it with blood conservation methods. In addition to risks
and complications, data became available demonstrating
the behavioral aspect of transfusion practice versus an
evidence-based practice. In this book, the authors address
many aspects of modern transfusion medicine, known
blood conservation modalities, and new approaches to the
treatment of perisurgical anemia, as well as special clinical
considerations. This approach, now termed “blood management”
by the Society for the Advancement of Blood
Management, incorporates appropriate transfusion practice
and blood conservation to deliver the lowest risk and
highest benefit to the patient. In addition, it brings all
these modalities to the patient’s bedside and above all is a
patient-centered approach. Blood management is a multidisciplinary,
multimodality concept that focuses on the
patient by improving patient outcome, making it one of
the most intriguing and rewarding fields in medicine.
The benefit-to-risk ratio of blood products needs constant
evaluation. Blood products, as therapeutic agents,
have had the test of time but lack the evidence we expect
from other medicinals. Blood, an organ, is used as
a pharmaceutical agent by the medical profession, due to
the achievements in collection, processing, banking, and
distribution. The fact that the most common risk of blood
transfusion is blood delivery error supports the notion that
blood is handled as a pharmaceutical agent. Over the last
few decades, the risk of blood transfusion and associated
complications has raised concerns about safety of blood
by both the public and health-care providers. At the same
time, experience with patients refusing blood and data on
blood conservation brought to light the real possibility of
other modalities to treat perisurgical anemia and to avoid
it with blood conservation methods. In addition to risks
and complications, data became available demonstrating
the behavioral aspect of transfusion practice versus an
evidence-based practice. In this book, the authors address
many aspects of modern transfusion medicine, known
blood conservation modalities, and new approaches to the
treatment of perisurgical anemia, as well as special clinical
considerations. This approach, now termed “blood management”
by the Society for the Advancement of Blood
Management, incorporates appropriate transfusion practice
and blood conservation to deliver the lowest risk and
highest benefit to the patient. In addition, it brings all
these modalities to the patient’s bedside and above all is a
patient-centered approach. Blood management is a multidisciplinary,
multimodality concept that focuses on the
patient by improving patient outcome, making it one of
the most intriguing and rewarding fields in medicine.

CARDIOTORACIC SURGICAL NURSING

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